Co-production is becoming an established methodology in mental health research, yet there remains a lack of condition-specific frameworks to guide its design and implementation. For bipolar disorder in particular, there is limited evidence on how to meaningfully engage lived experience experts in the context of possible mood instability and other impairments. This paper presents insights from a consultation with people with lived experience of bipolar disorder, aimed at developing recommendations for conducting co-production with people with bipolar.

A one-off, 1-h online consultation was conducted with four members of the AMBIENT-BD Lived Experience Advisory Panel (LEAP). The consultation used a semi-structured focus group format, guided by a topic guide, to explore strategies for recruiting and engaging co-producers in bipolar disorder research. Data were analysed using reflexive thematic analysis.

Four overarching themes were developed: (i) Communicating with co-producers- capturing how trusted channels and regular contact support recruitment and sustained engagement; (ii) Providing accessible information- addressing the need to balance sufficient detail with readable, low-burden formats during periods of instability; (iii) Building and sustaining trust- highlighting trust in the research process and partnerships with third-sector organisations as preconditions for meaningful involvement; and (iv) Perceived impact as a motivator- reflecting how community belonging and tangible incentives shape willingness to participate. A provisional set of practical recommendations was derived from these themes, including recruiting through trusted organisations, using non-technical language and multiple formats, offering meaningful incentives, and using low-burden communication methods during periods of unwellness.

Grounded in lived experience perspectives, this paper conceptualises co-production as a relational process in which trust, accessible communication and visible impact form the foundation for meaningful engagement with people with bipolar disorder. Positioned as a consultative contribution on the IAP2 Spectrum of Public Participation, the paper offers practical, mental health-specific guidance for researchers seeking to develop advisory groups and other participatory approaches with the bipolar population.

This study has been conducted in partnership with people with lived experience of bipolar disorder. They were involved in the conceptualisation, design and data collection of the study. They helped to inform the process of conducting a co-production with people with bipolar disorder. Findings from the consultation were shared with them in a separate feedback session.

Compassion-based interventions (CBIs) are effective transdiagnostic treatments for a wide range of psychopathological symptoms. While their efficacy is well established, their mechanisms remain insufficiently understood. Self-criticism (SC) has been proposed as a promising mechanism of change (MoC), given its central role in psychopathology and its theoretical link with CBIs. This study synthesises evidence from randomised controlled trials to examine whether reductions in SC mediate the effects of CBIs on psychopathological symptoms. Systematic searches in PubMed, Web of Science, Scopus and ProQuest identified 57 randomised controlled trials (n = 4877) of CBIs in adults reporting SC and psychopathological symptom outcomes, analysed using One-Stage Meta-Analytic Structural Equation Modelling (OMASEM). SC partially mediated the effects of CBIs on symptom reduction (e.g., depression, anxiety, eating disorders; indirect effect = -0.054, 95% CI [-0.085, -0.030]). Stronger mediation effects were observed in studies prescribing more daily home-practice minutes and shorter intervention duration. At posttreatment, CBIs achieved moderate reductions in SC (r = -0.20, 95% CI [-0.27, -0.13]) and psychopathological symptoms (r = -0.21, 95% CI [-0.27, -0.15]). Moreover, SC was positively correlated with psychopathological symptoms (r = 0.48, 95% CI [0.42, 0.54]), supporting partial mediation by SC. Considerable heterogeneity was observed across interventions and designs; 76.4% showed high risk of bias. These findings support SC as a potential MoC in CBIs and provide quantitative evidence for process-based formulations of CBIs. The results also highlight the clinical relevance of directly targeting SC in therapeutic practice and contribute to understanding the psychological processes underlying CBIs.

The Systematic Self-Reflection Model of Resilience Strengthening (Crane, Searle, et al., 2019) proposes that coping self-reflection on everyday stressors can generate coping-related insights that refine modifiable capacities for resilience (e.g., coping beliefs, coping adjustment, and coping-enabling resources), thereby increasing the likelihood of resilience. However, reflective engagement and insight generation may be constrained by individual and contextual factors, raising the possibility that externally modeled coping insights could scaffold subsequent self-reflection and strengthen downstream adaptation. This preregistered study tests whether narrative exposure that explicitly models coping-related insights enhances the effects of structured self-reflection among emerging adults (18-25 years). Participants (target final N = 400; recruited from Australia and the United Kingdom) will be randomly assigned to one of three conditions: (1) high-insight priming story + reflection, in which short video stories explicitly convey a coping-related insight; (2) low-insight priming story + reflection, in which the same stories omit explicit meaning-making; or (3) reflection-only. Participants complete five weekly tasks, with assessments at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). Primary outcomes include coping-related insight (self-report and blind-coded written insights), resilient capacities (coping self-efficacy, coping adjustment, support-seeking intentions, perceived social support), and mental ill-health symptoms (depression and anxiety). Resilience is operationalized as stressor reactivity, symptom levels relative to stressor exposure, calculated as residualised symptoms after accounting for adversity and daily hassles, at each time point. We hypothesize that high-insight priming narratives will increase insight and resilient capacities and reduce stressor reactivity over time. Mediation analyses will test underlying mechanisms.

Rates of suicide deaths involving firearms have been increasing among Hispanic/Latino adults in the U.S. The high lethality of firearm suicide attempts and critical gaps in characterizing firearm suicide deaths among Hispanic/Latino adults may pose challenges to suicide prevention. However, there is little systematic knowledge about the circumstances that manifest among Hispanic/Latino suicide decedents who die by firearms or about how those circumstances may differ between female and male Hispanic/Latino firearm suicide decedents. This study aimed to descriptively characterize recurring circumstances preceding firearm suicide deaths among a large sample of Hispanic/Latino adults in the U.S. and to examine sex differences in the occurrence of these circumstances.

This study analyzed deidentified data from the National Violent Death Reporting System. The analysis included a large sample of 1,170 Hispanic/Latino adult firearm suicide decedents who died from 2013 to 2021 in the U.S. Given the limited etiologic characterization of firearm suicide among Hispanic/Latino adults, a qualitative content analysis with quantification was conducted to systematically review and code recurring circumstances experienced prior to death using free-text coroner/medical examiner and law enforcement narratives abstracted by the National Violent Death Reporting System. This study grounded circumstance definitions inductively, directly in the language and contextual descriptions present in the narrative data.

Six major categories emerged to organize the recurring circumstances preceding firearm suicide deaths among the individuals included in the study sample: behavioral health, physical health, relationship dynamics, socioeconomic instability, scene of death, and firearm access and storage. Behavioral health circumstances were commonly noted among the decedents in the sample, including known mental health conditions and depressed or melancholy mood. Relationship and socioeconomic stressors were noted for a meaningful portion of the decedents in the sample, including romantic relationship challenges, interpersonal arguments, and legal issues. Notable sex differences were observed; female decedents in the sample were more frequently documented as having prior suicide attempts and accessing another person's firearm.

Although descriptive, these findings provide population-specific context on the circumstances preceding firearm suicide among Hispanic/Latino adults, a group historically underrepresented in the firearm suicide literature. Several findings extend existing knowledge to a population for whom such evidence remains limited. Many identified circumstances are consistent with prior research on suicide broadly, underscoring their relevance within this population. In addition, this study's findings align with existing National Violent Death Reporting System variables, offering insight into the quality and utility of National Violent Death Reporting System data. This study provides a foundation for subsequent hypothesis-driven research on circumstances and risk factors preceding firearm suicide among Hispanic/Latino adults.

To examine the trend of locational equity in utilising Medicare-reimbursed psychiatric consultations (face-to-face and telepsychiatry) across states/territories.

Time series analysis of administrative data.

Medicare-reimbursed private psychiatric consultations.

Greater coefficients of variation (CVs) represented higher state/territory variations in per capita consultations (2005 Q3-2023 Q4). We ran an autoregressive integrated moving average model for telepsychiatry-related CV change, with restricted rural-remote telepsychiatry items (2005-2022) and unrestricted telepsychiatry items (2020 Q1-2023 Q4) as the predictors. We examined the association between distance from mean per capita consultations and the fraction of per capita telepsychiatry consultations using state/territory-level data in another regression analysis, with telehealth legislative policy changes as another independent variable.

Including telepsychiatry items since their introduction resulted in lower all-item CVs (i.e., reduced state/territory variation) than the corresponding CVs for face-to-face items only. The rural-remote-restricted telepsychiatry items had a larger effect than the unrestricted ones. Every 1000 restricted consultations were associated with 0.287 units of CV improvement (i.e., reduction in regional variation), in contrast to 0.007 units per 1000 consultations for unrestricted items. Telehealth-enabling policy changes significantly modified the association between distance from mean per capita face-to-face consultations and the fraction of telepsychiatry consultations. Lower per capita face-to-face consultations were associated with higher telepsychiatry fractions.

Telepsychiatry may help improve mental health equity. Bulk-billed, incentivised telepsychiatry for rural and remote areas may enhance regional health access.

Against the backdrop of an aging population, the traditional nursing model struggles to meet diverse needs. Despite the significant social benefits of internet plus nursing services, misaligned preferences between nurses and patients hinder their widespread adoption. Discrete choice experiments (DCEs) are a key tool for quantifying stakeholder preferences and improving service adoption. No review has systematically synthesized evidence on patients' and nurses' preferences for internet plus nursing services.

To systematically review DCEs conducted in China that examined patients' and nurses' preferences for internet plus nursing services.

Eight electronic databases were systematically searched from inception to September 5, 2026. Two researchers used the conjoint analysis applications in the healthcare checklist to evaluate the quality of the literature. Descriptive analysis was used to summarize the data. A hybrid deductive-inductive thematic analysis was applied to classify the attributes into broad categories and subcategories, and each attribute was analyzed for frequency, significance, relative importance, and willingness to pay. The review was registered in PROSPERO (CRD420251172405).

A total of 11 studies from China were included, five of which had nurses as respondents and six of which had patients as respondents. A total of 63 attributes were extracted and categorized into 7 broad categories and 25 subcategories by theme. Economic guarantee-related attributes were the most common. Subgroup analyses showed that payment costs were the most common attribute subcategory among patients, whereas service revenue was the most common among nurses. In addition, nurses' preferences may vary by professional title, years of experience, and income, whereas patients' preferences may vary by income and educational attainment.

This review identified overlapping and divergent patterns in patients' and nurses' preferences for internet plus nursing services. Across these studies, both groups tended to prefer greater service safety, better service accessibility, and government or public healthcare institutions as service providers. However, patient studies indicated a preference for lower payment costs, whereas nurse studies indicated a preference for higher service remuneration. Future research should further explore the preferences of diverse populations, including people from different cultural backgrounds and informal caregivers, to enhance the broader applicability of internet plus nursing services.

Nursing administrators should refine service plans based on preferences reported by nurses and patients regarding internet plus nursing services. These plans should address the needs of both groups while promoting the efficient, balanced allocation of home-care nursing resources.

Alcohol use disorder (AUD) causes a high burden worldwide. The menstrual cycle and the progesterone-to-estradiol ratio are related to alcohol consumption in females and males with AUD. However, the underlying mechanisms triggering problem drinking in everyday life remain to be determined. This longitudinal multicentre study analysed associations of menstrual cycle phases (1316 of 70 naturally cycling females with AUD) and progesterone-to-estradiol ratios (quantified in 567 blood samples of 256 males with AUD) with real-world 12-month data on loss of control over alcohol consumption and craving measured via 17296 and 10482 smartphone entries using general linear mixed models. Females with severe AUD stated less frequent loss of control in the midluteal and late luteal phases characterized by high progesterone-to-estradiol ratios compared to the follicular phase. In the total female sample, craving was lower during the late luteal and menstrual phases compared to the follicular phase. Similarly, males with moderate and severe AUD reported less frequent loss of control in phases of a high progesterone-to-estradiol ratio. The identified biobehavioural interplay suggests that increasing progesterone relative to estradiol may assist individuals with AUD in re-establishing control over alcohol consumption and reducing craving. When employed in conjunction with customized just-in-time adaptive digital interventions, this approach has the potential to evolve into a novel precision medicine strategy for AUD. The findings also underscore the necessity for the development of treatments tailored to the phases of the menstrual cycle, thereby addressing the critical underrepresentation of females in AUD research.

To understand dementia stigma and help-seeking intentions amongst middle-aged and older community-dwelling Australians, a cross-sectional online survey was conducted in February 2023 amongst Australian adults aged ≥45 years. The survey collected demographic data, prior experience with people with dementia, dementia-related public stigma, and formal and informal help-seeking intentions for self and family members (modified General Help-Seeking Questionnaire). Multivariable regression models were used to examine factors associated with help-seeking intentions. Data from 1364 participants were analysed (41.4% aged ≥65 years; 60.7% women). Most participants reported that, if they observed signs of dementia, they were likely to seek help from family or friends (70.7% for self, 77.1% for family member) and from health professionals (83.7% for self, 82.3% for family member). Participants were significantly more likely to seek help formally than informally. There were no differences in formal help-seeking intentions for self or family member. Formal help-seeking intentions were associated with age, education, and previous formal dementia information seeking. There were small, significant associations between help-seeking intentions and dementia stigma factors relating to personhood, incapacity, and social distance; however, the direction of association varied when help-seeking was for self or a family member. This study demonstrates that help-seeking intentions amongst Australian adults were associated with demographic factors, prior help-seeking experience, and dementia stigma. Cross-sectional, scenario-based studies of help-seeking intentions may not sufficiently capture the relationship between dementia stigma and help-seeking behaviour. Future campaigns to increase help-seeking for dementia should consider targeting both cognitive and behavioural aspects of dementia stigma.

Being born prematurely has profound implications for feeding, which is one of the most complex and developmentally significant tasks in the first year of life. Various factors influence feeding outcomes and experiences including fatigue and coordination difficulties associated with prematurity, heightened parental anxiety, and altered parent-infant interaction that can result in maladaptive mealtime routines and behaviours. The transition from hospital to home is a sensitive period for parents of premature infants. This review aims to understand parents' experiences of feeding their premature infants in the first year after discharge. This synthesis will inform the development of effective post-discharge support strategies and guide future research. A systematic search of six databases (MEDLINE via PubMed, CINAHL, EMBASE, AMED, PsycINFO, and Web of Science) was conducted. Qualitative studies published between 2000 and 2025 that describe parents' experiences of feeding their premature infants after hospital discharge were quality-appraised and analysed using thematic synthesis. Twenty-two studies conducted across 10 countries were included. All studies focused on mothers of premature infants across all levels of prematurity and most centred on breastfeeding experiences. Four main themes illustrate that feeding experiences are shaped by personal, institutional, and societal influences and that mothers across diverse countries describe remarkably similar experiences despite variations in healthcare systems and models of care. The main themes were the complex reality of the feeding journey, negotiating agency in the feeding journey, navigating the institutional landscape and the impact of societal norms on feeding experiences. The review showed that the struggle to build and sustain maternal agency and confidence in feeding their premature infants, does not end at discharge; for many, it intensifies at home. Supporting parents of premature infants requires attention not only to feeding techniques but also to the relational, institutional, and societal forces that shape maternal agency and confidence long after hospital discharge.

Ambient voice technology (AVT) uses conversational AI to record and organize clinical consultations in real time. It is being adopted quickly across the National Health Service (NHS). However, evidence about its effects on productivity, costs, or staff experience across different health care settings is limited. Phase 1 of this research program developed a taxonomy, logic model, and outcome framework for evaluating AVT. Phase 2 will carry out a multisite, mixed methods evaluation of AVT in 4 NHS trusts. These include mental health outpatient services, acute hospital outpatient clinics, and accident and emergency departments.

This study aims to explore the real-world impact of AVT on productivity, costs, and staff experience across NHS adult services.

The study includes three parts: (1) a quantitative quasi-experimental analysis of routine NHS data to estimate the impact of AVT on documentation time, clinician activity, and service outcomes; (2) a comprehensive health economic evaluation comprising cost-consequence analysis, cost-benefit analysis, and budget impact modeling; and (3) interviews with up to 36 staff from 3 services (mental health outpatient, acute hospital outpatient, and accident and emergency) to explore their experience of using AVT, their views on its impact, and what helps and gets in the way of its use. Sites will be chosen to include different care settings, organizational environments, and AVT products. Quantitative and economic analyses will use NHS electronic health records and national datasets to understand changes over time and measure the impact of AVT. Interview data will be analyzed using thematic analysis and rapid assessment procedures to identify key themes. All study findings will be combined to give a clear view of AVT and its impact.

Data collection is expected to begin in August 2026 and conclude by January 2027. Publication of results is anticipated in February 2027.

This evaluation will provide real-world evidence on the productivity, economic, and experiential impacts of AVT in the NHS. Outputs will include peer-reviewed papers, a slide-deck summary for the funder, and a publicly available health economic decision-support tool to help NHS organizations decide whether they should adopt AVT.