This article applies a systemic trauma framework to perinatal PTSD and advances Written Exposure Therapy as a scalable, equity-aligned intervention that can be integrated into routine perinatal care pathways, addressing critical gaps in current obstetric and mental health systems. Perinatal posttraumatic stress disorder (PTSD) affects ~9% of pregnant and postpartum individuals in the United States, with another 18% at elevated risk, yet it remains inconsistently identified in clinic care. From a systemic trauma perspective, perinatal PTSD arises from interactions between individual experiences and structural inequities in healthcare, including discrimination, fragmented services, and access barriers. These factors intersect with pregnancy-, birth-, and NICU-related stressors to increase maternal morbidity, disrupt maternal-infant bonding, and affect early developmental outcomes. Despite this burden, few trauma-focused treatments are feasible during the perinatal period, as standard protocols often conflict with caregiving and medical demands. Written Exposure Therapy (WET), a five-session intervention, promotes trauma recovery through repeated written engagement with trauma narratives, facilitating emotional processing and extinction of trauma-related distress. WET offers a scalable alternative, with preliminary evidence for obstetric groups comparable to longer treatments in non-perinatal populations. This conceptual synthesis advances a systemic trauma-informed framework for embedding WET within perinatal care pathways, emphasizing how brief, low-burden interventions can be integrated into routine obstetric, postpartum, and NICU-linked settings to improve access to trauma-focused care. By linking mechanisms of trauma recovery with health system delivery structures, this framework clarifies how scalable interventions like WET may reduce inequities in treatment access and improve maternal and infant outcomes. While the proposed framework is grounded primarily in evidence from U.S. healthcare systems, it provides a foundation for future adaptation and evaluation in diverse international perinatal care settings. Future priorities include testing feasibility, mechanisms, and equity-focused implementation across diverse perinatal populations.

Nonsuicidal self-injury (NSSI), hereafter referred to as self-injury, is common among adolescents and is associated with elevated risk for suicide attempts and other adverse mental health outcomes. Because most adolescents who self-injure do not receive formal treatment, accessible alternatives are needed. Digital mental health interventions (DMHIs) may offer an accessible and scalable means of support. While previous research has examined DMHIs for youth, less is known about how adolescents who engage in self-injury understand their experiences and use digital technologies, including emerging tools such as artificial intelligence (AI), to support their mental health. This study explored adolescents' lived experiences of self-injury, help-seeking behaviors, and technology use for coping and support.

We conducted semi-structured interviews between May 2024 and April 2025 with 21 adolescents (14-18 years old) with lived experience of self-injury. Recruitment occurred through a mental health screener hosted on a large national mental health nonprofit's website. Interviews explored adolescent experiences with self-injury, barriers to seeking help, and the role of digital tools in their self-injury self-management. Interviews were audio-recorded, transcribed, and analyzed via thematic analysis.

Adolescents described self-injury as a coping strategy embedded within broader emotional and social stressors. While they were aware of the harms, they commonly expressed ambivalence about stopping the behavior. Stigma and concerns about disclosure often limited help-seeking and contributed to their use of digital technologies to access information and support. Participants reported using a range of tools, including music streaming platforms, journaling and mood-tracking apps, online communities, and AI systems such as ChatGPT to regulate emotions, reflect on their experiences, seek advice, and discuss sensitive topics. Although these technologies were valued for their accessibility, privacy, and immediacy, participants also highlighted limitations, including inaccurate or generic AI responses, limited moderation in online communities, and the complex emotional impacts of music.

Our findings underscore the complex and evolving role digital technologies, including AI, play in adolescents' experiences of self-injury, coping, and help-seeking. These insights have important implications for the development of future interventions and for clinicians, caregivers, and other health professionals supporting adolescents' mental health.

In the contemporary Chinese educational landscape, characterized by involution (neijuan) and increasing digital encroachment, the maintenance of educator well-being has become a critical challenge. This study investigated how teacher burnout and psychological capital (PsyCap) predict psychological well-being (PWB), with a specific focus on the mediating role of work-life balance (WLB).

An explanatory sequential mixed-methods design was employed. In the quantitative phase, survey data were collected from 842 primary and secondary school teachers across three Chinese provinces and analyzed using Structural Equation Modeling (SEM). In the qualitative phase, the Critical Incident Technique (CIT) was used with 20 teachers selected through deviant case sampling.

SEM revealed that WLB partially mediated the relationships between both burnout (β = -0.090) and PsyCap (β = 0.122) and PWB. The model accounted for 52.8% of the variance in teacher well-being. Analysis of 40 critical incidents revealed that successful WLB was driven by "tactical pathway generation" rather than passive optimism. However, qualitative narratives also exposed a "digital panopticon" fueled by WeChat-based expectations of 24/7 availability, which led to significant boundary thinning. Furthermore, a "competence trap" was identified, where high self-efficacy paradoxically accelerated burnout by encouraging teachers to accept excessive invisible labor.

These findings suggest that while PsyCap is a vital personal resource, its effectiveness is constrained by structural and digital boundary fractures within the Chinese school system. Implications for school leadership and policy interventions aimed at protecting teacher mental health in the digital age are discussed.

Long-acting injectable antipsychotics (LAIAs) may improve treatment continuity in schizophrenia, yet their acceptance in community-based care remains limited. This study examined factors associated with willingness to use LAIAs and dyadic perceptions and barriers among patients with schizophrenia and their primary caregivers in Yangpu District, Shanghai, where LAIA services and financial support were available.

This convergent mixed-methods study included a paired questionnaire survey of 425 community-managed patients who met LAIA treatment criteria but had not used LAIAs and their primary caregivers. Semi-structured interviews were conducted with 32 patient-caregiver dyads until information saturation was reached. Quantitative and qualitative findings were integrated using a joint display.

Willingness to use LAIAs was low among patients and caregivers (17.4% and 17.6%), and awareness was limited in both groups (26.6% and 28.0%). Four dyadic willingness profiles were identified: concordant unwillingness, patient-only willingness, caregiver-only willingness, and concordant willingness. Higher patient willingness was associated with female sex, patient LAIA awareness, physician recommendation at the highest frequency, and caregiver willingness, whereas higher caregiver willingness was associated with caregiver LAIA awareness, being married, and patient willingness. Qualitative findings explained low acceptance through safety and injection concerns, treatment inertia, limited knowledge, reliance on physicians, family-based decision-making, and service accessibility barriers.

These findings suggest that supporting informed LAIA acceptance may require patient-caregiver-centered decision support, safety communication, and coordinated follow-up beyond service availability and cost support.

To investigate the impact of sleep quality, anxiety, depression and somatic symptom burden on pregnancy outcomes among patients receiving donor-sperm assisted reproduction, and to explore heterogeneous associations across IVF/ICSI-D and IUI-D subgroups.

A prospective cohort study was conducted at the Reproductive Center of West China Second University Hospital, Sichuan University. From June 2020 to May 2024, 758 consecutive patients undergoing donor insemination-assisted reproduction were enrolled, including 234 undergoing IVF/ICSI-D and 516 undergoing IUI-D. Somatic symptom burden, anxiety, depression, and sleep quality were assessed using the Patient Health Questionnaire-15 (PHQ-15), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI), respectively. Baseline demographic characteristics and infertility-related variables were systematically recorded. Univariate screening followed by fully adjusted multivariable logistic regression and sensitivity analysis excluding educational attainment were performed to identify independent predictors of multiple pregnancy endpoints.

In the IVF/ICSI-D subgroup, higher PSQI scores (indicating poorer sleep) displayed independent correlative links to lower odds of clinical pregnancy (OR = 0.827, p = 0.012) and live birth (OR = 0.850, p = 0.031); higher sleep scores were also correlated with reduced odds of preterm delivery (OR = 0.733, p = 0.047). For the IUI-D cohort, elevated sleep scores showed a positive correlative association with miscarriage odds (OR = 1.976, p = 0.041). Notably, mild anxiety was observed in 97% of IVF/ICSI-D participants, and rising anxiety scores were positively correlated with higher odds of live birth (OR = 1.185, p = 0.043) and cesarean delivery (OR = 1.192, p = 0.029).

Sleep quality displays correlative predictive links to pregnancy outcomes among donor insemination recipients, with distinct correlative patterns observed across different ART modalities. Mild anxiety exhibits a positive correlative association with favourable live birth rates within the IVF/ICSI-D subgroup, alongside a correlative link to higher cesarean delivery prevalence. Our observational associations support the clinical value of routine sleep screening and individualized psychological support for this patient cohort.

Tennis is a psychologically demanding individual sport characterized by high competitive pressure and self-regulatory demands. However, data on depressive symptoms and competitive anxiety in tennis players remain limited.

To assess the prevalence of depressive symptoms and competitive anxiety in active tennis players and identify demographic and sport-related correlates.

In this cross-sectional online survey, 313 active tennis players (mean age 26.9 ± 10.2 years) completed the Beck Depression Inventory-II (BDI-II) and the Sport Competition Anxiety Test (SCAT). Associations between psychological outcomes and demographic and sport-related variables were examined using correlation and regression analyses.

Clinically relevant depressive symptoms were reported by 33.5% of participants. Female athletes reported higher competitive anxiety than male athletes (p = 0.003). Competitive anxiety was positively associated with depressive symptoms (r = 0.119, p = 0.036). A previous diagnosis of depression was the strongest predictor of clinically relevant depressive symptoms (OR = 6.81, 95% CI [2.22, 20.91]). Previous depression diagnosis, recent injury or illness, and psychotropic medication use were associated with greater depressive symptom severity.

Competitive tennis players demonstrated a substantial burden of depressive symptoms and competitive anxiety, with one third of athletes reporting clinically relevant depressive symptoms. Competitive anxiety was associated with depressive symptoms, indicating overlapping aspects of psychological distress. Athletes with a history of depression, recent injury or illness, or psychotropic medication use may represent groups with an increased burden of depressive symptoms and may benefit from closer monitoring. Routine mental health screening, integrated psychological support, and targeted interventions during injury rehabilitation should be considered to promote athlete well-being and reduce persistent psychological distress.

In recent years, videogames have attracted growing attention not only for their recreational value, but also for their potential to foster personal and social identity, enhance cognitive functioning, and promote psychological wellbeing. Consistent with a biopsychosocial perspective on health, this paper conceptualizes gaming as a psychological, behavioral, and social resource that can be purposefully integrated into health-promotion practice, and explores its use within care contexts, with a particular focus on university students. In 2025, Link Campus University in Rome launched a psychological support service funded by the Wave Pro-ben project (Project ID: PROBEN_0000007), supported by the Italian Ministry of University. The service targets students enrolled in degree programmes, PhDs, and master's courses, addressing emotional, relational, academic, and adaptation-related challenges. Counseling initiatives promote psychological wellbeing, prevent distress, and foster personal growth, thereby reducing dropout risk and supporting academic success. Activities include individual sessions, support groups, workshops, and psychoeducational interventions, offered confidentially and free of charge-a design choice intended to reduce barriers of access and stigma. The distinctive element of the service is the integration of videogames as tools for reflection and change. Traditional counseling has been complemented by structured gameplay, drawing on Video Game Therapy^® (VGT), developed by Francesco Bocci. VGT^® is conceptually intended to create opportunities for emotional recognition and regulation, cognitive engagement, agency, and social-skill development; however, evidence specifically evaluating VGT^® remains preliminary. Research shows that, while excessive gaming carries risks-such as isolation, anxiety, and problematic use-balanced and intentional play can provide meaningful benefits, stimulating flow states in which individuals process emotions, revisit past experiences, and develop adaptive coping strategies. By integrating games into counseling, the approach also engages students who may avoid traditional support due to stigma or skepticism, thus contributing to more equitable access to psychological care in higher education. As a conceptual and programmatic Community Case Study, the paper does not present effectiveness data. Instead, it describes the theoretical rationale, institutional context and key operational elements of the model, distinguishes the broader evidence on videogaming and wellbeing from the still preliminary evidence specific to VGT^®, and outlines a framework for prospective empirical evaluation.

With the acceleration of global population aging, mental health issues among older adults have become increasingly prominent. Aging anxiety, defined as apprehension regarding the aging process and associated physiological, psychological, and social role losses, significantly impacts the quality of life and health of the older adults. Physical exercise has been shown to be associated with better physical and mental health of older adults, yet the theoretical psychological mechanisms underlying their association remain insufficiently clarified. Therefore, this study aims to construct and test a serial mediation model to explore the statistical sequential indirect associations linking physical exercise to aging anxiety via self-efficacy and health anxiety.

This study employed a cross-sectional survey design, targeting Chinese adults aged 60 and above. A total of 721 valid questionnaires were collected. Data were gathered using the *Physical Activity Rating Scale (PARS-3)*, the Aging Anxiety Scale, the General Self-Efficacy Scale, and the Health Anxiety Scale. Data analysis was performed using SPSS 27.0 and PROCESS 4.0 software. Common method bias tests, correlation analyses, multiple linear regression, and Bootstrap mediation effect tests were conducted to examine the relationships among physical exercise, self-efficacy, health anxiety, and aging anxiety, as well as the mediating pathways.

Correlation analysis revealed that physical exercise was significantly negatively correlated with aging anxiety (r = -0.232, p < 0.001), significantly positively correlated with self-efficacy (r = 0.225, p < 0.001), and significantly negatively correlated with health anxiety (r = -0.193, p < 0.001). Aging anxiety was negatively correlated with self-efficacy (r = -0.474, p < 0.001) and positively correlated with health anxiety (r = 0.483, p < 0.001); self-efficacy and health anxiety were significantly negatively correlated (r = -0.420, p < 0.001). Mediation analysis further revealed that the total effect of physical exercise on aging anxiety was -0.0525 (95% CI: [-0.0685, -0.0364]); the direct effect was -0.0221 (95% CI: [-0.036, -0.0081]), accounting for 42.10% of the total effect, and the total statistical indirect effect was -0.0304 (95% CI: [-0.040, -0.0216]), accounting for 57.90% of the total effect. The independent statistical indirect effect of self-efficacy was the most prominent (indirect effect = -0.0159, 95% CI: [-0.022, -0.0105]; accounting for 30.28% of the total effect). The indirect effect through health anxiety alone was -0.0078 (95% CI: [-0.0143, -0.0023]; 14.86%), and the serial indirect effect was -0.0067 (95% CI: [-0.0095, -0.0044]; 12.76%).

This study supports that physical exercise is not only directly associated with lower aging anxiety in older adults but also shows significant statistical indirect associations through a potential serial pathway involving self-efficacy and health anxiety. Self-efficacy, as a crucial psychological resource, exhibits the strongest statistical indirect effect between physical exercise and aging anxiety. The findings deepen the understanding of the statistical association patterns through which physical exercise is linked to better mental health in older adults. They provide a theoretical basis and practical reference for designing targeted exercise interventions to mitigate aging anxiety among the older adults.

The intersecting crises of homelessness and substance use health (SUH) harms require a critical re-evaluation of mental health, SUH, and social care integration. Housing First (HF) is an evidence-based approach to ending chronic homelessness, but challenges in effectively supporting individuals with significant SUH needs within the intervention have not been well-documented. A national pan-Canadian workshop convened multidisciplinary partners to identify barriers, opportunities, and core components for the successful integration of SUH care within HF programs.

The workshop involved a diverse group of attendees (n = 59), including direct service providers, people with lived and living experience (PWLLE), healthcare professionals, community leaders, researchers, and policymakers. Following brief presentations on key topics, a series of structured breakout sessions were conducted. Discussions were centred on two primary issues: (1) the key challenges and opportunities for integrating SUH care in HF programs, and (2) the core components and strategies required to advance the use of SUH best practices within HF.

Qualitative data collected from the breakout sessions revealed four key challenges: (1) fragmented services; (2) workforce challenges; (3) restrictive policy and funding environments; and (4) stigma. Opportunities for integration included: (1) strategic alignment; (2) cross-sector collaboration; (3) equity-informed use of data; and (4) flexible model adaptation. Core components for effective SUH integration in HF programs were identified as: (1) person-centred and flexible approaches; (2) foundational support for the workforce; and (3) integrated and collaborative care systems.

Effectively integrating SUH care into HF requires a fundamental shift toward more person-centric systems: flexible, low barrier, culturally safe models that organize housing, health, harm reduction, treatment, recovery, peer, and community supports around individuals' self defined goals. The findings underscore the urgent need for coordinated policy action, grounded in evidence and lived expertise, to create a responsive system that upholds the right to both housing and health.

To investigate the prevalence of anxiety and depression symptoms in adolescents aged 11-14 years and their association with family functionality and social support networks.

This was a school-based cross-sectional study conducted in Passo Fundo, Rio Grande do Sul state. An online form was used to identify the participants' profile, the Sluzki network map to measure social support, and the family APGAR to assess family functionality. Association analysis between variables was performed using the chi-square automatic interaction detection (CHAID) method. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated using Poisson regression with robust variance.

374 students were evaluated. Among the participants, 46.3% presented symptoms of anxiety and 26.2% presented symptoms of depression. Adolescents with these symptoms had fewer close family members and people who were more distant in their social network. Girls reported more distant relationships in the family, community and work/study environment. Boys reported more close relationships in the community environment. 71.4% lived in dysfunctional families and 37.7% in extremely dysfunctional families. There was association between high family dysfunction and symptoms of anxiety (PR 4.67; 95%CI 2.35; 6.56) and depression (PR 5.26; 95%CI 3.08; 7.16).

High prevalence of anxiety and depression was identified among the students. Sex differences indicate that boys maintain more close relationships. Further investigations are needed to deepen the understanding of these relationships and support prevention and intervention strategies.