A precise and prompt automated depression detection system utilizing auditory signals is essential, considering the scarcity of psychiatrists and the exorbitant expense of clinical diagnosis, resulting in approximately 60% of psychiatric patients globally lacking access to mental health care. This study proposes a Depression Detection model utilizing voice, which integrates hierarchical higher-order spectral distribution with deep learning models to overcome these issues. The utilized dataset is the Distress Analysis Interview Corpus, Wizard of Oz (DAIC-WOZ), comprising audio recordings of clinical interviews designed to facilitate the detection of psychological distress disorders such as depression, anxiety, and post-traumatic stress disorder. Two categories of features are extracted: statistical, handmade and bispectral features, as well as deep features utilizing the Multi-level Convolutional Transformer with attention learning (ML-CoT-AL) model. The ML-CoT-AL integrates the Convolutional Transformer (CoT), Channel and Element-wise Attention Module (CEAM), and Negotiator Modules (NM). The study presents the RIME optimization technique utilizing ML-CoT-AL for hyperparameter tuning, leading to improved accuracy in multi-level depression identification.

Autistic adults are significantly more likely than non-autistic peers to have many physical and mental health conditions and unmet health care needs. One major barrier to meeting their needs is the scarcity of adult primary care physicians who are prepared to care for them.

We partnered with autistic adults to develop "Promoting Residents' Excellence in Patient-centered cARE (PREPARE) for Autistic Adults," a 5-hour training. It includes 6 asynchronous lectures, 6 synchronous case studies, and 2 virtual standardized patient experiences. Residents (N = 29) at a large midwestern US academic medical center completed a pre- and postcourse evaluation and qualitative interviews to report their self-efficacy, attitudes, perceived behavioral control, intention to treat in the future, and knowledge about caring for autistic adult patients.

The training had medium to very large effects on improving residents' self-efficacy (d = 2.98), perceived behavioral control (d = 1.08), and knowledge (d = 0.44), but did not improve attitudes toward or intention to care for autistic adults, likely due to ceiling effects. Resident feedback indicated an appreciation for the active learning elements of the training, insights from faculty facilitators and other residents, and the growth they experienced as practitioners.

This multifaceted training provides active learning opportunities in a low-stakes environment to increase residents' confidence in providing primary care for autistic adults. Future efforts include integration of this training into residency curricula at our institution and others.

Digital inclusion has become increasingly important for healthy aging, yet evidence on its association with depression among older adults remains limited, particularly with respect to potential cognitive heterogeneity.

This study examined the association between digital inclusion and depressive symptoms among Chinese older adults and explored whether cognitive function moderates this association, as well as potential mediating pathways.

Data were drawn from the 2020 wave of the China Health and Retirement Longitudinal Study, including 9,111 individuals aged 60 years and older. A multidimensional digital inclusion index was constructed based on access, use, and skills related to digital technologies, standardized to a 0-10 scale. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10; each item scored 0-3, total range 0-30, treated as a continuous score). Multi-variable regression models were used to examine associations, with interaction terms and Johnson-Neyman analysis applied to assess moderation by cognitive function, with effect size estimated using Cohen's f². Structural equation modeling was conducted to explore potential mediating mechanisms.

Cognitive function significantly moderated the association between digital inclusion and depressive symptoms (β = -0.002, P < 0.05). Among participants in the highest quartile of cognitive function, each unit increase in digital inclusion was associated with a 0.517-point decrease in depression scores, whereas no statistically significant association was observed among those in the lowest quartile (β = -0.137, P = 0.327). Pathway analyses suggested that the association operated through multiple pathways, with the direct pathway accounting for 66.7% of the total association-likely reflecting immediate psychological mechanisms including enhanced self-efficacy, expanded access to health information, and a sense of digital mastery-while cognitive-related and social participation pathways explained 8.3% and 8.0%, respectively; a sequential cognitive-social pathway accounted for a further 2.8%, and the remaining 14.2% was attributable to other model-estimated pathways, with all pathways together accounting for 100% of the total association. Executive function and immediate memory emerged as the cognitive domains most strongly associated with moderation patterns.

These findings suggest that greater digital inclusion is associated with lower depressive symptoms among older adults and that cognitive function shapes heterogeneity in this association. Enhancing digital inclusion while accounting for cognitive differences may help inform digital health strategies aimed at promoting mental well-being in aging populations.

South Africa faces a significant mental health treatment gap, with many individuals in need unable to access adequate psychological care. Registered Counsellors (RCs) were introduced to reduce this gap, particularly in impoverished communities, by offering accessible, affordable psychological services.

This article forms part of a broader study on the integration of RCs into public healthcare and specifically explores the lived experiences of mental healthcare users who received counselling from RCs within the Western Cape Department of Health and Wellness.

The sampling and interviews were conducted in primary healthcare clinics within the Western Cape Department of Health and Wellness.

An exploratory qualitative design was employed, using purposive sampling to recruit 10 participants. Semi-structured interviews were conducted and analysed using thematic analysis.

Four major themes were generated: (1) confronting stigma and misconceptions around counselling, (2) uncertainty about the role of RCs, (3) developing agency and self-reflection through counselling, and (4) recognising the transformative impact of counselling. Findings indicate that RCs play a vital role in providing first-line psychological support by creating non-judgemental spaces that promote self-reflection and emotional processing. However, the study also reveals persistent stigma surrounding help-seeking and a limited public understanding of the RC's role.

These insights underscore the need for clearer role definitions, enhanced public awareness and policy reforms to enhance the integration of RCs within primary healthcare.

Enhancing mental health literacy across communities remains essential to achieving equitable and effective service delivery.

Mental illnesses are more prevalent in people living with HIV (PLHIV) than in the general population, highlighting the need to integrate mental health services into primary healthcare (PHC). Health workers are key players in integrating these services.

This study assessed healthcare workers' perceptions, opinions, and experiences on barriers to integrating mental health services into antiretroviral therapy (ART) services.

The study was conducted in public health facilities in Windhoek, Namibia.

A descriptive mixed-methods study using a convergent parallel design was conducted among 44 healthcare workers (n = 44), including 10 in-depth interviews. Data were collected through questionnaires and in-depth interviews. Quantitative data were analysed using STATA version 15, while qualitative data were analysed using NVivo 12.

The study identified several barriers, including inadequate facility space, limited knowledge and skills for managing mental illness, insufficient in-service training, a lack of guidelines and standard operating procedures, and staff shortages.

Significant structural and workforce-related barriers hinder effective mental health screening, diagnosis, and treatment for PLHIV in PHC settings. Addressing these challenges requires facility restructuring, workforce training, task shifting, and strong political commitment to strengthen healthcare infrastructure.

The study provides valuable insights into healthcare workers' experiences and contributes much-needed regional evidence on barriers to integrating mental health services into HIV care in Namibia.

Increased politicization of health care, exemplified by bans on gender-affirming and reproductive care, has significantly impacted adolescents' ability to receive safe care. We conducted a rapid review of evidence examining politicized health legislation's impact on adolescents' right to health, focusing on reproductive, gender-affirming, and eating disorder care.

Politicization of care has impacted adolescents' right to health by creating financial barriers and changes in geographic access. For example, state legislative ban on abortion and gender-affirming care have created care deserts in which adolescents are forced to travel to receive care. These changes have resulted in delays in care, loss of bodily autonomy, and negative impacts on physical and mental health.

The findings of this rapid review have important implications for adolescent medicine clinical practices. Providers caring for adolescents require institutional support and resources to address increased patient psychosocial concerns and potentially higher patient volume as a result of restrictive legislation. Ultimately, policy advocacy is necessary to change legislation disrupting adolescents' right to health.

The online version contains supplementary material available at 10.1007/s40124-026-00379-9.

Introduction: This study investigates the well-being of Canadian adolescents who are blind or have low vision compared to their peers without visual disabilities. Methods: We analyzed cross-sectional data from the 2017-2018 Canadian Health Behaviour in School-aged Children survey. Our sample consisted of 19,702 Canadian adolescents aged 11 to 15 years, including 401 who self-reported a diagnosis of blindness or low vision, while the remaining 19,301 reported no visual disabilities. Chi-square tests assessing differences in proportions pertaining to subjective and psychological well-being, self-rated health, life satisfaction, and loneliness between these two groups were conducted. Binary and ordinal logistic regression models were used for multivariate analysis. Results: Canadian adolescents with blindness or low vision reported significantly diminished life satisfaction and a significantly higher prevalence of loneliness. They experienced mental illness and depressive symptoms at a significantly greater rate than their peers without visual disabilities. Well-being measures for adolescents who are blind or have low vision and multiple disabilities, which we defined as a participant who reported at least one additional disability other than blindness or low vision, were significantly more compromised. Discussion: Blindness or low vision was associated with lower well-being outcomes, including life satisfaction and loneliness, as well as poorer mental health among Canadian adolescents. The presence of multiple disabilities exacerbated the already lower levels of well-being outcomes experienced by adolescents with visual disabilities. Implications for Practitioners: Practitioners should recognize the well-being disparities experienced by Canadian adolescents who identify as being blind or having low vision, particularly those with multiple disabilities, and develop targeted interventions to address these challenges. Increasing access to specialized mental health support and promoting inclusive school environments are essential for improving the well-being of adolescents with visual disabilities.

Rurality is a key consideration for the Veterans Health Administration (VHA) in improving access to care. However, VHA's rural-urban taxonomy, which seeks to guide these efforts, has not been evaluated since new VHA geographic access standards were implemented. Therefore, we examined the degree to which VHA's and University of Washington's "Categorization B" rural-urban taxonomies designate the same veterans as rural and compared drive times to VHA care based on these taxonomies.

We determined Rural Urban Commuting Area (RUCA) codes of census tracts of VHA enrollees in Fiscal Year 2023 and rural-urban designations under VHA and Categorization B taxonomies, which each have three designations: urban/rural/highly rural and urban/large rural/small rural, respectively. For each RUCA code and rural-urban designation, we calculated frequencies and percentages of enrollees overall, and percentages of enrollees with drive times >30 minutes to VHA primary care sites and >60 minutes to VHA secondary and tertiary care sites, which parallel drive-time eligibility standards for VHA-purchased care under the 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act.

Most (81.0%) enrollees had similar rural-urban designations under VHA and Categorization B taxonomies; divergence was primarily due to RUCA 2.0, which is considered rural by VHA but urban by Categorization B. Compared with the Categorization B large and small rural designations, the VHA rural and highly rural designations captured more veterans with drive times that meet eligibility standards for VHA-purchased care under the MISSION Act. For example, 85.5% of veterans with tertiary care drive times >60 minutes were considered rural/highly rural by VHA while only 59.8% with tertiary care drive times of this length were considered large/small rural by Categorization B.

Aligning with VHA's access-to-care priorities, VHA rural and highly rural designations better capture veterans who may experience geographic barriers to care. For other VHA access priorities, such as temporal access, integrating additional data may be necessary to refine rural-urban taxonomies.

We explored how people with dementia (PwD) and their carers navigate Peru's health system for diagnosis and treatment.

We interviewed PwD (n = 4), carers (n = 18), and healthcare workers (n = 17) from four sites. We developed a patient journey map using thematic analysis and participant validation.

Three journey stages emerged. Pre-diagnosis: Families seek care across different sub-health systems and facilities 2-4 years after symptom onset.

Specialist consultation is sought in major cities and diagnosis occurs in hospitals based on clinical presentation. Continuity of care: Care focuses on controlling behavioral and psychological symptoms, with limited access to dementia-specific drugs and non-pharmacological interventions, and heavy reliance on carers' resources. Community mental health centers (CMHCs) are preferred facilities due to geographical and specialist accessibility and perceived care quality.

Without a formal entry point to dementia care, families navigate fragmented pathways, whereas CMHCs emerge as facilities with adequate care procedures for PwD.

National policies have been introduced to promote the delivery of Culturally Safe dental care for Aboriginal and Torres Strait Islander Australians. However, the understanding of what constitutes Culturally Safe dental care and how it can be effectively implemented into clinical practice, remains limited. This study aimed to gain a deeper understanding of Culturally Safe oral health care through collaboration with Aboriginal people residing in regional Victoria.

A Community-Based Participatory Research (CBPR) approach was utilised between the study team and a Victorian Aboriginal Community Controlled Health Service to design the study and develop yarning prompts. Following engagement, 40 individuals from the Victorian Aboriginal community participated in yarning groups that were audio recorded. Discussions were guided by a researcher who, through clinical work, had community familiarity. Following transcription and de-identification, the data were thematically analysed utilising a constructivist grounded theory approach.

The data analysis revealed 13 themes that were categorised according to Ramsden's foundational work with Cultural Safety domains: Holistic care (physical, mental, social, spiritual), power (clinical interactions, agency, overseas-trained practitioners, vulnerable space and sense of belonging), access to services (cost and time) and trust (trust building and historical distrust). These themes discuss significant barriers to achieving Culturally Safe oral health care for Aboriginal Australians in regional Victoria. These are influenced by structural issues like limited oral health funding, deficit narratives and a limited Aboriginal dental workforce.

Culturally Safe oral health care is a dynamic, relational practice that is embedded in Aboriginal worldviews. Achieving it requires structural reform, trust-based relationships and communication that empowers to ensure oral health is addressed holistically. These findings will help inform future policy, education and service delivery initiatives grounded in Aboriginal knowledge systems.