Unavailability and delays to mental health care are a significant problem that can lead to worsening psychological symptoms and less effective treatments. Within the intensive outpatient setting, pre-enrollment care is recommended to address delays to care. Although pre-enrollment care is intended to support at-risk individuals awaiting program entry, there remains a lack of clarity regarding structure, implementation, and impact on clinical outcomes. This article examines the impact of a pre-enrollment group on the access to care and outcomes of participants in a Military Treatment Facility Intensive Outpatient Program (IOP).

This retrospective Quality Improvement (QI) project examined access to care and outcome data from participants in an IOP during calendar year 2023. Groups of patients who did and did not receive the pre-enrollment group were compared before and after treatment using repeated-measures analysis of variance.

Analysis showed pre-enrollment group patients showed more improvement in both anxiety and depression symptoms over IOP treatment. Additional analysis by diagnostic group showed that these effects differed depending on the patient's primary diagnosis. Among patients with a trauma-related diagnosis engagement in pre-enrollment group was protective against increased anxiety and depressive symptoms although patients with a chronic adjustment disorder diagnosis showed a more significant decrease in both anxiety and depression symptoms. Finally, delay to care was generally associated with worse outcomes, which engagement in pre-enrollment decreased, although therapeutic alliance positively influenced treatment response.

This QI project demonstrates that engagement in pre-enrollment care can reduce delays to treatment and improve behavioral health outcomes. These findings support formalizing pre-enrollment programming as a core component of IOPs.

Involvement in clinical mental health research can be a challenge for services isolated from academic institutions, limiting opportunities for patients to receive innovative interventions and for clinicians to explore interest in research. We aimed to increase mental health research capacity in Somerset NHS Foundation Trust via a range of initiatives from collaboration between a senior clinician and research and development colleagues.

Over the course of the project, the number of participants recruited to National Institute for Health and Care Research-adopted mental health and dementia research projects quadrupled over a 2-year period, from 57 to 232, and the number of projects hosted rose from 9 to 23. A total of 165 clinicians signed up to receive information about ongoing studies.

We found considerable appetite for becoming involved in research among mental health clinicians, and were able to provide opportunities for research experience as well as access to innovative studies for local patients.

Depressive and anxiety disorders are among the most common mental disorders worldwide and are associated with unhealthy lifestyle behaviors. The Life's Simple 7 (LS7) guideline proposed by the American Heart Association aims to reduce cardiovascular risk by improving behaviors such as diet and physical activity, but its impact on mental health is not yet fully clear. This study examined the association between LS7 scores and symptoms of anxiety and depression in adults undergoing routine health examinations.

Data were collected from individuals who underwent health examinations from May 2015 to December 2024 at the Health Management Center of the Third Xiangya Hospital. All participants completed the LS7 assessments, the Self-Rating Depression Scale (SDS), and the Self-Rating Anxiety Scale (SAS). Participants were categorized into 4 LS7 score groups: Low (≤7), average (8-9), good (10), and excellent (11-14). Those with SDS or SAS≥50 were classified as having mental disorder symptoms; with this group, SAS≥50 indicated anxiety, SDS≥50 indicated depression, and SDS and SAS≥50 indicated comorbid anxiety-depression. Binary logistic regression was used to assess associations between LS7 score and mental symptoms, calculating odds ratio (OR) and 95% confidence interval (CI). A restricted cubic spline (RCS) regression model was used to analyze the dose-response relationship between LS7 score (continuous variable) and the risk of mental symptoms. Nodes were set at the 5th, 35th, 65th, and 95th percentiles of the LS7 score, with the 5th percentile as the reference point. All models were adjusted for covariates such as gender, age, living alone, drinking status, education level, and sleep quality. Logistic regression framework was used to fit and calculate the adjusted OR (aOR) and 95% CI. Nonlinear relationship tests were also conducted. Subgroup analysis was performed to explore the interaction between gender, age, drinking habits, education level, and other factors and the LS7 score in influencing the risk of mental symptoms.

A total of 5 449 participants were included; 1 363 (25.01%) had depressive symptoms, 398 (7.30%) had anxiety symptoms, and 259 (4.75%) had comorbid anxiety-depression. The prevalence of mental symptoms decreased significantly as LS7 scores increased. Univariate and multivariate Logistic regression indicated that LS7 score≥8 was protective against mental symptoms. Multivariate Logistic regression demonstrated moderate discriminative ability (AUC=0.672). Among individuals with anxiety, depression, or comorbid symptoms, LS7 score distributions showed a graded decrease from poor to excellent groups. After adjustment, an excellent LS7 score was associated with a 39% lower risk of depression (aOR=0.61, 95% CI 0.47 to 0.78, P<0.001), a 63% lower risk of anxiety (aOR=0.37, 95% CI 0.22 to 0.59, P<0.001), and a 66% lower risk of comorbid anxiety-depression (aOR=0.34, 95% CI 0.17 to 0.62, P=0.001). The AUC values of the anxiety model, depression model, and comorbid anxiety and depression model were 0.632, 0.672, and 0.619, respectively. All models demonstrated moderate discriminatory ability, which was statistically significant, but their capacity to distinguish cases from non-cases was limited. RCS analysis confirmed a linear inverse relationship between LS7 score and mental symptom risk. Not smoking and regular physical activity were the strongest protective behaviors. Subgroup analysis suggested stronger protective effects in men, younger adults (≤60), non-drinkers, and those with higher education levels, and revealed a significant interaction between alcohol use and LS7 score (P for interaction=0.021), indicating that alcohol consumption may weaken the protective effect of LS7.

Ideal healthy lifestyle behaviors, as reflected by higher LS7 scores, are associated with lower risks of anxiety and depression in adults. Promoting LS7-based lifestyle practices may serve as a practical and effective strategy for the prevention and management of anxiety and depression in both clinical and daily life settings.

Mobile phone dependence has become increasingly prominent among university students, posing significant risks to their social functioning and mental health. Previous studies suggest that perfectionistic personality traits may be key psychological predictors of mobile phone dependence, but the underlying mechanisms remain unclear. This study aims to identify core symptoms of mobile phone dependence among university students and to examine the pattern of associations between different dimensions of perfectionism and mobile phone dependence.

A cross-sectional questionnaire survey was conducted among 1404 university students nationwide. The Mobile Phone Involvement Questionnaire (MPIQ) and the Forst Multidimensional Perfectionism Scale (FMPS) were used to assess mobile phone use and perfectionism traits. The EBIC-GLASSO network model was constructed to analyze the network structure linking perfectionism and mobile phone dependence.

A total of 56.48% of university students in the sample met the criteria for mobile phone dependence. The total FMPS score was positively correlated with the total MPIQ score (r=0.47, P<0.001). Results of multiple linear regression controlling for demographic variables showed that dimensions of FMPS score significantly predicted MPIQ score (all P<0.05). Network analysis revealed that the central dimension in perfectionism is "organization" (expected influence=2.69) and the core symptom of mobile phone dependence was "I lose track of how much I am using my smartphone" (expected influence= 0.78). Bridge centrality analysis identified "organization" as a key bridging factor linking perfectionism and mobile phone dependence (bridge strength=1.96). Among the symptom-to-symptom connections, "parental expectations" showed the strongest positive association with "arguments have arisen with others because of my mobile phone use" (partial correlation coefficient=0.15), serving as a risk factor. In contrast, "organization" was most strongly negatively associated with the same symptom (partial correlation coefficient=-0.13), serving as a protective factor, suggesting a protective effect.

Mobile phone dependence is common among college students and is primarily characterized by a lack of self-control in phone use. Although perfectionism is generally positively associated with mobile phone dependence, its internal dimensions appear to exert a dual effect. Specifically, "parental expectations" and "doubt over actions" may increase the risk of mobile phone dependence, whereas "organization" serves as a protective factor, particularly against interpersonal conflicts related to phone dependency.

During long-duration manned space missions, the complex and extreme space environment exerts significant impacts on astronauts' physiological, psychological, and cognitive functions, thereby posing direct risks to mission safety and operational efficiency. As a key bridge between the brain and external devices, brain-computer interface (BCI) technology enables precise acquisition and interpretation of neural signals, offering a novel paradigm for human-machine collaboration in manned spaceflight. Non-invasive BCI technology shows broad application prospects across astronaut selection, mission training, in-orbit task execution, and post-mission rehabilitation. During mission preparation, multimodal signal assessment and neurofeedback training based on BCI can effectively enhance cognitive performance and psychological resilience. During mission execution, BCI can provide real-time monitoring of physiological and psychological states and enable intention-based device control, thereby improving operational efficiency and safety. In the post-mission rehabilitation phase, non-invasive BCI combined with neuromodulation may improve emotional and cognitive functions, support motor and cognitive recovery, and contribute to long-term health management. However, the application of BCI in space still faces challenges, including insufficient signal robustness, limited system adaptability, and suboptimal data processing efficiency. Looking forward, integrating multimodal physiological sensors with deep learning algorithms to achieve accurate monitoring and individualized intervention, and combining BCI with virtual reality and robotics to develop intelligent human-machine collaboration models, will provide more efficient support for space missions.

Efforts to reduce restrictive practices (RPs) in mental health care are growing internationally. Yet, inconsistent definitions and perspectives often challenge the consistent implementation and evaluation of reduction strategies. This study explored which scenarios different mental health stakeholders classify as RPs, examined the contextual factors influencing these classifications and compared classification patterns across clinicians, researchers, service users and family caregivers.

An international cross-sectional survey was conducted using a multilingual online questionnaire hosted on the Qualtrics platform. A total of 851 stakeholders participated, including clinicians (n = 517), service users (n = 80), family caregivers (n = 89) and researchers (n = 165). Participants were presented with 44 potential RP case scenarios and asked to rate whether each scenario should be classified as an RP using a four-point Likert scale (Definitely yes, Probably yes, Probably no, Definitely no). The scenarios were organized into 22 paired comparisons, each sharing the same core context but differing in specific details. Paired comparisons were analyzed one pair at a time, allowing us to identify classification patterns between the scenarios and isolate the effects of particular contextual factors using ordered logistic regression. Interaction analyses were then conducted to assess how classification patterns varied across stakeholder groups.

Substantial discrepancies exist both within and between stakeholder groups regarding whether a given action should be considered an RP or not. Physically visible actions were often identified as RPs across all groups, while less visible forms often went unrecognized. Contextual differences, such as the healthcare professional's intention, duration of the action, methods used, presence or absence of consent, door-locking status, and the severity of anticipated harm to be prevented influenced whether a given action was classified as an RP. Service users classified more scenarios as RPs than other groups; however, their decisions were more context-sensitive, shifting notably even with minor changes in scenario details. Among the 22 paired scenarios compared, 13 (59.09%) showed significant differences (p < 0.01) within at least one stakeholder group and eight demonstrated differences between groups.

Mental health stakeholders' interpretations of RPs were often shaped not only by the inherent coercive nature of actions but also by the context in which they occurred and the professional role of the assessors. This underscores the need for harmonized definitions and classification frameworks for RPs, co-designed with diverse stakeholders. Addressing less visible forms of RPs in policy and clinical practice is also essential.

In England, psychological therapies provided in primary care are recommended as first-line treatment for people living with mild-to-moderate dementia experiencing depression or anxiety. It is known that people living with dementia experience more barriers to accessing therapy than people without dementia, but such inequalities in terms of rates of access to primary care services are yet to be characterised.

In this retrospective, observational study of linked electronic healthcare records, the national database of the National Health Service (NHS) Talking Therapies for anxiety and depression programme was used to compare pathways to accessing therapy between 6623 people living with dementia and 4 825 489 without dementia between 2012 and 2019. Outcomes included access to an assessment, to therapy and reasons for discharge. Primary analyses used a propensity-score matched cohort to compare outcomes. Exact matching was used for the NHS service entity.

The prevalence of dementia in the study cohort was lower than the prevalence of dementia in a representative population, based on an estimation of prevalence in people with mild-to-moderate age over 35 (0.23% in our study vs 3.82% in previous research). Compared to people without dementia, people living with dementia were less likely to access an assessment (odds ratio [OR] = 0.60; 95% confidence interval [CI]: 0.55-0.65), to subsequently receive therapy (OR = 0.67; 95% CI: 0.61-0.73) and more likely to be discharged because services were deemed not suitable before having an assessment (relative rate ratio [RRR] = 4.90; 95% CI: 4.20-5.72) and starting therapy (RRR = 2.74; 95% CI: 2.24-3.35). Female gender, social deprivation, Asian ethnicity and less common dementia subtypes (such as frontotemporal dementia) were also associated with poorer access rates and a higher likelihood of services being deemed not suitable. Involvement of care partners in the referral process was associated with better access rates.

Pathways to accessing primary care psychological therapy services must be made more accessible for people living with dementia. Better access could be achieved by increasing referrer awareness and training for staff within services to promote access for people living with dementia (especially for groups under-represented in services), better understanding how to involve care partners in the process, as well as when specialist support might be more suited in secondary care. More granularity in the medical coding of rarer dementia diagnoses in electronic health records would also allow for better statistically powered research for these groups.

Up to 60% of persons with idiopathic Parkinson's disease (PD) will develop psychosis spectrum symptoms at some point during the course of illness. These symptoms are often undetected by attending physicians but are associated with great distress to patients and their caregivers.

To investigate the prevalence and association of positive psychosis symptoms with quality of life (QoL) and caregivers' burden among clinic attendees with PD at two tertiary general hospitals in South western Nigeria.

A case-control study was conducted between February 2023 to June 2024. Cases (N=150) were neurology outpatients with PD. Controls (N=150) were neurologically healthy individuals matched for age, sex, education, and outpatient status. Psychosis, QoL, and caregiver burden were assessed using the Scale for the Assessment of Positive Symptoms (SAPS), PD-QoL questionnaire (PDQ-8), and Caregivers Strain Index (CSI), respectively. Adjusted odds ratios (aO.R) and standardized coefficients (aCoeff.) were estimated using regression analyses. Estimates were within 95% confidence intervals (C.I).

Psychosis symptoms were present in 28% of cases. Hallucinations were the most frequent symptom (16.7%). Cases with Psychosis were more likely to be ≥60years (88.1%, p=0.020), ever users of alcohol (78.6%, p=0.012), had higher mean motor-severity scores (51.1±15.7, p<0.001), and probable dementia (21.4%, p=0.001). In unconditional logistic regression analyses, cases had approximately five-point increase in the independent odds psychosis (aOR=4.92, 95% C.I=2.20, 10.99), and two-point increase in the independent odds of requiring social support (aOR=1.95, 95% C.I=1.19, 3.21).

The near five-point increase in the odds of psychosis spectrum symptoms in PD and their greater requirement for social support underscores the need for multidisciplinary approaches that include not only neurologists but psychiatrists, and social workers.

In each edition of Healthcare Quarterly, our editorial team publishes articles on themes that are either top-of-mind for healthcare leaders or emergent issues that are starting to bubble up across the system. From time to time, we also identify extended themes that run across multiple editions, including on topics such as mental health and integrated care, where the depth of the issues and the breadth of solutions warrant a more profound exploration.

To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings.

This retrospective cohort study used VA administrative data to examine temporal trends in outpatient VA mental health use from January 1, 2019, through December 31, 2022-a period spanning the pre- and post-COVID-19 pandemic. The cohort included VA-enrolled women veterans ages 18-60 years with at least one outpatient mental health visit delivered by a VA provider in-person (VA-MH) or via SVT-MH. Outcomes included (1) any SVT-MH use and (2) annual SVT-MH visit counts. Models adjusted for demographics and used Bayesian logistic and Poisson regression to estimate effects and interactions over time.

SVT-MH use increased from 7% in 2019 to 32% in 2022. Rural women Veterans initially had higher SVT-MH use, but by 2022, urban women had higher use and visit counts. Black and Hispanic women Veterans showed the largest increases, especially in urban areas. American Indian and Alaska Native (AIAN) women Veterans were the only group without significant rural-urban differences in 2022, though they had lower overall visit counts.

SVT-MH use among women veterans increased substantially during the study period, with rural-urban gaps narrowing over time. These findings suggest SVT-MH differences may shift rapidly based on infrastructure, outreach, and policy implementation. Ongoing monitoring and tailored strategies are needed to ensure fair access to SVT-MH for all veterans, especially for AIAN and rural women veterans.