Globally, children and adolescents exposed to Adverse Childhood Experiences (ACEs) face an increased risk of developing mental health disorders. The prevalence of these mental disorders is further amplified by the lack of access to specialised mental health treatment especially in low resource settings. There is an urgent need for scalable mental health interventions that can effectively address the needs of these vulnerable populations. Non-specialist-delivered interventions, such as PROACT (Psychoeducation, Relaxation, Problem-solving, Activation, and Cognitive Coping Therapy), represent a promising scalable approach that could help bridge the existing mental health treatment gap in low-resource settings.

This study aimed to assess changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention delivered by trained social workers in Nairobi, Kenya.

Mixed-methods pre-post study design was employed. Twenty purposively selected sites across Nairobi County each contributed one social worker (N = 20), who received training to deliver the intervention. A total of 40 children participated and received 4-6 PROACT sessions. Quantitative data were analysed using STATA version 17. Paired t-tests were used to compare baseline and endline scores, while mixed-effects linear regression models with participant ID as a random effect were fitted to estimate changes in outcomes over time and account for repeated measures. Statistically significant improvements were observed across all mental health outcomes. Mean anxiety scores decreased from 6.2 at baseline to 2.7 at endline (mean difference: -3.5; 95% CI: -4.7 to -2.2; p < 0.001), while mean depression scores decreased from 6.4 to 2.9 (mean difference: -3.6; 95% CI: -4.9 to -2.3; p < 0.001). Mean PTSD scores decreased from 16.7 (95% CI: 12.8-20.5) at baseline to 7.3 (95% CI: 4.4-10.1) at endline (mean difference: -9.4; 95% CI: -14.6 to -9.3; p < 0.001). Mixed-effects linear regression analyses corroborated these findings, demonstrating significant reductions in PTSD (β = -9.44), anxiety (β = -3.48), and depression (β = -3.59) symptoms (all p < 0.001).

The PROACT intervention was feasible and acceptable when delivered by social workers in Nairobi primary healthcare facilities and was associated with improvements in mental health outcomes among children and adolescents. These findings highlight the potential of task-sharing approaches to expand access to mental healthcare in low- and middle-income countries (LMICs) and warrant further evaluation in controlled studies.

Back pain in pregnancy affects up to 90% of pregnant women, limits physical activity and mental health and has substantial socioeconomic implications. Musculoskeletal techniques (MT) are safe hands-on treatments for back pain and are easy to learn. This study evaluated the feasibility and impact of using MT on pain and function in pregnant women with back pain.

This feasibility study included pregnant women with moderate or severe back pain who received two MT treatments at a 14-day interval and a healthy reference group. Pain intensity (numeric rating scale), functional disability (the Oswestry Disability Index) and activity limitations (the Pelvic Girdle Questionnaire) were assessed at baseline and after treatment. We performed the Mann-Whitney, marginal homogeneity and paired t-tests to investigate differences between groups.

The intervention group (n = 50) showed a significant reduction in pain intensity (numeric rating scale 7.2 ± 1.6 to 2.3 ± 1.4, p less-than 0.001), Oswestry Disability Index score (50.5 ± 13.2 to 28.6 ± 14.8, p less-than 0.001), and Pelvic Girdle Questionnaire score (71.1 ± 11.9 to 47.7 ± 17.2, p less-than 0.001) after treatment. 72% of the intervention group reported severe pain, which decreased to 2% after the intervention. Post-intervention pain levels in the treatment group were similar to those of the reference group (n = 20) at baseline (p = 0.74).

Two MT treatments are implementable in a Danish public hospital setting and may be effective in relieving pregnant women from their severe back pain. A clinical randomised study is needed.

This study was supported by the North Zealand Hospital, Denmark.

The Danish Data Protection Agency (no. P-2021-535).

To examine nursing and midwifery (N&M) students' self-reported readiness for their professional experience placement (PEP) following the use of real-life actors, combined with Objective Structed Clinical Assessment (OSCA), in a Block Model.

A cross-sectional convergent mixed method study.

Quantitative data (n = 234) were collected via an online survey following OSCA completion. Qualitative data (n = 22) were obtained through face-to-face interviews after completion of the Mental Health PEP.

Responses to the 10-item online survey revealed that students reported positively on their learning experiences and perceived preparedness for clinical placements. Demographic factors, particularly students' living area and employment status, significantly influenced readiness scores. Qualitative responses were categorised into eight themes: Skills and Knowledge, Person-Centred Care, Understanding Symptoms, Therapeutic Communication, Trauma-Informed Care, Strength-Based Care, Recognising Clinical Deterioration, and Mental State Risk Assessment. Seven key insights frequently emerged, with both quantitative and qualitative responses suggesting that students perceived the involvement of real-life actors during simulations and OSCA as enhancing their readiness for PEP.

Real-life actors provide an innovative approach that students perceived as supporting their confidence, self-reported skill and knowledge development, and transition to PEP.

Combining real-life actors with OSCA better prepares N&M students for PEP and transition into the workforce. Practicing communication skills in realistic, actor-led scenarios strengthens students' therapeutic relationships and patient-centred care. Immediate, in-role feedback from real-life actors facilitates reflective practice, improving students' reported clinical reasoning and patient interaction.

This study highlights the need for educational methodologies that reflect real-life clinical environments to support students' professional development and perceived readiness for PEP. These insights are valuable for educators, curriculum developers, policymakers, and future N&M students, ultimately improving patient care quality.

The qualitative methodology and outcomes followed SRQR and COREQ standards.

No patients or members of the public were involved in the design, conduct, interpretation, or dissemination of the study.

Atopic dermatitis is commonly associated with depressive symptoms and fatigue, which significantly impact quality of life. While clinical trials suggest beneficial effects of dupilumab on mental health, real-world evidence remains limited. This longitudinal cohort study analysed data from adult patients treated with dupilumab in the TREATgermany registry. Subgroups were defined by baseline Center for Epidemiologic Studies Depression Scale (CES D) scores ≥16 (clinically significant depressive symptoms) and Fatigue Severity Scale (FSS) scores >4 (significant fatigue). Clinical severity (Eczema Area and Severity Index [EASI], objective Scoring Atopic Dermatitis [oSCORAD]), quality of life (DLQI), psychological symptoms, treatment needs and benefits (PNQ, PBI) and drug survival were assessed over 12 months. Among 633 patients, those with elevated baseline CES-D (n=309) or FSS (n=281) scores reported greater disease burden measured by DLQI, while EASI and oSCORAD did not differ between subgroups. Both CES-D and FSS scores decreased markedly within the first 3 months. Sleep and social functioning needs were more frequently reported in high-burden subgroups and more often fulfilled after 12 months. Drug survival was comparable across subgroups. Dupilumab treatment was associated with significant improvements in depressive symptoms, fatigue and skin severity. Patients with higher baseline mental health burden showed comparable improvements in patient relevant domains, supporting the broad relevance of dupilumab in real-world atopic dermatitis care.

The Veterans Community Care Program (VCCP) has become essential to how the Veterans Health Administration (VHA) delivers care. Although VCCP expands Veterans' access to community providers, ongoing process inefficiencies create barriers to timely care. Veterans affected by military sexual trauma (MST) are at heightened risk for behavioral health challenges, especially when care is delayed or fragmented. These delays may be particularly harmful for Veterans with MST living in rural communities where structural barriers exacerbate health risks. In this study, the primary author interviewed 38 Veterans with MST (29% rural-dwelling) to understand rural-urban differences in experiences with seeking psychotherapy through VCCP. Three major themes emerged: (1) emotional strain from structural barriers that influenced psychotherapy access, (2) concerns about worsening health and safety, and (3) value of timely and clear processes. While rural and urban Veterans with MST expressed similar frustrations about the VCCP process, rural Veterans raised specific concerns about the impacts of treatment delays on worsening health. By comparison, urban Veterans were emotionally burdened by administrative hurdles (such as miscommunication and billing issues). They also indicated broader concerns about the safety of Veterans facing long wait times without additional support. Study findings highlight opportunities to enhance transparency, streamline administrative procedures, and bolster support for Veterans with MST undergoing the VCCP process. In addition, developing systems to monitor at-risk Veteran groups (such as rural Veterans with MST) during care transitions is necessary to reduce the likelihood of adverse outcomes.

Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy manifested by progressive limb weakness. Anxiety and depression are significant yet under-recognised complications of GBS, particularly in low- and middle-income countries (LMICs). This study examined the proportion and progression of anxiety and depression in Bangladeshi GBS patients and their associations with clinical features, outcomes and quality of life (QoL).

A prospective cohort study.

National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.

A total of 148 GBS patients aged ≥18 years diagnosed by National Institute of Neurological Disorders and Stroke criteria for GBS, were recruited within 2 weeks of symptom onset.

Anxiety and depression were evaluated as the primary outcome using the Hospital Anxiety and Depression Scale (HADS) at week 13 and week 26 post-GBS. Secondary outcomes included Medical Research Council sum score, GBS Disability Score, fatigue severity, pain intensity and EuroQol 5-Dimension 5-Level. Statistical analyses involved descriptive summaries, group comparisons, correlation tests and longitudinal assessments by analysis of variance.

A total of 111 patients with complete HADS data were analysed (median age 36 years; 71% male). At week 13, 45% had anxiety reducing to 36% at week 26. Depression was 53% at week 13 and 41% at week 26. Baseline bulbar involvement was significantly associated with week 13 depression and week 26 anxiety. Between week 13 and week 26, 27%-30% of patients had persistent symptoms and 13%-16% experienced worsening. Anxiety and depression mostly followed concordant patterns, though 28 patients showed discordant patterns. Elevated mood symptoms were associated with greater fatigue, pain and reduced QoL.

Anxiety and depression are common and persistent in GBS adversely affecting recovery and QoL. Mental health monitoring and targeted support should be integrated into GBS management, especially in LMIC settings.

Cognitive aging is shaped by genetic variation, environmental factors, and health-related conditions. Until now, it is largely unclear why some individuals maintain their cognitive function, and others show progressive cognitive decline. This study uncovered determinants of distinct cognitive aging trajectories in the older population. To approach the inter-individual variability in cognitive aging, we clustered n = 696 dementia-free individuals from the prospective TREND study based on their longitudinal changes in comprehensive cognitive testing every 2 years over 13 years on average. Identified subgroups of cognitive aging were tested for differences in general physical health, motor function, mental and neuropsychological health, personality, lifestyle, diet, and genetic and biofluid markers as observed at the phenotypes' initial records. Comparing the best- and lowest-performing subgroups of cognitive aging, we found that individuals who maintain high cognitive function compared to those with low baseline and progressive cognitive decline showed significant faster gait speed, higher health-related quality of life, did sports and cognitive stimulating activities more frequently, and reported higher plant-based foods intake. Although there are fewer phenotypic differences involving the intermediate subgroups of cognitive aging, the best-performing subgroup compared to all other subgroups showed higher plant-based foods intake. Overall, this study identifies distinct, data-driven subgroups of long-term cognitive aging trajectories and reveals factors associated with these divergent paths using deeply phenotyped data. The findings highlight the substantial heterogeneity of cognitive aging and suggest that favorable trajectories are linked to modifiable behavioral and health-related characteristics, providing a foundation for future multidisciplinary strategies to promote healthy cognitive aging.

22q11.2 deletion syndrome (22q11DS) markedly increases risk of psychiatric disorders, including anxiety and mood disorders, and is associated with a spectrum of cognitive impairment, from borderline functioning to intellectual disability, with cognitive decline frequently reported. Despite widespread use of selective serotonin reuptake inhibitors (SSRIs) in 22q11DS, evidence regarding their safety, effectiveness, and potential effects on cognitive trajectories remains limited. We conducted a retrospective, observational multicenter study across nine international centers, including cross-sectional and longitudinal analyses. In the cross-sectional sample of 190 SSRI-treated individuals with 22q11DS (6-56 years), retrospective data on SSRI type, indication, perceived effectiveness, and side effects were analyzed descriptively (40-190 cases across variables). In the longitudinal analyses, intellectual quotient (IQ) trajectories were compared between 101 SSRI-treated and 213 SSRI-untreated participants (4-34 years) using mixed-model regression analyses. SSRIs were mainly prescribed for mood and/or anxiety disorders (94%) and were rated as overall effective in 71% of cases with available data, with side effects reported in 25%. SSRI-treated participants exhibited stable or modestly increasing IQ trajectories, whereas SSRI-untreated participants showed decreasing trajectories over time. In exploratory analyses, concomitant psychostimulant treatment was associated with the most favorable IQ trajectories. Treatment duration, but not dosage, was positively associated with IQ change. These findings suggest that the effects of SSRI treatment in individuals with 22q11DS may extend beyond symptom management. Controlled prospective studies are needed to confirm these findings and determine underlying mechanisms.

Matching intensity to people's needs and circumstances requires rethinking traditional care pathways and aligning them with personal recovery goals by reducing dependency on professionals where possible. Social support is recognized as a crucial factor in mental healthcare usage, and this study examined its role in how the intensity of mental healthcare is adjusted.

We analyzed data from a four-year naturalistic cohort study of Dutch individuals with mental disorders (n = 293). The Social Network Map was employed to assess social support. The Mental Healthcare Intensity Scale measured healthcare usage. A linear mixed-effects model was utilized to explore the relationship between social support and healthcare intensity, while controlling for demographic variables and healthcare usage one year earlier.

Previous levels of social support significantly influenced the intensity of mental healthcare. Participants with little support saw minimal changes in the intensity of the care they received. However, those with more support experienced dynamic changes, which differed significantly from those in the previous year. This effect was both positive and negative. It showed that social support acts as a catalyst by either escalating or deescalating the intensity of care needed.

Social support plays a vital role in adjustments in the intensity of mental healthcare. This underscores the need for mental health professionals to incorporate social support assessments into clinical evaluations and be aware of this effect when deciding on the intensity of mental healthcare needed for people with a mental illness.