Mental disorders are leading causes of disability worldwide but remain underprioritized in many low- and middle-income countries, including sub-Saharan Africa (SSA), where access to care, workforce capacity, and mental health infrastructure remain limited.

This study quantified the burden of mental and substance use disorders (SUDs) in SSA from 1990 to 2023 using Global Burden of Disease (GBD) 2023 estimates, with attention to long-term trends, late-period changes, country-level heterogeneity, sex differences, and risk-factor attribution.

We analyzed GBD 2023 estimates for 46 SSA countries from 1990 to 2023, including prevalence, disability-adjusted life years (DALYs), age-standardized rates, sex-specific estimates, country-level burden, and selected risk factors. Percentage changes were calculated for 1990-2023, with sensitivity analyses for 1990-2019 and 2019-2023 and segmented log-linear trend models using 2019 as the breakpoint.

From 1990 to 2023, the age-standardized prevalence rate of mental disorders increased from 11,138.8 to 14,841.0 per 100,000 (+33.24%), while the age-standardized DALY rate increased from 1634.9 to 2218.9 per 100,000 (+35.73%). Anxiety disorders showed the largest relative increases in age-standardized prevalence (+90.99%) and DALY rates (+92.11%). Depressive disorders also increased, while ADHD age-standardized rates remained largely stable. SUDs showed rising absolute burden despite declining age-standardized prevalence and DALY rates. Late-period analyses showed larger increases after 2019, particularly for anxiety disorders. Females had higher age-standardized rates and larger relative increases for anxiety and depressive disorders, whereas males had higher rates of ADHD and SUDs. Among selected risk factors, sexual violence against children had the highest age-standardized attributable DALY rate in 2023, while bullying victimization and intimate partner violence showed the largest relative increases.

Mental and SUDs represent a growing public health challenge in SSA. Strengthening mental health systems, integrating services into primary and general healthcare platforms, expanding SUD prevention and treatment, addressing violence-related risk factors, and reducing stigma are essential to improving mental health outcomes across the region.

Caring for an individual living with traumatic brain injury may place physical and emotional demands on caregivers, yet evidence on their specific needs remains fragmented. Synthesising this evidence is therefore essential to address this gap and to inform the development of targeted support strategies. The aim of this study was to appraise and synthesise the evidence the needs of caregivers of individuals living with moderate-to-severe traumatic brain injury.

A mixed-methods systematic review was conducted in 2024 across MEDLINE, PsycINFO, CINAHL and Web of Science (PROSPERO #CRD42023432812) to locate primary studies published in English or French after 2000. Two reviewers conducted the screening. Quality appraisal was completed using the Mixed Methods Appraisal Tool. The Joanna Briggs Institute approach informed data extraction and synthesis.

Thirty-two studies were included, nearly half being qualitative. Most study participants were women. The main needs identified included information, mental health support, hope, financial assistance, education of the social network and peer support.

Despite variations in quality assessment, findings guide the development of tailored interventions. Given the broad spectrum of needs identified, further studies are necessary to clarify and prioritise those needs to ensure support services are aligned with caregivers' priorities.

Childhood adversity has been linked to disruptions in the development of emotion regulation, yet few longitudinal studies have examined whether distinct dimensions of adversity are differentially associated with changes in affective inhibitory control across adolescence. This study examined whether threat and deprivation experiences differentially predicted changes in affective inhibitory control across early to middle adolescence. Participants were 902 adolescents (51.5% girls) from the UEVO study, assessed at ages 12-14 years at Time 1 (T1) and 15-16 years at Time 2 (T2). Affective inhibitory control was measured using an online emotional go/no-go task. Adolescents showed fewer false alarms to angry no-go stimuli at T2 than at T1, indicating improvement in affective inhibitory control over time. Latent change score modeling further supported this pattern, showing that adolescents with poorer baseline performance demonstrated greater improvement over time (β = -0.66, p < 0.001). In the primary model, higher levels of threat predicted less improvement in affective inhibitory control (β = 0.09, p = 0.013), whereas deprivation was not significantly associated with change (β = -0.05, p = 0.073). Neither threat nor deprivation predicted change in false alarms to neutral faces. In sensitivity analyses adjusting for gender, age, socioeconomic status (SES), and caregiver risk, threat remained a significant predictor of less improvement (β = 0.12, p = 0.004), whereas deprivation emerged as a small predictor of greater improvement (β = -0.06, p = 0.042). Post-hoc multigroup analyses provided no evidence that the associations between adversity and change differed by gender. These findings suggest that threat and deprivation show partly distinct associations with affective inhibitory control, with threat-related adversity emerging as the more consistent predictor of reduced improvement across early to middle adolescence.

As direct and continuous providers of patient care, nurses are more susceptible to various forms of psychological stress within the healthcare environment compared to other healthcare professionals. Nurses in paediatric wards, who maintain constant contact with children and their families, are particularly vulnerable to moral distress. This study aimed to explore the perceptions and experiences of Iranian nurses regarding moral distress in paediatric settings.

This qualitative study employed inductive content analysis, conducted between 2023 and 2024. Data were collected through semi-structured individual interviews and analysed following Graneheim and Lundman's approach. Twelve participants experiencing moral distress were selected via purposive sampling from the Babol and Tehran Universities of Medical Sciences.

The findings identified four primary categories and eight subcategories: moral distress related to colleagues (doctors and nursing colleagues); moral distress related to parents (conflict with children's rights and distrust of nurses); moral distress related to organizational factors (understaffing and workload undermining holistic care and professional ethics; and inadequate equipment and resources compromising care and fostering dishonesty); and psychological tensions following moral distress (mental conflict involving the cognitive and emotional burden of moral compromise; and helplessness and despair in the face of systemic failure). Rather than representing isolated individual experiences, these findings illustrate that moral distress in paediatric nursing is deeply rooted in the structural and relational conditions of healthcare settings. The results highlight that repeated exposure to ethical conflicts can erode professional values, impede the delivery of holistic care, and intensify emotional suffering. Consequently, this study contributes to a deeper understanding of moral distress as a systemic phenomenon requiring organizational intervention rather than merely an individual coping response.

The findings underscore the necessity for healthcare managers and policymakers to implement systemic mechanisms, such as specialized educational programmes and workshops, to mitigate moral distress among nurses. Furthermore, identifying the inherent stressors in paediatric nursing and reducing nurses' exposure to moral dilemmas are essential steps toward safeguarding ethical practice and enhancing care quality. This study contributes by shifting the focus from merely describing moral distress as a set of themes toward understanding it as a critical indicator of organizational strain and ethical vulnerability in paediatric nursing.

To observe the clinical effect and safety of Jiedu Yizhi Formula (JYF) in Alzheimer's disease (AD) patients.

Eligible patients with mild to moderate AD and Chinese medicine (CM) syndrome of Pi (Spleen)-Shen (Kidney) deficiency with phlegm-turbidity obscuring orifices were collected from the Third Affiliated Hospital of Changchun University of Chinese Medicine between December 2022 and December 2023. Patients were randomly assigned to JYF and donepezil groups at a 1:1 ratio by using a random number table and received a total of 24 weeks of continuous treatment. Both groups were given AD cognitive behavior training and health education at the same time. The Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), AD Assessment Scale-Cognitive (ADAS-cog), Activity of Daily Living (ADL), and Hamilton Depression (HAMD) scale scores were measured before treatment, 12 and 24 weeks after treatment. The cognitive domain scores and the total effective rates were also compared between groups. During the study period, any adverse reactions were recorded and compared between groups.

Totally 62 participants completed the study, with 31 in each group. The MMSE, MoCA, ADAS-cog, ADL, and HAMD scores significantly improved after 12 and 24 weeks of treatment in both groups (P<0.05 or P<0.01). Moreover, significant improvements in the ADL and HAMD scores were observed in the JYF group at 12 or 24 weeks than in the donepezil group (P<0.05 or P<0.01). Meanwhile, the cognitive domain scores of orientational and abstraction abilities and the total effective rate (64.52% vs. 45.16%) in the JYF group were significantly higher (P<0.05). No significant difference was found in the incidence of adverse reactions between groups (9.68% vs. 6.45%, P>0.05).

JYF can improve the cognitive dysfunction of mild to moderate AD patients with CM syndrome of Pi-Shen deficiency with phlegm-turbidity obscuring orifices, and its safety is good. (Trial registration No. NCT06393413).

This review summarizes recent advances in the genetics of Obsessive-Compulsive Disorder (OCD), their contribution to understanding disorder biology, and implication for clinical translation.

Recent GWAS identified 30 genome-wide significant loci and prioritized 25 putatively causal genes. Rare variant studies implicated specific genes, including CHD8, CELSR3, SLITRK5, and QRICH1. Evidence from common and rare variants support brain- and immune-related pathways. Genetic overlap with obsessive compulsive symptoms and other psychiatric disorders indicate shared underlying biology. Current evidence is largely based on individuals of European ancestry, although global efforts are underway to improve ancestral diversity in OCD genetics. Given the urgent need for improved treatment, genetically informed clinical translation approaches hold promise, including pharmacogenetics and drug repurposing. Recent advances in OCD genetics support a highly polygenic architecture, implicate specific neuro-biological and immune pathways, and provide new opportunities for clinical translation.

To examine dimensional associations between anxiety- and depression-related symptom severity, pain catastrophizing, and resting-state EEG features in patients with knee osteoarthritis (KOA). Resting-state EEG spectral power (delta, theta, alpha, beta) was analysed in 62 KOA patients from the DEFINE cohort. Emotional symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS), along with the Pain Catastrophizing Scale (PCS) and clinical-demographic variables. Multivariate regression analyses identified significant predictors, while linear and tree-based machine learning models were used post hoc to explore whether multivariate and non-linear approaches converged with the regression findings. Catastrophizing was independently and significantly associated with both anxiety and depression symptom scores across regression and exploratory machine learning models. For depression, a multifactorial pattern was additionally observed: higher bilateral parietal delta power, greater catastrophizing, lower education, and greater body weight showed independent associations with more severe symptom scores. Machine learning analyses indicated that EEG features were weak standalone correlates but showed modest complementary associations when combined with clinical variables. Pain catastrophizing was consistently associated with both anxiety and depression symptom scores, and resting-state EEG features showed limited but complementary associations with depressive symptom scores in KOA. Importantly, these associations were observed within a sample presenting predominantly subclinical HADS scores, and findings should be interpreted as reflecting dimensional associations within a rehabilitation cohort rather than clinical anxiety or depressive disorder.

The decision-making process for a patient to undergo breast reconstruction after mastectomy is complex and dependent on personal, cultural, and religious values. This systematic review explores the cultural influences on the patient's decision to undergo breast reconstruction that have been reported in the literature.

A systematic search was conducted on March 14, 2025, using Embase, PubMed, Medline, Web of Science, and CINAHL. Inclusion criteria required the focus on cultural preferences and values regarding breast reconstruction during patient clinical experiences. Two investigators independently conducted the screening, extraction, and synthesis of results.

Of the 1419 reports identified, eight articles were selected for analysis. The total number of patients across the review was 1,733. The average study sample size was 217 patients, with a range from 8 to 715 patients. The patient groups represented women from distinct ethnic or racial backgrounds as well as speakers of various languages: Chinese women, Hispanic women, African American women, women of Belgian nationality, Vietnamese-speaking women, Arabic-speaking women, and English-speaking women. Despite various measures and scales being used, all included studies depicted the patients' experiences, challenges, and strategies to navigate decision-making regarding breast reconstruction, which included these core factors: empowered and informed choices, self-advocacy, community, and maintaining physical as well as mental health. Of the studies that reported, 85 (5%) of patients decided to undergo breast reconstruction.

Understanding the preferences of women of various cultural backgrounds regarding breast reconstruction is essential to ensure culturally relevant and informed patient-centered care.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Metaverse technology is transforming health care, offering a wide range of applications in telemedicine, clinical care, education, mental health, and physical well-being.

This study aimed to explore the usability of a multidimensional metaverse rehabilitation platform for survivors of colorectal cancer. The platform integrates exercise training, dietary guidance, mental health education, and behavioral management.

A mixed research design was used. Survivors of colorectal cancer and their family members were recruited at the affiliated hospital to use the Metaverse multimodal rehabilitation platform. The platform's performance was quantitatively evaluated using Post-Study System Usability Questionnaires (PSSUQs) and System Usability Scales (SUSs). The average scores and SDs for each dimension were calculated, and the results were depicted using radar charts and violin plots. Additionally, correlation analysis was concurrently used to investigate score variations across diverse dimensions concerning different demographic factors. Structured questions were used to conduct qualitative interviews with participants to gather their opinions, suggestions, and perceived benefits regarding the platform.

The data from a total of 18 participants were ultimately included, with an average age of 47 (SD 3.73) years. The overall SUS score was 65 (SD 4.157), and the average total score of PSSUQ was 80 (median 90, IQR 20). No statistically significant differences (P>.05) were observed in the overall scores and dimension scores of the SUS and PSSUQ across gender, age, and educational level distributions. The radar chart illustrates that the learnability score for the metaverse platform was the lowest (mean 61.11, IQR 5.08), while the Interaction Quality score was the highest (median 86.67, IQR 27). The results of the qualitative interviews indicated that users were generally highly satisfied with the platform's content, finding it comprehensive, diverse in format, and convenient to use. However, the platform's operation was not yet sufficiently streamlined, and its learnability still needs improvement. The metaverse multidimensional rehabilitation platform demonstrates clinical usability and holds potential to enhance the quality of life for survivors.

The platform demonstrated strong clinical usability and received high ratings for several parameters. Learnability, usability, and satisfaction levels were found to be satisfactory, with no significant correlations with demographic factors.

Although the relationship between HIV and mental health is well-established, limited research has focused on the available interventions for adults living with HIV (ALWH), particularly those in sub-Saharan Africa (SSA) where the epidemic is most severe. In this paper, we systematically review the literature on mental health interventions for this population during the modern treatment era, aiming to situate them along the HIV care continuum and provide a concise examination of their efficacy. A comprehensive search across PubMed, CINAHL, EMBASE, and PsycINFO identified 13 studies that met the inclusion criteria, and risk of bias was assessed using the Quality Assessment of Controlled Intervention Studies tool. Depressive symptoms were the primary intervention target across all studies, followed by symptoms of anxiety (n = 7). Interventions employed psychosocial, pharmacological, and behavioral mechanisms, including counseling, problem-solving therapy, and antidepressants. Qualitative synthesis showed that interventions were primarily delivered during the "Receiving HIV Care" step of the HIV care continuum, with limited evidence at the HIV diagnosis, linkage to care, and viral suppression stages. While interventions were generally associated with improved mental health outcomes, statistically significant effects were not consistently observed. Evidence on HIV-related outcomes was also limited to eight studies and yielded mixed results. These findings underscore the need to expand mental health services and implementation research for ALWH. Addressing gaps across the HIV care continuum, including broader mental health outcomes and culturally adapted assessment tools, may strengthen integrated HIV and mental health programming in SSA and support efforts to end the HIV epidemic.The trial was preregistered at Prospero Registration Number: CRD42024577597.