Adolescence represents a developmental phase marked by profound and rapidly shifting emotional states. While some adolescents exhibit pronounced, day-to-day mood variability, others remain comparatively stable. Although emotional fluctuation has long been considered a core feature with implications for health and well-being, the determinants underlying these substantial individual differences remain insufficiently understood. To address this, we conducted a longitudinal study using daily app-based assessments, aiming to explore whether perceived stress and self-esteem dynamics help explain why some adolescents show greater mood variability than others. We asked N = 70 adolescents to rate their self-esteem, positive, and negative mood once per day for 15 days. For data analyses, we used path analytic mediation modeling. Fluctuation of self-esteem (FSE) significantly predicted both fluctuation of positive mood (FPM; b = 0.282, 95% CI [0.101, 0.464], p = .0.002) and fluctuation of negative mood (FNM; b = 0.395, 95% CI [0.147, 0.644], p = 0.002) indicating that greater variability in self-esteem is associated with greater mood fluctuation. Moreover, perceived stress (PS) significantly predicted FSE (b = 0.057, 95% CI [0.012, 0.102], p = 0.013), suggesting that higher perceived stress was associated with greater self-esteem fluctuation. Significant indirect effect emerged for PS on FPM (b = 0.016, 95% CI [0.003, 0.030], p = 0.019) and on FNM (b = 0.023, 95% CI [0.002, 0.043], p = 0 .028) via FSE, confirming a mediating role of self-esteem fluctuations. This study showed that perceived stress was associated with fluctuations in self-esteem, which were related to mood variability among adolescents. These findings suggest that stress reduction could be explored as a potential avenue for future interventions.

Intravenous ketamine and intranasal esketamine have shown rapid effects in reversing suicidality and improving depressive symptoms. In countries that allow psychiatric euthanasia and/or assisted suicide (EAS), we argue that potentially effective treatments for suicidal ideation and behaviour, such as ketamine, should be required before allowing patients to access psychiatric EAS. Ketamine can both help clarify patients' decision-making capacity and serve as a reasonable therapeutic alternative when determining irremediability. For patients who refuse potentially effective treatments such as ketamine, oversight bodies should establish a formal process through which they can petition for review of their EAS request-protecting their legal right to die while guarding against potentially preventable death.

Globally, parenting interventions have been shown to improve caregiving practices and child development. However, rigorous evidence from sub-Saharan Africa remains limited, particularly for programmes that leverage multiple community-based delivery platforms. We evaluated the effectiveness of the Moments that Matter (MTM) parenting programme delivered by community volunteers in partnership with faith leaders on child development and caregiving-related outcomes in Kenya.

We conducted a cluster-randomised controlled trial in two counties in western Kenya. Villages were randomly assigned to the MTM parenting programme or a standard-of-care waitlist control, stratified by county. Eligible participants were primary caregivers of children aged 0-18 months. The intervention consisted of monthly group sessions and home visits delivered over 18 months. Caregivers were surveyed at baseline and endline. The primary outcome was child development measured using the Caregiver Reported Early Development Instruments. Intervention effects were estimated using mixed-effects models with a difference-in-differences, intention-to-treat approach.

Between February and March 2023, 595 caregiver-child dyads in 46 villages were enrolled and randomly assigned to the intervention (n=310) or control (n=285). At endline, there were no overall intervention effects on child development outcomes. Moderate-to-large effects were observed across multiple secondary outcomes, including caregiver stimulation, harsh discipline, caregiver mental health, social support, intimate partner violence victimisation, child dietary diversity, and male caregiver engagement, as reported by female primary caregivers. Exploratory subgroup analyses revealed treatment heterogeneity by county, with small significant improvements in child language and socioemotional development in one county but null effects in the other.

A multicomponent parenting programme delivered in partnership between community volunteers and faith leaders improved multiple caregiving and family well-being outcomes but did not lead to overall improvements in child development. Findings highlight the potential of integrating multiple community-based platforms for delivering parenting programmes, while underscoring the need for implementation research to enhance impacts on child development at scale.

NCT05796934.

Schizophrenia is a chronic psychiatric disorder, frequently associated with stigma, including within healthcare settings that significantly impairs quality of life and may exacerbate symptoms. Virtual reality (VR), as an immersive tool, may allow healthy individuals to experience the first-person perspective of a patient experiencing psychotic symptoms. VR exposure may facilitate perspective-taking, foster empathy and help reduce stigma. However, the findings remain incomplete, with considerable variation between protocols and no data on implicit stigma. Here, we present a study designed to evaluate the effectiveness of a VR protocol simulating psychotic symptoms on explicit and implicit stigma.

A randomised controlled trial will be conducted targeting a sample size of 128 evaluable participants. Participants will include healthcare workers and students (medicine, nursing or psychology) recruited from CH Henri Laborit in Poitiers (France), Poitiers University Hospital, CH Nord-Deux-Sèvres in Thouars (France) and the University of Poitiers. Recruitment will take place over a 2-year period. Participants will be randomly assigned to either the intervention group or the control group.The protocol involves two short VR scenarios. In the intervention condition only, both scenarios will simulate auditory and visual hallucinations and persecutory delusions, immersing participants in the experience of someone living with schizophrenia. Stigma will be assessed before the VR intervention, immediately afterward and at 1-month follow-up. Assessment will be conducted using self-report scales (Attribution Questionnaire-27 (AQ-27), Reported and Intended Behaviour Scale and Community Attitudes toward the Mentally Ill scale) for explicit stigma and a behavioural test, Implicit Association Test, for implicit stigma.The primary outcome is the reduction in stigma toward individuals with schizophrenia, assessed with the AQ-27 scale, from baseline to the 1-month follow-up, comparing the intervention and control groups. The expected result is a greater reduction in stigma in the intervention group compared with the control group. Secondary outcomes include changes in implicit associations at 1-month follow-up, immediate post-intervention effects on stigma and changes in self-reported prejudice and discrimination over time.

All participants receive both oral and written information and will provide signed informed consent. The study has been approved by the French Research Ethics Committee (reference number: 2025-A01472-47, Comité de Protection des Personnes Ile-de-France III, Paris, France, approval date: 22 May 2026).Results will be disseminated through presentations, conferences and publications in peer-reviewed scientific journals.

NCT07375199.

Over the last two decades, increases in adolescent mental health difficulties have been recorded alongside a rapid expansion in social media use. In response to these trends, on 10 December 2025, the Australian government implemented Social Media Minimum Age legislation prohibiting Australians under the age of 16 years from having social media accounts. The introduction of this legislation allows for a unique quasi-experimental investigation of the impact of social media use on adolescent mental health and the mechanisms through which social media may impact young Australian adolescents' mental health, well-being and cognition.

To assess the relationship between social media use and young adolescents' mental health, well-being and cognition, a longitudinal mixed-methods approach will be taken. 422 young people (aged 10-15 years) and parent/carer dyads were recruited and invited to complete a baseline assessment before the implementation of the Social Media Minimum Age legislation (October-December 2025). Three follow-up assessments will then be completed after 6 (April-May 2026), 12 (October-November 2026) and 18 months (April-May 2027). Data from parent/carer and adolescent surveys, ecological momentary assessments (EMAs), cognitive tasks and smartphone-recorded screenshots of social media and messaging app use across each of these timepoints will be analysed. Linear regression analyses will be used to assess correlational relationships between social media experiences and responses and mental health outcomes as well as how individual factors moderate these relationships. To assess these relationships over time and between momentary experiences and responses (EMA data) and more stable trait-based (individual) and environmental (parenting and government restrictions) factors, we will use linear mixed-effects models and mixed-effects segmented regression.

This study has been approved by the UNSW Human Research Ethics Committee (iRECS 9197). Findings from this study will help identify potential opportunities for interventions at individual, micro (parental) and macro (governmental) levels to mitigate any negative impacts of social media for younger adolescents. Results will be disseminated through peer-reviewed publications, conference presentations, public engagement opportunities and researcher-associated websites. After each assessment timepoint, core findings will also be distilled into engaging formats such as infographics and videos, which will be shared with young people and their parent/carer.

Neglect is the leading cause of acute child protection interventions across high-income countries. In England, reducing the number of children subject to these interventions is a policy priority. However, limited evidence on the health and social factors driving recent trends in neglect constrains effective prevention. We aimed to assess the associations of area-level adult mental health, child poverty and employment, with recorded neglect, and to compare these associations with those observed for other forms of maltreatment.

Longitudinal ecological study using panel data.

147 upper-tier local authorities in England from 2014/2015 to 2022/2023.

Children aged 0-17 years.

Primary: annual rate of new child protection plans (CPPs) due to neglect. Secondary: annual rate of CPPs due to other maltreatment types (emotional, physical, sexual abuse) and rate of children entering care. We used two-way linear fixed effects models to estimate associations between each exposure and outcome, controlling for confounders.

Rising adult mental ill health was associated with higher rates of neglect and emotional abuse CPPs at area-level, but CIs included the null. Child poverty was positively associated with neglect CPPs: a one-percentage point increase was associated with around one additional CPP per 10 000 children (95% CI 0.2 to 2.2), equivalent to a model-estimated difference of over 30 000 plans over the study period. Higher employment was associated with fewer physical abuse CPPs, though CIs included the null. Care entry was positively associated with mental ill health and child poverty, and negatively associated with employment.

Recorded neglect and care entry appear particularly sensitive to wider social conditions affecting caregiving capacity and service response. Preventative policies to support parental mental health and tackle child poverty may help reduce the need for the most common and acute child protection interventions.

Despite the availability of student well-being services, university students remain highly susceptible to mental health challenges. Recent research highlights the potential of mindfulness-based interventions and attachment security priming in enhancing psychological well-being. This study compared the immediate and sustained effects of digitally delivered attachment priming and mindfulness-based practices on student mental health over one week. Using a randomized controlled design, 122 UK undergraduate students were assigned to one of three groups: repeated attachment security priming, mindfulness practice, or a waitlist control. Participants completed baseline assessments of stress, insomnia, attachment anxiety, emotion regulation, and mindfulness. The intervention groups engaged in five consecutive days of digital practice, and all participants completed follow-up assessments immediately after (T2), one week later (T3), and four weeks later (T4). Compared with the control group, both intervention groups showed significant long-term improvements in stress, insomnia, emotion regulation, and academic dropout intention. Attachment priming produced the most consistent and substantial benefits across time points. Each intervention also resulted in specific gains in mindfulness and attachment-related outcomes. These findings support the integration of digital attachment priming and mindfulness-based programs as promising supplements or alternatives to traditional university mental health services, especially when timely, accessible support is lacking.

Chronic diseases account for approximately 90% of the $4.5 trillion annual healthcare expenditure in the United States. While traditional clinical risk factors have been extensively studied, the predictive utility of multidimensional social determinants of health (SDOH), including psychosocial factors such as loneliness, psychological distress, and social support, remains inadequately characterized within machine learning (ML) prediction frameworks.

To develop and compare ML models that classify the presence of six major chronic conditions-hypertension, type 2 diabetes, coronary heart disease, COPD, depression, and anxiety-using an integrated framework encompassing demographic, socioeconomic, behavioral, psychosocial, healthcare access, functional status, and COVID-19-related predictors; and to quantify the relative predictive importance of each domain across disease categories.

We conducted a cross-sectional analysis of 32,614 adults from the 2024 NHIS. Twenty-four predictor variables spanning seven SDOH domains were used to train three ML algorithms: Logistic Regression (LR), Gradient Boosting Machine (GBM), and Random Forest (RF). Model performance was evaluated using 5-fold stratified cross-validation with AUROC, F1 score, and AUPRC. Subgroup analyses were performed by age, sex, and race/ethnicity. Because the design is cross-sectional, the models estimate the likelihood of prevalent disease, not incident risk; robustness was confirmed with alternative imputation (KNN and random-forest MICE), hyperparameter optimization, and three importance methods (Gini, permutation, and SHAP).

GBM achieved the highest AUROC for 5 of 6 outcomes, ranging from 0.793 (anxiety) to 0.857 (COPD). For cardiometabolic outcomes, age and BMI were dominant predictors (hypertension: age importance = 0.641, BMI = 0.117). In contrast, psychological distress (K6) and loneliness emerged as the top predictors for depression (importance = 0.285 and 0.234) and anxiety (0.245 and 0.161). Psychosocial factors collectively contributed 52% and 42% of predictive importance for depression and anxiety, but less than 3% for cardiometabolic diseases. Subgroup analyses showed consistent performance across demographic strata.

Integrating psychosocial determinants substantially enhances prediction of mental health outcomes but contributes minimally to cardiometabolic disease prediction. These findings support disease-specific screening and case-identification strategies that appropriately weight social, behavioral, and psychological dimensions.

Patients with Duchenne muscular dystrophy (DMD) experience increased rates of behavioral and neuropsychiatric disorders. The Centers for Disease Control and Prevention recommends routine mental health screenings and referrals for psychotherapy. However, utilization of psychosocial services among patients with DMD remains understudied.

We conducted a retrospective chart review of 163 male patients followed in a pediatric DMD clinic. Clinical documentation was reviewed for mental health concerns, pharmacologic treatment, and documentation of counseling referral and engagement within the electronic medical record.

Mental health concerns were reported in 86% of patients, and 63% of these individuals experienced more than one type of mental health concern. The most common concerns included anger, aggression, or irritability (52%), attention and hyperactivity disorders (34%), and symptoms consistent with autism spectrum disorder (31%). Among patients with documented mental health concerns, 44 (32%) received pharmacologic treatment. Documentation of counseling engagement was present in 36 (26%) patients, while 104 (74%) had no documented counseling engagement. Thirty-four (24%) patients had documentation of referral without documented attendance, and 70 (50%) patients had no documented referral or documentation of counseling services within the electronic medical record.

Neuropsychiatric symptoms were frequently documented among children with DMD in this cohort, while documentation of counseling referral and engagement was variable. Given the retrospective design, these findings may reflect documentation patterns rather than definitive measures of access to psychosocial care. Prospective studies are needed to further characterize psychosocial service engagement and evaluate multidisciplinary care approaches.

The United States maternal health crisis persists as a public health emergency characterized by high mortality rates and stark racial disparities. These disparities reflect structural racism and intersecting social inequities operating simultaneously across multiple systems.

This scoping review maps maternal health innovations implemented in the United States from 2017 to 2025, examining equity integration, implementation approaches, and scalability through structural racism, intersectionality, and RE-AIM frameworks.

A scoping review was conducted following PRISMA-ScR guidelines and JBI methodology. Systematic searches of PubMed/MEDLINE, CINAHL Plus, PsycINFO, and grey literature were performed from April through August 2025. Two independent reviewers screened records; a third reviewer resolved disagreements. Quality assessment used the Mixed Methods Appraisal Tool.

Fourteen studies across six categories were identified: Digital Health and Telehealth (n = 4, 29%), Clinical Quality Improvement (n = 2, 14%), Community Workforce Development (n = 2, 14%), Social Determinants of Health (n = 2, 14%), Policy and Payment Reform (n = 2, 14%), and Communication and Mental Health Access (n = 2, 14%). All retrieved innovations incorporated explicit equity considerations targeting Medicaid populations, racial and ethnic minorities, and safety-net communities. Nine innovations (64%) achieved scaled implementation; sustainability was strongest among policy-institutionalized and cost-effective interventions. The equity integration finding reflects characteristics of the equity-focused literature retrieved rather than a field-wide empirical claim. Critical scaling factors include infrastructure capacity, policy alignment, sustainable funding, and demonstrated cost-effectiveness.

Nurses are positioned to lead equity-centered maternal health innovation and advance the dismantling of structural determinants driving persistent racial disparities in maternal outcomes across the United States.