Older adults evaluated by consultation-liaison psychiatry services (CLPS) often present with complex psychiatric and medical comorbidity, frequent psychotropic exposure and a high prevalence of frailty. However, the relative contribution of these factors to clinical outcomes remains unclear.

We conducted a multicentre prospective cohort study including 465 consecutive patients aged ≥65 years evaluated by CLPS in 10 general hospitals in Spain between January and July 2024. Psychiatric history, post-consultation psychiatric diagnoses, psychotropic use, age group (65-74 vs ≥75 years) and frailty assessed using the Clinical Frailty Scale were recorded. Outcomes included falls, institutionalization, access to mental health follow-up and mortality at 1 and 3 months after discharge.

The mean (SD) age was 77.4 (7.8) years and 55.9% were women. Psychiatric history was present in 68.8% of patients and 55.8% received a new psychiatric diagnosis, most commonly delirium. Patients with falls also reported significantly higher levels of perceived loneliness. Psychotropic use was frequent (71.6%), particularly antidepressants (49.0%) and benzodiazepines (42.6%). Psychotropic polypharmacy was associated with falls. Frailty was prevalent (60.2%) and independently associated with early mortality, whereas age was the main predictor of mortality between 1 and 3 months. Older age was also associated with a lower likelihood of specialized mental health follow-up.

Among older adults evaluated by CLPS, frailty and medical comorbidity appear to outweigh psychiatric variables in predicting outcomes. Integrating comprehensive geriatric assessment and medication review into CLPS may improve care for this population.

Uganda criminalizes attempted suicide, exposing survivors to prosecution and imprisonment while mental health legislation requires assessment and care. This study examines the consequences of criminalization for access to care and the protection of health and dignity in Uganda. We conducted a comparative legal and policy review of legislation, constitutional adjudication, national reports, and published research through September 18, 2026. India, Ghana, and Kenya provided comparators. Uganda's 2016-2017 surveillance analysis reported attempted-suicide prevalence of 7.1 per 100,000 among males and 6.7 among females. It reported approximately 38 deaths per 1000 recorded male cases. The Ministry of Health recorded 616,175 mental-health outpatient attendances in 2023/24, including 96,277 for unipolar depressive disorders. Ugandan accounts describe imprisonment after treatment and threats of prosecution during recovery. Mental health workers differed over punishment as deterrence, while survivors described both punitive police encounters and referral for care. Fear of legal consequences can discourage disclosure, delay help-seeking, and impede accurate reporting. Constitutional protections and judicial recognition of health rights support scrutiny of this penal response. The Mental Health Act's treatment duties leave criminal liability for the attempt intact. The evidence supports repeal alongside funded crisis services, clear referral responsibilities, and continued clinical and social support. Decriminalization should remove punishment for surviving a suicidal crisis while making timely care and recovery the purpose of the public response.

Cognitive behavioral therapy (CBT) is an effective and widely used treatment for major depressive disorder (MDD). However, access is limited by long waiting lists and a shortage of trained therapists. Evidence-based guided and self-guided digital interventions can address these challenges, but their large-scale adoption in routine primary and specialized mental health care has been slow. Blended CBT (bCBT), combining face-to-face therapy with structured, guided digital treatment modules, may increase treatment capacity while maintaining the benefits of therapist support.

The European Comparative Effectiveness Research on Internet-based Depression Treatment study, conducted across 9 European countries, is the first large-scale comparative bCBT study for MDD. The hypothesis was that bCBT is clinically noninferior and cost-effective when compared with treatment as usual (TAU), which mainly consisted of face-to-face CBT.

A multisite randomized controlled trial was conducted with a noninferiority margin of d=0.20. Main inclusion criteria were age ≥18 years, a diagnosis of MDD based on the Mini International Neuropsychiatric Interview, and a baseline Patient Health Questionnaire-9 (PHQ-9) score of ≥5. The primary outcome was the PHQ-9, with secondary outcomes including MDD remission at 12 months, therapeutic alliance, and costs. Intention-to-treat analyses were performed, and linear mixed modeling was used to assess intervention effects. Cost-effectiveness analyses were conducted from a health care perspective.

A total of 835 patients were included in the study. bCBT was shown to be noninferior to TAU on the primary PHQ-9 outcome during treatment (3 months after the baseline assessment, d=-0.26, 95% CI -0.43 to -0.09), at 6 months (posttreatment, d=-0.21, 95% CI -0.39 to-0.04), and at 12-month follow-up (d=-0.01, 95% CI -0.19 to 0.17). Furthermore, the bCBT group had a significantly lower likelihood of experiencing an MDD episode at 12 months (odds ratio 0.67, 95% CI 0.45-0.99). Subgroup analyses indicated that participants with and with no antidepressant use at baseline in both groups benefited equally from their treatment. Deterioration rates (Reliable Change Index) were below 5% in both groups. bCBT appeared acceptable for patients and therapists, with a strong working alliance in both groups. From a health care perspective, bCBT was not cost-effective at 12 months' assessment, as its total costs were not significantly lower than TAU. However, the probability that bCBT is cost-effective is high (0.95) at a willingness to pay (WTP) of €3800 per improvement in the PHQ-9 score, and 0.76 at a WTP of €10,000 per MDD case prevented (average 2017 exchange rate was €1=US $1.13).

bCBT offers an effective and safe digitally supported alternative to face-to-face TAU for patients with MDD and their therapists in routine clinical care. From a health care perspective, its cost-effectiveness depends on policymakers' WTP for the additional clinical benefits achieved.

Digital health technologies offer promising opportunities to support physical health. However, their acceptance, use, and associated benefits are not equally distributed across society. While existing research has mainly focused on traditional socioeconomic indicators, broader sociological influences, including economic, cultural, social, and person capital, may provide a more comprehensive understanding of these inequalities. Yet, too little is currently known about how different subgroups, based on their economic, cultural, social, and person capital, relate to intentions to accept and use digital health technologies.

This study aimed (1) to identify distinct subgroups of individuals based on their acceptance and intended use of digital technologies to support their physical health and (2) to examine how these subgroups differ in terms of economic, cultural, social, and person capital.

We used cross-sectional data from the Longitudinal Internet Studies for the Social Sciences (LISS) panel, including data from the LISS Core Study on health, economic situation, and social integration and leisure. To supplement these data, we conducted an additional online survey in November 2023 via the LISS panel to assess participants' acceptance and intended use of digital technologies to support their physical health. The final sample included 1096 participants. We applied 3-step latent class analysis to identify subgroups based on constructs from the unified theory of acceptance and use of technology. Post hoc comparisons were used to characterize the subgroups based on 22 indicators of economic, cultural, social, and person capital.

Five subgroups were identified: neutral users (480/1096, 43.8%), uninterested users (235/1096, 21.4%), engaged users (226/1096, 20.6%), resistant users (102/1096, 9.3%), and enthusiastic users (53/1096, 4.8%). The largest group, neutral users, neither fully adopted nor rejected digital technologies to support their physical health. Higher levels of economic, cultural, and social capital were generally associated with greater acceptance and intended use of digital health technologies. However, person capital showed a different pattern: neutral users reported low self-confidence despite moderate use, while resistant users reported high self-image despite low acceptance and intended use. This suggests that person capital relates to the acceptance and intended use of digital health technologies in a different way than economic, cultural, and social capital.

Inequalities in digital health engagement extend beyond socioeconomic factors and reflect broader differences in economic, cultural, social, and person capital. The distinct user types that were identified reveal that combinations of different types of capital can influence acceptance and intended use in unexpected ways. Addressing these multidimensional disparities is crucial for designing targeted and equitable strategies to enhance digital health participation across diverse populations.

Mental health clinical notes contain decision-critical information often absent from structured electronic health record fields. Large language models (LLMs) can extract clinically relevant signals from narrative text; however, variability in output format, limited reproducibility, and inconsistent evaluation remain barriers to clinical deployment. Despite rapid advances in LLM-based information extraction, clear and reproducible guidance for interdisciplinary clinical teams is limited.

This tutorial aims to present a structured workflow for zero-shot information extraction from mental health clinical notes using locally deployed open-source LLMs. It aims to reduce barriers for clinicians and researchers with limited familiarity with natural language processing (NLP) or LLM-based pipelines. Each stage includes key decision points and examples. The workflow is illustrated on two tasks using synthetic notes: (1) detection of self-injurious thoughts and behaviors (SITB) in pediatric emergency department (ED) notes and (2) antipsychotic medication nonadherence detection in outpatient notes, using schema-constrained outputs and standardized evaluation.

We describe a five-stage zero-shot LLM pipeline: (1) infrastructure setup with local deployment via Ollama to prevent protected health information (PHI) transmission; (2) task definition specifying the clinical construct, output format, and evaluation; (3) dataset preparation using synthetic notes; (4) iterative prompt development using a hold-out development set with binary and Likert scale outputs constrained via JSON schemas; and (5) output parsing, normalization, and validation. We generated 300 synthetic notes per task using separate LLMs for generation and evaluation; 200 notes were used for evaluation, and 100 notes (50 positive and 50 negative) were used as a prompt-development set and excluded from final metrics. Evaluation used Large Language Model Meta AI (Llama) 3.2 and Llama 3.3 with deterministic decoding (temperature=0). Performance was assessed using accuracy, precision, recall, and F₁-score; Likert thresholds were optimized using the Youden index with bootstrapped CIs.

We demonstrated the pipeline's functionality using 2 example behavioral health detection tasks. Across both examples, the more capable model (Llama 3.3) performed better than the lighter model used earlier in development (Llama 3.2), and we described how the pipeline's evaluation and error-analysis steps work in practice. These examples also illustrated 2 useful design choices: requiring the model to output in a fixed format reduced errors, and using a graded rating scale, rather than a simple yes/no format, allowed the detection threshold to be adjusted based on clinical risk tolerance. These results are meant to show that the pipeline works as intended, not to serve as a benchmark of real-world accuracy.

A schema-driven, zero-shot LLM workflow can support reproducible extraction of clinically relevant information from narrative notes. Local deployment enables processing without transmitting PHI to external servers. This tutorial provides a transferable methodology for institutional adaptation and validation prior to clinical use. All prompts, code, and datasets are publicly available via Zenodo (European Organization for Nuclear Research [CERN]).

Sexual and gender diverse (SGD) youth experience unique minority stressors that can have a significant impact on their well-being. Many SGD youth use digital technologies to offset these stressors and develop resilience. To date, the role of video gaming in the well-being of SGD youth has not been explored.

The objectives of the LEVEL UP! study are to (1) investigate the motivations, preferences, behaviors, and experiences of SGD youth as they relate to video game playing and engagement in online video gaming communities; (2) explore how SGD people are represented in video games and how these portrayals are appraised by SGD youth video gamers; (3) identify how video games can support protective factors and processes that contribute to resilience among SGD youth video gamers; (4) develop recommendations and resources (eg, affirming media guides) to make video gaming safer for SGD youth; and (5) demonstrate the utility of video game screenshots as a novel and ecologically valid data source for eliciting discussion from SGD youth about the significance of video gaming in their lives.

A multipronged, targeted, web-based recruitment approach (social media-based convenience sampling, collaborating with video gaming influencers, Prolific panel recruitment) will be used to recruit approximately 2500 SGD youth aged 14 to 29 years in Canada, the United States, Mexico, the United Kingdom, and Australia to complete a mixed methods, cross-sectional survey hosted on Qualtrics. Key quantitative variables of interest include video gaming habits, preferences, play styles, and the psychological impacts of positive and negative video gaming experiences. Qualitative survey data sources include a brief screenshot elicitation prompt, recall of video gaming experiences, and appraisal of video game content. Canadian participants sampled from the survey will be invited to participate in a follow-up digital screenshot elicitation interview over Zoom to further elaborate on these experiences. Proposed quantitative analyses include exploratory factor analysis, one-way ANOVAs, correlational analyses, and multivariate regressions. Anticipated qualitative analyses include multimodal coding of survey screenshot elicitation data and constructivist grounded theory analysis of the digital screenshot elicitation interview data. Explanatory and convergent mixed methods analyses combining quantitative and qualitative findings are also planned.

The LEVEL UP! study was funded in March 2022, and data collection is expected to occur between October and December 2026, with initial results published in 2027.

LEVEL UP! will provide crucial insight into an underresearched digital subculture that may support the resilience of SGD youth. Opportunities for knowledge translation targeting SGD youth, caregivers, and video game industry professionals are suggested.

National Guard suicide rates have been comparable to active-duty rates, yet Guard members may face geographic, stigma-related, and occupational barriers to mental health care. Recruiting National Guard members at elevated suicide risk into remotely delivered mental health and suicide prevention trials is difficult, particularly when direct suicide-related language may deter participation. This study examined whether a construct-targeted label intended to align with warrior-culture values ("fearlessness about death") was associated with greater engagement and study eligibility than a broad "mental health" label.

Twenty recruitment posts were placed in military-related Reddit communities between January 19, 2021, and April 18, 2022. Each post offered 2 otherwise identical study links labeled as either "fearlessness about death" or "mental health"; link position was counterbalanced, and respondents self-selected a link. A brief screener assessed current National Guard status, contact information and preferences, and the 7-item Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD). Eligibility for the parent online suicide prevention trial required current National Guard membership and an ACSS-FAD score greater than 17. Bot-generated, duplicate, incomplete, and non-National Guard responses were excluded. Group differences were examined using chi-square, independent-samples t, Fisher's exact, and risk-ratio analyses. All study procedures were approved by the institutions IRB before data were collected.

The fearlessness-about-death link generated 797 raw responses, including 500 consecutive bot-generated responses, whereas the mental-health link generated 139. After exclusions, 124 valid and complete submissions remained. Valid submissions were more frequent through the mental-health label (99 vs. 25), contrary to the engagement hypothesis, χ² = 44.16, P < .001, ϕ = 0.60. Respondents entering through the fearlessness-about-death label had higher ACSS-FAD scores (M = 18.64, SD = 4.65) than those entering through the mental-health label (M = 16.47, SD = 5.15), t = 2.03, P = .049, d = 0.43. Eligibility rates were 60.0% (15/25) and 38.4% (38/99), respectively (risk ratio = 1.56); however, despite the large effect, this difference did not reach conventional statistical significance, Fisher's exact P = .073. Most respondents preferred email to phone contact.

A broad mental-health label was associated with substantially more valid responses and more eligible participants overall. The fearlessness-about-death label yielded fewer responses but may have concentrated respondents with greater suicide capability and thus study eligibility. Strengths include naturalistic recruitment of an understudied military population. Limitations include unequal group sizes. Suggestions for recruitment strategies that balance broad messaging that maximizes overall response volume against targeted messaging are provided. Methods include using staged anonymous screening, transparent eligibility criteria, and respectful explanations and resources to minimize disappointment among ineligible respondents in this important population.

Yes. Clinical Trials.gov: https://clinicaltrials.gov/study/NCT04098588.

BackgroundShelby County, Tennessee (Memphis) has the highest rate of HIV incidence in the country, and youth in the region are disproportionately impacted. Local plans to end the epidemic call for implementation of trauma-informed care (TIC).MethodsWe conducted a convergent parallel mixed methods study, including interviews and surveys, with adolescents receiving care in a youth-focused HIV clinic in Memphis.ResultsAlmost half (47%) of participants met the criteria for probable PTSD, with 30% meeting criteria for provisional PTSD. Participants reported the clinic was aligned with TIC principles (i.e., sense of trust, support, collaboration, safety, and inclusivity) and unanimously voiced support for integration of trauma screenings and assessments. Important recommendations were also raised for implementation, with attention to cultural responsiveness and peer support.ConclusionsFindings show a positive perception of the clinic. Follow-up research will be used to inform the development of a trauma-focused intervention to influence HIV health outcomes.

This study explored pharmacy students' lived experiences of mental health support structures at a University in South Africa. A qualitative phenomenological design was employed, with data collected through semi-structured interviews (n = 20) and document analysis of institutional mental health resources (2020-2024). Thematic analysis revealed five interrelated themes: awareness and visibility of support; barriers to access and utilization; institutional responses to mental health crises; cultural and contextual misalignment; and informal support and coping strategies. Although formal support services were available, students experienced them as fragmented, reactive, and insufficiently integrated into academic life. Barriers to access included long waiting times, stigma, and concerns about confidentiality. Institutional responses to crises were perceived as academically focused, with limited psychological follow-up. Students relied heavily on informal networks, including peers, family, and spirituality. These findings highlight a disconnect between institutional provision and student experience, underscoring the need for more integrated, culturally responsive, and student-centred approaches to mental health support within pharmacy education.

Introduction: Dating violence is an early form of intimate partner violence characterized by controlling behaviors, psychological and sexual abuse, and digital coercion. Despite its high prevalence among adolescents and young adults, it remains underrecognized and insufficiently addressed in healthcare settings. Nurses are strategically positioned to identify and respond to dating violence due to their close contact with patients and holistic approach to care. However, important gaps remain between existing protocols and their implementation in clinical practice. Methods: An exploratory qualitative study was conducted within a constructivist paradigm as part of a multicenter research project on dating violence among health sciences university students. Twelve experts, including nurses, healthcare professionals, and representatives of survivor-led organizations, participated in focus groups and reflective journals between September and December 2025 at the University of Barcelona. Data were analyzed using an interpretative phenomenological approach, with inductive thematic analysis guiding coding and theme development. Methodological rigor was ensured following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval was obtained. Results: Four themes emerged: (1) barriers to identification, including the normalization of controlling behaviors, myths of romantic love, and limited recognition of psychological and digital violence; (2) challenges in nursing responses, such as insufficient training, clinical uncertainty, organizational barriers, and lack of screening tools; (3) identification strategies, including systematic screening, relationship-centered interviewing, emotional education, and recognition of subtle warning signs; and (4) actions following identification, focused on validation, confidentiality, risk assessment, interdisciplinary referral, and ongoing support. Conclusions: Findings highlight the need to update protocols to explicitly address digital violence and strengthen nursing-led interventions. Participants emphasized the need for enhanced professional training, context-appropriate screening tools, and intersectoral collaboration as potential strategies to improve the identification and response to dating violence.