To examine the associations between migration experiences during different life stages and long-term health outcomes among middle-aged and older adults.

A retrospective study based on data from the China Health and Retirement Longitudinal Study (CHARLS).

A nationally representative survey conducted in 150 county-level and 450 village-level administrative units across China.

A total of 14 753 Chinese adults aged 45 years or older who completed both the 2014 and 2020 waves of the CHARLS.

The primary outcome measures included self-rated health, depression, cognitive function and physical disability.

Participants were categorised into four groups based on migration timing: never experienced childhood and adulthood migration (NCMAM); childhood migration only, no adulthood migration; adulthood migration only, no childhood migration (PAMNCM) and both childhood and adulthood migration experiences (PCMAM). Compared with the NCMAM group, the PAMNCM group reported poorer self-rated health (OR=1.12, 95% CI (1.02 to 1.23), p<0.05) but demonstrated better cognitive function (B=0.34, 95% CI (0.14 to 0.55), p<0.01). In contrast, the PCMAM group exhibited a lower prevalence of depression (OR=0.80, 95% CI (0.65 to 0.99), p<0.05).

Migration experiences showed complex associations with health outcomes among middle-aged and older adults. Migration during both childhood and adulthood was linked to better mental health, whereas migration limited to adulthood was associated with slightly better cognitive function despite poorer self-rated health. Policies should account for the diversity of migration backgrounds and equitably address the distinct needs of all migration status groups.

Aboriginal and Torres Strait Islander youth hold central roles in the preservation and transmission of cultural knowledge, community leadership and Australia's social and political future. Fostering youth well-being is essential in the context of historical, social and political impacts of colonisation. Social and emotional well-being (SEWB) is a holistic concept grounded in First Nations worldviews, encompassing connections to country, culture, spirituality, family, community, body and mind. Many programmes aim to support SEWB among First Nations youth; however, evidence describing programme success factors outcomes remains fragmented and is often shaped by Western-centric methodologies. This protocol outlines a culturally responsive scoping review that will map success factors and SEWB impacts of programmes delivered in Australia for First Nations youth aged 10-18 years that is designed to be undertaken collaboratively with First Nations people and non-Indigenous allies.

In recognition of the diversity of Aboriginal and Torres Strait Islander peoples and their right to self-identify using preferred terminologies, in this protocol, we respectfully use 'First Nations peoples' to refer to all Aboriginal and Torres Strait Islander peoples in Australia and 'First Nations youth' to refer to those aged 10-18 years. We further acknowledge that this use of this terminology may not capture the many and varied First Nations identities within Australia.

This scoping review protocol outlines a revised, culturally responsive version of the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be conducted using an Indigenous-informed, decolonising approach. Peer-reviewed and grey literature reporting on Australian SEWB programmes delivered to First Nations youth between 2000 and 2025 will be included. Databases to be searched include MEDLINE/PubMed, PsycINFO, ProQuest and EBSCOhost. Targeted Indigenous sources will be searched, including Informit Indigenous Collection, Australian Indigenous HealthInfoNet, National Aboriginal Controlled Community Health Organisation and Lowitja Institute repositories, along with relevant organisational and government websites. Three reviewers will independently screen records and extract data. Articles requiring cultural responsivity assessment will be reviewed by First Nations researchers. Data will be analysed using inductive content analysis to identify programme success factors and reported SEWB outcomes, with interpretation guided by First Nations members of the research team.

The protocol is guided by Australian Indigenous research ethics frameworks including the National Health and Medical Research Council (NHMRC), Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Code of Ethics for Aboriginal and Torres Strait Islander Research and the Lowitja Institute's guidance for Aboriginal and Torres Strait Islander health research. Findings will be disseminated through culturally appropriate channels to communities and stakeholders.

Protocol registration will be made available online via the Open Science Framework (osf.io/yq6sv).

An estimated 150 million people have mental health care needs in India, but only 15% are able to access care. Depression and anxiety contribute to a large proportion of mental morbidity. The Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health trial used a mobile-based clinical decision support system for primary care doctors and community health workers (CHWs) to identify and treat people at risk of depression, anxiety disorders, and self-harm. A community-based antistigma campaign was also delivered. The intervention led to improved remission rates for depression and anxiety and lower stigma scores.

A process evaluation assessed (1) implementation fidelity, barriers, and facilitators; (2) perceptions of doctors and CHWs on the use of SMART Mental Health; and (3) the causal pathways that led to trial outcomes.

A mixed methods evaluation combining backend program data and qualitative data was conducted. A total of 38 focus group discussions and 37 key informant interviews were conducted with primary doctors, CHWs, government officials, local community leaders, and research project staff. The data were coded and analyzed using a framework analysis approach based on the UK Medical Research Council guidance on process evaluations and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

The intervention had high implementation fidelity. Across clusters, the median proportion of participants with at least 1 CHW follow-up was 98% (IQR 96.6%-100%). The referral rate for a psychiatrist was low (224/1697, 13.2%), and only 23.6% (53/224) of those referred visited the psychiatrist. The median exposure to antistigma audiovisual content was 84% (IQR 65.7%-95.9%). At the community level, key implementation barriers included cultural inhibitions in seeking mental health care and the unavailability of patients due to competing demands. Proximity and tight social connections between CHWs and their communities were important facilitators in seeking medical help. Doctor and CHW training, mentoring, and feedback provided by program staff were important facilitators to support the use of the digital health components by the health workforce.

A complex intervention that included both community-based antistigma and clinical digital health interventions achieved high implementation fidelity. Key areas to consider for maintenance of such interventions include (1) the need for sustained community-based strategies to address stigma and other cultural barriers; (2) health workforce strengthening policies, including supportive supervision for CHWs and doctors to increase capability in the use of mental health digital health tools; and (3) strategies to improve access to specialist care for those with more complex care needs.

Clinical Trial Registry India CTRI/2018/08/015355; https://tinyurl.com/5r63suxp.

Latin America and the Caribbean have a long-standing tradition in brain research characterized by unique regional features. However, the region faces significant hurdles in maintaining pace with the rapid global advances in Brain Sciences observed over the last few decades. The Latin America Brain Initiative (LATBrain) was established to integrate regional efforts and catalyze the interdisciplinary development of Brain Sciences. To support this mission, LATBrain conducted the first survey to assess the perceptions of researchers, students, and professionals regarding opportunities and systemic barriers in the field across Latin America and the Caribbean. Respondents identified notable strengths, including high academic achievement, creativity, and a robust capacity for collaboration. Conversely, critical concerns centered on the need for sustained funding, access to state-of-the-art technology, and specialized interdisciplinary training. Public interest was perceived to be primarily aligned with applied societal issues, such as neurodegenerative disorders and mental health. Furthermore, the survey highlighted how insufficient funding compromises infrastructure sustainability and the retention of promissory and top-tier researchers. Our findings underscore a critical need to refocus training to be more socially relevant and academically interdisciplinary. LATBrain is actively collaborating with partners across Latin America and the Caribbean to overcome these limitations by strengthening scientific integration and interdisciplinarity, promoting resource sharing, and advocating for the socio-economic importance of brain research. This strategic plan seeks to solidify the region's position as a global leader in brain research.

Victim-survivors of intimate partner violence are at an increased risk of developing a range of physical and mental health conditions (i.e., post-traumatic stress disorder, depression, cardio-vascular disease, chronic pain, sleep difficulties), all of which have the potential to be supported via physical activity. Whilst a limited number of studies have demonstrated that moderate-vigorous forms of physical activity, such as non-contact cardio-boxing, may be beneficial for victim-survivors' healing and recovery, few have been co-designed with lived-living experience experts. Therefore, this study aimed to centre women victim-survivor voices to understand their needs in the design and delivery of a trauma and violence-informed, non-contact cardio boxing exercise intervention. Semi-structured one-on-one interviews were conducted online with n=14 self-identified women or biological females with lived-living experience of intimate partner violence across Australia. Interviews explored factors influencing acceptability, feasibility, trauma and violence-informed design, barriers to adoption and sustainable implementation. Data were interpreted using Reflective Thematic Analysis. Four themes were developed: 1) the evolving relationship victim-survivors have with exercise and their bodies; 2) cardio boxing as an empowered exercise choice to move through anger 3) understanding that safety considerations come first for victim-survivors; and 4) real-world trauma and violence-informed solutions. Whilst these findings underscore the importance of collaborative trauma and violence-informed approaches to physical activity intervention development and design for intimate partner violence victim-survivors, these insights are applicable beyond this population, including real-world use within a range of physical activity settings (i.e., community gyms, sporting clubs, exercise physiology clinics).

Neuroinflammation is the brain's immune response to injury or disease and can negatively impact neurological functions, ranging from mood, cognition, learning and memory, as well as promote neurodegenerative disease and even psychiatric conditions. Different environmental factors may trigger a neuroinflammatory response; the mechanisms of this activation may influence the pattern of activation, the immune subsets involved, and the persistence of the response. The duration of neuroinflammation may significantly outlast exposures, creating a potential unique vulnerability for rare or intermittent exposures. The neuroinflammatory response can be classified into acute, sub-acute and chronic phases, with sub-acute neuroinflammation representing a transient state between acute and chronic inflammation. This phase, lasting from days to weeks, is denoted by metabolic disruptions, cognitive impairments, and peripheral immune activation. Environmental exposures such as such as air pollution, pesticides, heavy metals, and social factors impact oxidative stress, glial activation, and blood-brain barrier disruption leading to neuronal injury and cognitive decline. Notably, exposures like diesel fumes and wildfire smoke have been shown to induce neuroinflammation, subsequently impacting memory and learning, and exacerbating mental health conditions such as PTSD, depression and anxiety. Triggering of reactive astrogliosis via impacts on the blood-brain barrier function may be the most common non-specific manner that environmental toxicants drive neuroinflammation, but direct outcomes from compounds that readily access the brain are also possible.

We draw on in-depth qualitative longitudinal research with 62 people using food aid to explore the impact on their mental health, identifying multiple ways in which food aid organisations both support and damage mental health. Organisations adopting an inclusive and democratic approach, in which barriers to entry are low and opportunities for social contact and support are prioritised, are most beneficial to the mental health of service users. Nevertheless, the scope for positive impact is markedly lower among service users with pre-existing mental health conditions. We find that experiences can vary markedly longitudinally, with deteriorations and improvements in people's mental health over long time periods connected to their experiences of food aid. We ask a - sociological - question concerning contemporary responsibility for mental health amid state retrenchment and the growing importance of food aid in a pluralist welfare landscape. Utilising the concept of biopower, we show how food aid services embody responsibilities for mental health that previously primarily belonged to the state. The scope for organisations to wield power over hunger and mental health is, however, ultimately constrained by diminishing organisational resources. Methodologically, our evidence underlines the value of longitudinal approaches in illuminating the variable and situated nature of lived experiences, and illustrates the importance of exploring lived experiences of different models of food aid. While some food aid organisations may offer social connection that is beneficial to mental health, food aid is no replacement for a fit-for-purpose mental health system and social security which protects people from poverty.

With the reduction in police involvement in front-line mental health responses in New Zealand (implemented November 2024), this study evaluates the primary legal justification supporting paramedics in using force to prevent suicide: Section 41 of the Crimes Act 1961.

We conducted a qualitative analysis of 20 legal cases (1986-2023) identified through a systematic search. The analysis was structured thematically, focussing on the legal criteria for intervention, the role of de-escalation, the threshold for "reasonable force" and the unresolved conflict between intervention and patient autonomy. Cases were included if Section 41 was central to the legal reasoning or as a justification; cases where Section 41 was cited in passing without substantive discussion were excluded.

Case review suggests that while Section 41 can provide a legal justification, its application is highly context dependent. Courts have held that force is justifiable only to prevent immediate and unlawful harm and that it should be proportionate to the threat. Failing to attempt viable, less-restrictive alternatives can render even minimal force unreasonable. Cases involving excessive force demonstrate judicial focus on proportionality and the availability of other options. The analysis highlights a legal and ethical "grey area" concerning patient capacity and the limits of intervention.

There is limited case law interpreting Section 41 (20 substantive cases identified between 1986 and 2023). To improve safety for patients and practitioners, we suggest clearer operational guidance, multidisciplinary education and consideration of legislative options that would better support healthcare-led responses to mental health emergencies.

Military sexual trauma (MST) can have significant adverse effects on mental health and well-being, often leading to posttraumatic stress disorder (PTSD) symptoms and maladaptive beliefs. Although effective psychotherapies exist, stigma, confidentiality concerns, and systemic barriers often hinder help-seeking among service members and veterans. Mobile mental health apps offer an accessible and anonymous support alternative, potentially addressing such barriers. However, app effectiveness depends on user engagement and emerging evidence suggests that engagement may be shaped by symptom severity.

This retrospective observational study aimed to explore the relationship between posttraumatic symptom severity and user engagement with Beyond MST (US Department of Veterans Affairs [VA] National Center for PTSD), an app for individuals who experienced MST. Specific aims included (1) characterizing trauma-related symptom levels and app engagement among users who completed in-app assessments, and (2) evaluating how PTSD symptom severity, negative posttraumatic cognitions, and mental well-being relate to objective measures of engagement.

Anonymous usage data from 27,517 users collected between March 11, 2021 and July 29, 2024, were analyzed. Three subsamples were identified: those who completed the in-app PTSD checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]; PCL-5, n=3689), the Posttraumatic Maladaptive Beliefs Scale (PMBS; n=2197), and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS; n=2160). Engagement metrics included duration of use (ie, days of use and minutes of use), frequency of feature access (ie, coping tool and psychoeducation access), and frequency of feature use (ie, total assessment completions). Regression analyses, including quadratic terms, were conducted to evaluate how symptom severity and well-being levels influenced engagement and identify possible curvilinear trends.

Median engagement levels ranged across subsamples as follows: 3-4 days of use (IQR 5-6), 22-30 minutes of use (IQR 33.7-42.9), 1-5 feature accesses (IQR 6-9), and 2-3 assessment completions (IQR 2). Subsamples were highly symptomatic. Analyses revealed that moderate PTSD symptom and negative posttraumatic cognition severity were associated with higher engagement relative to users with very low and very high symptom levels, particularly for days of use and frequency of coping tool access. Conversely, higher mental well-being scores were generally linked to increased app engagement with linear effects. Effect sizes were small, suggesting limited clinical impact.

This study highlights the possible challenges in engaging highly symptomatic individuals with digital mental health interventions. Although Beyond MST successfully reaches its targeted population, very low or high symptom levels and lower well-being may hinder sustained engagement. These findings suggest that symptom levels should be considered in app development (ie, personalization) and when integrating apps into professional care. Interpretation is limited by the anonymous nature of the data, which prevented characterization of users and their trauma histories. Further research is needed to clarify how symptom patterns influence engagement, especially in trauma contexts.

RR2-10.31979/etd.882a-5fcx.

There is a paucity of research on the role of circadian rhythm disruption in Alzheimer disease (AD)-related cognitive impairments in adults with Down syndrome (DS). The aim of this study was to examine the association of the 24-hour rest-activity rhythm with cognition, dementia symptoms, and clinical AD status in adults with DS.

In this cross-sectional study, adults with DS aged 25-61 years in the Alzheimer's Biomarkers Consortium-Down Syndrome underwent wrist-worn actigraphy (≥4 days) and cognitive assessment. Primary variables included interdaily stability, intradaily variability, relative amplitude, most active 10-hour period (M10), and least active 5-hour period (L5). Secondary measures included coefficient of variation of total sleep time, sleep midpoint, sleep efficiency, and the sleep regularity index. Cognitive outcomes included modified Cued Recall Test (mCRT), Wechsler Block Design with Haxby Extension (Block Design), Purdue Pegboard, Cat and Dog Modified Stroop Task, DS Mental Status Examination (DSMSE), National Task Group-Early Detection Screen for Dementia (NTG-EDSD), Dementia Questionnaire for People with Learning Disabilities (DLD), and clinical AD status based on a case consensus process (stable vs mild cognitive impairment [MCI]/dementia). Linear and logistic regression models were adjusted for age, sex, intellectual disability level, site, and obstructive sleep apnea severity, with false discovery rate (FDR) correction.

Of 115 participants (mean age 40.0 ± 9.2 years; 43.5% female), higher interdaily stability was associated with higher DSMSE scores B = 20.6 (95% CI 5.0-36.2). Higher intradaily variability was associated with worse cognitive performance and increased dementia symptoms: mCRT B = -9.2 (95% CI -15.2 to -3.1), Block Design B = -11.0 (95% CI -19.0 to -3.0), DSMSE B = -12.0 (95% CI -20.1 to -3.9), and DLD-cognitive B = 6.3 (95% CI 3.0-10.5). Lower M10 was associated with increased dementia symptoms: NTG-EDSD B = -0.004 (95% CI -0.008 to -0.001); DLD-cognitive B = -0.004 (95% CI -0.006 to -0.001), and DLD-social B = -0.003 (95% CI -0.005 to -0.0008). All associations remained significant after FDR correction (p < 0.05). Fifteen participants had MCI/dementia. Higher intradaily variability was associated with increased odds of MCI/dementia (OR: 1.45; 95% CI 1.04-2.29) although this was not significant after FDR correction.

Fragmentation and low amplitude of the 24-hour rest-activity rhythm are associated with AD-related cognitive impairment, dementia symptoms, and increased odds of MCI/dementia in adults with DS. Circadian rhythm disruption may contribute to AD-related outcomes in adults with DS and potentially serve as a modifiable risk factor.