To explore how sexuality and sexual boundary violations are perceived and experienced in healthcare teams and organisations.

Qualitative focus group study.

Mental health and disability care.

In total, 56 people participated across 15 focus groups in three healthcare organisations. Participants included client experts (former clients), healthcare professionals such as a psychologist, speech therapist, sexologist and personal coach, team leaders, managers and directors.

We identified 14 different types of situations in which sexuality and sexual boundary violations play a role on four different levels: between clients, between clients and healthcare professionals, between healthcare professionals and on the management level. Situations ranged from attraction and intimacy between clients and/or professionals, promoting sexual health of clients, gut feelings and speaking up, transgressive behaviour from clients and professionals, false accusations and investigations into allegations.

Situations regarding sexuality and sexual boundary violations are varied and complex. They unfold at different levels of interaction within the organisation. To deal with this and come to practical approaches, it is important that clients, professionals and managers engage in reflection and dialogue about their experiences, opinions and perspectives.

Depression and sub-diagnostic depressive syndromes are prevalent and associated with suffering and reduced life expectancy. Access to care is limited even in countries with developed healthcare systems. In this context, it is important to strengthen the self-management expertise of people suffering from depressive symptoms. Smartphones offer the possibilities for improved self-management based on long-term monitoring of symptoms.The present multicentre randomised controlled trial (the Protecting mental health in times of change (MENTINA) trial) aims to evaluate whether (1) daily smartphone-based monitoring and automatic rule-based feedback+smartphone-based outcome evaluations versus (2) smartphone-based outcome evaluations alone will improve depressive symptoms and other clinically relevant outcomes in participants with current depressive symptoms and/or one or more prior depressive episodes during a 12-month trial period.

The MENTINA trial is a multicentre randomised controlled parallel-group trial conducted in Denmark, Germany and Spain. Participants with current depressive symptoms and/or one or more previous depressive episodes are invited to participate. The included participants will be randomised to (1) daily smartphone-based monitoring and automatic rule-based feedback+outcome evaluations via smartphone (intervention group) or (2) outcome evaluations via smartphone alone (control group). All participants can continue with ongoing treatment in case they receive it. The trial started in May 2025 and has currently included 115 participants. The outcomes are differences between the intervention group and the control group in (1) Patient Health Questionnaire 9-items (PHQ-9) measured every 14th day during the 12-month trial period (primary), (2) WHO Quality of Life-BREF, Generalised Anxiety Disorder-7, monthly change in PHQ-9, proportion of participants with ≥50% reduction in PHQ-9, remission rate defined as PHQ-9≤9 and ≥5-point improvement, PHQ-9 scores after 6 months, area under the curve for PHQ-9 over the 12 months trial period, subgroup analyses in PHQ-9 in participants with or without lifetime depression, Perceived Stress Scale, user-reported healthcare contacts, usability of the app and negative effects, number of depressive episodes+duration and depressive-free days based on PHQ-9. A total of 660 participants will be included in the MENTINA trial.

The MENTINA trial is funded by the European Union under Grant Agreement No. 101 080 651. Ethical approval and approval from Medical Agencies have been obtained from Denmark (CIV-25-02-051094), Germany (CIV-25-02-05109) and Spain (CIV-25-02-051094). The results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patients' organisations and media outlets.

NCT06919133.

Version 6, January 2026.

Although increasing research examines climate anxiety, little is known about the situational factors related to it. To assess these factors, we developed and evaluated a situated psychometric instrument for assessing how much climate anxiety individuals recall experiencing in 31 situations where climate anxiety is likely (e.g., hearing about climate catastrophes on the news). Of interest was how climate anxiety is experienced in a country like the UK, where climate disasters are mostly heard about in the media and anticipated in the future, relative to countries where climate disasters are experienced directly and regularly. In an online survey (N = 303; 50.8% female), we investigated how much climate anxiety individuals recall experiencing in situations where climate anxiety is likely to occur, along with how much they recall experiencing 13 factors potentially related to climate anxiety (e.g., threat, violation, rumination). An individual measure of climate anxiety, averaged across situations, exhibited high reliability, construct validity and content validity. Climate anxiety varied widely across situations, with individuals further varying in how much climate anxiety they remembered experiencing in each situation. As predicted, the 13 situational factors tended to correlate significantly with climate anxiety across situations, explaining a median 75% of its variance in individual regressions.

This study explored demographic characteristics of people who disclosed self-harm ideation (SHI) or behaviors (SH) and their accessing of mental health services (MHS) during three government-declared waves of the COVID-19 pandemic in Ontario, Canada.

We analyze the results of a cross-sectional survey of adults in Ontario aged 18 years or older, representative of the provincial population based on age, gender, and location. The survey was conducted using Delvinia's AskingCanadians panel at three timepoints: August 2020 (n = 2500), March 2021 (n = 2500), and March 2022 (n = 5000). Accessing of MHS was identified in a subsample of survey respondents who reported SHI (wave 1, August 2020, N = 421) and SH (wave 2, March 2021, N = 105; wave 3, March 2022, N = 259). Chi-square tests, Fisher's exact test, and binary logistic regression were employed to identify associations between service access and demographics across waves.

The survey in wave 1 identified 421 respondents with SHI (16.8%). Surveys in wave 2 and 3 identified 105 (4.1%) and 259 respondents (5.2%), respectively with SH. The majority of respondents who disclosed SHI (wave 1) and SH in wave 2 did not access MHS [wave 1 (36.3%); wave 2 (46.7%)], whereas more accessed MHS in wave 3 (60.6%). Older adults, men, people living with others, and in rural areas were less likely to access MHS overall.

MHS access is a key component of comprehensive suicide prevention and intervention. Future prevention efforts should aim to increase MHS access, particularly in specific demographic groups, ensuring timely service access.

Sleep deprivation negatively impacts both physical and psychological health in both humans and animal models. Exercise, on the other hand, can have beneficial effects on various aspects of physical and mental health. However, little is known about the ways in which sleep deprivation and exercise may interact, especially for exceptionally high levels of exercise. We studied High Runner (HR) mice from a long-term artificial selection experiment to investigate how genetically high exercise level could impact the response to sleep deprivation. A total of 192 adult mice from four replicate HR and four non-selected Control lines (balanced for sex) completed six days of baseline wheel access, followed by three days with or without 6 h/day of total sleep deprivation (TSD) via gentle handling. As expected, HR mice ran farther and faster compared to Controls during days 1-6. TSD reduced the running distance and duration in mice from Control lines, while HR increased running speed and maintained distance (treatment × linetype interaction). TSD-induced changes in body mass differed between linetypes (treatment × linetype interaction): Controls tended to gain mass, whereas HRs lost mass. During the three days prior to TSD, HR mice consistently exhibited more active and fewer maintenance behaviors than Controls. TSD increased resting and decreased wheel activity in Controls but not HRs (treatment × linetype effects significant for both categories). These results demonstrate that genetically based high voluntary activity levels are associated with altered responses to TSD.

Nature experienced with peers may mitigate the harmful outcomes of loneliness on health and wellbeing. The H2020 RECETAS 'Friends in Nature (FiN)-Helsinki' group intervention for lonely older adults in Helsinki assisted living facilities (ALFs) aimed to investigate the effects on participants' loneliness and health-related quality of life (HRQoL). We also examined factors influencing effects between the intervention and the outcomes.

Lonely participants were recruited from 22 ALFs in Helsinki area, Finland and randomised into two groups: (i) nature-based group intervention once a week for 9 weeks (n = 162) and (ii) usual care (n = 157). Loneliness (modified De Jong Gierveld Loneliness Scale = mDJGLS) and HRQoL (15D) were assessed as the primary outcomes at baseline, 3, 6 and 12 months.

Most participants (mean age 83 years, 73% women) were living with frailty (66%) and had dementia (55%). Whilst loneliness was reduced in the intervention group at three months (mean change -2.2 points [95% confidence interval (CI) -3.5 to -0.9] in mDJGLS, it remained at baseline level amongst controls (mean change -0.1 (95% CI -1.4 to 0.9); P = .025 between groups). During the 6- and 12-month follow-ups the difference was reduced. No difference emerged between groups in changes of HRQoL according to the 15D. However, the 'sleep' dimension in 15D improved in the intervention relative to controls during the 12-month follow-up. Frequent attendance in group sessions and extended time spent outdoors affected effects on both HRQoL and loneliness. High self-efficacy at baseline influenced effect on both HRQoL and mDJGLS. Being male, <85 years old, non-frail, having Mini-Mental-State Examination >20 and exhibiting a high Nature Connection Index at baseline influenced the magnitude of effect in reducing loneliness.

Group intervention with nature contacts had favourable effects on loneliness and sleep amongst physically and cognitively frail, lonely older adults in ALFs.

ClinicalTrials.gov, ID: NCT05507684. Registration 19/08/2022.

Children and adolescents in the Middle East and North Africa (MENA) region experience high rates of psychological distress due to armed conflict and displacement, with limited access to traditional mental health care. This has led to increased interest in digital mental health interventions (DMHIs) as a potential solution.

This systematic review evaluates the effectiveness of DMHIs in reducing PTSD, anxiety, and depression symptoms, as well as improving overall wellbeing in MENA children and adolescents affected by armed conflict. It also explores barriers and facilitators to implementation in conflict-affected and displacement settings.

The review included studies involving children and adolescents ages (5-18), from MENA countries affected by armed-conflict or displacement.

We conducted a systematic search of PubMed, PsycINFO, CINAHL, and gray literature using a structured Population, Intervention, Outcome (PIO) framework, along with expert consultations, following PRISMA guidelines. The quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT), and findings were synthesized narratively.

Ten studies on digital games, telehealth, and online interventions showed significant reductions in PTSD, anxiety, and depression, with medium to large effect sizes. Gamified interventions in schools and healthcare settings had the highest engagement. Key barriers included infrastructure, digital illiteracy, and stigma, while facilitators were cultural adaptation and integration into existing systems.

DMHIs are a promising strategy for addressing mental health needs in conflict-affected children and adolescents. Future efforts should prioritize cost-effective, offline compatible models and greater integration into education and healthcare systems for sustainability.

Access to cognitive behavioral therapy for insomnia (CBT-I) in children and adolescents is limited. Mobile health applications (MHAs) available in app stores may provide an accessible and scalable option for delivering CBT-I. This study systematically evaluated the quality of MHAs targeting insomnia in children and adolescents and examined their evidence base and treatment components.

In November 2024, a systematic search of the Google Play and Apple App Stores was conducted to identify MHAs targeting insomnia in children and adolescents. MHAs were screened for eligibility in a two-level process: first based on app store descriptions, then after downloading the MHA. Eligible MHAs were independently evaluated using the German Mobile Application Rating Scale (MARS-G), which rates MHAs from 1 (inadequate) to 5 (excellent) across the subscales engagement, functionality, aesthetics, and information. Additionally, the featured treatment components and supporting scientific evidence were assessed.

Of 2341 MHAs initially identified, eight MHA products met the inclusion criteria. The overall quality was moderate (mean = 3.5, SD = 0.4). Among the subscales, functionality was rated highest (mean = 3.8, SD = 0.6), followed by aesthetics (mean = 3.6, SD = 0.6), engagement (mean = 3.3, SD = 0.4), and information (mean = 3.1, SD = 0.8). Sleep hygiene was the most commonly featured treatment component (seven MHA products). While scientific evidence was identified for five MHA products, none specifically evaluated insomnia in the target population.

Although many MHAs claim to target sleep in children and adolescents, few incorporate CBT-I components beyond sleep hygiene. The moderate quality and limited evidence base underscore the need for theory-driven, rigorously evaluated MHAs tailored to this age group.

In the UK, an estimated two million migrants are irregular or subject to No Recourse to Public Funds (NRPF) visa conditions, restricting welfare access and often requiring payment for NHS maternity care. The impact on maternity and perinatal service use remains poorly quantified.

Retrospective cross-sectional study.

We used linked electronic health records from maternity, neonatal, and mental health services in South London (eLIXIR-BiSL cohort). The sample included 56,690 women with 67,308 pregnancies (Oct 2018-Oct 2023). Migration status was categorised as UK-born, migrants with recourse to public funds, NRPF, or unknown visa status. Adjusted risk ratios (aRRs) were estimated using generalised linear models, controlling for sociodemographic and clinical characteristics.

Compared with UK-born women, migrants, particularly those with NRPF, had lower engagement with services. Women with NRPF were less likely to access early antenatal care (aRR 0.36 [0.33-0.38]), attend maternity triage (0.89 [0.82-0.96]), or birth in midwife-led settings (0.51 [0.36-0.71]). They were more likely to access care late (3.61 [3.33-3.92]), receive inadequate antenatal care (1.41 [1.30-1.53]), transfer providers (1.54 [1.36-1.74]), and experience prolonged postnatal stays (1.38 [1.21-1.57]). Women with NRPF had lower mental health care contact before (0.05 [0.03-0.08]) and during pregnancy (0.51 [0.37-0.69]), and reduced engagement with social care (0.36 [0.17-0.70]) and the criminal justice system (0.30 [0.19-0.44]).

Migrants with NRPF or unknown visa status face persistent barriers to maternity and mental health care. Inclusive reforms are needed to address inequity.

Serious mental illnesses (SMIs) are associated with high relapse rates and limited access to continuous care, particularly in low-resource settings such as urban slums. Traditional clinical monitoring is constrained by accessibility and scalability challenges. Digital phenotyping, through passive smartphone data, offers a novel approach to predict relapse by capturing real-world behavioral changes.

This study aims to evaluate the feasibility and predictive value of smartphone-based digital phenotyping for detecting relapse in individuals with SMIs living in the Korail slum of Dhaka, Bangladesh.

This prospective 6-month cohort study will recruit 430 participants diagnosed with SMIs who own Android (Google LLC) smartphones. Passive data (eg, screen time, mobility, and call or text frequency) will be continuously collected using a custom-built app (DataDoc). Monthly active data, including symptom and functioning assessments, will be collected via self-report and clinical engagement. Machine learning models will integrate these data to detect early warning signs and predict relapse trajectories.

This study was funded by the NIHR (National Institute for Health and Care Research; award number NIHR200846) in October 2022. Data collection commenced in August 2025 and is ongoing. A total of 14 participants have been recruited, as of January 2026. Preliminary data analysis is ongoing, with expected results to be published in fall 2026.

This study is one of the first to apply smartphone-based digital phenotyping and machine learning for relapse prediction in low- and middle-income countries' slum settings. The findings will inform scalable, low-cost digital interventions to address the mental health treatment gap in underresourced communities.