The mental health treatment gap is an important issue for young people in the East Mediterranean Region as financial constraints and cultural factors continue to play a limiting role. This paper examined predictors and barriers for help-seeking for mental health problems in children and adolescents in Lebanon.

The Psychopathology in Children and Adolescents in Lebanon Study, a nationally-representative household sample of n = 1,517 youth aged 5-17 years, was used. Parents and adolescents completed several self-reported mental health questionnaires, and a demographic information sheet. Potential barriers to care utilization assessed included: (i) discomfort in discussing mental health, (ii) stigmatization, (iii) distrust in effectiveness of mental healthcare, (iv) costs, (v) unavailability of nearby services. Regression models were conducted to examine the correlates of help-seeking for psychiatric disorders.

Of the n = 498 youth with a positive screen for a psychiatric disorder, only n = 25 (5.0%) reported ever receiving professional mental healthcare services. Male gender, receiving school accommodation, higher parent-reported hyperactivity and depression were associated with help-seeking after adjustment for other variables. For children with a positive screen who had not sought help, the most often endorsed barriers were costs (22.3% major barrier) and unavailability of nearby services (16.1% major barrier).

This study showed that costs and unavailability of nearby services were the biggest barriers to help-seeking among children and adolescents in Lebanon, underscoring the importance of incorporating mental health in public health policies and budget allocation in the East Mediterranean Region.

Caregiving is a universal human experience with a wide range of consequences on caregivers' physical and mental health, social life, and economic well-being. Yet caregiving among the farming population has seldom been studied, even though this population might have greater needs for care due to the dangerous and physical nature of the work, aging of the population, and the role of childcare as a safety strategy.

We drew on a publicly available survey of 704 farming caregivers in the U.S. Northeast and Midwest to answer four research questions: 1) Who are the caregivers? 2) What resources does caregiving require? 3) How does caregiving impact farming caregivers' finances and well-being? 4) What type of support do caregivers use and what support do they want? We conducted bivariate analysis to tease out similarities and differences based on the type of care provided: children, adults (with a disability and/or older), or both (i.e. children and adults).

Almost two-thirds of respondents (60%) cared for both children and adults, while 22% cared only for children and 17% cared only for adults. Respondents are diverse - with a variety of caregiving responsibilities and demands on their time and finances. A majority of respondents reported a mix of both largely negative impacts on financial wellbeing and mostly positive and neutral impacts on mental, physical, and social wellbeing. Most respondents used social safety net programs and desired more caregiving support. Significant differences emerge when we compare different types of caregiving. Respondents caring for children and adults are more likely to have higher resource demands, negative financial impacts, and desires for support.

Our findings reemphasize the importance of attending to the social and economic needs of farmers and farmworkers in research, outreach, and policy. This includes helping farming community navigate their caregiving responsibilities in a way that accounts for how their realities (e.g. needs of people they care for, self-employment status, immigration status, rurality of residence) shape their needs and ability to access help. Our findings also add to the growing scholarship challenging stereotypes that farming communities are socially tight-knit, self-sufficient, and do not want help.

ObjectiveTo examine the usage of a standardized screening tool bundle in guiding care recommendations within a regional coordinated access service (1Call1Click.ca) for children, youth and their families seeking mental health, addictions, and substance use health (MHASUH) care. To explore how the screening tools align with each other and with Level of Need, an assigned designation used to indicate acuity, needs, and guide service recommendations.MethodBetween May 31, 2021, and December 31, 2023, 8,280 clients aged 6-21 were administered the CASH screening tool bundle (CASH is an acronym for the included screening tools, the CRAFFT, Ask Suicide Questions {ASQ}, HEADS-ED (Over 6 and Under 6) and assigned a Level of Need (used to describe acuity and guide referrals). We describe the most common needs, correlations between Level of Need and each screening tool, and agreement between the HEADS-ED Domains of Suicidality and Drugs and alcohol with the ASQ and CRAFFT screening tools.ResultsWe observe a significant moderate correlation (r(8,280) = .507, p < .001) between the total HEADS-ED score and the assigned Level of Need and significant differences in HEADS-ED total score between each Level of Need (F(4, 8,275) = 766.810, p < .001). Additionally, ASQ and CRAFFT results align with the Suicidality and Drugs and alcohol domains of the HEADS-ED. Referrals were accepted by services at a rate of 94.4%.ConclusionThe CASH screening tool bundle is effective for screening child and youth MHASUH concerns. The HEADS-ED can give a non-specialist healthcare provider an overview of the nature and acuity of child and youth MHASUH and guide the application of more specialized tools included in the bundle. Used as described in this manuscript, the standardized screening bundle is a useful means for assessing needs and guiding referrals to specialized care, including in-depth specialized assessments.

Syria has undergone significant socio-political turmoil since 2011 as internal conflict displaced portions of the population, destroyed infrastructure, and destabilized the economy. In the context of multilevel healthcare system disruptions, there have been increasing reports of substance use. This study seeks to evaluate patterns of substance use in Northwestern Syria.

Trained staff administered questionnaires to community members in Azaz, Syria. Questions focused on the substance use prevalence, societal and public health impacts, and perspectives on treatment availability.

480 individuals were surveyed (80·88% male, 19·12 % female; 43·39% were 18-25 yrs, 11·5% reported personal substance use). H-booz (amphetamines), hashish (cannabis), and tramadol were the top 3 used. Displaced individuals exhibited twice the odds of substance use compared to non-displaced, with higher education and age demonstrating strong protective effects.

The current sociopolitical and economic situation shaped patterns of substance use within Syria, with reported prevalence likely an underestimate given social desirability bias. Those commenting on their use met the criteria for substance use disorder. Results underscore the need for improved access to treatment options in the region.

Nonsuicidal self-injury (NSSI) is a common clinical concern among adolescents, yet the roles of shame and guilt as proximal drivers of NSSI in daily life remain unclear. Using an ambulatory assessment design, we examined how these self-conscious emotions relate to momentary NSSI urges and how they fluctuate before and after NSSI acts.

We recruited 25 adolescents (M = 15.9 years, 72% female, 8% male, 20% gender-diverse) who reported shame, guilt, and NSSI urges four times per day for seven consecutive days on their smartphones. NSSI acts were logged using event-contingent prompts, followed by repeated ratings 10, 20, and 30 minutes after each act. Linear mixed-effects models were used to test concurrent and lagged associations between shame, guilt, and NSSI urges and to estimate event-related changes in these emotions.

Both shame and guilt were positively associated with concurrent NSSI urges at the within- and between-person levels. Shame showed more pronounced temporal variability, with higher levels on Sundays and during the evening hours, and it increased in the minutes following NSSI. Guilt, however, showed no consistent diurnal or weekly pattern and did not change post-NSSI. Neither emotion predicted higher urges at the next prompt one to approximately three hours later.

In adolescents who engage in NSSI, shame and guilt co-occur with episodes of elevated urges rather than predict them over short periods. Shame appears more involved in the aftermath of NSSI, consistent with a maintenance process, whereas guilt tracked urges to a similar extent but did not change post-NSSI. Clinically, spikes in both shame and guilt may serve as actionable real-time markers, and post-episode support targeting self-criticism and anticipated judgment may be especially beneficial. Schools and health care settings can reduce barriers to help-seeking by using non-stigmatizing language around NSSI, given that shame frequently drives concealment.

Social Anxiety Disorder (SAD) is a prevalent mental disorder characterised by fear of negative evaluation. Although effective treatment approaches are available, access remains limited due to psychological and organisational barriers. Internet-based cognitive behavioural therapy (iCBT) has shown promising results and may facilitate an easy and more resource-efficient access to treatment.

We developed an app-based self-help intervention for SAD based on the Clark and Wells treatment program, implemented as an unguided smartphone application, which was evaluated in this quasi-experimental pre-post pilot study consisting of N = 33 patients with a primary diagnosis of SAD. Feasibility was assessed through usage parameters and qualitative feedback. Effectiveness was evaluated in regard to SAD and depression, using clinician-rated measures (LSAS, QIDS-C) at post-treatment (12 weeks) and self-report measures (SPIN, SCQ, BDI-FS) at midpoint and post-treatment. Additionally, moderating effects of usage parameters on symptom reduction were examined.

Clinician- and self-reported SAD symptoms were significantly reduced at post-measurement (within-group effect sizes LSAS: η² = .54; SPIN: η² = .47), with 52% of patients achieving a clinically significant improvement. Despite moderate overall adherence, the amount of conducted behavioural experiments moderated reduction in self-reported SAD symptom severity and SAD-related cognitions. Open feedback supported feasibility and acceptability of the app.

In conclusion, findings provide preliminary support for feasibility, acceptability, and potential effectiveness of Mindable: Soziale Phobie. A randomised controlled trial will further evaluate the effectiveness and explore the impact of therapist guidance.

Depression is increasingly prevalent among older adults worldwide, exacerbated in the post-pandemic era and driven by aging populations, economic strain, and quality-of-life declines. In China, these factors contribute significantly to arise in depression among this demographic. Meanwhile, Artificial Intelligence (AI) shows growing promise in mental health management, potentially offering valuable tools to mitigate depression. This study examines AI's capacity to alleviate depressive symptoms in older adults from a macroeconomic perspective, particularly in aging societies like China and other developing nations. Using data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011-2020, employ a two-way fixed-effects model to empirically analyze AI's impact on depression in this demographic. Our results indicate a significant negative association between AI development and depressive symptoms among older adults. Mediation analysis reveals that macroeconomic factors, such as increased Internet access, robot application density, and investment in science and technology, and micro-level factors, like life satisfaction and cognitive function, contribute to AI's beneficial impact on mental health. While our findings are robust, limitations include data constraints and the need for further exploration of specific AI applications on depression outcomes. Future research could focus on interdisciplinary approaches integrating AI with psychomedical technologies, emphasizing support for vulnerable groups, including those in rural or under-resourced areas, and fostering public awareness and accessibility of AI health tools.

Global population ageing has heightened mental health concerns among older adults. Traditional reminiscence therapy (RT) is effective but faces limitations in accessibility and scalability due to its reliance on clinical settings and professional guidance. Digital technologies, including multimedia platforms, virtual reality, and social robots, offer promising alternatives. The purpose of this study is to explore the perceptions, attitudes, needs, and concerns of older adults and healthcare providers regarding digital reminiscence technology.

A qualitative descriptive design was used, employing focus groups with 14 older adults from communities and nursing homes, and 10 healthcare providers from a tertiary hospital. Four focus groups were conducted between November and December 2024, following demonstrations of digital tools. Data were analyzed using conventional content analysis with NVivo 12.

The analysis revealed three major categories: Integration of reminiscence and digital tools; Enhancing accessibility and usability; Ethical and social considerations in digital reminiscence.

Digital technologies can enrich RT by improving immersion and scalability, but challenges like affordability, usability, and ethical risks must be addressed. Findings from both older adults and healthcare providers in the Chinese cultural context highlight the need for affordable, simple, culturally sensitive, and ethically robust digital solutions, suggest that tailored strategies should be developed for family, community, and clinical settings to support the wellbeing of older adults.

Internet-delivered psychodynamic therapy (IPDT) has been found to be effective for adolescents with depression in previous randomized controlled trials. The present study aimed to evaluate an adaptive, feedback-informed version of IPDT, designed to improve outcomes for participants identified early as at risk of non-response.

A randomized controlled trial targeting adolescents aged 15-19 years with mild to moderate major depressive disorder. Participants were recruited through social media, national and local advertising, schools, and user organizations. After three weeks of standard IPDT, participants classified as at risk by a prediction algorithm were randomized to either adapted or standard treatment. The planned sample size was 240 participants. Despite extensive nationwide recruitment efforts during 2024, only 35 participants were enrolled before the study was discontinued.

Recruitment difficulties were primarily due to recent European Union regulations prohibiting profiling-based online advertising for minors, which eliminated access to previously effective social media recruitment channels. Participants who completed treatment showed significant pre- to post-treatment improvements in depressive symptoms (d = 1.08), anxiety (d = 0.74), and emotion regulation (d = 0.79). The predictive algorithm showed promising results in classifying patients as responders or non-responders.

Although the trial was underpowered, the findings provide promising within-group effects and valuable lessons for future digital mental health research involving minors. New recruitment infrastructures that comply with data protection laws are needed to ensure feasibility of online psychotherapy trials. Continued development of adaptive, feedback-informed IPDT for adolescents with depression is needed.

ClinicalTrials.gov Identifier: NCT06193772.

Methotrexate (MTX) is one of the first-line treatments for Rheumatoid arthritis (RA) but sub-optimal adherence to MTX is common. Adherence can be challenging to detect in the clinic but can be assessed objectively using a MTX biochemical adherence test measuring levels of MTX in the blood. However, it remains unknown how to use the results of MTX biochemical adherence tests to improve adherence. COMMIT (development of a COMplex Methotrexate adherence IntervenTion utilising biofeedback) is a qualitative study designed to explore adherence to MTX in RA patients and aid the development of a behaviour change intervention that can be delivered alongside MTX biochemical adherence testing.

Potential participants were identified from the Rheumatoid Arthritis Medications Study (RAMS), a large national study of patients with RA commencing MTX. An interview topic guide was developed using the Capability, Opportunity and Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Consenting participants took part in a 1:1 semi-structured telephone interview. Transcripts were inductively analysed and mapped to themes.

Seventeen participants treated with MTX for a mean 3 years (range 3-20) took part in the semi-structured interviews. Five overarching themes were identified and mapped to behaviour change techniques. Themes included 1. Knowledge of MTX and its impact, 2. Motivators versus barriers for continuation of MTX, 3. The healthcare approach in shaping patient adherence, 4. Creating habits and routines 5. MTX biochemical adherence blood tests and external monitoring of behaviour.

This study has identified many of the key facilitators and barriers that influence adherence to methotrexate in RA patients. Through identifying the capabilities, opportunities, and motivations that shape engagement with MTX biochemical adherence testing, we can select targeted behaviour change techniques to address these factors. This theory-driven approach offers a novel pathway to improving uptake of MTX adherence testing.