Children's exposure to trauma is a ubiquitous stressor associated with severe adjustment problems. Although mental health services can effectively reduce this distress, families often spend months waiting for treatment. Beyond timely access to care, the needs and concerns of families on the waitlist for trauma-focused treatment are unknown. In the present study, we addressed this gap by conducting interviews with key participant groups: adult caregivers with a child on the waitlist for trauma-focused services (n = 16) and providers of trauma-focused treatment (n = 17). Participants completed semistructured interviews on the needs and concerns of families on the waitlist for trauma-focused mental health services for their child. Interview transcripts were analyzed using a combination of deductive and inductive thematic analysis. Consolidated thematic coding yielded four themes related to waitlist concerns: waitlist duration, worsening symptoms, family not feeling supported, and safety. Six additional themes emerged related to waitlist needs: parenting services, psychoeducation on trauma, check-ins on well-being and status, case management, financial resources, and referrals to other services. The results suggest that both caregivers and providers are largely aligned in their perspectives of the needs and concerns of families on the waitlist for trauma-focused treatment. Several of the identified needs could be addressed by low-intensity interventions delivered by paraprofessionals. The accessibility and appropriateness of providing support to families on the waitlist for treatment should be explored.

As adults age, most aspects of their living environment, physical and mental health, personal relationships and perspectives on life change. The ability of older adults to adapt to this myriad of physical and social changes, known as environmental press, is important for maintaining autonomy and well-being as they age. Understanding the concept of environmental press for older adults could improve person-centred care provided by gerontological nurses.

To analyse the concept of environmental press in relation to aging older adults and gerontological nursing.

Walker and Avant's 8-step method of concept analysis was used to examine and understand the theoretical framework of Environmental Press for older adults as it applies to gerontological nursing. A search of databases (PubMed, Library of Congress, WILEY Online Library, EBSCO, ProQuest and Scopus) with the key words "environmental" and "press" and "older" and "person" in titles and abstracts identified 169 studies. Removal of duplicates and screening of 139 abstracts produced 15 full-text articles. A total of eight articles related to environmental press were analysed for this study.

Three defining attributes for the concept of environmental press were identified that could help gerontology nurses provide person-centred care for aging older adults: (1) their internal and external environments; (2) their social and physical environments; and (3) their physical and psychological competence. These attributes can positively or negatively influence environmental press and outcomes of well-being and quality of life for aging older adults.

Attributes of environmental press can influence the ability of older persons to meet the demands of aging. Understanding the concept of environmental press can help gerontological nurses provide person-centred care that includes strategies for addressing changes in the lives of older adults and improving outcomes, which could improve quality of life.

Engage is an empirically-supported brief behavioral intervention for later-life depression yet to translate from randomized controlled trials to implementation. This study evaluated a real-world implementation demonstration of Engage across a geriatric mental health care setting.

The exploration, preparation, implementation, sustainment framework guided this demonstration. Interprofessional case managers received training and ongoing consultation in Engage and applied it with older adults with depression over four months. Upon completion of the implementation trial, providers participated in a 1-h focus group to provide feedback about training, treatment perceptions, and facilitators and barriers to implementation. Focus group transcripts were double-coded using thematic analysis to extract themes informed by the Consolidated Framework for Implementation Research (CFIR).

Thirteen themes emerged from focus groups (N = 21 provider participant respondents) related to CFIR constructs of innovation adaptability, innovation design, critical incidents, compatibility, access to knowledge and information, need, and capability. Findings suggest that Engage is feasible and fits the needs of providers, patients, and the healthcare system. Implementation barriers included depressive symptom burden, patient complexity, and therapist concerns related to self-efficacy and previous experiences.

Provider feedback can inform and strengthen implementation of evidence-based psychotherapies such as Engage.

Psychiatrists and anthropologists both rely on observation, discourse analysis and access to participants' internal and external worlds. Ethnographic fieldwork, a key method in medical anthropology, offers a powerful tool to establish a robust evidence base of how to address mental health inequalities in ethnic minority communities.

A growing body of evidence suggests a high prevalence of comorbidity between functional gastrointestinal disorders (FGIDs) and mental health conditions, with clinical studies consistently highlighting strong associations between FGIDs and psychosocial factors. Despite the well-established connection, the exploration of the underlying mechanisms in animal models remains relatively limited. This review synthesizes key findings from academic research published over the past decade, systematically investigating the potential mechanisms linking FGIDs with psychiatric disorders. Core mechanisms include the gut-brain axis, gut microbiota interactions, neuroimmune processes, dysregulation of the endocrine system, and inflammatory signaling pathways. By integrating current interdisciplinary evidence, this review seeks to advance foundational research on FGID-psychiatric comorbidity and provide insights into the development of more targeted therapeutic strategies. Ultimately, deepening our understanding of the mechanisms driving this comorbidity holds the potential to alleviate patient burdens and improve healthcare outcomes through mechanism-driven interventions.

Distress related to perceived dignity (DPD) has been associated with mental health comorbidity, intensive treatment, and quality of life among patients with rheumatic diseases (RMDs). Within the RMD landscape, each individual diagnosis might present with distinctive sociodemographic characteristics, clinical phenotypes, and prognoses, all of which shape the patient's perceived dignity. The study utilized a cross-sectional design to determine the impact of underlying RMD diagnosis on DPD phenomenon and to compare DPD patterns in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc). Between February 2022 and April 2023, consecutive outpatients diagnosed with SLE, RA, and SSc completed the Mexican version of the Patient Dignity Inventory (PDI-Mx), along with additional patient-reported outcomes, which assessed participants perceived mental health, resilience, disease activity/severity, family functioning, fatigue, disability, quality of life, and satisfaction with medical care (SMC). A score of 54.5 or higher on the PDI-Mx was defined as indicating DPD. The attending rheumatologist determined the adequacy of control for the underlying RMD, comorbidities, and RMD diagnosis. Multivariate logistic regression analyses were performed to identify the factors associated with DPD. There were 137 patients (38.3%) with SLE, 124 (34.6%) with RA, and 97 (27.1%) with SSc. Among them, 88 patients (24.6%) had DPD. SSc diagnosis (exp ß, 95% confidence interval [95% CI] and P value: 0.291, 0.109-0.773, .013), World Health Organization Quality of Life-Brief questionnaire score (0.953, 0.926-0.980, .001 [irrespective of the specific dimension]), age (0.970, 0.942-0.999, .040), at least moderate severity for depression (9.512, 4.019-22.021, ≤.0001), 1-year previous hospitalization (2.673, 1.249-5.723, .011), Health Assessment Questionnaire Disability Index score (2.495, 1.409-4.420, .002), Routine Assessment of Patient Index Data score (1.084, 1.015-1.158, .016), and Functional Assessment of Chronic Illness Therapy score (1.023, 1.006-1.041, .009) were the factors associated with DPD, with an R² of 0.627. Overall, scores for PDI-Mx and its corresponding domains were similar across the 3 patient groups. Among patients with SLE, RA, and SSc, a diagnosis of SSc was found to be a protective factor against DPD. We also identified other protective factors, including age and quality of life. On the other hand, mental health comorbidity, disability, and more severe clinical phenotypes were associated with an increased risk of DPD.

To explore the relationship between the level of parental control and peer relationships and prosocial behavior of junior high school students.

In June-July 2022, a total of 2564 junior high school students were selected from one junior high school in each of the urban, rural and combined urban and rural areas of Xuancheng City and Suzhou City, Anhui Province, using random whole cluster sampling to collect data using the Level of Parental Control Scale, the Tendency to Prosocial Behavior Scale for Junior High School Students, and the Children's Junior High School Student Peer Relationships Scale, and the SPSS 25.0 software was used to data were analyzed, descriptive analysis, t-test, ANOVA and correlation analysis were performed on the data, and the mediating effects of parental control and prosocial behavior were verified using the bias-corrected nonparametric percentile Bootstrap method.

The study population consisted of 1281 boys and 1283 girls, aged between 11 and 17 years with a mean age of(13.39±0.80) years. Male students had higher parental control score than female students(185.31±27.49 vs 178.21±25.13, P<0.01) and male students had lower peer relationship score than female students(47.13±10.84 vs 48.41±11.26, P<0.01). Rural students had lower parental control scores than urban and urban-rural students(172.47±25.40 vs 183.03±24.63 vs 190.37±26.61, P<0.01). Rural students had higher peer relationship scores than urban and urban-rural students(49.57±10.57 vs 48.33±10.84 vs 45.25±11.39, P<0.01). Rural students had lower pro-social behavior scores than urban and combined urban and rural students(86.27±16.98 vs 91.64±17.26 vs 95.14±19.27, P<0.01). The differences in parental control and peer relationship scores among middle school students of different genders were statistically significant(P<0.01). The differences in parental control, pro-social behavior and peer relationship scores among students from different cities, urban-rural areas and rural areas were statistically significant(P<0.01). Parental control was positively correlated with both pro-social behavior scores of junior high school students(r=0.315). Peer relationship played a masking effect between parental control and junior high school students' pro-social behavior(a×b and c' heteroscedastic, |a×b|/c'=8.50%). Among students in rural and urban-rural combined areas, peer relationship played a masking effect between parental control and junior high school students' prosocial behavior(a×b and c' heteroscedastic, |a×b|/c'=17.81%), and the mediating effect of peer relationships was not statistically significant among students in urban areas(Bootstrap 95% CI-0.0157-0.004).

Parental control positively affects peer relationships and prosocial behavior among junior high school students, and good peer relationships significantly and positively affect the development of pro-social behavior among junior high school students; the mediating effect of peer relationships between parental control and prosocial behavior varies with urban and rural areas.

Pediatric concussion can affect the autonomic nervous system. Understanding the prevalence and characteristics of physiological autonomic dysregulation (AD) and symptom provocation following concussion is crucial for optimizing recovery and developing targeted interventions.

To determine the prevalence of AD and symptom provocation upon postural change and to (1) explore the overlap between AD and symptom provocation, (2) apply adult orthostatic tachycardia criteria (heart rate [HR] ≥30 bpm) to this pediatric population, (3) explore associations of demographic and injury characteristics with AD and symptom provocation, and (4) characterize AD presentation and identify the predominant orthostatic sign.

This retrospective cohort study used electronic medical record review of clinical data at tertiary care concussion clinics that operate as a learning health system in Canada. Patients aged 5 to younger than 18 years who presented to those clinics within 45 days of a diagnosed concussion between August 2022 and January 2024 were included. Analysis was conducted from April to October 2024.

Diagnosis of concussion.

Primary outcomes were AD presence (defined as the presence of either a decrease in systolic BP [≥20 mm Hg], decrease in diastolic BP [≥10 mm Hg], or increase in HR [≥40 bpm]), and symptom provocation (new or worsening). HR, blood pressure (BP), and symptoms were measured after a 2-minute supine rest and 1 minute of unsupported standing.

Of 764 eligible patients, 451 (231 female [51.22%]; 129 [28.60%] aged 5-11 years and 322 [71.40%] aged 12 to <18 years) were included; objective AD was identified in 45 patients (9.98%; 95% CI, 7.54%-13.09%), primarily by HR changes (22 of 45 patients [48.89%]). When applying adult tachycardia criteria, AD prevalence was 23.73% (95% CI, 20.03%-27.88%). Orthostatic symptom provocation occurred in 103 of 445 patients (23.15%; 95% CI, 19.47%-27.28%). Among 134 patients with either AD or symptom provocation, 12 (8.96%) exhibited both. Patients with AD had higher rates of neurodevelopmental disorders than patients without AD (15 of 45 patients [33.33%] vs 75 of 406 patients [18.47%]; P = .02), while symptom provocation was associated with female sex (63 of 103 patients [61.17%] vs 166 of 342 patients [48.54%]; P = .03), preexisting mental health disorders (28 of 103 patients [27.18%] vs 45 of 342 patients [13.16%]; P < .001), higher concussion symptom burden (median [IQR] symptom intensity score, 46.00 [16.00-67.00] vs 21.00 [6.00-46.00]; P < .001), and status of posttraumatic amnesia at injury (22 of 103 patients with posttraumatic amnesia [22.68%] vs 63 of 342 patients without [18.92%]; P = .009).

In this cohort study of children and adolescents with concussion, approximately 1 in 10 exhibited AD and 1 in 4 exhibited symptom provocation. The observed low concordance between physiological AD and symptom provocation, along with their distinct clinical profiles, might suggest these represent separate phenomena in pediatric concussion; future research should explore whether incorporating both measures into clinical assessments enhances understanding of concussion and informs targeted interventions to optimize recovery.

There are few effective pharmacotherapies for treating eating disorders (EDs). High rates of substance use among individuals with EDs suggest potential self-medication of symptoms.

To explore the experiences of individuals with EDs regarding use of prescribed and nonprescribed drugs.

This survey study assessed responses to the Medications and Other Drugs for Eating Disorders (MED-FED) survey, which was advertised internationally using social media, online forums, and clinical services and recruited adults who self-reported an ED or disordered eating from November 10, 2022, to May 31, 2023. The online survey queried about recent prescribed and nonprescribed drug use as well as the perceived benefits and harms of each substance.

EDs or disordered eating and co-occurring mental health conditions. Substances evaluated included caffeine, alcohol, nicotine, cannabis, prescription psychotropics, psychedelics, ketamine, 3,4-methylenedioxymethamphetamine (or ecstasy), stimulants, opioids, and other drugs.

Respondents described drug use over the past 12 months. For each drug used, they rated their agreement or disagreement on a 5-point Likert scale (-2, strongly disagree; -1, disagree; 0, neutral; 1, agree; or 2, strongly agree) with the following 3 statements: (1) this medication/drug makes my eating disorder symptoms better; (2) this medication/drug has overall benefits for my mental health; and (3) this medication/drug has unpleasant side effects.

There were 7648 participants recruited, of whom 6612 completed the demographic portion, and 5123 completed the entire survey. Among the 6612 respondents (mean [SD] age, 24.3 [7.7] years), the sample was predominantly female (6217 [94.0%]), and most resided in Australia (1981 [30.0%]), the UK (1409 [21.3%]), or the US (1195 [18.0%]). Diagnosed EDs included 2696 (40.8%) individuals with anorexia nervosa, 1258 (19.0%) with bulimia nervosa, 757 (11.4%) with binge-eating disorder, and 589 (8.9%) with avoidant/restrictive food intake disorder. Many respondents (2493 [37.7%]) were undiagnosed. Psychiatric comorbidities were highly prevalent; depression was reported by 4333 respondents (65.5%). Cannabis and psychedelics were highest-rated for improving ED symptoms. Prescription antidepressants were rated highly for overall mental health but not for ED symptoms, with the exception of fluoxetine for bulimia nervosa and lisdexamfetamine for binge-eating disorder. Alcohol, nicotine, and tobacco were rated as the most harmful drugs.

The findings of this survey study of prescription and nonprescription drug use suggest that cannabis and psychedelics were perceived by survey respondents as efficacious in alleviating their ED symptoms, which supports further research in this area. Prescription psychotropics were perceived as being relatively ineffective for ED symptoms but beneficial to general mental health.

Suicide rates have increased in recent years to the third leading cause of death among youths. Children presenting to the emergency department (ED) for suicide thoughts and behaviors (STB) are at high risk for recurrent mental health (MH) concerns.

To quantify rates of STB among children presenting to EDs across the US and to identify risk factors for return ED visits for STB.

This cohort study examined electronic health records of children who presented to the ED from January 2010 to December 2020 using the State Emergency Department Database within the Healthcare Cost and Utilization Project. All ED visits were screened among children aged 8 to 12 years in 12 states with data linking patients across visits. International Classification of Disease (ICD) codes separated non-STB MH and STB-related visits. Data were analyzed from August 2024 to January 2025.

Analyses examined characteristics of visits for MH vs STB and patients returned for subsequent ED visit(s) for STB. Analyses compared visits for MH vs. STB and examined factors related to subsequent ED return visit(s) for STB. This included sociodemographic, clinical, and temporal factors derived from electronic health records.

A total of 10 131 432 ED visits were screened, and 627 517 visits (6%) among 374 118 unique patients implicated ICD codes for non-STB MH causes (534 654 visits [5%]; mean [SD] age, 10.25 [1.41] years; 189 701 female [35%]) or STB (92 863 visits [1%]; mean [SD] age, 10.87 [1.27] years; 50 679 female [55%]). MH and STB visits increased from 36 623 ED visits (5%) in 2010 to 22 443 ED visits (10%) in 2020. Compared with non-STB MH visits, patients with STB were more likely to have private insurance and reside in areas with higher income and less deprivation (via linkage to social deprivation index). There was an age-by-sex interaction (z = 48.22; P < .001); a greater percentage of STB patients were female at older ages vs younger ages. Suicide behaviors mostly implicated injury by ingestion (7121 [43%]) or sharp or blunt object (6518 [39%]). Additionally, 68 897 patients had multiple ED visits (18%), 6537 with multiple STB visits (10%); 117 377 of 187 864 return ED visits were within 3 months (62%). STB was strongly associated with ED return for STB (aOR, 9.71 [99% CI, 9.66-9.76]; z = 127.93). Return STB visits within 1-year were more common for females and patients with more MH comorbidity, longer initial visits, and without private insurance.

Suicide risk is common but remains understudied among children. Early suicide risk was associated with recurrent STB, particularly in the months following ED discharge. Understanding risk and protective factors among children can enhance ED screening, intervention, and follow-up care.