Socioeconomic status (SES) and group exercise participation (GEP) influence happiness. Higher SES may be necessary for the GEP. However, the interrelationships among these factors remain unclear. This study aimed to examine the relationship between SES and happiness among older adults, focusing on the potential mediating role of GEP.

A cross-sectional study was conducted among 1375 community-dwelling older adults aged 60-89 years residing in Tsukuba City, Ibaraki Prefecture, Japan. Of these, 1062 participants (581 men and 481 women) with available data from a self-administered questionnaire returned by mail were included in the final analysis. To integrate key SES variables (economic status, educational level, and work engagement), principal component analysis was used. Analysis of covariance (ANCOVA) and mediation analysis were used to examine the mutual relationships between SES, GEP, and happiness.

ANCOVA confirmed significant effects for SES and GEP but no interaction effect. In the mediation analysis of the total sample, SES was associated with happiness directly (β = 0.194) and indirectly via GEP (SES-GEP β = 0.100; GEP-happiness β = 0.112). In sex-stratified analyses, a similar association was observed among women. In contrast, SES and GEP were independently associated with happiness in men.

This study observed that SES and GEP were positively associated with happiness in older adults. SES facilitates GEP in women, whereas in men, both factors independently contribute to their happiness. Our results suggest that a portion of women's happiness is based on SES fulfillment, which leads to GEP and reinforces their happiness.

Little is known about experiences of psychiatric hospitalization, access to mental health providers, and trust in mental health providers for deaf, transgender and gender diverse (TGD) adults, especially for those who identify outside of the gender binary and those who identify as a racial/ethnic minority. This project used data collected as part of the 2017 TransLifeline Mental Health Survey. Chi-square analyses compared endorsement of hospitalization and endorsement of having a mental health provider between TGD deaf and TGD hearing adults. Spearman's rank order correlation coefficients compared trust in providers and access to providers between TGD deaf adults and their TGD hearing adult peers. Compared to their TGD hearing peers, TGD deaf participants, regardless of gender identity, were more likely to report a history of psychiatric hospitalization. History of involuntary hospitalization did not differ between groups. Current or historical use of therapy providers also did not differ between groups. However, TGD deaf participants and TGD deaf White participants did endorse more difficulty with finding a therapy provider. Similarly, TGD deaf, TGD White, TGD racial/ethnic minority, and TGD non-binary participants reported diminished trust in therapy providers compared to their TGD hearing peers. Current or historical use of and access to psychiatric care did not differ between groups. However, TGD deaf racial/ethnic minority participants reported diminished trust in psychiatric providers compared to their TGD hearing racial/ethnic minority peers. deaf TGD adults are at an increased risk for psychiatric hospitalization and report difficulties with finding mental health providers and trusting those providers.

Evidence suggests that compared with the general population, a higher proportion of UK veterinary professionals engage in at-risk drinking; however factors influencing alcohol use and barriers to help-seeking remain under-explored.

An online survey was completed by 652 UK veterinary workers who currently consumed alcohol. Validated measures of alcohol-related risk of harm, drinking motives, mental health status and behavioural influences on alcohol reduction and help-seeking were used. Statistical analyses comprised correlations, multiple regression and mediation.

Overall, 40.4% of participants reported at-risk drinking, related to poor mental health, being male and older in age. Drinking to cope and for enhancement predicted alcohol risk and amplified the relationship between poor mental health and alcohol risk. Lower alcohol risk was predicted by self-efficacy and knowledge of low-risk drinking, viewing drinking as essential to socialise or a habit, having an enabling lifestyle and positive attitudes towards help-seeking. Perceived stigma remained a barrier.

Cross-sectional design limits causal inference. Self-reporting may introduce bias.

At-risk drinking was linked to drinking to cope, for pleasure and poor mental health. Interventions to reduce drinking and improve help-seeking for alcohol use should target promotion of adaptive coping, knowledge of low-risk drinking and stigma reduction.

Approximately 25% of patients with bipolar disorder are reported to have treatment-resistant bipolar depression (TRBD). Accelerated intermittent Theta Burst Stimulation (aiTBS) is an innovative form of repetitive transcranial magnetic stimulation (rTMS), delivering bursts of stimulation at theta wave frequencies, which are believed to enhance synaptic plasticity. This pilot study aimed to explore the safety, tolerability, and preliminary efficacy of aiTBS in individuals with treatment-resistant bipolar depression (TRBD).

This open-label pilot study (registered at Overview of Medical Research in the Netherlands (OMON), NL-OMON53634), conducted between July 2023 and September 2024, included patients aged 43-64 years who were diagnosed with bipolar I or II and were experiencing a current moderate-to-severe depressive episode. Patients were required to have treatment-refractory symptoms according to the Hidalgo-Mazzei criteria. All patients were receiving antidepressant medication. Patients received eight daily sessions of intermittent Theta Burst Stimulation (iTBS) over five consecutive days, with 50-min intervals between sessions. Stimulation targeted the left dorsolateral prefrontal cortex (DLPFC) using the BeamF3 targeting method. Outcomes included safety, tolerability, and efficacy and were assessed at day 3, day 5, week 2, week 4 and week 12 post-treatment. Safety was assessed by documentation of serious adverse events (SAEs) and adverse events (AEs); tolerability was evaluated based on reported side effects. Efficacy was measured by the mean reduction in depression symptoms using the 17-item Hamilton Depression Rating Scale (HDRS-17).

Eight patients were recruited, all of whom completed the treatment course. aiTBS was well tolerated and no SAEs occurred during the treatment week or during follow-up. The most frequently reported AEs were discomfort at the stimulation site and fatigue (87.5%). Although one patient experienced hypomanic symptoms (YMRS = 13) at the 3-month follow-up visit, this was considered unrelated to the study treatment due to the timing of onset, and because several significant psychosocial stressors were identified in the patient's life during that period. Mean HDRS scores decreased from 22.9 (SD = 4.4) at baseline to 16.6 (SD = 4.2) on day 3 of treatment (difference = 6.3 (95% CI, 1.6-10.9); 27.3% improvement, p = 0.01), 12.8 (SD = 4.1) on day 5 (difference = 10.1 (95% CI, 2.2-18.1); 44.3%, p = 0.02), 11.1 (SD = 3.8) at week 2 (difference = 11.8 (95% CI, 4.5-19.0); 51.4%, p = 0.004) and 13.5 (SD = 3.9) at week 4 (difference = 9.4 (95% CI, 1.0-17.7); 41.0% improvement, p = 0.03). At month 3, the mean HDRS score was 13.7 (SD = 6.9, difference compared to baseline = 9.1 (95% CI, -3.0 to 21.3); 40.0% improvement, p = 0.2).

This pilot study extends prior evidence suggesting the antidepressant effects, safety, and tolerability of aiTBS in patients with TRBD; however, its durability may be limited. We recommend that future RCTs investigate relapse prevention following acute aiTBS and determine the optimal strategy for maintaining antidepressant effects.

Occupational therapy students and novice occupational therapists often face considerable challenges when entering acute mental health settings, particularly within South Africa's culturally diverse and resource-constrained contexts. This study explored the preparedness of University of KwaZulu-Natal (UKZN) occupational therapy students and novice practitioners for acute mental health practice within KwaZulu-Natal's complex healthcare landscape.

A qualitative, exploratory design was used with purposive sampling to recruit 15 participants. Ten fourth-year students and five novice occupational therapists participated in focus group discussions and individual interviews. Data were analysed thematically to identify key patterns related to preparedness, challenges and experiential learning.

Three overarching themes emerged: (1) educational preparation gaps, (2) practice readiness challenges and (3) systemic and transition constraints. Participants demonstrated strong theoretical knowledge but reported limited practical readiness, particularly regarding culturally responsive care, emotional regulation and evidence-based intervention in acute settings.

The findings emphasise the need to strengthen occupational therapy education through earlier and more intensive acute mental health exposure, enhanced clinical supervision and greater emphasis on cultural competence and acute care interventions. Grounded in experiential learning theory (ELT), improved experiential learning opportunities may better prepare graduates for effective, contextually relevant practice in South Africa's acute mental health environments.

Population ageing has intensified long-term care demands globally, necessitating innovative, data-driven, and technology-enabled approaches to support caregivers. This study aimed to assess mental health and quality of life among caregivers of older adults in the Northeast of Thailand and to examine structural relationships among key determinants. A cross-sectional analytical study was conducted between January and August 2025 among 438 caregivers using multistage stratified random sampling. Standardized instruments were used. Multivariate logistic and linear regression analyses, along with Structural Equation Modeling were conducted to identify predictors and examine direct and indirect pathways. The prevalence of depression was 24.2% (95% CI: 20.2-28.5). High caregiver burden (AOR = 3.48, 95% CI: 2.12-5.71), poor social support (AOR = 3.02, 95% CI: 1.82-5.01), and low income (AOR = 2.31, 95% CI: 1.29-4.14) were significantly associated with depression. Social support positively predicted QoL (β = 0.38, p < 0.001), while depression negatively influenced QoL (β = -0.44, p < 0.001). SEM demonstrated good fit (CFI = 0.95, RMSEA = 0.045), confirming depression as a mediator. Caregiver burden and inadequate social support emerged as key determinants, highlighting opportunities for integrating predictive analytics and digital health interventions in long-term care systems.

Social media-based Mental Health (MH) informatics often focuses on disorder detection, overlooking psychological aspects like coping mechanisms and stressors. Furthermore, user-generated texts, although contains MH signals at scale, lack clinical validation. This paper presents a two-stage framework for mental coping detection that combines a coping strategy classifier and a Retrieval-Augmented Generation (RAG) system. The coping classifier identifies coping strategies from user text, while the RAG generates responses grounded in expert-validated knowledge bases and the coping labels. A pilot study demonstrates that the classifier achieves 79.7% accuracy and 0.797 weighted F1 on a held-out dataset. The RAG system produces structured, readable, and expert-verified responses. The classifier-conditioned RAG architecture provides responses grounded in validated psychological knowledge, offering a scalable approach to bridging social media data with evidence-based insights.

Extreme Risk Protection Orders (ERPOs) temporarily restrict firearm access from those at risk of harming themselves and/or others. This case series describes when and how ERPOs have been used for people experiencing homelessness.

We examined ERPO court case files previously abstracted in California (n = 37, 1/1/2016-6/30/2020) and Colorado (n = 12, 1/1/2020-12/31/2022) involving housing insecurity among respondents. We determined whether the respondent was experiencing homelessness (i.e., sleeping in a public place, shelter, vehicle, motel, or temporarily "couch surfing" with a friend). For each such case, we created narrative summaries and conducted thematic analysis.

We identified 25 ERPO respondents experiencing homelessness in California and 11 in Colorado; 83% (n = 30) were male, 44% (n = 16) were white, 25% (n = 9) were Black, and 22% (n = 8) were Hispanic. Domestic violence was mentioned in 44% (n = 16) of cases and a similar percentage (42%) mentioned suicide; 25% of cases involved threats of mass violence. ERPOs were often filed in response to violence that occurred while respondents were losing their housing; reasons for impending homelessness included financial hardship, eviction, and loss of relationships. Other respondents experienced homelessness prior to the ERPO; threats of violence were intertwined with challenges of housing instability, loss of employment, family estrangement, untreated mental illness, and substance misuse. Serving ERPOs to people experiencing homelessness was challenging.

ERPO respondents who were experiencing homelessness were in crisis and at high risk of violence. Courts and law enforcement agencies should consider how to improve serving ERPOs, recovering firearms, and providing services to homeless respondents.

Wearable accelerometers are widely used in health research, but differing placements (e.g. wrist vs. thigh) hinder harmonising activity classification across studies. Prior studies report 1.5- to 2.0-fold differences in physical activity level by wear location, hampering data comparability, and compromising the potential for pooling data to develop consortia and carrying out Meta- and Individual Participant Data analysis. Although supervised machine learning is increasingly used in wearables research, its reliance on extensive labelled data limits its use in free-living datasets. Semi-supervised learning offers an efficient alternative by using laboratory collected labelled data to iteratively self-train models on unlabelled free-living data. Using a self-training approach, the aim of this study was to train and evaluate algorithms for wrist- and thigh-worn devices to facilitate harmonisation of posture and activity type classification between placements.

A total of 146 participants aged 30-75 years completed either structured laboratory-based activity trials or one of two independent free-living assessments while wearing Axivity AX3 accelerometers on the wrist and thigh. For each placement, a supervised Random Forest classifier was initially trained using a labelled laboratory dataset (n = 40) to classify sitting, standing, walking, running, stair climbing, and cycling - and then re-trained using self-training on free-living data (n = 53, independent to the laboratory study sample). The final models were validated using another hold-out free-living independent dataset (n = 53) with ground-truth activity labels obtained via direct video observation. Overall model comparison and performance was assessed using accuracy, kappa statistic, and F1 scores. Individual activity class comparison and performance was evaluated using equivalence testing, confusion matrices, and coefficient of variation between the wrist and thigh estimates.

During a total of 43,800 min, of which 19,080 min were in the hold-out dataset, both self-trained models achieved high overall classification accuracy: 91.8% (SD = 6.8%) for the wrist and 95.1% (SD = 5.4%) for the thigh. The overall F1 score was 88.2 (SD = 9.6%) for the wrist classifier and 90.1 (SD = 9.3%) for the thigh classifier. Equivalence testing demonstrated that both classifiers produced activity duration estimates statistically equivalent to ground-truth for all activity types except stair climbing. Confusion matrices for the wrist demonstrated very good to excellent (88% - 97%) classification accuracy for sitting, walking, running, and cycling, and good accuracy for standing and stair climbing (71%-78%). For the thigh, classification performance was very good to excellent (83% - 98%) across sitting, standing, walking, running, and cycling, with good accuracy for stair climbing (75%). The coefficient of variation values ranged from 0.022 for running to 0.140 for standing.

These findings highlight the potential of self-training models to support harmonisation of wearable accelerometer data collected using different wear placements. Self-training models reduce reliance on extensive labelled data and demonstrated high activity type classification accuracy for both wrist- and thigh-worn accelerometers, with a high degree of agreement and equivalence with ground-truth data across almost all activity types.

Emergency responders are regularly exposed to potentially traumatic events, placing them at risk of developing posttraumatic stress symptoms (PTSS). Within this group, lifeguards remain an understudied population. The present study examined the building block effect in volunteer emergency responders of the German Lifesaving Association (DLRG), hypothesizing that a higher number of stressful events would be associated with greater PTSS. In addition, potential influencing factors on symptom severity and on the relationship between event exposure and PTSS, including gender, age, perceived social support, and peer support measures, were investigated.

Data were collected via a web-based self-report survey, resulting in a final analysis sample of 365 lifeguards from the DLRG. Participants were nested within 198 local subgroups. Generalized linear mixed models were constructed, with predictors entered in a stepwise manner.

The findings support the building block effect of stressful experiences, indicating that greater exposure is associated with higher PTSS among lifeguards in Germany. Hypothesis testing further revealed protective effects of higher age, male gender, greater perceived social support, and stronger peer support measures in reducing symptom severity. Interaction effects of these protective factors on the relationship between the number of traumatic events and PTSS were non-significant. Exploratory analyses also suggested that higher rank within the organization may be associated with lower symptom severity.

The study highlights the importance of addressing mental health challenges among volunteer lifeguards, acknowledging that PTSS do not necessarily stem from a single worst traumatic event but can develop cumulatively. The findings also indicate target groups for additional training efforts, particularly younger women, and underscore the value of fostering support networks.