Cognitive behavioral therapy (CBT) is the most examined psychotherapy for depression and anxiety, but delivery faces significant barriers such as limited access, cost, and time constraints. CBT-oriented psychological chatbots offer a promising means of addressing these challenges. Yet, their overall efficacy, user engagement, and acceptability have not been systematically synthesized.

This study aimed to evaluate the efficacy, user engagement, and acceptability of CBT-oriented chatbots for adults with depressive and/or anxiety symptoms.

A systematic search of 9 databases, including PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, WanFang, and VIP Databases, was conducted from inception to February 2026. Eligibility criteria included randomized controlled trials comparing CBT-oriented chatbots with control groups in adults with depressive and/or anxiety symptoms. Risk of bias (ROB) was assessed using the Cochrane ROB tool. Random-effects meta-analyses (Hartung-Knapp-Sidik-Jonkman adjustment) calculated pooled effect sizes (Hedges g), 95% CIs, and 95% prediction intervals (PIs). Heterogeneity was evaluated using the I² statistic, and Galbraith plots were used to identify outliers for subsequent sensitivity analyses. Subgroup and meta-regression analyses examined potential moderators. The certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data on user engagement and acceptability were extracted and synthesized using narrative and quantitative methods where available.

Twenty-nine eligible randomized controlled trials were included. CBT-oriented psychological chatbots produced a moderate reduction in depressive symptoms at postintervention (g=-0.55, 95% CI -0.70 to -0.40, 95% PI -1.23 to 0.13) and a small reduction in anxiety symptoms (g=-0.26, 95% CI -0.37 to -0.14, 95% PI -0.67 to 0.15). At follow-up, effects were small for depression (g=-0.32, 95% CI -0.55 to -0.09, 95% PI -0.93 to 0.29) and nonsignificant for anxiety (g=-0.19, 95% CI -0.43 to 0.04, 95% PI -0.84 to 0.46). Subgroup and meta-regression analyses revealed that anxiety outcomes were significantly moderated by clinical profiles-showing distinct advantages for comorbid symptoms-and the proportion of female participants. The CBT-oriented chatbots received an adequate level of engagement that complied with digital intervention standards. Although user satisfaction ratings were generally favorable, technical limitations and repetitive interaction patterns remain to be addressed to enhance overall acceptability. Regarding the limitations of evidence, the overall certainty was rated as very low to low, predominantly driven by high ROB and substantial heterogeneity.

This study innovatively isolates CBT-oriented chatbots from broader digital interventions, providing a precise, methodology-driven evaluation of theoretically grounded therapeutics. This review brings critical evidence to the field that these tools yield significant short-term relief, particularly for comorbid anxiety profiles. In the real world, CBT chatbots offer profound potential as scalable, low-barrier first-line tools. To sustain engagement, future developments must evolve from rigid rule-based scripts toward adaptive, large language model-driven architectures while ensuring clinical safety.

Morbidity and mortality among homeless populations in California continue to grow. Unsheltered individuals suffer from mental illness, physical disability, cognitive impairment, and acute and chronic illness. Many of these individuals qualify for care, yet encounters with nurses often miss these opportunities for care and referrals. We will examine the needs of a local homeless encampment in Southern California, to determine whether missed nursing contributed to their lack of access to health care resources.

Volunteers, licensed registered nurses, were trained for this project and consented to offer nursing care to a local unsheltered encampment. With oversight from the Institutional Review Board, data were collected in the camp to describe demographics and health care needs of those served.

The unsheltered population is disproportionate in representation compared with the community at large (21.2% Black vs. 6.4% representation in the greater community and 51% White versus 55.2% in the community at large). Of 236 participants included in the investigation, 33 (14%) had access to a case manager. Having an assigned case manager was significantly associated with access to shelter (p = .019, φc 0.457), and more commonly associated with challenges in activities of daily living (p = .011, φc 0.352). Most participants had a recent encounter (discharge within 1 month) with nursing (n = 20,134, or 56.8%).

This investigation offers concrete evidence of missed nursing care in unsheltered populations. In addition, access to a case manager was significantly associated with protection (access to shelter), a variable associated with better health outcomes.

To examine the social experiences of youth with Juvenile idiopathic arthritis (JIA).

This systematic review synthesizes findings from 18 qualitative studies (2014-2024) based on a search from four databases (Scopus, PubMed, Web of Science, and PsycINFO). The studies were assessed for quality using the Critical Appraisal Skills Programme Qualitative Checklist (CASP, 2024).

Six key themes emerged: (1) Physical Barriers to Social Interaction, (2) Lack of Understanding from Others, (3) Enacted Stigma, (4) Anticipated Stigma, (5) Internalized Stigma, and (6) Resources.

The review findings support increasing public awareness, fostering peer support, enhancing self-advocacy skills, and implementing stigma-reduction strategies to better support the social functioning of youth with JIA. Future research should explore long-term effects of stigma and evaluate targeted interventions to improve social experiences and quality of life for this population.

Single-session interventions (SSIs) are an innovative, scalable approach for addressing the unmet behavioral and mental health needs of pediatric patients and their families. Specifically, digital SSIs, which are self-guided and delivered online, offer a low-cost and accessible approach but are currently underutilized in pediatric psychology.

This topical review aims to describe SSIs broadly and the specific need for digital SSIs, explore potential applications within pediatric psychology, outline future directions and considerations, and present two examples of community-engaged digital SSI design.

SSIs evidence small to medium effects across a range of mental health concerns, including distress, anxiety, and depression, supporting their broad applicability. Incorporating community voices during the development process is essential to ensure SSIs are contextually relevant in pediatric populations. Two illustrative SSIs currently in development within pediatric psychology are described: (1) an intervention supporting adolescent siblings of children with cancer and (2) a program targeting depression in adolescents with type 1 diabetes. Both examples incorporate input from key community members, underscoring the value of participatory design in enhancing intervention relevance and impact.

SSIs offer a brief and scalable strategy to help address gaps in psychological care, particularly for youth and families with limited access to services. Pediatric psychologists are well positioned to develop, evaluate, and implement SSIs across diverse populations and intervention targets. Ensuring the effectiveness, equity, and sustainability of SSIs will require ongoing collaboration with community partners and integration across pediatric care settings.

Maternal pre- or early-pregnancy obesity is a risk factor for adverse health outcomes not only in the mother but also for the child later in life. It can lead to sustained and inappropriate stimulation of regulatory circuits, eventually resulting in multisystem dysregulation, termed allostatic load (AL). We hypothesized that maternal prepregnancy weight status, as measured by body mass index (BMI), exerts long-lasting effects on offspring, potentially resulting in elevated AL. Using data from the Mater University of Queensland Study of Pregnancy (MUSP), a longitudinal birth cohort (>8500 pregnant women), we investigate the association between maternal prepregnancy BMI and AL in adult offspring at age 30. Analyses were conducted in a subsample of 923 offspring with complete biomarker data, from whom an AL index capturing 17 multisystem physiological dysregulations was constructed. Structural equation modelling (SEM) was used to examine pathways linking maternal prepregnancy BMI to offspring AL index (ALI). Lower maternal socioeconomic status (SES) was associated with higher maternal BMI. Maternal prepregnancy BMI was positively associated with offspring AL index (β = 0.17, standard error (SE) = 0.01, p < 0.001), whereas mental health risk factors did not mediate this relationship. These findings suggest that maternal metabolic status at pre- and early-pregnancy exerts a long-lasting effect on offspring physiology, independent of maternal SES and mental health. Our findings underscore the practical importance of maternal weight management before pregnancy to support optimal offspring development.

Depressive symptoms in older adults are amplified by social isolation and limited access to clinic-based mental health care. Ecological momentary assessment (EMA) enables remote self-monitoring and unobtrusively captures response times (RTs), which may serve as indicators of psychomotor and cognitive functioning.

This study investigated the use of EMA-based RT dynamics for predicting symptom change and profiling potential responders for repeated self-monitoring in late-life depression.

Forty-nine community-dwelling adults aged 65 years or older (mean age 70.7, SD 5.8 years; female: 35; male: 14) with a history of major depressive disorder received case management incorporating daily EMA. Participants provided self-reports of mood, appetite, sleep quality, and general well-being. Preassessment and postassessment included the 15-item Short Geriatric Depression Scale (GDS-15), the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), the 9-item Patient Health Questionnaire, and the Beck Anxiety Inventory. RTs were cleaned with an asymmetric IQR rule, z standardized within-person × response level, and modeled with exponential decay curves over successive EMA trials. The efficacy of EMA-adjunctive care was evaluated using pre-post comparisons of symptom scales. We then examined associations between RT-derived features and symptom change using correlational analyses. Finally, Bayesian multilevel modeling was applied to assess the clinical relevance of RT dynamics, including group differences in adaptation patterns.

Older adults at risk for depression showed significant symptom reductions over the 4-week EMA-adjunctive care period across all 4 psychological scales (CESD-R: mean Δ 11.5; rank-biserial r=0.78; GDS-15: mean Δ 2.14, Cohen d=0.76), alongside high EMA adherence (>90%). In correlational analyses, descriptive EMA score metrics and raw RTs showed modest, symptom-specific associations with symptom change (ΔCESD-R: |r|≈0.29; Δ9-item Patient Health Questionnaire: |r|≈0.32; ΔBeck Anxiety Inventory: |r|≈0.35) but were not significantly related to change in geriatric depression (ΔGDS-15: |r|≈0.24). In contrast, exponential-decay model parameters derived from standardized RT were significantly associated with geriatric depressive symptom change (Δ GDS-15), with the strongest effects observed for the feeling item (eg, decay rate θb: r=-0.398, asymptote θc: r=-0.321). Bayesian multilevel modeling further indicated that EMA-adjunctive care responders showed faster RT adaptation than nonresponders (median decay-rate ratio≈4.9, 95% credible interval 1.44-14.31), whereas differences in postadaptation RT levels were smaller and uncertain (median postadaptation RT ratio≈1.25, 95% credible interval 0.95-1.58). Sensitivity analyses showed consistent decay-rate effects across alternative specifications.

Dynamic characteristics of EMA-based RTs emerged as a sensitive proxy for monitoring changes in depressive symptoms among older adults at risk. These findings highlight the potential use of RTs as digital biomarkers derived from brief, low-burden EMA self-monitoring, supporting the development of scalable and personalized mental health interventions for geriatric populations.

IntroductionWomen, both cisgender and transgender, experience persistent inequities in sexual and reproductive health (SRH) due to sexism, transphobia, racism, and systemic discrimination. In Canada and globally, these intersecting inequities are exacerbated by limited, biomedical, and colonial models of care that overlook women's needs, leaving them underserved in HIV and sexually transmitted and blood-borne infection (STBBI) prevention. Our study describes the development of the Women-Centred Prevention (W-PREV) Model, designed to integrate HIV/STBBI prevention and SRH through an intersectional, women-led approach.MethodsGuided by the implementation science Knowledge-to-Action Framework, we adapted the existing Women-Centred HIV Care (WCHC) Model to address HIV/STBBI prevention and SRH needs for women. The development process included a rapid scoping review, environmental scan, and stakeholder interviews with women, clinicians, and service providers in two Canadian provinces, Ontario and Saskatchewan.ResultsFindings highlighted that structural barriers such as housing insecurity, stigma, and systemic racism often overshadow women's ability to prioritize HIV/STBBI prevention and SRH. The resulting W-PREV Model addresses these realities by integrating HIV/STBBI prevention within six interrelated domains: SRH care, gender-specific care, mental health care, substance use and harm reduction, social connection and peer support, and individual capacity building. The model's trauma- and violence-aware, person-centred, and culturally responsive foundation ensures prevention is accessible, relevant, and empowering across the life course. W-PREV is distinct in its focus on HIV/STBBI prevention and early intervention, integrating SRH, peer support, and outreach within community and clinical settings.ConclusionsThe W-PREV Model provides a comprehensive, women-centred framework that bridges clinical and community settings to support personalized HIV/STBBI prevention and SRH self-care. By grounding prevention in women's lived experiences and peer support, W-PREV promotes equitable, holistic, and sustainable care for women and gender diverse people in Canada.

The Brain Care Score (BCS) is a recently developed tool that measures modifiable risk factors for brain health. This study evaluated the association between BCS and cognitive performance in a community-based cohort from Singapore.

Data were drawn from the Health District @ Queenstown baseline study, a representative multiethnic community cohort. The BCS (range 0-21; higher scores = healthier profiles) was derived from baseline questionnaires across physical, lifestyle, and socioemotional domains. Cognitive recall was assessed with the five-item word recall test, and executive function with the Eriksen flanker task.

A total of 5224 participants (mean age 52.8 ± 17.5 years; 53.1% women) were surveyed between September 2023 and May 2024. Participants with impairment had lower mean BCS than those without (14.9 ± 3.1 vs. 16.2 ± 2.8; p < 0.001). Each one-point BCS increase was linked to 5% lower odds of impaired recall (odds ratios [OR] 0.95; 95% confidence intervals [CI] 0.92-0.98; p = 0.002), whereas per five-point higher BCS corresponded to 23% lower odds (OR 0.77; 95% CI 0.66-0.91; p = 0.002). Each one-point BCS increase was also associated with a 0.03-point higher executive function score (β 0.03; 95% CI 0.01-0.05; p = 0.02), with per five-point higher BCS yielding a 0.15-point higher score (β 0.15; 95% CI 0.03-0.27; p = 0.02). Associations were stronger among younger, Chinese, and higher income participants.

Higher BCS was associated with better cognitive performance. These findings support its use as a potential community-based tool for brain health risk assessment in Asian populations.

Mental health disorders among medical students represent a persistent global challenge. Disclosure, defined as the act of revealing a mental health disorder to peers, educators or institutions, is shaped by cultural norms, institutional structures and professional expectations. Despite growing awareness of well-being, disclosure remains complex and fraught with stigma, confidentiality concerns and fears of professional repercussions. This international qualitative meta-synthesis explores how medical students experience and navigate mental health disclosure, aiming to clarify the social, cultural and institutional forces that shape disclosure decisions. It further seeks to inform policies that create psychologically safe learning environments.

A systematic search of nine databases (updated December 2025) identified peer-reviewed qualitative and mixed-methods studies published between 2013 and 2025. Data were synthesised using Thomas and Harden's thematic synthesis method within an interpretivist paradigm. Reporting followed the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodological quality was assessed using the critical appraisal skills programme (CASP) checklist. Confidence in the review findings was evaluated using confidence in the evidence from reviews of qualitative research (GRADE-CERQual). The review protocol was registered with the international prospective register of systematic reviews (PROSPERO; CRD42024521037).

Eighteen studies from seven countries (n = 379 participants) met the inclusion criteria. Six overarching themes and 16 subthemes were identified. Key barriers to disclosure included stigma, professional anxiety, confidentiality concerns, institutional rigidity and uncertainty about support services. Peer influence emerged as the only consistent facilitator of disclosure. The findings illustrate how medical culture, systemic structures and social expectations intersect to sustain nondisclosure and limit access to support.

Disclosure of mental health disorders in medical education is a negotiated, relational process embedded within socio-cultural and institutional power dynamics. This synthesis advances understanding by situating disclosure within disability and critical theory frameworks, highlighting how ableism and professional identity norms perpetuate silence. Addressing these structural forces through inclusive policies and psychologically safe learning cultures is essential to normalising openness and supporting the well-being of future doctors.

Youth mental health and brain development are profoundly shaped by highly heterogeneous childhood environments. However, research often operates under the assumption that neural networks linked to psychopathology function in the same way across different individuals, with limited consideration of how brain-behavior associations themselves may vary across environmental contexts. This poses challenges for identifying the precise neural correlates of risk or resilience to psychopathology.

In a large, longitudinal sample (N = 8,078), we examined differences in psychological symptoms and their associations with brain network functional connectivity across three clusters of youth identified by their home, school, and community environments.

Child environment groups differed in mental health symptoms, as well as the links between large-scale functional network connectivity and symptoms. Youth exposed to high trauma and familial risk showed the highest symptom levels over time compared to those youth in low-risk or economically disadvantaged environments. Moreover, youth in the high trauma and familial risk group showed stronger functional connectivity between the salience and frontoparietal networks with increased symptoms, whereas youth in the high disadvantage group showed the opposite pattern. Notably, these brain and mental health associations were not observed when examined across the entire sample, and group differences were more pronounced in female and older youth.

The same neural patterns of functional network connectivity can have different implications for mental health depending on the environment. These findings highlight the importance of context-sensitive approaches for developing personalized interventions in supporting youth mental health.