Technology-assisted sexual abuse (TASA) mostly involves the production and non-consensual sharing of sexual images; however, evidence-based support for young people (YP) who have experienced TASA is scant. Digital Health Interventions (DHIs) have the potential to increase access to support and provide timely therapeutic input in a familiar format to YP. However, studies describing engagement with DHIs is nascent. Our objective is to describe engagement patterns for YP people who used the i-Minds app.

The i-Minds app is a co-designed mentalisation-based DHI for YP who have experienced TASA. Usage data was collected during the 6-week intervention window using Matomo analytics software and analysed according to the AMUsED framework.

Forty-one participants were onboarded to the app. Of these, 95 % completed the introductory mandatory module, and nearly half completed the remaining three modules. Median duration of app engagement was 33 days. Most participants used the app on weekdays in the afternoon. Demographic variables, namely gender not matching with sex assigned at birth/prefer not to disclose and higher baseline clinical severity were associated with higher app engagement.

Participants showed high module completeness and engagement duration, suggesting the potential for real-world use. Potential participant-level predictors of engagement, such as gender identity and severity of TASA related traumatic stress and emotional distress, were identified. Achieving satisfactory engagement in DHIs is challenging yet necessary for delivering effective interventions. Future studies should explore participant-level predictors of engagement to inform real-world use of DHIs with a diverse sample.

Common mental disorders (CMD) are one of the main causes for work absenteeism. While traditional cognitive behavioural therapy is effective for symptom reduction, its impact on return to work is less pronounced. Work-focused therapy for those with CMD has shown positive results on return to work, but availability of such treatment is scarce.

To investigate a transdiagnostic work-focused Internet Delivered Cognitive Behavioural Therapy (W-ICBT) intervention. Further, to investigate its feasibility in terms of use and adherence, including the participants experience of perceived effects, for outpatients on sick leave with diagnoses of depression and/or anxiety.

We conducted a naturalistic feasibility study using a convergent, mixed-methods pre-post design. Outcomes included adherence and use of the treatment, return to work, work related self-efficacy, symptoms of depression and anxiety, quality of life and the experience of participants through qualitative interviews.

19 patients were screened, 15 included and 11 completed the 12-week treatment. Degree of sick leave was reduced from 79 % to 32 % for the completer sample (g = 0.95, p = .003), with statistically significant results on self-efficacy (g = 1.05 p = .005), depression (g = 0.81, p = .024), quality of life (g = 1.20, p = .002). No significant changes were observed on measures of anxiety and impairment of daily living. These results were supported by the findings from the qualitative interviews.

W-ICBT appears to be a promising approach to reducing work absenteeism and warrants further research.

Depressive disorders are increasingly recognized as a major public health challenge, especially in aging societies. This study aims to explore the impact of air pollution on the mental health of middle-aged and older adults, with a particular focus on identifying the vulnerable subgroups and underlying mechanisms.

We employ micro-level data to empirically examine how exposure to fine particulate matter (PM2.5) affects short-term mental health outcomes, as measured by the Centers for Epidemiologic Studies Depression Scale (CES-D). We also explore the potential mediating channels through which air pollution may influence psychological well-being, including sleep quality, life satisfaction, physical health, and cognitive functioning.

Our findings show that the increment in fine particulate matter (PM2.5) increases the scores of Centers for Epidemiologic Studies Depression Scale (CES-D), indicating a deterioration in mental health. The negative effects of air pollution are particularly pronounced among older adults, females, and widowed individuals. Mechanism analysis reveals that air pollution significantly worsens sleep quality, reduces life satisfaction, impairs cardiopulmonary health, and diminishes cognitive competence.

This study highlights the substantial mental health burden of air pollution, especially for vulnerable populations. We find suggestive evidence that improving access to pollution information and urban greening can help mitigate these adverse effects. Our findings underscore the urgent need for targeted public health interventions and environmental policies to address the mental health consequences of air pollution, particularly in the context of climate change and population aging.

People with disabilities experience significant health inequalities and barriers to healthcare access globally. While poverty alleviation interventions show promise for improving health outcomes, evidence specifically for people with disabilities remains limited. This study evaluated the effectiveness of a disability-inclusive graduation (DIG) programme on health outcomes among ultra-poor people with disabilities in Uganda.

We conducted a two-arm, parallel cluster-randomized controlled trial in four districts of Northern Uganda. Clusters were randomly assigned to either the DIG intervention (96 clusters) or control group (89 clusters). This analysis focused on households with people with disabilities, as identified by the Washington Group Short Set questions and verified by BRAC programme managers. Households in treatment clusters received up to 18 months DIG intervention between December 2020 and June 2022, combining asset transfers, cash support, skills training, financial inclusion activities, and disability-specific services including rehabilitation and assistive devices. The primary outcome was experience of illness/injury in the past 3 months, assessed at both first follow-up (immediately post-intervention) and second follow-up (about 16 months post-intervention), with secondary outcomes including unmet health needs, mental health status, unmet assistive product needs, and healthcare expenditure. Effects were estimated using linear mixed-effects regression or generalized estimating equations, reporting minimally-adjusted and fully-adjusted mean differences (FAMD) or odds ratios (FAOR) with 95% CIs. The trial was registered with RIDIE (RIDIE-STUDY-ID-626008898983a) and ISRCTN (ISRCTN-78592382).

At baseline, 691 participants (370 intervention, 321 control) were included. The DIG intervention did not significantly impact overall illness/injury prevalence at either first follow-up (41.18% vs 45.86%, FAOR 0.84, 95% CI 0.58-1.22) or second follow-up (55.65% vs 53.98%, FAOR 1.07, 95% CI 0.74-1.56). However, the intervention demonstrated a progressively strengthening effect on reducing unmet health needs, from marginal improvement immediately post-intervention (FAOR 0.56, 95% CI 0.31-1.02, p = 0.06) to significant reduction at 16 months post-intervention (FAOR 0.4, 95% CI 0.22-0.71, p = 0.002). Notably, the intervention produced temporal potential shifts in disease patterns, with malaria showing contrasting trends between follow-up periods. Sex-differentiated effects emerged by second follow-up, with females in the intervention group experiencing fewer injuries (FAOR for interaction 0.17, 95% CI 0.04-0.74, p = 0.02) but more pain-related conditions compared to males (FAOR for interaction 2.43, 95% CI 1.05-5.59, p = 0.04), though these subgroup findings require replication in future studies. No significant differences were observed in mental health outcomes or health expenditure.

This first randomized evaluation of a disability-inclusive graduation programme demonstrates that while economic empowerment alone may not reduce overall illness prevalence among people with disabilities, it can progressively improve healthcare access over time. The temporal evolution of effects and emerging sex-differentiated impacts highlight the need for sustained support and gender-sensitive approaches in future disability-inclusive poverty reduction programmes, with additional health-specific components to achieve broader improvements in health outcomes.

PENDA, funded by the UK Foreign, Commonwealth and Development Office.

Osteoarthritis is the leading cause of disability among older adults in the United States. People experiencing homelessness (PEH) face worse health outcomes and higher rates of musculoskeletal diseases than housed individuals. Despite this burden, PEH often lack access to orthopaedic care. This project examines surgical outcomes among PEH and investigates where in the care process barriers to access may exist.

New patient visits to the Zuckerberg San Francisco General Hospital Arthroplasty Clinic in 2022 were examined to establish a retrospective cohort. Patients were grouped by housing status, and data on demographics, disease severity, and comorbidities were collected. Analysis was performed using descriptive statistics and logistic regression. Presentation rate was calculated among clinic-presenting PEH and compared to a similarly captured population of patients on the San Francisco Health Plan.

Of 250 patients, 4 were unhoused and 41 were unstably housed. PEH and housing insecurity had worse Kellgren-Lawrence scores, higher rates of substance use, mental illness, HIV, and hepatitis C virus than stably housed patients. There were no differences in surgical progression, emergency department visits, readmission, reoperation, or follow-up. Significantly fewer PEH presented to clinic compared to those on the San Francisco Health Plan (X² = 11.37, P = .0007).

No differences in progression to surgery or surgical outcomes were found between housing groups. PEH accessed arthroplasty services less frequently than housed individuals. These findings suggest that PEH from the study population may be good surgical candidates and have limited access, but conclusions are limited by a short study follow-up.

Theory of mind (ToM) is fundamental for social interactions, allowing individuals to appreciate that others have their own mental states. Children and youth with neurodevelopmental conditions (e.g., autism, attention-deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD)) often show differences in ToM abilities compared to their neurotypical (NT) peers. Given the phenotypic heterogeneity and overlap associated with these conditions, this motivates a transdiagnostic investigation of ToM across neurodevelopmental conditions.

Five hundred and fifty-five participants (5-22 years; 193 ADHD, 189 autism, 33 OCD, and 140 NT) were recruited via the Province of Ontario Neurodevelopmental Disorders network. To measure ToM, participants completed the Social Attribution Task (SAT), where participants attribute social stories to videos of moving shapes. The Animation Index (ability to attribute social stories to the videos) and Pertinence Index (how pertinent the attributions are) were calculated from the descriptions. Three analyses were performed: (1) a case-control analysis, comparing the SAT indices amongst the diagnostic groups, (2) a univariate dimensional analysis, examining associations with phenotypic variables (e.g., full-scale IQ, verbal IQ, and social communication difficulties), (3) and a multivariate analysis (partial least squares) that identifies a latent space that describes the associations between the SAT and phenotypic measures.

There were no between-group differences in the Animation Index, but the Pertinence Index was significantly lower in autism compared to the other diagnostic categories. Phenotypic variables (full-scale IQ, verbal IQ, and social communication difficulties) were found to be significantly associated with SAT performance across groups, and explained more variance than the diagnostic categories. In the multivariate analysis, the phenotypic variables contributed more strongly to the identified latent component compared to the diagnostic categories.

The verbal requirement of the SAT limited the inclusion of non-verbal participants, while the overall cognitive demand limited the participation of those with lower IQs. Additionally, our OCD group was significantly smaller than the other groups, which may have limited our ability to detect OCD-specific effects.

In a large sample, we found that transdiagnostic measures, such as IQ and social communication difficulties, are related to SAT abilities across neurodivergent and neurotypical children and youth and better describe differences in SAT performance compared to the individual diagnostic categories. Although poorer performance on ToM tasks has been classically associated with autism, this study highlights that transdiagnostic, phenotypic variables are a stronger predictor of SAT performance than diagnostic group.

Undiagnosed depressive and anxiety disorders may be widespread. The study aimed to assess the prevalence and associated factors of undiagnosed depressive and/or anxiety disorders (DAD) among women in two low-resource countries, Bangladesh and Nepal.

Data were analyzed from 19,987 women (aged 15-49 years) in the 2022 Bangladesh Demographic and Health Survey and 7,442 women (aged 15-49 years) in the 2022 Nepal Demographic and Health Survey who completed the interview-administered nationally representative sub-survey component on mental health. DAD was categorized as either 'undiagnosed DAD' (meeting symptom criteria on the PHQ-9 and/or GAD-7 but without a prior diagnosis or treatment) or 'diagnosed DAD' (having a prior diagnosis and/or current treatment). Relative to diagnosed DAD, associations with undiagnosed DAD were estimated using logistic regression.

The analytic sample included 2,388 women in Bangladesh and 960 women in Nepal with undiagnosed DAD and diagnosed with DAD. The prevalence of undiagnosed DAD was 44.8% in Bangladesh and 60.0% in Nepal. In Bangladesh, in adjusted logistic regression analysis, having a big problem with permission to go to a health facility (Adjusted Odds Ratio-AOR: 1.53, 95% Confidence Interval (CI): 1.21-1.93, p < 0.001), being widowed (AOR: 2.04, 95% CI: 1.40-2.99, p < 0.001) and being divorced or separated (AOR: 2.30, 95% CI:1.40-3.77, p < 0.001) were significantly positively associated with undiagnosed DAD. Having secondary or higher education (AOR: 0.75, 95% CI: 0.58-0.97, p = 0.028) was significantly negatively associated with undiagnosed DAD. In Nepal, compared to the rich or richest wealth status, poor or poorest wealth status (AOR: 1.55, 95% CI: 1.09 to 2.21), compared to Bramin/Chhetri ethnicity, being Dalit (AOR: 1.77, 95% CI: 1.08-2.89) and being Janajati (AOR: 1.72, 95% CI: 1.17-2.54) were positively associated with undiagnosed DAD. Increasing age (AOR: 0.97, 95% CI: 0.96-0.99) was negatively associated and history of cervical cancer screening (AOR: 0.57, 95% CI 0.32-1.02) was marginally negatively associated with undiagnosed DAD.

Nearly half of the women in Bangladesh and three in five women in Nepal had undiagnosed DAD. Targeted interventions addressing these factors are needed to improve mental health screening and access to care for women in Bangladesh and Nepal.

Eating disorders are serious psychiatric disorders associated with high levels of co-occurring physical and mental health conditions and poor treatment outcomes. The collection of standardised, routinely collected data within clinical services holds promise to improve patient care.

To agree on a set of biopsychosocial variables for routine data collection within eating disorder services in the UK.

Two online workshops were conducted using an adapted nominal group technique to agree on priorities for data collection in adult and child/adolescent eating disorder services. Workshop participants (n=43) consisted of people with lived experience, carers, clinicians and researchers. Two researchers independently conducted a reflexive thematic analysis of the workshop transcripts to identify qualitative priorities for data collection. Descriptive statistics were used to analyse the results of online voting.

Thematic analysis identified four superordinate themes for data collection in eating disorder services: (1) a mutually valued and beneficial collaboration; (2) a holistic approach; (3) a balance between standardisation and individualisation; (4) doing no harm. Quantitative analysis of voting identified priorities across a range of domains, leading to a proposed biopsychosocial dataset.

This project agreed on a set of biopsychosocial variables for routine data collection in the UK Eating Disorders Clinical Research Network. Further research should evaluate the implementation success of these variables.

Patients, caregivers and clinicians support routine data collection in eating disorder services so long as the measures used are considered meaningful, not overly burdensome, non-stigmatising and collected in collaboration between patients and treatment providers.

Digital technologies can facilitate comprehensive mental health assessment of an individual's treatment needs, while also enabling data aggregation and analysis at the population or service level. The Service Needs Index (made up of clinical, psychosocial, and comorbidity components) collectively expresses a concise metric for the type, range, and complexity of young people's treatment needs. This study aimed to examine variation in the Service Needs Index across service settings and assess its potential to inform population-level mental health planning.

Using data from 1611 young people, we examined the Service Needs Index (made up of Clinical, Psychosocial, and Comorbidity subscores) across four mental health service populations (headspace Camperdown, urban headspaces, regional headspaces, and Mind Plasticity [a private practice in Sydney, Australia]). ANCOVA and pairwise comparisons were conducted controlling for age and sex. Bayesian logistic regression was used to examine the association between index scores and the odds of exceeding the Kessler-10 threshold for moderate psychological distress (K-10 ≥ 25).

There was significant variability in Service Needs Index scores (and subscores) between the four service populations. The private practice (Mind Plasticity) and regional headspaces had greater complexity than urban headspace services and headspace Camperdown. Complexity was driven by different patterns: Mind Plasticity had relatively higher clinical and comorbidity needs, while regional headspace services had higher clinical and psychosocial needs. Higher index scores were associated with increased odds of scoring in the moderate psychological distress range, with the Service Needs Index requiring the smallest score increase (6.1 units) to double the odds of scoring 25 or above on the K-10 (OR = 2.0).

The differences across service groups provide examples on how indices may shape policy and system-level decision-making in headspace services and other Primary Health Networks. The Service Needs Index measures complexity and could inform system-level decision-making by providing insights into trends, resource allocation, and the efficacy of interventions across broader groups.

In this position statement the British and Irish Hypertension Society (BIHS) present a review of the current evidence for blood pressure (BP) treatment thresholds and targets. The BIHS recommend initiating pharmacological antihypertensive therapy, irrespective of cardiovascular disease risk, following a confirmed diagnosis of hypertension (sustained out-of-office BP ≥ 135/85 mmHg despite diet and lifestyle advice). The BIHS recommend an on-treatment BP target < 130/80 mmHg or as low as reasonably achievable without causing unacceptable side-effects, within 6-months of initiating treatment, for all adults. Possible subgroups to whom this may not apply are those who are frail and/or have limited life expectancy where higher targets may be appropriate based on clinical judgement and the individuals' tolerance to treatment. The BIHS believe that this simple 2-step approach will facilitate practitioners deliver evidence-based best practice, discourage therapeutic inertia around BP lowering and improve heath outcomes for all adults living with high BP.