Adolescent suicidal ideation is a critical public health issue, with limited support options in low-resource settings.

This study aimed to evaluate the acceptability, usability, and preliminary effects of Emo-Safe, an Android-based application designed to enhance emotional regulation and reduce suicidal ideation among adolescents.

This study utilized a sequential, explanatory mixed-methods approach, consisting of quantitative followed by qualitative methods. Sixty students, aged 15-18, participated in the study, divided into an intervention group (n = 30) and a control group (n = 30) for 4 weeks. Core app features included daily mood tracking, reflective journaling with AI-assisted reframing guided by cognitive-behavioral therapy (CBT) principles, breathing exercises, personalized insights, and an AI "friend" for encouragement. Outcomes measured were the Indonesian Depression Anxiety Stress Scales for Youth (IDASS-Y) and the Suicidal Ideation Scale (SIS).

Results indicated that the intervention group had significantly lower post-test IDASS-Y scores (28.43 vs. 33.17; p = 0.037) and reduced stress levels (8.83 vs. 12.37; p = 0.001). The SIS also favored the intervention group (14.83 vs. 21.70; p < 0.001). Acceptability was high (mean rating 4.24/5) with positive feedback on material clarity and facilitator effectiveness, along with suggestions for improvements.

Findings demonstrate the acceptability and usability of Emo-Safe, alongside promising short-term reductions in stress and suicidal ideation. However, further systematic evaluation of broader feasibility indicators, such as recruitment and long-term engagement, is needed in future trials.

Community college (CC) students face significant mental health concerns but are unlikely to receive treatment. Barriers to mental health service uptake among CC students have been delineated, but few studies have identified strategies to improve uptake. Text messaging has been used to address engagement barriers to mental health services among adolescents and adults, but little research has explored this strategy for CC students.

The goal of this study was to partner with CC students to co-design and conduct pilot usability testing of a text messaging intervention to address barriers and increase uptake of a mental health screening and treatment program, called Screening and Treatment for Anxiety and Depression (STAND), offered to CC students.

We conducted 2 parallel sets of 4 co-design focus groups with CC students who had varying levels of engagement with STAND. We used rapid qualitative analysis to extract key themes, create text message prototypes and refine them, and present updated prototypes to gather feedback across workshops. We also assessed six usability factors on a 5-point Likert scale: satisfaction, helpfulness, attractiveness, readability, comprehension, and likelihood of getting started with STAND after receiving texts.

Key themes emerged about perceptions of texting, barriers to STAND, a basic framework for the text message intervention, feedback about the format of messages, and feedback about the content of messages. Students expressed positive regard for text messaging and general agreement on key barriers to STAND. Students codeveloped a framework for the intervention, including (1) delivering introductory texts to engage students in the text messages, (2) providing a personalized approach for students to select barriers most salient for them, and (3) delivering tailored content designed by students to address each barrier. Across workshops, several themes emerged with regard to how messages should be formatted and delivered, including the following: use short messages; use not too many messages; use relevant language; use images, memes, and short videos; and make messages "human-like." Themes related to the content of messages included the following: reminders that you are not alone, knowledge that STAND has worked for other students, expressing understanding of student context and stressors, and providing an option to speak to a team member. Mean ratings on usability factors ranged from 3.88 (SD 0.64) to 4.25 (SD 0.46).

This study describes a process for co-designing a text messaging mental health engagement intervention with CC students that is grounded in a human-centered design approach. Further research is needed to rigorously test this intervention and make iterative refinements to improve response and effectiveness.

With total hip arthroplasty (THA) volumes rising worldwide, scalable home rehabilitation strategies are needed. Home-based digital physiotherapy can improve recovery after THA, and adding wearable motion sensor feedback may further enhance exercise performance and adherence. However, the impact of sensor-augmented digital rehabilitation on patient outcomes and cost-effectiveness remains unclear.

This study aimed to evaluate the clinical effectiveness (including adherence) and cost-effectiveness of adding wearable sensor feedback to a home-based digital THA rehabilitation program compared with the same digital program without sensors.

We conducted a single-center randomized controlled trial in Shanghai from June 2023 to June 2024. A total of 240 patients who had undergone primary THA were randomized (1:1) to a 12-week home exercise program delivered via a mobile app either with wearable motion sensors for real-time feedback (intervention) or without sensors (control). Both groups received identical exercise content and weekly teleconsultations. Outcomes were assessed at 6, 12, and 24 weeks by blinded evaluators. The primary outcome was the Hip Disability and Osteoarthritis Outcome Score (HOOS) at 24 weeks. Secondary outcomes included HOOS subscales, timed up-and-go (TUG), Berg Balance Scale, 36-item Short Form Health Survey (SF-36) physical and mental scores, Hospital Anxiety and Depression Scale (HADS) anxiety/depression, patient satisfaction, adherence metrics, and total 24-week costs. Intention-to-treat analyses were used. Mixed effects models and χ² tests were used for group comparisons. Cost-effectiveness was evaluated from a societal perspective.

The sensor-based rehabilitation group showed significantly greater improvement in the primary outcome (HOOS overall) than the control group at 24 weeks (P=.01). Early postoperative gains were larger: At 6 weeks, 4 of the 5 HOOS subscales, TUG time, and all patient-reported outcomes remained significant after Bonferroni correction for 47 secondary comparisons (adjusted P<.001). By 24 weeks, hip-specific functional differences had narrowed, but SF-36 physical and mental scores (both P<.001) and HADS anxiety and depression scores (both P<.001) remained significant after correction. Total 24-week costs were similar between the groups (¥87,967 vs ¥94,396 [US $12,879.80 vs $13,821.10] per patient; P=.32). The sensor intervention was associated with numerically lower costs on average (¥6428.98 [US $941.31] less per patient), yielding negative incremental cost-effectiveness ratios, though the cost difference was not statistically significant. Adherence was high in both groups but higher with sensors: The intervention group completed more exercise sessions (P=.002) and showed greater participation in weekly assessments and follow-up calls (both P<.001). Adverse events were uncommon in both groups (5.8% vs 7.5%) and mostly minor, with no serious events reported.

Augmenting home-based digital rehabilitation with wearable sensor feedback led to statistically significant improvements in the primary hip function outcome and in patient-reported quality of life and psychological outcomes that persisted after Bonferroni correction through 24 weeks. Several early hip-specific secondary outcome differences did not survive correction for multiple comparisons. The between-group HOOS differences were below the established minimal clinically important difference. Exercise adherence was significantly higher in the sensor group. These benefits were achieved with no increase in cost, suggesting the sensor-enhanced program is a safe and feasible approach to THA rehabilitation that enhances adherence and accelerates early recovery.

Anxiety disorders are among the most common mental health conditions worldwide, but their burden varies substantially across countries with different income levels. Evidence remains limited on how anxiety disorder burden, violence-related risk factors, and future trends differ across middle- and high-income countries (MHICs). This study examined inequalities in the burden of anxiety disorders across MHICs from 1990 to 2023, quantified the burden attributable to major risk factors, and projected prevalence trends to 2035.

Data on incidence, prevalence, and disability-adjusted life years (DALYs) for anxiety disorders were obtained from the Global Burden of Disease 2023 database. We estimated counts, age-standardized incidence rates (ASIRs), age-standardized prevalence rates (ASPRs), and age-standardized DALY rates (ASDRs), with 95% uncertainty intervals (UIs), by income group, sex, age, country, and year. Risk-attributable DALYs were assessed for intimate partner violence (IPV), bullying victimization (BV), and sexual violence against children (SVAC). Temporal trends were evaluated using Joinpoint regression, and Bayesian age-period-cohort (BAPC) models were used to project prevalence rates to 2035.

In 2023, MHICs accounted for 91.3% (95% UI 60.7-137.2) of global prevalent cases, 90.8% (95% UI 50.4-153.7) of incident cases, and 91.2% (95% UI 44.8-177.6) of anxiety disorder DALYs. High-income countries (HICs) had the highest ASIRs, ASPRs, and ASDRs, whereas lower-middle-income countries (LMICs) had lower rates but larger absolute numbers of cases. From 1990 to 2023, the burden increased across MHICs, with the fastest growth observed in LMICs. Females had consistently higher ASIRs, ASPRs, and ASDRs than males, and the highest burden was observed among children and adolescents. IPV, BV, and SVAC were associated with substantial anxiety disorder DALYs, with marked differences by income group, age, and sex. BAPC projections suggested that prevalence rates may continue to increase through 2035, particularly among females and in lower-income settings.

Anxiety disorder burden remains high and unequally distributed across MHICs. The burden is characterized by persistent differences by income group, sex, and age, and is associated with violence-related risk factors. These findings support the need for income-sensitive, gender-responsive, and age-targeted mental health strategies, with particular attention to prevention of violence-related risks and improved access to mental health services in lower-income settings.

Perinatal depression (PD) actually affects 10-15% of pregnant women and represents one of the most debated topics as potentially implicated in offspring neurodevelopmental disorders etiology, particularly Autism Spectrum Disorder (ASD). Scientific evidence supports the role of Human Endogenous Retroviruses (HERVs) in ASD, as a link among environmental stimuli, epigenetic remodeling and biological processes. The aim of the present study was to characterize the expression profile of different HERVs and selected cytokines in peripheral blood mononuclear cells from women who have experienced PD in comparison to women without history of PD and their respective children stratified according to ASD diagnosis, by RT Real-Time PCR. We showed that ASD children and their PD mothers share abnormal expression of pHERV-W, syncytin-2 and IL-6 likely influenced by the common environment, maternal status, genetic predisposition, or postnatal factors. Of note, mothers with a history of PD were also evaluated at the time of blood sampling using the Hamilton Depression Rating Scale, and a positive correlation with pHERV-W levels was observed. Together with previous results in preclinical models and human studies, our results support the role of HERVs in autism as a contributing factor in creating an adverse environment for normal neurodevelopment, strengthening the view of a mother-child association in the context of autism. PD being associated with the altered activity of HERVs could be considered to be an additional risk factor in the pathogenesis of autism.

Previous studies have shown that physical activity (PA) can improve cognitive function (CF) and depressive symptoms in middle-aged and older adults, and that there is a bidirectional relationship between the two. However, there is a lack of research on the temporal sequence and potential mechanisms of these three factors. This study conducted a large-scale longitudinal study to explore the mediating role of PA in the bidirectional association between CF and depressive symptoms in middle-aged and older adults.

A longitudinal study was conducted using data from the English Longitudinal Study of Aging (ELSA) collected in 2014-2015 (T1), 2016-2017 (T2), and 2018-2019 (T3). PA, CF, and depressive symptoms were assessed via questionnaires, with Spearman's correlation analysis used to examine variable correlations. A Cross-Lagged Panel Model (CLPM) was constructed to test the longitudinal causal relationships among the three variables, and a longitudinal mediation model was developed to analyze the mediating role of PA.

A total of 6,787 participants aged 50 years or older were included, comprising 3,777 women (55.7%) and 3,010 men (44.3%), with a median baseline age of 66 years. Spearman correlation analysis indicated a significant correlation among the three variables (rs=[-0.225, 0.447], P < 0.001). CLPM results showed that poorer CF predicted more severe depressive symptoms in the future (βT1-T2 = -0.038, P < 0.001; βT2-T3 = -0.040, P < 0.001), and more severe depressive symptoms predicted poorer future CF (βT1-T2 = -0.022, P = 0.005; βT2-T3 = -0.021, P = 0.005). The Wald test indicated that CF was the dominant factor in the bidirectional negative relationship between CF and depressive symptoms (Wald χ² = 7.546, P = 0.006). Longitudinal mediation model results showed that poorer CF at T1 predicted lower PA at T2 (βT1-T2 = 0.043, P < 0.001), and lower PA at T2 predicted more severe depressive symptoms at T3 (βT2-T3 = -0.053, P < 0.001). Bootstrap results further confirmed the significant indirect effect of T1-CF on T3-depressive symptoms through T2-PA (β = -0.002, 95% CI=[-0.004, -0.001]), with the mediation effect accounting for 5.71%. However, the indirect effect of T1-CF on T3 depressive symptoms through T2-PA was not significant (β = -0.001, 95% CI=[-0.002, 0]).

CF was negatively correlated with depressive symptoms. PA mediated the positive effect of CF on depressive symptoms in middle-aged and older adults, but failed to alleviate the negative effect of depression on CF. This study indicates that active participation in PA contributes to maintaining cognitive and mental health in middle-aged and older adults.

The Mental Health Continuum-Short Form (MHC-SF) is a widely used instrument designed to assess three dimensions of positive mental health: emotional, social, and psychological well-being. However, there is limited evidence regarding its validity within Arab populations.

This study aimed to validate the Arabic version of the MHC-SF (AMHC-SF) among a community-based sample in Oman. A total of 1,101 participants aged 18-65 years (M = 31.49, SD = 9.69) completed the questionnaire through an online survey. Confirmatory factor analyses (CFA) were performed to examine factorial validity, while internal consistency reliability was assessed using Cronbach's alpha and McDonald's omega coefficients. Discriminant validity was examined through correlations with anxiety scales.

Confirmatory factor analysis supported the superiority of the bifactor model over the original three-factor structure, demonstrating excellent model fit (CFI = 0.99, TLI = 0.98, RMSEA = 0.032) and substantial general factor loadings (0.64-0.76). Reliability estimates for the total scale and subscales were excellent, with Cronbach's alpha and McDonald's omega coefficients ranging from 0.86 to 0.95. The AMHC-SF also showed apparent discriminant validity, as higher well-being scores were associated with lower anxiety levels.

The findings support the factorial validity, reliability, and discriminant validity of the AMHC-SF, confirming its cross-cultural applicability within the Arab context. The scale represents a brief, psychometrically sound instrument for assessing positive mental health among adults in Oman and other Arabic-speaking populations.

Khat consumption represents a complex health challenge where agricultural intensification, specifically the unregulated use of persistent organic pollutants such as DDT, creates a bridge between environmental degradation and human pathology. Despite the severe health implications of chemically contaminated fresh leaves, empirical evidence regarding consumer awareness and protective engagement remains limited. This study in Eastern Ethiopia aimed to assess consumer awareness and protective practices regarding the potential of multiple toxins (encompassing pharmacological effects, heavy metals, and pesticide residues) and evaluated related self-reported health ailments among adult chewers to inform multisectoral reform. A quantitative community-based cross-sectional study was conducted in Dire Dawa, Harar, and Jigjiga with 803 regular khat chewers. Data were collected using pre tested, and structured questionnaire were analyzed via descriptive statistics, and multivariable binary logistic regression. General risk awareness was high (86.4%), yet only 37.4% of the respondents consistently adopted protective practices. High awareness was significantly associated with tertiary education being seven times more likely to be aware than illiterate chewers were (AOR: 7.23, p = 0.003). Awareness was notably greater among individuals who experienced mental (AOR: 2.05, p = 0.040) or gynecological ailments (AOR:2.36, p = 0.006). The adoption of protective practices was overwhelmingly predicted by high monthly income (AOR: 12.48, p < 0.001) and awareness (AOR: 7.41, p < 0.001). The primary barriers included cost (55.8%) and availability (53.7%). The self-reported ailments included digestive issues (82.3%) and decreased libido symptoms (48.1%). The study concludes that there is a significant gap between awareness and protective practices among consumers. We recommend targeted public health education and multisectoral collaboration between health and agricultural bureaus to improve pesticide regulation and consumer safety. Interventions should focus on overcoming cultural barriers to protective behaviors rather than relying solely on individual behavioral change.

Canadian psychiatry residents must demonstrate consultation competency, assessed using the standardized assessment of a clinical encounter report (STACER). However, opportunities to practice these skills and receive constructive assessment remain limited in clinical settings.

This study aimed to evaluate the technical feasibility of an agentic AI system designed to support psychiatry residents' consultation competence through simulated patient encounters with a patient agent and structured feedback from a rater agent.

We conducted a two-phase technical feasibility prospective single-arm cohort study of the STACER Agentic System, a large language model-based platform integrating a patient agent and a rater agent. Phase 1 involved automated evaluation of the patient agent using a psychiatrist agent across 227 synthetic major depressive disorder cases. Performance was assessed using DeepEval metrics (correctness, clarity, medical faithfulness, turn relevance, and role adherence) with descriptive statistics and 95% CIs. Phase 2 involved a preliminary user study with 14 convenience-sampled participants: a total of 5 members of the clinical research team and 9 psychiatry residents from the University of Alberta. Participants completed simulated diagnostic interviews and case presentations. Performance was evaluated using STACER-based scoring by the rater agent and 2 psychiatrists. Interrater reliability was assessed using intraclass correlation coefficients (α=.05). Participants rated realism, behavioral consistency, psychiatric nuance, and feedback utility using Likert scales and free-text answers.

The patient agent demonstrated high behavioral (51/56, 91.07%) and symptom fidelity (105/110, 95.45%), with strong automated performance (medical faithfulness mean 0.99, 95% CI 0.99-1.00; turn relevance 0.99, 95% CI 0.986-0.992). Participants rated simulations as psychiatrically plausible and diagnostically useful, particularly for depressive symptom representation, although rapport building was moderate (mean 2.78, SD 1.56 to mean 3.00, SD 1.41, out of 5.00) due to limited nonverbal cues. The rater agent generated structured STACER-aligned feedback with high intrarater consistency, especially at the section subtotal level. Interrater reliability with psychiatrists was poor at the item level (intraclass correlation coefficient range=0.25-0.49) but improved to good-to-excellent agreement at the section level for psychiatry resident sessions (intraclass correlation coefficient range=0.89-0.93). The rater agent's scores fell between those of the 2 psychiatrists for the clinical research team and were lower than both human raters for psychiatry residents.

The STACER Agentic System demonstrates the technical feasibility of using agentic AI to simulate psychiatric consultations and deliver STACER-aligned formative feedback. By combining adaptive multiturn psychiatric simulation with competency-based evaluation, it shows promise in supporting cognitive aspects of consultation, though it remains limited in facilitating relational skills such as rapport building. These findings suggest agentic AI could expand scalable, low-risk opportunities for deliberate practice and formative feedback in competency-based psychiatric education. Further controlled studies are needed to evaluate educational effectiveness and integration into residency training.

During the COVID-19 pandemic, geographic isolation, host-nation healthcare limitations, and broader geopolitical considerations contributed to limited access to care for dependents of active duty service members in Okinawa. This research explored perceived healthcare access barriers among military spouses in Okinawa, Japan, during the COVID-19 Public Health Emergency and identified potential demographic and structural factors associated with perceived access and wellness outcomes.

This study used a cross-sectional online survey from February to May 2023 during the COVID-19 Public Health Emergency. Ethical approval was received from the University of Nebraska Medical Center. The 35-item instrument captured demographics, healthcare utilization, access barriers, and wellness perceptions. Access to emergency, urgent, routine, specialty, and preventive care was assessed against TRICARE standards, with percentages calculated to indicate whether benchmarks were met across demographic groups. Logistic regression evaluated associations between age, sponsor rank, and MTF assignment with access outcomes.

Emergency care met TRICARE standards for 90% of respondents, but fewer met urgent (19%), routine (17%), specialty (25%), or preventive care (47%) benchmarks. Only 22% of spouses perceived they could access care when needed. Younger spouses (19-30) and those assigned to Kadena's 18th Medical Group reported the lowest access. Nearly half reported worsened mental health, and 40% reported food or medical cutbacks. Enlisted spouses were disproportionately affected.

Military spouses in Okinawa perceived significant barriers to healthcare access during the COVID-19 pandemic, with military treatment facility (MTF) enrollment, sponsor rank, and age emerging as the most consistent factors associated with disparity. Policy implications include the need to provide military families with adequate and accurate information on MTF access to care wait times and civilian healthcare availability before arrival at a new duty station. These findings highlight the need for further research examining military spouse healthcare access in overseas and remote locations.