The mechanisms underlying pharmacological treatments for stimulant use disorders are poorly understood. This study examined whether changes in craving, depressive symptoms, and/or impulsivity mediate treatment effect in pharmacotherapy with combined naltrexone and bupropion for methamphetamine use disorder (MUD).

The study was based on secondary analysis of data from the Accelerated Development of Additive Pharmacotherapy Treatment for methamphetamine disorder (ADAPT-2) trial which randomized adults with MUD to combined treatment with injectable naltrexone (380 mg every 3 weeks) plus oral bupropion (450 mg daily) versus placebo. A total of 403 adults with MUD participated in the first stage; 225 of first stage participants in the placebo arm who did not respond to treatment were re-randomized in the second stage. Mediation effects were examined using longitudinal multi-level structural equation modeling.

Naltrexone-bupropion treatment was associated with decreases in drug use, craving, depressive symptoms, and impulsivity. The indirect effect of treatment through change in craving was significant (self-reported use = -0.21, 95% credible interval (CrI) = -0.35, -0.09; drug screen-ascertained use = -0.36, 95% CrI = -0.63, -0.16). Change in craving mediated 56% of the treatment effect on self-reported drug use and 45% of the effect on drug screen-ascertained use. Estimates for mediated effects for depressive symptoms and impulsivity were smaller in magnitude and nonsignificant.

Reduction in craving mediates the effect of naltrexone-bupropion pharmacotherapy in MUD. Craving may serve as a surrogate measure of treatment efficacy in short-term trials and help identify promising candidate medications to be tested in larger and longer-term trials.

ClinicalTrials.gov number: NCT03078075.

Concerns over postoperative opioid use after open spinal fusion continue to rise. Many randomized controlled trials (RCTs) have sought to reduce postoperative opioid consumption; however, the influence of sociodemographic variables on this consumption remains underappreciated. This study evaluated the extent to which sociodemographic characteristics are reported in RCTs assessing postoperative opioid consumption following lumbar fusion surgery.

A structured literature search (Medline via PubMed, 2015-2025) was conducted to identify English-language RCTs focused on postoperative opioid use after open lumbar fusion. Exposures of interest included demographics, insurance status, education level, and prior opioid use; the primary outcome was postoperative opioid consumption. Following full-text review of 321 articles, 63 RCTs met inclusion criteria for data extraction. Reported variables included sex (96.8%), age (93.7%), preoperative opioid history (19.0%), race (6.3%), psychiatric comorbidity (6.3%), employment (3.2%), and insurance status, ethnicity, and education (1.6% each). Reporting of preoperative opioid history was associated with North American or European trial settings (adjusted p = 0.017).

Sociodemographic underreporting limits interpretability of postoperative opioid outcomes in lumbar fusion RCTs. Greater inclusion of patient-level variables is needed to advance interpretability of postoperative opioid consumption in lumbar fusion RCTs.

Objective: To analyze the association between fine particulate matter (PM_2.5) exposure and dyslipidemia, and the potential modifying role of dietary factors in children and adolescents in rural China. Methods: A multi-stage cluster random sampling method was applied to conduct questionnaire survey, biochemical measurements, and physical examination in children and adolescents aged 8 to 15 years in 103 key surveillance counties where the Nutrition Improvement Program for Rural Compulsory Education Students was conducted. The average PM_2.5 concentration in previous 3 years was used as the long-term exposure level. The linear mixed-effect model was used to evaluate the association between PM_2.5 exposure and dyslipidemia. Stratified analyses by dietary factors were conducted to analyze their potential modifying effects. Results: A total of 10 788 children and adolescents were included, including 5 391 boys (49.97%) and 5 244 primary school students (48.61%). The annual PM_2.5 exposure level was (30.36±10.62) µg/m³, and the prevalence rate of dyslipidemia was 21.84%. Higher PM_2.5 exposure was significantly associated with the increased risk for dyslipidemia (OR=1.501, 95%CI: 1.028-2.192), with stronger associations observed in boys, junior high school students, and those attending schools in county towns. Stratified analyses indicated that no significant association was observed between high PM_2.5 exposure and dyslipidemia in children and adolescents with greater vegetable intake diversity. Conclusions: High level of PM_2.5 exposure increased the risk for dyslipidemia in children and adolescents. Greater diversity of vegetable intake might play a modifying role in the adverse association between PM_2.5 exposure and dyslipidemia.

Depression is a leading global health concern and is projected to become one of the major contributors to the global burden of disease in the coming decades. Increasing evidence highlights the role of social determinants-including socioeconomic conditions, social relationships, life stressors, discrimination, and environmental influences-in shaping the risk and clinical expression of depressive disorders. This study aimed to investigate social determinants associated with the presence and severity of depressive symptoms in Italian general population.

A cross-sectional survey was conducted among 1,036 adults from the Italian general population, recruited through personal networks and online platforms using snowball sampling. Participants completed a structured questionnaire assessing sociodemographic characteristics, social support, stressful life events, quality of life, minority stress experiences, social media use, environmental and societal concerns, substance use, and mental health symptoms. Comparative analyses were performed between individuals reporting a clinician-diagnosed depressive disorder (n = 143; 13.8%) and those without a diagnosis (n = 893).

Participants with a depressive disorder reported significantly higher exposure to multiple adverse social determinants. They were more likely to experience stressful life events, reduced perceived social support, poorer quality of life, minority stress, and negative psychosocial effects related to social media use. Concerns regarding broader socio-environmental issues, including political instability and climate change, were also more prevalent in the diagnosed group. These social vulnerabilities were accompanied by greater severity of depressive symptoms, anxiety-related manifestations, impulse-control difficulties, aggressive behaviors, and the use of substances as a coping strategy (all p ⩽ .003).

The findings support social determinants framework for understanding depression, highlighting the contribution of social adversity, environmental stressors, and relational factors to the development and severity of depressive symptoms. Population-based surveys can help identify vulnerable groups and inform preventive strategies and public health interventions aimed at addressing the social conditions that contribute to depression.

Numerous explanations have been provided for recent increases in mental distress and poorer well-being. One avenue of research has linked specific beliefs about emotions with poorer psychological outcomes, including heightened mood and anxiety symptoms and lower levels of life satisfaction. The current project builds on this prior work by developing a new measure of beliefs that the experience of negative emotions can cause physical or psychological harm, akin to ingesting a toxic substance and exploring its association with various psychological outcomes in three large independent samples (N_total = 1,849) collected from 2023 to 2025. In Sample A (N = 954), we describe the initial development of the Beliefs That Negative Emotions Are Toxic Scale (B-NETS). In Samples B (N = 419) and C (N = 476), we validate the B-NETS and link higher B-NETS scores with greater irritability, depression, and anxiety. These associations remained significant even after accounting for existing emotion belief, emotion regulation, and experiential avoidance measures. If replicated, especially in non-U.S. samples with greater racial and ethnic diversity, these findings suggest this new measure may provide unique information about mental health beyond existing measures. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The rapid evolution of Padel in Saudi Arabia (SA) has positioned the sport as a popular recreational and social activity, mainly among young adults. However, limited research has examined how different forms of sport motivation are associated with mental health outcomes in this emerging context. Drawing on Self-Determination Theory (SDT), this study investigated the associations between intrinsic and extrinsic motivation and depression, stress, and anxiety among Padel players in SA. A quantitative, cross-sectional online survey was conducted with a sample of 475 players, the majority of whom were aged 17-35 and held at least a bachelor's degree. Data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM) to evaluate the relationships between multidimensional motivation factors and mental health symptoms. The findings revealed a nuanced, at times paradoxical, pattern of relationships. Intrinsic motivation to experience stimulation (engaging in an activity because of the positive sensations, excitement, enjoyment, or stimulation that the activity itself provides, rather than for external rewards or pressures) was consistently associated with lower levels of depression, stress, and anxiety, suggesting that enjoyment-driven involvement is associated with better mental health outcomes. In contrast, intrinsic motivation to accomplish was positively correlated with all three mental health indicators, indicating that achievement-oriented engagement might intensify emotional pressure. Among extrinsic motivations, external regulation was significantly associated with poorer mental health outcomes. In contrast, introjected regulation unexpectedly displayed a negative association with psychological distress, demonstrating a potentially adaptive role in this setting. Identified regulation, however, was not significantly associated with any mental health symptoms. These results underscore the "double-edged" nature of sport motivation, showing that not all internal or external motives yield uniformly positive consequences. The study contributed to the growing literature by providing a context-specific understanding of how motivational dynamics function within a rapidly growing sport in Saudi Arabia. In practice, the findings suggested that enjoyment-based involvement was associated with more favourable mental health outcomes, whereas performance-related pressures might be associated with less favourable outcomes.

Background: Competitive esports represents a rapidly developing digital performance environment in which players must regulate attention, affect, psychophysiological activation, and performance under dynamic, high-demand conditions. Although cognitive overload and related states are increasingly relevant to esports research, these constructs have not been consistently defined, operationalized, or measured. Objective: This scoping review aimed to map empirical evidence on cognitive overload and related states in competitive esports, with emphasis on cognitive demands, psychophysiological and neurophysiological markers, coping and recovery approaches, game genres, and performance outcomes. Methods: The review followed Joanna Briggs Institute guidance and PRISMA-ScR reporting principles. Searches were conducted in Scopus, PubMed, Web of Science, and EBSCOhost on 5 May 2026. Eligible studies were peer-reviewed empirical articles involving ranked, collegiate, semi-professional, professional, elite, or otherwise competitive esports players and included at least one objective or semi-objective indicator relevant to overload-related states. Results: Forty-eight studies were included. Evidence was distributed across in-game performance, stress and arousal, cardiometabolic load, mental workload, sleep and recovery, perceptual-cognitive processing, neurophysiological markers, and intervention-oriented approaches. Heart rate (HR), heart rate variability (HRV), eye-tracking, sleep or wearable measures, electroencephalography (EEG), event-related potential (ERP), cortisol, pupil diameter, electrodermal activity (EDA), cognitive tasks, and in-game metrics were used across the literature. However, these measures were rarely integrated into unified, multimodal models. Conclusions: Cognitive overload in esports is best understood as a dynamic, multidimensional state emerging from interactions between game demands, competitive context, player regulation, and performance consequences. Future research should develop genre-sensitive, multimodal, and time-synchronized models that distinguish workload, stress, fatigue, arousal, tilt, and performance decline.

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women's nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women's experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women's experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating "good motherhood"; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support.

Objective: To explore the relationship between long-term exposure to atmospheric ozone (O₃) and adolescent depressive mood, and provide baseline data for the prevention of depression in adolescents and mental health interventions in schools. Methods: Daily environmental pollutant and meteorological data were collected from Inner Mongolia Autonomous Region between 2023 and 2024. A total of 83 601 adolescents from 12 leagues (103 banners/counties/districts) in the region were selected by using stratified random cluster sampling. Depressive symptoms were measured by using the Center for Epidemiologic Studies Depression Scale. A multivariate logistic regression analysis model was used to evaluate the association between O₃ exposure and the prevalence of depression. Results: A total of 83 601 adolescents were surveyed, with a depression detection rate of 18.4% (15 356 individuals). There was a significant association between long-term O₃ exposure and the risk for depression in adolescents. The annual average concentration of O₃ one year prior to the survey showed the greatest effect, with every 10 μg/m³ increase in O₃ exposure associated with a 15% rise in depression risk (OR=1.15, 95%CI:1.10-1.21). Stratified analysis revealed that the following subgroups had significant higher risks for depression:girls (OR=1.36, 95%CI:1.25-1.49), junior high school students (OR=1.39, 95%CI:1.27-1.52), those whose mother's had educational attainment at and above university or college level (OR=1.35, 95%CI:1.15-1.58), and those whose father had educational attainment at or below the primary school level (OR=1.41, 95%CI:1.21-1.65), non-only children (OR=1.28, 95%CI:1.18-1.39), those with parents suffering from chronic diseases (OR=1.26, 95%CI:1.13-1.41), students without personal health conditions (OR=1.27, 95%CI:1.17-1.36), those who had experienced harm (OR=1.42, 95%CI:1.15-1.75), those satisfied with life (OR=1.37, 95%CI:1.20-1.57), participants reporting moderate stress (OR=1.35, 95%CI:1.21-1.50), individuals with daily internet use exceeding 4 hours (OR=1.26, 95%CI:1.06-1.49), members of large families (OR=1.47, 95%CI:1.24-1.74), and residents of the eastern region (OR=1.67, 95%CI:1.50-1.86). The results of the sensitivity analysis model remained relatively stable, indicating that O₃ has an independent effect on the risk of depression onset. Conclusion: There is a statistically significant association between long-term O₃ exposure and the risk of depression in adolescents, which warrants more attention.

This study aims to evaluate the association between hormone replacement therapy (HRT) use and clinical outcomes in women with rotator cuff tears (RCTs) over a five-year follow-up period.

Between February 2011 and June 2015, a total of 77 women aged ≥ 45 years with symptomatic RCTs in a multi-center cohort were retrospectively analyzed. The HRT status was self-reported. Patient-reported outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Pain and Disability Index (SPADI), and Mental Health Inventory (MHI), assessed at multiple time points over 60 months. Magnetic resonance imaging data were used to evaluate tear size, muscle atrophy, and fatty infiltration.

Of a total of 77 women included in the analysis, the HRT group consisted of 13 patients and the non-HRT group consisted of 64 patients. The mean age of women receiving HRT was 58.7 ± 7.0 years, compared to 63.5 ± 8.6 years in those not on HRT (p = 0.061). No statistically significant differences in baseline characteristics or clinical outcomes were observed between HRT and non-HRT groups (p > 0.05). Patients on HRT showed distinct recovery trends, particularly among those managed non-operatively, with early improvements in ASES and SPADI scores that fluctuated over time. Imaging analysis revealed significantly greater odds of moderate-to-severe muscle atrophy in the HRT group (p = 0.0187), although fatty infiltration and tear size did not significantly differ.

Hormone replacement therapy use demonstrated distinct functional recovery trends in women with rotator cuff tears, particularly among non-operatively managed patients, though no statistically significant differences in overall clinical outcomes were observed. These findings suggest that hormonal status may selectively influence musculoskeletal recovery and warrant further investigation to better inform sex-specific management for rotator cuff tears during and following the menopause transition.