Social participation greatly determines health-related quality of life, while people with hemophilia face severe social engagement restrictions. Current studies only explore such barriers from single dimensions including joint function, employment and mental distress, lacking a comprehensive social-ecological perspective. Based on social-ecological systems theory, this study systematically analyzes multi-level barriers to social participation among Chinese hemophilia patients to support integrated nursing intervention development.

A descriptive phenomenological qualitative design was employed. Purposive and snowball sampling strategies were used to recruit 15 adults with hemophilia from the hematology department of a tertiary hospital in China between February and July 2026. Individual semi-structured in-depth interviews were conducted using a topic guide informed by the three-system framework (micro-, meso-, and macro-). Data were analyzed using Colaizzi's seven-step method, with two researchers independently coding and reaching consensus through discussion. NVivo 14 was used to facilitate data management.

Nine themes and 20 sub-themes were identified across the three system levels. Micro-system barriers comprised: (1) progressive joint damage and functional limitations; (2) psychosocial distress and maladaptive coping; and (3) inadequate disease knowledge and self-management deficits. Meso-system barriers comprised: (4) catastrophic medication costs and family resource depletion; (5) family caregiving deficits and role overload; and (6) employment exclusion and social network contraction. Macro-system barriers comprised: (7) insurance coverage gaps and treatment access barriers; (8) geographic disparities in healthcare access; and (9) social stigma and inadequate institutional support. Critically, barriers across the three levels did not operate in isolation but interacted to produce a cumulative, compounding deprivation of social participation.

Social participation barriers among people with hemophilia represent a complex, multi-layered phenomenon embedded within the micro-, meso-, and macro-systems of the social ecology. Nursing care should shift from a biomedical-only paradigm toward an integrated model: strengthening symptom management and psychological empowerment at the micro-level, promoting family enablement and social network reconstruction at the meso-level, and advancing policy advocacy and public education at the macro-level.

Physical activity (PA) may improve physical and mental health in alcohol use disorder (AUD), yet poor adherence limits its clinical impact. Inpatient alcohol withdrawal represents a critical window for initiating health behavior change, although patients are often encouraged to rest.

We evaluated whether supervised adapted physical activity (APA) can be feasibly implemented during inpatient withdrawal care and whether it influences short-term health and exercise engagement and motivation compared with free access to a PA room (FPA).

In this real-world study, 64 participants with severe AUD (26.5% women; mean age = 45.8 ± 11 years) completed pre- and post-assessments during a three-week inpatient withdrawal program. Participants were sequentially allocated to supervised APA or FPA with general advice. Feasibility (attendance and adverse events), session satisfaction, health outcomes (anxiety, depressive symptoms, self-esteem, craving, sleep quality, and physical functional capacity), and PA motivation (amotivation, extrinsic, and intrinsic motivation) were assessed after acute withdrawal at hospital discharge (post-test).

APA participants engaged in significantly more PA (p < 0.05), with high levels of session satisfaction (median = 8.86 and 8.83/10), and an attendance rate of 83%. Health outcomes and amotivation improved over time in both groups (p < 0.001), without group-by-time interaction. Motivation showed a significant group and interaction effect (p < 0.05): APA participants scored higher post-test, while FPA participants decreased in extrinsic motivation (p = 0.013). Intention-to-treat analyses revealed consistent findings.

Implementing supervised APA during early withdrawal treatment is feasible and acceptable. While short-term clinical improvements were similar across groups, APA strengthened motivational processes relevant to PA engagement during recovery.

This study aimed to investigate the associations among perceived stress, sleep quality, physical exercise, and suicidal ideation among Chinese graduating-grade secondary school students. Specifically, this study examined whether sleep quality mediated the association between perceived stress and suicidal ideation and whether physical exercise moderated these relationships. In addition, machine-learning prediction models and network analysis were applied to identify important predictors and interconnected symptoms associated with suicidal ideation.

A cross-sectional survey was conducted among ninth- and twelfth-grade students from 13 secondary schools in Yunnan Province, China. A total of 4,372 valid questionnaires were collected. Participants completed measures of perceived stress, sleep quality, suicidal ideation, and physical exercise. Mediation and moderated mediation analyses were conducted using PROCESS models after adjusting for demographic covariates. Furthermore, ridge regression and gradient boosting tree models were used to predict suicidal ideation, with Shapley additive explanations (SHAP) applied to evaluate predictor contributions. Network analysis was conducted to explore central and bridge nodes among study variables.

Perceived stress was positively associated with suicidal ideation, and sleep quality partially mediated this association. Physical exercise significantly moderated the direct association between perceived stress and suicidal ideation as well as the association between sleep quality problems and suicidal ideation. Specifically, higher levels of physical exercise weakened the positive relationships between perceived stress, sleep problems, and suicidal ideation. Machine-learning analyses showed that sleep quality problems, perceived stress, physical exercise, and their interaction terms contributed substantially to the prediction of suicidal ideation, with both models achieving an R² of approximately 0.41 in the hold-out test set. Network analysis further identified subjective sleep quality, sleep latency, sleep disturbances, stress-coping burden, and physical exercise frequency as highly connected nodes within the network.

Among Chinese graduating-grade secondary school students, perceived stress, poor sleep quality, and suicidal ideation were closely interconnected, whereas physical exercise appeared to attenuate these risk associations. Integrating stress management, sleep improvement strategies, and regular physical exercise into school-based mental health programs may provide potential approaches for suicide risk prevention among adolescents.

Regular exercise is vital for preventing cardiovascular disease, maintaining a healthy body weight and supporting mental well-being, yet most people exercise insufficiently often due to motivational barriers.

This study examined two types of exercise motive-functional (divided into health/fitness and enjoyment) and appearance-and their interplay with mood and exercise engagement in daily life. Two hypotheses were tested: (H1) functional motives, compared to appearance motive, predict greater exercise engagement, and (H2) higher (more positive) mood, in interaction with exercise motives, predicts greater exercise engagement.

Ninety-eight healthy BMI women completed a 2-week smartphone Ecological Momentary Assessment (EMA) protocol reporting exercise motive (baseline), exercise engagement (frequency, intensity, duration) and mood several times/day.

Partially supporting H1, enjoyment motive predicted greater exercise frequency and duration, whereas-contrary to H1- health/fitness motive predicted shorter duration and appearance was unrelated to engagement. H2 was not supported: mood did not predict engagement and functional motives did not strengthen the mood-engagement link. Contrary to H2, the appearance motive strengthened the (same-moment) within-person association between mood and exercise intensity, such that women higher in appearance motive showed a stronger positive mood-intensity link. Multilevel temporal networks revealed that higher (more positive) mood at one assessment weakly predicted greater exercise intensity and duration at the next assessment.

Together, enjoyment emerges as central to exercise engagement, while positive mood temporally precedes exercise, informing future lifestyle interventions. Further research on the temporal dynamics linking mood and exercise is warranted.

Across West Africa, HIV, mpox, stigma, and health-system barriers may interact in ways that compound clinical and social harms and challenge disease-specific models of care. This commentary proposes a practical, tripartite harm-reduction framework for integrated, person-centred syndemic management, designed not only to reduce morbidity associated with HIV and mpox but also to reduce harms arising from stigma, criminalization, inadvertent disclosure, and discriminatory health services. We propose: [1] integrated clinical pathways that provide HIV, mpox, and mental health services through co-location or discreet referral options while preserving voluntary access, confidentiality, and patient choice; [2] person-centred surveillance using ethically governed, de-identified data linkage to reduce fragmentation while protecting privacy and autonomy; and [3] funded, community-led interventions that address stigma, discrimination, criminalization, and exclusion from care through peer navigation, targeted communication, and legal and policy advocacy. We argue that this operational shift, supported by pragmatic implementation research, provides a testable approach to reducing clinical, social, and health-system harms associated with the syndemic. We encourage national health ministries, regional bodies, and global health partners to support the co-design, resourcing, and rigorous evaluation of pilot programmes in appropriate settings. Through integrated action that treats the whole person within their social context, this framework provides a testable approach to informing more equitable and resilient health-system responses in West Africa.Clinical trial number: Not applicable.

This study aims to identify the socio-demographic and health-related factors associated with depression among individuals in Türkiye and to examine whether the pattern of factors associated with depression varies across educational groups.

This study uses data from the 2022 Türkiye Health Survey conducted by the Turkish Statistical Institute. The sample consists of 22,742 individuals, including 13,070 with below-high school education and 9,672 with high school education or higher. Binary logistic regression models were applied to identify the factors associated with individuals' likelihood of experiencing depression within the last 12 months according to educational level.

Among individuals with lower educational attainment, female sex, older age, marital status, alcohol use, tobacco use, poorer self-rated general health, the presence of chronic disease, and a history of heart attack were significantly associated with depression. Among individuals with higher educational attainment, female sex, age, marital status, alcohol use, tobacco use, general health status, chronic disease, and limitations in daily activities due to health problems were significantly associated with depression.

Policies aimed at improving mental health outcomes should focus on reducing socioeconomic disadvantages, improving access to mental health services, and implementing targeted interventions for high-risk groups. Understanding how the factors associated with depression vary across educational levels may contribute to more effective and equitable mental health strategies.

Refugee communities across the world have long gathered to connect and support one another during times of crisis, and this has been well-documented. Despite the vast amount of literature pertaining to coping and resiliency among refugee communities, there is limited knowledge about refugee community healing. Approximately one in three refugees experiences depression, anxiety, or post-traumatic stress that can persist long after displacement. Dominant approaches within Western, Educated, Industrialized, Rich, Democratic (WEIRD) psychologies tend to conceptualize trauma through an individualistic lens, often overlooking social, historical, and collective dimensions of suffering. This can result in siloed findings with limited relevance to refugee communities. Addressing this gap, this paper reports on the third phase of a Decolonizing Participatory Action Research (PAR) study examining historical trauma and intergenerational healing among second-generation Tamil refugee young adults in Toronto. This community-driven study foregrounds a praxis of healing envisioned with, by, and for refugee communities. Two research questions guided the inquiry: (1) What elements are important for community healing among Tamil young adults? and (2) What do community healing practices and therapeutic interventions look like in this context? Using storytelling and participatory avatar-based community circles, alongside reflexive thematic analysis, seven key elements of community healing were identified: (1) agency and self-determination; (2) historical trauma-informed approaches; (3) cultural safety; (4) intergenerational connectedness and belonging; (5) destigmatized access and delivery; (6) holistic and authentic healing practices; and (7) truth-telling as justice. Findings highlight community healing as a dynamic, dialectical process, requiring both resistance to intersecting systems of oppression and the cultivation of radical hope for justice and liberation. Findings also emphasize the importance of culturally grounded, community-led interventions in promoting mental well-being. This study contributes innovative, participatory methodology and actionable insights for practitioners and policymakers, advancing a shift toward liberatory approaches to refugee health.

Ketamine induces a sequence of temporally distinct effects on brain function, yet its impact on reward processing beyond the acute post-administration phase remains unclear. In this single-blind, placebo-controlled, crossover study, 28 healthy participants received 0.5 mg/kg racemic ketamine or placebo via a 40 min intravenous infusion. Functional magnetic resonance imaging was acquired approximately 5 h post-infusion during the Monetary Incentive Delay (MID) task, targeting the subacute phase after resolution of acute dissociative effects. Plasma concentrations of ketamine and norketamine were obtained for pharmacokinetic modeling and area under the curve estimation. At 5 h post-administration, ketamine did not significantly modulate brain activation during the MID task in either ROI-based or whole-brain analyses, despite measurable subjective drug effects. Pharmacokinetic modeling yielded ketamine and norketamine concentration-time profiles consistent with expected pharmacokinetic patterns, however, neither individual drug exposure nor psychometric measures showed robust associations with MID task-related neural activation. These findings suggest an absence of detectable task-evoked effects under the present methodological conditions. When considered alongside prior work, they are consistent with the possibility that ketamine's effects on reward circuitry are time-sensitive and may be more prominent during the acute post-administration phase or in clinical populations with pre-existing reward dysfunction.

Prosocial behavior, the tendency to act for others' benefit, is essential for mental health. Although social contexts strongly shape prosocial behavior in healthy individuals, its relevance across psychiatric disorders remains unclear. We examined whether context-dependent prosocial behaviors were associated with baseline psychiatric symptoms and longitudinal symptom trajectories. In a one-year longitudinal cohort study, Swedish adults (n = 4484) with at least one self-reported psychiatric disorder completed standardized questionnaires of six prosocial behavior subtypes at baseline, followed by monthly reports of alcohol use, substance use, anxiety, and depressive symptoms. Latent class linear mixed models identified longitudinal symptom trajectories, and logistic regression models investigated their associations with baseline prosocial behavior subtypes. All models adjusted for demographic covariates and shared variance across psychiatric symptom domains. Three prosocial behavior subtypes showed longitudinal associations with stable psychiatric symptom trajectory classes. Higher anonymous prosociality was associated with lower odds of belonging to the stable high alcohol use trajectory (OR = 0.89, p = 0.013). Higher public prosociality was associated with higher odds of belonging to the stable high substance use trajectory (OR = 1.15, p = 0.036). Higher emotional prosociality was associated with higher odds of belonging to the stable high anxiety trajectory (OR = 1.25, p < 0.001). No prosocial subtype was associated with depressive symptom trajectories. Overall, context-dependent prosocial behaviors were associated with persistent levels of alcohol use, substance use, and anxiety symptoms. These findings suggest that specific prosocial behaviors may refine transdiagnostic models of social dysfunction by indexing stable patterns of psychiatric symptom burden.

Emotional disorders-primarily anxiety and unipolar depressive disorders-are highly prevalent, disabling, and frequently comorbid. Disorder‑specific cognitive behavioral therapy (DS‑CBT) is considered a gold standard treatment, yet it can be inefficient in the context of high comorbidity and service constraints. Transdiagnostic psychotherapies that target shared maintaining mechanisms (eg, emotion dysregulation and neuroticism) have been developed, including the Unified Protocol, transdiagnostic behavior therapy, emotion regulation therapy, and various transdiagnostic internet-delivered cognitive behavioral therapy protocols. Recent meta-analyses suggest that transdiagnostic interventions are effective or likely effective, but a comprehensive comparative evaluation across different transdiagnostic protocols, DS‑CBT, other evidence‑based psychotherapies, and control conditions is lacking.

This study aims to conduct a network meta-analysis (NMA) to compare the efficacy and acceptability of various transdiagnostic therapies (eg, the Unified Protocol, transdiagnostic behavior therapy, and emotion regulation therapy), DS-CBT, other evidence-based active therapies (eg, acceptance and commitment therapy, behavioral activation, and mindfulness-based cognitive therapy), and control conditions (waitlist or care as usual) in improving symptoms in adults with anxiety and/or depressive disorders and generate a probabilistic ranking of their efficacy.

This meta-analysis will include randomized controlled trials from PubMed, Embase, PsycInfo, and the Cochrane Library, complemented by existing meta‑analytic research domain databases for depression and anxiety. Eligible participants are adults (≥18 years) with a principal diagnosis of anxiety and/or unipolar depressive disorder according to established diagnostic classification systems (eg, any version of the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, 10th or 11th revisions) or scoring above a validated cutoff on anxiety or depression scales. Primary outcomes are continuous measures of anxiety and depressive symptom severity at the posttreatment time point; secondary outcomes include study dropout (acceptability) and response or remission where available. We will perform random-effects network meta-analyses within a frequentist framework using the netmeta package in R to estimate relative treatment effects and P scores for treatment rankings and examine transitivity and consistency. We will conduct additional Bayesian NMAs as sensitivity analyses using the surface under the cumulative ranking curve for ranking.

As of September 2026, the literature search has been completed, and title and abstract screening is ongoing. Data analysis will be conducted in late 2026. We expect the meta-analysis to be completed and submitted for publication by the end of 2026, with results expected to be published in early 2027.

This NMA will provide comprehensive comparative evidence on the efficacy and acceptability of transdiagnostic psychotherapies for emotional disorders, which can inform clinical decision-making and guideline development.

OSF Registries osf.io/p8957; https://osf.io/p8957/overview.

DERR1-10.2196/104791.