ObjectiveThis study aimed to examine empathy and Theory of Mind (ToM) abilities among adolescents involved in cyberbullying and to identify the risk factors associated with different involvement roles.MethodsA total of 244 adolescents were categorized into four groups based on the Revised Cyberbullying Inventory-II: cyberbully-victims (CBV, n = 110), pure cybervictims (CV, n = 53), pure cyberbullies (CB, n = 20), and non-involved controls (C, n = 61). ToM was assessed using the Reading the Mind in the Eyes Test (RMET) and the Hinting Test (HT), while empathy was measured with the KA-SI Empathic Tendency Scale. Clinical evaluations were conducted using the K-SADS-5.ResultsThe CBV group showed significantly lower HT and affective empathy scores, along with higher rates of Major Depressive Disorder (MDD), compared to the control group. No significant differences were observed in RMET scores between groups. Logistic regression analyses indicated that higher affective empathy and HT scores reduced the risk of cyberbullying involvement, whereas an MDD diagnosis was a significant risk factor for both CBV and CB groups.ConclusionsUnderstanding distinct profiles regarding ToM and empathy may inform targeted prevention and intervention strategies against cyberbullying. Additionally, integrating mental health assessments may further enhance the effectiveness of existing programs.

Depression and anxiety remain major, largely unaddressed drivers of disability in low- and middle-income countries (LMICs), where scarce resources and persistent stigma constrain access to care. Scalable solutions are urgently needed. Low-intensity psychological interventions, delivered by trained non-specialists offer a promising pathway to close the treatment gap. This study examines the prospective acceptability of these interventions in Java, Indonesia, an exemplar of an under resourced health system, to guide targeted cultural adaptation and inform optimal implementation.

Using a qualitative descriptive design guided by the Theoretical Framework of Acceptability (TFA), we conducted semi-structured interviews (n = 33) with people experiencing anxiety and depression and 21 focus groups with families (n = 34), health workers (n = 36), and community/religious leaders (n = 37) across 12 sites in Java. Data were collected in Bahasa/local languages, transcribed, translated, and analysed using TFA informed Framework Analysis. 5% of translations were independently back-verified. Stakeholder workshops and advisory panels shaped study design and interpretation.

Low mental health literacy and stigma undermined intervention coherence and affective attitude, with many conflating LIPIs with general counselling. Help-seeking was often delayed until distress became severe, reflecting limited understanding of mental health problems and available support. Despite these challenges, strong perceptions of effectiveness and positive affective attitudes were driven by cultural values of self-reliance and community support. Concerns centered on ethicality, particularlyprivacy risks and fear of social judgment, alongside undercertainty regarding the role of traditional healers and the burden associated with time and workload demands. Trust in lay health workers was high in rural areas but more variable in urban contexts.

Findings highlight that cultural, structural, and interpersonal factors shape anticipated intervention acceptability. While stigma and low literacy remain barriers, strong perceived need and cultural alignment suggest the potential for promising subsequent uptake. Addressing privacy, role clarity, and logistical burden through tailored adaptations and partnerships is critical. This study offers one of the first theoretically framed qualitative explorations of LIPI acceptability in Southeast Asia, highlighting culturally congruent pathways for subsequent LMIC implementation.

Virtual reality (VR) offers immersive, interactive environments, with growing evidence supporting its use in mental health diagnostics and therapy. Despite the increasing availability of VR equipment in clinical settings, integration into routine mental health care remains limited. Understanding health care workers' attitudes, knowledge, and perceived barriers is essential for bridging the gap between technological availability and clinical implementation.

This study aimed to investigate health care workers' attitudes toward VR in mental health treatment and identify factors influencing its adoption in settings where VR equipment is already available.

A qualitative study design was used, combining structured one-to-one interviews with a supporting narrative literature review. The narrative review informed the interview design and contextualized findings within the existing evidence base. Structured interviews were conducted with 16 mental health professionals (n=12, 75% women; n=4, 25% men) working in psychiatric and mental health settings in one city in southern Poland where VR equipment was available for patient care. Descriptive statistics summarized closed-ended question responses, and thematic analysis was applied to open-ended questions.

Of the 16 participants, 10 (62.5%) had heard of VR technology before and held a favourable view of it, but only 6 (37.5%) were aware of its applications in mental health care. Participants aged under 35 years (6/16) rated the value of VR in therapy more positively than those aged over 50 years (3/16). Among those with prior VR exposure, 85.7% (6/7) expressed confidence in its effectiveness compared with 44.4% (4/9) of those without prior exposure. The most frequently mentioned benefits included interactivity, the ability to individualize therapeutic activities to patient needs, isolated visual and auditory interactions, and an increased sense of patient involvement and control. High costs were identified as the primary barrier by 75% (12/16), and 68.8% (11/16) expressed a need for comprehensive training. Women rated their subjective VR knowledge lower than men despite demonstrating comparable objective knowledge during interviews. VR equipment was described as being restricted within certain service areas. Legal and insurance constraints limited the use of home-based VR.

Access to VR equipment alone is insufficient to drive adoption in mental health services. Effective integration requires targeted education, comprehensive training, clear institutional guidelines on equipment responsibility and insurance, and supportive infrastructure. Addressing barriers and knowledge gaps identified in this study is essential for realizing VR's therapeutic potential in routine clinical practice.

Defining and measuring unmet medical needs (UMN) from all health care stakeholders is essential for optimizing health care resource allocation decisions and guiding research and development priorities to address them.

To understand UMN experience and prioritize UMN elements from the perspective of patients and caregivers.

The mixed-method study consisted of a qualitative listening workshop and a quantitative ranking exercise. Adult patients with self-reported chronic diseases or disabilities and unpaid family caregivers were recruited through patient advocacy organizations, physician specialty organizations, academic centers, and social media. We conducted a virtual listening workshop to solicit patients' and unpaid family caregivers' perceptions of UMN and what has impacted them the most. Recruited patients were those living with a chronic disease or disability, including cancer, autoimmune, mental health, and rare diseases. A presurvey was designed to capture demographic and other qualitative information. Coding was performed for transcript analysis and reviewed by the patient moderator for accuracy. Following the qualitative workshop, we conducted a quantitative prioritization exercise to identify the most important domains of UMN for patients and caregivers.

We recruited 22 patients and caregivers to participate in the workshop via patient advocacy organizations. The majority (90.5%) of participants were patients, with a few having dual roles as unpaid family caregivers (23.8%). Patients and caregivers defined UMN as gaps in access to appropriate and quality care, specialists, providers knowledgeable about the specifics of their needs, patient access to trusted information about the condition, mental health, and financial support. Perceptions of UMN that patients experienced and considered important included financial hardship, mental health, barriers to care, caregiving burden, employment impacts, and health care system challenges. The ranking exercise identified health care system functioning, economic burden, and impacts on quality of life as the top-priority UMN domains, followed by more traditional measures anchored in clinical effectiveness.

Our exploratory findings support both the depth and breadth of UMN faced by patients and unpaid caregivers, highlighting that UMN experienced by and important to them is not limited to traditional clinical effectiveness but also includes additional patient-centered components. Given the exploratory nature of this study owing to its small sample size, these findings are limited in generalizability and should be interpreted as hypothesis generating rather than definitive. Decision-makers should expand existing UMN frameworks to capture the full spectrum of patient-centered unmet medical needs.

Digital phenotyping is increasingly presented as a means of detecting mental distress through smartphones, wearables, and other sensor-rich personal devices. In this article, we argue that the central philosophical and clinical issue raised by digital phenotyping extends beyond predictive accuracy to interpretive authority, which concerns who gets to name what a feeling, behavioral pattern, or physiological fluctuation means. Psychiatry has always involved uncertainty, proxy reasoning, and the negotiation of testimony, but digital phenotyping intensifies these dynamics by translating lived states into behavioral and physiological signals that are then modeled as indicators of psychopathology. This translation promises earlier detection and more continuous monitoring, yet it also risks displacing first-person understanding, narrowing the available interpretive vocabulary, and recoding distress through pattern recognition in ways that can obscure meaning. Drawing on work in digital phenotyping, philosophy of technology, phenomenological psychopathology, and epistemic injustice, we develop a theoretical account of how digital systems may compete with patients and clinicians for the right to interpret symptoms. We show that the most consequential conflicts concern credibility, categories, temporality, and subject formation. The result is a new diagnostic tool embedded in a new social arrangement of knowledge in which persons may come to mistrust their own experience unless it is confirmed by data. We conclude by proposing a dialogical and clinically modest model for digital mental health, one that treats algorithmic outputs as revisable prompts within a larger interpretive practice while preserving space for human interpretation.

Pain is common in juvenile idiopathic arthritis and may be challenging to treat. Clinical observation has highlighted that pain and markers of disease activity may not align, with important implications for clinical management. This scoping review aimed to map and describe the extent, nature, and findings of studies examining relationships between pain and objective or clinical disease activity markers in children and young people with juvenile idiopathic arthritis.

JBI methodology for scoping reviews was followed and the review reported against the PRISMA-ScR reporting guideline. MEDLINE, EMBASE, and Scopus were searched from inception to 12 June 2025. Studies examining the relationship between self- or proxy-reported pain and at least one objective or clinical disease activity marker in individuals with juvenile idiopathic arthritis aged ≤24 years were included. Data were charted capturing study characteristics, pain measures, disease activity markers, analytic methods, and reported relationships. Findings were synthesised descriptively and presented in tabular, visual, and narrative formats.

One hundred and twenty-two studies were included. Overall concordance between pain and disease activity markers was uncommon. Pain aligned more consistently with physician-assessed clinical measures and composite disease activity scores than with blood biomarkers or imaging, although these disease activity measures may have included subjective or pain-related components.

Relationships between pain and markers of disease activity in juvenile idiopathic arthritis are complex and frequently discordant. Divergence between pain and disease activity markers should be anticipated in clinical care and interpreted in parallel rather than as interchangeable indicators.

Early identification of catch-up growth (CUG) in small-for-gestational-age (SGA) infants is critical. Head circumference at the first postnatal visit may capture distinct dimensions of early growth programming. We investigated its association with time to weight and length CUG.

A retrospective cohort of 1338 SGA infants with an initial visit <60 corrected days was followed to 2 years. Time-to-CUG was analyzed using Cox models; nonlinearity was assessed via restricted cubic splines and segmented regression.

Head circumference Z-score was independently associated with both outcomes. For weight CUG, a non-linear relationship was observed (P = 0.006), with a threshold at -2.42 (below: HR 1.74, 95% CI 1.18, 2.58; above: HR 1.59, 95% CI 1.44, 1.75). For length CUG, the relationship was linear (HR 1.74, 95% CI 1.59, 1.90). Preterm infants showed a stronger association for weight CUG (P = 0.01).

Early head circumference Z-score independently predicts CUG timing in SGA infants, exhibiting a non-linear threshold effect for weight recovery and a linear association for linear growth. This routinely available measure offers a pragmatic tool for risk stratification in SGA follow-up.

Early postnatal head circumference measured at the first child health visit (<60 days) independently predicts catch-up growth timing in SGA infants, providing a pragmatic, routinely available tool for risk stratification in follow-up protocols. A non-linear threshold for weight catch-up was identified at Z-score -2.42 (HR 1.74 below; HR 1.59 above), pinpointing a high-risk subgroup requiring intensive monitoring, while the linear association with length catch-up was consistent across all head sizes. Preterm SGA infants showed stronger weight catch-up associations (P = 0.01), highlighting their vulnerability and need for prioritised intervention.

Methamphetamine use disorder is associated with significant cognitive control deficits, and effective treatments remain limited. Frontal midline theta (FM-theta) oscillations are implicated in cognitive control, but whether theta-frequency transcranial alternating current stimulation (theta-tACS) can improve proactive and reactive control in this population remains unclear. This study initially enrolled 68 male participants diagnosed with methamphetamine use disorder according to DSM-5 criteria. Among them, 56 individuals completed all study procedures and were included in the final analysis. Cognitive control was assessed using a conditional stop-signal task with concurrent EEG recording. The stimulation protocol comprised 15 consecutive daily sessions, during which participants received either active theta-tACS or sham stimulation (2 mA, FCz - Pz montage) in a double-blind design. Following the 15-day theta-tACS stimulation, patients exhibited a significant improvement in preparation cost (p = 0.001) and an increased inhibition rate (p = 0.003). EEG analyses showed that tACS selectively enhanced late-stage proactive control-related theta power (p = 0.026), without significantly modulating theta activity associated with reactive control (p > 0.05). Importantly, the tACS stimulation restored the functional coupling between FM-theta activity and proactive control performance (p = 0.04), and baseline late-stage theta power at T0 positively predicted improvement in preparation cost (ΔT1 - T0) during proactive control (p = 0.01). Finally, a mediation analysis revealed that the tACS-induced improvement in inhibition rate was mediated by the enhanced preparation cost. These findings suggested theta-tACS enhances proactive control by restoring the functional coupling between FM-theta activity and proactive control, which in turn triggers a cascading improvement in reactive control.

Prolonged Grief Disorder (PGD) is a recently recognized psychiatric disorder in ICD-11 and DSM-5-TR, characterized by persistent yearning and/or preoccupation with the deceased, alongside other grief-related symptoms. PGD affects 5%-16% of bereaved individuals and is associated with mental and physical morbidity, functional impairment, elevated suicidality, and premature death, underscoring its importance as a public health priority, with particular relevance to older adults given their increasing and often cumulative exposure to bereavement. Current treatment for PGD relies primarily on grief-focused psychotherapy, which is associated with substantial dropout, and does not lead to full remission for many patients. Despite growing interest in pharmacological, psychedelic, and neuromodulatory approaches, no biologically-based intervention has yet demonstrated efficacy for the core symptoms of PGD. At the same time, emerging neurobiological evidence implicates alterations across multiple interacting neural systems in PGD, with reward-related circuitry showing particular relevance to persistent yearning. Low-intensity Focused Ultrasound (LIFUS) enables noninvasive, reversible, high-precision modulation of deep brain structures. This addresses several key limitations of conventional neuromodulation approaches (e.g., rTMS and DBS) while maintaining a promising safety and tolerability profile. Recent studies have investigated LIFUS across a range of neurological and psychiatric disorders, including opioid use disorder, with early findings suggesting therapeutic potential. Taken together, these observations suggest that LIFUS may offer a promising and theoretically grounded direction for future research in PGD. In this paper, we outline the scientific rationale for investigating LIFUS neuromodulation as a novel intervention for PGD, discuss its potential implications for research and clinical translation, and conclude that an initial clinical trial is warranted to evaluate the feasibility, safety, tolerability, and preliminary efficacy of LIFUS for PGD.

Complete dentures positively impact the oral health-related quality of life (OHRQoL) of geriatric individuals; however, longitudinal changes in broader functional and cognitive outcomes following complete denture rehabilitation remain insufficiently characterized.

To characterize longitudinal changes in cognitive performance, functional mobility and oral functional capacity (OFC) during the first three months following complete denture rehabilitation in edentulous older adults.

Seventy one completely edentulous individuals aged > 60 years were enrolled in this single-arm prospective clinical study and rehabilitated with maxillary and mandibular complete dentures. Cognitive function, functional mobility and OFC were assessed prior to treatment and at 1 and 3 months following denture insertion. Cognitive performance was evaluated using the Mini-Mental State Examination (MMSE), functional mobility using the Timed Up and Go Test (TUGT), and denture-related OHRQoL using the OHIP-EDENT questionnaire. Within-subject changes were analysed and associations between changes in MMSE and TUGT scores and patient age and OHRQoL were examined.

Significant within-subject changes were observed in MMSE, TUGT and OFC across the three assessment time points. MMSE scores increased significantly from pretreatment to both 1 and 3 months, with no significant difference between the two post-treatment assessments. TUGT performance and OFC showed significant changes across all pairwise time-point comparisons. No significant associations were observed between age and changes in TUGT, MMSE, or OHIP-EDENT scores.

Favourable longitudinal changes in cognitive performance and functional mobility were observed during the three months following complete denture rehabilitation, alongside favourable shifts in OFC parameters that may reflect changes in oral care-related capacity.

NCT06688669.