This study aimed to investigate the association between borderline personality traits and addictive features of non-suicidal self-injury (NSSI) in adolescent patients with depressive disorder, identify independent risk factors for NSSI addictive features and provide evidence for clinical intervention.

A cross-sectional study design was utilised. A total of 320 adolescent patients with depressive disorder (aged 12-18 years, mean ± SD: 15.82 ± 1.74 years; 238 females, 74.38%) admitted to Jingzhou Mental Health Center between January 2024 and October 2025 were enrolled. Assessments were conducted using the 17-item Hamilton Depression Rating Scale, the Borderline Personality Features Scale for Children (BPFS-C), the Adolescent Self-Rating Life Events Checklist (ASLEC), the 20-item Toronto Alexithymia Scale, the Family APGAR Index and the Addiction Subscale of the Ottawa Self-Injury Inventory (OSI-AS). Pearson correlation analysis was conducted to explore the association between borderline personality traits and NSSI addictive features. Binary logistic regression analysis was performed to identify independent influencing factors for NSSI addictive features.

Based on the presence or absence of NSSI addictive features, the 201 patients in the NSSI group were further divided into an addictive NSSI subgroup (n = 111) and a non-addictive NSSI subgroup (n = 90). The OSI-AS score was significantly higher in the addictive NSSI subgroup than in the non-addictive subgroup (p < 0.001). The total BPFS-C score and its subscale scores showed significant positive correlations with NSSI addictive features (p < 0.001). Binary logistic regression analysis revealed that, after adjusting for confounders such as age, gender, severity of depression and family function, the total BPFS-C score (odds ratio [OR] = 1.116, 95% confidence interval [CI]: 1.077-1.157, p < 0.001) and the total ASLEC score (OR = 1.051, 95% CI: 1.021-1.082, p = 0.001) were independent risk factors for NSSI addictive features. The overall prediction accuracy of this model was 84.7%.

Borderline personality traits are an independent risk factor for NSSI addictive featuresin adolescent patients with depressive disorder and are closely associated with the severity of addictive NSSI. In clinical practice, screening for borderline personality traits should be implemented for adolescents with depression and NSSI. Early psychological interventions targeting core features such as affective instability and impulsivity should be conducted to reduce the risk of NSSI addiction.

Depressive disorders represent a major global health challenge, with inflammation and insulin resistance identified as key pathophysiological factors. The C-reactive protein-triglyceride glucose index (CTI), a novel composite biomarker integrating the inflammatory and metabolic pathways, has demonstrated enhanced predictive value in cardiometabolic diseases. However, its relationship with depression remains unexplored. This study examined the association between CTI and depressive symptoms in a nationally representative U.S. adult population.

We conducted a cross-sectional analysis using National Health and Nutrition Examination Survey data from 2005 to 2023. Depressive symptoms were assessed using the Patient Health Questionnaire-9, with scores ≥10 indicating clinically significant symptoms. CTI was calculated as 0.412 × Ln(CRP) + Ln[triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariable logistic regression models were employed to evaluate CTI-depression associations, adjusting for sociodemographic factors, comorbidities and laboratory parameters. Restricted cubic spline analysis assessed dose-response relationships, and subgroup analyses examined consistency across demographic and clinical strata.

Among 15,318 participants (mean age 48.97 years; 49.78% female), 8.73% exhibited depressive symptoms. After comprehensive adjustment, each unit increase in CTI corresponded to a 23% increase in the risks of depression (odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.11-1.36, p = 0.0001). Participants in the highest CTI tertile demonstrated 48% elevated odds compared with those in the lowest tertile (OR = 1.48, 95% CI: 1.17- 1.86, p = 0.0009), with a significant linear trend (p for trend = 0.0005). Restricted cubic spline analysis confirmed a linear dose-response relationship (p for nonlinearity = 0.1665). Associations remained consistent across age, sex, race/ethnicity and comorbidity subgroups (all p for interaction >0.05).

Elevated CTI levels are independently associated with increased depression risk in U.S. adults, demonstrating a linear dose-response relationship. CTI may serve as a practical screening tool for identifying individuals at heightened depression risk, enabling integrated cardiometabolic-mental health interventions.

Individuals with Sjögren's syndrome (SjD) experience notable health challenges, including chronic pain, fatigue, and depression; however, the potential benefits of physical activity in alleviating these issues remain unclear. We aim to systematically assess the comprehensive effects of physical activity on individuals with SjD.

A comprehensive literature search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane Library, SPORTDiscus, and ClinicalTrials.gov for studies published from inception to November 2025. Two independent reviewers screened the search results and extracted the data. Effect sizes were calculated as the standardized mean difference (SMDs) with 95% confidence intervals (CIs) using random-effects models. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias Tool 2.0, and the certainty of evidence was evaluated with the GRADEpro online tool. Sensitivity, subgroup, and regression analyses were performed to explore potential sources of heterogeneity.

This analysis included six studies with a total of 277 participants with SjD. Compared to controls, physical activity interventions significantly improved cardiopulmonary function (SMD 0.59 [95% CI 0.20 to 0.99]), functional capacity (SMD 0.69 [95% CI 0.33 to 1.05]), general health status (SMD 0.46 [95% CI 0.15 to 0.76]), vitality (SMD 0.51 [95% CI 0.15 to 0.86]), and mental health (SMD 0.42 [95% CI 0.13 to 0.72]). However, no significant improvements were observed in pain, social aspects, fatigue, and the EULAR Sjögren's Syndrome Disease Activity Index.

The results highlight aerobic and resistance training are regarded as effective and practical exercise options.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024513141.

Serbia's first fatal school shooting on 3 May 2023, followed by a subsequent mass murder, resulted in widespread societal distress.

This study aimed to assess the emotional, cognitive, and behavioral responses of parents of school-aged children who were neither directly nor indirectly exposed to the events. It also examined parental perceptions of children's safety at school, access to information and psychological support, attitudes toward proposed preventive measures, and trust in institutional capacity to prevent future incidents.

A total of 1,996 parents and caregivers were recruited through a stratified survey-delivery method, with the Ministry of Education distributing the survey to schools, which then forwarded it to parents. The pilot study commenced 60 days after the Belgrade school shooting at "Vladislav Ribnikar" Elementary School, and the confirmatory phase began 12 months later. Parents of children directly or indirectly involved in the shooting were excluded.

Of the 1,927 parents who participated, over 98% reported no direct or indirect exposure to the shooting. Nevertheless, 69% expressed concern about their children's safety at school. More than half (56%) attributed responsibility to the underage perpetrator, and 65.7% supported lowering the age of criminal responsibility, most commonly to 12 years. Although 46% perceived psychological support as accessible, actual utilization was minimal (3.8% among children; 2.9% among parents). Parents predominantly favored strict enforcement of child protection laws over security or mental health-based preventive measures. Institutional trust was low, with 60.6% reporting minimal confidence in authorities' ability to prevent similar events.

The findings indicate that Serbia's first mass school shooting had broad community-level effects, including heightened parental safety concerns, low institutional trust, and minimal use of psychological services. These results highlight the need for transparent communication, strengthened institutional trust, and integrated prevention strategies that include accessible psychosocial support.

Healthcare research is an essential driver of evidence-based practice, leading to improved service delivery and outcomes. Despite being integral to pharmacy (e.g., in driving safe and effective use of medicines), research engagement is relatively low. This service evaluation study aimed to assess pharmacy professionals' research engagement inclusive of capacity (opportunity and time) and ability (skills and knowledge), and to explore potential barriers and facilitators to research engagement.

The study was conducted at a single Mental Health and Community Trust in the UK between February and June in 2024. Data were collected in two phases: phase 1: an online survey assessed current research engagement, and phase 2: virtual individual interviews and a focus group explored in-depth views on research engagement. All practising pharmacists and pharmacy technicians were eligible to participate and were invited via email through a senior pharmacist. Quantitative data were descriptively analysed, and qualitative data were audio-recorded, transcribed and thematically analysed. As a service evaluation, no ethical approval was required.

Of the 62 invited pharmacy professionals, 32 responded (52%, n = 20 pharmacists). Around 47% (n = 15) reported prior involvement in research activity/training. Most viewed research as relevant (63%, n = 20) and extremely valuable (72%, n = 23) to practice, and 47% (n = 15) expressed interest in engaging in future research. However, few expressed having confidence across a range of research skills. Seven interviews and one focus group were conducted. Three main themes were identified: research-related views and experience, barriers to research engagement, and strategies to improve research engagement.

Overall, positive views on research were reflected. Current research involvement rate is low, as is the confidence in applying research to practice. Several barriers were identified, which require addressing to enhance research activity. Organisations therefore should assess research capacity and ability of their staff to identify encountered barriers to enhance research engagement.

Awareness of mental health is important to reduce stigma and discrimination and increase access to care. From the viewpoint of mental health conditions, this study examined the relationships among highly sensitive personality (HSP) traits and neuroticism in the general population.

After obtaining informed consents, an anonymous web-based survey for adult participants with equal data collection across genders and age groups (20s, 30s, and 40s) was conducted using self-report questionnaires about HSP, neuroticism, mental health conditions including depression, anxiety, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), trauma-related stress, adverse childhood experiences (ACEs), and awareness of HSP and neurodevelopmental disorders. Participants were divided into the three groups based on HSP or neuroticism, with low, medium, and high groups defined by the mean value ± 1 SD.

Data from 2593 participants were analyzed. High-HSP and high-neuroticism groups exhibited higher levels of depression, anxiety, ASD, ADHD traits, trauma-related stress, and ACEs, compared to the other medium and low groups, respectively. Regarding ACEs, both the high-HSP and high-neuroticism groups showed significantly high rates of psychological abuse and neglect. While the high-neuroticism group showed broad associations across all ACE categories, the high-HSP group showed specific and comparable, or slightly stronger, associations with household mental disorders and physical abuse. In the high-HSP group, more participants answered that being HSP or having a neurodevelopmental disorder was part of their identity.

High HSP and high neuroticism show mental health similarities, but HSP uniquely internalizes traits as identity.

Adolescent mental distress has increased in recent decades. It is unclear whether this is associated with changes in health-risk behaviors.

We analyzed five waves (2002-2018) of the repeated cross-sectional Swiss Health Behavior in School-aged Children study (ages 11-15; N = 30,122). Latent Profile Analyses identified health-risk behavior profiles in each wave using five indicators (physical inactivity, poor sleep, unhealthy diet, smoking, alcohol use). Associations with sociodemographic variables and mental distress (internalizing and somatic symptoms, life satisfaction) were tested using multinomial and linear regressions, including profile*sex interactions.

A consistent four-profile solution (low-risk; high alcohol use/slightly elevated substance use; moderate substance use; highest risk) fit best across waves. The low-risk profile was most prevalent and increased in later cohorts (2014-2018), while elevated-risk profiles declined. Older adolescents were more likely to belong to elevated-risk groups, which were associated with greater mental distress, especially in earlier cohorts. No significant sex interactions were found.

Health-risk behavior profiles remained stable, but their associations with mental distress weakened over time. Prevention efforts should adapt to evolving adolescent contexts.

Digital technologies hold promise for building capacity of non-specialist providers to scale-up access to depression care. This study evaluated the preliminary effectiveness and acceptability of a digital program to train non-specialists in the delivery of an evidence-based behavioral activation (BA) intervention for depression.

Non-specialist providers without prior mental health counseling experience employed within the Baylor Scott & White Health system in Texas were recruited to complete a two-course digital training, and knowledge assessments-at baseline and follow up-to determine preliminary effectiveness. Acceptability and feasability were assessed through focus groups.

Of 73 non-specialist providers enrolled in the program, 42 completed both courses. Intent-to-treat analysis showed pre-post improvement in knowledge assessment scores (mean difference = 5.4; 95% CI: 1.6, 9.2; t(53) = 2.87, p = 0.006). Subgroup analyses demonstrated that participants who fully completed the training had pre-post improvement in knowledge scores (mean difference = 6.8; 95% CI = 2.8, 10.8; t(39) = 3.46, p = 0.001), whereas those who did not start or who only partially completed the training did not show improved knowledge scores. Framework analysis of the focus groups revealed four themes: training program evaluation, participant feedback and improvements, communication strategies, and support and resources.

This digital program shows potential for building skills and knowledge of non-specialist providers in delivering BA. Continued efforts are needed to support these providers in practice, and ensure quality through supervision.

The program offers a scalable solution to expanding the behavioral health workforce, representing an opportunity to overcome the significant mental health workforce shortages and ensuring access to quality mental health services.

Emergency departments (EDs) are the primary entry point for individuals in acute mental health crisis in Australia. However, EDs are ill-suited to meet the complex needs of this population, often resulting in suboptimal outcomes. This study evaluates the impact of a novel model designed to improve crisis care coordination by integrating a transition coordinator (TC) role and the AIMS (Assessment, Intervention, Monitoring, Step-up/Step-down) framework across community mental health services, ED, and inpatient settings.

Data were collected from an Australian metropolitan public mental health service over 5 years (2020-2024). Routinely gathered TC records documented proactive identification of mental health deterioration and subsequent care pathways. Additional data from 2022 onward tracked all ED presentations by individuals receiving case management. Descriptive statistics were used to examine changes in service use and care coordination outcomes.

Over the study period, 4382 individuals were proactively flagged to the TC, with 72.6% supported in the community and 1230 admitted via direct or coordinated pathways. Coordinated admissions rose substantially, while unplanned ED presentations declined by 21.4% from 2022 to 2024. Among flagged individuals, uncoordinated admissions dropped by 66.1%. Early detection and enhanced communication across services were key contributors.

The introduction of the TC role and AIMS framework significantly improved proactive identification, reduced unplanned ED presentations, and fostered timely, coordinated crisis responses. These changes illustrate the importance of building capacity, capability, and culture to shift from reactive to proactive care.

This study demonstrates the role of structured coordination in improving outcomes for individuals experiencing mental health crises. The TC functions as a dedicated clinical bridge between community and hospital settings, facilitating earlier identification of mental health deterioration and streamlined crisis responses. Importantly, this role supports case managers in navigating logistical and systemic barriers, ensuring people received timely, appropriate care while minimizing unnecessary ED presentations. From a clinical practice perspective, the findings advocate for investment in roles and frameworks that prioritize continuity of care, shared decision-making, and person-centered pathways. The implementation of the AIMS framework offers a common clinical language across services, enhancing communication and reducing fragmentation during transitions. Clinicians are empowered to move away from a crisis-driven mindset and instead adopt a proactive stance, treating admission not as a failure but as a legitimate and therapeutic component of care when appropriately timed. The reduction in unplanned admissions not only improved patient outcomes but also relieved pressure on ED and inpatient services, suggesting benefits for both care quality and system efficiency. For clinical teams, this model underscores the value of multidisciplinary collaboration, reflective practice, and a shift in service culture that prioritizes early intervention and recovery-oriented care. These insights are especially pertinent as mental health systems seek to balance demand pressures with compassionate, effective service delivery.

People with serious mental illness (SMI) and substance use disorders (SUD) experience difficulties accessing high-quality medical care, despite their elevated risk for chronic health conditions. One proposed solution is the integration of medical and behavioral health services. This study identifies the barriers behavioral health agencies (BHAs) face when attempting to incorporate physical health services for their patients, following a legislative change requiring managed care organizations (MCOs) to oversee all Medicaid-covered medical, mental health, and SUD services.

We conducted semi-structured interviews (n = 34) with MCO and BHA leaders to identify the barriers to integrating care following this policy change.

BHAs highlighted the absence of established integrated care models for serving patients with SMI or SUD. Integrating services incurred additional costs, and motivated BHA leaders sought out grants to fund their efforts. MCOs described the limitations to offering alternative payments to BHAs, and BHAs reported that reimbursement rates were insufficient to hire primary care clinicians due to their relatively small size. BHAs expressed a need for reimbursement rates and methodologies better aligned with their patients' needs.

Supporting integrated care within settings that serve patients with SMI and SUD is essential for addressing this population's higher rates of chronic illness and inequities in healthcare access and treatment.

Current obstacles suggest that only the most mission-driven BHAs are likely to attempt integration. Engaging states and payers to overcome these barriers is a critical step toward implementing and sustaining integrated care in behavioral health settings.