Circadian dysfunction is involved in the pathophysiology of bipolar disorders (BD), and circadian-based interventions are gaining recognition in their management. Moreover, basic and epidemiologic research has generated findings inspiring circadian-informed self- and clinician-management strategies. Despite these gains, many Clinical Practice Guidelines and clinical training programs have not incorporated this evidence in their recommendations and curricula. This International Society for Bipolar Disorders (ISBD) Chronobiology and Chronotherapy Task Force position paper reports a Delphi-based expert consensus on what is essential for mental health clinicians to know about the chronobiology and chronotherapy of BD.

An initial pool of statements was extracted from academic and grey literature, and experts could suggest additional statements. Statements were rated on a 5-point scale ('essential'; 'important'; 'don't know/depends'; 'unimportant'; 'should not be included'). Consensus was reached when statements were rated as essential or important by ≥ 80% of experts.

Thirty experts from 15 countries in Europe, North and South America, and the Asia Pacific participated (mean age of 55.3 years [SD = 11.8]; 40% female; 83% psychiatrists; mean clinical experience of 26 years [SD = 10.8]). Eight-hundred-and-thirty-seven statements were rated across three rounds. Consensus was reached on 342 statements spanning four major themes: basic circadian science; circadian health and disruption; chronobiology of BD; and six chronotherapies (e.g., protocols, outcomes, risks/contraindications).

An expert consensus was obtained on the essential information about the chronobiology and chronotherapy of BD, intended to help clinicians optimise their management of BD. Dissemination of this knowledge is expected to enhance the training and efficacy of clinicians.

Early intervention in psychosis is associated with improved outcomes, yet prolonged duration of untreated psychosis remains a major barrier globally. Public health campaigns offer a promising strategy for promoting early detection and help-seeking, although findings on their effectiveness remain mixed. This scoping review examines the characteristics, strategies, and outcomes of psychosis public health campaigns published between 2008 and 2025, with particular attention to metrics that are used to evaluate campaign success.

Six databases were searched for peer-reviewed studies reporting outcomes of psychosis public health campaigns. Studies were included if they reported on campaign effectiveness and used a comparison condition. Data extraction focused on campaign characteristics, strategies, messages, target audiences, and outcomes.

Nineteen studies describing 14 distinct campaigns met inclusion criteria. Campaigns varied widely in geographic scope, target audiences, duration, and messaging strategies. There was substantial heterogeneity in how duration of untreated psychosis was defined. Although some campaigns demonstrated significant reductions in overall duration of untreated psychosis, most showed mixed effects or improvements in subcomponents only. Campaigns employing multi-modal and sustained engagement strategies were more likely to report positive outcomes. Recent digital campaigns offered targeted outreach but showed inconsistent effects.

Findings highlight the need for standardized definitions of the duration of untreated psychosis construct and consideration of more proximal outcomes for a public health intervention. Future campaigns should incorporate digital strategies, stakeholder-informed messaging, and alternative success metrics-such as referral volume and service engagement-to more accurately capture impact and guide implementation efforts in diverse settings.

While rates of youth homelessness appear to be increasing across different countries, young people experiencing homelessness face particularly critical situations, with a notably high prevalence of mental health problems and extended histories of stressful life events. This article analyzes the life trajectories and current health and needs of 392 individuals experiencing homelessness (207 men and 185 women) in the city of Madrid (Spain). People who had first experienced homelessness during their youth (under the age of 30) were, on average, younger but had experienced longer and more frequent episodes of homelessness. They had also been exposed to multiple stressful life events early in life and had a higher prevalence of victimization and criminal justice involvement throughout their lives. Likewise, youth-onset homelessness was associated with lower use of healthcare services, increased rates of mental health diagnoses and suicide attempts, and more symptoms of anxiety, depression, and substance dependence. The ongoing adversity experienced by individuals who experienced youth-onset homelessness suggests that social support systems may be failing to address the needs of vulnerable families and children. These deficiencies may contribute to the intergenerational transmission of poverty and disadvantage, and lead to situations of greater hardship for people experiencing youth-onset homelessness.

Fasting-related headache has traditionally been attributed to dehydration, caffeine withdrawal, and sleep disruption, but pre-existing primary headache disorders may also play an important role in determining susceptibility.

To determine the prevalence, clinical characteristics, and predictors of headache during Ramadan fasting and to explore the relative contribution of pre-existing primary headache disorders and the lifestyle-related factors assessed in this study to headache occurrence during fasting.

In this multinational cross-sectional survey across 14 countries, adults (18-65 years) observing Ramadan fasting completed a 17-item questionnaire. Headache during Ramadan was the primary outcome. Classification and regression tree (CRT) modelling were used to identify predictors and characterize fasting related headache.

Headache attacks occurred mainly in the afternoon/pre-iftar period and improved after iftar in 54.6% of cases. Pre-existing primary headache disorders, particularly migraine, were more strongly associated with headache occurrence within the exploratory CRT model than the lifestyle variables assessed in this study.

Fasting-related headache is highly prevalent and is influenced by both lifestyle-related factors and underlying headache susceptibility. A history of primary headache disorders was strongly associated with headache occurrence during Ramadan fasting, highlighting the importance of considering individual headache history alongside fasting- related exposures when assessing vulnerability.

Sarcopenia, an age-related muscle disease, is influenced by a variety of factors, making it essential to explore the associations of physical activity, psychological health, employment, and exercise with this condition in a healthy, well-nourished population.

This study was conducted with 766 healthy adults to assess these relationships based on EWGSOP2. Participants completed the IPAQ and provided a work and exercise history. Mental health was evaluated using BDI-13 and DASS-21.

Physical activity, both current and past, was significanly associated with a lower odds of sarcopenia. Employment status and type of work were also associated with odds of sarcopenia. Participation in sports and exercise duration were linked to decreased odds (OR = 0.687 (95% CI = 0.600-0.787), p < 0.005), with specific activities like swimming and certain traditional Iranian sports showing strong associations. Psychological factors such as scores of depression (OR = 1.149 (95% CI = 1.112-1.189), p < 0.005), anxiety (OR = 1.233 (95% CI = 1.176-1.293), p < 0.005), and stress (OR = 1.084 (95% CI = 1.056-1.114), p < 0.005) were associated with an increased odds of sarcopenia. The multivariable analyses confirmed the independent relationships of physical activity and some mental health components with sarcopenia. Predictive models highlighted the importance of physical activity, exercise, and employment status as key variables associated with sarcopenia.

This study revealed that higher work engagement, better mental health components (including lower stress, depression, and anxiety), higher levels of physical activity and, longer duration of exercise, and engaging in specific types of exercise may be related to lower odds of sarcopenia.

To conduct a socioeconomic analysis of Individual Placement and Support (IPS) integrated with specialized substance use disorder treatment. Additionally, we explored group differences in the use of social and welfare services and assessed the validity of a previous simulation model.

We used Early Health Technology Assessment (eHTA) to estimate socioeconomic gain using data extracted from a completed randomized controlled trial comparing IPS and enhanced treatment as usual (enhanced TAU) for patients in specialized substance use disorder treatment.

IPS was socioeconomically beneficial compared to enhanced TAU during the first year after end of the intervention (€992,224 for IPS, and €778,121 for enhanced TAU), equal to a group difference of €214,103 (modelled for 100 patients). During the trial period, IPS participants showed a total cost saving of €157,593 due to less use of social and welfare services, compared to participants receiving enhanced TAU. These estimates are comparable to our previous eHTA simulation.

Our estimates indicate a net socioeconomic gain of IPS starting during the intervention year, which exceeds that of enhanced TAU in the first year following the intervention. Additional cost savings were found in favor of IPS. Our early simulated eHTA proved valid in one scenario.

BACKGROUND: Growing evidence links air pollution to cognitive dysfunction in older adults. The gut microbiome and circulating metabolites present an important yet unexplored pathway given their crucial role in the gut-brain axis. OBJECTIVES: We aimed to explore the potential roles of gut bacteria, fungi, microbial functional potentials, and circulating metabolites in the association of residential PM_2.5 and O₃ exposure with cognitive dysfunction. METHODS: We analyzed gut microbiome data from 1,027 older adults using metagenome and internal transcribed spacer sequencing to profile bacterial and fungal taxa, functional pathways, and enzyme abundances. Targeted metabolomics quantified 195 circulating metabolites, such as amino acids and organic acids. Annual average ambient PM_2.5 and O₃ exposures were estimated by using satellite-based models. Cognitive outcomes, including mild cognitive impairment and cognitive decline, were assessed using the Mini-Mental State Examination and Hasegawa Dementia Scale. Statistical analyses included Microbiome Multivariable Association with Linear Models (with a false discovery rate threshold of 0.25) for microbial associations and multivariate regression for metabolites and cognitive outcomes. RESULTS: Higher PM_2.5 and O₃ exposures were associated with disturbances in microbial composition, altered taxonomic profiles (e.g., decreased abundances of Blautia obeum and Gordonibacter pamelaeae), and disrupted functional pathways, particularly those regulating 2-oxoglutarate. These findings were partially replicated in an independent population. Higher air pollution levels were associated with increased circulating levels of 2-oxoglutarate and l-glutamine (key metabolites in neurodegenerative progression), which were further linked to higher odds of concurrent mild cognitive impairment (OR: 1.39-1.56) and an increased 2-year risk of cognitive decline (OR: 1.26-1.37). These associations were partially mediated by air pollution-related changes in microbial anaerobic energy metabolism pathways, especially involving 2-oxoglutarate metabolism and the enzyme aspartate transaminase. CONCLUSIONS: Our findings highlight the role of the gut microbiome and microbial metabolites in mediating the detrimental impact of air pollution on cognitive health in older adults, providing new insights into the underlying etiology for future hypothesis generation.

Athletic injury is a biopsychosocial event rather than a purely mechanical one. Athletes recovering from musculoskeletal injury or sport-related concussion may experience depressive symptoms, anxiety, sleep disruption, fear of reinjury, role disruption, and reduced psychological readiness for return to sport. This article is explicitly presented as a narrative and conceptual review, not as a systematic or scoping review. Its aims are threefold: to synthesize the literature on mental health outcomes after athletic injury; to identify patterns by injury type, age group, competition level, and career stage; and to introduce a conceptual prototype, the Athlete Mental Health Change Index (AMHCI). The reviewed evidence supports several cautious conclusions. First, musculoskeletal injury is consistently associated with short-term psychological distress and impaired return-to-sport confidence. Second, concussion is associated with mood and recovery-related psychological symptoms, while repetitive head-impact exposure and later-life psychiatric outcomes remain associated in some studies but are limited by heterogeneous methods, recall bias, and confounding. Third, psychological response is moderated by premorbid mental health, coping style, athletic identity, social support, and environmental pressure to return prematurely. The AMHCI is presented as a provisional, hypothesis-generating framework rather than a validated clinical instrument. Its five domains and weighting coefficients were derived from theory and an illustrative literature review, not from Delphi consensus, content validity testing, pilot testing, or psychometric calibration. Accordingly, the model should not be used for diagnostic or return-to-sport decision-making without future validation. A validation roadmap is proposed, including assessment of content validity, factor structure, reliability, convergent validity, predictive validity, and threshold calibration.

Mental health conditions, particularly depression and anxiety, are common among individuals with life-limiting illnesses and significantly affect their quality of life. However, little is known about their burden in palliative care in rural Malawi.

This study assessed the prevalence and factors associated with depression and anxiety among adult patients enrolled in the palliative care program in Neno District, Malawi.

A cross-sectional study was conducted across nine health facilities from January to June 2024. Using simple random sampling, 152 adult participants were selected from the Neno district palliative care database. Quantitative data was collected using the PHQ-9 and GAD-7 as screening tools for depression and anxiety. The analysis used descriptive statistics and multivariable ordered logistic regression to identify factors associated with depression and anxiety, with results reported as adjusted odds ratios and 95% confidence intervals.

Of 152 eligible patients, 151 completed the study (99% response rate). The mean age was 67 years (SD = 16.3); 78% (n = 117) were female, and 66% (n = 99) were unmarried. Depression was present in 72% (95% CI: 65.0%-79.4%, n = 109) and anxiety in 70% (95% CI: 62.1%-77.0%, n = 105). Suicidal ideation was reported by 3% (n = 4) of participants. Depression and anxiety were strongly associated (depression model: aOR = 1.490, p < 0.001; anxiety model: aOR = 1.506, p < 0.001). Older age was associated with higher anxiety severity (aOR = 1.027, p = 0.016). No other sociodemographic variables were significantly associated with either outcome.

The study findings underscore the high burden of depression and anxiety among patients under a palliative care program in Neno District, age-trailed mental health in chronic ill patients, and integration of mental health services and palliative care programs. Future research should examine how depression and anxiety develop in older adults to tailor interventions for this population.

Heated tobacco products (HTPs) and nicotine pouches (NPs) are emerging nicotine containing products. This study aims to examine the prevalence and patterns of use of HTPs and NPs, and factors associated with starting to use HTPs among European Union (EU) Member State (MS) citizens.

We conducted a secondary analysis of data from the Special Eurobarometer 539 survey on attitudes towards tobacco and related products, carried out between May and June 2023, which included 26359 individuals aged ≥ 15 years across the 27 EU MS. We performed two-level logistic regression models, including sociodemographic factors as independent variables, to identify factors associated with HTP and NP current and ever use and reasons to start using HTPs.

In 2023, 1.7% (95% CI: 1.4-1.9) of EU MS citizens were current users of HTPs and 1.0% (95% CI: 0.9-1.3) were current users of NPs; 81.2% (95% CI: 75.6-85.8) of all current HTP users were concurrently smoking tobacco, while 43.5% (95% CI: 34.4-53.1) of current NP users were also current smokers, whereas 4.3% (95% CI: 2.16-83.6) of HTP users and 18.3% (95% CI: 12.1-26.8) of NP users had never smoked tobacco. Individuals aged 15-24 years were more likely to be current users of HTPs (AOR=4.21; 95% CI: 2.67-6.64), ever users of HTPs (AOR=9.70; 95% CI: 7.66-12.29), current users of NPs (AOR=7.36; 95% CI: 4.11-13.18) and ever users of NPs (AOR=6.48; 95% CI: 4.95-8.47). Finally, individuals aged 15-24 years (AOR=5.31; 95% CI: 1.72-16.38) and 25-39 years (AOR=2.68; 95% CI: 1.19-6.42) were more likely to have reported to have commenced HTP use because they liked HTP flavors.

Although the overall prevalence of HTP and NP use in 2023 within the EU remained low, usage was concentrated among younger individuals, with dual use with conventional tobacco products being common. The emergence of NP use among individuals who have never smoked, along with the role of HTP flavors on HTP initiation among young people, are particularly concerning.