Working in a chronically high emotional exhaustion environment, clinical nurses are prone to psychological burnout and associated professional psychological risks. Interpersonal guilt is recognized as an important potential mechanism affecting nurses' mental health, which may impair their personal well-being and nursing quality. However, there is still a lack of applicable assessment tools for measuring interpersonal guilt among Chinese clinical nurses.

The aim of this study is to translate the Interpersonal Guilt Rating Scale-20 (IGRS-20) into Chinese and evaluate its psychometric properties among clinical nurses in China.

A cross-sectional research design.

A total of 451 Chinese clinical nurses were recruited using the convenience sampling method.

The IGRS was translated into Chinese via the Brislin back-translation method. Its reliability was assessed by internal consistency, split-half, and retest reliability; validity was evaluated using content validity indicators, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

The Chinese version of IGRS contained 18 items. Its Cronbach's α coefficient was 0.833, with subscale values ranging from 0.780 to 0.831; split-half reliability was 0.860 and retest reliability was 0.868. The scale's I-CVI ranged from 0.833 to 1.000, and S-CVI was 0.981. The KMO value was 0.827, and Bartlett's sphericity test yielded χ² = 1524.165 (df = 153, p < 0.001). EFA adopting unweighted least squares extraction combined with Promax oblique rotation identified a robust four-factor model explaining 52.095% of total common variance (factor loadings: 0.569-0.957). CFA confirmed good model fit (χ²/df = 1.432, CFI = 0.959, IFI = 0.960, GFI = 0.917), validating the model's effectiveness for assessing nurses' interpersonal guilt.

The Chinese IGRS has good reliability and validity among Chinese clinical nurses. It can be used to measure nurses' interpersonal guilt level, facilitate the understanding of their psychological state, lay a foundation for targeted mental health interventions, and ultimately improve nursing quality.

The Chinese version of the IGRS provides a reliable assessment tool for nursing management to identify clinical nurses with high interpersonal guilt, enabling the design of culturally tailored psychological support programs that enhance nurses' emotional resilience and reduce professional psychological risks, thereby stabilizing the nursing workforce.

This study aimed to explore dietitians' views, experiences, and perceived barriers and enablers to working with people with mental illness in Australian private and public mental health settings, with a focus on clarifying the contribution of private practice dietitians to mental healthcare.

A combination of convenience and snowball sampling was used to recruit dietitians who primarily work in private practice or public mental health sectors. Virtual semi-structured interviews were conducted in two discrete 3-6-month blocks between 2021 and 2024. A constructivist-interpretivist approach informed the development of the interview guide, data collection and analysis processes. Semi-structured interviews explored experiences, facilitators and barriers of private practice dietitians working with people with mental illness. Data were analysed by three authors using reflexive thematic analysis using semantic, inductive coding.

In total, 14 dietitians completed interviews, comprising 7 working in private practice settings and 7 in public mental health services. Data adequacy was reached with interviews generating 5 main themes and 15 subthemes. Themes included (1) the complex needs of people living with mental illness, (2) access barriers and enablers to private practice dietitian services, (3) gaps in mental health-specific training and support for dietetics, (4) structural limitations of the private healthcare systems and (5) advantages of integrated care in specialised mental healthcare settings for working with people with mental illness.

To harness the full potential of private practice dietitians in mental healthcare requires targeted reforms to funding, training and referral systems to ensure equitable, community-based nutrition support.

South Korea has one of the highest suicide rates among developed countries, with suicide being the leading cause of death among individuals in their teens to 40s. Despite this serious situation, systematic interventions for suicide prevention remain limited, particularly concerning borderline personality disorder (BPD), which is strongly associated with suicidality. This narrative review examines 11 empirical studies involving clinically diagnosed BPD samples in South Korea, focusing on the prevalence, clinical characteristics, and treatment challenges of BPD within the Korean sociocultural context. The available evidence suggests that BPD is substantially underrecognized in South Korea, with a prevalence rate considerably lower than international estimates and a relatively older mean age of onset, likely reflecting the impact of mental health stigma and barriers to care. Korean individuals with BPD also demonstrate marked functional impairment and a strong association with suicidality, with sociocultural factors further complicating treatment engagement and outcomes. These findings highlight the need for earlier identification and timely diagnosis, broader implementation of evidence-based treatments, and greater dissemination of generalist treatment models and basic training for frontline clinicians. Such coordinated efforts may also contribute to suicide prevention efforts in the country.

Suicide is a major public health challenge. Traditional assessments of suicidal thoughts and behaviors rely on retrospective measures that are subject to recall bias and show limited predictive accuracy. Ecological momentary assessment (EMA) can improve suicide risk assessment by capturing real-time information in participants' natural environments. However, EMA burden often results in short follow-up periods.

This study aimed to examine the association between suicidal ideation (SI) and multiple variables collected in real time using smartphone-based EMA over 6 months, with the goal of identifying short-term predictors of suicide risk in a clinical population. A secondary objective was to explore whether baseline depression and psychological pain predicted EMA-reported SI.

This is a prospective EMA-based study carried out among outpatients at high risk of suicide, recruited in Madrid, Spain. At baseline, depression, suicidality, and psychological and physical pain were assessed using traditional questionnaires (Inventory of Depressive Symptomatology, Columbia Suicide Severity Rating Scale, and Visual Analog Scales). During the 6-month follow-up, participants completed daily smartphone-based EMA prompts assessing SI, nonsuicidal self-injury, negative affect, interpersonal experiences, sleep, and eating habits. Each day, 2-4 questions derived from validated instruments were randomly selected from a pool of 34 items to minimize participant burden. Mixed-effects models examined within-person variability, temporal trends, and real-time associations between EMA variables and SI. Intraindividual variability was quantified using intraclass correlation coefficients and root mean squared successive differences. Linear regression analyses explored associations between EMA variables and demographic covariates and evaluated whether baseline depression and psychological pain predicted the mean and variability of SI and negative affect.

A total of 99 participants were included in the final analysis, and 13,900 EMA responses were obtained. The slope of SI showed no significant changes over time, with similar results for negative affect, interpersonal difficulties, sleep problems, and appetite. Substantial within-person variability was observed across all EMA domains. Negative affect (ß=0.193, SE 0.03; t₉₈=6.21; P<.001) and interpersonal difficulties (ß=0.03, SE 0.168; t₉₈=5.96; P=.001) were significantly associated with SI and remained significant in combined models. In a subsample of 37 participants, lower baseline psychological pain was associated with lower levels of negative affect and SI over time, whereas higher baseline depression was associated with greater negative affect.

This study provides novel insights into the real-time relationship between SI and key psychological and behavioral variables, particularly negative affect and interpersonal difficulties, using smartphone-based EMA in a high-risk clinical population. The substantial within-person variability highlights the dynamic nature of suicide risk and the limitations of traditional assessments. Future studies should aim to translate EMA-based monitoring into actionable interventions to provide real-time support for individuals at high risk of suicide.

Large language models (LLMs) are increasingly deployed in mental health applications, yet growing evidence suggests they encode algorithmic biases that influence clinical outputs. Because these models now mediate patient-facing decisions, such biases carry the potential for direct harm. Whether they systematically affect psychiatric diagnosis across demographic groups remains underexplored.

This study aims to examine whether LLMs exhibit implicit demographic biases when generating psychiatric diagnoses.

We developed 1152 synthetic clinical vignettes using a matched-pair design that manipulated gender, race and ethnicity, age, socioeconomic status, English proficiency, and urbanicity while holding clinical content constant. Vignettes were divided into control (unambiguous anorexia nervosa [AN]) and ambiguous conditions designed to permit differential diagnosis. Ten LLM configurations across 5 model families were tested.

Control vignettes produced near-unanimous AN diagnoses (mean 100%, SD 0.1%), while ambiguous vignettes elicited greater variability (mean 23.6%, SD 10.1%). Intermodel agreement was moderate for ambiguous vignettes (Fleiss κ=0.410, 95% CI 0.397-0.422). Mixed-effects logistic regression with LLM as a random intercept revealed significant demographic biases: Black patients were over 6 times more likely to receive a major depressive disorder (MDD) diagnosis than White patients with identical presentations (odds ratio [OR] 6.09, 95% CI 5.13-7.24), Latine patients were over 9 times more likely (OR 9.57, 95% CI 8.00-11.45), and Asian patients were nearly 3 times more likely to receive an AN diagnosis (OR 2.88, 95% CI 2.44-3.42). Female patients were less likely than males to be diagnosed with AN (OR 0.43, 95% CI 0.37-0.49).

These findings demonstrate that LLMs exhibit systematic demographic biases in psychiatric diagnosis even when clinical content is held constant, revealing measurable patterns that can inform improvements to training data, model architecture, and clinical deployment frameworks.

Clean intermittent catheterization (CIC) is an established treatment for lower urinary tract dysfunction and has been used across age groups with voiding problems due to various etiologies. Although medically safe and straightforward, CIC may create social and emotional challenges for adolescents and their caregivers. During adolescence, when autonomy and peer acceptance become central, the need for continuous catheterization in daily life and, at times, dependence on another person can be difficult to cope with and may affect psychological well-being and peer relations. This study aimed to examine factors associated with potential psychopathology, self-perception, peer relationship characteristics, and quality of life in adolescents performing CIC.

This prospective cross-sectional study included 50 adolescents aged 12-18 years: 25 performing CIC and 25 age and sex-matched healthy controls. Participants with intellectual disability, low mental capacity preventing comprehension of study procedures, or uncorrected vision/hearing deficits were excluded. Psychiatric diagnoses were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version DSM-5 (K-SADS-PL). Self-perception, quality of life, behavioral difficulties, and peer relationships were evaluated using the Piers-Harris Children's Self-Concept Scale, Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire, and Peer Relationship Scale. Parental attitudes and caregivers' psychological symptoms were assessed using the Parental Attitude Research Instrument and the General Health Questionnaire-28. Statistical analyses were performed using SPSS version 23.0. Group comparisons were conducted using the independent samples t-test or Mann-Whitney U test as appropriate; categorical variables were analyzed with the Chi-square or Fisher's exact test. Multiple linear regression analysis was performed to identify independent predictors. A two-tailed p value <0.05 was considered statistically significant.

The groups were similar in age, sex and sociodemographic characteristics. Adolescents performing CIC showed higher social avoidance and poorer peer relationships. Eight adolescents (32%) in the CIC group met criteria for at least one psychiatric disorder according to DSM-5. Negative parental attitudes, maternal mental disorders, primary etiology requiring CIC, age at self-catheterization initiation, and catheterization performed by another individual were identified as significant predictors of lower self-esteem, reduced quality of life, and poorer peer relationships.

CIC may have meaningful psychological and psychosocial effects on adolescents, influenced by clinical variables and parental factors. Early identification of risk indicators and strengthening of protective factors are essential. A multidisciplinary approach incorporating psychiatric, familial, and psychosocial components should be included in the management and follow-up of adolescents performing CIC.

Self-harm, including suicidal thoughts, self-injurious behavior, and disordered eating, is a major public health concern among adolescents and young adults. Youth increasingly encounter self-harm-related content online, including websites that explicitly encourage harmful behaviors. Although exposure to such content has been linked to poorer mental health, most research is cross-sectional and has not examined longitudinal exposure trajectories. Whether persistent exposure represents a distinct digital risk pattern remains unclear.

This study examined longitudinal trajectories and correlates of exposure to self-harm-encouraging websites over 1 year and tested whether persistent exposure was associated with subsequent suicidal ideation, self-injury, and disordered eating.

We analyzed data from 2197 US youth aged 13 to 22 years who completed waves 2 and 4 of Project Lift Up, a national longitudinal cohort study. Website exposure was categorized into 4 trajectories: none, desist (wave 2 only), new (wave 4 only), and persistent (both waves). Categories reflected reported exposure at the 2 assessment waves rather than the frequency or continuity of website use between assessments. Logistic regression models estimated associations between exposure trajectory and wave 4 suicidal ideation, self-injury, and disordered eating, restricting analyses to participants without the respective outcome at wave 2. Models were adjusted for demographics and wave 2 depression or anxiety symptoms and other mental health indicators.

Overall, 26.5% (583/2197) reported exposure to self-harm-encouraging websites at wave 2, and 18.5% (407/2197) reported persistent exposure. Privacy concerns, embarrassment, curiosity, and lack of offline support were associated with greater odds of persistence (adjusted odds ratios [aORs] 1.84-3.23), whereas accidental exposure was associated with lower odds of persistence (aOR 0.28, 95% CI 0.19-0.41). Compared with no exposure, persistent exposure was associated with higher odds of suicidal ideation (aOR 1.88, 95% CI 1.24-2.86; P=.003), self-injury (aOR 3.14, 95% CI 2.05-4.80; P<.001), and disordered eating (aOR 2.46, 95% CI 1.54-3.93; P<.001). Adjusted predicted probabilities showed a graded pattern, with persistent exposure associated with the highest predicted probabilities (suicidal ideation: 33.4% vs 21.3%; self-injury: 25.7% vs 10.2%; disordered eating: 11.7% vs 5.3%). New exposure was associated with increased odds of self-injury (aOR 2.32, 95% CI 1.30-4.15; P=.004) but was not significantly associated with suicidal ideation or disordered eating. The desist trajectory was not significantly associated with outcomes.

Persistent exposure to self-harm-encouraging websites may represent a distinct digital risk pattern associated with higher subsequent odds of suicidal ideation, self-injury, and disordered eating. Assessing patterns of repeated website exposure and youths' motivations for seeking this content-not merely whether exposure occurred-may improve the identification of youth at heightened risk and inform digital prevention and clinical intervention strategies.

Gaming time, impulsivity, and self-control are known determinants of internet gaming disorder (IGD). However, their reciprocity has not been empirically tested.

This study investigated the reciprocal relationships among gaming time, impulsivity, self-control, and IGD simultaneously within a single cross-lagged panel model among Chinese adolescents, hypothesizing that all 4 variables would be prospectively associated with each other.

This 1-year, 2-wave prospective longitudinal cohort (observational) study recruited grade 7 and grade 8 students from a convenience sample of 6 junior high schools in Chengdu and Guangzhou, China. Students completed an identical self-administered questionnaire in classrooms (using paper and pencil, without teachers present) in December 2018 (wave 1 [W1]) and December 2019 (wave 2 [W2]). Impulsivity, self-control, gaming time, and IGD were assessed using validated scales. The 2238 students (mean age 12.60, SD 0.63 years, 95% CI 12.58-12.63; male: n=1102, 49.24%, 95% CI 47.27%-51.21%) who completed the W1 survey were included in the final data analysis, with multiple imputations addressing missing data from dropouts and unmatched assessments across the 2 study waves.

Adjusting for background characteristics, autoregressive correlations, and concurrent correlations, the cross-lagged panel model showed that (1) the prospective association between gaming time at W1 and IGD at W2 was statistically nonsignificant (β=0.02, 95% CI -0.04 to 0.08), but IGD at W1 was prospectively and positively associated with gaming time at W2 (β=0.08, 95% CI 0.01-0.16; P=.02); (2) self-control at W1 was prospectively and negatively associated with both gaming time at W2 (β=-0.13, 95% CI -0.19 to -0.07; P<.001) and IGD at W2 (β=-0.11, 95% CI -0.17 to -0.05; P<.001), and IGD at W1 was prospectively and negatively associated with self-control at W2 (β=-0.09, 95% CI -0.15 to -0.03; P<.001), but gaming time at W1 was not associated with self-control at W2 (β=0.04, 95% CI -0.01 to 0.09); and (3) the prospective associations between impulsivity at W1 and IGD at W2 (β=0.03, 95% CI -0.03 to 0.09) and between impulsivity at W1 and gaming time at W2 (β=-0.04, 95% CI -0.10 to 0.03) were statistically nonsignificant; reciprocally, neither IGD at W1 (β=0.05, 95% CI -0.01 to 0.11) nor gaming time at W1 (β=-0.01, 95% CI -0.07 to 0.05) was prospectively associated with impulsivity at W2.

This prospective longitudinal cohort study is the first to disentangle the reciprocal prospective associations among gaming time, impulsivity, self-control, and IGD simultaneously within a single cross-lagged panel model. Unlike prior studies, which examined these variables separately and largely cross-sectionally, this design clarified their bidirectionality and relative longitudinal importance. The findings revealed novel differential associations among the 4 variables, findings that promise to reorient the field from gaming time toward the cognitive and motivational processes regulating gaming behaviors. Practically, if replicated in studies with more robust designs, prevention and control programs for IGD should prioritize strengthening adolescents' self-control rather than merely restricting their gaming time.

Generative artificial intelligence (GenAI), including large language models and large multimodal models, is increasingly used to support psychological assessment and digital mental health measurement. This review proposes a lifecycle framework for evaluating these uses without weakening psychometric standards. The framework covers construct definition; item, prompt, indicator, or signal generation; evaluation of content, response processes, usability, and data quality; piloting and calibration; validation; fairness and measurement invariance; scoring and interpretation; documentation; and post-deployment monitoring. We argue that digital traces from smartphones, chatbots, ecological momentary assessment, wearables, social media, clinical notes, and multimodal systems should not be treated as psychometric measures by default. They should remain raw data, candidate indicators, or algorithmic scores until their construct interpretation and intended use are theoretically specified, technically verified, empirically calibrated, and validated with human data. GenAI may help generate candidate items, refine wording, classify open-text responses, extract structured information, support multimodal integration, and assist scoring under explicit rules. These uses may improve efficiency and scale, but they do not establish validity, objectivity, fairness, or clinical meaning. We distinguish two complementary facets: GenAI for psychometrics, in which models support measurement development and scoring, and psychometrics for GenAI, in which psychometric methods evaluate model behavior when LLMs are part of measurement workflows. Key risks include construct drift, face validity without structural validity, compressed variability in synthetic respondents, algorithmic bias, lack of invariance, prompt sensitivity, model drift, automation bias, data-security and privacy failures, and loss of subjectivity and disagreement. Responsible use requires human oversight, transparent reporting, validation with human data, fairness evaluation, secure data governance, and continuous monitoring. GenAI should augment, not replace, psychometric science.

Validated patient-reported outcome measures are needed to assess personal recovery alongside symptom-based outcomes in mental health care. The Questionnaire about the Process of Recovery (QPR) assesses subjective recovery aligned with CHIME processes, but no version of the QPR has previously been validated in Danish, including the widely used QPR-15 and the more recently developed QPR-7. This study assessed psychometric properties, sensitivity to change, and meaningful difference thresholds for the Danish QPR in community mental health samples.

Pooled analyses were conducted using baseline (n = 353) and follow-up (n = 234) data from adults with mental illness in Danish community mental health services. Confirmatory factor analysis, measurement invariance testing across subgroups, content validity, internal consistency, convergent/discriminant validity, responsiveness analyses were applied, as well as anchor-based methods (CGI-S, MANSA) to establish meaningful difference thresholds.

QPR-15 showed poor unidimensional fit. QPR-7 demonstrated satisfactory fit (CFI = 0.96, TLI = 0.95, SRMR = 0.039, RMSEA = 0.061), internal consistency, invariance across sex, age, education, mental disorder type, and over time. The data were normally distributed without floor/ceiling effects, and correlations supported convergent/discriminant validity. QPR-7 change was strongly associated with changes in quality of life. Meaningful difference values: 2.5 (small)/3.5 (moderate) points within-person; 1.5(small)/2.5 (moderate) points between-group.

The Danish QPR-7 is a valid and reliable brief measure for patient-centered recovery assessment in mental health care. Its invariance properties, interpretability thresholds, and low respondent burden support its usefulness in routine monitoring of individual recovery gains alongside clinical outcomes.