Frontline occupations, including military, healthcare, and first responders, often include frequent exposure to traumatic events, increasing the risk of substance use disorders (SUDs). Research has shown that those in high-intensity occupations are at higher risk of developing SUDs compared to the general population. Women face unique experiences related to substance use, including greater functional impairment and barriers to treatment access. Yet, understanding of the effectiveness of digital health technologies in addressing substance use among women in frontline occupations is limited. This systematic review evaluates the effectiveness of digital health interventions in reducing substance use among women in frontline roles. Four databases (PsycINFO, Ovid MEDLINE, Embase, PsycArticles) were searched for English language full-text articles (2007-2024) that (1) evaluated a digital intervention designed to reduce substance use, (2) reported changes in substance use outcomes such as frequency, intensity or duration, using validated tools (3) included current or former frontline public service workers, and (4) included women as the primary target population or as a subgroup within the sample. 13 papers met inclusion criteria, focusing on eight distinct web and mobile-based interventions for alcohol, tobacco and illicit substances. Most studies (n = 11) reported substantial post-intervention reductions in alcohol and tobacco use, although results for PTSD symptoms, illicit drug use, and quality of life were mixed. This review highlights the potential of digital health interventions for reducing substance use but underscores significant gaps in research. The scarcity of studies focused on women, small and heterogeneous samples, and focus on veterans limits the generalisability to women in frontline roles. These gaps present a pressing challenge in understanding gender-specific digital intervention efficacy. Future research should prioritise larger, representative samples of women across diverse frontline occupations to drive the development of digital technologies tailored to the unique challenges faced by women in these roles.

Little is known about how gender identity develops and how it affects gender-affirming hormone therapy (GAHT) utilization among transgender people in China.

To investigate gender identity development among Chinese transgender men (TM) and transgender women (TW) and to explore how identity-related factors are associated with GAHT utilization.

This cross-sectional study is based on the latest Chinese Transgender Health Survey targeting the transgender population in China conducted from May to December in 2021. Data analysis was completed in December 2024. Participants were recruited online via snowball sampling.

The primary outcomes are the timing of gender identity development milestones (first perception of gender incongruence, confirmation, disclosure, and initiating GAHT) and GAHT utilization status. Multivariable binary logistic regression identified factors associated with GAHT-related behaviors and feedback.

A total of 4296 transgender people (1462 TM [34.0%] and 2834 TW [66.0%]; median [IQR] age, 21 [18-24] years) were included in the final analysis. The age distribution of first perceived gender incongruence exhibited a bimodal pattern, with peak occurrences at ages 5 to 6 and at 12 years. The median (IQR) ages at gender identity development milestones were all younger for TM than for TW: 6 (4-10) years vs 9 (6-12) years for perception, 14 (11-16) years vs 15 (12-17) years for confirmation, and 16 (14-19) years vs 17 (15-20) years for disclosure, whereas the age of initiating GAHT was older in TM than in TW (median [IQR] age, 19 [17-22] years vs 18 [16-21] years). The demand for GAHT (3759 participants [87.5%]), usage (2247 participants [52.3%]), and the rate of valid prescriptions among hormone users (339 participants [15.1%]) have all increased significantly compared with 2017. Being a TW and without a college education were associated with starting GAHT before age 16 years, while being a TM, having family disclosure of gender identity, and having official prescriptions were associated with positive feedback on GAHT.

In this cross-sectional study of Chinese TM and TW, gender identity development differed by gender, with TM recognizing incongruence earlier and TW progressing faster in initiating GAHT. Both groups showed strong demand for GAHT. Despite recent improvements in GAHT service accessibility, challenges persist in medical accessibility. These findings highlight the need for personalized support for transgender youths and underscore the importance of improving formal transgender health care services in China to enhance the well-being of this population.

Immigrant caregivers and their children encounter manifold barriers to mental health service use with unique challenges in the U.S.-Mexico border region. This study examined predisposing, enabling and need factors associated with mental health service use by immigrant caregivers and their children. A cross-sectional survey of 240 immigrant caregivers with children living in New Mexico was conducted. Three domains were examined for their associations with mental health service utilization among caregivers and children. Domains included predisposing (caregiver age, household composition, gender, education, religiosity, duration of US residency, adverse childhood experiences, English proficiency), enabling (caregiver resilience, employment, income, insurance status, health/social service use, social safety net use, resource navigation, help-seeking attitudes), and need (depression symptoms, immigration stress, housing insecurity) factors. Multiple logistic regression models were constructed for each domain and significant variables at a p < 0.05 level were included in final models. In the final model, caregiver mental health service utilization was positively associated with help-seeking attitudes and depression symptoms. For children, mental health service utilization was positively associated with health/social service use. This study identifies factors that may impact the use of mental health services by immigrant families living along the US-Mexico border. Results highlight the importance of culturally informed mental health outreach and integrating mental health services within coordinated and supportive health, social, and safety net services.

To investigate sex-dependent effects of polygenic risk (PRS-SCZ) and exposome score (ES-SCZ) for schizophrenia, both independently and jointly, on distressing psychotic experiences (PEs) in early adolescents.

Baseline to 3-year follow-up data of the Adolescent Brain and Cognitive Development Study (ABCD) were used. PRS-SCZ and ES-SCZ were calculated to assess cumulative genetic and environmental (childhood adversity, cannabis use, hearing impairment, and winter births) risk for schizophrenia, respectively. The primary outcome was past-month distressing PEs at the 3-year follow-up. Secondary outcomes included distressing PEs across four yearly assessments: lifetime (≥ 1 wave), repeated (≥ 2 or ≥ 3 waves), and persisting (≥ 4 waves). Sex-stratified multilevel logistic regression models were used to test the independent and joint associations of binary modes (> 75th percentile) of PRS-SCZ (PRS-SCZ₇₅) and ES-SCZ (ES-SCZ₇₅) on the outcomes. As sensitivity analysis, the sex-stratified analyses were repeated on a randomly selected unrelated sample, and the coefficients of males and females were compared.

PRS-SCZ₇₅ was not associated with past-month distressing PEs in either sex but significantly associated with lifetime and repeated (≥ 2 waves) distressing PEs only in females. In both sexes, ES-SCZ₇₅ was significantly associated with all PE outcomes but did not additively interact with PRS-SCZ₇₅ in predicting them. Sensitivity analysis confirmed the findings and revealed a significant sex difference in the association between PRS-SCZ₇₅ and lifetime distressing PEs.

The influence of genomic risk for schizophrenia on distressing PEs might be sex-dependent, whereas that of the exposomic risk was universal in early adolescence. Further studies in larger samples are needed.

Trans and non-binary individuals are particularly vulnerable to discrimination in public spaces, workplaces, housing, and healthcare. The exclusion they experience also affects their participation in physical activity (PA). This study aimed to estimate the proportion of trans and non-binary individuals living in Spain that engage in PA several times per week and to explore potential associated factors. A cross-sectional study was conducted using data from 1473 participants aged 15 or older, recruited between October 2023 and March 2024 through an online national survey on trans and non-binary health. PA engagement was estimated with 95% confidence intervals (95% CIs). A Poisson regression model with robust variance was used to identify associated factors, obtaining adjusted prevalence ratios (aPRs) with 95% CI. Overall, 23.2% (95% CI: 21.1%-25.5%) reported engaging in PA several times per week. In the adjusted analysis, PA was less common among trans women (aPR = 0.46, 95% CI 0.35-0.62) and non-binary individuals (aPR = 0.67, 95% CI 0.52-0.85) compared to transmasculine individuals. Lower PA levels were also observed in those unable to legally change their name due to barriers (aPR = 0.71, 95% CI 0.52-0.97), and those with mental health issues in the past year (aPR = 0.76, 95% CI 0.62-0.93). Higher PA participation was associated with being ≥29 years old (aPR = 1.41, 95% CI 1.08-1.84) and better self-perceived health (aPR = 1.33, 95% CI 1.07-1.65). Trans women and non-binary individuals engage in PA less frequently. Sociodemographic factors, health, and legal barriers significantly impact PA participation. Policies should encourage PA, especially among young trans individuals, and ensure equitable and discrimination-free access.

Music engagement traits are linked to important developmental language, cognitive, and mental health outcomes, but longitudinal studies have not examined the developmental stability of music engagement across the first few decades of life, especially using genetically informative designs. The current study examined music engagement-defined as being interested and skilled at musical instruments and taking music lessons-across four timepoints in childhood and adolescence to test the hypothesis that genetic influences explain an increasingly larger proportion of variance over time. We also examined how these measures relate to the frequency of music engagement and music listening in adulthood. Analyses were based on archival data from 1878 individuals in the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife), who completed self-reported measures of music engagement at ages 7, 10, 12, and 16 years, and two additional items in established adulthood (mean age 33 years). Results indicated that music engagement was moderately stable throughout childhood and adolescence (r = 0.20 to 0.49). Heritability was larger in males than in females, but only in childhood, with greater stability of shared environmental influences in female children. These measures were modestly correlated with the frequency of musical instrument playing in adulthood (r = 0.07 to 0.29) but not the frequency of music listening. These findings suggest that early music engagement is a dynamic phenotype that changes considerably between childhood, adolescence, and beyond. This work highlights the need for a developmental perspective in theoretical models of music engagement and its relation to language, cognition, and health.

Korea's national suicide prevention strategies emphasize the role of local authorities. Evaluating local government performance helps determine whether suicide reduction goals are being met. This study assesses the performance of basic local government suicide prevention activities and explores their implications.

Data were drawn from the 2023 Survey on Suicide Prevention Activities. Seventeen indicators, covering both process and outcome measures, were used to evaluate performance. A composite score (0-100) was calculated by weighting and summing the indicators, with weights based on average scores for each indicator. The 229 local governments were grouped into four categories by urbanization and population size: large Si (≥ 300,000 population), small Si (< 300,000), Gun, and Gu. The maximum-minimum (max-min) value ratio was used to examine composite score variation.

Among the 229 local governments, 29 were large Si areas, 49 small Si, 82 Gun, and 69 Gu. Significant disparities were found across several indicators, such as the operation of community suicide prevention centers, availability of mental health professionals, and allocated budgets. Composite scores were highest in large Si areas (59.8), followed by small Si (59.3), and Gu (57.9). The greatest variation was in Gun areas (max-min ratio: 2.6), suggesting inconsistent performance.

There are notable disparities in suicide prevention performance among Korea's basic local governments. Customized strategies that reflect local capacities and contexts are essential to reduce these gaps and improve overall effectiveness.

The good farmer typology is embedded in New Zealand (NZ) farmer culture as a resilient farmer persevering through tough times without needing help or support from others. This article explores how NZ's good farmer typology influences the mental health help-seeking behaviours of agricultural university students.

This research took place at the two primary land-based universities in New Zealand.

Fifteen university students who had recently completed a young farmer mental health education programme participated in this study.

This is a qualitative exploratory study utilising semi-structured interviews and thematic analysis.

This study finds that the NZ good farmer identity dominates agricultural students' attitudes towards help-seeking activities. Despite students saying that the stoic attitude of older farmers was not as prevalent amongst their generation, this was not evident in their attitudes.

Students believed it was important to talk about mental health issues, but did not prioritise this for themselves and were reluctant to engage in help-seeking. The research has implications for those delivering mental health and wellbeing messages and support to young people studying agriculture. It suggests that there is still work to do to address unhelpful attitudes amongst all generations of farmers to break down barriers to mental health education and help-seeking.

Major depressive disorder (MDD) is a common affective disorder with complex etiologies and largely unclear pathophysiological mechanisms. The nucleus accumbens (NAc) plays a central role in reward processing, motivational regulation, and emotional integration. Neuroimaging studies suggest that structural and functional abnormalities of the NAc are key contributors to the pathogenesis of MDD. However, the alterations in structure-function coupling (SFC) of the NAc in MDD remain poorly understood. This study aims to systematically investigate abnormal functional connectivity (FC) and SFC of the NAc in patients with MDD by integrating functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) techniques.

A case-control design was adopted. Patients who met diagnostic criteria for a current depressive episode of MDD and had a 17-item Hamilton Rating Scale for Depression (HAMD-17) total score ≥17 were enrolled as the MDD group, while age-, sex-, and education-matched healthy controls (HCs) were included as the HC group. All participants underwent high-resolution T₁-weighted structural imaging, resting-state fMRI, and DTI scanning using a 3.0T MR system. fMRI data preprocessing was performed using SPM12 (Statistical Parametric Mapping 12) and DPARSF (Data Processing Assistant for Resting-State fMRI), while DTI preprocessing was conducted using FSL (FMRIB Software Library). Based on the Brainnetome Atlas, the cerebral cortex was parcellated into 246 regions. FC values between bilateral NAc and the whole brain and the strength of structural connectivity (sSC) derived from probabilistic tractography were calculated. SFC values of bilateral NAc were computed using region-wise Spearman correlations between sSC and FC (ρ). A multiple linear regression model was constructed using FC as the dependent variable and age, gender, years of education, and head motion parameters as covariates, and corrected FC values were extracted from the regression residuals. Group differences in corrected FC values were assessed using independent-sample t-tests with false discovery rate (FDR) correction at a significance level of P<0.1. Analysis of covariance was used to compare SFC values between groups, controlling for age, gender, and years of education (a significance level of P<0.05). FC values showing significant intergroup differences and SFC values of bilateral NAc were correlated with HAMD-17 total scores using Spearman correlation analysis.

There were no significant differences between the MDD and the HC groups in gender (χ²=0.792, P=0.373), age (t=-0.930, P=0.292), or years of education (t=0.003, P=0.059). Compared with HCs, patients with MDD exhibited significantly increased FC in the following connections: BG.L.3 (left NAc)-IPL.R.4 (right inferior parietal lobule), BG.R.3 (right NAc)-IPL.R.4, BG.R.3-Tha.R.8 (right lateral prefrontal thalamus), and BG.R.3- MFG.R.4 (right middle frontal gyrus) (all FDR-corrected P<0.1). The SFC values of bilateral NAc were significantly reduced in the MDD group compared with the HC group (left: F=11.768, P=0.001; right: F=4.386, P=0.047). Spearman correlation analyses showed no significant associations between altered FC or bilateral NAc SFC values and HAMD-17 total scores in the MDD group (all P>0.05).

Patients with MDD exhibit enhanced NAc FC, predominantly between the NAc and cognition-related regions such as the inferior parietal lobule and middle frontal gyrus, suggesting imbalance between the reward circuit and cognitive regulatory networks. Moreover, the significantly reduced SFC of bilateral NAc indicated impaired structural-functional integration in MDD. These findings provide potential neuroimaging evidence supporting the involvement of the NAc in the pathophysiological mechanisms of MDD.

Digital cognitive behavioral therapy (DCBT) is an online form of cognitive behavioral therapy delivered through digital means. It utilizes interactive online, electronic, mobile, and internet-based media, offering treatment through simple operational procedures and highly structured, interactive formats such as animations, videos, audio, and text. DCBT has become an important tool for adolescent psychological intervention due to its high accessibility, low treatment cost, strong privacy protection, and efficient data collection capacity. Several Western countries have achieved significant progress in addressing adolescent mental health problems, particularly in the design and implementation of DCBT intervention programs. DCBT holds promising feasibility and application value in interventions for adolescent depression, anxiety, and post-traumatic stress disorder. However, limitations remain, including small sample sizes, heterogeneity in intervention protocols, short follow-up durations, and constraints in adherence management. Future research in China should include more high-quality studies with long-term follow-up, as well as improvements in the integration of technologies and therapeutic protocols, to promote the standardized and evidence-based application of DCBT in adolescent mental health services.