COVID-19 coincided with increased mental health needs in Alberta, Canada, intensifying pre-existing access gaps and service strain. Alberta responded with publicly funded interventions spanning digital care, youth-focused services, and recovery-oriented programs. To evaluate Alberta's system-level response to pandemic-related increases in mental health help-seeking/service uptake using a health economics and policy lens. We extracted empirically reported program delivery outputs from the 2023-2024 Alberta Mental Health and Addiction Annual Report. We used a simulation calibrated to reported trends to examine directional changes in help-seeking (demand), service capacity (supply), and the modeled equilibrium quantity under a zero-copayment design. Empirically reported outputs indicate that delivery met or exceeded planned/funded milestones for CASA Mental Health, VODP, and tele-mental health, while recovery communities reflected phased implementation. In the illustrative simulation, the demand-implied volume increases from 60 to 87 services/month, but delivered volume is capacity-constrained at 78 services/month (implying ~9 services/month unmet demand), while a unit-cost proxy is held constant for visualization (not an observed market price or patient copayment). Alberta's response illustrates how coordinated, publicly funded capacity expansion and access-oriented policies can support service delivery during system shocks; the model also highlights that if capacity growth lags demand growth, unmet need may persist even under zero copayment.

Despite the high number of news articles, images and public debate on forcibly displaced individuals, there is, with some rare exceptions, a lack of comprehensive surveys on their living conditions. In this context, our paper contributes to filling part of this gap by presenting the results of a new survey conducted in Italy in 2024 in the framework of the AVRAI research program. The survey collected responses from 1,327 adults with international protection or a history of seeking asylum, who arrived in Italy after 2011. This paper describes the main dimensions of vulnerability, offering insights on existing disparities based on gender and area of origin. Our survey reveals legal uncertainty, especially common among newcomers from Bangladesh, Pakistan and MENA countries. Health data shows that self-rated physical health is generally good but mental health outcomes are poorer, particularly among women, recent arrivals and those from Central and the Horn of Africa. Women also face greater employment challenges. Economic hardship is widespread, with over one-third experiencing severe material deprivation and high food insecurity, especially among Nigerians, Sub-Saharan Africans and MENA nationals. Despite adversities, many respondents show strong resilience, particularly those with higher education and coming from Sub-Saharan Africa and the Horn of Africa. About two thirds of respondents plan to remain in Italy and nearly two thirds feel welcome in Italy. However, discrimination and racism, especially against individuals of African origin, remain a significant concern. Although many express their satisfaction with life in Italy, experiences of exclusion are common. This survey sheds light on legal precarity, health risks, economic vulnerability, living conditions and lived experiences and perceptions in the peculiar Italian political, legal and administrative environment.

Severe obesity (defined as a BMI ≥ 40 kg m-2) is often accompanied by significant mental health co-morbidities such as eating disorders and depressive disorder and people living with severe obesity often experience feelings of shame, self-criticism and feelings of inferiority in relation to others. Compassion Focused Therapy (CFT) was specifically designed for people with high levels of shame and self-criticism and aims to promote self-compassion which is regarded as an adaptive emotional regulation strategy.

To explore the effect on psychological outcomes of a 10-session (weekly for 2 hours) in-person, group-based CFT intervention for people living with severe obesity. We sought to determine whether CFT would lead to improved self-compassion, depressive symptoms, emotional eating, shame, self-criticism, submissive behavior, and negative social comparison.

A single-centre, randomized controlled trial was carried out with 91 participants allocated to either 'treatment as usual' (n = 46) or 'treatment as usual with additional group based CFT' (n = 45). Treatment as usual included dietary advice, assessment by a Consultant Endocrinologist with possible prescription of medication, and participation in an eight-week lifestyle modification programme. Psychological outcomes were recorded at three time points (pre-treatment, post-treatment, and three-months after the end of group-based CFT).

CFT led to statistically and clinically significant improvements in self-compassion, self-coldness, mood, shame, emotional eating, self-criticism, social comparison, and submissive behaviour (all p < 0.001) compared with treatment as usual. These results were maintained at three-month follow-up.

Group CFT appears to be an effective psychological intervention to alleviate psychological distress in people living with severe obesity.

ClinicalTrials.gov NCT03249441.

This study investigated the association between high-density lipoprotein cholesterol (HDL-C) levels and the risk of cognitive disorders in older adults. Data were obtained from the 2011 Chinese Health and Retirement Longitudinal Study and included 7,509 participants. Cognitive function was assessed using a scale that measured episodic memory and mental status. Statistical analyses included multiple linear regression, restricted cubic splines, and threshold effect analysis to explore the relationship between HDL-C levels and cognitive scores. Compared with Q1 (<35 mg/dL), very high HDL-C was associated with lower cognitive scores (Q4: β = -0.622 [95% CI, -0.908 to -0.337]; Q5: β = -0.322 [-0.627 to -0.017]). A U-shaped association was observed, with a turning point at 67.43 mg/dL. Below the threshold, a 1-SD higher HDL-C was associated with a 0.08-SD higher cognitive score (β = +0.08; 95% CI, 0.06-0.11; p < 0.001), whereas above the threshold a 1-SD higher HDL-C was associated with a 0.07-SD lower score (β = -0.07; 95% CI, -0.14 to -0.01; p = 0.019). Therefore, the relationship between lipid profiles and cognitive health is nuanced and nonlinear. Understanding these complexities is crucial for developing strategies to maintain cognitive function in older adults.

People of sub-Saharan African and Caribbean descent are significantly more likely to be diagnosed with psychotic disorders than other ethnic groups in the United Kingdom. The National Institute for Health and Care Excellence in the United Kingdom recommends family therapy as a clinically effective treatment for the management of psychosis. The National Institute for Health and Care Excellence also recommends that family interventions should be culturally informed to meet the needs of an increasingly ethnically diverse population. People from minoritized backgrounds are rarely offered family therapy; however, the rise in digital mental health worldwide offers unique opportunities to support culturally informed approaches at scale and at a low cost.

The overarching aim of culturally adapted family intervention (CaFI):Digital was to help address inequalities in the provision of mental health care for people of sub-Saharan African and Caribbean descent, including those of Mixed heritage. A digital platform, CaFI:Digital, was built to support delivery of a CaFI. The purpose of developing CaFI:Digital was to provide an accessible, user-friendly, and engaging website for service users, their families, and therapists as an alternative or adjunct to in-person therapy.

We used an iterative Agile co-design approach to develop a user-friendly and inclusive website. Co-design workshops (n=2), semistructured interviews (n=2), and collaborative research team meetings (n=3) were used to capture and prioritize end-user feedback on the clinician- and service-user-facing components of the platform. The software was developed using Agile sprints, with each sprint lasting 3 weeks, allowing feedback to be integrated rapidly and revised software prototypes to be shared with end users for review, revision, and approval.

Key software requirements, such as accessibility and diverse content, were identified in the co-design activities and were implemented to maximize accessibility and usability of the website. Following software development, we successfully beta-tested the software with our target end user population of service users and therapists to ensure it was defect-free and ready for use.

A digital platform to support delivery of CaFI for psychosis was rapidly developed through a series of co-design activities. To our knowledge, this is the first bespoke digital therapy platform that has been co-designed with and for people of sub-Saharan African and Caribbean descent who experience psychosis. This is important given the disproportionate rates of diagnosis and lack of access to psychological therapies experienced by this population.

To identify key barriers and facilitators to designing and implementing collaborative care (CC) for children with developmental disabilities (DD) in safety-net primary care.

This pre-implementation qualitative study involved semi-structured interviews with safety-net primary care leaders. Using purposive and respondent-driven sampling, interviews were conducted with 16 leaders across 9 safety-net organizations in Northern California between August 2024 and January 2025. Key Consolidated Framework for Implementation Research (CFIR) constructs guided data collection. Data were analyzed using the Rapid Assessment Process and validated through structured member checking.

Leaders from 8 of 9 organizations reported existing integrated behavioral health programs staffed by mental health counselors and/or psychiatrists, but nearly all noted that these programs did not address the specific needs of children with DD. When asked about developing a CC intervention for this population, leaders identified implementation barriers and facilitators that mapped to CFIR inner and outer setting domains. Four themes were distilled: inner setting barriers (space and cost), inner setting facilitators (perceived clinical need among leadership), outer setting barriers (restrictive Medicaid reimbursement policies and limited performance measurement pressure), and outer setting facilitators (alternative financing mechanisms).

Safety-net leaders indicate a clinical need for CC models specifically for children with DD, but implementation success will depend on addressing space, financing, and policy barriers through targeted implementation strategies.

Noncompliance with mental health referrals among US military personnel remains a significant barrier to care. Operational deployments and military stressors contribute to mental health challenges, impacting treatment access and increasing costs for the Department of Defense. Identifying service members unlikely to follow through on referrals may enable targeted interventions.

To develop machine learning (ML) models to predict noncompliance with mental health referrals and identify key predictors among active-duty personnel.

This study utilized retrospective data to create predictive models for referral noncompliance.

The study sample consisted of 14,289 active-duty personnel who received mental health referrals through the Periodic Health Assessment (PHA) from 2016 to 2020.

Predictors included demographics, health screenings, medical history, and prior health care utilization. Outcome measures focused on noncompliance within 90 days of referral.

Noncompliance with referrals occurred in 34.0% of the sample. Among predictive models, extreme gradient boosting (XGBoost) achieved the highest performance (AUC ≈ 0.80), with prior health care utilization (eg, previous clinic visits and mental health diagnoses) identified as the strongest predictor, followed by alcohol screening and age.

ML models demonstrated strong potential for identifying at-risk individuals, supporting targeted interventions to improve mental health care follow-up. Future research will emphasize validation and explore mechanisms influencing noncompliance.

Public discussion has increasingly focused on violent incidents involving individuals diagnosed with schizophrenia, particularly those who are nonadherent with treatment or are in the early stages of illness before treatment needs are recognized.

Although people with serious mental illness are somewhat more likely to commit violent acts than those in the general population, only a small proportion of individuals with schizophrenia do so, and they are far more often victims than perpetrators of violence. Misconceptions linking schizophrenia with violence contribute to stigma, delay early diagnosis and intervention, and divert attention from contributing factors such as substance use disorders. While structured assessment tools exist, precise methods for identifying those at highest risk for committing a violent act remain limited.

Early recognition of the prodromal phase of schizophrenia, combined with timely pharmacological and psychosocial interventions, can meaningfully reduce the risk of violence. Ongoing research should emphasize improving predictive tools and promoting effective prevention and treatment strategies.

People with serious head injuries describe psychological distress and existential disruptions, often struggling to find meaning in their lives post-injury. Understanding the differential associations of the three facets of the tripartite model of meaning - coherence, purpose, and mattering - among people with serious head injury may thus benefit and guide intervention and treatment. Using data from the Midlife in the United States national survey, we assessed differences in coherence, purpose, and mattering between people with serious head injury and case matched controls. Differences in depression were also assessed, as was whether meaning mediated the relationship between group and depression. Independent samples t-tests found that people with serious head injury reported less coherence and greater depression than controls, but no differences were found for purpose or mattering. Coherence further mediated the relationship between group and depression. These findings suggest that targeting coherence may support clinical interventions and improve patient health and well-being.

The dual-factor model of mental health postulates a role for positive mental health, alongside mental illness, in determining mental health care needs. Informed by this model, the present study delineated profiles of social-emotional competencies and difficulties during middle childhood in a population-based sample of girls and boys and determined their association with adolescent mental disorder diagnoses.

Latent profile analyses were conducted across five indices of social-emotional competency and four indices of psychopathology that were measured by questionnaire self-report among 13,349 girls and 13,488 boys at age ~11 years. The association of the profiles with adolescent presentations to hospital or ambulatory services (ages ~12-17 years) were determined using logistic regression.

Analyses yielded five profiles in each sex: complete mental health (44% girls; 42% boys), average mental health (30%; 33%), internalising symptoms with poor relationship skills (9%; 7%), externalising symptoms with poor self-management (12%; 9%) and low mental health (5%; 10%). Profiles associated differentially with adolescent presentations with any mental disorder, externalising disorders, internalising disorders and self-harm/suicidal ideation, identified in linked health records. Greater odds of any and specific mental disorder diagnoses were characteristic of all profiles relative to average mental health (adjusted odds ratios [aOR]: 1.7-3.3) except complete mental health (aOR: 0.7-0.9), with different strengths of association according to profile.

Combining information on social-emotional competencies and psychopathology in middle childhood may help refine the provision of mental health promotion and early intervention to alleviate adolescent mental disorder.