To assess associations between disability severity, multimorbidity (number of disabilities), and suicidality among US adolescents, including suicidality specifically attributable to COVID-19.

We analyzed 28,402 adolescents (ages 12-17 years) from the 2021-2023 National Survey on Drug Use and Health. Survey weights and design variables produced estimates representative of the US civilian, noninstitutionalized adolescent population. Disability severity (none, mild, moderate/severe) was derived from self-reported functioning across six domains-vision, hearing, cognition, mobility, self-care, and communication. Multimorbidity was the count of moderate/severe disability domains (0, 1, 2, ≥3). The primary outcome was past-year suicidality, categorized as none, any ideation or plan (general suicidality), and COVID-19-attributed suicidality.

In the weighted sample, 45.5% had mild disability and 17.9% had moderate/severe disability. Relative to peers without disabilities, youth with mild disability had higher odds of general suicidality (adjusted odds ratio [AOR] = 2.25; 95% confidence interval [CI]: 1.82-2.77), whereas their elevated odds of COVID-19-attributed suicidality were not statistically significant (AOR = 1.64; 95% CI: .99-2.72). Youth with moderate/severe disability had higher odds of general suicidality (AOR = 3.81; 95% CI: 3.02-4.81) and of COVID-19-attributed suicidality (AOR = 2.58; 95% CI: 1.50-4.44). A dose-response by disability count was observed; adolescents with three or more disabilities had the highest risk of general suicidality (AOR = 2.20; 95% CI: 1.45-3.33).

During the COVID-19 era, adolescents with disabilities-particularly those with greater severity or multiple disabilities-faced elevated risk for suicidality. Findings underscore the need for disability-informed suicide risk screening and uninterrupted access to mental-health services, including flexible, accessible care modalities during periods of system disruption.

Postpartum depression (PPD) is a prevalent condition with important consequences for both mothers and infants. Although Cognitive Behavioural Therapy (CBT) is considered the first-line psychological treatment, Positive Psychology Interventions (PPIs) have recently emerged as promising approaches by promoting well-being alongside symptom reduction. This randomized clinical trial compared the acceptability of an online Positive Psychology programme (Maternal insights for Awareness, Thriving, Emotions and Resilience [MATER]) with a CBT programme for women with PPD. A total of 136 women were randomly assigned to one of the two conditions, both consisting of 10 weekly online group sessions. Acceptability was assessed through indicators of satisfaction and adherence. Results showed no significant differences between groups in overall satisfaction, perceived skill acquisition, perceived therapists' empathy and understanding, quality of treatment or willingness to recommend the programme. However, a significant interaction between intervention type and symptom severity emerged for perceived therapist competence: Among participants with more severe depressive symptoms, therapists in the PPI condition were rated as more competent than those in the CBT condition. Dropout rates were similar across groups, and session attendance declined over time in both interventions. Employment predicted greater retention, whereas having two or more children increased the likelihood of dropout. These findings support the feasibility and acceptability of both interventions and suggest that Positive Psychology-based programmes may be particularly well perceived by women experiencing more severe postpartum depressive symptoms. Trial Registration: ClinicalTrials.gov: Identifier: NCT05676918.

Alzheimer's disease (AD) is the most common cause of dementia worldwide, yet awareness, diagnosis-seeking, and caregiving practices are strongly shaped by cultural and social contexts. Minority groups often face compounded barriers due to stigma, limited knowledge, and systemic inequalities. In Israel, a multicultural society, little is known about how non-professional community members from different minority groups perceive AD, seek diagnosis, and conceptualize appropriate care. We conducted a qualitative comparative study using six focus groups with 43 non-professional community members from three minority groups in Israel: Israeli Arabs (n = 14), immigrants from the Former Soviet Union (FSU; n = 15), and Ethiopia (n = 14). Discussions were conducted in Arabic, Russian, and Hebrew, audio-recorded, transcribed, and analyzed thematically. Three overarching themes emerged across groups: (1) Stigma: across all groups, participants demonstrated limited knowledge and misconceptions about AD, accompanied by stigmatizing stereotypes, fear, and behavioral responses such as social distancing, with variations in how stigma was expressed; (2) Diagnosis-seeking patterns: Participants from Arab community and Ethiopian descent reported delayed help-seeking linked to low awareness, stigma, and cultural or spiritual interpretations, whereas FSU participants more often emphasized consulting physicians, despite ongoing confusion between normal aging and AD; (3) Care preferences: Participants from Arab community and Ethiopian descent strongly preferred family-based home care, reflecting cultural and religious obligations, whereas FSU immigrants expressed greater support for institutional care, shaped by medicalized perceptions of dementia, their older age profile, and smaller family caregiving networks. The findings highlight both shared and culturally specific perceptions of AD among minority groups in Israel and demonstrate how stigma, diagnosis-seeking, and care preferences are closely interconnected. These insights underscore the need for culturally responsive public education, stigma-sensitive communication in primary care, and efforts to support earlier recognition and engagement with diagnostic services that account for diverse understandings of aging and dementia. At the system level, the findings point to the importance of targeted community outreach, culturally adapted information and interpretation services, and flexible care arrangements that better align formal dementia services with family-based caregiving norms across minority communities.

BackgroundImproving global maternal health is a key goal within the United Nations' Sustainable Development Goals. In Northwest Territories, Indigenous mothers face significant disparities in maternal healthcare, with higher risks of maternal mortality and healthcare access challenges.ObjectiveTo explore Indigenous mothers' perspectives on opportunities to improve maternal healthcare services in Northwest Territories, Canada, using qualitative data from the Maternal and Infant Health study.DesignQualitative design.MethodsSelf-identifying Indigenous women of childbearing age (17-49 years) who were pregnant at the time of the interview or had given birth within the last three years were invited to participate. A culturally appropriate, interviewer-administered, semi-structured questionnaire was utilized for quantitative and qualitative data collection. Qualitative data were analyzed using reflexive thematic analysis.ResultsIn total, 156 Indigenous women participated (mean age =29.7 years, SD=6; age range 17-47 years). 93% gave birth in the past three years, and 18% were pregnant. Three themes emerged regarding areas in which to improve maternal healthcare: experiences and challenges with service delivery, support networks, including more connections with Elders, and cultural sensitivity. Specifically, participants reported a preference for childbirth to take place within home communities, aided by midwives and family members and utilizing Indigenous maternal care practices. Participants also voiced the necessity of increasing the provision of mental healthcare, postpartum care, and support group services that incorporate traditional local languages.ConclusionTo improve maternal healthcare services within Indigenous communities, building trusting relationships with healthcare professionals that honour Indigenous practices, improving healthcare accessibility, and increasing the delivery of local healthcare services and support are of priority. This paper contributes to the sparse literature currently available, providing Indigenous-informed evidence to guide the conceptualization, practice, and policy of maternal healthcare in Northwest Territories.

First responders are at high risk of posttraumatic stress disorder (PTSD), yet little research has examined PTSD prevalence within this population after individuals retire or resign from service. The current study is the first systematic review and meta-analysis aiming to describe the evidence available on point and lifetime PTSD prevalence among former first responders, estimate pooled PTSD prevalence, and examine differences between subgroups. Searches were conducted across the PsycInfo, Web of Science, Embase, PubMed, and Google Scholar databases in November 2025. Peer reviewed observational studies were included. Separate random effects meta-analyses were run on point PTSD prevalence among studies assessing PTSD related to any (general) exposures and PTSD related to single disasters. A total of 10 studies (12 unique samples) were included in the analyses. Studies were exclusively conducted within high-income, English-speaking countries among nonvolunteer former first responders and predominantly focused on firefighter and police samples. A pooled point PTSD prevalence of 15.4% was found among eight general exposure studies, and a pooled prevalence of 11.8% was found among two single-disaster exposure studies. No subgroup differences were significant, although these analyses were constrained by the restricted pool of available studies. Insufficient data were obtained to examine lifetime PTSD prevalence. The limited attention this population has received in the literature does not reflect their high level of need. Former first responders constitute a high priority for further research and mental health intervention, particularly given their loss of access to systems, services, and social support available to them through their prior roles.

While large language models (LLMs) have been widely used to assist clinicians and support patients, no existing work has explored dialogue systems for standard diagnostic interviews and assessments. This study aims to bridge the gap in mental healthcare accessibility by developing an LLM-powered dialogue system that replicates clinician behavior.

We introduce TRUST, a framework of cooperative LLM modules capable of conducting formal diagnostic interviews and assessments for post-traumatic stress disorder (PTSD) following the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). To guide the generation of appropriate clinical responses, we propose a Dialogue Acts schema specifically designed for clinical interviews. Additionally, we develop a patient simulation approach based on real-life interview transcripts to replace time-consuming and costly manual testing by clinicians.

A comprehensive set of evaluation metrics is designed to assess the dialogue system from both the agent and patient simulation perspectives. Expert evaluations by conversation and clinical specialists show that TRUST performs comparably to real-life clinical interviews.

Our system performs with clinical quality approaching that of human clinicians, with room for future enhancements in communication styles and response appropriateness.

Our TRUST framework shows its potential to facilitate mental healthcare availability.

In Australia, one in five adults experiences a mental disorder and 1.5 million individuals exercise with a personal trainer or coach. Consequently, personal trainers are likely exposed to individuals with mental health concerns, despite having minimal mental health training. This study aimed to explore personal trainers' exposure and responses to clients' mental health concerns.

Australian personal trainers responded to an online survey which assessed how frequently personal trainers observed clients with mental health concerns and their responses to these concerns. Bivariate correlations, chi-square tests of independence and independent samples t-tests were used to assess relationships between variables.

Of 56 personal trainers, almost all (96%) reported encountering mental health concerns from clients and 48% reported a frequency of at least weekly. Worry/anxiety (50%) and significant interpersonal stress (46%) were identified by the personal trainers as the most frequently observed client concerns. In response to client concerns, most personal trainers (89%) used listening skills, while those who had received mental health training were more likely to refer clients to mental health professionals.

Despite a lack of formal training, personal trainers are frequently exposed to individuals with mental health concerns. There is a need for appropriate mental health training in this profession to allow for adequate referral pathways. SO WHAT?: Our findings indicate personal trainers play a role in mental health promotion. By providing personal trainers with adequate training, they can refer clients with mental health concerns to mental health professionals.

Adolescents are among the most frequent smartphone users worldwide. Yet, few studies have examined how smartphone use appears among minority adolescents, including sexual and gender minority (SGM) youth and children of immigrant parents, who often experience unique stressors and heightened mental-health risk. Passive smartphone monitoring provides a promising, low-burden method for continuously and objectively assessing real-world behavior, offering new opportunities to identify dynamic markers of mental health challenges, including suicide risk, in daily life. The present study evaluated the feasibility of a replicable framework for passive smartphone monitoring among adolescents at high risk for suicidal thoughts and behaviors (STB) and explored longitudinal differences in smartphone-derived behavioral features across minority subgroups. Ninety-nine adolescents aged 11-18 with recent STB completed baseline assessments and installed the iFeel app, which collected passive smartphone data for 6 months, including total and social-media screen time and phone-inactivity-based proxy sleep indicators inferred from nighttime phone inactivity. Participants contributed 1500 participant-weeks of data, with an average of 11.9 weeks of valid monitoring, supporting the feasibility and acceptability of this approach. Daily smartphone use time, social-media activity time, and sleep duration were comparable to normative adolescent data. No significant longitudinal differences emerged between SGM and non-SGM adolescents. However, immigrant-origin adolescents displayed shorter but more stable sleep patterns compared to non-immigrant origins, who exhibited longer baseline sleep with steeper declines over time. Findings highlight passive sensing as a feasible, inclusive, and scalable method for examining real-world behavioral processes associated with STB and mental health outcomes among diverse adolescents. This framework offers a scalable approach that future studies can apply to deepen real-time understanding of mental-health challenges and behavioral patterns among diverse adolescents.

Chronic spine pain is linked to self-reported cognitive complaints. However, objective markers are lacking. The 90-s Continuous Visual Attention Test (CVAT) quantifies key attention subdomains: reaction time (RT, alertness), RT variability (VRT, sustained attention), omission errors (focused attention) and commission errors (impulsivity).

This study aimed to identify which specific attentional subdomains, measured by the CVAT, are impaired in adults with chronic spine pain.

This prospective case-control study included 84 adults with chronic lumbar/cervical pain (≥ 3 months) and 118 healthy controls. A MANCOVA tested group differences on CVAT variables, controlling for age and sex, followed by Bonferroni-corrected ANCOVAs. To isolate cognitive variability from general processing speed, the coefficient of variability (VRT/RT) was also analysed. Logistic regression assessed the predictive power of CVAT indices for pain status.

The MANCOVA showed a significant group effect (Pillai's Trace = 0.46, F(4,195) = 41.43, p < 0.001). Patients exhibited impairments in all measures p < 0.001 (η² = 0.093-0.44). The VRT deficit persisted when using VRT/RT. Logistic regression identified VRT as the strongest predictor of chronic spine pain (χ²(1) = 147.53, p < 0.001), correctly classifying 86.6% of participants. This finding remained when using VRT/RT (χ²(1) = 130.55, p < 0.001; 82.7% accuracy).

Patients with chronic spine pain demonstrate attentional deficits, with sustained attention instability (VRT and VRT/RT) as the most robust marker. The CVAT detects this impairment, offering a practical tool for clinical assessment to inform treatment and monitor cognitive function in pain management.

III (prospective case-control).

A brief, 90-s computerized attention test provides an objective, clinic-ready screen for sustained-attention instability in spine pain patients. Identifying cognitive vulnerability at the point of care can inform perioperative counselling, driving/work-safety guidance and rehabilitation planning, and it may help monitor treatment response alongside pain metrics, offering a noninvasive, nonpharmacologic complement to standard pain assessment.

Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels.

Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990-2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute's APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010-2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data.

In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17-78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58-23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015-2019 was approximately 60% lower than 2000-2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68-0.78) in the 1980 cohort to 0.90 (95% CI: 0.70-1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010-2019.

Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.