Search Results (23,605)

Background: With the rising demand for psychiatric mental health services and the development of online technology, telemental health services are gaining popularity. Psychiatrists and psychologists differ significantly in service patterns and ethical models. This study investigated their ethical patterns and used the technology acceptance model (TAM) to explore how professionals’ attitudes influence their ethical and regulatory use of telemental health services. Methods: The online survey included their basic information, telemental health service patterns, attitudes toward telemental health services, and ethical norms. This cross-sectional online survey was conducted among psychiatrists and psychologists in China between April and October 2022. Of the 1071 respondents in the parent survey, 690 professionals who reported using telemental health services were included in the present subgroup analysis. Results: In some instances, practitioners offering telemental health services may not adhere to ethical standards, particularly in the case of psychologists. A significant proportion of respondents expressed concerns including potential emergencies, technical issues, and security, suggesting the need for a re-evaluation of the ethical framework. The TAM showed higher behavioral intention was associated with lower ethical compliance scores. Conversely, elevated subjective norms and perceived behavioral control have the potential to encourage ethical compliance. Conclusions: Telemental health services are widely used in China, but important gaps remain in ethical compliance and regulatory implementation. Future efforts should focus on strengthening professional training, improving platform security and emergency response procedures, and developing clearer institutional and professional guidelines for ethical telemental health practice. Full article

Background/Objectives: Structured transition care models for adolescents with congenital heart disease (CHD) are increasingly advocated, but methodological evidence to support the design of adequately powered randomized trials remains limited. This pilot randomized study was designed primarily to assess the feasibility of repeated patient-reported outcome (PRO) collection and to generate empirical parameters for planning a future confirmatory trial, rather than to formally evaluate intervention efficacy. Methods: This was a single-center, parallel-group, pilot randomized controlled trial conducted at Meyer Children’s Hospital, Florence, Italy, within the TELEMACO project (NCT05713591). Twenty-three adolescents with CHD were randomized 1:1 to a structured transition care intervention (n = 11) or usual care (n = 12). PROs, including the SF-12 Physical (PCS12) and Mental (MCS12) Component Summaries, health engagement, life satisfaction, and healthcare needs, were collected at baseline and at 3, 6, 9, and 12 months. Pre-specified exploratory analyses addressed retention, missingness, linear mixed-effects models, intraclass correlation coefficients (ICCs), and sample size scenarios. Results: Retention at 12 months was 63.6% (intervention) and 58.3% (control), with substantially lower completion rates at intermediate assessments (T2–T3: 27–50%), directly affecting the reliability of longitudinal estimates at those time points. Mixed-effects models showed no significant time-by-group interaction for PCS12 (p = 0.13) or MCS12 (p = 0.39); unadjusted contrasts suggested nominally higher PCS12 values in the intervention group at selected assessments. ICCs were approximately 0 for PCS12 and 0.56 for MCS12, indicating fundamentally different variance structures. Conclusions: Repeated PRO collection was feasible, though retention across intermediate assessments was inconsistent. The pilot generated empirically grounded estimates for the design of a future confirmatory trial. Sample-size scenarios were highly sensitive to uncertainty in the PCS12 variability estimate, ranging from approximately 25 to 115 analyzable participants per group, depending on the true standard deviation. Within this pilot dataset, PCS12 at 12 months, analyzed cross-sectionally with baseline adjustment, emerged as a provisional endpoint option requiring further evaluation in an adequately powered confirmatory trial. Full article

Background: Adults closest to children, including parents and caregivers, teachers, and therapists, are major determinants of child mental health outcomes. However, access to high-quality psychological training for these groups remains severely limited and inequitable. Artificial intelligence (AI) tools may offer a scalable, accessible, and low-cost route to training delivery. This review aimed to provide the first systematic synthesis of evidence on AI tools used to train caregivers, educators, and therapists/practitioners in psychological approaches relevant to child and adolescent mental health. Methods: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261336167). Five databases, MEDLINE, PsycINFO, Embase, Web of Science, and ERIC, were searched from inception to March 2026, supplemented by reference hand-searching and forward citation tracking. Studies were eligible if they evaluated an AI-based training tool used with adults in caregiving, educational, or therapeutic roles involving children or adolescents aged 0–18 years, delivered a defined psychological approach, and reported at least one training outcome. Owing to substantial methodological and outcome heterogeneity, findings were synthesised narratively, and meta-analysis was not undertaken. Results: Twenty-four studies from nine countries, published between 2019 and 2026, met inclusion criteria. Studies were grouped into caregiver training (Group A, 5 papers), educator training (Group B, 3 papers), and therapist/practitioner training (Group C, 16 papers). Identified AI modalities included natural language processing (NLP)-based chatbots, generative AI/large language model (LLM) systems, AI-integrated virtual reality (VR), and AI-based feedback and analysis tools. Feasibility and acceptability findings were generally positive across groups. However, the evidence base was limited by pervasive methodological weaknesses, including small samples, with most studies enrolling fewer than 30 participants, reliance on unvalidated self-report outcomes, and the absence of follow-up data beyond one month. Conclusions: AI tools show early promise as scalable approaches to psychological training, particularly for procedural skill acquisition and enhancement of practitioner self-efficacy. However, the current evidence base is insufficient to support claims of effectiveness. A structural credibility–accessibility paradox characterises the field: tools with the strongest controlled evidence are the least scalable, while the most accessible tools have the weakest empirical support. Adequately powered, independent randomised controlled trials (RCTs) using validated outcomes, active comparators, and follow-up extending over multiple months are needed across all three population groups. Full article

Alzheimer’s disease (AD) is a neurodegenerative disorder, whereas myasthenia gravis (MG) is an autoimmune neuromuscular disease. Despite their distinct clinical manifestations, both disorders involve immune dysregulation and cholinergic dysfunction, and epidemiological evidence for an association remains inconclusive. Here, we investigated the genetic architecture underlying the AD–MG relationship using large-scale European-ancestry genome-wide association study (GWAS) data, including early- and late-onset MG, within a multi-resolution analytical framework. Genome-wide analyses indicated modest polygenic overlap between AD and MG, supported by nominally significant and directionally consistent correlations across datasets, SNPeffect concordance in the primary GWAS, and robust gene-level overlap. Evidence for genome-wide correlation was weaker and non-significant across AD-MG subtypes. Local genetic correlation analyses revealed that shared AD-MG signals were largely locus-specific and heterogeneous, with regions showing both concordant and discordant effects, particularly across MG subtypes. Subtype-specific analyses indicated broader and more heterogeneous overlap for AD–late-onset MG, including both major histocompatibility complex (MHC) and non-MHC loci, whereas AD–early-onset MG showed more restricted patterns largely confined to the MHC. Cross-trait meta-analysis and colocalisation further refined these findings, identifying a limited number of loci with evidence of shared AD-MG association, while most regions were consistent with distinct causal variants. A chromosome 16 locus showed the most consistent shared cross-trait AD-MG signal across multiple analytical frameworks. Mendelian randomisation analyses provided no evidence of a causal effect of AD liability on MG and yielded only suggestive, and inconclusive evidence for the reverse direction. Gene-level and expression-informed analyses prioritised immune-related genes, as well as regulators of transcription, chromatin organisation, and synaptic processes, without implying concordant causal variants across traits. Tissue and pathway analyses suggested shared immune involvement, with differential emphasis on innate immune processes in AD and adaptive immune pathways in MG. Notably, heterogeneity of effects within the MHC and across loci suggests that overlap reflects a complex, context-dependent architecture rather than a uniform immune-driven signal. Overall, our findings indicate that the AD–MG relationship is characterised by modest genome-wide polygenic overlap, substantial locus-specific heterogeneity, and partial convergence on immune-related genetic architecture, rather than a uniformly shared mechanism. Full article

Background: Mental health concerns are notably common among students attending universities in Saudi Arabia, and low engagement with psychological services has been widely documented in this population group. Telemental health has emerged as a promising alternative under Vision 2030’s digital transformation agenda, although the determinants of university students’ intentions to use these services have received limited empirical attention in Saudi Arabia. Objective: This study examined attitudes toward telemental health services, perceived barriers to seeking psychological help, and predictors of behavioral intentions to use telemental health services among university students in Saudi Arabia, based on the Technology Acceptance Model and Theory of Planned Behavior. Methods: A cross-sectional design was employed using an online, self-administered questionnaire. A total of 236 undergraduate students from three large universities in Riyadh were recruited using convenience sampling methods. We examined demographic variables, telemental health attitude variables (ease of use, usefulness, subjective norms, trust in telemental health, relative advantage, intentions, and attitudes), and barrier subscales (fear of stigma, trust in mental health professionals, difficulties in self-disclosure, perceived devaluation, and lack of knowledge) among university students. Descriptive statistics, Welch’s t-tests, and multiple linear regression analyses were conducted using SPSS (version 29). Results: Participants demonstrated moderately positive attitudes toward telemental health (M = 74.15, SD = 16.11) and reported moderate overall barriers (M = 50.76, SD = 14.44), with trust in mental health professionals being the most prominent barrier. The regression model explained 58.0% of the variance in behavioral intentions (F(19, 211) = 15.35, p < 0.001). Attitude was the strongest predictor (β = 0.534, p < 0.001), followed by trust in telemental health, sex, and difficulty in self-disclosure. Conclusions: Culturally tailored awareness campaigns, trust-building communication, and gender-sensitive service design are recommended to promote the adoption of telemental health by Saudi university students. These efforts align with Vision 2030’s digital health priorities and may support the equitable expansion of mental healthcare access in this population. Full article

For almost fifty years, Crew Resource Management (CRM) has been a cornerstone of aviation safety and training. This narrative review examines the current state of CRM training and identifies key directions for future development, including the integration of artificial intelligence, increasing attention on mental health and resilience, and workforce diversity. While there is evidence of gradual evolution in CRM practices, reflected in updated regulatory frameworks, competency-based approaches, and a growing community of human factors and aviation psychology specialists, progress remains uneven across the industry. We argue that many aviation operators and training organizations still lack robust institutional mechanisms to systematically translate emerging scientific evidence into training design and delivery. As a result, advances in research on teaching and learning methods and human performance are not consistently brought forward into everyday training practices. The review concludes with a set of practical recommendations aimed at strengthening knowledge exchange between researchers and operational stakeholders, enhancing evidence-informed training, and supporting the modernization of CRM in a rapidly changing operational environment. Full article

More than one million adults in Mississippi have hypertension. We examined the association between a summary measure of social determinants of health (SDOH) and health equity (SDOH/HE) and hypertension prevalence among Mississippi adults. Using data from 3867 respondents to the 2023 Mississippi Behavioral Risk Factor Surveillance System SDOH/HE Module, we performed multivariable logistic regression analyses to examine the association between hypertension prevalence and a summary SDOH/HE measure. The SDOH/HE summary measure score was created using responses to 10 questions assessing employment/economic and housing stability, receipt of food assistance, access to quality food and transportation, utilities security, social isolation, social and emotional support, life satisfaction, and mental well-being of the participants. The likelihood of experiencing 0, 1, 2, 3, or 4 or more SDOH/HE risk factors was 38.6, 22.9%, 13.7%, 7.9%, and 16.8%, respectively. Mississippi adults experiencing one (adjusted odds ratio, AOR, 1.47) and four or more (AOR, 2.62) of SDOH/HE risk factors had higher odds of hypertension compared to those experiencing no SDOH/HE risk factors. Associations between presence of two or three SDOH/HE risk factors and hypertension were not significant. Mississippi adults with one and at least four SDOH/HE risk factors had significantly higher odds of hypertension risk than those with no SDOH/HE risk factors. These findings highlight an association between SDOH/HE factors and the burden of hypertension and underscore the need for targeted inventions among Mississippi adults with multiple SDOH/HE risk factors. Full article

Introduction: Problematic internet use has been increasingly associated with depression, anxiety and other psychiatric symptoms; however, its impact on attentional functioning has not been thoroughly researched. This cross-sectional study was conducted in Târgu Mureș, Romania, and aimed to examine the associations between problematic internet use, attentional control, and symptoms of depression and anxiety in adults, and to determine whether problematic internet use independently predicts attentional control after accounting for emotional symptoms. Methods: A cross-sectional study was conducted on 224 adults who completed an anonymous online survey between 1 January 2026 and 1 April 2026. Problematic internet use was assessed using the Compulsive Internet Use Scale-14 (CIUS-14), attentional control using the Attentional Control Scale (ACS), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 scale (GAD-7), and eating disorder risk using the SCOFF questionnaire. Descriptive statistics, internal consistency analyses, Pearson correlations, group comparisons according to the CIUS-14 screening threshold, and multiple linear regression analyses were performed. Results: Problematic internet use was significantly associated with lower attentional control (r = −0.493, p < 0.001), higher depressive symptoms (r = 0.408, p < 0.001), and higher anxiety symptoms (r = 0.467, p < 0.001). In the regression model, problematic internet use remained the only significant independent predictor of attentional control (B = −0.597, p < 0.001), whereas depressive and anxiety symptoms were not significant after adjustment. Participants above the CIUS-14 screening threshold reported significantly lower attentional control and higher depression and anxiety scores than those below the threshold. Conclusions: Problematic internet use was associated with poorer attentional control and greater emotional symptom severity in Romanian adults. These findings suggest that problematic internet use may be linked to a broader cognitive–emotional vulnerability profile. However, because of the cross-sectional design, self-report measures, convenience sampling, and lack of detailed information on specific online activities, the findings should be interpreted cautiously. Longitudinal studies using objective cognitive measures and more detailed assessment of digital behaviors are needed. Full article

Digital interventions can increase the reach and continuity of physical activity promotion, but evidence remains fragmented across mental health and addictive behaviors. We conducted a comprehensive integrative review supported by structured searches (2015–2026) in biomedical, psychological, multidisciplinary and technology-oriented databases, complemented by backward/forward snowballing. Eligible studies included digital interventions in which physical activity (or sedentary reduction) was a core component and those that reported mental health outcomes (e.g., depression, anxiety, stress, and well-being) and/or addiction-related outcomes (e.g., craving, consumption, lapses/relapse, and treatment retention). We synthesized findings thematically by intervention typology (apps, wearables, hybrid models with human support, and adaptive approaches) and by key active ingredients (goal setting, self-monitoring, feedback, reinforcement, planning, and engagement strategies). Overall, most studies targeted mental health outcomes and used app-based multicomponent programs, sometimes complemented by wearables, with generally short follow-up and heterogeneous engagement metrics. Evidence in addictions was more context-specific and concentrated in alcohol treatment and opioid agonist therapy settings, supporting feasibility and a plausible role for physical activity as a coping strategy. Advanced personalization frameworks (EMA/EMI/JITAI) provide a clear implementation pathway but are less consistently operationalized when physical activity is the central therapeutic component. This review highlights practical design recommendations and research priorities for scalable, safe, and equity-oriented digital physical activity interventions in mental health promotion and relapse prevention. Full article

Background/Objectives: The growing population of multicultural adolescents (MCAs) has become a vital focus for national health policy. Despite their increasing numbers, MCAs often encounter unique socioeconomic challenges and dietary issues that may heighten mental health vulnerabilities. This study aimed to assess the dietary behaviors of MCA and non-MCA and to explore the association between these behaviors and mental health outcomes, specifically generalized anxiety disorder (GAD) and severity of suicidal behavior. Methods: Using data from the 2024 Korea Youth Risk Behavior Survey, we analyzed the dietary behaviors of 44,796 adolescents, focusing on five key areas: breakfast consumption, fruit intake, caffeine drinks, sweetened beverages, and fast food. We also calculated a composite dietary behavior score and assessed mental health using the GAD-7 and a three-component suicidal behavior scale (including ideation, planning, and attempts). Results: MCAs experienced significant disparities in socioeconomic status and had a notably higher prevalence of suicide attempts compared to non-MCAs (p = 0.0107). In both groups, poorer dietary behaviors were linked to an increased likelihood of GAD and greater severity of suicidal behavior (p_trend < 0.05). This association with suicidal behavior severity was particularly pronounced in MCA (p_interaction = 0.0358). Conclusions: Dietary behavior is significantly associated with mental health issues among Korean adolescents. Given the vulnerabilities faced by MCA, it is essential to implement multifaceted policy support and targeted dietary interventions to improve outcomes for this population. Full article

Parental divorce, as an adverse childhood experience, may disrupt family systems and exert enduring effects on psychological development, with impacts becoming particularly salient during emerging adulthood, a stage characterized by identity exploration and increasing autonomy. Within the Thai cultural context, inner strengths grounded in Buddhist values may serve as important resources for resilience. This study examined associations between inner strength dimensions derived from the Ten Perfections (Pāramīs) and resilience among emerging adults who experienced parental divorce in childhood. A cross-sectional design was employed with 160 Thai participants aged 20 to 29 years, who completed the Inner Strength-Based Inventory (I-SBI) and the Resilience Inventory (RI-9). Correlation analysis indicated that equanimity, determination, perseverance, wisdom, meditation, and loving-kindness were positively correlated with resilience. Multiple regression analysis showed that equanimity (β = 0.312, p < 0.001), determination (β = 0.227, p < 0.01) and loving-kindness (β = 0.213, p < 0.01) were significantly associated with resilience. These findings suggest that culturally embedded inner strengths are associated with resilience in a non-Western context. More specifically, among the ten dimensions examined, equanimity, determination, and loving-kindness emerged as being significantly associated with resilience in Thai emerging adults with childhood parental divorce experiences. Full article

Negative life events (NLEs) are robust environmental correlates of adolescent internalizing problems (IPs), yet the psychological mechanism and boundary conditions remain unclear. To examine whether self-esteem accounts for the association between NLEs and adolescent IPs, and whether resilience conditions these links, 400 adolescents completed anonymous measures assessing NLEs, IPs, self-esteem, and resilience. The results show that (1) NLEs were positively associated with IPs, (2) self-esteem mediated the association between NLEs and IPs, (3) resilience moderated the relationship between NLEs and IPs, and (4) resilience also moderated the link between NLEs and self-esteem, such that associations were weaker at higher resilience. The index of moderated mediation was significant, indicating that the indirect effect via self-esteem decreased as resilience increased. These findings suggest that reduced self-esteem is an important link between exposure to negative life events and internalizing symptoms. Moreover, the findings indicate that resilience functions as a protective factor that attenuates both direct and indirect associations, suggesting potential targets for school-based prevention aimed at strengthening self-worth and resilience. Full article

Firearm homicide is a leading cause of death among children and young men in the U.S. (ages 1–19), with young Black males in urban environments facing rates 18-to-24-fold higher than their non-Hispanic White peers in 2023. A key precursor to firearm violence victimization is weapon-carrying behavior (WCB), defined as carrying, concealing, or displaying firearms or other weapons in community or social contexts that elevate risk for injury, interpersonal threats, or law enforcement contact. Several structural, behavioral, and trauma-based risk factors fuel weapon-carrying. Yet these WCBs are rarely studied in tandem, leaving a critical gap in our understanding of these high-risk behaviors for youth. This cross-sectional study leveraged baseline data from a convenience sample of 226 violence-exposed urban young Black males, ages 15–24 (M_age = 18.3 years; SD = 3.1) enrolled in a trauma-informed digital firearm violence prevention pilot study. Eligibility required prior personal or witnessed experience of youth violence; reported prevalence therefore characterizes a high-risk subgroup rather than urban young Black males as a whole. Past-30-day weapon-carrying frequency was measured across five YRBS-aligned categories (0, 1, 2 to 3, 4 to 5, and 6+ days) and modeled as a categorical index under negative binomial regression. Associations with peer and community violence exposure, substance use, sociodemographic, and socioeconomic factors were estimated as incidence rate ratios (IRRs) with 95% CI. Past-30-day weapon carrying was reported by 42.5% of participants, with carrying frequency ranging from 1 day to 6 or more days. Participants reported high levels of direct victimization (64.8%), witnessing community violence (76.4%), and use of nonprescribed medications, including in instances preceding violence. In the fully adjusted model, indicators of violence exposure were the most consistent correlates of carrying. Direct victimization (IRR = 1.15, p < 0.05), general exposure to violence or aggression (IRR = 7.82, p < 0.01), and physical fighting (IRR = 1.11, p < 0.05) remained independently significant. Conversely, associations with substance use, dating aggression, and employment were attenuated, suggesting shared ecological vulnerability rather than independent causal pathways. Findings underscore the central role of chronic violence exposure and support the need for trauma-informed, multilevel prevention strategies in clinical and community settings. Full article

Background: Artificial Intelligence (AI) and Machine Learning (ML) technologies, such as conversational agents, are becoming increasingly essential tools across multiple industries, particularly in healthcare. This paper presents a scoping review (PRISMA-ScR) of conversational agents (CAs) in mobile health coaching systems (MHCS). It examines existing applications of MHCS, focusing on development strategies, usage contexts, impacts on users, benefits, and research gaps, emphasizing the ability of explainable artificial intelligence (XAI) in making health guidance and decision-support recommendations transparent, trustworthy, and interpretable, if properly integrated. This scoping review identifies opportunities to maximize the use of conversational agents, explainable AI, and mobile technologies to make mobile health coaching systems more accessible and trustworthy, as well as further research gaps worth exploring. Objective: This scoping review maps the evidence on CAs and XAI-enabled technologies in MHCS, identifies trust-related design criteria, categorizes reported outcomes, and highlights opportunities for explainable conversational agents (XCA) in a mobile health context, especially in tackling general medical conditions pertinent in underserved settings. Eligibility criteria: Reported eligible resources evaluated, designed, or conceptually analyzed existing CAs, XAI techniques, and MHCS, AI-supported medical dialogue systems, e-coaching systems, and mobile health applications. We considered sources only relevant to healthcare, health coaching, trust, explainability, or patient engagement that were published between 2006 and 2025. Sources of Evidence: Searches were conducted in IEEE Xplore, Google Scholar, Springer, ScienceDirect/Elsevier, ProQuest, and ACM Digital Library, supplemented by targeted web searches and backward citation checks. Charting methods: Data were charted by system type, communication mode, health context, operational mode, technology used, XAI/trust features, degree of automation, study designs and outcome classification. We applied a revised outcome classification: generated desired outcome (GDO) and partially generated desired outcome (P-GDO), and did not generate desired outcome (DN-GDO). Results: A total of 201 resources were collected. Charted studies clustered around CAs in health, MHCS for chronic diseases and stress management, XAI methods such as LIME, SHAP, Prospector, and counterfactual explanations, and trust-related elements such as voice quality, communication style, appearance, social intelligence, privacy, and performance quality. Most health CAs and MHCS addressed chronic diseases, mental health, or behavior change; fewer addressed general medical diagnosis or autonomous mobile-based primary care support. Conclusions: Existing evidence suggests that CAs and MHCSs can support engagement, coaching, education, and selected decision-support tasks, but evidence for safe, autonomous, explainable general practice functionality remains limited. Future work should prioritize clinically supervised XCA designs, core safety assessment, interfaces with transparent explanation, data protection, culturally and linguistically responsive implementation, and future-oriented review in underserved mobile health settings. Full article

Major depressive disorder (MDD) is a mental illness with high mortality, suicide, and relapse rates that could become the leading cause of health problems worldwide by 2030. The microbiota–gut–brain axis involves bidirectional communication between the human gut microbiota and the central nervous system (CNS). The gut microbiome is a complex ecosystem of approximately 100 trillion microorganisms, including viruses, bacteria, and fungi. The gut microbiota has recently been recognized for its impact on various diseases and health concerns. Several factors influence the composition and structure of gut microbes, ultimately affecting human physiology, with the nervous system being particularly vulnerable. The gut–brain–microbiota axis influences several important brain functions through numerous pathways, including vagus nerve signaling, gut microbial synthesis of metabolites, and immune-related chemicals. These factors can influence neurotransmitter activity, neuroinflammation, behavior, and mental health. Despite increased interest, the possibility of modifying the gut microbiota as a therapeutic approach remains unclear. Although numerous studies suggest that microbiota play an important role in many illnesses, the precise mechanisms are yet to be elucidated, and there are currently no evidence-based, microbiota-focused treatments for these illnesses. Recent research indicates that gut dysbiosis (GD) causes increased intestinal permeability (leaky gut), initiates systemic inflammation, and contaminates the blood. Opportunistic microbial metabolites cross the blood–brain barrier, triggering a neuroinflammatory cascade and apoptotic pathways while affecting neurogenesis and neurotransmitters, ultimately resulting in the development of MDD and anxiety. This review examined the factors influencing normal gut microbiota and GD-mediated MDD, as well as possible therapeutic options. The study outlines its objectives and methodological approaches, including the screening and filtering of research on GD-induced depression. Furthermore, it explored the daily use of dietary supplements, revealing new paths for clinical and preclinical research. Full article