Paternity leave may be associated with maternal mental health through fathers' involvement and coparenting, but short-term family-process associations during the early postpartum period remain unclear.

We examined modeled structural and indirect associations among paternity leave duration, mother-reported paternal involvement and coparenting, and maternal depressive symptoms from 3 to 6 months postpartum, separately by parity.

This two-wave online survey included 396 Japanese mothers (244 primiparas and 152 multiparas). At the 6-month follow-up, mothers reported the father's total paternity leave duration, categorized as no leave, short leave (1-31 days), or long leave (32 days or more). Paternal involvement at 3 and 6 months was modeled as a latent construct indicated by four domains of childcare and housework; coparenting and depressive symptoms were assessed using the CRS-J and CES-D, respectively. A multigroup two-wave structural equation model of structural and indirect associations was estimated. Indirect associations were evaluated using 5,000 bootstrap samples and bias-corrected 95% confidence intervals. All principal variables were mother-reported.

The freely estimated multigroup model showed good fit, χ²(194) = 309.282, CFI = 0.961, TLI = 0.946, and RMSEA = 0.039. Long leave, relative to no leave, was associated with greater paternal involvement at 3 months in both parity groups, whereas short leave was not clearly associated with paternal involvement. Paternal involvement and coparenting showed continuity from 3 to 6 months. The CRS-at-6-months to CES-D-at-6-months association and the total indirect association between long leave and CES-D were statistically supported within primiparas but not within multiparas. However, formal metric-invariant between-group comparisons were not significant for either the CRS-to-CES-D path, Δχ²(1) = 0.482, p = 0.488, or the total indirect association, ΔB = -0.225, 95% bias-corrected CI [-0.903, 0.441], p = 0.454.

Long paternity leave was associated with greater mother-reported paternal involvement and short-term coparenting continuity. The modeled indirect association with maternal depressive symptoms was very small, and formal comparisons did not establish parity differences. These findings describe short-term observational associations rather than causal effects.

Understanding patient values and preferences can provide valuable insight and help improve patient care for patients with inborn errors of immunity (IEIs). Therefore, this review sought to systematically review the values and preferences of patients with IEIs and their caregivers towards the management of IEIs. We searched MEDLINE, Embase, PsycINFO, and CINAHL from database inception up to June 7, 2026, for studies addressing the values and preferences of patients with IEIs or their caregivers. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. We used iterative thematic content analysis to qualitatively synthesize our findings and the GRADE-CERQual approach to rate the confidence of the evidence supporting each theme. Fifty-two studies enrolled 6,388 participants. We identified 6 key themes: (1) Patients are probably more willing to engage with and accept treatment if counseled by healthcare professionals knowledgeable in IEIs (moderate confidence). Patients probably place a high value on IEI treatments that (2) minimize needle pricks and adverse effects, and (3) maximize independence, efficiency, and flexibility (moderate confidence). (4) Patients probably place a high value on effective transitions from pediatric to adult care services (moderate confidence). (5) Patients may have significant concerns about the financial impact of IEI management (low confidence). (6) Patients may place a high value on the integration of mental health and social support into their care (low confidence). Ultimately, these 6 key themes on the values and preferences of patients with IEIs and their caregivers may inform optimal clinical practice and future research in IEIs.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251114032.

Social frailty and oral health literacy (OHL) may be influenced by the residential environment; however, evidence regarding regional differences among older adults remains limited. This study aimed to examine differences in social frailty and OHL between older adult study populations recruited from urban and rural areas.

This cross-sectional study included 176 community-dwelling older adults (88 participants in the urban study population and 88 participants in the rural study population) enrolled between November 2024 and November 2025. Social frailty was assessed using a five-item assessment, and OHL was evaluated using a 16-item questionnaire. Oral health status was assessed using the Japanese version of the Oral Health Assessment Tool (OHAT-J), and health-related quality of life (QOL) was measured using the Short Form-8 (SF-8). Ordinal logistic regression and multinomial logistic regression analyses were performed to examine the associations of study population (rural vs urban) with social frailty and OHL, respectively, adjusting for demographic and health-related factors.

Compared with the urban study population, the rural study population showed a higher prevalence of social frailty (p = 0.004) and low OHL (p < 0.001). In contrast, mental health-related QOL and oral health status were more favorable in the rural study population (p < 0.001). Multivariable analyses showed that participants in the rural study population had higher levels of social frailty and lower OHL than those in the urban study population.

Participants in the rural study population demonstrated favorable mental health-related QOL and oral health status; however, higher levels of social frailty and lower OHL were also observed. Given the cross-sectional design and differences in participant recruitment settings between the two study populations, these findings should be interpreted as exploratory and hypothesis-generating rather than as definitive evidence of causal relationships. Nevertheless, these findings may inform the development of region-specific, integrated approaches that combine support for social participation with improved access to health-related information.

Metabolic bariatric surgery induces significant anatomical and physiological changes in the gastrointestinal tract that may substantially affect the pharmacokinetics of orally administered drugs. These changes include, among others, reduced gastric volume, increased gastric pH, bypass of absorption segments in the small intestine, alterations in drug metabolism, as well as rapid weight loss and changes in body composition. Many neuropsychiatric medications are characterized by a narrow therapeutic window; therefore, the effects of metabolic bariatric surgery may lead either to reduced drug absorption and therapeutic failure or, conversely, to increased drug levels with a risk of toxicity. Interindividual variability is considerable, making it difficult to predict pharmacokinetic responses in individual patients. This review presents the impact of metabolic bariatric surgery on commonly used neuropsychiatric medications, aiming to promote safe and optimal pharmacotherapy in this population. The article includes a literature review, recommendations for therapeutic drug monitoring, and guidance for clinical and laboratory follow-up. Given the complexity of this issue, a proactive approach is recommended, including assessment of drug levels prior to surgery and close monitoring in the early postoperative period until clinical and laboratory stability is achieved, followed by periodic monitoring based on drug characteristics, patient factors, and the specific surgical procedure performed. A multidisciplinary approach involving a neurologist and/or psychiatrist, along with a clinical pharmacist, is essential to optimize neuropsychiatric treatment in patients undergoing metabolic bariatric surgery.

University students are at risk of suicidal thoughts and behaviors (STB), with prevalence rates higher than those in the general population. Machine learning (ML) enhances the accuracy of STB prediction and provides new possibilities and explanatory frameworks for this issue. This study extends prior research in two ways: (1) by employing, for the first time, a sample of Taiwanese university students and (2) by synthesizing suicide-related theoretical knowledge and empirical findings to identify individual, risk, and protective factors. Based on these elements, a comprehensive ML-based prediction model of STB among university students was developed with four analytic modes to evaluate the relative importance and contributions of three predictor categories. Using data from the NTU Students' Physical and Mental Health Assessment System, a total of 3,901 students were retained in the current study, with 13 self-report assessments administered. Classic logistic regression and five ML classifiers (e.g., bagged LR, RF, LightGBM, linear SVM, and RBF SVM) were utilized. Compared with traditional statistical methods, ML algorithms improved prediction of STB among high‑risk students. RF and LightGBM performed best, with similar results in Mode 2 (risk factor only) and Mode 4 (integrated individual, risk, and protective factors), both outperforming Mode 3 (protective factor only) and Mode 1 (individual factor only). Ultimately, this study enhances the interpretability of ML-based models for predicting STB. Moreover, it provides researchers with deeper insights for developing systematic prediction models and offers a screening tool for identifying university students at high risk of STB.

Coercive measures remain used in psychiatric care, despite ongoing ethical concerns and efforts to minimize their application. Psychotherapeutic or competence-oriented frameworks may contribute to reducing situations that lead to coercion, yet empirical evidence is scarce.

This naturalistic study examined whether the introduction of Modular Competence-Oriented Psychotherapy (MCP) at site A was associated with changes in the frequency and duration of coercive measures (2022-2024), compared to site B providing treatment as usual.

Routinely collected inpatient data from two psychiatric sites in Germany were analyzed retrospectively (n = 15,361 cases). Generalized linear models assessed annual changes in the use of restraint and seclusion. Linear models examined changes in the duration of restraint and seclusion episodes.

Overall, the probability of coercive measures was significantly higher at site B than at site (A). At site A, the likelihood and duration of restraint and the duration of seclusion significantly declined over time, while the likelihood of seclusion remained stable. Except for seclusion duration, time trends did not differ significantly between sites. For seclusion duration, site A showed a significantly stronger decline than site (B). Descriptively, assaults decreased at site A but remained stable at site B.

Implementation of MCP at site A was associated with reductions in the duration of restraint and seclusion, without indications of increased risk events. Although the naturalistic design and concurrent changes at site B preclude causal conclusions, the findings offer preliminary evidence for the feasibility and potential value of integrating a competence-oriented psychotherapeutic framework in psychiatry.

Not applicable.

Military-affiliated adults including veterans, active-duty service members, and their families experience elevated rates of mental health conditions such as PTSD, depression, and anxiety. Addressing these needs requires accessible, high-quality, and evidence-based care delivered at scale. Cohen Veterans Network (CVN), a national network of community-based military family clinics, was established in 2015 to provide rapid access to mental healthcare, emphasizing evidence-based psychotherapies, measurement-based care, and standardized clinical and operational practices. This retrospective study examined ten years of outpatient mental health care (2016-2025) across CVN clinics (N = 45,947 clients). Analyses focused on symptom change, clinically significant improvement, and trends over time, with stratification by client type and gender. Results indicate that across more than a decade of care, clients demonstrated consistent, meaningful symptom reductions. Among clients who screened positive at intake, mean PHQ-9 improvements ranged from 6.05 to 7.10 points, GAD-7 improvements from 5.67 to 6.24 points, and PCL-5 improvements from 16.50 to 18.37 points, with 55-68% of clients achieving clinically significant change. Outcomes remained stable despite network expansion, shifts in client composition, and external stressors such as the COVID-19 pandemic. Outcomes are also described by client type and gender, with all subgroups demonstrating symptom reductions. These findings demonstrate that using a social franchise model combining centralized infrastructure, local clinic management, standardized training requirements, and rigorous quality control can sustainably deliver high-quality, effective psychotherapy at scale. The CVN experience provides a replicable framework for addressing mental health disparities among military-affiliated populations and other underserved groups.

Attention-deficit hyperactivity disorder (ADHD) is associated with a higher risk of premature mortality compared to the general population, although reported risks vary. The aim of this paper was to review studies that have examined associations between premature mortality and ADHD and consider factors that could explain variation in risk estimates. A literature search was carried out using online databases (PMC, OVID, and Scopus library) to identify relevant articles. We then considered: sample ascertainment, sample size, method of diagnosing ADHD and age at diagnosis, sex, age range for mortality data, hazard ratio/ mortality rate ratio (95% confidence interval), sample size, and cause of death, as factors that could explain variation in risk estimates. We focus on nine papers that report risk of all-cause mortality in population samples via hazard ratios, odds ratios, and mortality ratios, which varied from 1.07 to 4.44. Higher risk estimates were found in studies that followed up to older ages and among individuals who were female, diagnosed with ADHD later, and had psychiatric comorbidity. Most follow up found non-natural causes (e.g. suicide, accidents) to be the most prevalent cause of death but studies with longer follow up suggested that non-natural causes may be more important in older individuals. Evidence suggests that ADHD medication reduces the risk of premature mortality but findings are clearer for stimulant than for non-stimulant medication. Clinicians need to be aware that females with ADHD, those with a delayed ADHD diagnosis and who show psychiatric comorbidity are at highest risk of premature mortality. However prescribing ADHD medication may reduce this risk.

Neurodevelopmental disorders such as Autism and ADHD pose significant challenges for families. Parents face additional parenting challenges and stressors, and are more likely to experience mental health problems compared to the general population. This is associated with a more unfavourable course in the children. Still, it is unknown whether addressing parental mental health is of additional benefit for the children.Families with a child referred to a developmental clinic for neurodevelopmental problems, and a parent who was experiencing subclinical or clinical mental health symptoms, were recruited. One hundred and twenty-seven families (caregivers: female n = 119, male n = 23; children: female n = 37, male n = 90) were randomised into (1) standard Stepping Stones Triple P, a parenting program for children with neurodevelopmental issues (n = 63), or (2) Enhanced Stepping Stones Triple P (n = 64) which includes additional modules addressing parental mental health. Participants completed pre and post intervention surveys including the Adult Self Report (ASR) and the Child Behaviour Checklist (CBCL).Significantly greater improvements were seen in the Enhanced Stepping Stones Triple P ASR ADHD scores compared to the Stepping Stones Triple P group, however this was not significant after correcting for multiple testing. No additional benefits of the Enhanced Stepping Stones Triple P group were seen for the children's scores. In both groups, the CBCL oppositional defiance and ASR anxiety scores showed nominally significant improvements. None of these remained significant after correcting for multiple testing.The results highlight that families with concurrent parent and child mental health symptoms face unique challenges and increased burdens, and further research is needed in how to tailor programs that best suit their needs and to improve program engagement.