The objective of this scoping review is to summarize the evidence on barriers to outpatient mental health services experienced by Medicaid recipients.

Medicaid recipients commonly face challenges in accessing outpatient mental health services. This scoping review will categorize existing evidence on barriers to outpatient mental health services experienced by adult Medicaid recipients and identify knowledge gaps that warrant further investigation.

This review will consider studies that address barriers to outpatient mental health service access among the adult Medicaid population (18 years or older) in the United States. We will only consider services provided by mental health specialists. Since barriers to care may have evolved after the implementation of the Affordable Care Act in 2014, the search will be limited to studies that use data from January 1, 2014, onward.

We will search the databases MEDLINE (Ovid), Scopus, and Embase, as well as gray literature and key organizational websites. Study screening will occur in 2 stages: i) titles and abstracts will be screened for key text words, and ii) the full text of potentially relevant sources will be examined in detail against the eligibility criteria. Two reviewers will independently be involved in study selection, and unresolvable issues will be decided by a third reviewer. The review will map extracted data to the Barriers to Health Services Framework, which groups barriers into structural, provider-level, social, and patient-cost barriers. We will provide a narrative summary of our findings and present extracted data in a tabular format.

OSF https://osf.io/rbxmn.

As cannabis legalization expands and professional sports organizations reassess cannabinoid policies, elite contact sport athletes are increasingly exposed to cannabis use for therapeutic, recovery, and recreational purposes. Despite these shifts, limited evidence-based education and persistent stigma may hinder informed decision-making and athlete-clinician communication.

Professional and elite-level contact sport athletes exhibit inconsistent knowledge and perspectives regarding cannabis use, shaped by stigma, inadequate education, and regulatory ambiguity.

Qualitative descriptive study.

Level 4.

A total of 10 semi-structured interviews were conducted with current or former elite contact sport athletes from professional and collegiate leagues, including the National Hockey League, National Football League, National Basketball Association, American Hockey League, National Collegiate Athletic Association, and USports. Interviews explored athletes' knowledge, attitudes, and experiences related to cannabis and cannabinoid products in sport. Transcripts were analyzed using Braun and Clarke's 6-step thematic analysis framework to identify recurring patterns and themes.

A total of 5 primary themes emerged: (1) athletes use cannabis; (2) insufficient education and lack of credible information sources; (3) persistent stigma and fear of judgment; (4) limited trust and communication with medical staff; and (5) inconsistency in laws, policies, and organizational responses. Athletes reported cannabis use for pain management, sleep, recovery, and mental health, typically with deliberate control over dosage, timing, and administration methods. Across interviews, participants emphasized the need for accessible, evidence-based education for both athletes and medical personnel.

Elite contact sport athletes use cannabis intentionally for recreational, therapeutic, and recovery purposes but face systemic barriers related to misinformation, stigma, and inconsistent policy guidance. Enhancing athlete and clinician education and standardizing cannabis-related regulations across leagues may support safer, evidence-informed practices.

This study identifies critical educational and policy gaps regarding cannabis in elite sport and underscores the need for multidisciplinary collaboration to guide responsible cannabinoid use among athletes.

Psychiatric medications contribute to high rates of metabolic dysfunction in psychotic disorders. Ketogenic diets reduce metabolic syndrome, have anticonvulsant effects in epilepsy, and may improve symptoms of schizophrenia and bipolar disorder. We report the first randomized controlled trial to assess effects of ketogenic diets on metabolism, psychiatric symptoms, and cognition in people with schizophrenia-spectrum and bipolar-1 disorders.

Participants were randomized to a ketogenic diet (KETO; n = 28) or diet-as-usual (DAU; n = 30) for 1 month. Partway through the trial, a KETO extension was offered to both groups, resulting in a sub-group who completed the diet for 4 months (n = 25). We assessed changes in metabolic health, clinical symptoms, and cognition after 1 month (KETO versus DAU) and after 4 months (KETO versus baseline).

KETO participants' daily ketone levels surpassed the standard ketosis threshold. Relative to DAU, KETO participants showed reductions in weight (Padj <  .001), hemoglobin A1c (Padj = .05), and insulin resistance (Padj = .05). Clinical symptoms (positive, negative, depression) and cognitive performance improved after 4 months on the KETO (all P-values < .001). Increased blood ketone levels in KETO participants correlated with improvements in pre-diabetic markers and depressive symptoms (all P-values < .001). Reduced weight following the KETO was unrelated to metabolic and symptom improvements.

We demonstrate feasibility of administering a KETO in outpatients with schizophrenia and bipolar-1 disorder. Participants showed improvement in metabolic health, cognitive performance, and clinical symptoms. Improvement in depressive symptoms was associated with ketosis rather than weight loss, implicating ketosis as the therapeutic mechanism.

Over the past two decades, research has shown that measurement-based care (MBC) improves clinical outcomes in mental health care. However, translating MBC into routine practice remains challenging. In this systematic review, the authors aimed to synthesize evidence gathered from 2000 to 2024 on interventions supporting MBC implementation in adult mental health services in order to identify effective strategies and contextual factors.

Literature searches were conducted in MEDLINE, PubMed, Web of Science, Google Scholar, and PsycNet databases, yielding 1,120 records in a first search (2000-2022) and 1,095 in a second (2023-2024). The full texts of articles were assessed, and 16 articles selected for final analysis were critically appraised with the Mixed Methods Appraisal Tool.

Quantitative descriptive study designs were most common. MBC interventions were linked to symptom reduction, improved medication adherence, and increased use of self-report tools. Patient satisfaction rose when MBC supported shared decision making. Providers viewed MBC positively, although feedback practices varied and concerns about relational impact remained. Psychologists engaged more with MBC than did psychiatrists. System-level strategies and electronic health record integration increased MBC uptake, but broad adoption remained difficult. Key barriers included time constraints, lack of training, hierarchical structures, negative attitudes, and technical limitations.

Effective MBC implementation requires context-sensitive strategies, interprofessional collaboration, and active involvement of patients, service users, and caregivers. Future research may focus on underrepresented settings, diverse professional roles, and hybrid designs. Standardized measures and detailed reporting are essential to advance MBC integration and improve care quality.

National guidelines emphasize the value of community-based behavioral health crisis care for youths, including mobile crisis response and telehealth. This study aimed to assess characteristics associated with receipt of crisis care via mobile or community services and telehealth among Medicaid-enrolled youths.

A retrospective study was conducted of a national sample of youths ages 6-17 years who received crisis services and had data in the 2022 Merative MarketScan Medicaid database. Locations of care included mobile or community, telehealth (i.e., virtual), in-person onsite (e.g., hospitals), and other. Multivariable logistic regression was used to evaluate sociodemographic and clinical factors associated with receipt of crisis services via mobile or community response and via telehealth.

The sample included 18,993 youths who received behavioral health crisis services in 2022. The most frequent service location was in person onsite (63.0%), followed by mobile or community (29.2%), other (9.3%), and telehealth (9.1%). Compared with results for White youths, the odds of receiving crisis care via mobile or community services were higher for Black youths (adjusted odds ratio [AOR]=1.12) and Hispanic youths (AOR=1.26), and the odds of receiving crisis care via telehealth were higher for Black youths (AOR=1.30) and lower for Hispanic youths (AOR=0.05).

Despite recommendations that prioritize community-based behavioral health crisis care, most crisis services occurred in person onsite. Racial-ethnic differences were found in receipt of mobile or community and telehealth crisis care. Future research to investigate facilitators, barriers, and preferences may enable more youths to receive community-based crisis care.

This study aimed to examine treatment patterns among U.S. adults with co-occurring substance use disorder (SUD) and mental illness, identify sociodemographic factors associated with receipt of treatment for both conditions, and characterize barriers to care.

The authors analyzed cross-sectional data from the 2021-2023 National Survey on Drug Use and Health. Adults age 18 years and older who met criteria for past-year SUD and either any mental illness or serious mental illness were included. The primary outcome was receipt of treatment for both conditions in the past year, and secondary outcomes included self-reported barriers to treatment. Weighted prevalence estimates and multivariable logistic regression models were used.

Among adults with co-occurring SUD and any mental illness, receipt of treatment for both increased from 7.5% in 2021 to 16.9% in 2022 and 18.2% in 2023. Among adults with co-occurring SUD and serious mental illness, receipt of treatment for both increased from 12.3% in 2021 to 25.0% in 2022 and 25.6% in 2023. Female sex, older age, and poorer self-rated health were associated with higher odds of receiving treatment for both conditions. Non-White and uninsured adults had significantly lower odds. Less than 2% of untreated adults reported perceiving a need for and seeking treatment. Commonly reported barriers included treatment not being a priority, stigma, cost, limited access, and lack of readiness.

Receipt of both substance use treatment and mental health treatment remained low among U.S. adults with co-occurring disorders despite modest post-COVID-19 pandemic increases. Persistent disparities and barriers suggest a need for stronger parity enforcement, stable financing, and improved coordination across behavioral health services.

Physical activity (PA) is essential for physical and mental health, yet remains insufficient across populations. Environmental factors, such as air pollution (AP), are increasingly recognized as dynamic influences on daily PA behavior. This study investigated within-person relationships between AP (particulate matter PM₁₀) and device-based PA (step counts) over 14 days in a sample of 693 adults living in an industrial region in the Czech Republic (9702 daily observations; 47.2% women; Mage = 38.78, SD = 12.28). The sample was recruited using non-probabilistic quota sampling. Using multilevel Bayesian modeling, we found that on days when PM₁₀ was higher than a participant's average across the 14 days, step counts were lower (b = -0.027; 95% CI = [-0.047, -0.006]), while controlling for the effects of temperature, sunshine, and precipitation. Specifically, a 1-SD increase in PM₁₀ was linked to 361 fewer steps. Self-reported AP monitoring tendency did not moderate the within-person relationship between AP and step counts (b = -0.003; 95% CI = [-0.044, 0.038]). Findings highlight the importance of capturing short-term environmental exposures in PA research and underscore the public health relevance of behavioral adaptation under conditions shaped by climate change, including AP. Results may inform individual-level digital interventions focused on adaptive behavior change as well as policy-level urban planning strategies that promote PA under varying environmental conditions.

Hospital morbidity data are used for hospital reimbursement in many countries and are also critical for epidemiological profiling and health planning, both of which depend on data quality. Exploring the clinical coders' perspective is crucial for implementing targeted interventions in this field.

To identify the main factors influencing the quality of health registries, the coding process and data quality, from the perspective of clinical coders in Portugal.

We conducted a nationwide online survey of clinical coders, informed by prior focus groups and a literature review, to assess their perspectives on the quality of health records, the clinical coding process, and coded data.

A total of 162 responses were obtained. Respondents primarily used electronic health records, including discharge notes, clinical diaries, and surgical reports. Common problems in health records included "copy-paste" practices (67%) and the use of unspecified acronyms (52%). Incomplete records, inconsistent information, and the lack of support affected coding quality. Half agreed that a reduction in the number of coders contributed to delays. Financial incentives for quality, software availability, and frequent internal audits were identified as priority measures to improve data quality.

This study highlights the importance of clinical documentation for coding accuracy. Despite the use of electronic health records and the transition to ICD-10-CM/PCS, difficulties such as "copy-paste" practices and the use of unspecified acronyms persist. Continuous training, standardisation of documentation practices, and collaboration between clinical coders and other health professionals are essential to ensure coding accuracy. These problems and potential improvements may affect national policymaking and initiatives such as the European Health Data Space and international health prioritisation.

Persons with severe dissociative states constitute a vulnerable group in psychiatric inpatient care and are at risk of being misunderstood and mistreated. The aim was to describe experiences of psychiatric inpatient care among persons living with severe dissociative states.

Sixteen persons with lived experience of severe dissociative states and previous contact with psychiatric inpatient care participated in semi-structured interviews that were analyzed using qualitative content analysis. This study is reported in accordance with the COREQ guidelines.

Participants' experiences are described in one theme, Stuck between a rock and an unnecessarily hard place, and three subthemes. At the mercy of others in a place intended to provide support, Distrusted and rejected in a place intended to allow existence and Lacking control in a place intended to be safe.

The results suggest a gap in understanding of trauma dynamics in psychiatric inpatient care, implying a need for increased trauma awareness. Mental health nurses should lead the promotion of safe, person-centred and trauma-informed psychiatric inpatient care for persons with severe dissociative states, requiring authority, education, support, supervision and resources.

Intermittent theta-burst stimulation (iTBS) is an established treatment for major depressive disorder (MDD), but sham-controlled evidence for once-daily protocols remains limited.

To determine whether 10 sessions of once-daily iTBS is superior to sham iTBS for adults with MDD.

This randomized clinical trial was conducted at an outpatient psychiatric clinic in North Norway between January 1, 2022, and June 30, 2025, among 73 patients with MDD, aged 22 to 65 years, with a Montogomery-Åsberg Depression Rating Scale (MADRS) score of 20 or more, regardless of treatment refractoriness level. Statistical analyses were completed in October 2025.

Participants were randomized to 10 weekday sessions of once-daily iTBS (600 pulses at 120% of the resting motor threshold) or sham stimulation delivered with a validated sham coil to the left dorsolateral prefrontal cortex. A 4-week follow-up evaluated sustained effects.

Main outcomes were between-group differences in depression scores on day 10, measured with the clinician-rated MADRS and the Beck Depression Inventory-II (BDI-II). Secondary outcomes included MADRS scores on day 5, MADRS and BDI-II scores at follow-up, and response and remission rates on day 10. Repeated depression measures were analyzed using linear mixed-effects models in a modified intention-to-treat sample. Adverse events were assessed daily and compared between groups.

Seventy-three participants (mean [SD] age, 36.1 [10.6] years, 40 female [54.8%]) completed the study: 41 were randomized to active iTBS and 32 to sham. iTBS was superior to sham on day 10 for MADRS scores (mean difference, 3.57 [95% CI, 0.79-6.35]; Hedges g = 0.61; P = .01), but not for BDI-II scores (mean difference, 3.05 [95% CI, -2.72 to 8.82]; P = .30). iTBS was also superior to sham on day 5 for MADRS scores (mean difference, 2.89 [95% CI, 0.13-5.64]; Hedges g = 0.50; P = .04) but not significant at follow-up due to improvement in the sham group. Treatments were well tolerated, with mild and transient adverse events.

In this randomized clinical trial of adults with MDD, a fixed 10-session schedule of once-daily iTBS resulted in greater reductions in clinician-rated depressive symptoms than sham during the treatment phase. The group difference was not sustained at the 4-week follow-up. These findings highlight the importance of treatment duration and extended follow-up in interpreting clinical response.

ClinicalTrials.gov Identifier: NCT05516095.