Background Tobacco use continues to be a significant global public health issue, causing over 8 million deaths each year. People with mental health conditions face a higher risk, and new nicotine products have increased the complexity of the challenge. Despite this, there is limited information on psychological distress, nicotine dependence, and quality of life among cigarette and e-cigarette users. Objective The primary objective of this study was to compare psychological distress and quality of life among cigarette smokers, e-cigarette users, and non-smokers in Jeddah, Saudi Arabia. The secondary objective was to examine the association between nicotine dependence severity and psychological distress and quality of life among cigarette smokers and e-cigarette users. Methods A cross-sectional study was conducted among 368 adults (≥18 years) living in Jeddah from April to June 2026. Participants were recruited using stratified quota convenience sampling through online distribution via Telegram and WhatsApp applications, and community networks. The participants were divided into three groups: cigarette smokers (n=117), e-cigarette users (n=95), and non-smokers (n=156). Data were collected using a self-administered questionnaire covering sociodemographics, smoking history, psychological distress (K6), quality of life (World Health Organization Quality of Life - Brief Version (WHOQOL-BREF)), and nicotine dependence (Fagerström Test for Nicotine Dependence (FTND)/electronic Fagerström Test for Cigarette Dependence (e-FTCD)). Results Non-smokers scored higher than both smoking groups on most WHOQOL-BREF domains (p < 0.05). The mean K6 score was 15.20 (SD = 5.67), and 64.9% of participants screened positive for serious psychological distress. The proportion of serious psychological distress did not differ significantly by smoking status (p = 0.111). Among cigarette smokers and e-cigarette users, nicotine dependence severity showed a significant non-linear association with psychological distress (p = 0.001 and p = 0.004, respectively). Conclusion Non-smokers had higher WHOQOL-BREF scores than cigarette smokers and e-cigarette users on most domains. Although 64.9% of participants screened positive for serious psychological distress, this finding should be interpreted cautiously given the convenience sampling approach and may not be generalizable to the broader population. Further research is needed to clarify the relationship between nicotine dependence, psychological distress, and quality of life and to assess the potential implications for tobacco cessation and mental health interventions in Saudi Arabia.

Prevalences of psychological distress among young women are high and rising. Despite a vast number of potentially helpful mental health apps (MHA), dissemination is limited. The current study aims to inform user-centered development and implementation of mental health apps for young women by examining mental health problems in the target population, existing help-seeking patterns and their gaps, perceived barriers to both conventional and digital care, and preferred MHA characteristics.

521 women between the ages of 18 and 35 participated in a cross-sectional online survey. Alongside descriptive data on psychological distress, help-seeking behaviour, and barriers to mental health app use, associations between indicators of psychological distress and MHA use were examined using binary logistic regression. Thematic analysis was used to reveal attributes of MHA that are considered professional and most helpful by this group.

The most common psychological distress symptoms were fatigue (79%), worry (79%), and tension (74%). Frequently used support sources included self-help books (60%), primary care (51%), and psychotherapy (51%); 31% had ever used MHA. Barriers to MHA use were mainly a lack of knowledge (32.5%), concerns about effectiveness (9.8%), and financial costs (9.6%). General psychological distress (OR = 1.03 [1.01-1.06], p = .012), anxiety and appetite/weight problems (ORs between 1.95 and 1.99, ps ≤ .004) were most strongly associated with MHA use. Thematic analysis showed that young women view professional appearance and helpfulness in MHA as multifaceted, emphasizing usability, security, as well as personal and technical support as relevant aspects.

Although psychological distress is common among young women, only a minority uses MHA. Use is associated with the type of symptoms, symptom burden, knowledge of and expectations toward these tools. Improving awareness and accessibility, ensuring app quality, credibility, and data security may represent key factors for strengthening uptake and sustained use in this population.

Adolescent girls and young women affected by conflict experience persistent sexual and reproductive health challenges along with poorer mental health and wellbeing. Among Syrian adolescent girls and young women living in Lebanon, these challenges are exacerbated by displacement, economic challenges, and barriers to accessing needed health services. Community-based interventions are being increasingly adopted to address these gaps, however evidence remains limited on how these interventions can be effectively implemented while preserving fidelity and quality during periods of active conflict, especially when centralized delivery models are not feasible.

This paper presents a comment on implementation insights from the Self-Efficacy and Knowledge (SEEK) trial, a community-based integrated intervention conducted in two primary healthcare centers in Lebanon to improve sexual and reproductive health service uptake and psychosocial wellbeing among Syrian adolescent girls and young women aged 15-24. Specifically, during implementation, escalating conflict severely restricted mobility and on-site supervision by the central team, threatening intervention continuity. As a result, the team shifted the implementation model from a centralized structure to a decentralized one, emphasizing co-leadership with local communities. To that end, local and affected community members were recruited, trained, and supervised to assume responsibility for field coordination, management of logistical procedures, and decision-making in real time, supported by remote supervision. Subsequent outcome evaluations identified positive effects on some outcomes, and limited effects on others, indicating that SEEK's effectiveness varied across outcomes. Beyond these findings, the experience highlighted how adaptive approaches that shift power to affected communities during implementation amid active conflict can transform contextual constraints into opportunities for culturally responsive and resilient implementation.

The implementation of SEEK demonstrates that community-led models may not be merely emergency substitutes when traditional delivery systems fail, but foundational strategies for effective humanitarian programming during conflict. Shifting power to local and affected communities as co-implementers can strengthen ownership, adaptability, and sustainability during active conflict. Community leadership, supported by flexible planning and agile decision-making may be essential for building resilient health interventions.

Ecological Momentary Interventions (EMIs) using machine learning (ML)-based assignment algorithms may improve mental health outcomes by delivering more person-tailored content, but evidence is pending. The study aimed to determine whether ML-based assignment of EMI components augments effects on momentary mental health outcomes when compared to random assignment in youth from the general population and psychological counselling services. A within-subject micro-randomized trial was conducted. Participants were randomly assigned up to seven times daily (1:1 ratio; up to 210 decision points) to either an ML-based (experimental condition) or a random (active control condition) assignment of EMI components. Proximal outcomes were time-lagged changes in positive affect, momentary resilience, and negative affect at t_n+1. Feasibility and safety were assessed. Distal outcomes included psychological distress, resilience, and emotion regulation. A total of 49 youths (mean age 20.6; 78% female) were included. At baseline, participants reported mild-to-moderate psychological distress on average (K10 mean = 23.8, SD = 7.1), with more than one third reporting moderate or severe distress. An initial, outcome-specific signal favoring ML-based over random assignment was observed for momentary resilience (B = 0.147, 95% confidence interval (CI), 0.004 - 0.290, p = 0.044), whereas there was no evidence of beneficial effects on positive or negative affect. Feasibility indicators supported delivery of the AI4U training, with favorable ratings of satisfaction, acceptability, and usability; no serious adverse events were reported. Uncontrolled pre-post comparisons suggested a small reduction in psychological distress (d = -0.23) and improvements in resilience (d = 0.55) and adaptive emotion regulation (d = 0.53). Taken together, this study demonstrates the feasibility and preliminary safety of a ML-based adaptive EMI in youth and provides an initial, outcome-specific signal that ML-based assignment may improve momentary resilience relative to random assignment, whilst underscoring the need for larger, adequately powered MRTs and formal validation of whether forecasting performance translates into policy value.

Children in out-of-home care (OOHC) have significantly poorer physical, mental and dental health than their peers. In Sweden, child protection services (CPS) are required to initiate health assessments (HAs) when a child is placed in OOHC. Despite this statutory requirement, fewer than half of eligible children undergo an HA. Factors influencing implementation remain poorly understood.

This qualitative study explored CPS caseworkers'change experiences of initiating and coordinating HAs for children placed in OOHC in Sweden. Five semi-structured focus group discussions were conducted with 18 CPS caseworkers. Participants were recruited nationwide through purposive snowball sampling. Data were analysed using reflexive thematic analysis, applying a decision-making ecology framework to interpret individual, organisational and interagency influences.

Four interrelated themes captured factors influencing implementation across the HA pathway: (1) Ideally, we do it for the child (initiation); (2) Negotiation and uncertainty (scheduling); (3) What we request is not always what we receive (conduct); and (4) Variable reporting and the challenge of closing the loop (reporting and follow-up). Across all phases, CPS caseworkers assumed a de facto coordinating role to compensate for fragmented interagency structures.

From the perspective of CPS caseworkers, organisational and interagency factors influenced HAs across the assessment pathway. Fragmented routines and unclear responsibilities may reduce their usefulness for care planning and follow-up. Strengthening shared ownership and improving assessment, reporting and follow-up processes may support implementation. HAs may be most useful as part of a broader pathway of assessment, referral, care planning and follow-up.

Introduction Despite growing research on Indigenous traditional medicine, the literature still lacks studies that examine holistic understandings of health among Indigenous people. This study aimed to explore Wixárika conceptions of health and illness in western Mexico in order to deepen understanding of their health-related practices and guide intercultural strategies to improve their quality of life. Methods  A qualitative study with an ethnographic approach was conducted among 127 adult Wixárika participants in two contrasting contexts in western Mexico, using semi-structured in-depth interviews and thematic analysis. Results Findings show that, for the study participants, health is understood as a state of balance encompassing physical, spiritual, mental-emotional, and economic-occupational dimensions. Illness is perceived as a disruption of this balance, shaping therapeutic practices that combine ancestral knowledge with biomedical care. Functional capacity to carry out everyday activities and economic well-being also emerged as important indicators of health status. The use of traditional remedies alongside Western medicine reflects an adaptive strategy. Conclusions This study contributes to a broader intercultural understanding of health and provides a basis for respectful dialogue aimed at promoting the well-being of these Indigenous people.

To discuss the origins of assertive community treatment (ACT) and the adoption of its framework by a Northeast Florida Community Outreach Center, Sulzbacher, through the Mental Health Offender Program (MHOP). With recent changes to health policy and resource funding, MHOP implemented an alternative approach to providing patient care through Open Access Scheduling (OAS). This article examines the hypothesis that OAS may improve the outcomes on rates of missed long-acting injectable (LAI) antipsychotics, overdue psychiatric appointments, and incarceration.

 A retrospective comparative analysis was conducted among participants of the MHOP 12 months before and 12 months after implementation of OAS. With Institutional Review Board (IRB) exemption status granted, de-identified data obtained from the electronic medical record and publicly available arrest rates were compiled into a Microsoft Excel spreadsheet and subjected to statistical analysis using the Data ToolPak software. Primary outcomes measured were the percentage of overdue psychiatric appointments and missed LAI antipsychotics, and rates of incarceration before and after the implementation of OAS.

 Using a paired t-test design, the mean weekly percent of overdue psychiatric appointments and missed LAI antipsychotics increased from 51.7% pre-intervention to 57.0% post-intervention with a t-value of approximately 2.22 and a statistically significant p-value (0.032). However, rates on incarceration remained roughly the same. An unpaired t-test, assuming unequal variances, yielded a t-value of approximately 0.26 and a non-statistically significant p-value of 0.796.

Data analysis of 52 weeks before and after the implementation of OAS highlights the potential role of OAS as a viable alternative to psychiatric follow-up.

The discovery of decomposed human remains in private residences is a relatively common occurrence in forensic practice. However, finding a living individual cohabiting with a corpse represents an exceptionally rare medico-legal situation, raising complex psychiatric, forensic, and ethical issues. Such cases are most often associated with severe mental illness, social isolation, or pathological grief. We report the case of a 55-year-old unmarried former military serviceman with a long-standing history of schizophrenia who was brought to the psychiatric emergency department under police requisition after being found living with the decomposing body of his brother. Following a report of a foul odor, authorities entered the home and discovered the patient's brother's decomposed body after the patient threatened them with a knife and exhibited bizarre behavior. Upon examination, the patient exhibited severe psychotic symptoms, including persecutory delusions, auditory hallucinations, thought disorganization, impaired insight, and marked behavioral disturbances. The deceased brother had apparently remained undiscovered for 15 days, while the patient continued to occupy the residence without notifying authorities. A multidisciplinary forensic and psychiatric assessment was conducted to clarify the circumstances surrounding the delayed discovery and to evaluate the patient's mental state. Cohabitation with a deceased individual should prompt systematic psychiatric evaluation whenever severe mental illness is suspected. The early identification of vulnerable individuals living in social isolation may help prevent delayed corpse discovery and improve both public health and forensic outcomes.

Digital mental health tools hold potential to bridge barriers to services, and efficient screening could facilitate access and assessment. An internet-based tiered assessment procedure (i-TAP) screening for common psychiatric symptoms among refugees has been developed and validated in previous work. Further validation requires investigation of acceptability and content validity, which in turn can inform potential implementation.

This study aimed to explore the user experience with the i-TAP among individuals with a refugee background in Sweden, with a particular focus on acceptability and content validity.

In conjunction with a psychometric validation study of the i-TAP, semi-structured interviews were conducted with 71 adult participants with a refugee background living in Sweden. Interviews were conducted in Arabic, Dari, Farsi and Swedish, and analysed using reflexive thematic analysis.

Four themes were generated. Two themes addressed the content and usability of the i-TAP: Capturing what matters - but not everything that matters and A user-friendly and accessible tool - provided sufficient (health) literacy. A third theme: Digital mental health screening could facilitate care, but can not replace a care visit, highlighted perspectives on prospective implementation. The fourth theme, Sharing can be difficult, but opens the door to support, reflected emotional and cultural aspects of addressing mental health issues.

Participants mainly found the i-TAP to be relevant and easy to use, and the digital format familiar. Items were comprehensible and relevant topics were covered, supporting content validity. Concurrent and prospective acceptability was high; however, with the prerequisite that screening must lead to action. The results highlighted the importance of trust and language when addressing mental health. We suggest developments to increase usability and comprehensiveness, and discuss considerations important for implementation.

Multiple neurodevelopmental disorders (NDDs) in children and adolescents are associated with greater impairment and reduced responsiveness to standard treatments, yet their prevalence and associated factors remain poorly understood. We aimed to investigate prevalence of, and factors associated with multiple NDDs among children and adolescents in the United States (US).

This nationwide cross-sectional study used data from the National Survey of Children's Health 2016-2023. Multiple NDDs were defined as the concurrent presence of two or more conditions. Weighted prevalence estimates were calculated, and logistic regression was applied to assess associated factors of multiple NDDs adjusting for sociodemographic and health variables.

The prevalence of multiple NDDs among children aged 3-17 years increased from 5.8% in 2016 to 7.7% in 2023, with the strongest cross-sectional association observed for depression or anxiety (aOR = 5.53, 95% CI: 5.09-6.02), followed by fair or poor health (aOR = 2.82, 95% CI: 2.33-3.42), heart conditions (aOR = 1.93, 95% CI: 1.59-2.35), underweight status (aOR = 1.30, 95% CI: 1.13-1.50), and allergies (aOR = 1.17, 95% CI: 1.08-1.26). Lower odds were observed among female children (aOR = 0.40, 95% CI: 0.37-0.43) and those with higher parental education (aOR = 0.86, 95% CI: 0.80-0.93).

This study revealed a rising prevalence of multiple NDDs and identified associated factors across clinical, demographic, and socioeconomic domains. Although the cross-sectional design precludes temporal or causal inference, the findings highlight the importance of integrated and equity-driven strategies to ensure timely access to health services and family-centered support for children and adolescents with multiple NDDs.