Veterans and first responders like firefighters, police officers, paramedics, and military personnel face higher rates of mental health issues and suicide compared to the general population. Implementing and evaluating mental health projects for Veterans and first responders is crucial for enhancing their ability to serve society effectively. Economic evidence is increasingly used to improve the effectiveness and accountability of health and social programs. However, current methods are insufficient for comparing resource efficiency and value for money across different sectors and countries. This study introduces a novel methodology to accommodate heterogeneity across multiple projects within a grant program, enable standardization, and facilitate comparison in real-world implementation research.

The choice of perspective in economic evaluation depends on context, stakeholder viewpoints, resource availability, and intended use. We used a flexible approach, combining various methods to standardize resource utilization, valuation, and outcome assessment. This allowed us to estimate an overall return on investment at the program level by pooling diverse projects together. We evaluated costs from the funder's perspective, using general population valuation for healthcare interventions.

We estimated overall and individual project Return on Investment ratios for the funder's investment in the Mental Health Program, considering both total and in-kind costs. Results show that for every $1 invested in the Veterans and first responders Mental Health Program, the program returns $1.14 in overall health value, slightly exceeding the financial resources invested.

Standard economic evaluation methodologies do not accommodate real-world complexities and the heterogeneity across projects inherent in grant programs. Yet the development of pragmatic economic methods to assess value and return on investment of grant programs is essential given current funding pressures. Our study demonstrates the feasibility of addressing economic evaluations across heterogenous, international projects. Although not strictly adhering to established methods, our pragmatic approach focuses on funder return on investment. This methodology provides a pathway for economic analysis of grant programs.

Individuals around the world report nonordinary experiences that stand out to them compared to their day-to-day or ordinary experiences. Yet, they can be appraised in very different ways, resulting in wellbeing and personal growth, or in marginalization and mental health problems. One challenge is that there are relatively few systematic efforts to explore possible appraisal processes and the overall contextual features of these experiences. In study 1, we report a validation and extension of a previously designed set of appraisal and contextual questions to the Inventory of Nonordinary Experiences, with a sample of Brazilian participants (N = 160). The study successfully validated all original appraisal categories with minor modifications and added nine new context and appraisal categories. In study 2, we conducted a prevalence study by administering these questions in a general population sample (N = 5,117) in which individuals reported on one of 38 nonordinary experiences. Most contextual features and appraisals followed a unimodal distribution approximating a normal distribution. This suggests that nonordinary experiences, however heterogeneous they may be, appear to be interpreted within the same set of beliefs and appraisals, in addition to sharing similar temporal characteristics. Furthermore, although 20% of participants reported an immediate negative impact and 25% reported some degree of suffering or discomfort from experiences, 51% evaluated experiences as promoting overall positive long-term life effects. These findings highlight the potential of human resilience and the complex role of nonordinary experiences vis-a-vis protective factors in promoting health. Our results provide new insights into consciousness states and their mental health and wellbeing implications.

Arithmetic processing is represented in a fronto-parietal network of the brain. However, activation within this network is thought to undergo a developmental shift from domain-general cognitive processing in the frontal cortex towards domain-specific magnitude processing in the parietal cortex. This assumption is primarily based on findings in children and young adults. In this registered report, we set out to replicate the proposed gradual fronto-parietal activation shift in arithmetic processing and, for the first time, to explore how neural development of arithmetic continues during aging. This registered report focuses on the behavioral and neural correlates of arithmetic and arithmetic complexity across the lifespan, i.e., childhood, when arithmetic is first learned; young adulthood, when arithmetic skills are well established already, and old age, when individuals have lifelong arithmetic experience. Therefore, brain activation during mental arithmetic was measured in children, younger adults, and older adults using functional near-infrared spectroscopy (fNIRS). Arithmetic complexity was manipulated via carry and borrow operations in two-digit addition and subtraction. The results provide evidence that increasing arithmetic complexity is associated with increased activation in the fronto-parietal network across all age groups. Even though behavioral carry and borrow effects decrease during development, suggesting improvements in place-value processing, the underlying categorical and continuous processing characteristics and cortical activation remain relatively stable. While frontal activation may decrease from childhood to adulthood, parietal activation does not show a corresponding increase. Thus, the developmental fronto-parietal shift in arithmetic processing might only apply to single-digit arithmetic - but not to two-digit arithmetic across the lifespan. Overall, these results suggest that arithmetic skills acquired in childhood are maintained throughout the lifespan.

In racially and economically segregated communities, structural violence and chronic adversity perpetuate the risk for community violence and related trauma exposure. Despite widespread awareness of community violence, urban youth of color are among those least likely to have access to services that promote trauma recovery. When these youth do encounter the mental health system, the focus is often on behavioral control rather than understanding and addressing the continuous traumatic stress they face. This paper, components of which were first presented at the 41st Annual Meeting of the International Society for Traumatic Stress Studies, describes multipronged, interdisciplinary efforts to provide youth and families affected by community violence with trauma-informed, structurally competent services in both office- and community-based settings within an academic medical center that sees one of the highest volumes of bullet-related injuries in the United States.

Individuals with subthreshold posttraumatic stress disorder (PTSD) often experience significant impairment yet face barriers to care (e.g., insurance denials and exclusion from clinical trials) due to strict Diagnostic and Statistical Manual of Mental Disorders (DSM)-based diagnostic criteria that rely entirely on symptom counts. Symptom counts assume all symptoms contribute equally to underlying (within-criterion) severity. Recently, item response theory and nonlinear factor analysis models have been used to estimate PTSD severity, accounting for differences in the relative weight of symptoms. We examined a subset of treatment-seeking adults with comorbid PTSD and substance use disorders in Project Harmony who met the criteria for full PTSD based on weighted severity scores regardless of whether they met the full DSM-defined criteria. Latent class analysis was then used to identify differences in symptom endorsement patterns in this empirically estimated full-threshold PTSD group. Three distinct classes were identified: (a) participants with full-threshold PTSD based on both DSM and weighted classification, (b) underdiagnosed participants who did not endorse either DSM Criterion C (avoidance) symptom, or (c) underdiagnosed participants who only endorsed one DSM Criterion E (alterations in arousal/reactivity) symptom. Endorsement of two DSM Criterion D symptoms (negative alterations in cognitions and mood) did not differ across classes, suggesting that they could be "priority symptoms" indicating high distress and impairment, regardless of DSM diagnostic status or severity level. Accounting for symptom weighting and prioritizing these symptoms in assessment and diagnosis could increase precision in PTSD assessment and ensure equitable access to care.

Objective: Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are often comorbid. While exposure-based treatments can be effective for each, given that comorbid OCD and PTSD symptoms often interact dynamically, concurrent treatment may be most beneficial. The aim of the current analysis was to examine the naturalistic effectiveness of concurrently delivered exposure and response prevention (ERP) and prolonged exposure (PE) therapy among individuals with comorbid OCD and PTSD. Methods: This retrospective, observational analysis examined clinical data from adults (N=181) diagnosed with comorbid OCD and PTSD who were treated with concurrent ERP and PE through an online specialty therapy platform. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5) and OCD symptoms using the Dimensional Obsessive-Compulsive Scale (DOCS). Linear mixed models examined symptom change from baseline to three timepoints: (1) session 20, (2) session 40, and (3) the final assessment timepoint completed by each patient. Results: PTSD symptoms decreased from mean=43.5 (SD=14.2) at baseline to mean=26.4 (SD=17.6) at final session (Hedges g=1.03, 95% CI: 0.85-1.21). OCD symptoms decreased from mean=35.2 (SD=13.7) to mean=19.5 (SD=13.9) (Hedges g=1.16, 95% CI: 0.97-1.35). By the final session, median percent improvement was 40.9% (interquartile range [IQR]: 11.5%-70.7%) for PTSD and 50.0% (IQR: 25%-67.6%) for OCD. A total of 67.4% of patients achieved a clinically significant PTSD response (≥10-point PCL-5 reduction), 64.1% achieved a clinically significant OCD response (≥35% DOCS reduction), and 49.2% achieved a clinically significant PTSD and OCD response. Analyses of secondary treatment outcomes showed significant reductions in depressive and anxiety symptoms and disability, along with improvements in quality of life. Conclusion: Findings suggest that concurrent ERP and PE, delivered remotely via video therapy in a real-world setting, may be a clinically effective treatment approach for individuals with comorbid OCD and PTSD.

The Circle of Security-Parenting program (COS-P) is a widely disseminated attachment and mentalization-informed parenting intervention. Outcome studies, however, have yielded mixed results and its effectiveness for parents from different demographic groups is largely unknown. This study examined the outcomes of COS-P and explored parent demographics (mother/father status and education). Participants were 117 parents who attended COS-P at an Australian Early Parenting Center. The Composite Caregiving Questionnaire (CCQ) assessed caregiving representations (self-efficacy regarding emotion/affection and empathy/understanding, hostility, caregiving helplessness, and parental reflective functioning). Outcomes were analyzed using a mixed model repeated measures design. Results revealed significant post-intervention improvement on all CCQ domains, with some demographic differences. Fathers reported a greater rate of improvement in parental self-efficacy regarding empathy and understanding compared to mothers, after starting from a lower level. There were no differences in any outcomes between parents who were university-educated and those who were not. Findings provide further evidence that COS-P improves caregiving representations, but there may be some differences for mothers and fathers.

Post-operative delirium (POD) is a serious complication of surgery particularly in older adults, characterized by acute disturbances in consciousness and cognition and associated with increased mortality and long-term cognitive impairment. Despite its clinical relevance, the underlying pathophysiology remains poorly understood. To address this, we performed multi-omics profiling of live brain tissue from patients undergoing neurosurgery. Single-nucleus RNA sequencing revealed POD-specific transcriptional alterations in glial cells, especially microglia, characterized by enhanced neuroinflammatory signatures. Astrocytes also exhibited changes in synaptic and migratory pathways. Upstream analysis implicated external cytokines as potential drivers of glial responses, while downstream analysis linked POD to encephalitis and dementia. DNA methylation profiling identified immune-related epigenetic alterations, suggesting a regulatory role in POD-associated neuroinflammation. Integration of bulk methylation and cell type-specific transcriptomic data suggested that epigenetic changes may influence gene expression during POD pathogenesis. These findings provide the convincing evidence of neuroinflammation and glial involvement as the pathophysiological mechanism of POD based on the first multi-omics analysis using patient brain tissue.

There is an increasing trend towards embedding consumer and community involvement in all health and medical research. The Executive Committee of the International Journal of Eating Disorders (IJED) disseminated a survey for eating disorder researchers investigating their practices and perspectives regarding Patient and Public Involvement (PPI) in research, with the goal of informing our procedures in future.

A survey was distributed globally via eating disorder organizations, professional networks, and individual researchers. Researchers (N = 119) of various career stages completed the survey.

Three quarters of the researchers had consulted people with lived experience to inform their research; 45% said that they employed lived experience and/or peer researchers across all stages of their research, and 75% viewed PPI as improving the quality, relevance, feasibility, adoption, or implementation of research. Concerns were expressed about the challenges associated with PPI, including cost, time, expertise, disclosure of lived experience status, the need to maintain robust scientific principles, concern about the validity of results, and potential harm to the person with lived experience. Most did not want disclosure of PPI to be mandatory or to impact the review process.

These insights informed the development of an approach to recognizing the involvement of PPI in our publishing. Rather than an obligatory statement, IJED encourages use of PPI and disclosures, with inclusion of a description and implications for the interpretation of the research detailed in manuscripts.

Emerging evidence suggests that interoception-the perception and interpretation of internal bodily signals-may play a role in voice perception and voice disorders; however, no self-report measure currently assesses interoception specifically in relation to voice processing. The present research aimed to develop and validate the Interoception in Voice Scale (IVS), a self-report measure designed to capture awareness of bodily cues related to voice production and perception. In total, 33 novel items were developed by drawing on existing interoceptive measures and expert input from speech and language specialists. In Study 1 (N = 584), exploratory factor analysis indicated a 19-item scale with four interpretable factors: Emotional Voice Awareness, Physical Voice Awareness, Voice-related Concern, and Voice-related Attention. These factors demonstrated good-to-excellent internal consistency (ω = .84-.91). In Study 2 (N = 320), confirmatory factor analysis supported the four-factor structure, demonstrating acceptable model fit. Correlational analyses supported construct validity through meaningful associations with dimensions of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), and Voice-related Concern was consistently associated with self-perceived voice handicap. Together, the findings support the composite reliability and construct validity of the IVS. The scale provides a tool for investigating the role of interoception in voice perception and may be useful for future research and for speech and language therapists engaged in clinical work involving voice disorders. The survey and scoring instructions are available here: https://jswlab.co.uk/IVS.