Background: Post-traumatic stress disorder (PTSD) is prevalent among children and adolescents, with cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) widely used treatment options. This study compared the effects of CBT and EMDR in children and adolescents using a meta-analysis approach.Methods: PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and PsycInfo were searched in March 2025. Randomized controlled trials that compared the effectiveness of CBT and EMDR on PTSD symptoms in children and adolescents aged 6-18 years who had been exposed to traumatic events were included. The Cochrane Risk of Bias version 2 was used to assess the methodological quality of the included studies. A random-effects model was applied to calculate the standardized mean difference (SMD) along with 95% confidence interval (CI), and the I² statistic was used to quantify statistical heterogeneity.Results: Five trials (248 participants) were included. There was no statistically significant difference in PTSD symptoms between the CBT and EMDR groups, whether reported by children (SMD: 0.18; 95% CI: -0.07-0.43; I²= 0%) or by parents (SMD: 0.23; 95% CI: -0.02-0.48; I²= 0%). For anxiety, the pooled estimate did not reach statistical significance (SMD: 0.44; 95% CI: -0.19-1.07; I²= 69%). Depression symptoms were higher in the CBT group than in the EMDR group (SMD: 0.44; 95% CI: 0.13-0.76; I²= 0%).Conclusion: The comparative effects of CBT and EMDR in reducing PTSD and anxiety symptoms remain inconclusive. Although CBT was associated with higher depression symptoms compared with EMDR, the current evidence is based on a small number of trials, and the pooled estimates should be interpreted with caution.

Background: As the war in Ukraine has become protracted, civilians have been forced to adapt to chronic danger, uncertainty, and repeated military threat. This prospective study examined mental health symptom change during a pivotal six-month period in 2023, encompassing the high hopes surrounding the rise of the Ukrainian counteroffensive and the subsequent disappointment of its stall.Methods: We conducted a two-wave online longitudinal study of 208 Ukrainian civilian adults (80.8% female; mean age 29.4 years) assessed in June 2023 and November 2023. Primary outcomes were generalised anxiety, depression, and somatic symptoms. We further examined whether symptom change was associated with baseline sleep disturbance, trait resilience, and sociodemographic factors. Subjective threat perception, confidence in military success, and objective indicators of military threat were included as contextual variables.Results: Confidence in military success declined significantly across the two waves, while objective indicators of military threat, including artillery attacks and air raid alarms, increased. Subjective threat perception remained stable. Despite this unfavourable context, generalised anxiety, depression, and somatic symptoms decreased on average over time. Individual differences in symptom change were partly associated with baseline characteristics. Higher baseline sleep disturbance predicted smaller reductions in anxiety and depression. Female sex was associated with smaller reduction in depression, and older age with greater reduction in anxiety. Trait resilience and socioeconomic factors were not significantly associated with symptom change.Conclusion: The findings suggest that anxiety, depression, and somatic symptoms may decrease over time even under worsening objective wartime conditions. This pattern is more consistent with partial adaptation under chronic threat than with improvement in external circumstances. Sleep disturbance emerged as a robust predictor of less favourable symptom change, highlighting sleep as a potentially important target for mental health support under prolonged war-related stress.

Smoking is associated with depressive symptoms, and smoking cessation has been associated with improved mental health; however, the specific duration and timing of smoking cessation remain unclear. Persuasive evidence is required to support smoking cessation among older adults with long histories of smoking. Consequently, we aimed to examine the associations among duration of smoking cessation, age at smoking cessation, and depressive symptoms among community-dwelling older adults.

This cross-sectional study included 20,950 older adults from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Participants were classified as never, former, or current smokers. Former smokers were further divided into eight groups according to the number of years since smoking cessation. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, with scores ≥6 defined as depressive symptoms. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) for depressive symptoms according to smoking status.

Among the 20,142 participants, 6.6%, 32.0%, and 61.4% were current, former, and never smokers, respectively. Overall, 2,389 participants had depressive symptoms. Compared with current smokers, those who had quit smoking for ≥7 years had significantly lower odds of depressive symptoms (AORs = 0.540-0.718). Participants who quit smoking after the age of 65 years also had lower odds of depressive symptoms than current smokers (AOR = 0.765).

Long-term smoking cessation, even later in life, was associated with lower odds of depressive symptoms. These findings highlight the importance of promoting smoking cessation and supporting long-term abstinence among middle-aged and older adults.

Not applicable.

Problematic self-criticism has been widely recognised as a transdiagnostic factor associated with a range of mental health disorders. Emotion-focused therapy (EFT) targets self-criticism primarily via two-chair dialogue for self-criticism, a core intervention within the approach. An increasing number of pre-post studies and randomised controlled trials (RCTs) have examined the effectiveness of EFT in reducing self-criticism. The present meta-analysis synthesised existing quantitative studies utilising EFT to reduce self-criticism and evaluated its overall effectiveness across study designs. Four pre-post studies and seven RCTs were identified through a systematic literature search. Effect sizes were calculated separately for 11 within-group pre-post EFT intervention groups (four single-arm pre-post studies and seven RCT intervention groups) and seven between-group RCT comparisons. Study quality, risk of bias and sensitivity analyses were conducted. Using random-effects models, the pooled within-group effect size (Hedges' g) was -0.86, and the pooled between-group effect size in RCTs was -0.73, indicating moderate to large effects of EFT in reducing self-criticism. Leave-one-out sensitivity analyses showed that these effects remained robust after the removal of outliers. This meta-analysis provides the first quantitative synthesis of EFT for self-criticism and offers preliminary evidence supporting its effectiveness in addressing this transdiagnostic factor linked to the number of mental health difficulties.

Psychiatric Mental Health Nurse Practitioner (PMHNP) students are expected to synthesize complex patient data, formulate differential diagnoses, and justify management decisions despite limited opportunities to develop diagnostic reasoning early in clinical training. PMHNP education lacks a developmental framework that aligns learner progression with faculty teaching, scaffolding, and assessment.

This conceptual article presents the five-phase developmental diagnostic reasoning framework (DDRF), integrating Benner's novice-to-expert framework, Stoltenberg's integrated developmental model, and meta-cognitive modeling to guide developmentally matched teaching, scaffolding, and assessment.

The DDRF aligns learner developmental readiness with progressive teaching strategies, scaffolding, assessment indicators, and a case exemplar to intentionally develop diagnostic reasoning.

The DDRF reframes diagnostic reasoning as a developmental process and provides faculty with a practical roadmap for curriculum design, clinical supervision, learner assessment, and diagnostic reasoning development in PMHNP education.

Clinical judgment skills, a key component of nursing competency, are difficult to accurately and consistently assess. To support evaluation of these skills using Lasater's (2007) clinical judgment rubric (LCJR), rater training resources were developed and evaluated.

A one-group pretest-posttest design evaluated the effect of developed resources on agreement between two novice raters (NRs) and resource developers. NR-CE had content expertise; NR-NNE had no nursing experience.

Pre-training, total scores showed poor agreement between novice and trained raters (ICC_absolute(2,1) LCJR_{total for NR-CE} = -.59; LCJR_{total for NR-NNE} = .24). Posttraining, agreement was higher (ICC_absolute(2,1) LCJR_{total NR-CE} = .70; LCJR_{total NR-NNE} = .76). Dimension-level scoring showed more variability in reliability estimates.

Training supported raters with and without content expertise in developing a shared mental model of CJS. Future work should replicate these findings with larger samples for more confidence in results and examine convergent validity by comparing ratings to external benchmarks.

To examine the association between Adverse Childhood Experiences (ACEs) and Autism Spectrum Disorder (ASD) identification among Israel Defense Forces (IDF) personnel, focusing on predictors of ASD identification during military service.

A retrospective cohort study was conducted on 288,633 IDF conscripts evaluated between 2009 and 2021. ASD diagnoses at enlistment and during service were analysed in relation to demographic factors, cognitive scores, and self-reported ACEs. Logistic regression was used to assess predictors of in-service ASD diagnosis.

At enlistment, 935 individuals (0.33%) had an ASD diagnosis, and 635 were identified during service. Those with ASD were more likely to be male (90.1%), Jewish (97.9%), Israeli-born (91.4%), from higher socioeconomic backgrounds, and to have ≥12 years of education and high IQ scores (31.8% vs. 19.7%, p < .001). Several ACEs, including emotional/verbal abuse, physical abuse, neglect, parental substance use, and incarceration, were significantly associated with ASD identification during service. A cumulative ACE score of ≥2 predicted ASD diagnosis with an odds ratio of 2.27.

Early-life adversity is associated with increased risk of ASD identification during military service. Integrating ACE screening into enlistment procedures may help identify recruits at risk for later ASD identification and facilitate timely clinical interventions.

The aims of this study were to explore the bidirectional relationships between depression, anxiety, and suicidality among autistic and non-autistic undergraduates in the UK, and the impact of gender and autism diagnosis on these relationships, over time.

A cross-lagged panel model (CLPM) was used to explore bidirectional relationships between (i) anxiety and worry, (ii) behavioural symptoms of depression and anxiety, and (iii) suicidality across two time points. At Wave 1 (November 2022/June 2023), 747 undergraduates participated. At Wave 2 (May/December 2023), 209 participants took part, with 179 providing complete data at both waves, six months apart. Autism status was determined via self-reported clinical diagnosis, including participants who reported receiving a first diagnosis between Wave 1 and Wave 2. Autism diagnosis and gender were included as covariates.

Cross-lagged relationships were observed over time between suicidality and anxiety and worry, and suicidality and behavioural symptoms of depression and anxiety. Mental health problems remained stable across participants over time. Although an autism diagnosis was associated to higher levels of anxiety, depression, and suicidality at baseline, neither autism diagnosis nor gender was associated with changes in mental health problems over six months.

Initially, relative to non-autistic undergraduates, autistic undergraduates had elevated (or higher) anxiety, depression, and suicidality. Elevated suicidality predicted subsequent increases in anxiety and depression six months later. However, neither an autism diagnosis nor gender had a significant impact on mental health over time. Interpretation of findings is limited by substantial attrition between waves.

Forensic age estimation in living individuals is a critical component of medicolegal practice, particularly for determining whether a subject has reached the legal age of majority of 18 years. The Third Molar Maturity Index (I3M) proposed by Cameriere et al. provides a quantitative radiographic approach based on the ratio between open apical widths and tooth length of the mandibular third molar, with a widely validated cut-off value of 0.08. However, population-specific validation remains essential, as dental maturation is known to vary across ethnic groups, and to the best of our knowledge, there are no data available for North Africa, and in particular for Morocco. This study aimed to validate the I3M cut-off value of 0.08 for assessing the legal adult age of 18 years in a Moroccan population sample and to identify an optimal population-specific cut-off value using ROC curve analysis. A cross-sectional study was conducted on 629 digital panoramic radiographs from Moroccan patients aged 10 to 36.8 years (333 females, 296 males). The I3M was measured on the lower left third molar (tooth 38). Sensitivity, specificity, accuracy, positive and negative predictive values, likelihood ratios, and the area under the ROC curve (AUC) were calculated. Test ROC analysis was used to determine the optimal cut-off value. Using the standard I3M ≥ 0.08 cut-off, sensitivity was 79.71% (95% CI: 68.31-88.44%), specificity 93.28% (95% CI: 89.46-96.04%), and diagnostic accuracy 90.37% (95% CI: 86.61-93.36%). The AUC was 0.907. An optimal population-specific cut-off of I3M ≥ 0.049 was identified, yielding a sensitivity of 91.3% and specificity of 91.7%. The I3M is a valid and accurate forensic tool for distinguishing minors from adults in the Moroccan population. The standard cut-off of 0.08 demonstrated high specificity, thereby minimizing misclassification of minors as adults. A population-specific cut-off of 0.049 may offer improved balanced diagnostic performance. These findings provide the first I3M reference data for Morocco and support its integration into forensic age estimation protocols in North Africa.

Self-harm is a significant global public health issue, particularly among young people. Drug use has emerged as a growing risk factor, yet comprehensive assessments of self-harm attributable to drug use remain limited. This study aimed to systematically assess temporal and spatial trends in self-harm attributable to drug use at the global, regional, and national levels from 1990 to 2021 and predict the trend of burden changes until 2040.

The data employed in this study were obtained from the 2021 Global Burden of Diseases (GBD) database. The temporal changes in age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life year (DALY) rates (ASDR) were examined by calculating estimated annual percentage changes (EAPC) from 1990 to 2021. To forecast the future burden, we employed the Bayesian age-period-cohort (BAPC) model.

In 2021, the global number of deaths from self-harm attributable to drug use increased by 16.8%, while DALYs rose by 13.3%. In contrast, ASMR and ASDR declined, with EAPCs of - 1.77 (95% CI: - 2.07 to - 1.47) and - 1.70 (95% CI: -2.00 to -1.39), respectively. The burden is highest in High-income North America, South Asia, and Eastern Europe, with East Asia showing the greatest decrease. Males bear a higher burden than females, and the 25-29 age group is most affected. Projections suggest stable burden levels from 2021 to 2040.

Despite a general decline in the burden of self-harm attributable to drug use across most countries between 1990 and 2021, the burden in High SDI regions remains substantial and is exhibiting a rising trajectory. These findings underscore the necessity for the formulation of policies pertaining to drug control, alongside the reinforcement of mental health prevention and education initiatives, particularly for males and young adults.