AI is increasingly incorporated into psychiatric triage, risk prediction, passive monitoring, clinical documentation, and patient-facing conversational systems. These applications may improve access, continuity, efficiency, and pattern recognition, but they also redistribute epistemic authority and complicate responsibility when harm occurs. European regulation is developed in relation to market access, data governance, risk management, and product safety, yet remains fragmented regarding civil liability, organizational negligence, and the psychiatric standard of care. This Viewpoint examines how liability and standard of care should be understood when AI becomes part of psychiatric reasoning in Europe. It advances one central thesis: psychiatric AI requires justified integration supported by layered accountability within, but not determined by, European regulation. It presents a targeted doctrinal and normative synthesis of binding European Union instruments, regulatory guidance, selected national governance materials, and psychiatric, bioethical, legal, and digital mental health literature. It distinguishes binding law from guidance and policy, and separates ex ante regulation from ex post liability, and from professional standards of care. Four illustrative domains are analyzed: conversational or therapeutic chatbots, suicide prediction, digital phenotyping and passive monitoring, and large language model documentation. Psychiatric AI raises distinctive concerns because psychiatric judgment depends heavily on testimony, contextual meaning, therapeutic trust, risk interpretation, privacy, and liberty-sensitive decisions. Existing European instruments, including the AI Act, Medical Device Regulation, General Data Protection Regulation, revised Product Liability Directive, and European Health Data Space Regulation, establish governance duties, but do not provide a harmonized fault-based liability framework for AI-assisted health care. Regulatory compliance may inform later legal assessment, but it does not determine whether psychiatric care was reasonable. The proposed standard of justified integration requires knowledge of intended use and model limits, assessment of local and patient-level applicability, active clinical interpretation, disclosure when AI use is material to consent or trust, documentation in high-stakes decisions, and organizational audit. Accountability should be distributed across developers, deployers, and clinicians according to control and preventability. Mixed-fault scenarios are therefore likely to be common. The augmented-clinician model and layered accountability are offered as normative proposals rather than settled European legal standards. Clinicians should remain responsible for contextual, patient-centered judgment; developers for design, validation, documentation, and foreseeable misuse; and deployers for procurement, training, workflow integration, local validation, monitoring, and escalation. Future empirical research should evaluate effects on clinician reliance, documentation burden, patient outcomes, coercive interventions, therapeutic trust, and feasibility across differently resourced services.

Marital status has been associated with cognitive aging; however, whether such associations vary according to cognitive assessment modality remains unclear. This study examined whether associations between marital status and incident screen-positive cognitive impairment (MCI) differ by screening instrument and population subgroups in a large longitudinal cohort of community-dwelling older adults in Taiwan. We analyzed 103,863 adults aged ≥65 years from the Taipei City Elderly Health Examination Database (2005-2016). Cognitive status was assessed using the Short Portable Mental Status Questionnaire (SPMSQ; 2005-2011) and the 8-item Ascertain Dementia questionnaire (AD8; 2012-2016). Baseline marital status was categorized as married, divorced, widowed, or never married. Cox proportional hazards models with time-updated covariates were fitted separately for each assessment period, adjusting for demographic, socioeconomic, health, and lifestyle factors. Sensitivity analyses were conducted to examine potential reverse causation and variation in follow-up duration. Among 61,304 participants assessed during the SPMSQ period, never-married individuals had a higher risk of incident MCI compared with married individuals (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.08-1.74). In contrast, among 42,559 participants assessed during the AD8 period, never-married status was associated with a lower risk of MCI (HR 0.60, 95% CI 0.46-0.77). Effect modification by sex and age was observed across periods. Sensitivity analyses yielded consistent findings. Associations between marital status and incident MCI differed across assessment periods that varied in screening instrument, follow-up duration, and population composition; this measurement heterogeneity, rather than a confirmed temporal change, may account for the reversal observed among never-married participants. These findings suggest that interpretation of marital status-cognition associations should be considered alongside the measurement approach and study period under which they were derived.

Psychiatry combines clinical expertise with substantial institutional authority over diagnosis, treatment access, coercion, clinical records and the credibility assigned to people receiving care. This Essay examines how that authority can impede learning from recurrent warnings across professional misconduct, coercive care, diagnostic practices and iatrogenic harm. We propose institutional non-learning as a cross-cutting problem: professional interpretation can shape whose testimony is believed, which harms are measured, how events are recorded and whether reform is evaluated. Drawing on epistemic injustice, psychiatric survivor research, treatment-safety research, publication and outcome-reporting bias, and empirical studies of diagnostic bias, we develop a framework for epistemic reciprocity and accountability. It distinguishes occurrence from prevalence, recognises that treatment risk varies across populations and contexts, separates benefit from safety, applies reflexive scrutiny across clinical, academic and lived experience expertise, and extends representativeness to both research participants and the published evidence base. We use ignorance culture, exclusion culture, defensiveness and diagnostic weaponisation to describe recurring institutional functions. A responsibility culture requires independent scrutiny, prospective harm surveillance, lived experience governance, remedy and redress, and publicly evaluable evidence that practice has changed and safety has improved.

Unlike in psychiatric disorders such as psychosis where treatment trajectories are well defined, little is known about pathways to care for depression which is increasingly prevalent among young people across the globe. Whilst empirical evidence is slowly becoming available on pathways to care for common mental disorders in the general population in Ghana and Zimbabwe, there is no study that specifically considered treatment pathways for young people.

This study explored trajectories used by young people (15-24 years) to access specialised mental healthcare in order to determine referral pathways for depression in Ghana and Zimbabwe.

This sub-analysis forms part of a larger formative, exploratory, descriptive qualitative study conducted within the Youth in Mind consortium. The study engaged 172 participants including young people, healthcare providers, policymakers, faith-based and traditional healers, lay health workers, and school staff across Ghana (N = 105) and Zimbabwe (N = 67) who were sampled purposively and using snowball techniques until saturation was reached. Data were analysed using an iterative combination of inductive and deductive coding, followed by thematic analysis.

Diagnostic and treatment trajectory for young people's access to specialized mental healthcare are complex in both Ghana and Zimbabwe and punctuated with several barriers that culminate in delayed access to treatments. Chief among the barriers facing young people are the catastrophic costs linked with accessing specialized mental health care, lack of autonomy of the youth, long waiting times perpetuated by a limited number of specialists and stigma. Opportunities for optimising access included the use of referral cards, which sped up the referral process, improved communication among referring agents, and establishment of youth corners in some hospitals in Zimbabwe to address concerns of privacy.

The findings highlight that pathways to specialised mental healthcare in Ghana and Zimbabwe are inherently complex, hindered by intersecting structural, financial, and social barriers. To mitigate these challenges, a multi-faceted strategy is essential. This should include systemic interventions such as task-shifting, the implementation of streamlined referral tools, dedicated youth-friendly services, and concerted efforts to reduce stigma and costs, thereby fostering more equitable and timely access to care.

To document the availability and quality of mental health measures in regularly collected national surveys in the United States. We conducted a review of the mental health measures included in eight publicly available health-focused recurring surveys capable of producing nationally-representative estimates. For each measure, we documented the constructs measured, number of items in the measure, the populations for whom the measure is collected, and the years in which the measure was collected. We examined peer-reviewed literature for psychometric properties of the measures. U.S. national surveys vary substantially in their measurement of mental health constructs in terms of the number of constructs (3-15), measure complexity (1 item - 233 items), populations covered, years administered, and the proportion of constructs that have validated measures (0%-100%). The Medical Expenditure Panel Survey offered the best mix of mental health measures (9; 56% validated), years covered (1996-Present), and related health information; however, each of the surveys offered distinct advantages in terms of the geographic information available (e.g., national, state, census tract), populations covered (e.g., children, teens, and/or adults) and measured mental health constructs (conditions, the impact of those conditions, and mental health service use). Mental health is measured in various ways across the nationally-representative surveys, with each survey offering distinct advantages and disadvantages. Mental health researchers should consider these differences when using national survey data. Future research should attempt to validate the mental health measures used in these surveys and efforts should be made to address existing gaps in measurement.

Despite elevated rates of co-occurring mental health needs among autistic youth, availability of and access to mental and behavioral health evidence-based practices (EBPs) remain limited in U.S. community-based settings. Further, community-based service systems are complex, with client- and provider-level characteristics situated within broader system contexts that collectively influence adoption and implementation of EBPs. Thus, the current convergent mixed methods study aimed to evaluate agencies, or Community Service Boards (CSBs), in Virginia's statewide Department of Behavioral Health and Developmental Services in terms of CSB leaders' perspectives of: (1) their CSB's organizational context, including leadership, structure, and climate around new practices, and (2) the process of adoption and implementation of EBPs for autistic youth at their CSB, including needs and barriers, processes for making adoption decisions, and leadership attitudes about EBPs. Surveys and interviews were conducted with 23 CSB leaders and data analyses and interpretation were guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. CSB leaders rated their organizations as ready for change and moderately supportive of EBPs, but reported barriers to adoption and implementation, including resource constraints, organizational silos, and misalignment between EBP characteristics and organizational context. Conversely, implementation was facilitated by funding, leadership support, collaboration, and EBP fit. These findings reinforce the importance of understanding local contexts to make place-based recommendations for equitable, sustainable implementation of EBPs for autistic youth in community settings. Future efforts to adopt, implement, and sustain EBPs within similar service settings should proactively address these factors. Intervention developers should proactively consider community mental health systems as end users to improve fit between EBPs and these systems' organizational contexts.

Adolescents are increasingly screened for suicide risk in primary care (PC), leading to increased suicide risk identification. Research highlights the importance of parents in promoting adolescent safety and well-being. However, parents and adolescents are not always aligned in how to engage parents in adolescent care. Furthermore, little is known about what support parents need when caring for a child with suicidal thoughts and behaviors (STB) in PC. In this study, 16 pediatric PC professionals, 20 adolescents with histories of STB, and 18 parents of adolescents with histories of STB completed interviews regarding their perspectives on adolescent suicide care in PC. Interviews asked about barriers, facilitators, needs, and if and how parents should be involved in PC-based adolescent suicide care. Interviews were audio recorded, transcribed, and analyzed using inductive and deductive thematic analysis. Results demonstrated that adolescents, parents, and PC professionals believe parents play an important role in adolescent suicide care in PC. However, all groups reported key challenges that impede effective parent involvement, including the following: (a) concerns about mental health and suicide stigma, (b) poor parent-child relationships, (c) parent-child difficulty communicating about mental health and safety, and (d) concerns about patient confidentiality and privacy. Additionally, parents reported needs, including (a) help navigating youth mental health services, (b) emotional support, and (c) education/resources about adolescent STB. Results highlight a tension between adolescent hesitancy toward parent involvement, parents' desire to be more included and informed in their child's care, and PC staff concerns regarding how to navigate this discrepancy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Quality of life (QoL), a critical factor for sustaining recovery from alcohol use disorder (AUD), has been examined as an AUD-related outcome in randomized controlled trials (RCTs) that evaluated pharmacotherapy for AUD. This review evaluates the efficacy of this therapy in improving mental and physical health-related QoL.

RCTs were identified across seven databases. Study quality was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2. A systematic review with meta-analysis was conducted. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered with PROSPERO (CRD420261277890).

Eighteen RCTs with 4376 participants were evaluated. Naltrexone was linked to improvements in both mental QoL (d = 0.30, 95% CI: 0.08-0.52) and physical QoL (d = 0.16, 95% CI: 0.01-0.31). Nalmefene improved physical QoL (d = 0.13, 95% CI: 0.02-0.25) but not mental QoL (d = 0.18, 95% CI: -0.004 to 0.354). Topiramate showed no improvement in either domain. However, further analysis indicated that topiramate was associated with a small improvement in physical QoL, which could correlate with a reduced percentage of heavy drinking days. Interpret these findings with caution. Acamprosate, sertraline, and psilocybin were associated with improved mental or physical QoL, whereas ketamine, varenicline, levetiracetam XR, and quetiapine were not. Interpretation is limited to single trials-no eligible RCTs reporting the specified QoL outcomes for disulfiram.

Certain medications for AUD are linked with improved mental and physical QoL, but evidence remains limited. Future RCTs should assess QoL and establish whether improvements are clinically meaningful.

Confirmation bias is the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or hypotheses. Confirmation bias leads to errors due to access to extraneous, contextual information. These errors have caused a significant number of unjust convictions. This article discusses the origins of confirmation bias and focuses on its relevance in cases involving forensic mental health experts. Forensic clinicians need to assess ambiguous data and emotionally upsetting events. Three additional cognitive biases that fit within confirmation bias in the forensic mental health evaluation context are also discussed: anchor bias (the primacy effect), adversarial bias (the tendency to arrive at an opinion that favors the attorney that retained the forensic expert), and observer bias (the thoughts, feelings, and beliefs that influence expert conclusions). Finally, we discuss approaches to reduce confirmation bias.

Perinatal mental disorders (PMD), including perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI), pose a critical public health concern with consequences for birthing persons and their children. Evidence on racial and ethnic disparities is mixed, and little is known about how these disparities have changed over time.

To evaluate long-term trends and racial and ethnic disparities in the prevalence of hospital-reported PMD.

We analysed all live hospital births in California from 1997 to 2019 (N = 10,703,966). PMAD and SMI were identified using ICD-9-CM and ICD-10-CM codes from hospital discharge records. We estimated age-standardised prevalence and average annual percentage change (AAPC) by race/ethnicity and used modified Poisson regression to estimate unadjusted and adjusted risk ratios (RRs). Temporal changes in disparities were examined using smoothed multi-year periods.

Overall, PMD prevalence was 2.0% (PMAD: 1.6%; SMI: 0.6%) and increased across all racial and ethnic groups, with Hispanic and Asian or Pacific Islander birthing persons experiencing the largest AAPC. Compared to their non-Hispanic white peers, American Indian or Alaska Native birthing people had a higher risk of any PMD (RR 1.16, 95% confidence interval [CI] 1.11, 1.21), and Black birthing people had a higher unadjusted SMI risk (RR 1.10, 95% CI 1.07, 1.13). Over time, disparities showed persistently lower risk among Asian or Pacific Islander and Hispanic individuals, and comparable or higher risk among American Indian or Alaska Native individuals; SMI risk among Black birthing people approached parity with White birthing people in several periods.

Hospital-reported PMD increased substantially over two decades, with racial and ethnic differences likely shaped by structural barriers to care, stigma, and diagnostic bias that contribute to underdiagnosis among minoritised populations. Future research should examine social and structural drivers to inform equity-focused interventions.