The sociopolitical environment can act as a potent stressor with significant consequences for health and well-being. Of increasing global relevance in this context is soft political repression, including denunciation and surveillance, which is employed to prevent oppositional behavior while minimizing international attention. Although common in authoritarian regimes, including the former German Democratic Republic (GDR; 1949-1990), little is known about its psychobiological health consequences. We examined 100 individuals raised in the GDR (49 exposed to repression, 51 matched controls) to investigate stress responses, a key pathway to long-term health. Participants completed questionnaires and, if health-related inclusion criteria were met and they felt able to complete the task, underwent the Trier Social Stress Test (TSST; repression n = 29, controls n = 46). Subjective stress, cortisol, heart rate, and heart rate variability were assessed. The repression group reported higher stress, but did not differ from controls in physiological measures. Subgroup analyses showed that repression participants who declined attending the TSST exhibited elevated symptoms of distress, anxiety, depression and trauma, whereas completers were comparable to controls. Our findings suggest differential long-term consequences of soft political repression, with preliminary evidence for both vulnerable and resilient groups and raise broader methodological questions regarding the ecological validity of laboratory-based stress research in vulnerable groups.

Maladaptive self-beliefs are a core symptom of major depressive disorder. These beliefs are perpetuated by a negatively biased integration of self-related feedback. Understanding the neurocomputational mechanisms of biased belief updating may help to counteract maladaptive beliefs and the maintenance of depression.

The present study uses a belief-updating task and functional neuroimaging to examine the neurocomputational mechanisms associated with self-related feedback processing in individuals with major depression (n = 35) and matched healthy controls (n = 32). We hypothesized that increased symptom burden in depression is associated with negatively biased self-belief updating and altered hemodynamic responses to social feedback.

Our findings show that, in the clinical sample, the incorporation of unexpected positive feedback was reduced with greater symptom burden, and that insula reactivity was generally elevated to unexpected negative feedback.

The interplay of increased hemodynamic responsiveness to negative feedback and the reduced learning from positive feedback provide new insights into cognitive distortions in depression and may explain the persistence of maladaptive self-beliefs and, thus, the maintenance of depression.

Suicide is the leading cause of death among adults aged 20-34 in England and Wales. Around 80% of those who die by suicide have consulted a GP within the previous year, making primary care a critical setting for prevention. Rates in Yorkshire and the Humber (YH) exceed the national average (12-13 deaths per 100 000 population).

To explore GPs' perspectives on suicide prevention in primary care across YH.

Qualitative study with GPs from diverse practices in YH.

Purposive sampling ensured variation in demographics and patient populations. Semi-structured interviews were conducted until data saturation. Transcripts were analysed using Thematic Analysis.

Fourteen interviews were completed (10 female, 4 male). Participants served varied populations, including asylum seekers and Roma patients. Four themes emerged: "Integration with mental health and third sector services" highlighted inconsistent mental health service organisation and the role of third sector support. "Challenges of assessing and managing risk" highlighted perceived barriers to responding to suicide risk within time and resource constraints. "Continuity of care" describes the importance of developing ongoing relationships to support suicide prevention in primary care and the risks and threats to achieving this. "Building on knowledge" describes the absence of systematic case review in general practice after suicide.

An integrated, resourced system with equitable access to primary care mental health workers and third sector support may enhance suicide prevention. Continuity of care was valued but undermined by inflexible models prioritising same-day triage over personalised mental health primary care.

To evaluate the effectiveness of Tuberculosis Treatment Support Tools (TB-TST), a patient centred digital adherence technology, in improving treatment outcomes among individuals with drug susceptible tuberculosis in Argentina.

Pragmatic, two arm, parallel randomised controlled trial.

Four public reference hospitals in Buenos Aires, Argentina.

555 patients aged ≥16 years with newly diagnosed drug susceptible tuberculosis, recruited between November 2020 and July 2023, randomised to standard of care (n=278) or standard of care plus TB-TST (n=277).

A mobile application that enabled daily adherence reporting, bidirectional messaging with treatment supporters, educational content, and a weekly urine based isoniazid test for verification of adherence. Participants and care givers were aware of their group assignment, but data collectors and data analysts were masked.

The primary outcome was treatment success (cure or treatment completion). Secondary outcomes included loss to follow-up. Analyses used intention-to-treat and per protocol approaches.

525 participants (94.6% of the enrolled population) were included in the analysis after exclusion of 30 individuals who deviated from the protocol. In the intention-to-treat analysis, treatment success was higher in the intervention group (208/255; 82%) than in the control group (201/270; 74%). The risk difference was 7.1% (95% confidence interval 1.1% to 14.1%), and the risk ratio was 1.10 (1.00 to 1.20; P=0.04). Loss to follow-up was lower in the intervention group (17% v 24%; risk ratio 0.70, 0.50 to 0.98; P=0.04). Greater benefit was observed among female participants and those aged under 35 years.

A multifaceted, interactive digital adherence tool improved tuberculosis treatment outcomes, particularly among younger participants and women, showing feasibility and effectiveness in supporting adherence to tuberculosis treatment in low resource settings. Future research should evaluate the impact of app engagement, context factors such as the covid-19 pandemic, cost effectiveness, and use of the tool beyond tuberculosis in the management of chronic diseases. AI powered features and integrated mental health support may enhance the scalability and personalisation of care.

ClinicalTrials.gov NCT04221789; International Registered Report Identifier DERR1-10.2196/28094.

Identifying those at highest risk of making a first suicide attempt during adolescence is crucial to inform early suicide prevention. Our study aimed to predict the first ideation-to-attempt transition during adolescence among children with suicidal ideation at baseline using 187 sociodemographic, clinical, neurocognitive, functional and structural brain predictors.

Data was obtained from the multisite, longitudinal Adolescent Brain Cognitive Development (ABCD) study, conducted in 21 US sites among 11,864 children aged 9-10 years at baseline with 4 follow-up waves measured between 2018-2022. The primary outcome was suicide attempt reported at any of the follow-up waves amongst children with suicidal ideation at baseline. Machine learning models were trained using 70% of the sample from 14 sites, and validated in participants from 7 holdout sites.

The final sample included 660 children with suicidal ideation at baseline (no previous suicide attempt; mean[SD] age: 9.91[0.63] years; 42% female at baseline), of whom 83 children had a first suicide attempt within 4 year follow-up. The final model, which excluded the brain imaging feature as its inclusion did not improve performance, generalized well to the external holdout sites (AUC-ROC[95% CI]=0.75[0.68, 0.83], sensitivity = 0.65 [0.61, 0.75], specificity = 0.69 [0.50, 0.80], PPV = 0.23 [0.15, 0.34], NPV = 0.94 [0.88, 0.97]), p <.001) with good expected calibration error of 0.03. The model was unbiased across race and sex subgroups. The top contributing features included female sex, presence of self-harm, access to means, generalized anxiety disorder, social anxiety, impulsivity, severity of suicidal ideation, parental income and clinical treatment history.

Our model using clinically accessible features predicts the first-onset suicide attempt in children. Most predictors (e.g., suicidal ideation severity, impulsivity, anxiety symptoms) are modifiable, highlighting the potential intervention targets. Findings provide longitudinal evidence for key risk factors for the ideation-attempt transition in current suicide theories.

Most tobacco use begins during adolescence. We used National Youth Tobacco Survey (NYTS) data from 2023 and 2024 to examine menthol tobacco product use among US middle and high school students.

We used pooled data from the 2023 and 2024 NYTS (n = 51,930) to calculate nationally representative prevalence estimates for past 30-day menthol and nonmenthol tobacco product use, stratified by sociodemographic and mental health indicators. We used χ² tests with Benjamini-Hochberg adjustments to compare behaviors.

During 2023 and 2024, 22.1% of students who currently used tobacco (representing 520,000 students) used menthol products. Overall, menthol products were used by 40.0% of students who smoked cigarettes, 18.0% who used e-cigarettes, and 11.5% who smoked cigars. Menthol tobacco use was significantly higher among males (vs females) (26.1% vs 18.3%), high schoolers (vs middle schoolers) (23.9% vs 17.0%), and those with moderate to severe anxiety or depression (vs no or mild symptoms) (25.0% vs 18.8%). By race and ethnicity, use ranged from 12.0% (non-Hispanic Black) to 28.6% (non-Hispanic multiracial). Compared with students who used nonmenthol products, a higher proportion of those who used menthol cigarettes or e-cigarettes reported younger age at first use of tobacco (<11 y) (42.5% vs 26.8% and 19.9% vs 13.2%, respectively), use on 20 to 30 of the past 30 days (38.2% vs 20.2% and 53.4% vs 33.2%, respectively), and fewer past-year smoking quit attempts (49.7% vs 63.2%, respectively).

More than 500,000 US middle and high school students used menthol products; prevalence varied by sociodemographic and mental health indicators. Menthol tobacco use correlates with earlier initiation, higher frequency of use, and reduced past-year quit attempts. Additional efforts to reduce access to menthol products among young people may reduce tobacco use in this population.

Cognitive function is a critical concern in older adults, and digital exclusion may accelerate its decline. However, the underlying mechanisms remain unclear. This study examined the serial mediating roles of social participation and depressive symptoms in the association between digital exclusion and cognitive function.

7806 participants aged ≥ 60 years from the China Health and Retirement Longitudinal Study were included in the study. Cognitive function was assessed using the Mini-Mental State Examination, while digital exclusion was operationalized through internet access and usage. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, while social participation was characterized by engagement in nine activities. Serial mediation analyses were conducted using the SPSS PROCESS macro, controlling for significant covariates.

After adjustment for covariates, digital exclusion was significantly associated with poor cognitive function. The indirect effect was significant (B = -0.964, 95% Confidence Interval [CI]: -1.175, -0.755), accounting for 77.68% of the total effect, whereas the direct effect was not statistically significant. Social participation was the main mediator (B = -0.869, 95% CI: -1.075, -0.755), followed by depressive symptoms (B = -0.061, 95% CI: -0.109, -0.019). A significant serial mediating effect of social participation and depressive symptoms was also observed (B = -0.034, 95% CI: -0.057, -0.016).

Social participation and depressive symptoms act as significant serial mediators between digital exclusion and cognitive function in older adults. The findings underscore the relevance of psychosocial well-being in the relationship between digital exclusion and cognitive health in later life.

Face-to-face psychotherapy remains the gold standard for mental health treatment; however, it faces accessibility barriers, including geographical constraints, costs, and stigma. Although videoconferencing psychotherapy addresses some limitations, challenges with engagement and therapeutic alliance persist. Avatar-mediated telepsychotherapy (AMT) in a metaverse-informed virtual environment has been proposed as a possible extension of digitally delivered mental health care, combining digital accessibility with enhanced presence through anonymous avatar-mediated communication.

This exploratory qualitative study examined how participants experienced avatar-mediated psychotherapy within a virtual environment, with particular attention to perceived design features that may facilitate psychological engagement, self-disclosure, and sustained participation.

We conducted a qualitative study using a minimum viable product platform among adults aged 19-70 years who self-reported psychological health management needs but had not been diagnosed with a major mental disorder, recruited from Korea University Anam Hospital and Korea University (n=60). The participants attended 4 weekly sessions (50 minutes each) using anonymous avatars reflecting real-time facial expressions and nonverbal cues. After completion, 30 participants (16 women and 14 men; 15 hospital employees and 15 university students) were purposively selected for semistructured interviews (30-50 minutes). Data were analyzed by 4 researchers using thematic analysis with ATLAS.ti software (Lumivero).

From 508 initial codes, 4 main themes emerged through iterative analysis. (1) Balancing anonymity and self-disclosure through avatars: anonymous avatars appeared to facilitate greater self-expression, with a sense of psychological safety throughout therapy sessions while maintaining emotional connection with therapists through synchronized nonverbal expressions. The synchronization of nonverbal expressions appeared to contribute to self-identification. (2) The holistic role of metaverse spaces in psychotherapy: pretherapy spaces were perceived as a psychological transitional area, alleviating tension and anticipatory anxiety. Therapy spaces required focused design that accommodated user preferences regarding the visibility of their own avatars. Posttherapy spaces were perceived as supporting self-reflection and anonymous community connection. (3) Consideration for meta-connection: participants described a need for cyclic feedback mechanisms that could help connect session experiences with everyday reflection and intended behavior. Metaverse settings demanded distinct therapist protocols to confirm therapists' attentiveness through avatar-mediated verbal and nonverbal communication to maintain therapeutic alliance. (4) Consideration for metaverse-informed psychotherapy space design: avatar customization may serve not only as a means of self-expression but also as a source of social connection or a sense of community. Technical stability, cross-platform accessibility, and user guidance were identified as key design considerations for developing psychologically engaging and technically reliable avatar-mediated psychotherapy environments.

This study yields a set of qualitative design requirements for AMT, including anonymous avatars with behavioral realism rather than visual similarity, multistage spaces supporting the therapeutic journey, cyclic feedback mechanisms connecting virtual and real-world experiences, and integrated therapist competency development. These findings provide preliminary design implications for accessible and engaging AMT environments.

Many features of social media platforms can influence safety in relation to self-harm/suicide-related content. In 2019, platforms including Meta updated their policies regarding self-harm/suicide content. This included community guidelines, content restrictions, and signposting. The impact of these safety measures has yet to be fully evaluated.

This study aimed to better understand the perspectives of social media users on safety measures related to self-harm/suicide content, including perspectives of those with a history of self-harm.

This was a cross-sectional mixed methods study. Participants were recruited through convenience sampling. Quantitative data were collected using a fixed-response cross-sectional survey (5294 respondents aged 16-84 years, largely women/girls or nonbinary). Questions related to the experience of self-harm and suicide content, the change policy in 2019, and specific features of platforms. Qualitative data were collected via semistructured interviews (17 participants aged 16-56 years) with interview guides broadly following the topic areas of the survey. Interviews were analyzed using thematic analysis.

Half of the survey respondents (49.8%, 95% CI 47.8%-51.8%; 2476/4970) stated the current restrictions made social media feel safer, 34.9% (95% CI 32.6%-37.2%; 1736/4981) reported that this changed what they saw on social media, and just 9.9% (95% CI 7.5%-13.0%; 492/4479) stated that this changed what they posted. Furthermore, 64.3% (95% CI 62.6%-65.9%; 3212/4997) stated that they would be "very likely" to click on a post marked with a generic content warning, with 15.1% (95% CI 12.6%-17.9%; 753/4998) being "very likely" to click on a post with a self-harm specific content warning. Of the respondents who had content removed due to mental health or self-harm content, ~90% indicated that this was harmful or very harmful to them at the time, particularly where content was removed because of visible scars (extremely harmful 58.3%, 95% CI 54.3%-62.3%; 599/1027; harmful 31.3%, 95% CI 26.3%-36.7%; 321/1027). Thematic analysis of in-depth interviews revealed 13 subthemes organized into 7 overarching thematic areas. Participants described the experience of social media platforms before and after the policy changes, with opinions divided on whether existing safety features were effective. Participants described the distress caused by inappropriate censoring of images, for example, where healed self-harm scars were visible. Suggestions were made for how platforms can continue to improve, including age verification procedures for young people, tailored signposting, and increased control over content.

To our knowledge, this is the first study to explore the 2019 change in platform policies with respect to self-harm/suicide-related content from the perspectives of those with a history of self-harm. This research adds to the evidence of the risks and unintended consequences of imposing untested blanket restrictions in online settings. Full evaluation of these restrictions is essential to allow platforms to continue to improve, encouraging a safe space for supportive communities while mitigating potential harm.

Older adults living with dementia often have limited tolerance for intraoral procedures, which can restrict access to even basic oral health assessment in clinical care. Procedural burden-characterized by sustained intraoral manipulation, sensory overload, and limited opportunities for interruption-may represent a key barrier to equitable oral care. Intraoral scanning (IOS) enables stepwise, interruptible acquisition of oral data and may reduce this burden, but feasibility and tolerability in people living with dementia have not been systematically evaluated.

This study aimed to assess the feasibility and tolerability of bedside maxillary IOS compared with a conventional impression procedure in people living with dementia.

A single-center, nonrandomized, counterbalanced, crossover feasibility study was conducted in a geriatric ward. Nineteen hospitalized participants with dementia (mean age 83.5, SD 3.4 years; mean Mini-Mental State Examination score 18.2, SD 4.8) underwent both bedside maxillary IOS and a conventional alginate-based impression procedure during a single visit. The order of procedures was not randomized but assigned using an alternating allocation sequence based on chronological enrollment to counterbalance potential order effects. The primary outcome was feasibility, defined as procedure completion without premature termination due to gag reflex, defensive movements, participant refusal, or withdrawal of assent or cooperation. Secondary outcomes included participant-rated discomfort using a 0 to 10 visual analog scale (VAS); clinician-rated manageability using a 0 to 10 VAS, with higher scores indicating greater difficulty; adverse reactions, including gag reflex and defensive movements; and active bedside procedural time in minutes. Paired comparisons were performed using the Wilcoxon signed-rank tests for VAS outcomes, a sign test for active bedside procedural time, and McNemar tests for binary outcomes, with a 2-sided significance level of .05.

Participants reported significantly lower discomfort with IOS than with the conventional impression procedure (median 1.0, IQR 0.5-1.5 vs median 7.75, IQR 3.7-8.5; P<.001), and clinician-rated manageability was more favorable for IOS (median 2.0, IQR 1.0-3.0 vs median 5.0, IQR 3.0-6.5; P<.001). Active bedside procedural time was similar in the analysis of all initiated procedures, with a mean duration of 3.02 (SD 0.72) minutes for IOS and 2.92 (SD 0.78) minutes for the conventional impression procedure. Exploratory analyses showed no statistically detectable evidence of an order effect. Gag reflex occurred less frequently during IOS (1/19, 5.3% vs 9/19, 47.4%; P=.004).

Bedside IOS was feasible in hospitalized older adults living with dementia and was associated with lower immediate procedural burden than a conventional alginate-based impression procedure. These findings support further evaluation of IOS as a low-burden approach for oral data acquisition in dementia care, while downstream treatment effects and implementation in other settings require further study.