To help combat a shortage of child and adolescent psychiatrists and assist primary care providers in managing pediatric mental health care cases, the Medical College of Wisconsin established the Wisconsin Child Psychiatry Consultation Program. The program provides educational support to primary care providers with mild to moderate pediatric mental health concerns via phone or email consultation with board-certified child and adolescent psychiatrists, as well as offering on-demand didactic training sessions and assistance locating therapeutic resources.

We sought to assess participating primary care clinicians' satisfaction with consultations and their perceptions of program services, specifically its impact on self-reported diagnostic decision-making and patient outcomes.

Primary care providers' responses to both post-consultation and annual surveys were analyzed to determine the program's impact. Five survey questions used a 5-point Likert scale, and 1 "select-all-that-apply" question was included on the post-consultation survey.

Overall, 99.2% of respondents were satisfied with their most recent consultation. Additionally, mean Likert scale scores assessing provider confidence after program enrollment in the areas of diagnosing (mean 3.7, SD 0.8), prescribing medications (mean 3.6, SD 0.9), and managing child mental health problems (mean 3.5, SD 0.9) were all significantly greater than provider confidence before enrollment (P < 0.0001 for all).

Our study revealed that most primary care providers utilizing the Wisconsin Child Psychiatry Consultation Program find it a valuable resource for diagnostic decision-making and improving patient outcomes. This suggests that expanded utilization of the program should be encouraged.

Despite the growing enthusiasm for and a proliferation of digital mental health innovations, their integration into routine clinical care remains limited-often stalled at the pilot, research, or demonstration stage. This editorial argues that the successful adoption, scale-up, and sustainability of digital mental health innovations require intentional infrastructure, not just technology. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) implementation science framework, we examine how challenges across the seven framework domains (condition, technology, value proposition, adopters, organization, wider context, and their interactions over time) continue to hinder meaningful progress. We describe a focused digital mental health innovation infrastructure as a model for overcoming these barriers. Drawing on experiences from the Digital Innovation Hub at Canada's largest mental health and addictions teaching hospital, we illustrate how investing in the right infrastructure may move digital mental health innovations from "promising" to "impactful." We call for global collaboration to share knowledge and accelerate the real-world integration of digital innovations in routine mental health clinical care.

Personal support workers (PSWs) are often expected to provide ongoing support for complex conditions and have identified an increased need for training in several areas, including dementia and mental health. Web-based interventions may be helpful complements to traditional in-person continuing education and training, but their effectiveness must be explored further.

This study's objective was to evaluate the usability, usefulness, satisfaction with, and effectiveness of the web-based Dementia Foundations Program among unregulated care providers who provide care to persons living with dementia or are in training.

A cohort of 50 PSWs, PSW trainees, and paid care companions from 3 recruitment sites were invited to access the Dementia Foundations Program, a 4-hour self-paced web-based program composed of 4 courses, for up to 6 weeks. Usability, usefulness, and satisfaction were assessed using surveys after each course and following the program. Dementia knowledge and attitudes were measured using the Dementia Knowledge Assessment Scale and the Dementia Attitudes Scale, with differences between baseline and postprogram scores analyzed using repeated measures ANOVA.

Participants reported high levels of satisfaction with the program. Of the 50 participants, 46 (92%) agreed that the web-based training met their expectations, 47 (94%) agreed that the training covered a broad range of topics and was not missing any important content, and 49 (98%) agreed that the web-based training would benefit them. There was a significant postprogram improvement in dementia knowledge as measured by the Dementia Knowledge Assessment Scale, with an average 30% improvement across all cohorts. Dementia Attitudes Scale scores were also significantly improved postprogram across all cohorts.

This pilot study in PSWs, PSW trainees, and unregulated care companions demonstrated high satisfaction levels with the web-based Dementia Foundations Program. There were substantial improvements in knowledge and small improvements in attitudes for participants, and it was perceived as a useful tool that complemented their existing education and training. The Dementia Foundations Program is a user-friendly and effective e-learning program, which can be conveniently scaled and spread to enhance unregulated care provider dementia education.

Despite increased awareness and improved access to care, depression remains underrecognized and undertreated, in part due to limitations in how current assessment tools capture emotional distress. Traditional depression scales often rely on fixed diagnostic language and may overlook the varied and evolving ways in which individuals express depressive symptoms-particularly in digital environments. Social media platforms have emerged as important spaces where people articulate psychological suffering through informal, emotionally charged language. These expressions, while nonclinical in appearance, may hold meaningful diagnostic value.

This study aimed to develop and validate the Depression Scale for Online Assessment (DSO), a tool designed to capture ecologically valid expressions of depressive symptoms as articulated in digital contexts.

A cross-sectional, observational study was conducted with a community sample of 1216 adults, from which 1151 valid responses were retained for analysis. The scale's items were developed based on expert reviews and social media research. To identify the factor structure, exploratory factor analysis (EFA) was conducted on a randomly selected half of the sample (n=575), followed by confirmatory factor analysis on the remaining half (n=576) to validate the model. Internal consistency was assessed following the EFA, and convergent validity was examined by correlating each DSO factor score with established depression measures, including the Korean version of the Center for Epidemiologic Studies Depression Scale-Revised and the Patient Health Questionnaire-9.

EFA identified a 5-factor structure (ie, social disconnection, suicide risk, depressed mood, negative self-concept, and cognitive and somatic distress) that explained 66.53% of the total variance, indicating an acceptable level of explanatory power for a multidimensional psychological construct. confirmatory factor analysis indicated acceptable model fit (χ²₁₀₉=403.5, P<.001; comparative fit index=0.96; Tucker-Lewis index=0.95; standardized root-mean-squared residual=0.03; root-mean-square error of approximation=0.07). The scale showed high internal consistency (total Cronbach α=0.95), and subscales were significantly correlated with the Center for Epidemiologic Studies Depression Scale-Revised (r=0.68-0.77) and the Patient Health Questionnaire-9 (r=0.64-0.74), supporting convergent validity.

The DSO is a psychometrically sound and clinically relevant tool that captures both core and emerging expressions of depression. Its digital adaptability makes it especially useful for research and clinical practice in mobile and remote care settings.

The United States (US) faces a mental health crisis characterized by persistent unmet mental health needs, provider shortages, and pronounced mental health inequities for systematically marginalized communities, including the Latine population. Integrating community health workers (CHWs) into mental healthcare delivery via task-shifting is one promising approach to address longstanding inequities in treatment access. Yet, most studies of CHW mental health models have been conducted outside of the US, necessitating an evaluation of the evidence base for these models domestically, and in particular, their use with Latines living in the US. This systematic review examines the evidence for CHW-delivered mental health interventions for US-based Latines. In total, 27 articles (25 trials) met the eligibility criteria. The majority of interventions were delivered in Spanish to immigrant populations. The most common mental health targets included depression, stress, and parenting or the parent-child relationship. Common intervention components included psychoeducation, general coping skills, behavior management, case management, communication skills, relaxation, and problem solving. The majority of studies found that CHW-delivered interventions led to significant mental health symptom improvements. However, there was a high risk of bias across studies. Thus, there is promising preliminary evidence supporting CHW-delivered mental health interventions for US Latines, but more rigorous evaluation of these models is needed.

Working memory (WM) plays a pivotal role in cognitive processes; yet, its resources are strictly limited, making it crucial to understand how these resources are allocated. Motivation, such as reward and punishment, has been widely recognized as a key factor influencing WM. Previous research has either examined the impacts of reward and punishment on the availability of WM resources separately or focused solely on the effects of reward on resource allocation. We posit that integrating these effects into a single study is essential for a comprehensive understanding of their interplay. To this end, we conducted three experiments using a delay estimation task, combined with the Target Confusability Competition model, to systematically investigate how reward and punishment affect the availability and allocation of WM resources. In Experiment 1, participants memorized the orientations of two arrows, each associated with reward or punishment cues. In Experiments 2 and 3, participants encountered both reward and punishment cues within the same trial, testing three hypotheses about resource allocation: reward dominance, punishment dominance, and no difference. Results from Experiment 1 revealed that reward and punishment equally enhanced the availability of WM resources. In Experiment 2, which was the first to integrate rewards and punishments within the same trial, reward prioritized the allocation of WM resources over punishment. Eye-tracking data from Experiment 3 indicated that this effect was driven by greater attentional focus on reward targets, which led to more WM resource allocation. We provide novel evidence that reward outweighs punishment in WM resource allocation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In China, government-funded free treatment programmes have substantially expanded access to mental healthcare for patients with severe mental illnesses (SMIs). However, the effectiveness and patient satisfaction associated with these programmes can vary significantly. Understanding the factors underlying these variations is crucial for optimising patient adherence and rehabilitation outcomes.

To identify factors influencing SMI patients' satisfaction with a government-funded free treatment programme in District S, Nanjing, China, and propose targeted measures to enhance the programme's effectiveness and improve patient outcomes.

A cross-sectional study.

This study was conducted in 23 community healthcare centres in District S, Nanjing, China, from January to July 2022. A total of 924 SMI patients enrolled in the programme were selected using a two-stage random sampling method. Data on patients' individual characteristics, health behaviours and satisfaction with the programme were collected by a self-developed structured questionnaire. Guided by Andersen's Behavioural Model, hierarchical logistic regression analysis was employed to determine factors associated with patient satisfaction.

Among the 924 valid responses, 51.3% of patients with SMIs reported low satisfaction with the programme. Factors associated with patient satisfaction included individual predisposing, enabling, need and health behaviour variables. Specifically, patients who were employed, had schizophrenia, experienced adverse drug reactions, feared program exposure of their condition and received treatment in hospital were more likely to report lower satisfaction.

This study revealed that satisfaction among SMI patients with the programme remains low, with patient satisfaction primarily determined by individual need and health behaviour factors. Policymakers and stakeholders should implement targeted measures to address these factors and improve patient satisfaction.

The findings offer new insights and scientific bases for policymakers seeking to improve the programme and practical recommendations for stakeholders to develop effective solutions.

STROBE guidelines.

No patient or public contribution.

The spatiotemporal distribution of depressive tendencies across China from 2011 to 2022 was investigated using the Baidu Depression Search Index (BDSI). We examined key influencing natural factors, such as water pollution, air pollution, and deforestation, along with economic indicators, such as gross domestic product per capita, disposable income per capita, and health professionals per 10,000 population. Geographical and Temporal Weighted Regression (GTWR) was applied to capture the spatiotemporal heterogeneity of the BDSI determinants. The results revealed significant regional disparities, with the China's eastern region consistently exhibiting the highest values reflecting heightened mental health concerns, while the western region were found to have the lowest. The BDSI trends followed different trajectories, all of which peaked in 2019 before a sharp decline in 2020. Water pollution transitioned from negative to positive influence in the East, while deforestation exhibited regionally variable effects. Air pollution, peaking in 2019 and 2022, demonstrated the highest impact variability. The economic indicators showed complex regional and temporal patterns underscoring the need for tailored interventions. Together, these findings provided critical insights into the intricate interplay between environmental, economic, and healthcare factors in shaping mental health that highlighted the necessity of region-specific policies to mitigate depressive tendencies and enhance public mental well-being. These research results offer targeted recommendations for regionally adaptive mental health strategies across China.

The premorbid phase of treatment-resistant schizophrenia (TRS) may reveal underlying mechanisms and inform early interventions. According to the neurodevelopmental hypothesis, treatment resistance may be linked to pronounced developmental impairments. We examined school grades and attendance trajectories in children who later developed TRS.

This case-control study analyzed school grade point average and attendance among all individuals born after 1990 and started on clozapine in Chile's public health system as a proxy for TRS. Control groups included children later diagnosed with treatment-responsive schizophrenia, bipolar disorder, and unaffected classmates. Linear mixed models accounted for individual and school-level confounders.

We included 1072 children (9929 observations, 29.3% female) subsequently diagnosed with TRS, 323 (2802 observations, 25.7% female) with schizophrenia, 175 (1784 observations, 53.8% female) bipolar disorder, and 273,260 (533,335 observations, 47% female) unaffected classmates. Children who later developed TRS had worse grades across levels than their classmates (-0.26 SD [-0.2, -0.4]), but not treatment-responsive schizophrenia. All severe mental illness groups showed grade declines in later school levels, with TRS showing steeper linear decline than treatment-responsive schizophrenia (group×age of -0.03; 95%CI -0.04, -0.01) and steeper quadratic decline than bipolar disorder (group×age² of -0.005; -0.01, -0.001). Attendance declined over time in the two groups developing schizophrenia compared to their classmates. Those developing TRS experienced the sharpest drop (group×age compared to schizophrenia -0.03; -0.05, -0.01 and bipolar disorder -0.027; -0.049, -0.006).

TRS may stem from a more aggressive pathological process or pronounced late-maturation abnormality, rather than an early premorbid impairment, suggesting an intervention target.

The availability of diverse assessment methods, based on different devices and conditions, for respiratory sarcopenia is crucial for developing community health initiatives. Thus, in this study, we aimed to compare the concordance in diagnosing respiratory sarcopenia based on the maximal respiratory pressure (MRP) and peak expiratory flow rate (PEFR), which are specific indicators of respiratory-muscle strength, in a community-dwelling older adult population.

In the Otassha Study conducted in 2023, 499 community-dwelling adults aged >65 years in Itabashi Ward (184 men and 315 women) were evaluated for MRP, PEFR, walking speed, grip strength, and appendicular skeletal muscle mass (ASM). We determined two respiratory-sarcopenia models using low skeletal muscle mass and low MRP/PEFR (both <80% for predicted values). Pearson correlation coefficients were used to compare each measurement; the agreement between respiratory sarcopenia diagnosed using low MRP and PEFR was evaluated using kappa coefficients (κ).

PEFR was correlated with MRP (maximal expiratory pressure: r = 0.415; maximal inspiratory pressure: r = 0.380; P < 0.01, respectively). A moderate level of agreement was found between respiratory sarcopenia diagnosed using MRP and that diagnosed using PEFR (κ = 0.597, match rate = 87.2%), suggesting a fair consistency level between the methods.

Although PEFR had a moderate correlation with MRP, the concordance of respiratory sarcopenia diagnosed using the two methods was moderate, suggesting that the two approaches are partially interchangeable and are complementary. The findings showed that PEFR, proposed as an alternative to MRP, is valid for diagnosing respiratory sarcopenia, supporting its role as an alternative to the gold standard for evaluating respiratory-muscle strength. Geriatr Gerontol Int 2025; ••: ••-••.