Mental health among medical trainees has typically been framed as an individual deficit, addressed through resilience training and counseling services. This perspective examines how the hidden curriculum within Chinese psychiatry training may shape psychological safety and professional identity formation. Drawing on psychological safety theory, hidden curriculum scholarship, Bronfenbrenner's ecological systems theory, and recent empirical literature on medical trainee distress in China, we propose a theoretically derived and empirically testable conceptual model through which experiences of vulnerability may become socially and professionally invisible. The proposed vulnerability-to-invisibility process describes four interconnected phases: the encounter with vulnerability, perceived or enacted prohibition of emotional expression, internalization of silence, and potential fragmentation of professional identity. Existing evidence supports several constituent components of this pathway, but direct empirical evidence establishing the complete sequence remains limited. We therefore call for institutional reforms that embed psychological safety into clinical training, including protected reflective spaces, reflective faculty modeling, peer support, and curriculum-integrated mentorship, while emphasizing adaptive emotional regulation rather than forced suppression.

Reproductive life stages, menopausal symptoms, and hormonal exposures are increasingly recognized as potential determinants of cognitive outcomes in women. However, these associations remain largely understudied in Latin American and Caribbean (LAC) populations. In this systematic review, we identified 18 observational studies published between 2003 and 2025. Of these, 16 were conducted across 13 LAC countries and two were conducted among latina women in the United States. Evidence was organized across four reproductive life stages domains: reproductive history, menopausal hormone therapy use, type of menopause and menopausal symptoms, and postmenopausal factors. Most LAC studies were cross-sectional and demonstrated substantial methodological heterogeneity. Across studies, shorter reproductive span, earlier menopause, higher parity, surgical menopause, and greater menopausal symptom burden were generally associated with poorer cognitive performance or higher odds of mild cognitive impairment. Some studies suggested favorable associations between menopausal hormone therapy use and cognitive outcomes. Postmenopausal factors, such as sarcopenia and obesity, as well as a longer duration of menopause, were predominantly linked to poorer cognitive outcomes. Only one population-based cohort evaluated incident dementia, underscoring the scarcity of longitudinal evidence in the region. Overall, the evidence suggests that reproductive life stages in LAC women are meaningfully associated with cognitive outcomes, reflecting the influence of hormonal transitions, menopausal characteristics, and postmenopausal health within distinctive regional contexts. However, the predominance of cross-sectional designs and limited regional representativity, coupled with a lack of integrated physiological indicators, reveal a substantial knowledge gap. Longitudinal and regionally representative cohorts incorporating standardized assessments of reproductive life stages alongside comprehensive cognitive measures are essential to understanding how reproductive life stages shape cognitive outcomes in LAC women. Systematic review registration: The systematic review was registered in the Open Science Framework (OSF). Registration DOI/unique identifier: https://doi.org/10.17605/OSF.IO/ME7XK.

Concussion disrupts brain connectivity, and effective treatments remain limited. Mindfulness-based interventions (MBIs) may influence functional connectivity (FC) of networks affected by concussion, but pediatric trials are lacking. This study investigated whether an app-delivered MBI produced greater FC changes than a sham condition across the default mode (DMN), salience (SN), and central executive (CEN) networks.

This randomized clinical trial (NCT05105802) recruited participants aged 12.00-17.99 years from the emergency department or interdisciplinary concussion clinic, then randomly assigned them to MBI or cognitive sham. Brain imaging sessions occurred at 72 h and 4 weeks post-concussion. Region-of-interest and seed-to-voxel analyses examined Group × Time interactions in FC across DMN, SN, and CEN (p < 0.050 _FDR ).

Thirty-six participants were included (MBI: n = 16, median [IQR] age = 14.23 [13.52-15.65] years, 31% female; Sham: n = 20, median [IQR] age = 14.05 [13.13-16.26] years, 45% female). Intention-to-treat analyses revealed significant Group × Time interactions across networks. DMN-CEN FC patterns differed, with MBI participants showing diminished FC. Within DMN, four clusters showed significant interactions (p < 0.050 _FDR ), three exhibiting larger FC reductions at 4 weeks in MBI participants. MBI participants showed greater FC increase in one SN cluster (p = 0.040 _FDR ) and larger FC decrease in one CEN cluster (p = 0.024 _FDR ) at 4 weeks. Per-protocol analyses identified one significant DMN cluster (p < 0.001 _FDR ) where MBI participants exhibited greater FC increases.

Mindfulness-based intervention training led to changes in FC in networks implicated in concussion recovery. Larger studies are needed to support these findings.

https://clinicaltrials.gov/study/NCT05105802, identifier NCT05105802.

Muslim mental health is an emerging field of inquiry in the global South. Understanding how mental health conditions are interpreted within diverse Muslim communities is important for culturally responsive psychological care.

This qualitative study explored psychologists' experiences of providing services to Muslim clients in the Western Cape, South Africa, and explored psychologists' accounts of explanatory models of mental health conditions encountered in therapeutic practice. Semi-structured interviews were conducted with 15 clinical and counseling psychologists practicing in the Western Cape. Data were analyzed using Reflexive Thematic Analysis.

Three themes were constructed. First, psychologists emphasized the importance of understanding Muslim clients within their broader sociocultural and historical context, particularly the enduring influence of Apartheid, migration histories, intergenerational trauma, and institutional mistrust. Second, psychologists reported encountering diverse explanatory models among Muslim clients, including interpretations of distress in relation to religiosity, supernatural influences, stigma, personal weakness, and biomedical understandings. These explanatory models were described as shaping emotions such as fear, guilt, and shame, as well as pathways to help-seeking and engagement with treatment. Third, psychologists highlighted the importance of culturally responsive practice, including reflexive engagement with clients' religious worldviews, ongoing self-education, culturally informed supervision, and ethical collaboration with Muslim religious leaders.

The findings suggest that explanatory models are not solely individual beliefs about MHC but are embedded within broader religious, familial, historical, and sociopolitical contexts. By exploring psychologists' accounts of therapeutic encounters with Muslim clients in the Western Cape, this study extends explanatory-model scholarship by highlighting how collective histories and relationships with systems of care shape understandings of mental health and help-seeking.

Type 2 diabetes mellitus (T2DM) is frequently accompanied by complex brain microstructural abnormalities and cognitive decline. Conventional diffusion tensor imaging (DTI) metrics can reflect both tissue diffusion properties and extracellular free-water effects, complicating the interpretation of T2DM-related brain changes. We aimed to characterize free-water-corrected diffusion alterations in white matter (WM) and cortical gray matter (GM) and examine their associations with cognitive performance and fasting blood glucose.

We enrolled 48 patients with T2DM and 48 healthy controls (HCs). Diffusion measures included conventional fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), together with free-water-corrected FA (FAt), free-water-corrected MD (MDt), free-water-corrected AD (ADt), and free-water-corrected RD (RDt), as well as the free-water fraction (FW), estimated using a free-water elimination (FWE) DTI model. Tract-based spatial statistics (TBSS) was used to evaluate all nine diffusion metrics in WM, whereas gray matter-based spatial statistics (GBSS) was used to evaluate six metrics in the cortical GM skeleton (AD, MD, RD, ADt, MDt, and RDt). Voxel-wise association analyses were performed using FMRIB Software Library (FSL) randomise based on a general linear model with nonparametric permutation testing to examine the relationships of imaging metrics with fasting blood glucose and Mini-Mental State Examination (MMSE) scores, while adjusting for age, sex, and total intracranial volume in the primary models; sensitivity models additionally included diagnostic group as a covariate.

Compared with HCs, patients with T2DM showed widespread diffusion abnormalities across the WM and GM skeletons, including lower FAt and higher MDt, ADt, and RDt. No skeleton-wide between-group difference in the estimated FW was detected. In the primary analyses, higher fasting blood glucose was associated with higher FW in selected WM regions and greater cortical GM diffusivity, whereas lower MMSE scores were associated with widespread WM and GM diffusion abnormalities.

T2DM-related diffusion abnormalities persisted after free-water correction, whereas no skeleton-wide between-group difference in the estimated FW was detected. Integrating FWE with complementary spatial analyses of WM and cortical GM may help characterize diffusion-derived brain phenotypes and their clinical correlates in T2DM.

Adult ADHD and autism assessment services increasingly receive clinically heterogeneous referrals in which the sequelae of childhood adversity may overlap with neurodevelopmental presentations. The distribution and clinical significance of adverse childhood experiences (ACEs) in this referral population remain insufficiently characterized.

This retrospective cross-sectional cohort study analyzed routinely collected clinical data from 389 adults who attended either the ADHD or the autism diagnostic pathway of a regional National Health Service (NHS) Adult ADHD and Autism Service. The analytic sample consisted of 233 adults with a definitive diagnostic outcome at data extraction; 149 were awaiting an outcome, six had an inconclusive outcome, and one underage case was excluded. ACE exposure was measured with the 10-item ACE Questionnaire. Psychiatric symptom burden was assessed with routinely administered screening instruments (PHQ-9, GAD-7, AUDIT, DAST-10, MDQ, HELPS and IPDS). The primary analysis examined the association between ACE score, analyzed as a continuous variable, and diagnostic outcome, with adjustment for age, gender and assessment pathway in binary logistic regression; all other analyses were exploratory.

Forty-seven participants (20.2%) received a diagnosis of ADHD or autism and 186 (79.8%) did not meet DSM-5 criteria. The mean ACE score was 3.10 (SD = 2.59), and 39.7% of participants reported four or more ACEs, compared with 8.3% in an English national household survey. Participants who were not diagnosed reported higher ACE scores than participants who were diagnosed (3.37 vs. 2.04; Hedges g = 0.52, 95% CI 0.19-0.84, p = 0.002). In the adjusted model, each additional ACE was associated with lower odds of receiving a neurodevelopmental diagnosis (odds ratio 0.85, 95% CI 0.73-0.99, p = 0.040). The proportion diagnosed declined across ACE categories from 35.6% (no adversity) to 6.2% (six or more ACEs). ACE scores correlated positively with depressive symptoms (r = 0.37), anxiety symptoms (r = 0.28) and drug use scores (r = 0.27), but not alcohol use, and were higher among participants screening positive for possible personality disorder, head injury and mood disorder. In an exploratory model additionally adjusting for depressive symptoms and personality disorder screening status, the ACE association attenuated and was no longer statistically significant, indicating that it is not independent of concurrent psychiatric symptom burden.

ACE exposure in this referral cohort was substantially higher than English population estimates and was associated with diagnostic non-confirmation and with greater psychiatric symptom burden. These findings support consideration of childhood adversity within trauma-informed formulation during adult neurodevelopmental assessment. Prospective studies incorporating direct measures of trauma-related psychopathology are needed to determine whether trauma-related mechanisms contribute to neurodevelopmental-like presentations. The cross-sectional retrospective design precludes causal inference.

Effective management of drug-resistant tuberculosis requires molecular assays that not only detect Mycobacterium tuberculosis but also identify resistance-associated variants, support drug-level interpretation, and indicate when broader confirmatory testing is needed. This narrative review applies a mutation-to-drug-to-decision framework to distinguish assay validity, exact-variant detection, drug-level inference, and decision impact. We synthesize evidence on target accessibility, minority-allele preservation, multiplexing, direct-specimen testing, and sequencing enrichment, emphasizing how these factors shape clinical interpretability. Current evidence remains dominated by analytical studies, isolate-based evaluations, and small direct-specimen investigations, with prospective multicenter treatment-impact validation still lacking. Population-level benchmarks indicate incomplete biological coverage for compact target regions, reaching approximately 92.6% for rpoB RRDR-based rifampicin detection, 85.4% for katG codon 315 plus the inhA promoter for isoniazid, and 84.7%-88.2% for gyrA/gyrB-based fluoroquinolone detection. Allele-specific CRISPR is therefore best suited to rapid rule-in of selected resistance-associated variants, while dispersed or heterogeneous mechanisms require broader molecular or phenotypic assessment. CRISPR should complement WHO-recommended rapid molecular testing and targeted next-generation sequencing rather than replace established molecular or phenotypic methods.

Schizophrenia is a chronic psychiatric disorder that leads to substantial disability, impaired quality of life, and reduced life expectancy. In addition to its profound impact on affected individuals, the disorder places a considerable financial burden on health care systems, caregivers, and society. Although the cost of schizophrenia has been studied in several individual countries, comprehensive global estimates across multiple cost categories remain scarce. This study aimed to estimate the global socioeconomic burden of schizophrenia using health economic modelling.

We conducted a prevalence-based cost-of-illness analysis for 204 countries in 2019, focusing on adults aged 20 years and older. Data on direct (medical and nonmedical), indirect (productivity losses), and informal (nonprofessional, unpaid) care costs were systematically retrieved through a PubMed-based literature search covering records published between 02/2010 and 04/2023. Extracted per-patient costs were standardized to 2019 purchasing power parity (PPP) USD, and missing data were imputed using a stratification approach based on four gross national income (GNI) groups. Costs were scaled to the national level by multiplying the per-patient costs by country-specific prevalence estimates from the Global Burden of Disease Study. Costs were additionally expressed as a proportion of gross domestic product (GDP). To ensure data validity from a clinical perspective, all estimates were scrutinized by a panel of psychiatry experts.

An estimated 22.1 million adults were living with schizophrenia in 2019 (0.39% prevalence). Total economic costs across upper-middle, lower-middle, and high-income regions reached $243.2 billion (PPP), with direct costs representing 47%, indirect costs 29%, and informal care costs 24%. Upper-middle-income countries bore the greatest burden relative to GDP, whereas high-income countries had the highest per-patient and national costs.

This study provides the most comprehensive global assessment to date of the economic burden of schizophrenia. Per-patient costs were identified as the main driver of the absolute global burden, underscoring the importance of effective disease management strategies. Policy-makers and other stakeholders should prioritize interventions that enhance patient functioning and societal participation.

As artificial intelligence (AI) expands across mental health services, questions arise about whether it can replace digital health navigators (DHNs), including those with lived experience. The DHN role generally resists automation because lived experience deepens specific dimensions that AI cannot replicate. Drawing on emerging evidence of AI's limitations in contextual reasoning, cultural sensitivity, and clinical safety, the authors identify where DHNs with lived experience are least substitutable: real-world knowledge of services, cultural grounding in the communities they serve, and relational trust. A practical model is also outlined in which AI augments DHN workflows through triage, documentation, and engagement monitoring.

The fast development of social media platforms has changed the way Generation Z communicates, sharing information and consuming digital material. One of such innovations is Instagram Reels, a popular short and long video-sharing functionality that helps with communication, knowledge exchange, and content usage. The feature was first introduced as Instagram TV (IGTV) in 2018 and subsequently integrated into Instagram Reels during the 2022 product consolidation of Instagram, however, the user behaviors underlying this topic, including video content consumption, creator engagement, and trust building, are still the center of the existing video ecosystem on the platform. Although the use of video-based content on Instagram is becoming increasingly popular, scarce studies have considered which factors affect its use and the consequences of this usage on the mental health and psychological wellbeing of users.

The paper examines the predictors of Instagram Reels use and the connection between Instagram Reels and mental health outcomes in Generation Z users. Based on Social Influence Theory, Expectation Confirmation Theory and the Technology Acceptance Model (TAM), a conceptual framework was created with consideration of Social Influence, Expectation Confirmation, Behavioral Intention, Idea Sharing, Building trust, Instagram Reels Usage, and Mental Health Outcomes.

The quantitative research design was used and a survey with 422 Generation Z users in Jordan was carried out using a structured questionnaire. Partial Least Squares Structural Equation Modeling (PLS-SEM) and Artificial Neural Network (ANN) were the methods that were used to analyze the data.

The results showed that, Social Influence and Expectation Confirmation play significant roles in Idea Sharing and Building Trust which consequently leads to the increased use of Instagram Reels. Behavioral Intention was cited and found to predict the relationship between Idea Sharing, Trust Building and platform engagement. Moreover, the Usage of Instagram Reels was also revealed to have a substantial impact on Mental Health Outcomes, with both positive and negative wellbeing indicators demonstrating varying effects. The Importance-Performance Map Analysis (IPMA) has determined Idea Sharing to be the most significant driver of Instagram Reels Usage, then Social Influence and Expectation Confirmation.

The paper finds that interactive features and perceived benefits of social media platform have a pivotal role in determining users engagement and psychological experiences. The results add to the body of literature on social media adoption and digital wellbeing and offer some practical implications to educators, policymakers, and platform developers interested in creating healthier digital spaces in which Generation Z users can operate.