Obsessive-compulsive disorder (OCD) is a debilitating mental health problem that is frequently inadequately treated in several areas owing to restricted access to specialised services, societal stigma, and elevated treatment expenses Internet-based cognitive-behavioural therapy (ICBT) offers an effective and accessible alternative. To date, no Persian-language ICBT for OCD has been rigorously established or evaluated.

This study aimed to develop and evaluate the feasibility of a culturally adapted Persian ICBT for OCD in Iran, examining its acceptability, applicability, and preliminary clinical outcomes from the perspectives of both clinicians and clients.

The ICBT protocol was designed and constructed based on Salkovskis's model and culturally tailored for Iran. Feasibility was evaluated by 19 CBT therapists and 15 clients using a structured feasibility scale. Clients also completed pre- and post-treatment assessments of OCD severity (Y-BOCS), satisfaction (CSQ), credibility/expectancy (CEQ), and adherence (TAAS).

All feasibility subscales were rated significantly above threshold (p < .001), with "Applicability/Demand" receiving the highest endorsement. Secondary exploratory outcomes demonstrated significant symptom reduction (M baseline = 27.80; M post = 18.06; Z = -3.42, p < .001), with 53% showing clinical response and 13% remission in the client group. Also, high satisfaction, credibility, and adherence were reported. Exploratory regressions did not identify significant predictors of outcome.

These findings suggested the preliminary feasibility and strong demand for ICBT for OCD in Iran. The positive evaluations from both professionals and clients, coupled with significant symptom reduction and high user satisfaction, position this program as a promising, accessible treatment alternative for OCD patients.

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder associated with reduced quality of life and psychological distress. Although several effective self-management interventions exist, patient access is often limited. Internet-delivered interventions may enhance accessibility and scalability. We aimed to evaluate the effectiveness of a CBT-based module, a FODMAP diet module, or their combination, when added to internet-delivered general patient education, compared to general patient education alone, on IBS symptom severity in adults.

In this four-arm randomized controlled trial, 642 adults with IBS were allocated to (1) internet-delivered general patient education alone (control) or with the addition of (2) a CBT-based module, (3) a FODMAP diet module, or (4) both the CBT-based module and the FODMAP diet module. All groups could receive personalized guidance from a clinical dietitian via the platform's asynchronous messaging function. The primary outcome was the proportion of IBS symptom responders at 3 months, defined as a ≥ 50-point reduction on the IBS severity scoring system. Secondary outcomes included IBS-related quality of life, psychological symptoms, module adherence, and treatment satisfaction.

Of 557 participants who received their allocated intervention, 373 (67%) completed questionnaires at the primary endpoint at 3 months. Responder rates were comparable across all groups at 3 months ranging from 42.6% to 45.1%, with no significant between-group differences in the primary outcome (OR (95% CI) = 0.97 (0.54 to 1.72), p = 0.989). Adherence to the content-specific modules was low, with 9-20% of participants completing the CBT-based and/or FODMAP diet module. All groups showed within-group improvements in IBS symptoms and IBS-related quality of life in secondary continuous analyses, but these did not translate into between-group effects.

All intervention groups, including internet-delivered general patient education alone and general patient education with an additional CBT-based and/or FODMAP diet module, demonstrated clinically and statistically meaningful improvements in IBS symptoms and IBS-related quality of life. Although no additional benefit of the content-specific modules was observed, this finding should be interpreted in the context of the low adherence to these modules. These findings highlight the value of low-intensity internet-delivered interventions for IBS within resource-constrained health systems and emphasize the importance of addressing adherence and engagement in future research.

ClinicalTrials.gov ID: NCT06117865. Registered 31.10.2023.

Over the past decades substantial progress has been made in addressing health disparities of people with intellectual disability. The "era of awareness" (pre-2005) identified a "cascade of disparities" of more adverse health conditions, less attention to health needs, poorer health care access, and fewer opportunities for health improvement. This occurred alongside emerging governmental recognition of the poor health of people with intellectual disability. The "era of assessment" (2005-2015) saw advances in improved health data, population health surveillance, attention to environmental contributors, and passage of the Convention on the Rights of Persons with Disabilities. Research extended from clinical samples to population-based studies with greater focus on social determinants of health. The "era of context" (2015-2025) was characterized by the COVID-19 pandemic, technology, and greater inclusion of people with intellectual disabilities in their communities. Data advances included a disability data framework, clearer disability definitions and identification, and greatly expanded data-linkage research to inform programs and policies. Disability health competencies were developed in multiple countries for multiple disciplines. For the coming decade, we anticipate greater use of technology, especially Artificial Intelligence, expansion of the "inclusion movement," and attention to ableism. Data linkage and analysis in multiple countries will map longitudinal health trajectories. We anticipate a much-needed resurgence in attention to mental health. Global climate change will demand inclusive emergency preparedness. Future advances require that research, health care, service programs, and communications be co-designed with people with intellectual disability and their supporters. Focus and funding are critical through investment proportionate to need.

Globally, reports of suicide by sodium nitrite poisoning have been growing. To determine whether sodium nitrite poisoning in suicide is an issue in the UK, we conducted an analysis of the cohort of cases analysed by the sole provider of nitrite assessment for postmortem sample in the UK.

Retrospective cohort analysis of biochemical measures for nitrite and nitrate anion in postmortem samples of 201 cases provided by HM coroners of suspected suicide over a period from March 2019 to August 2024. Secondary measures included sample collection and analysis dates, age and sex of deceased, sample number per case, sample types, and coroner regional location.

Of the 201 cases assessed by the laboratory during the inclusive time period, permission to include data was received from HM coroners for 164 of the cases. Suspected suicide by sodium (or potassium) nitrite/nitrate was confirmed in 87% of cases, with measured nitrite and/or nitrate concentrations ~100× normal physiological levels. Sex was known for 98% of cases and 68% were men. The age range was 14-82 years, and most (71%) cases were from Generation Z and Millennial generation. Cases came from across the UK, with the greatest proportion from Greater London, South East England, the Republic of Ireland, and the Midlands.

The data indicate that suicide associated with the ingestion of nitrite or nitrate salts is substantial in the UK, with a disproportionately high prevalence in young men. There is an urgent public health need for policy makers to consider strategies aimed at preventing and mitigating the harms associated with free access to these salts. This could include restrictions to purchase to facilitate prevention and adoption of easy to implement treatment protocols for both prehospital and emergency healthcare staff in suspected suicide by sodium nitrite/nitrate.

This study investigated emotion regulation (ER) difficulties and repetitive negative thinking (RNT) in individuals with depression, anxiety disorders, or both, compared to nonclinical controls. We aimed to determine which aspects of ER difficulties and RNT are transdiagnostic or specific to one of the disorders, and whether the presence of comorbidities is associated with greater ER difficulties and higher levels of RNT. A total of N = 731 participants, including n = 354 individuals with depression, anxiety disorders, or both (mixed group), and n = 377 nonclinical controls, completed the Difficulties in Emotion Regulation Scale (DERS) and the Perseverative Thinking Questionnaire (PTQ). Parametric and nonparametric analyses were conducted to assess group differences and comorbidity effects. The depression and anxiety disorders groups exhibited significantly greater ER difficulties and higher levels of RNT than nonclinical controls. The mixed group showed more pronounced difficulties in certain aspects of ER (nonacceptance of emotional responses, difficulties engaging in goal-directed behavior, impulse control difficulties, and limited access to ER strategies) and higher levels of RNT compared to the single-diagnosis groups. No significant differences were found in emotional awareness and clarity across clinical groups. Evidence regarding the relationship between the number of comorbid diagnoses and the severity of the difficulties was less clear. This suggests that specific disorders may have a more significant impact than comorbidity alone. Our findings highlight the transdiagnostic role of ER difficulties and RNT in depression and anxiety disorders and suggest that they may be a promising target for transdiagnostic interventions. Future research should further explore the nuanced ways in which ER difficulties and RNT vary across different mental disorders.

Early Intervention for Psychosis Services (EIPS) enhance outcomes for individuals experiencing their first episode of psychosis (FEP). However, in low-resource settings, there is limited knowledge about i) the pathways patients take to access EIPS, ii) the proportion and factors associated with acceptance of referral to EIPS, and iii) if different pathways to EIPS services affect clinical outcomes. Uganda's first EIPS, the Specialised Treatment Early in Psychosis Service at Makerere University Hospital (STEP_MaKH), presents a unique opportunity to explore these important questions.

We aimed to examine the pathways to EIPS, the factors associated with referral to specialised psychosis care and the impact of initial treatment-seeking behaviour on long-term symptom remission and quality of life.

We conducted a multiple-method study. Pathways to care were assessed retrospectively using the WHO Encounter Form among adults with FEP eligible for referral to STEP_MaKH. Among those who completed referral and enrolled in STEP_MaKH. Symptom severity and quality of life were followed prospectively for 12 months. Modified Poisson regression identified predictors of referral completion. Kaplan-Meier methods and Cox proportional hazards models examined time to symptom remission and time to achieving a good quality of life.

Of the 187 adults with first-episode psychosis eligible for referral to STEP_MaKH, Native/religious healers (n = 86) were the predominant first point of contact. Only 56 (29.9%) accepted referral to STEP_MaKH. Participants referred from Mulago National Referral Hospital more likely to enrol than those referred from Butabika (RR = 4.7; 95% CI: 2.90-7.87). Longer delays from first treatment contact were associated with reduced likelihood of reaching STEP_MaKH (RR = 0.99 per month; p = 0.041). After enrolment, symptoms improved rapidly with 60% achieving PANSS remission by Month 1, and fewer than 10% remained non-remitted by Months 2-3. In adjusted Cox models, participants initially seen by mental health workers achieved remission more quickly than those initially seen by non-medical personnel (HR = 1.48; 95% CI: 1.05-2.10). Older age was associated with slower remission (HR = 0.94; p = 0.023). Quality of life improved over the follow-up period, with earlier attainment of good quality of life among those initially managed by mental health workers.

Pathways to care for FEP in Uganda are complex and culturally mediated, with substantial attrition before specialised early psychosis care is reached. Referral completion is strongly shaped by referral site and by delays in the care pathway. Once in specialised care, clinical outcomes improve rapidly, and initial contact with mental health workers is associated with faster symptom remission and earlier gains in quality of life. Strengthening referral systems, reducing pathway delays, and developing collaborative detection-and-referral links with community and frontline providers are key priorities for optimising early psychosis outcomes in low-resource settings.

Comprehensive brain health is increasingly being recognized as critically important worldwide and incorporates elements of neurological and psychiatric health. This evolution in the view of cerebral wellbeing considers the many factors that can affect brain health and the interconnectedness of conditions affecting this organ. Such interplay between neurological and depressive diseases is highlighted by observations that these conditions share underlying pathophysiology and frequently co-occur in the same patient. A review of the literature on depression in post-stroke, Parkinson's disease, multiple sclerosis, and migraine, confirmed the high prevalence of depression in patients with neurological diseases, with approximately one third of patients with neurological diseases having depression. The search results also highlighted the importance of early detection of depression, and that appropriate treatment may substantially improve outcomes of both the depression and the neurological disease. However, there was a disparity in the amount of literature on depression in the different neurological diseases, with only three of the 80 retrieved articles discussing migraine and depression. Information on multidisciplinary care was also limited. Unmet needs with respect to management of depression in patients with neurological diseases include effective screening processes that can differentiate between overlapping symptoms. There is also a lack of clear, evidence-based treatment guidelines. Based on our clinical experience, we provide recommendations for best practice management of depression in patients with neurological diseases, including structured patient interviews to aid with diagnosis of depression, involvement of patient families and friends where relevant, multidisciplinary care that incorporates personalized treatment based on the specific symptoms, co-medications and needs of the patient, and continued follow up and monitoring. Antidepressant options are available with different mechanisms of action and adverse event profiles. Overall, evidence indicates that depression in neurological disorders is underdiagnosed and undertreated. We suggest that structured screening and tailored, multidisciplinary care can improve outcomes.

Depression is highly prevalent among patients undergoing hemodialysis in Arab countries, adversely affecting quality of life, treatment adherence, and clinical outcomes. Despite its significance, mental health issues remain underdiagnosed and undertreated due to cultural stigma, limited healthcare integration, and resource constraints.

This systematic review aims to evaluate the prevalence, key predictors, and management challenges of depression among hemodialysis patients in Arab countries.

Following PRISMA guidelines, comprehensive searches of multiple databases were conducted for studies published from 2010 to June 2025. Inclusion criteria encompassed original quantitative, qualitative, and mixed-methods research focusing on depression in dialysis patients across Arab nations. Data extraction and quality assessment used standard tools, with a narrative synthesis employed to integrate findings due to heterogeneity.

Analysis of 59 studies revealed a high prevalence of depression, averaging 55.6%, with rates ranging from 18% to 86.9%. Key predictors include female gender, older age, longer dialysis duration, low socioeconomic status, and comorbidities. Cultural stigma, lack of integrated mental health services, and limited provider training pose significant management barriers.

The findings underscore the substantial mental health burden among dialysis patients, exacerbated by socio-cultural factors unique to the region. Addressing these challenges requires culturally sensitive screening, integrated psychosocial support, and healthcare system reforms to improve early diagnosis and treatment.

Depression among hemodialysis patients in Arab countries is a critical public health issue, necessitating multidisciplinary, culturally tailored strategies to enhance mental health care, improve adherence, and elevate overall patient outcomes.

This study assessed the association between self-reported psychiatric diseases and the number of present teeth in older adults.

It was included 569 older adults selected using a probabilistic per cluster sampling strategy. Structured questionnaire was applied, and an oral health examination was performed. Self-reported psychiatric diseases were defined as the primary exposure, while the number of present teeth was the outcome. Adjusted analyses were performed using Poisson regression with robust variance (α < 0.05).

The prevalence of self-reported psychiatric disease was 16.5% (n = 94; 95% confidence interval [95% CI]: 13.5%-19.6%). In the final adjusted model, lower number of present teeth was associated with self-reported psychiatric diseases (rate ratio [RR]:0.69; 95% CI:0.51-0.94). Women (RR:0.72; 95% CI:0.61-0.84), those without access to the dentist (RR:0.54; 95% CI:0.45-0.65), and of higher age (RR:0.96; 95% CI:0.94-0.97) also presented lower number of present teeth when compared to their counterparts. Those with medium level of education presented higher number of teeth (RR:1.68; 95% CI: 1.43-1.98).

Older adults with self-reported psychiatric diseases, females, and those without dental access exhibited higher rates of tooth loss. Public policies should aim to integrate mental and oral health, ensuring equitable access to dental care for these most vulnerable groups.

Patients with disorders of consciousness (DoC) resulting from severe traumatic brain injury (TBI) may recover consciousness and independence years later. There is a prevailing belief that recovery, when limited to the restoration of independence in activities of daily living, will be accompanied by poor self-reported quality of life (QOL) and psychological health. This perception may influence early clinical decision-making related to the provision of life-sustaining treatment and access to specialized rehabilitation. In this observational study, we utilized data from the multisite TBI Model Systems (TBIMS) to evaluate the outcomes of QOL (Satisfaction With Life Scale [SWLS]), anxiety (Generalized Anxiety Disorder-7 Scale [GAD-7]), and depression (Patient Health Questionnaire-9 [PHQ-9]) in participants who were admitted to inpatient rehabilitation with DoC and recovered the ability to provide self-report on these measures by 1 year post-TBI. Among 887 TBIMS participants admitted to inpatient rehabilitation with DoC (defined as the absence of command-following; 74% male; mean [standard deviation, SD] age = 36.82 [17.87] years; days post-injury on rehabilitation admission = 33.63 [22.51]), 50% regained the capacity to respond to questions on self-report measures at the 1-year follow-up time point. The mean (SD) total scores were as follows: SWLS = 20.38 (7.81), GAD-7 = 4.00 (5.66), and PHQ-9 = 5.22 (5.04). A minority of patients endorsed dissatisfaction (15%) or extreme dissatisfaction (9%) with life, and similarly, only 14% and 16%, respectively, reported anxiety and depression symptoms above the clinical cutoff points. The results were similar at the 2- and 5-year follow-up time points. In summary, at the group level, QOL and psychological health in persons who recover from DoC are similar to those of individuals with less severe brain injuries and to the general population. These findings challenge the assumption that recovery from DoC is associated with poor QOL and psychological health. Clinicians should be aware that patients with a broad range of residual disability after DoC are unlikely to report dissatisfaction with life or have significant anxiety and depression up to 5 years post-TBI.