Adolescents perceive both immediate and long-term benefits and losses related to internet gaming, affecting their risk of internet gaming disorder (IGD). These perceptions could also be shaped and reinforced by IGD, indicating potential bidirectionality.

This study aimed to investigate the bidirectional relationships between perceived immediate and long-term benefits in 3 domains (mental health, social relationships, and personal achievement) and IGD, and between perceived immediate and long-term losses in 6 domains (mental health, sleep quality, academic performance, family relationships, social relationships, and personal achievement) and IGD.

A 12-month 2-wave prospective longitudinal study was conducted among junior middle school students who had played internet games in the past 12 months in Guangzhou and Chengdu, China, with a baseline survey (T1, December 2018) and the other identical follow-up survey conducted 1 year later (T2, December 2019). The participating schools were conveniently selected; all Grade 7 and 8 students were invited to self-administer the questionnaires in a classroom setting without the presence of the schoolteachers. The final sample size was 1173 students (mean age 12.5, SD 0.6 y; male: 693/1173, 59.1%). IGD was assessed by using the 9-item Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition IGD checklist.

Cross-lagged panel analysis (adjusting for background factors) showed (1) stronger perceived immediate benefits of mental health (β=.08, 95% CI 0.01-0.15) and personal achievement (β=.10, 95% CI 0.01-0.20) at T1 significantly predicted more IGD symptoms at T2; (2) more IGD symptoms at T1 significantly predicted stronger perceived immediate and long-term benefits of social relationships (immediate: β=.09, 95% CI 0.03-0.15; long-term: β=.11, 95% CI:0.05-0.17) and personal achievement (immediate: β=.12, 95% CI 0.06-0.18; long-term: β=.10, 95% CI 0.04-0.16) at T2; (3) more IGD symptoms at T1 significantly predicted stronger perceived immediate and future losses in mental health (immediate: β=.09, 95% CI 0.03-0.15; long-term: β=.08, 95% CI 0.02-0.14), sleep quality (immediate: β=.10, 95% CI 0.04-0.16; long-term: β=.13, 95% CI 0.07-0.19), academic performance (immediate: β=.09, 95% CI 0.04-0.15; long-term: β=.07, 95% CI 0.01-0.13), and family relationships (immediate: β=.11, 95% CI 0.05-0.17; long-term: β=.10, 95% CI 0.04-0.16) at T2, as well as perceived long-term losses in social relationships at T2 (β=.08, 95% CI 0.02-0.14).

This study was innovative in integrating time perspective into both perceived benefits and losses of internet gaming, a cognitive dimension previously overlooked in literature. The current findings advance the field by revealing the unidimensional predictive effects of IGD on perceived immediate and long-term benefits and losses, with 2 exceptions of perceived immediate and long-term benefits of mental health and personal achievement conversely predicting IGD. These results contribute to the development of effective interventions: the cognitive components should go beyond the general pros and cons of gaming and target the potential temporal bias gamers hold.

The primary objective of this study was to estimate the prevalence of new-onset anxiety diagnoses in the postpartum period. We also aimed to estimate the prevalence of psychiatric comorbidities, explore changes by year, and identify risk factors for new-onset postpartum anxiety.

This retrospective cohort study used the Merative™ MarketScan® Commercial Database and included adult women with commercial insurance who were at least 18 years of age, delivered a singleton or multiple gestation between 2008 and 2021, and did not have a preexisting or prepregnancy diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD). The primary outcome was a new-onset anxiety diagnosis, based on International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes, during the postpartum period (up to 12 months after childbirth). Secondary outcomes were comorbid anxiety with depression and PTSD. We also estimated the prevalence of each psychiatric condition by year and identified risk factors associated with postpartum anxiety. Univariable and multivariable regression models were constructed to identify risk factors.

From the 1,469,121 individuals identified without prenatal mental health disorders, 84,984 individuals (5.8%; 95% CI, 5.7-5.8%) were diagnosed with new-onset postpartum anxiety within 12 months of childbirth, with 9,490 diagnosed in the first month and 75,494 diagnosed between 1 month and 1 year postpartum. Comorbid anxiety and depression occurred in 18.0 per 1,000 individuals in the study cohort (95% CI, 17.8-18.2), and comorbid anxiety and PTSD occurred in 0.9 per 1,000 individuals (95% CI, 0.9-1.0). The prevalence of postpartum anxiety increased from 30.8 per 1,000 individuals in 2008 to 122.9 per 1,000 individuals in 2021 (P for trend<.001). Independent risk factors for new-onset postpartum anxiety diagnosed 1-12 months postpartum included younger age, North Central U.S. residence, earlier gestational age at delivery, cesarean delivery, antenatal or early postpartum sleep disorders, severe maternal morbidity (including transfusion), neglected medical conditions, and neonatal complications.

Postpartum anxiety was estimated to affect nearly 6% of patients with commercial insurance in the United States and has increased fourfold since 2008. Risk factors associated with postpartum anxiety may help to identify at-risk individuals who could benefit from early intervention.

Specialized mental health services are facing high demand, potentially leading to lower-quality care. One solution may be to prepare patients for attending treatment. Digital pretherapy psychoeducation may be particularly relevant. However, the effectiveness of such an intervention depends on user engagement and satisfaction, and usability is therefore one of the most important factors.

This article has 2 objectives. Study 1 describes the development of StartHelp, a co-created digital pretherapy psychoeducation program for patients on waiting lists before their first consultation in outpatient specialized mental health services. Study 2 explores the usability of StartHelp, aiming to identify potential issues and assess whether the intervention is suitable for further evaluation in a randomized controlled trial.

Guided by co-creation principles, we developed StartHelp in accordance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) checklist. To assess the app's usability, we recruited 10 patients from specialized mental health care to complete tasks during individual think-aloud interviews. Afterward, they completed questionnaires, including open-ended questions, an item assessing perceived video quality, 2 versions of the System Usability Scale (SUS), the 4-item Client Satisfaction Questionnaire (CSQ-4), and a modified version of the CSQ-4 (CSQ-Video). The StartHelp project group discussed the results, and solutions to the identified issues were proposed and implemented.

Study 1 involved the development of StartHelp over 24 months. The app comprises 27 tasks, including 24 videos and links to 14 websites containing in-depth information. Study 2 involved usability testing with 5 men and 5 women. SUS scores for StartHelp's videos indicated good usability, with a mean of 83.7. By contrast, SUS scores related to navigating StartHelp's overarching architecture were barely acceptable, with a mean of 63.6. For the CSQ-4, the sample mean was 12.3, indicating moderate satisfaction. Mean scores on the CSQ-Video (10.9) indicated satisfaction in the lower moderate range. However, patients perceived the videos as high quality and rated them as nonoffensive. The qualitative findings supported the quantitative results. The usability tests revealed 1 major issue and several minor issues. The primary issue concerned navigation of the overarching technological infrastructure on which StartHelp was developed, rather than StartHelp itself. To address these issues and impracticalities related to interacting with the overarching technological infrastructure, we made minor changes to the StartHelp app.

Through a collaborative co-creation process, we developed StartHelp, a digital pretherapy psychoeducation program. Usability testing indicated that the content itself was highly usable, with video-related SUS scores suggesting good usability, whereas navigation of the overarching technological infrastructure received lower scores. Although patients rated the clinical material as high quality and nonoffensive, satisfaction scores were lower than anticipated. Nevertheless, StartHelp was deemed ready for further testing in a clinical trial.

US veterans with mental health disorders have high rates of smoking and low rates of smoking cessation.

This study aims to focus on an adaptation of a web-based acceptance and commitment therapy (ACT) tobacco cessation intervention (Vet WebQuit) for veterans with mental health disorders who use tobacco and used a qualitative approach to test its usability (n=16).

Participants were asked to walk through the site during laboratory-based usability testing and "think aloud" about the features of the intervention. A trained facilitator used semistructured interview questions to assess participants' experiences with Vet WebQuit and obtain feedback on their impressions of the site. Qualitative analyses identified themes regarding participants' experiences with the intervention, usability concerns, and recommendations for improving Vet WebQuit.

Overall, veterans found that the Vet WebQuit layout was simple and easy to navigate and use. Veterans reported that several features of the program were useful, including the quit plan, identification of triggers, content that targets mental health concerns (eg, dealing with anger), information on the health effects of smoking, tools for managing triggers (eg, urge surfing), and involving others in their quit plan. Veterans reported that particular features of the ACT approach for tobacco cessation were appealing to them, including the distinction between internal and external smoking triggers, the inclusion of the serenity prayer, and mindfulness exercises, which they could use as a tool reduce the intensity of cravings. Veterans reported wanting more information on the health aspects of smoking (ie, effects on breathing and lung capacity) as a way to motivate them to quit smoking. In addition, they suggested targeting specific mental health concerns that serve as triggers for smoking, including nightmares, boredom, and social isolation.

Overall, results from this project identified important elements of ACT digital tobacco cessation interventions for veterans with mental health disorders.

Myotonic dystrophy type 1 (DM1) frequently leads to chronic respiratory failure, yet the effectiveness of noninvasive home mechanical ventilation (HMV) remains understudied. Our objective was to assess the effects of HMV on gas exchange, health-related quality of life (HRQL), and daily functioning, and to explore baseline predictors of treatment response. A prospective multicenter study was conducted in which clinical data, pulmonary function tests, blood gas analysis, polysomnography and overnight pulse oximetry with transcutaneous CO₂ monitoring, and validated questionnaires were collected at baseline and after six months of treatment. Paired t-tests and correlation analyses assessed treatment outcomes and predictive factors. Forty participants (mean age 46.6 years, 63% male) were enrolled, and follow-up data of 38 participants were available for analysis. After six months of treatment, significant improvements in gas exchange were observed with a reduction in daytime pCO₂ of 0.48 ± 0.81 kPa (p = 0.001) and nocturnal mean pCO₂ of 0.92 ± 0.81 kPa (p < 0.001). HRQL, assessed with the Severe Respiratory Insufficiency (SRI) questionnaire, improved significantly, with a mean increase of 9.9 ± 8.9 points (p < 0.001).No significant changes were seen in daily functioning measured with the DM1-Activ^C questionnaire. Improvements in nocturnal pCO₂ correlated with HRQL gains (r = 0.427, p < 0.021), while baseline characteristics were not predictive of response. This prospective multicenter study demonstrates that nocturnal HMV is associated with significant improvements in gas exchange and HRQL in patients with DM1 over six months.

ObjectiveTo translate and culturally adapt the facial disability index (FDI) into Korean following established guidelines, and to evaluate its reliability and validity in patients with facial palsy.MethodsThe translation process followed Beaton's cross-cultural adaptation methodology, involving forward translation, back translation, expert committee review, and prefinal testing. This prospective cross-sectional observational validation study included 100 adult patients with facial palsy recruited from a facial palsy center between May and July 2021. Reliability was assessed using Cronbach's α for internal consistency and intraclass correlation coefficient (ICC) for test-retest reliability (3-week interval). Construct validity was examined using Spearman's correlation between the Korean FDI and House-Brackmann (HB) grade, 36-Item Short Form Health Survey (SF-36), and Synkinesis Assessment Questionnaire.ResultsThe Korean FDI demonstrated acceptable internal consistency (total Cronbach's α = 0.783; physical function = 0.810; social/well-being = 0.683). Test-retest reliability showed ICC values of 0.762 for physical function and 0.645 for social/well-being. The physical function subscale correlated moderately with HB grade (r = -0.461), whereas the social/well-being subscale correlated strongly with SF-36 mental component summary scores (r = 0.639). These findings were generally consistent with Turkish and Spanish validation studies, although ICC values were slightly lower, possibly due to the longer retest interval and inclusion of patients undergoing treatment.ConclusionsThe Korean version of the FDI is a reliable and valid patient-reported tool for assessing functional and psychosocial outcomes in patients with facial palsy. Its use may enhance patient-centered treatment planning, monitor treatment responses, and facilitate standardized data collection in clinical research. Future studies should examine its responsiveness in larger and more diverse patient populations and explore its application in clinical trials or real-world studies of integrative treatment strategies. Embedding the Korean FDI within multidisciplinary care frameworks may further strengthen evidence for patient-centered management of facial palsy.

In recent years, artificial intelligence (AI) systems have increasingly been used to assess emotional states in health care. AI offers a safe, quick, user-friendly, and objective emotional evaluation method. However, evidence supporting its implementation in health care remains limited.

This study aimed to explore the concurrent validity and test-retest reliability of emotion recognition AI based on facial expressions.

In this study, we used the Kokoro Sensor, an accurate and widely recognized automated facial expression recognition system. The Japanese version of the Profile of Mood States-Short Form was used to screen the potential influence of mental states on facial expressions. The study participants made positive, negative, and neutral expressions, which were analyzed by the emotion recognition AI. Agreement between the results of the AI and subjective evaluations was assessed by participants and a researcher using a 4-point Likert-type scale. The facial expressions and emotion analysis process were repeated after a 30-minute interval to investigate reliability. Concurrent validity was evaluated using the content validity index (CVI) and κ coefficient, and test-retest reliability was determined using the κ coefficient.

The study participants were 40 individuals whose mental states did not deviate from the reference range of the Profile of Mood States manual. Among the participants, the CVI values for positive, neutral, and negative expressions were 95%, 98%, and 85%, respectively. Among the researchers, the corresponding CVI values were 100%, 100%, and 70%, respectively. The overall weighted κ coefficient was 0.55 (CI 0.44-0.67), indicating moderate agreement. The agreement was almost perfect for distinguishing positive from neutral expressions (κ=0.83, 95% CI 0.70-0.95) but not statistically significant for distinguishing negative from neutral expressions (κ=0.15, 95% CI -0.07 to 0.37). Test-retest reliability analysis showed an overall weighted κ coefficient of 0.66, reflecting substantial reliability. Almost perfect agreement was observed for distinguishing positive from neutral expressions (κ=0.85, 95% CI 0.73-0.97), while distinguishing negative from neutral expressions showed limited reliability (κ=0.36, 95% CI 0.16-0.57).

Our findings suggest that the Kokoro Sensor may be useful for identifying positive affect, given its acceptable concurrent validity for overall valence estimation and its high agreement for distinguishing positive from neutral expressions. However, concurrent validity for negative expressions did not meet the prespecified benchmark based on the researcher's ratings, and agreement for distinguishing negative from neutral expressions was limited, which may constrain clinical utility for detecting negative affect. Therefore, in clinical settings, the Kokoro Sensor should be used as an assistive tool rather than a stand-alone method.

Committees are a core component of organizational infrastructure and clinical governance in health and hospital systems and a viable mechanism through which to accomplish goals, facilitate departmental initiatives, produce deliverables, and improve departmental functioning. In this article, authors describe the development, evolution, and activities of a hospital social work department simulation (SW SIM) committee, which culminated in the production and deployment of a simulation-based learning (SBL) course designed specifically for social workers employed in a large, urban, quaternary pediatric hospital. With its focus on suicide risk assessment and treatment competencies, a priority identified through departmental surveys in conjunction with social work (SW) leadership, this course was the first to be developed at the institution specifically for social workers that targeted psychosocial (as opposed to medical or interprofessional) competencies. Using development and production of the SBL suicide risk assessment and management course as a case example, this article illustrates the SW SIM committee's collaboration processes with the SW department, SW leadership, key content experts, and the institution's simulation program. The article concludes with a discussion of lessons learned and factors to consider when engaging in committee-led departmental initiatives such as SBL course development.

The PROMIS-29 questionnaire assesses general aspects of physical and mental health that may be relevant to surgical recovery. Although this tool has been endorsed by expert consensus for use in perioperative care, evidence regarding its psychometric performance in this context is limited. This study aimed to assess the content validity, internal consistency, construct validity, and responsiveness of PROMIS-29 as a measure of recovery after colorectal surgery.

This study was conducted according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. A cohort of adult patients undergoing elective colorectal resection at two academic hospitals in Canada completed the PROMIS-29 questionnaire preoperatively and weekly until postoperative week (POW) 4. Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were derived from PROMIS-29 t-scores (higher = better health status). Content validity was assessed by comparing PROMIS-29 items against a previously reported conceptual framework of recovery after abdominal surgery. Internal consistency was assessed using Cronbach α. Construct validity was assessed by testing a priori hypotheses that PROMIS-29 scores would be better in patients: (1) with shorter length of stay (≤4 days); (2) without 30-day complications; (3) undergoing minimally invasive surgery; and (4) without a new stoma. Responsiveness was examined by hypothesizing that PROMIS-29 scores would follow the expected recovery trajectory-showing an initial postoperative decline followed by gradual improvement toward preoperative levels. Consistent with PROMIS guidelines, a minimal important difference of 3 points was used as the criterion for confirming hypotheses.

A total of 282 patients were included (mean±SD age 59±16 years; 48% female; 78% minimally invasive; 19% with stoma; median [IQR] hospital stay 3 [1-6] days). PROMIS-29 items covered 36% of health domains considered important by patients in the conceptual framework, indicating limited content validity. Internal consistency across PROMIS domains was acceptable, with Cronbach α ranging from 0.81 to 0.98. Construct validity of PHS and MHS was limited, with 0 of 4 predefined hypotheses supported on POW1 and only 1 to 2 hypotheses supported in subsequent weeks (mean difference between groups ≥3). Responsiveness was supported until POW2 (mean difference between timepoints ≥3), but not after.

Despite demonstrating adequate internal consistency, PROMIS-29 has limited content validity, construct validity, and responsiveness within the first 4 weeks after colorectal surgery. These findings suggest that PROMIS-29 may not fully capture patients' recovery experiences, underscoring the need for psychometrically sound PROMs tailored to the context of perioperative care.

Auditory Verbal Hallucinations (AVH) are among the most frequent and severe symptoms in schizophrenia and related psychotic disorders. Virtual Reality (VR)-assisted interventions have emerged, demonstrating promising potential in reducing AVH severity. This treatment approach may be challenged with regards to feasibility, particularly when therapeutically managing the anxiety-related reactions associated with AVH. This pilot study evaluates the feasibility and acceptability of augmenting VR-assisted therapy with real-time biofeedback to address these challenges. The integration of biofeedback enables continuous adaptation of therapy based on physiological responses while allowing participants to train self-regulation of these parameters.

Neuro-VR is a randomized clinical pilot trial utilizing a mixed-methods design. Thirty participants with schizophrenia spectrum disorders and AVH will be randomized to either eight sessions of VR-assisted therapy or eight sessions of VR-assisted therapy augmented with real-time biofeedback. Assessments will be conducted at baseline and post-treatment. Outcome measures include both clinical metrics, electroencephalogram recordings, and qualitative interviews to evaluate feasibility, acceptability, and potential treatment effects of the combined approach.

This study will explore whether integrating biofeedback into VR-assisted therapy enhances personalization, supports emotion regulation, and improves tolerability. The findings will provide preliminary evidence on the utility of physiological markers to guide VR-based interventions for AVH and inform the development of individualized, effective treatments for patients with schizophrenia.

ClinicalTrials.gov NCT06628323.