ObjectivesTo examine the clinical governance implications of Health of the Nation Outcome Scales (HoNOS) rating quality in Australian mental health services. The paper argues that HoNOS occupies a distinctive position among clinician-rated measures because it requires clinicians to translate the overall clinical assessment into structured ratings across domains of behaviour, symptoms, impairment, and social functioning. It considers why poor-quality HoNOS ratings should not be treated as a narrow technical or training problem, but as a signal of potential risk in assessment practice, documentation quality, organisational reporting, and service credibility.ConclusionsHoNOS rating quality should be understood as a clinical governance responsibility. Because HoNOS data are embedded in routine outcomes and casemix infrastructure, unreliable or invalid ratings can compromise clinical interpretation, service monitoring, benchmarking, system reporting, and funding-related classification processes. Maintaining rating quality therefore requires more than individual clinician training. Health service organisations need structured implementation protocols, supervision, periodic calibration, documentation standards, and routine monitoring of rating patterns. HoNOS should be treated not simply as a clinical instrument, but as a governed clinical data asset whose integrity is necessary for accountable mental health service delivery.

To investigate the association between apolipoprotein E (APOE) gene polymorphisms and coronary heart disease (CHD) risk within a localized Mongolian clinical cohort.

This hospital-based case-control study recruited 63 patients with angiographically confirmed CHD and 61 sex-matched healthy controls. Anthropometric measurements and lipid profiles and pathways for APOE genotypes were strictly assessed. This exploratory hospital-based case-control study was not designed as a nationally representative population-based survey, and participant recruitment was limited to a single tertiary referral center in Mongolia.

High-density lipoprotein cholesterol levels were significantly higher in the case group than in the control group (1.56 ± 0.14 vs. 1.33 ± 0.18 mmol/L, P < .001), while total cholesterol was significantly lower in cases than in controls (3.91 ± 0.60 vs. 5.34 ± 0.80 mmol/L, P < .001). The distribution of APOE genotypes (ε2/ε3, ε3/ε3, ε3/ε4, and ε4/ε4) differed significantly between the case and control groups (P = .009). Both systolic and diastolic blood pressure significantly correlated with waist circumference (P = .026). Multivariable logistic regression revealed that the ε2/ε3 genotype was associated with significantly lower odds of disease (odds ratio [OR] = 0.29, P = .007, 95% CI: 0.12-0.71), whereas ε4-related findings were highly imprecise due to sparse genotype counts and lacked statistical significance (OR = 1.07, P = .930, 95% CI: 0.23-5.02).

This study showed a significant association between the APOE genotype and CHD in a Mongolian population. These findings highlight the importance of considering qualitative aspects of lipid metabolism, rather than total cholesterol alone, and suggest that genetic factors, including APOE polymorphisms, may contribute to CHD risk independently of absolute cholesterol levels, underscoring the need for population-specific cardiovascular risk assessment.

Post-migration stressors can exacerbate post-traumatic stress disorder (PTSD) and reduce treatment effectiveness among refugees. Evidence for integrated care models in high-income settings remains limited.

To compare treatment as usual (TAU) with an add-on integrated care intervention for unemployed refugees with PTSD.

We conducted a two-arm, parallel-group superiority trial with 1:1 randomisation to TAU or TAU with an add-on integrated care intervention, delivered at a specialised out-patient clinic in Denmark (ClinicalTrials.gov NCT04244864). TAU included sessions with a psychologist and physician over 8-12 months. The integrated care intervention also included structured collaboration with employment services. The primary outcome was functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS) interview. Secondary outcomes included symptoms, quality of life and post-migration stressors. Analyses followed the intention-to-treat principle, using analysis of covariance and linear regression with multiple imputations.

The study included 195 patients in treatment from 2020 to 2025. No difference was observed in WHODAS score between groups pre- to post-treatment (mean difference 0.30, 95% CI -2.40 to 3.00; P = 0.825). Similarly, no differences were found for secondary or exploratory outcomes, and overall change was limited. However, the integrated care group had a lower rate of early dropout (P = 0.042) and higher level of treatment satisfaction (P = 0.035).

Integrated care was feasible but not superior to TAU in improving outcomes for refugees with longstanding symptoms and unemployment. Future research should examine how the timing and intensity of integrated care interventions influence outcomes, including earlier implementation and adequate support for refugees with longstanding and complex needs.

Emerging adulthood represents a period of life characterized by a high prevalence of mental health problems, including depressive symptoms. This is especially evident among sexual minority individuals who continue to face discrimination despite increasing societal acceptance. Attachment insecurity, which has been widely recognized as a vulnerability factor for mental health problems, may play a key role in how sexual minority individuals experience and cope with stress, particularly in relation to the internalization of negative beliefs regarding one's sexual orientation. Nevertheless, we are not aware of previous studies that have considered internalized homonegativity when investigating the connection between attachment insecurity and depressive symptoms in this group. We used structural equation modeling to explore the cross-sectional direct and indirect associations between attachment insecurity (anxiety and avoidance) and depressive symptoms through internalized homonegativity in a sample of 536 Chilean emerging adults self-identified as gay, lesbian and bisexual. Our analyses revealed that higher attachment insecurity was associated with higher depressive symptoms directly and indirectly. Specifically, higher attachment anxiety and attachment avoidance were linked to greater internalized homonegativity, and thus to higher depressive symptoms. The theoretical and clinical implications of our findings are discussed.

More than 20% of individuals with schizophrenia show minimal or no response to antipsychotic medications and little is known about genetic contributions to more severe forms of illness. This study sought to explore if cases with continuously-hospitalized, treatment-resistant schizophrenia (CH-TRS) carry a higher burden of common genetic variants compared to less severe forms. CH-TRS cases were recruited from Pennsylvania state psychiatric hospitals in the USA, with ≥ 5 years of continuous hospitalization, active treatment, and non-response to ≥ 3 antipsychotic medications. Three comparator groups were obtained from cohorts in the USA, Sweden, and the UK including TRS, general schizophrenia and non-psychiatric controls. Polygenic scores (PGS) of schizophrenia and cognitive ability were generated in individuals of European and African ancestry. Logistic regression assessed the association of PGS and CH-TRS cases (vs. comparators), with sex differences and sensitivity analyses excluding individuals with other diagnoses conducted to assess robustness. We included 18,571 individuals of European ancestry (346 CH-TRS, 10,757 TRS, 1148 general schizophrenia, 6320 non-psychiatric controls) and exploratory analyses of 476 individuals of African ancestry (78 CH-TRS, 398 non-psychiatric controls). For each standard deviation increase in the schizophrenia PGS, the odds of CH-TRS among individuals of European ancestry increased by 40-80% compared to general schizophrenia and TRS. Results in African ancestry participants mirrored those of European ancestry albeit with reduced levels of significance. Sex interactions and sensitivity analyses did not materially alter the estimates. This study demonstrates a greater burden of common genetic variants is associated with more severe forms of illness in schizophrenia.

Accumulating evidence has demonstrated that dysfunction in the brain reward circuit plays a pivotal role in the pathogenesis of both major depressive disorder (MDD) and addictive disorders (substance use and behavioral addictions). However, it remains unclear whether the neural dysfunctions during reward processing are shared or distinct between these disorders. To address this, we employed the Seed-based d Mapping (SDM) toolbox to explore shared and distinct task-based fMRI findings in MDD and addictive disorders during the processing of reward (anticipation and outcome) and loss (outcome). The electronic databases PubMed, EMBASE, Scopus, Web of Science, and PsycINFO were searched from their inception until September 20, 2025. Studies were included if they used fMRI to compare brain responses during reward/loss tasks between patients (with MDD or addictive disorders) and healthy controls, and reported whole-brain coordinates (in Talairach or MNI space). The analysis included 76 articles, including 45 articles with 1212 addiction patients, 31 articles with 1211 MDD patients, and 2126 healthy controls aggregated from the 76 articles. Conjunction analysis revealed no significant common hypo- or hyper-activated brain regions between patients with addictive disorders and those with MDD (addiction & MDD) relative to healthy controls across all experimental conditions. Differential analysis showed addiction patients had greater left striatum activation (vs. MDD) during reward anticipation, and greater right putamen and left striatum activation (vs. MDD) during reward outcome. No significant differences were found under the loss outcome. Our findings indicate that during reward processing, the striatum is a common functionally abnormal brain region in both MDD and addictive disorders, but the activation directions of the two disorders in this region show opposite trends. The striatum can serve as a transdiagnostic common abnormal marker for MDD and addictive disorders. Our results provide potential targets for future research on neuromodulatory, pharmacological, and clinical interventions in patients with MDD alone, addictive disorders alone, and comorbid patients of the two disorders.

Neurodiverse diagnoses (NDs) have been largely conceptualised as distinct categories with clear-cut diagnostic boundaries. However, converging research evidence is showing that this conventional approach may inadequately capture the individual variation and overlaps that are commonly observed in population studies. This study extended emerging quantitative research frameworks for understanding diagnostic complexity, adopting a transdiagnostic dimensional approach toward characterising the cognitive and mental health dimensions associated with NDs. A cohort of 175 adults with suspected or previously diagnosed neurodiverse conditions was recruited using convenience sampling. Cognitive domains of executive function, language, attention, processing speed, and memory were assessed using the National Institute of Health (NIH) Cognition Toolbox©. A battery consisting of the Extended Strengths and Weaknesses Assessment of Normal Behavior (E-SWAN), Strengths and Difficulties Questionnaire (SDQ), and Emotion Regulation Skills Questionnaire (ERSQ) was administered to provide additional proxy measures of mental health. Cluster analyses revealed that the sample of neurodivergent adults was best represented by three data-driven clusters, none of which mapped coherently onto traditional diagnostic labels. In contrast, these transdiagnostic groups were best characterised by a combination of strengths and weaknesses along two multivariate dimensions: 1) cognitive flexibility and processing speed, and 2) language, memory, emotional wellbeing, and behavioral regulation. This study provides novel, data-driven evidence to support the emerging dimensional structure of NDs, and highlights several component processes which may contribute to the complexity associated with neurodiversity in adults. These findings may be used to inform future assessment and/or support strategies for neurodivergent adults, beyond those framed by strictly categorical approaches.

People with physical disabilities in low- and middle-income countries experience elevated rates of psychological distress. This study explored the impact of a peer support intervention ('friendship group') for people with disabilities attending prosthetic and orthotic clinics in Cambodia. A total of 462 individuals were screened using the Kessler Psychological Distress Scale (K10), 47 met inclusion criteria (scores 20-29). Of these, 27 enrolled in the intervention, while 20 did not participate. Psychological distress was assessed across four domains of the K10 (nervousness, agitation, fatigue and negative affect). Intervention participants were measured at three time points (2 baseline measures and 1 follow-up), non-participants contributed baseline data only. Quantitative data were analysed using linear mixed-effects models, qualitative data from post-intervention focus groups (n = 21) were analysed thematically. Reductions in K10 scores were observed across all domains following the intervention (p < 0.001). Qualitative findings highlighted perceived benefits including restored family and community roles, emotional relief and improved self-regulation. Given the pre-post design without a full comparator group, findings should be interpreted cautiously. This exploratory study suggests that peer support may offer a feasible and culturally acceptable route to support people with disabilities in low-resource settings.

Anxiety is one of the most prevalent global mental health disorders, with its incidence having risen substantially since the COVID-19 pandemic and remaining elevated in the post-pandemic era. According to the process model of emotion regulation, mindfulness may serve as an early-stage cognitive change strategy that enhances emotional stability and ultimately reduces anxiety. While previous research has demonstrated robust interconnections among anxiety, emotional stability, and mindfulness, the majority of studies have relied on cross-sectional designs and aggregate scores, neglecting their longitudinal, item-level dynamic relationships.

This study collected data from 547 college students (M _age ± SD = 20.11 ± 1.20) across three time points and utilized a cross-lagged panel network (CLPN) approach to analyze item-level temporal dynamics. The goal was to build network models of anxiety, emotional stability, and mindfulness, and to investigate how these constructs were temporally interrelated at the item level in an exploratory manner.

Mindfulness items had higher out-Expected influence (OEI), whereas anxiety symptoms had stronger in-Expected Influence (IEI), with anxiety and emotional stability having the strongest bridge effects. Specifically, mindfulness components "Thought Acceptance" (M7) and "Nonjudgmental Awareness" (M8) exerted significant effect on anxiety and emotional stability. Anxiety symptoms were highly responsive to other symptoms, which undermined emotional stability. The network analysis revealed complex temporal and predictive associations among anxiety, emotional stability, and mindfulness.

This study is the first investigation to reveal the longitudinal dynamic connections between anxiety, emotional stability, and mindfulness at the item level, consequently provided longitudinal support consistent with the emotion regulation process model.