Child maltreatment is a pressing concern in the United States, with more than four million children referred to child protective services in 2022. Parental mental health and substance use disorders are strongly associated with child maltreatment. We use administrative data from 2004-2022 to study the relationship between the number of mental health and substance use treatment centers and child maltreatment reports in U.S. counties. Findings show that a 9.6% increase in the supply of treatment centers per county reduces child maltreatment reports by 0.7% and child injury deaths by 0.4%. These findings suggest that improved access to mental health and substance use treatment may help reduce child maltreatment.

Digital remote monitoring technologies, including smartphones and wearables, offer promising avenues for early detection of psychosis relapse. However, selecting devices that are acceptable to participants and produce high-quality data remains challenging.

The aim of this nested pilot study was to assess the acceptability and data quality of 3 commercially available wearable devices in people with psychosis recruited to the CONNECT cohort study.

Participants recruited to the CONNECT study before July 31, 2024, were included in the pilot study and selected 1 of 3 wearable devices: a Fitbit Charge 5, Samsung Galaxy Watch 5, or Apple Watch SE. Baseline demographics were compared between device groups. Acceptability of devices to participants was assessed through a Wearable Device Satisfaction Questionnaire after 3 months of use, with the proportion of positive responses to each question calculated and compared. Data completeness was also assessed by calculating the number (and percentage) of valid days of step count, heart rate, and sleep data, and comparing between groups. Data quality was assessed through summarizing the amount of troubleshooting required, additional metrics available from the wearables, and continuity of data completeness by calculating the proportion of participants with at least 3 days of heart rate data per week for the first 20 weeks of follow-up. Predefined criteria were used to determine the next steps for the wider CONNECT study: if one device was superior, this would be selected; if none were found to be superior and the Fitbit was found to be noninferior, then Fitbit would be retained.

Of the first 107 participants recruited to CONNECT, 105 were included in the pilot study evaluation. The Samsung Galaxy Watch was selected most frequently by participants (46/105, 43.8%), followed by the Apple Watch (27/105, 25.7%), and Fitbit Charge (23/105, 21.9%). Differences in participant demographics were observed across device groups. Self-reported acceptability after use did not differ substantially between devices. However, in terms of data completeness, the median proportion of valid heart rate data days was significantly lower for Samsung Galaxy (median 31.2%, IQR 8.5%-46.0%) compared to Fitbit (median 80.1%, IQR 26.7%-95.0%; P=.003) and Apple Watch (median 49.3%, IQR 21.5%-86.0%; P=.02). There was no significant difference between Fitbit and Apple Watch. Similar patterns were observed for step count and sleep data. The Samsung Galaxy Watch required more frequent troubleshooting for data flow issues and lacked additional physiological metrics, available from the other devices.

Due to comparatively lower data quality and technical performance, the Samsung Galaxy Watch was discontinued for use in the subsequent phase of the CONNECT study. The study highlights the importance of incorporating nested evaluations of devices in long-term research.

Procrastination has a maladaptive impact on health and survival, yet it remains moderately heritable, presenting a biological paradox. Procrastination has been conceptualized as a byproduct of impulsivity, explaining its prevalence despite no discernible adaptive benefit. However, their shared neurobiological substrates have yet to be elucidated. Using a longitudinal twin cohort (N = 154), we show that nonplanning impulsivity (NPI) during late adolescence and early adulthood is prospectively associated with procrastination in later life. This effect was independently replicated in two cross-sectional cohorts (N = 327; N = 1,543). Twin modeling using an additive genetic and nonshared environmental (AE) framework, together with a meta-analysis of twin studies (N = 3,656 twin pairs), revealed significant shared genetic contributions (r_g = 0.51). Beyond genetic overlap, neuroimaging meta-analysis (NeuroSynth meta-analysis for impulsivity: k = 198 studies, 5855 loci; mini meta-analysis for procrastination: k = 5 studies, 7 independent samples, N_cumulative = 893 participants), normative modeling (N = 37,407), and seed-based d mapping (SDM) converged on the left dorsolateral prefrontal cortex (DLPFC) as the region of maximal overlap between NPI and procrastination. The transcriptional profiles of the left DLPFC and impulsivity-associated genes exhibited functional convergence on regulation of biological and cellular processes. These genes showed brain-specific expression and associations with cortical metabolism, neurodegenerative disease, and developmental expression peaks, indicating a shared molecular basis for the neurogenetic architecture of procrastination. Together, our findings delineate a cross-scale characterization of the shared neurogenetic substrates linking NPI and procrastination, offering empirical evidence that elucidates the biological origins of procrastination.

ObjectiveDelirium is a common psychiatric condition in general hospitals and a known risk factor for suicidal ideation. However, little is known about suicide deaths among patients with delirium. This study examined the clinical characteristics of hospitalized patients with delirium who died by suicide.MethodsAnalyzed were anonymized medical incident data reported to the Japan Council for Quality Health Care from 2010 to 2022. Among reported inpatient suicide deaths, cases with documented delirium were identified and analyzed.ResultsA total of 403 inpatient suicides were identified during the study period, of which 12 (5.1%) involved patients with delirium, all of whom were admitted to medical wards. The most common methods of suicide were jumping from a height and hanging, often occurring in hospital rooms. Suicidal ideation and distress related to physical illness, including depression, anxiety, and pain, were frequently observed. However, only about half of the patients had received specialist interventions, such as psychiatric consultation. Patient characteristics, including sex and primary illness, were consistent with previous studies of inpatient suicide, with the exception of age.ConclusionsWhile this study cannot determine whether delirium independently contributes to suicide risk, the findings suggest that recognizing and managing delirium-together with timely specialist interventions, such as psychiatric consultation, and standard inpatient safety measures, including restricting access to means and making appropriate decisions regarding patient leave-may be important components of suicide prevention in general hospital settings. Further research is needed to better understand how delirium influences suicide risk.

Academic stress (AS) can be understood as a multidimensional form of chronic stress that has been linked to adverse patterns across physical and mental health in university students. This protocol outlines a longitudinal, observational study to examine within-semester associations between AS and indicators of nutritional status, eating-related patterns, sleep quality, and depressive symptoms. By integrating physiological, behavioral, and psychological indicators within a repeated-measures framework, the study aims to generate evidence that can inform prevention-focused actions and early support strategies in university health contexts.

(i) Higher AS will be longitudinally associated with less favorable eating-related patterns, nutritional and somatic indicators, and higher depressive symptoms in university students. (ii) Higher AS will be associated with altered post-awakening cortisol dynamics, specifically a lower cortisol awakening response (CAR) and lower AUCi, together with a higher AUCg, and with higher salivary alpha-amylase (sAA) levels, consistent with stress-related activation of HPA-axis and sympathetic pathways.

A longitudinal, observational, nonexperimental design with repeated measurements will be implemented across three assessment cycles during an academic semester. A feasibility-based convenience sample will be recruited from undergraduate students (2nd to 4th year) enrolled in the Faculty of Medicine, University of Concepción (Chile). Students receiving psychological or pharmacological treatment will be eligible to reflect real-world heterogeneity and support ecological validity.

Data will be collected through standardized questionnaires, nutritional assessments, biological sampling, and wearable-derived somatic indicators. Electronic surveys administered via REDCap will assess AS, perceived stress, eating-related patterns, and depressive symptoms. Diet will be assessed through interviewer-administered nutritional interviews, including repeated 24-hour dietary recalls treated as time-specific observations and modeled longitudinally as time-varying measures, and complemented by diet-quality and dietary inflammatory potential indices. Wearable devices will record nonclinical somatic indicators, including heart rate, oxygen saturation, and sleep-related metrics during monitoring periods. Saliva will be collected twice per week during each assessment cycle to quantify salivary cortisol dynamics and sAA activity, and peripheral blood samples obtained at baseline and end of semester will be used to determine lipid profile, fasting glucose, albumin, globulin, and total proteins.

Analyses will include descriptive and bivariate summaries, followed by multivariable models appropriate to outcome type. Longitudinal associations will be examined using mixed-effects models, and temporal cross-lagged associations will be explored using random-intercept cross-lagged panel models across the three assessment cycles. All inferences will be framed as associational given the observational design.

Rather than prespecifying outcomes, this protocol is expected to generate longitudinal evidence on how within-semester variation in AS aligns with eating-related patterns, diet, nutritional and somatic indicators, depressive symptoms, and stress-related physiological indicators (salivary cortisol dynamics and sAA activity). The integrated, feasibility-oriented measurement framework may serve as a replicable template for future research and inform prevention-focused actions to support student well-being in university settings.

Advance care planning is a crucial element of high-quality, person-centred end-of-life care for people with dementia; however, levels have remained persistently low. Recent debates have emphasised informal conversations within families. Understanding factors associated with advance care planning and informal conversations may help target support more effectively. Data were collected in face-to-face interviews with 420 dyads of people with dementia and their carers, within 18 months of diagnosis, as part of the observational DETERMIND cohort study. Cross-sectional multivariable logistic regression analyses of observational data were used to examine factors associated with five types of future care planning. Nearly a quarter (22.1%) had undertaken no future care planning at all, not even informally with their carer. Less than half (44.9%) reported having an informal conversation with their carer, with only 16.9% saying that they had 'definitely' had such a conversation and the remaining 28% saying they had done so only 'to some degree.' Lasting powers of attorney (LPA) for health and welfare (64.7%) were common but frequently not underpinned by informal discussions. Conversations with a GP (14.1%), advance statements (9.1%) and advance decisions (10%) appeared to occur late, when people were older, had more severe dementia symptoms and lower quality of life, and carers were experiencing greater burden. People with dementia with better-resourced carers were more likely to engage in future care planning, suggesting inequalities in access. This included carer use of support and information services, associated with conversations with a GP or other professional and LPAs for health and welfare, and higher carer educational attainment, associated with having informal conversations. Lower dementia severity was also associated with informal conversations, suggesting a more active role for people with mild dementia. Our findings suggest a need for more relational approaches, including support for informal conversations, high-quality carer support, timely and consistent professional involvement and additional support for those without close carers.

The war in Ukraine has intensified mental health vulnerabilities, including alcohol misuse among conflict-affected men. The CHANGE intervention, a transdiagnostic mental health programme building on WHO's Problem Management Plus (PM+), addresses alcohol misuse and common mental disorders among conflict-affected populations. This study explores stakeholder perspectives on the scalability of CHANGE under active wartime conditions in Ukraine. Here, scalability refers to the potential for future scale-up rather than retrospective evaluation of actual scale-up, feasibility or effectiveness. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted online interviews with 20 stakeholders: 13 implementers, 2 adopters, and 5 maintainers. Perceived barriers in the outer setting included limited primary care referrals, lack of policy integration, societal stigma, normalization of alcohol use, competition among service providers, intersectoral trust gaps regarding NGOs and funding instability. Inner setting barriers included psychological distress among implementers and payment instability. Perceived facilitators across CFIR domains included established multisectoral partnerships, a supportive organizational environment, team professionalism, and strong motivation for implementation. The war introduced additional barriers, including service disruptions, insecurity and economic hardship. At the same time, the online adaptation of the intervention, and increased community engagement around mental health needs emerged as key facilitators. Suggested implementation strategies focused on strengthening stakeholder relationships, ensuring continues training and supervision, and engaging service users through awareness campaigns. Overall, findings from CHANGE provide contextually grounded insights for scaling psychological interventions in humanitarian and conflict-affected settings globally.

ObjectiveAvoidant Restrictive Food Intake Disorder (ARFID) remains under researched and there are currently no National Institute for Health and Care Excellence (NICE) guidelines, the UK body that produces national, evidence-based clinical guidelines for treatment. Our study aims to capture the qualitative experiences of carers of young people with ARFID who have received treatment, aiming to understand caregivers' experiences of caring for a young person with ARFID and what their experience of treatment is like.MethodQualitative semi-structured interviews with 11 caregivers of young people receiving treatment in a national tertiary feeding and eating disorder service were conducted. Thematic analysis was used to analyse interview transcripts, following Braun and Clarke's six-phase approach (2006, 2022a, 2022b).ResultsFour overarching themes were developed: Care with Constant Concern: the emotional and practical impact of caring for a child with ARFID; Navigating Fragmented Systems: delays, knowledge gaps, and access barriers; Balancing Survival and Safety: the complexities of implementing feeding interventions; and Building Strength Through Shared Experiences: the value of communication and collaborative support within treatment.ConclusionEffective management of ARFID requires clear care pathways, integrated multidisciplinary plans, and recognition of caregiver burden. Services should balance physical safety with strategies to promote oral exposure while adopting flexible, child-led approaches. Future research must amplify young people's voices and broaden caregiver perspectives to inform responsive, evidence-based interventions.

Although mental health and healthy lifestyle interventions are associated with functional outcomes in adolescence, the extent to which particular lifestyle factors explain relationships between mental health and outcome are unclear. Here we examined mediating effects of lifestyle factors on relationships between mental health and two functional outcomes measured 2-3 years later, as well as moderating effects of environmental risk factors on mediation strength in early adolescence.

We analyzed data from three waves of the Adolescent Brain Cognitive Development Study (ages 10-11, 11-12, and 12-13 years). Mediating effects of sleep quality, screen time, physical activity, and Mediterranean diet on the relationships between depression, anxiety, psychotic-like experience (PLE) distress, and total problems with two subsequent functional outcomes (academic functioning and social problems) were examined. Secondary analyses included environmental factors as moderators.

Sleep quality mediated 18.5%, 36.3%, and 8.3% of the relationships between depression, anxiety, and PLE distress with academic functioning, respectively (total problems mediation was nonsignificant). Screen time was the second strongest mediator. For social problems, only sleep quality showed >3% mediation (19.6-23.3%). Mediating effects of sleep and screen time on academic functioning decreased as financial adversity increased. Conversely, mediating effects of sleep quality on social problems increased with worsening family conflict, financial adversity, and school environment.

These results suggest that healthy lifestyle factors (particularly sleep quality) may partially explain associations between mental health and functioning in adolescents and suggest that these effects are modulated by environmental factors. These results may have implications for future intervention studies.

Behçet's disease (BD) is a chronic, inflammatory multisystem disease that has impact both physical health and mental well-being. However, the psychological impact of BD remains underexplored, particularly in Arabic-speaking populations. The aim of this study was to assess the prevalence of anxiety and depression in Arabic-speaking BD patients, evaluate their association with health-related quality of life (HRQoL), and identify key predictors of psychological distress in these patients.

This cross-sectional study included 192 BD patients recruited from our rheumatology clinic and an online survey among BD patients. Psychological distress was assessed using the Arabic version of Hospital Anxiety and Depression Scale (HADS), while HRQoL was assessed via the Arabic version of Short Form 36 (SF-36) Health Survey. Univariate and multivariate regression analyses were performed to identify main factors linked with anxiety and depression.

Anxiety and depression were highly prevalent in BD patients, with 53.1% of the study participants exhibiting abnormal anxiety levels and 38.5% showing abnormal depression scores. Higher levels of psychological distress were statistically significantly associated with BD disease activity and elevated erythrocyte sedimentation rate levels (p = 0.017). Additionally, patients with greater anxiety and depression scores had significantly lower HRQoL scores across all SF-36 domains (p < 0.001). Gender differences were observed, with females showing higher anxiety rates (p = 0.006).

Anxiety and depression are major contributors to reduced HRQoL in BD patients, necessitating a multidisciplinary approach that integrates mental health care into disease management.

Not applicable.