ImportanceMetacognitive Reflection and Insight Therapy for Occupational Therapy (MERIT-OT) is a novel adaptation of an evidence-based psychotherapy model designed to enhance metacognitive capacity and support recovery. Its philosophical alignment with occupational therapy-particularly the emphasis on meaning-making and life participation-makes it a promising intervention for Veterans with serious mental illness. However, to date no implementation studies of MERIT-OT have been conducted.ObjectiveTo evaluate the implementation of MERIT-OT within a Veterans Affairs (VA) occupational therapy setting and to explore preliminary findings regarding clinical effectiveness.DesignPilot study evaluating the implementation and preliminary effectiveness of MERIT-OT when delivered by occupational therapists in a VA setting.SettingOne VA Medical Center across four occupational therapy practice areas: psychosocial rehabilitation, outpatient mental health, home health, and women's health.ParticipantsFive occupational therapists; three implemented MERIT-OT with nine Veterans over 37 sessions.Outcomes and MeasuresImplementation outcomes were assessed using the Consolidated Framework for Implementation Research when analyzing interviews and chart review data. Clinical outcomes were measured using the Metacognition Assessment Scale-Abbreviated (MAS-A).ResultsFacilitators included perceived relative advantage and tension for change. Barriers included competing priorities and documentation challenges. Quantitative analysis showed early gains in metacognitive mastery; other subscales showed limited change.Conclusions and RelevancePreliminary findings suggest ongoing consultation, additional training, and improved tools and resources may facilitate MERIT-OT implementation in VA outpatient mental health.What This Article AddsMERIT-OT offers a structured, recovery-oriented approach aligned with occupational therapy values and shows promise for enhancing metacognitive outcomes in mental health settings.

ImportanceIdentifying factors associated with sustained engagement in harm reduction-oriented occupational therapy may help inform more accessible interventions for individuals with substance use disorders (SUDs).ObjectiveTo examine participant characteristics associated with sustained engagement in the Real-Life Program (RLP), a harm reduction-oriented outpatient occupational therapy program for individuals with SUDs, and to explore changes in occupational and psychosocial outcomes among participants who continued the program.DesignRetrospective cohort study.SettingSingle-site outpatient occupational therapy program.ParticipantsFifty-five individuals with SUDs enrolled in the RLP. Participants were classified into continued (≥47% attendance) and noncontinued (<47%) groups based on the median participation rate.Outcomes and MeasuresCanadian Occupational Performance Measure (COPM), Rosenberg Self-Esteem Scale-Japanese version, Shitsu-Taikan-Sho Scale, and visual analog scales for craving intensity and perceived connectedness to others.ResultsPrior self-help group experience was significantly associated with continued participation. Older age showed a nonsignificant association. No other demographic or clinical characteristics differed significantly between groups. Among participants who continued the program, COPM Satisfaction improved significantly, whereas COPM Performance, self-esteem, alexisomia, craving intensity, and perceived connectedness did not.Conclusions and RelevancePrior self-help group experience was associated with sustained engagement in the RLP. Among participants who continued the program, satisfaction with daily occupations improved, although the clinical significance of this change remains uncertain. The RLP may provide a feasible harm reduction-oriented occupational therapy option for individuals with SUDs who have difficulty engaging in abstinence-based treatment programs.

Substance use and co-occurring mental health conditions are common among adolescents and young adults and represent an important clinical and public health concern in North America. Trauma exposure, psychiatric symptoms, and social adversity frequently co-occur with substance-related problems in this population. This systematic review aimed to synthesize evidence on prevalence patterns, associated clinical and psychosocial factors, and care-related implications described in the literature on adolescents and young adults with substance use and co-occurring mental health conditions.

This systematic review followed PRISMA guidelines and was preregistered in PROSPERO (CRD42024581685). A systematic search was conducted in MEDLINE (Ovid), Embase, PsycINFO, and Google Scholar. Eligible studies examined adolescents and young adults (≤ 25 years) in North America. A combination of subject headings, keywords, and synonyms for the concepts "adolescents," "young adults," "substance use disorders," and "co-occurring mental health conditions" was used. Of 1,882 records identified, 29 studies met the inclusion criteria. Given the heterogeneity of the literature, findings were synthesized narratively.

The included studies showed heterogeneity in population, setting, denominator, and ascertainment method. Across the literature, depressive, anxiety-related, trauma-related, and externalizing mental health presentations were frequently reported alongside substance-related problems in adolescents and young adults. Trauma exposure, adverse childhood experiences, and broader social adversity were also commonly reported in association with substance-related problems across studies. Care-related implications were more limited and were largely derived as future directions mentioned across studies rather than direct evaluations of youth-specific service models.

Co-occurring mental health and substance-related problems were frequently reported among adolescents and young adults in high-risk and service-engaged populations in North America. Trauma and social adversity were prominent across the reviewed literature, while direct evidence for evaluated, integrated, youth-specific care models remains limited. These findings support the relevance of developmentally appropriate, integrated, and trauma-informed approaches to care and highlight the need for further research directly evaluating improved service delivery models for this population.

Not applicable.

Women on probation (community supervision) report high rates of adverse childhood experiences (ACEs) and ongoing trauma, yet little research has examined how trauma across the life course relates to perinatal outcomes during community supervision. This study examined associations between lifetime trauma and perinatal violence, infant separation, and postpartum mood symptoms among women who experienced pregnancy, childbirth, and postpartum while on probation.

We conducted a cross-sectional secondary analysis from N = 60 women in South-Central Texas who had a pregnancy within the past five years while on community supervision. Trauma exposures included selected ACEs and adulthood/perinatal trauma (domestic, intimate partner, and sexual violence). Outcomes were perinatal violence, permanent infant removal after childbirth, and postpartum mood symptoms (PHQ-2/GAD-2). We used logistic regression to examine associations between trauma exposures and outcomes; given the ordinal structure of key trauma measures, we used Kendall's tau to estimate correlations between cumulative ACEs/lifetime trauma and perinatal outcomes.

Participants spent an average of 5 years (SD = 3) on community supervision, and most reported partner violence (n = 52, 87%); no mental health care in the year prior to their last arrest (n = 55, 92%); and possible major depressive disorder (n = 20, 33%) and generalized anxiety disorder (n = 34, 57%). ACE prevalence included caregiver incarceration (n = 34, 56%), physical abuse (n = 25, 42%), witnessing abuse (n = 27, 45%), foster care (n = 17, 8%), and childhood sexual abuse (n = 29, 48%); 25% reported four (n = 9, 16%) or five (n = 6, 10%) ACEs. Cumulative ACE exposure was correlated with perinatal violence (p = 0.03), and childhood forced sexual intercourse was associated with perinatal violence (p = 0.04). Trauma in adulthood was associated with permanent infant removal (p = 0.003). Sexual violence in adulthood was correlated with cumulative ACE exposure and postpartum mood symptoms (p = 0.006).

Trauma across the life course is associated with perinatal violence, infant removal, and postpartum mood symptoms among women on community supervision. Trauma-informed, gender-responsive perinatal and community supervision interventions are needed to improve safety, mental health, and family stability.

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Female athlete health encompasses multiple interconnected domains; however, the self-report screening tools used to assess these domains have not been comprehensively synthesised.

To systematically identify self-report health screening tools used to assess female athlete health, map domain coverage, determine validation reporting, and describe application across participation levels.

This systematic review was pre-registered with PROSPERO ( CRD420251056910 ) and conducted in accordance with PRISMA guidelines. Four databases (PubMed, MEDLINE, SPORTDiscus and Web of Science) were searched from inception to January 2026 using female health and screening-related terms. Methodological quality was appraised using Joanna Briggs Institute and National Institutes of Health tools, and findings were synthesised descriptively. Eligible, peer-reviewed studies reported the use, development or validation of self-report health screening tools assessing one or more domains relevant to female health applied in female athlete populations, spanning recreational through elite participation levels. All sports and activities were included. The search was restricted to English language with no date limits.

In total, 360 studies (1990-2026) representing 134,506 female participants spanning recreational to elite sport and 273 screening tools were included. Mental health (n = 77, 34.1%), disordered eating (n = 33, 14.6%) and body image (n = 30, 13.3%) predominated. Domains related to female health, including menstrual health, pelvic floor health, pregnancy/postpartum and breast health were comparatively underrepresented. Most studies reported tools were used for risk identification (n = 323, 80.3%). Validation reporting was inconsistent, with half (n = 180, 50%) reporting use of at least one validated tool. Tool use was concentrated in professional and elite sport, with limited inclusion of recreational, masters and disability athlete cohorts. Health literacy constructs were explicitly assessed in 12.5% of studies (n = 45).

Health screening in female athlete populations remains fragmented and uneven in domain coverage, with inconsistent validation reporting. Development of integrated, multi-domain and contextually inclusive screening frameworks is warranted.

Rheumatoid arthritis (RA) and depressive disorders (DEP) frequently co-occur in clinical populations, but their population-level temporal patterns and variation across developmental contexts remain insufficiently characterized. Using Global Burden of Disease (GBD) 2021 data, this study assessed population-level spatial concurrence, temporal predictability, and projected combined estimated incident cases of RA and DEP across 204 countries and territories, with particular attention to the role of the Sociodemographic Index (SDI).

Countries were grouped by SDI quintile. Annual age-standardized incidence rates (ASIRs) for RA and DEP from 1992 to 2021 were analyzed. ARIMAX models were used to describe single-disease trends, whereas VARX models jointly modelled RA and DEP while adjusting for SDI. Granger causality tests assessed whether the past burden of one condition improved prediction of the other, and impulse response functions (IRFs) summarized model-estimated responses over subsequent years. Projections to 2030 were interpreted as conditional model-based estimates.

RA and DEP incidence rates were positively correlated globally. After SDI adjustment, the number of countries showing bidirectional temporal predictability increased from 67 to 104. IRF analyses indicated larger and more heterogeneous model-estimated RA-to-DEP responses than DEP-to-RA responses, while supporting bidirectional temporal associations. Conditional projections suggested that some middle-SDI countries may experience changes in population-scaled combined estimated incident cases by 2030, whereas several higher-SDI settings showed stable or declining projected rankings under the model assumptions.

Developmental context shaped the detectability and magnitude of country-level RA-DEP temporal associations. These findings provide population-level context for interpreting RA and DEP patterns across settings; clinical screening and treatment decisions require evidence from individual-level studies and guidelines. Key Points • SDI adjustment increased the number of countries with detectable bidirectional temporal predictability between rheumatoid arthritis (RA) and depressive disorders (DEP) from 67 to 104. • Granger analyses of both-sex country-level annual ASIR series indicated bidirectional temporal predictability, while impulse response analyses showed larger and more heterogeneous model-estimated RA-to-DEP responses than DEP-to-RA responses. • Conditional time-series projections suggested that some middle-SDI settings may experience changes in population-scaled combined estimated incident cases by 2030 under historical-trend and model assumptions. • The findings provide population-level context for interpreting RA and DEP patterns across settings.

Brain-age models use neuroimaging features to predict chronological age. The resulting brain-age gap (BAG), defined as predicted brain age minus chronological age, quantifies deviations from age-expected brain characteristics. Structural brain-age acceleration is well established in schizophrenia spectrum disorders (SSD), but the utility of resting-state functional connectivity (rs-FC)-based brain age remains unclear. Here, we trained rs-FC brain-age models on aggregated lifespan data from healthy controls (n ≈ 2200) and evaluated them in four independent SSD case-control cohorts. Across independent cohorts and two brain atlases, SSD showed higher FC-based BAG than healthy controls (β ≈ 0.4-0.6), indicating modest functional brain-age elevation at the group level. However, within SSD, more negative (younger appearing) BAG was associated with poorer cognitive performance, longer duration of illness, and higher neurological soft signs (NSS). Over 12-24 weeks, increases in BAG were associated with reductions in NSS motor coordination and hard signs. Together, these findings suggest that rs-FC brain age captures both a small case-control shift and a clinically relevant dimension within SSD that is not well described by uniform "acceleration". FC-based BAG may therefore reflect heterogeneity in network-level development and reorganization, with younger-appearing functional profiles potentially indexing greater neurodevelopmental burden.

Psychological distress has been associated with inferior outcomes after major joint arthroplasty, but its impact on outcomes after total ankle arthroplasty (TAA) remains unclear. The main aim of this study was to investigate whether patients reporting anxiety or depression before TAA surgery had inferior outcomes 1 year after surgery.

Retrospective analysis of prospectively collected data from a single-centre ankle arthroplasty registry. The exposure was preoperative anxiety/depression, defined from EuroQol-5 Dimensions-3 Level (EQ-5D-3L) item 5, and dichotomized, reflecting self-reported symptoms rather than a clinical diagnosis. The primary outcome was the adjusted difference between the exposure groups in the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) score at 12 months postoperatively. Multivariable linear regression with multiple imputation of missing baseline MOxFQ was used to assess the association between preoperative anxiety/depression and 12-month MOxFQ, adjusting for baseline MOxFQ, age, sex, and diagnosis.

Three hundred patients were included, of whom 90 (30%) reported preoperative anxiety and/or depression. These patients were younger and reported worse baseline pain and function. Although patients with preoperative anxiety/depression had worse absolute MOxFQ scores at 12 months (mean 30.2 vs 20.1; P < .001), their improvement from baseline was comparable to patients without anxiety/depression (ΔMOxFQ 41.3 vs 43.9; P = .40). In multivariable regression analyses including baseline values, preoperative anxiety/depression was not independently associated with worse 12-month MOxFQ (β = 4.3; 95% CI -0.9 to 9.5). Among patients with baseline anxiety/depression, approximately two-thirds no longer reported anxiety/depression at 12 months.

Preoperative self-reported anxiety or depression was common among patients undergoing TAA and was associated with worse symptoms before surgery. However, the reporting of such symptoms did not appear to limit postoperative improvement in patient-reported outcomes at 12 months. Among patients reporting anxiety/depression preoperatively, approximately two-thirds no longer reported anxiety/depression at 12 months.

Level III, retrospective cohort study using prospectively collected registry data.

Accurate and complete clinical documentation underpins the assignment of International Classification of Disease codes used for epidemiological research, hospital activity based funding, and health service planning. Objective: To develop, implement, and evaluate an education program for clinicians and clinical documentation specialists (CDS) to improve clinical documentation of stroke.

An education program to improve clinical documentation of stroke was developed by the Australia and New Zealand Stroke Coding Working Group. Eligible participants were clinicians (doctors, nurses, and allied health) and CDS in Australia or New Zealand. The education program comprised 4 modules in a pre-recorded 10-minute educational video. Surveys were administered before and after the educational video to evaluate knowledge (Kirkpatrick level 2) and obtain feedback. Quantitative data were summarised using descriptive statistics. Open-text responses to the feedback survey were analysed using inductive thematic analysis.

Among 72 eligible participants, 41 (57%) completed the pre- and post-educational knowledge assessment surveys (n = 35 clinicians, n = 6 CDS). Compared with the pre-education survey, the median number of correct responses significantly increased in the post-education survey (pre: 3 [interquartile range (IQR) 2-4]; post: 5 [IQR 4-5]; p < 0.001). Most respondents (>90%) were satisfied with the education program, stating it provided "practical and transferrable knowledge" and that the education was "quick, clear, concise."

Our education program was associated with an increased knowledge of appropriate clinical documentation of stroke. Ongoing monitoring of clinical coding and clinical documentation is required to ascertain whether the education of the participants translates to improved clinical coding of stroke.Implications for health information management practice:Accurate and complete clinical documentation directly impacts clinical coding, which in turn affects reimbursement, patient safety, and data quality for epidemiological research, resource allocation, and health policy decision-making.

Postsecondary institutions around the world are grappling with how best to respond to what is described as a crisis in student mental health, with urgent calls for evidence-based advocacy, campaigning, and global action. In response to this call to action, in this article we advocate for a stronger role for occupational therapy in supporting student mental health in postsecondary settings through the enactment of the Okanagan Charter: An International Charter for Health Promoting University and Colleges, which celebrated its tenth anniversary in 2025. We share examples of innovative occupational therapy services and developments from the United States and Ireland specifically addressing the growing mental health needs of postsecondary students; highlight advocacy efforts and international collaborations and offer suggestions for how occupational therapy practitioners can work to consolidate and expand this vibrant and necessary emergent practice area through the basic tenets of the Okanagan Charter: An International Charter for Health Promoting University and Colleges.