The effects of smartphone use on mental health and brain activity in adolescents have received much attention; however, the effects on older adults have received little attention. As more and more older adults begin to use smartphones, exploring the effects of nonaddictive smartphone use on mental health, cognitive function, and brain activity in older adults is imperative.

This study aimed to examine differences in cognitive performance, emotional symptoms (depression, anxiety, and insomnia), and brain functional activity between older adults who use smartphones and those who do not.

A total of 1014 community-dwelling older adults aged 60 years and above were surveyed in a rural area of China. Participants were categorized into 2 groups based on their smartphone use status. The Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Insomnia Severity Index, and Montreal Cognitive Assessment-Basic were used to evaluate the symptoms of depression, anxiety, insomnia, and cognitive function of the participants by trained medical staff. To explore neural mechanisms, a subsample of 130 participants (89 smartphone users and 41 nonusers) was selected using stratified random sampling for resting-state functional magnetic resonance imaging scanning. Participants with contraindications for magnetic resonance imaging (eg, metal implants or claustrophobia) or who refused to participate were excluded. Functional brain activity was analyzed and compared between groups.

Among all 1015 older adults, 641 reported using smartphones, while 373 reported never using smartphones. Older adults who use smartphones exhibited better cognitive function compared with those who never use smartphones (z=3.806, P<.001), especially in the domains of fluency (z=3.025, P=.002) and abstraction (z=5.311, P<.001). However, there were no significant differences in levels of depression (z=0.689, P=.49), anxiety (z=0.934, P=.35), and insomnia (z=0.340, P=.73). In terms of the magnetic resonance imaging findings, a total of 130 participants completed functional magnetic resonance imaging scanning, including 89 who use smartphones and 41 who never use smartphones, and results showed that older adults who were smartphone users exhibited higher degree centrality values in the left parahippocampal gyrus.

These findings suggest that smartphone use among older adults is associated with better cognitive performance and fewer emotional symptoms, potentially linked to enhanced brain activity in key cognitive regions. Promoting digital engagement may offer cognitive and emotional benefits for aging populations. Longitudinal studies are warranted to examine causal relationships.

Aims/Background Intellectual developmental disorders (IDD) are characterized by significant limitations in intellectual functioning and adaptive behavior, affecting conceptual, social, and practical skills. They impact 1% of the global population, with mild cases being more common. Major causes include prenatal, perinatal, and postnatal factors, although a clear cause is often not identified. This study aims to evaluate the comorbidity of psychological disorders in individuals diagnosed with IDD. Methods Following the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" (PRISMA) statement, studies from 2014 to 2024 were considered using the databases Web of Science, PsycInfo, and PubMed. Articles focusing on psychopathology in individuals with IDD from birth were selected, excluding studies involving individuals under 16 years old and cases of severe and profound IDD. Results Of the 2895 articles retrieved, 11 were included. These studies showed heterogeneity in comorbidities such as schizophrenia spectrum and other psychotic disorders, mood disorders, anxiety disorders, developmental disorders, personality disorders, substance use disorders, and adjustment and stress reaction disorders. Conclusion Individuals with IDD are more vulnerable to mental health conditions, underscoring the need for comprehensive assessments and multidisciplinary treatments to improve their quality of life and optimize public resources. Future research should develop validated diagnostic tools for IDD and conduct longitudinal studies on their impact on quality of life. It should also explore gender differences and address specific needs in disadvantaged contexts with tailored interventions. Systematic Review Registration PROSPERO (CRD42024529405).

Catatonia is a severe psychomotor syndrome predominantly associated with depressive, bipolar, and psychotic disorders. Untreated catatonia has a 10% mortality rate and may lead to complications such as renal failure, rhabdomyolysis, pneumonia, embolism, and contractures. High doses of the benzodiazepine lorazepam, a gamma-aminobutyric acid (GABA)-A receptor modulator, are the primary pharmacological treatment, enhancing GABA's inhibitory effect, potentially reducing symptoms of catatonia. However, lorazepam is ineffective in about 25% of cases, leaving electroconvulsive therapy (ECT) as the only well-investigated alternative. Although often effective, ECT may have severe side effects and is not easily accepted among patients and caregivers. Therefore, there is an urgent need for novel therapies for catatonia. Sodium oxybate, a GABA precursor and GABA-B receptor agonist, is a promising alternative treatment based on observational data, but its efficacy has never been thoroughly investigated.

This study aims to evaluate the efficacy and safety of sodium oxybate in treating catatonia unresponsive to lorazepam, while also capturing the natural course and determinants of catatonia through an observational cohort.

The Laborit trial consists of a cohort study and an embedded single-blind randomized controlled trial (RCT). Patients with catatonia admitted to a psychiatric ward may join the study's cohort, where their clinical characteristics are recorded. Standard care, including lorazepam up to 24 mg/day, will be administered. On day 4, the Bush Francis Catatonia Rating Scale (BFCRS) will be used to measure symptom response. Patients with ≤50% improvement on the BFCRS, compared to the score at start, will be eligible for the trial. A total of 42 patients will be randomly assigned to either the sodium oxybate group, after a 2-day lorazepam reduction period, or the continuation of lorazepam. The primary endpoint is response, measured by the BFCRS score change after 4 days of treatment. A ≥50% reduction in BFCRS will define a responder, who will continue allocated treatment for an additional 10 days, with a secondary endpoint at 14 days. Data will be analyzed using intention-to-treat and per-protocol methods, with chi-square and logistic regression tests to compare group response and remission rates.

This study was funded by the Dutch Brain Foundation (Hersenstichting) in December 2020. The study protocol was approved by the Amsterdam UMC Ethics Board on May 22, 2023. As of March 2025, the first 4 participants have been included in the cohort, with no trial participants enrolled yet.

If positive, the results of this RCT may pave the way for international catatonia researchers and clinicians to introduce a new pharmacological treatment option for catatonia. Implementation could potentially benefit patients who endure this severe syndrome and present health care professionals with an additional treatment option.

ISRCTN ISRCTN11236443; https://tinyurl.com/4px5s4aa.

PRR1-10.2196/68356.

The trove of information contained in child maltreatment narratives represents an opportunity to strengthen the evidence base for policy reform in this area, yet it remains underutilized by researchers and policy makers. Current research into child maltreatment often involves the use of qualitative methodologies or structured survey data that are either too broad or not representative, thereby limiting the development of effective policy responses and intervention strategies. Artificial intelligence (AI) approaches such as large language models (AI models that understand and generate language) can analyze large volumes of child maltreatment narratives by extracting population-level insights on factors of interest such as mental health and treatment needs. However, when applying such methods, it is useful to have a framework on which to base approaches to the data. We propose a seven step framework: (1) data governance; (2) researcher vetting; (3) data deidentification; (4) data access; (5) feasibility testing of baseline methods; (6) large-scale implementation of black box algorithms; and (7) domain expert result validation for such exercises to ensure careful execution and limit the risk of privacy and security breaches, bias, and unreliable conclusions.

Acceptance and commitment therapy (ACT) relies heavily on the between-session practice of therapeutic exercises to promote skill acquisition and improve psychological flexibility. However, adherence to this between-session practice remains a challenge. Mobile apps offer a promising solution to bridge this gap. However, few ACT apps focus exclusively on supporting clients in their between-session practice, and fewer apps involve stakeholders in their design. ACTaide, a therapy companion mobile app co-designed with stakeholders, addresses these barriers by guiding clients through ACT exercises and metaphors using annotated image sequences, supporting their between-session practice.

This study aimed to co-design ACTaide with therapists and clients, incorporating their feedback to ensure the app aligns with clinical goals and the needs of end users. The research explored stakeholder preferences and feedback on app functionality, design, and features to guide iterative design improvements.

Using a qualitative, user-centered design framework, we conducted 4 consecutive focus groups: 2 with 10 licensed ACT therapists and 2 with 14 psychotherapy clients. Each focus group included semistructured discussions and co-design activities. Data were collected through audio recordings and design artifacts (eg, sketches), which were analyzed using thematic content analysis.

A total of 9 themes were identified, reflecting areas of convergence and divergence between therapists and clients. The therapists and clients expressed enthusiasm for ACTaide as a tool to support between-session practice. Both groups emphasized the importance of a user-friendly, intuitive, and aesthetically appealing interface, with a preference for high-quality visuals over text-heavy features. Personalization and customization were viewed as essential for enhancing app engagement. The therapists prioritized accessibility and clinical appropriateness, voicing concerns about features that may be inconsistent with ACT principles, such as symptom rating scales, and clarified their role in app delivery. By contrast, the clients emphasized wanting greater interactivity and elements of gamification to improve engagement. Slight discrepancies were noted between therapists' preferences for minimal designs and clients' preferences for more vibrant and engaging aesthetics. Overall, both groups recognized the app's potential to address barriers to homework adherence and to extend the benefits of therapy into clients' daily lives.

The study illustrates the value of using a user-centered, co-design approach in the development of ACTaide, an adjunctive mental health app for the between-session practice of ACT exercises and metaphors tailored to therapist and client preferences. Through the integration of stakeholder feedback, the findings provide actionable insights for designing psychotherapy tools that balance clinical goals with user preferences. Future research will focus on testing high-fidelity prototypes to evaluate acceptability, usability, and engagement.

Just-in-time adaptive interventions (JITAIs) are a promising approach in mental health care given the potential scalability (ie, interventions are offered automatically and remotely) and preciseness (ie, the right interventions are offered at the right moments). Typically, a smartphone app is programmed to assess users' psychological states in daily life; when a particular state is detected, the app prompts users to engage in specific behaviors. Conceptually, JITAIs hold significant potential for precision health, although there is currently limited evidence in the literature.

We implemented this scheme as a smartphone intervention for daily stress management, based on cognitive behavioral therapy (CBT), and evaluated its feasibility and efficacy using a single-case experimental design.

A total of 8 Japanese adults (community sample: 4 women; mean 37.6, SD 13.1 y) were recruited. An AB phase design with multiple random baselines was used, where "A" represents the baseline phase and "B" represents the intervention phase. Throughout the study period (28 d), participants were prompted to indicate their momentary levels of stress (range 0-100) using a smartphone thrice a day. The baseline phase duration was randomly varied among participants, lasting between 7 and 14 days. The remaining period was used as the intervention phase (14-21 d), where 6 CBT-based exercises (ie, breath control, mindfulness, relaxation, self-talk, cognitive defusion, and cognitive restructuring) were offered depending on the reported levels of stress.

Approximately 70% (6/8) of the participants perceived the intervention to be useful and helpful. A randomization test detected a statistically significant decrease in reported stress levels after the intervention began (P=.005), though this effect was less pronounced when analyzed individually for each participant. Multilevel model analysis detected a significant acute reduction in the momentary level of stress right after completing a CBT-based exercise (pre-exercise: mean 47.98, SD 21.65; post exercise: mean 42.13, SD 19.88; P=.03; Cohen dz=0.58). Also, a significant reduction in depressive rumination was observed in the postintervention assessment (preintervention: mean 13.00, SD 3.21; post intervention: mean 9.25, SD 2.60; P=.01, Cohen dz=1.17).

The intervention was feasible and effective in reducing subjective stress (and rumination) in the study sample. The small sample size and the nonclinical nature of the sample may limit the generalizability and implications of the study findings for clinical practice. More evidence should be collected to draw solid conclusions for technical and technological as well as clinical aspects of mobile interventions. Accumulating exemplars with different implementations will clarify how a JITAI can be designed and developed on a mobile platform and how the program can be delivered in the prevention and treatment of mental ill health.

The number of women in the armed forces has steadily increased across all branches, even as the overall size of the military remains stable. The population of women veterans is also expanding. The existing literature has extensively reported the impact of military environmental exposures (MEEs) on adverse physical and mental health outcomes in service members and veterans; however, most of these studies focus on the experiences of men. In response to the growing need to address women-specific health care concerns, particularly for women with MEEs, the Women's Operational Military Exposure Network Center of Excellence (WOMEN CoE) developed and implemented the Women's Health Addendum (WHA).

The primary objective of this project is to (1) describe the development and implementation of a comprehensive health questionnaire for women veterans, (2) systematically describe and characterize the health conditions of women seeking care for MEE-related health concerns, and (3) use findings to inform clinic policies and develop targeted programs.

The WHA was introduced to assess the prevalence of health conditions that are female-specific, or disproportionately impact women; examine the relationship between these health conditions and MEEs; and use findings to improve care. The WHA was developed through an iterative process, incorporating literature review, veteran and clinician feedback, and clinical expertise. It consists of 81 questions across 7 categories related to health conditions across the lifespan and was implemented in 2 phases. Phase 1 was administered to women at the California War Related Illness and Injury Study Center (WRIISC), and phase 2 included women at the New Jersey and Washington, DC, WRIISC sites. Descriptive findings are presented here.

A total of 63 women participated in the program evaluation from October 2022 to April 2024. In phase 1, 39% (29/75) of the women who were invited agreed to participate. In phase 2, 34 (10%) of the 325 invited veterans responded. Several women's health conditions were reported, with approximately 97% (61/63) of women reporting at least one health condition and 87% (55/63) reporting 3 or more. Among respondents, the most prevalent conditions included sexual dysfunction (23/33, 70%), urinary incontinence (33/56, 59%), pelvic floor dysfunction (33/63, 52%), and pregnancy loss (20/45, 44%). Overall, more than 40% (3/7) of the most frequent conditions were related to urinary health and pelvic floor dysfunction.

Findings highlight the need for services related to women's health, especially for this cohort with MEE concerns seen at a tertiary care center. Initial findings emphasize concerns that women have about fertility and MEE experienced during deployments. Next steps include administering the WHA to women at sister WRIISC sites in real time and establishing a wider distribution network for the WHA. Future efforts to further evaluate the relationship between MEE and women's health concerns are underway.

Mental health support workers (MHSWs) are an important workforce within the mental health care system. Research shows that support services delivered by MHSWs are effective at improving the outcomes of individuals with mental illness. However, there is also literature suggesting that this group of workers are facing many challenges in their roles. This qualitative systematic review sought to explore, analyze and synthesize available primary research literature on the experiences of MHSWs with the aim of identifying the barriers to and facilitators of effective delivery of their roles. An electronic search of Medline, CINAHL, PsycINFO, and Web of Science was conducted for studies from database inception to March 28, 2025. Additional search was conducted via Google Scholar and in the reference lists of the included articles. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to assess the methodological quality of included articles. Fourteen primary research articles met the eligibility criteria and were included in the review. Data synthesis from these articles generated 116 findings and 20 categories, which were aggregated into four synthesized findings: a supportive work environment, service user care barriers, professional and role-related barriers, and operational and support barriers. The review highlights the importance of a supportive work environment in the delivery of support work roles. However, several barriers were also identified and recommendations that can be used to inform practice and policies of mental health support work provided. If addressed, the identified barriers can be translated into facilitators that would enhance the provision of quality care to people with mental illness and enhance the overall job satisfaction of MHSWs.

Cognition monitoring is crucial for care planning in people with mild cognitive impairment (MCI) and Alzheimer's dementia (AD).

To develop a machine learning model to assist cognition monitoring.

Florey Fusion Model (FFM) was constructed and validated in two phases: (i) model development and cross-validation using data collected via the Australian Imaging, Biomarker, and Lifestyle of Ageing (AIBL) study, and (ii) simulation and missing data trials with 30 new participants.

This prognostic study recruited 238 participants in the AIBL study. Support vector machine, gradient boosting and random forest were trialled to develop the FFM. Cognitive decline was assessed via changes in Clinical Dementia Rating Sum of Boxes (CDR-SB) and Mini-Mental State Examination (MMSE) scores. Model performance was evaluated by cross validation and compared against baseline models.

The FFM achieved a median area under receive character curve (AUC-ROC) of 0.91 (IQR 0.87-0.93) for MCI-to-AD progression prediction. A mean absolute error (MAE) of 1.32 (IQR 1.30-1.33) for CDR-SB and 1.51 (IQR 1.50-1.52) for MMSE was achieved for 3-year cognition forecast. Simulation and missing data trials yielded up to 94% accuracy for MCI-to-AD conversion and MAEs of 1.27-2.12 for CDR-SB score prediction.

The FFM holds the potential to facilitate cognition monitoring in people with MCI/AD; however, a larger trial will be required to refine it as a clinical grade tool.

This evaluation explored the adoption of sporting programs as an adjunct to the rehabilitation of inpatients with acquired brain (ABI) or spinal cord injuries (SCI). It investigated the characteristics of participating individuals, levels of participation, experiences, and uptake of sport in the community post-discharge.

Inpatients of three rehabilitation units were invited to engage in sporting sessions. Patient-reported measures of participation and exercise were collected at enrolment, hospital discharge, and 3-months post-discharge. Surveys measured perceptions of the program from participants and coaches. Qualitative interviews were conducted 3-months post-discharge to explore the uptake of sport in the community and were analysed using thematic analysis.

30 participants (ABI: 57%; SCI: 43%) consented to participate. The mean age of participants was 43 (SD = 18) and 80% (n = 24) were male. Qualitative interviews produced four themes: Participation enhanced the rehabilitation experience, operational factors impacted experience, Sporting programs were not considered a pathway to competitive sports and, Moving forward with sport in the community.

Participation in an inpatient sports program helped participants feel a sense of social connection and improved mental-wellbeing. It did not, however, improve links to sport in the community within the short time frame that follow-up was completed.