Psychiatrization may contribute to the deterioration of public mental health observed in recent decades. The cultural aspects of psychiatrization can be understood as a form of concept creep (progressive expansion) of mental health terminology. Over time, concepts of psychopathology have expanded to encompass a broader range of human experiences, potentially diluting their meaning. Accordingly, previous research has shown a gradual decline in the semantic severity of the word trauma. However, the semantic severity of anxiety and depression has been increasing over time.

This study aims to replicate and explain the increases in semantic severity of anxiety and depression by distinguishing between disorder constructs (clinical terms) and lay emotional constructs (everyday emotional terms) and assessing how their semantic severity changes over time. Additionally, we investigate whether mental health discourse and the broader context in which these terms appear influence these changes.

We analyzed the semantic severity of anxiety, depression, and trauma using leading paragraphs from 4.7 million New York Times articles (1970-2023). We extended this analysis to broader disorder constructs (both generic terms, such as mental illness, and specific terms, such as schizophrenia) and lay emotional constructs (eg, sad and worried). A word2vec model was used to estimate the degree to which these terms appeared in mental health-related contexts, and a Mental Health Index was developed to quantify shifts in discourse. Regression analyses were conducted to assess whether changes in semantic severity were influenced by time and context.

The semantic severity of depression increased significantly (τ=0.35; P<.001), while anxiety (τ=0.08; P=.42) and trauma (τ=0.10; P=.33) showed no significant change. However, when controlling for context, severity was consistently higher in mental health-related contexts, and the effect of time became nonsignificant. For specific mental disorder constructs (eg, schizophrenia), semantic severity decreased over time, whereas generic disorder terms (eg, mental illness) remained stable. Lay emotional constructs became increasingly associated with mental health discourse but showed no clear severity trend.

The increasing semantic severity of depression appears to be driven by its growing presence in mental health discourse rather than an inherent shift in meaning. The declining severity of specific, but not generic disorder constructs suggests that the overall representation of mental disorders remains severe, despite its expansion to less serious experiences. Meanwhile, ordinary emotions such as sadness and fear are increasingly discussed in mental health contexts. These trends highlight the evolving cultural framing of mental health and suggest that psychiatrization is shaping public perceptions of emotional experiences.

The approach to pediatric psoriasis requires special considerations, given the potential for negative consequences on overall physical and psychosocial health.

The aim of this study was to systematically review the literature to characterize the burden of pediatric psoriasis.

Papers assessing associations between pediatric psoriasis (in children <18 years old) and quality of life, physical symptoms (e.g., skin pain, itch, sleep disruption), and adverse psychological, social, and financial effects were searched with no date restrictions through July 2023. Databases searched included Ovid MEDLINE^®, CENTRAL, the Cochrane Database of Systematic Reviews, and PsycInfo. Articles were excluded if they focused on comorbidities (including psoriatic arthritis/enthesitis), were of low quality, or were not in English.

64 publications met eligibility criteria. Composite quality of life was the most frequently reported domain (40 publications) and was negatively impacted by psoriasis as a function of severity. Physical burdens, especially itch, occurred in 44.1-96.3% of children with psoriasis, while skin pain was less common. Psychosocial and family burdens were less frequently assessed and often with non-validated tools. Children with psoriasis participated less in social activities, but there were no clear associations between psoriasis and school performance or interpersonal relationships. Psoriasis was associated with a higher mental health burden on caregivers and greater family financial burden.

Psoriasis leads to high burden for pediatric patients and caregivers. Evaluation and management decisions should include and incorporate a thorough assessment of burden. Additional studies using validated tools are necessary to fully assess psychosocial and family burdens of psoriasis.

The majority of incident HIV infections among women in the US occur among Black cisgender women with significant heterogeneity by age. This study aimed to explore the differences in PrEP barriers and facilitators among Black young and older adult women in Baltimore, Maryland.

We purposively recruited young adult 18 to 29 (n = 12) and older adult women ages 30 to 44 (n = 14) from Baltimore, Maryland, who have never used PrEP to participate in a semi-structured interview. We utilized a combination of deductive and inductive coding to analyze the data. Coded segments were analyzed by age group and were presented using the socioecological model.

At the individual level, low PrEP awareness and knowledge, lack of perceived PrEP candidacy, and concerns about PrEP side effects and efficacy were barriers to PrEP interest. At the relationship level, monogamy and anticipated partner reaction to PrEP use (only for young adult Black women) were barriers to PrEP interest. At the community level, HIV stigma impeded PrEP interest, whereas sexual norms in college among young adult Black women contributed to PrEP interest. Finally, on a structural level, medical mistrust and PrEP costs were barriers to PrEP interest.

Taken together, these data suggest the need for increasingly tailored approaches to better serve young and older adult Black women. Engaging Black women in specific venues such as health centers on college campuses may be optimal to reach young adult Black women, whereas healthcare settings may be optimal to reach older adult Black women.

Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.

In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.

The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.

Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.

Implementation of community mental health in Indonesia has been limited and under-resourced. Pasung (physical restraint and confinement) is still commonly used and many people do not receive formal mental health care. While pluralistic use of traditional and faith healing and psychiatric services is common, the relationship between the two systems is ambiguous and overlooked in mental health policy. Meanwhile, examples of collaboration between health professionals and traditional and faith-based healers (TFHs) for mental health exist in various settings, including Indonesia. However, there is limited research on the lived experiences and everyday practices of those engaged in such partnerships, including mental health workers, healers, and families, and what makes them successful. This paper presents findings from the visual research project 'Together for Mental Health' to illustrate the facilitators and barriers to pluralistic collaborations in the Indonesian context. Our focus was on partnerships that were already established, rather than those implemented as part of research projects or interventions. Using visual ethnography, we observed eight case studies in locations representative of the three main religions in the country: Java (predominantly Muslim), Bali (Hindu), and Flores (Roman Catholic). We conducted filmed ethnographic observations of collaborative practices and in-depth interviews with 20 mental health professionals, 12 TFHs, 28 people living with mental health conditions, and 16 caregivers. The study found converging themes related to facilitating factors and barriers in practices of pluralistic collaboration for mental health care in Indonesia. Facilitating factors included actors' role perception and motive, openness to collaboration, and negotiations of care. Barriers included negative role perceptions, inadequate infrastructure, and unfavourable social environments. Findings suggest potential for successful collaboration between TFHs and formal mental health practitioners, drawing on lessons from existing good practices. To support future pluralistic collaboration for mental health care, incorporating these lessons into professional education and policies and stronger mental health care governance are needed.

ObjectivesTo provide actionable, co-designed ideas for how to optimize the built environment and service of inpatient stroke rehabilitation facilities.BackgroundInput from diverse stakeholders is needed to ensure that stroke rehabilitation spaces address the unique learning and practice needs of users. In this paper, we report the first phase of the Neuroscience Optimized Virtual Environments Living Lab (NOVELL) Redesign project.MethodWe engaged with key stakeholders across: (1) Four co-design workshops (n ranged between 23 and 31 people per workshop including stroke survivors, clinicians, and designers) to generate ideas for design innovation; (2) a workshop with a healthcare architecture firm responding to these ideas; and (3) an online prioritization task to rank outcomes from previous workshops.ResultsOutputs included: (1) A framework of objectives describing what is important in stroke rehabilitation environments and services; (2) 28 actionable design ideas for achieving these objectives; (3) 10 scenarios that integrate these design ideas and objectives to describe a speculative, visionary stroke rehabilitation facility; and (4) prioritization of these scenarios. Key scenarios included: Bedrooms that achieve the benefits of both a single and shared room; environments/services that allow stroke survivors access to appropriate levels of risk; and therapy spaces that provide supported challenge and real-world practice.ConclusionsWe identified opportunities for innovation that bring service design and architectural design together symbiotically. The interdisciplinary methods-combining co-design, Design Thinking, Speculative Futures, and Multi-Attribute Evaluation within a Living Lab framework-were successful in generating collaborative, actionable, and visionary design ideas.

Objective: To develop and validate a specialized scale for the diagnosis and evaluation of flavor perception disorders, providing a reference tool for clinical diagnosis and treatment. Methods: The core dimensions of the Flavour Perception Dysfunction Scale were identified, including basic information, type and degree of flavour perception disorder, impact on quality of life, and mental and physical health status. After initial development, the scale underwent expert consultation, with revisions based on feedback. The revised scale was administered to a clinical sample to measure its reliability (Cronbach's alpha coefficient) and validity (content validity and structural validity), validating its measurement performance. Results: The scale comprised 40 entries covering 3 sections: basic information, characteristics of flavour perception disorder, and assessment of quality of life impact and psychosomatic health. In 106 clinical samples, the internal consistency test of the scale showed a Cronbach's alpha coefficient of 0.979, with all dimensions>0.8; the split-half coefficient was 0.872. The content validity assessment showed that the content validity index of the scale reached 1.0 for the entries and 1.0 for both items and the full scale, demonstrating excellent content validity. For structural validity, the KMO test yielded a coefficient of 0.839 by KMO adaptability, and the Bartlett's test of sphericity was significant (P<0.05), supporting factor analysis. T Exploratory factor analysis extracted two factors, with a cumulative variance contribution rate of 87.725%, confirming high reliability and validity. Conclusion: The Flavor Perception Dysfunction Scale demonstrates strong reliability and validity, effectively assessing the severity of flavor perception disorders and their combined physical-psychological impacts. It provides a reliable tool for clinical diagnosis and intervention in flavor perception disorder.

Problem-solving courts (PSCs) are major diversionary programs in the United States (U.S.) criminal legal system, mandating substance use and mental health treatment as an alternative to incarceration. While they reduce recidivism, their impact on clinical outcomes remains uncertain. A significant challenge is ensuring participants have access to and remain in evidence-based medication treatments. Notable barriers to treatment engagement and retention include a lack of relationships between PSCs and community treatment providers, as well as pharmacotherapy expertise. A case study highlights the role of a clinical pharmacist in recovery courts. The pharmacist position was created to address a gap in substance use treatment expertise in recovery courts. The position was funded by a research grant and supplemented by the state court administrative office. The pharmacist role evolved into five categories, a liaison between recovery courts and providers; a medication consultant, educating and advising court staff on medications and toxicology test interpretation; court participant care, through medication reviews and adherence support; court educator, providing staff with up-to-date information on new treatments, contaminants, and practical medication considerations; and participant educator on similar issues. The case describes the value of integrating pharmacists in PSCs, enhancing treatment access, participant outcomes, and medication knowledge of court staff.

Patients transitioning from pediatric to adult HIV care have lower rates of retention in care and viral suppression. Health system interventions can improve outcomes in adolescents and young adults living with HIV (AYA-HIV). We designed and implemented an Adolescent Young Adult Healthcare Transition (AYAHCT) clinic in a U.S.-based healthcare system. We present a mixed-method (quantitative and qualitative) evaluation. The quantitative analysis included retrospective clinical outcomes between 2017-2023. Qualitative analysis included stakeholder interviews in pediatric, AYAHCT, and adult HIV clinics. The pilot cohort included 18 patients. Patients attended 4.4 visits/year, and retention in care was 100% in the first year in the AYAHCT clinic. However, only 70% of patients were virally suppressed. Seven patients (38.8%) transitioned to adult care, with 85.7% retention in care and 96.8% viral suppression. Stakeholders identified strengths including Ryan White funding, institutional support, and program adaptability. Stakeholders identified barriers, including HIV stigma and political climate in the Southern U.S., with resources needed for mental health, disclosure, and case management. We describe the initial outcomes of the AYAHCT cohort with a qualitative evaluation of clinical implementation. The pilot cohort demonstrated excellent retention across HIV care transitions but low viral suppression. Qualitative analysis revealed opportunities for program improvement.

Interventions targeting core characteristics of eating disorders (EDs) can effectively alleviate symptoms. However, it remains unclear whether these characteristics exhibit cultural specificity within the Chinese population. This study combines exploratory graph analysis (EGA) and network analysis to identify key psychological characteristics in Chinese patients with EDs.

The psychological characteristics of 1,001 patients with EDs were assessed using the Eating Disorder Inventory-1 (EDI-1). Nineteen representative items were selected and categorized into different dimensions through EGA. Network analysis was then performed to identify key psychological characteristics by determining central and bridge nodes.

In addition to the "ED-specific" and "Non-specific" categories, an unexpected category, "Perfectionism," was identified. Across these three categories, four key psychological characteristics were highlighted: "terrified of gaining weight," "guilty after overeating," "worry that feelings will get out of control," and "must do things perfectly."

Beyond drive for thinness, perfectionism and emotional regulation difficulties may represent key psychological characteristics among Chinese individuals with EDs. These findings could help inform the development of culturally tailored treatment strategies for EDs in China.