In the context of high awareness but low utilization of university counseling services, an important question is whether university mental health support may still carry psychological significance when actual service use remains limited. Drawing on social support theory and stigma theory, this study extends the understanding of university mental health support beyond a utilization-based perspective by examining whether students' perceptions of university mental health support are associated with mental health through perceived stigma. Using survey data from 642 university students in China, this study developed an analytical model examining the associations among perceived institutional support, perceived stigma, and mental health outcomes. The results showed that perceived institutional support was positively associated with mental health and negatively associated with perceived stigma. In addition, perceived stigma was negatively associated with mental health and statistically accounted for part of the observed association between perceived institutional support and mental health, suggesting an indirect association consistent with the proposed theoretical model. These findings suggest that the potential value of university mental health support may extend beyond actual counseling utilization. Rather, students' perceptions of institutional recognition, accessibility, and acceptance of psychological support may represent an important aspect of the campus mental health environment. This perspective is particularly relevant within the Chinese higher education context, where concerns about social evaluation and stigma may influence students' willingness to acknowledge psychological difficulties and seek support. This study contributes to the literature by moving beyond a utilization-based framework and highlighting the potential contextual significance of perceived institutional support in relation to stigma and mental health. Practically, the findings suggest that Chinese universities may consider not only service availability but also students' perceptions of institutional support when evaluating campus mental health environments.

Intimate partner violence (IPV) and depressive symptoms are major public health concerns during the preconception, prenatal, and postpartum periods and are shaped by both interpersonal and structural conditions, including economic hardship and food insecurity. State-level Supplemental Nutrition Assistance Program (SNAP) eligibility policies, including eliminating the SNAP asset test and increasing the SNAP income limit under broad-based categorical eligibility (BBCE), influence access to food assistance and may be associated with maternal well-being.

We conducted a repeated cross-sectional analysis of data from 66,677 women with lower income in the 2016-2020 Pregnancy Risk Assessment Monitoring System. We categorized states as having two BBCE policies, one BBCE policy, or no BBCE policies, reflecting more expansive SNAP eligibility. We conducted log-binomial regression with generalized estimating equations to calculate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs), estimating associations of state BBCE policies with preconception and prenatal physical IPV and postpartum depressive symptoms.

Compared to women in states with no BBCE policies, those in states with both BBCE policies had a lower prevalence of preconception and prenatal physical IPV (PR: 0.79, 95% CI: 0.66-0.94) and postpartum depressive symptoms (PR: 0.83, 95% CI: 0.75-0.93). Estimates for states with one BBCE policy were smaller and less precise but also suggested a decreased prevalence of preconception and prenatal physical IPV and postpartum depressive symptoms compared to states with no BBCE policies (PR = 0.80, 95% CI: 0.64-1.00; PR = 0.91, 95% CI: 0.81-1.03, respectively).

Results suggest that structural conditions shaping access to economic resources may represent a pathway through which risk for IPV and maternal mental health challenges can be prevented.

Chronic nausea is commonly associated with disorders of gut-brain interaction (DGBI). Pediatric functional nausea (FN) is defined as predominant nausea generally unrelated to meals. It is unclear if FN is a distinct entity or clustered with pain-associated DGBI. This multi-center study aimed to investigate the burden and comorbidities of FN and compare it to other DGBI.

Patients ages 8-21 years with DGBI were enrolled in a cross-sectional, multi-center observational registry across seven outpatient gastroenterology clinics and classified by Rome IV criteria. FN was compared to non-FN DGBI using validated symptom surveys: (1) Nausea Severity Scale (NSS), (2) Abdominal Pain Index (API), (3) PROMIS Global Health Scale (GHS), (4) PROMIS Pediatric Anxiety, (5) PROMIS Pediatric Depression, (6) Children's Somatization Inventory (CSI), and (7) Functional Disability Inventory (FDI).

292 subjects were analyzed. Fifty (17%) met FN criteria, of which 72% were female. Eighty-four and 32% of FN patients also met criteria for functional dyspepsia (FD) post-prandial distress subtype and irritable bowel syndrome (IBS), respectively. FN versus non-FN reported greater abdominal pain (p = 0.008), anxiety (p = 0.007) and depression (p = 0.002). FN versus IBS more commonly had long-term nausea and abdominal pain (p = 0.011, p = 0.014), postural dizziness (p = 0.034), migraines (p < 0.001), lower global health (p = 0.003), along with greater anxiety (p < 0.001) and depression (p < 0.001).

Children who meet formal FN criteria do not have isolated nausea. FN overlaps highly with pain-associated DGBI, and nearly all FN patients report abdominal pain. FN is coupled with extra-intestinal symptoms, mental health comorbidities, and poor global health.

Alone, the Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) only allows for ARFID-like symptom detection, potentially overestimating its prevalence. We aimed to investigate the prevalence of ARFID-like symptoms and DSM-5-compatible ARFID (based on medical chart review) in irritable bowel syndrome (IBS), and to compare characteristics associated with these definitions.

Adult patients with IBS according to Rome IV criteria, consulting in our tertiary care center between January 2024 and February 2025, were included. Patient data were collected using validated questionnaires, including NIAS-Fr. ARFID-like symptoms were defined as meeting the cut-off for at least one NIAS-Fr subscale (≥ 10 on "picky" or "fear," or ≥ 9 on "appetite"). A medical chart review using our center's clinical data warehouse was conducted for detecting medical impairment and eating disorder (ED) diagnosis. Patients with a positive NIAS-Fr, without ED, and with at least one medical/psychosocial impairment were considered to be in the "DSM-5 compatible ARFID" group. Univariate and multiple logistic regression analyses were conducted.

Among the 326 included patients, 47.5% had ARFID-like symptoms, and 33.4% met DSM-5-compatible criteria for ARFID. Functional dyspepsia (FD) was prevalent in 60.4% of patients. Depressive symptoms, somatic symptom severity, and FD were independently associated with having ARFID-like symptoms (Nagelkerke R² = 0.138). Depressive symptoms and IBS symptom severity were independently associated with DSM-5 compatible ARFID (Nagelkerke R² = 0.203).

ARFID-like symptoms were more prevalent than DSM-5-compatible ARFID in our population. Applying DSM-5-compatible criteria was associated with more severe gastrointestinal and depressive symptoms. Standardized DSM-5 ARFID assessment methods remain to be established.

Risk assessment and management are key elements of clinical practice in mental health. Existing literature on risk assessment in mental health has focused more on the predictive validity of tools and less on the clinical utility of tools in daily practice.

To explore risk assessment and management processes, and how clinicians use risk tools in daily practice, across a single health board.

This was a large mixed-methods study in a health authority responsible for the care of 1.3 million people covering a wide range of settings. Data collection involved multiple approaches including staff surveys, focus groups, non-participant observations of team meetings, case-file audits and reviews of incident reports.

Although risk was routinely discussed in team meetings, the risk tool was rarely used to inform decision-making. Barriers to meaningful use of the tool included time constraints, lack of training and perceived lack of relevance. Both staff and carers reported limited involvement of patients and families in risk assessment processes. Case-file audits showed high completion rates of the risk tool but little evidence that it influenced decision-making.

This study demonstrates a significant challenge for services, with clinical teams discussing risk but not using the mandated formulation-based risk tool to do so. This is set against the need for health authorities to demonstrate consistent standards in risk management across specialties and settings and to have a format that makes risk management plans easily available to clinicians unfamiliar with the patient. Further research is required to develop a method of recording risk mitigation strategies that is collaborative and can be easily completed in a clinical setting.

Mental health disorders are the primary driver of the global disease burden among young people, yet nationally representative data for Central Asia remains scarce. This study aimed to determine the prevalence and sociodemographic correlates of potential depression, anxiety, and suicidality among the young population in the Central Asian nation of Kazakhstan.

A cross-sectional analysis was conducted using data from the 2024 Kazakhstan Multiple Indicator Cluster Survey (MICS), a nationally representative, multi-stage probability sample. Potential depression and anxiety were screened using the PHQ-2 and GAD-2 instruments (cut-off ≥ 3), while suicidality was assessed via self-reported thoughts (past two weeks) or attempts (past 12 months). Weighted prevalence estimates were calculated, and modified Poisson regression models identified independent sociodemographic risk factors. Population attributable fractions (PAFs) were estimated to quantify the impact of associated risks.

We included 5,079 individuals aged 15-24 years. The weighted national prevalence was 1.70% (95%CI = 1.31-2.08) for potential depression, 1.59% (95%CI = 1.23-1.96) for potential anxiety, and 0.96% (95%CI = 0.65-1.27) for potential suicidality among the population aged 15-24 years. In adjusted analyses, female sex was the strongest predictor of both potential depression (adjusted risk ratio [aRR] = 2.72, 95%CI = 1.55-4.79) and anxiety (aRR = 2.80, 95%CI = 1.58-4.96). Non-Kazakh ethnicity was also significantly associated with an increased risk of depression (aRR = 1.88, 95%CI = 1.17-3.02) and anxiety (aRR = 1.99, 95%CI = 1.28-3.11). PAFs indicated that female sex accounted for 45.6% and 46.8% of the risk for depression and anxiety, respectively. No significant sociodemographic correlates were identified for suicidality.

These findings provide the first nationally representative benchmarks for youth mental health in Kazakhstan. While prevalence rates are lower than global averages, the marked disparities by sex and ethnicity highlight the need for targeted, culturally sensitive mental health interventions. Strengthening early detection and resource allocation for these vulnerable subgroups is essential to meet national and Sustainable Development Goal targets.

Intimate partner violence (IPV) is a major global public health issue that adversely affects women's physical, psychosocial, and reproductive health. Although individual characteristics have been widely studied, relational dynamics and intergenerational experiences of violence remain less explored, particularly in the Turkish context. Examining these factors together may contribute to a more comprehensive understanding of IPV and inform prevention strategies.

This study aimed to examine IPV exposure among women of reproductive age in Türkiye and to identify sociodemographic, partner-related, and relational factors associated with such exposure.

A descriptive, cross-sectional study was conducted between 15 November 2024 and 15 January 2025 with 453 women aged 18-49 years who had a current partner. Participants were recruited through snowball sampling via five social media platforms. Data were collected using a researcher-developed online questionnaire comprising sociodemographic and partner-related characteristics and a single-item measure of exposure to IPV. Statistical analyses included the chi-square test, the Mann-Whitney U test, and Firth penalized logistic regression to address sparse-data bias and quasi-complete separation. Multicollinearity was assessed using variance inflation factors. Internal validation was performed using bootstrap optimism correction (B = 500) and 10-fold cross-validation repeated 10 times. Statistical significance was set at p < .05.

Overall, 11.3% of participants reported IPV exposure. Firth penalized logistic regression showed that witnessing the partner's violent behavior toward others (OR = 94.42; 95% CI: 6.06-1471.46), low relationship satisfaction (OR = 24.71; 95% CI: 4.43-137.92), a history of family violence (OR = 15.48; 95% CI: 5.21-46.02), lower income relative to expenses (OR = 19.12; 95% CI: 4.93-74.14), and increasing age (OR = 1.27 per year; 95% CI: 1.17-1.38) were independently associated with IPV exposure. The model yielded a Nagelkerke R² of 0.746 and an optimism-corrected AUC of 0.966. Given the limited number of IPV events and the wide confidence intervals for several estimates, the magnitude of the observed associations should be interpreted cautiously.

IPV exposure in this study was associated with individual, relational, socioeconomic, and prior violence-related characteristics. The observed associations are consistent with a multilevel understanding of IPV and highlight the relevance of considering relational and family experiences alongside individual and socioeconomic characteristics in IPV prevention and assessment.

Green Health Prescribing involves health and care professionals prescribing structured, nature-based interventions, such as gardening, walking in green spaces, or cultural activities outdoors. With population ageing and increasing pressure on healthcare systems, Green Health Prescribing has been proposed as a potentially cost-effective approach to support healthy ageing in older adults with long-term conditions. This review summarises evidence on the effectiveness of Green Health Prescribing and related nature-based interventions for older adults.

A systematic review was conducted of intervention studies reporting the effectiveness of Green Health Prescribing and nature-based interventions for adults aged 50 years and over in primary or community care settings. Eligible designs included randomised trials, other comparative designs, and before-after studies. Searches up to October 2024 were performed in major medical, psychological, social science, and environmental databases, alongside grey literature sources. Study selection, data extraction, and quality appraisal were undertaken independently by at least two reviewers. Quantitative findings were synthesised narratively using a Grading of Recommendations, Assessment, Development and Evaluation-informed approach, with reporting guided by established systematic review standards. Patient and provider input informed the design and interpretation of findings.

Twenty-one studies, including 11 randomised trials, evaluated interventions among older adults living in the community or residential care. Interventions included activities in nature, exercise in green spaces, indoor gardening, and horticultural therapy. Many studies reported improvements in at least one health or wellbeing outcome; however, statistically significant effects compared with control conditions were uncommon. Evidence suggested potential benefits for quality of life, mental health, physical function, fatigue, loneliness, and social connectedness, but findings were inconsistent. Overall certainty of evidence was low or very low, largely because of small sample sizes, risk of bias, and limited replication across outcomes.

Evidence supporting the effectiveness of Green Health Prescribing and nature-based interventions for older adults remains limited. Given continued policy priority and funding for green space prescribing, high-quality pragmatic trials and implementation studies are needed, particularly among older adults, to robustly assess health outcomes, cost-effectiveness, and healthcare resource use in routine practice for Green Health Prescribing as a referral option in primary and community care.

CRD42025603199.

Stigma and violence experienced by transgender women and women engaged in transactional sex may negatively impact health and access to HIV care. We investigated typologies of past-year violence experienced by transgender women living with HIV (TWLH), with or without involvement in transactional sex (TWLH-TS and TWLH-nTS, respectively) in France.

We used data from the 2020-2022 French national cross-sectional ANRS-TRANS&HIV survey, which included TWLH recruited in 36 HIV care centres. We performed latent class analyses using variables representing combinations of past-year violence type and perpetrator separately for TWLH-TS and TWLH-nTS. Correlates of the resulting past-year violence typologies among TWLH-TS were assessed using multinomial logistic regression.

Among TWLH-TS (66% of the 501 participants), three typologies emerged: low reported violence (42% of the 501 participants), multiple-perpetrator violence (8%) and client and street violence (17%). Among TWLH-nTS (34% of the 501 participants), two typologies emerged: low reported violence (30% of the 501 participants) and multiple-perpetrator violence (3%). In TWLH-TS, correlates of client and street violence were inadequate housing, ART interruption, stimulant use and daily cannabis use, while those of multiple-perpetrator violence were depression and a lack of emotional support. Client and street violence and multiple-perpetrator violence were correlated with meeting clients in outdoor locations.

TWLH in France face intersecting forms of systemic violence and structural vulnerability. One in ten experienced multi-form, multiple-perpetrator violence, regardless of transactional sex involvement, with potential consequences for mental health. Client and street violence affected one in four TWLH-TS, and was associated with precarious housing and working conditions, as well as substance use and ART adherence difficulties. Ensuring equitable access to HIV care and mental health services for transgender women is essential and inseparable from protecting their fundamental human rights and improving their socioeconomic conditions.

NCT04849767.

Digital health interventions for psychosis, like SloMo, leverage smartphone technology to help transfer learning from therapy to real-life situations. Usage relies on motivation, recall, and awareness. Wearable devices that track physiological signs of stress can boost engagement by encouraging the use of coping strategies when most needed.

This study aims to co-design an integrated user interface for wearable technology and the SloMo mobile app, and explore its usability, acceptability, engagement, and preliminary clinical outcomes for individuals with psychosis through a feasibility study.

A co-design team developed the wearable augmented SloMo app using the Double Diamond framework. The team included 10 experts by experience based across three UK National Health Service (NHS) mental health trusts, who had completed SloMo as part of a randomized controlled trial, and were purposively recruited to ensure a range of demographic backgrounds. Users tested the app for 8 consecutive weeks during a 5-month data collection period in 2018, providing feedback that guided iterative improvements. Self-reported engagement, usability, and acceptability were collected through quantitative ratings and interviews, evaluated through qualitative content analysis. Assessments of paranoia and well-being were completed pre- and post use, summarized descriptively, with change scores calculated and evaluated for reliable change.

The Spire Stone clothing-adhered biosensor, which monitors respiratory rate and stress physiology, was chosen to augment SloMo. A minimum viable product of an integrated interface was developed. Feedback identified that users needed the technology to be easy to use, secure, and tailored to them through user control. Eight (8/10, 80%) users reported that the wearable prompted increased use of the SloMo app's features and other coping strategies. Self-reported engagement varied according to EBE user experience of the technology: higher use of the technology (n=3) was associated with higher usefulness (25% reduction in paranoia, SD 6%) and acceptability (84% satisfaction, SD 13%). Conversely, individuals that engaged with the device less (n=7) did not find it as useful (11% increase in paranoia, SD 17%) and were only modestly satisfied (63%, SD 20%).

Wearable technology is acceptable and can be integrated with a digitally supported therapy for psychosis to promote engagement and potentially support management of difficulties. However, further development work is needed to ensure acceptability and usefulness across a broader range of user needs.