Across interventions for major depressive disorder (MDD), symptoms often persist after treatment. These residual symptoms increase risk for depression relapse and reduce quality of life. Exercise is a common adjunctive intervention for MDD with potential to reduce common residual depression symptoms, yet the frequencies and types of residual symptoms following exercise interventions have seldom been examined and could inform recommendations for maximizing response.

This study was a secondary analysis of a randomized clinical trial comparing weekly exercise therapy programs (i.e., surf or hike) among 96 active duty service members with MDD. Symptom measures were completed at preprogram, postprogram, and 3-month follow-up. Among the 88 service members who completed a postprogram assessment, analyses examined whether exercise therapy type and loss of diagnosis were related to the odds of reporting each residual depression symptom.

Both interventions significantly improved depression symptoms. Exercise therapy type was not related to the odds of any individual residual symptom (ps ≥ .225). Loss of MDD diagnosis reduced the odds of residual depression symptoms (ps ≤ .039), except for suicidal ideation at 3-month follow-up (p = .088). Sleep difficulties (56%), low energy (38%), and appetite changes (22%) remained common at postprogram among participants who lost their diagnosis. Secondary analyses examined residual posttraumatic stress disorder (PTSD) symptoms in the subgroup with this comorbidity (n = 58, 66%). PTSD results showed similar patterns, with sleep disturbance (42%) frequently persisting at postprogram even among those who lost their PTSD diagnosis.

Residual depression symptoms were commonly transdiagnostic and mirrored those reported following evidence-based depression treatments. Additional strategies for reducing residual symptoms following weekly exercise therapy may be warranted for maximum symptom reduction.

Omega-3 polyunsaturated fatty acids (PUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), possess anti-inflammatory properties, yet their association with obesity-depression comorbidity remains unclear. This study investigated the association among US adults and explored underlying mechanisms. We performed a cross-sectional analysis of 4,423 individuals participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2004 & 2011-2014. Serum fatty acids were quantified by gas chromatography. Obesity was defined using anthropometric criteria, and depression was assessed using the PHQ-9 or antidepressant use. Multivariable logistic regression estimated odds ratios (ORs) per standard deviation (SD) increase in PUFA levels. Mechanistic explore through network pharmacology identified potential pathways, which were examined using correlation analyses with inflammatory indices. Higher omega-3 PUFA levels were associated with lower odds of central obesity comorbid depression in females (OR: 0.82, 95% CI: 0.69-0.96) and older adults (OR: 0.79, 95% CI: 0.64-0.97). DHA was significantly associated with lower odds of central obesity (OR: 0.83, 95% CI: 0.73-0.95), depressive symptoms (OR: 0.88, 95% CI: 0.77-1.00), and their comorbidity (OR: 0.85, 95% CI: 0.74-0.98), whereas no significant associations were found for EPA. Mechanistic exploration implicated DHA in TNF and IL-17 signaling pathways, supported by inverse correlations with monocyte-to-HDL ratio (r: -0.138, P < 0.001) and lymphocyte-to-HDL ratio (r: -0.108, P < 0.001). In conclusion, serum DHA is inversely associated with obesity-depression comorbidity, with potential involvement of anti-inflammatory pathways. These findings underscore the potential of DHA for the management of obesity comorbid depression and the need for further interventional trials.

Mood disorders are highly prevalent in society, often disabling, and can lead to a reduced healthspan and lifespan, including by suicide. Depression and bipolar disorders are currently deemed to be chronic and/or treatment-refractory in up to half the patients treated. Additionally, depression and bipolar disorders need to be better distinguished, especially upon initial depressive presentations, as treatments can be quite different. Lack of widespread use of objective and/or quantitative information has hampered treatment and prevention efforts. We sought to uncover the underlying genomic and biological basis of mood disorders in a way that is reliable, comprehensive, and actionable. Blood biomarkers that track mood state can provide a window into the biology of mood, as well as could help with assessment and treatment of mood disorders. Previous studies by us were encouraging. Here we describe new studies we conducted trans-diagnostically in psychiatric patients, starting with the whole transcriptome, to expand the identification, prioritization, validation and testing of blood gene expression biomarkers for mood disorders, and their practical application. We first studied separately the two diametrical phenotypes, low mood/depression and high mood/mania. For each of the phenotypes, we carried out two separate studies, each of them on two different platforms, microarrays and RNA sequencing, using for each platform and study a multiple independent cohorts design. This was done to ensure both the biological and technical reproducibility of the final findings. We focused on biomarkers that were convergent and reproducible between the platforms in each study, for each phenotype. We found new as well as previously known biomarkers that were predictive of depression and of mania states, and of future hospitalizations related to them. We then compared and integrated the findings from the studies on the two phenotypes at the end, identifying bipolar biomarkers, that were changed in expression in opposite direction in the two phenotypes. Using a polyevidence score, the overall top gene expression blood biomarkers for depression were FKBP1A and FOSL2, for bipolar CTSB, and for mania ATP6V1C2. The top biological pathways for depression were related to immune response, for bipolar apoptosis, and for mania necroptosis. Top therapeutic matches for depression were omega-3 fatty acids, lithium, and vortioxetine; for bipolar depression lithium, valproate, and clozapine; and for mania lithium, valproate, and omega-3 fatty acids. Drug repurposing also identified the natural compounds curcumin and berberine as potential treatments for depression. We also illustrate how personalized patient reports for doctors based on gender- specific panels of top blood biomarkers would look like, which can aid with diagnosis and match patients in a personalized way to potential suggested treatments. Using such reports in n = 569 patients clinically diagnosed with depression or bipolar disorder, we distinguish 8 subtypes (depressive disorder, bipolar 2, bipolar 1, bipolar 3, and manic disorder, as well as the milder forms- dysthymia, cyclothymia, hyperthymia, and no mood disorder). Up to half of the patients were classified differently by our reports compared to their clinical diagnosis. Moreover, we demonstrate the clinical utility of our reports by showing that a mismatch between clinical diagnosis and biomarker- based assessment can lead to worse future hospitalizations outcomes. Specifically, patients who were (mis)diagnosed clinically as depression and were in fact on the bipolar spectrum based on biomarkers had increased future hospitalizations, not only for mood disorders exacerbation but also for suicidality and alcoholism. The converse was not true, patients who were (mis)diagnosed clinically as bipolar and were in fact on the depressive spectrum based on biomarkers fared well. Taken together, our results suggest that mood stabilizers, such as low-dose lithium, could be considered more often empirically first line in mood disorders patients, without or with the use of antidepressants, especially given the anti-suicidal properties. As mood disorders are highly prevalent, can severely affect quality of life, and lead to shortened lifespans, there is an urgent need for such insights, and for the added precision and personalization that biomarker tests can offer, to be applied to and improve clinical diagnosis, treatment, and prevention.

Ojectives The repercussions of a first episode psychosis (FEP) can be very trying for people suffering from it and those around them. The recovery process remains laborious and some people have difficulty engaging in it. Understanding better the effects of group intervention on people suffering from so-called negative symptoms or on those more resistant to usual treatments appears necessary. Adventure therapy stands out among group interventions for its outdoor activities, in a natural setting, aimed at behavioral changes. This study aims to better understand emerging group phenomena, as well as the functions of a group of young psychotic adults who participated in an adventure therapy program. The program included four weeks of preparatory meetings, followed by a four-day expedition in nature and a postexpedition debriefing session. Method This qualitative study is based on participant observation conducted throughout the program, as well as semi-structured interviews with 8 participants who experienced a FEP, carried out up to 6 months after the expedition. The research material was analysed using a thematic analysis, followed by an interpretative phenomenological analysis, in order to deepen the understanding of participants' lived experience. Results The analyses highlighted 8 key themes, 4 focused on group phenomena that emerged during the expedition (mutual support and initiative in interpersonal context, motivational effect, destigmatizing effect, solidarity) and 4 on the functions of group dynamics (containment, regulation, mediation, contemplation). Discussion Adventure therapy appears to promote setting in motion and the recovery of self-confidence among participants in addition to helping them overcome significant relational difficulties related to their mental health diagnosis. The structure of the program, the continuous presence of mental health professionals, as well as the presence of peers with a similar life path, seem reassuring and to allow for breaking isolation, socializing, developing emotional regulation skills, initiating reflections on lifestyle habits and, for some, changing these habits following the expedition. Conclusion This study highlights the therapeutic potential of adventure therapy, which can be beneficial and complementary to usual treatment in a global approach to the treatment of a FEP.

Military operations expose service members to stressful environments, characterized by anxiety, sleep deprivation, and physical and cognitive fatigue. Readiness, defined as the ability to deploy and sustain operational missions, is critical to military effectiveness but remains difficult to measure and quantify. The Army's Holistic Health and Fitness (H2F) System emphasizes that physical and cognitive readiness contribute to mental toughness and performance, yet practical readiness assessment tools remain limited. Previous research demonstrated associations between self-perceived readiness, measured using the Acute Readiness Monitoring Scale (ARMS), and performance on discrete perceptual-cognitive tasks. This exploratory mixed-methods study investigated the relationship between self-perceived readiness, objective performance outcomes, and cadets' perceptions of readiness. The objectives were to: (1) explore cadets' perceptions of readiness and the dual-task treadmill protocol in relation to future military service; (2) determine whether self-perceived readiness was associated with cognitive and physical performance during the protocol; and (3) examine whether self-perceived readiness was associated with changes in perceptual-cognitive control following the protocol. We hypothesized that higher self-perceived readiness would be associated with enhanced perceptual-cognitive control and performance.

Twenty-five physically active ROTC cadets (11 males, 14 females; mean age 19.5) from a large university participated. During a single visit, participants completed the 32-item ARMS, brief surveys assessing pain, stress, and mental fatigue, a dual-task treadmill protocol, and the Single Leg Memory Hop (SLMH) before and after treadmill testing. The treadmill protocol combined progressive physical exertion with 330 executive function tasks. Participants also completed semi-structured interviews exploring perceptions of readiness and the protocol experience. Quantitative data were analyzed using descriptive and correlational statistics, whereas qualitative data were analyzed using a constant comparison approach. Trustworthiness was maintained with peer debriefing, reflexive journaling, audit trail, triangulation, and member checking.

Cadets demonstrated variable physical and cognitive performance during the dual-task treadmill protocol. Most maintained high cognitive accuracy (mean Stroop score 96.6%), but endurance declined as exercise intensity increased. Correlation analyses revealed few significant relationships between overall ARMS scores and objective performance outcomes, although several ARMS subscales demonstrated moderate associations with endurance and perceived exertion. Qualitative findings indicated that cadets viewed readiness as a multidimensional construct influenced by sleep, physical fitness, nutrition, emotional regulation, commitment, and mindset. Participants perceived the protocol as physically and cognitively demanding and believed it provided insight into readiness for future military service.

Few significant relationships were observed between self-perceived readiness and objective performance measures. However, the qualitative findings suggest that cadets conceptualize readiness as a multidimensional construct extending beyond physical and cognitive performance alone. Together, the findings indicate that self-perceived readiness and objective performance may represent distinct but complementary aspects of military readiness. Additional research is needed to develop and evaluate readiness assessment approaches for future military leaders.

Although biological sex is frequently associated with distinct emotion regulation profiles, this dichotomy often overlooks the influence of sociocultural constructs. This study aimed to determine whether specific gender role attitudes predict the use of cognitive reappraisal and expressive suppression, and whether biological sex moderates these relationships.

A cross-sectional sample of 201 Ecuadorian university students completed the Gender Role Attitudes Scale and the Emotion Regulation Questionnaire. Data were analysed using multiple linear regressions and moderation analyses, controlling for income, mental health history, and marital status.

Biological sex neither significantly differentiated the use of cognitive reappraisal and expressive suppression, nor moderated the relationship between gender beliefs and these strategies. Following adjustments for multiple comparisons, non-egalitarian gender roles significantly and negatively predicted the use of both cognitive reappraisal and expressive suppression, whereas adherence to traditional roles positively predicted only the use of expressive suppression.

The findings suggest that the internalisation of sociocultural gender beliefs accounts for individual differences in specific emotion regulation strategies. Emotion regulation appears to be driven by perceived social permissibility, offering additional explanatory value beyond biological sex. Consequently, the promotion of egalitarian gender beliefs may be associated with increased psychological flexibility and adaptive emotional functioning.

Type 1 diabetes (T1D) incidence is rising globally, especially among children, with Systematic evaluation of these registries can highlight disparities in diagnosis, access, and management while supporting cross-regional learning to improve care delivery.

To assess the global burden of T1D by synthesizing key epidemiological indicators, including incidence, complications, and management approaches in children aged 0-14 years, and to characterize registry populations by sociodemographic and clinical features to identify care disparities.

A systematic review and meta-analysis of five databases identified 51 eligible studies (1969-2023). Data on incidence, diabetic ketoacidosis (DKA), and continuous glucose monitoring (CGM) use were pooled from 39 studies.

51 studies comprising 433,727 participants from 38 countries were analysed. Registries included 20 national, 11 regional, and 7 hospital-based datasets. The pooled global incidence of T1D was 20.16 per 100,000 population (95% CI: 16.49-23.84; I² = 89%). Incidence varied geographically, with higher estimates reported in Europe (22.2/100,000) compared with Asia (8.90/100,000). Registries applying ISPAD criteria reported higher incidence estimates (26.45/100,000) compared with EURODIAB criteria (19.15/100,000), although diagnostic criteria subgroup differences were not statistically significant. No significant gender differences were observed. DKA at diagnosis occurred in 38% of children, with substantial variability across settings. CGM use was reported in only four registries, with a pooled prevalence of 12.5%, highlighting gaps in access and adoption of diabetes technologies.

Global T1D registries demonstrate substantial heterogeneity in incidence and persistent disparities in diagnosis and diabetes care. Harmonized registry standards and equitable access to diabetes technologies are needed to strengthen surveillance and improve outcomes.

Continuous glucose monitoring (CGM) offers real-time and longitudinal insights into glycemic patterns, time in range, and hypoglycemia. Adopting CGMs into practice can improve clinical outcomes while strengthening patient engagement and enabling data-driven care across routine visits and population health programs. Despite strong evidence of benefit, CGM remains underused in primary care, where most patients with diabetes mellitus are managed. Barriers include limited familiarity with CGM technology, interpretation, workflow, documentation and billing, and patient access and education. The purpose of this clinical review was to help equip primary care clinicians with a concise, family medicine-focused framework for adopting CGM, including technology overview, patient selection and education, practical interpretation of standardized reports, team-based workflow, documentation, and reimbursement.

In rural Appalachian Kentucky, managing chronic conditions presents a challenge due to limited healthcare access, inadequate health education, and poor dietary resources. This study explores factors contributing to healthcare barriers and examines how social support may help individuals better manage chronic illness.

We interviewed residents of rural Appalachian Kentucky and asked them to describe resources that helped or hindered their access to adequate health care and identify qualities essential for an effective healthcare leader. Thematic analysis was used to identify recurring patterns related to healthcare barriers, resources needed for self-management, and social support and its role in managing chronic illness.

Among the 79 interviewees, most were long-term residents of the region, and approximately half were currently employed. Barriers to chronic disease management included distrust of medical professionals, limited health education, restricted access to care, and challenges with affordability and transportation. Participants cited a need for both general health education and diabetes mellitus-specific education.

This study highlighted significant barriers to the management of chronic illness in Appalachian Kentucky. Strong existing community bonds present an opportunity to improve outcomes. Such programs could leverage local support networks to enhance self-management for chronic diseases, including type 2 diabetes mellitus.