Epidemiology and Psychiatric Sciences

Objective. To estimate lifetime and 12 month mental health contact gaps among Peruvian adults with survey-defined mental disorders, and to describe inequalities in contact, perceived need for care, and mental health service use. Methods. We analyzed the information for adults of the 2022 Peruvian National Mental Health Survey, a cross-sectional household survey. The primary outcome was the survey-weighted proportion of adults with a 12 month mental disorder who reported no contact with an included source of mental health-related care during that period; the lifetime contact gap was descriptive. Perceived need was assessed using two derived 12 month perceived-need measures based on direct ENSM variables and service contact routing items. Analyses incorporated weights, strata, and clusters. Adjusted prevalence ratios were estimated using survey weighted Poisson models. Results. The dataset contained information on 13,840 individuals; 13,833 had complete survey-design information. Contact gap denominators were 3,927 for lifetime disorders and 1,649 for 12-month disorders. The lifetime and 12-month contact gaps were 61.0% (95% CI 58.4-63.7) and 84.5% (95% CI 81.5-87.6), respectively. Rural estimates exceeded urban estimates in both periods; after adjustment, poverty and rural residence were associated with the lifetime gap, and extreme poverty with the 12-month gap. Among individuals meeting survey-based criteria for one or more 12-month mental disorders, 37.3% (95% CI 33.4-41.4) reported self-perceived need, whereas 25.6% (95% CI 21.8-29.8) reported that need had been identified by others. Annual psychological and psychiatric service use was 3.7% and 1.1%, respectively. Conclusions. Mental health contact gaps were high, particularly for one or more 12-month mental disorders, and were associated with social and territorial variables. These contact measures do not establish adequate, continuous, or effective treatment, which needs to be addressed to understand the impact of the Peruvian mental health reform.

One-to-one peer support is widely used in mental health services, but the components associated with better outcomes remain unclear. We systematically reviewed randomised controlled trials and conducted additive component network meta-analyses to identify which components of one-to-one peer support worker interventions were associated with outcomes for adults using mental health services. CINAHL Ultimate, Embase, MEDLINE, PsycINFO, CENTRAL, ClinicalTrials.gov and ISRCTN were searched, supplemented by citation tracking, previous reviews and expert consultation. Interventions were coded for seven components: Training and development, Maintaining peer support worker wellbeing, Relationship-building, Social support, Emotional support, Practical support and Cultural adaptation. The review followed PRISMA-NMA reporting guidance and was registered with PROSPERO (CRD42022355291). Thirty-six trials randomised 6,645 participants across nine countries. Only quality of life and recovery yielded estimable component effects at one or more follow-up points. For quality of life, Practical support had a positive incremental estimate at 3 months (standardised mean difference 0.52, 95% confidence interval 0.17 to 0.87); no component showed clear evidence of benefit at 6 months; and at 12 months Social support had a positive estimate (1.57, 0.12 to 3.01), whereas Maintaining peer support worker wellbeing had a negative estimate (-1.66, -3.05 to -0.28). These estimates were not consistent across follow-up points. For recovery, Relationship-building had positive estimates at 6 months (0.90, 0.03 to 1.78) and 12 months (0.50, 0.29 to 0.72). Networks were sparse and often disconnected, and additivity could not be tested in disconnected networks. Current trials do not permit definitive prioritisation of peer-support components. Relationship-building was the most consistent candidate component, but all findings remain provisional. Future trials should prospectively specify, manipulate and measure component delivery.

Oregon (OR) and Colorado (CO) were the first states to enact regulations for provision of psilocybin with support of licensed "facilitators." As more states and countries adopt similar policies, informed public policy decisions require that client characteristics and rationale for using psilocybin, psilocybin dosing practices, mental health outcomes, and adverse events are understood. We performed a retrospective observational study of responses for 2363 individuals receiving psilocybin at OR and CO regulated service centers. Clients and facilitators entered data before and after receiving psilocybin, including the Mystical Experience Questionnaire-30 (MEQ-30), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and World Health Organization Well-Being Index-5 (WHO-5). Preexisting mental health issues were common (66%) in participants. Psilocybin doses ranged from 1-95 mg, with a mean total of 28*8 mg. We observed improvements of 49% in PHQ-9 scores, 51% in GAD-7 scores, and 22% in WHO-5 scores at two-weeks after dosing. MEQ-30 scores were dose-dependent. Changes in PHQ-9 and GAD-7 scores were not different for psilocybin doses [≤]30 mg and >30 mg, and only weakly correlated with MEQ-30 scores. There were 94 mild adverse events during and after dosing, five more serious events not clearly related to treatment, and evidence of possible risk of increased suicidality. Study limitations include open label administration, self-reporting, loss of participants for follow-up, and a short 2-week post-dosing end-point. We conclude that psilocybin services, delivered within these regulated frameworks, is associated with improvements in mental health in real world populations, however, more robust monitoring is needed to ensure safety.

Introduction: Self-rated health is an important patient-centred measure of health. The relationship between cannabis use and self-rated health has been previously studied, although with methodologic concerns which we aimed to address in this investigation. Methods: Propensity score weighted analyses of the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were conducted. The primary exposure was self-reported cannabis use in the 30 days prior to survey response. The primary outcome was self-rated health measured on a five-level ordinal scale. Secondary outcomes included the number of days in the past months with: i) poor physical health, ii) poor mental health, and iii) activity limitations related to poor health. A weighted proportional odds regression model was used for the primary analysis and weighted zero-inflated negative binomial regression models were used for each secondary analysis. Results: Among 22,055 adults aged 20-59 responding to the NHANES cannabis questionnaire, 14.4% endorsed use in the past 30 days. After reweighting the sample to balance cannabis users and non-users across sociodemographic, medical, and lifestyle characteristics, there was no statistically significant association between recent cannabis use and higher levels of self-rated health (OR 0.90, 95% CI 0.80-1.01). Cannabis use was associated with poor mental health and activity limitations in the past month, but not poor physical health. Conclusions: Recent cannabis use was not associated with self-rated health but was associated with poor mental health and activity limitations in the past month. Cannabis users at risk of poor mental health should be connected with clinicians to help guide therapy.

Objective: To examine if food insecurity moderates the relationship between rurality and mental health outcomes (suicide mortality, poor mental health days, frequent mental distress) and to assess if these effects vary across U.S. Census divisions. Methods: This county-level (n=2,397) cross-sectional study used OLS and spatial error regression to analyze public data from sources including the County Health Rankings and USDA. We modeled suicide mortality, poor mental health days, and frequent mental distress as functions of the Index of Relative Rurality (IRR) and food insecurity, controlling for median income and provider rates. The suicide model was also tested across nine U.S. Census divisions. Results: Baseline models revealed a paradox: rurality was a direct risk factor for suicide (B=0.400) but protective for poor mental health days (B=-0.224). The national multivariable model revealed a significant, positive rurality-food insecurity interaction for suicide mortality (B=0.861), indicating a synergistic risk. This interaction was not significant for general mental distress, which was more strongly predicted by income and food insecurity. Regional analysis confirmed the suicide interaction was potent in five divisions, including the Pacific (B=3.048) and Mountain (B=1.712) , but absent in others (e.g., South Atlantic). Conclusions: The drivers of suicide are distinct from those of general mental distress and are geographically heterogeneous. The interaction of rurality and food insecurity creates a compounded risk for suicide. Suicide prevention must be regionally-tailored and address structural inequalities, such as food insecurity, alongside clinical care.

Introduction: In 2020, Oregon became the first US state to legalize state-regulated psilocybin services. This study aims to examine: 1) the clinical and demographic characteristics, 2) psilocybin use motivations, and 3) differences in preparedness among patients seeking care in a Oregon- based pilot consult service specializing in psilocybin risk reduction. Methods: This retrospective chart review abstracted sociodemographics, trauma history, and medical and psychiatric risks of patients (November 2023 - September 2025). The Psychedelic Preparedness Scale (PPS), a validated self-report questionnaire, measured preparedness. Two sample t-tests examined associations of PPS scores by insurance, consult motivations, and prior psychedelic use. Results: Patients (N=29) had a mean age of 47.14 years (SD=15.9), were majority female (55.2%); White (82.8%); and privately insured (62.1%). Patients mostly sought psilocybin to address only a psychiatric concern (75.9%); 27.6% anticipated naturalistic (non-state regulated) use. Most patients were deemed low risk for adverse events. Prevalence of prior challenging psychedelic experiences (CPE) was 17.2%; 58.6% reported lifetime psilocybin use. 86.2% endorsed >1 form of lifetime trauma. Of PPS completers (N=23, 79%), mean score was 91.3 (SD = 23.99). Scores did not significantly differ by insurance; consultation motivation; CPE; prior psilocybin or psychedelic use. Conclusion: Patients utilizing a novel consultation service demonstrate a high prevalence of trauma, prior psilocybin use, and baseline preparedness. While preliminary, this is among the first descriptions of patients seeking medical and psychiatric consultation when considering psilocybin and highlight the potential role of healthcare systems in providing evidence-based patient education and risk reduction as interest in psychedelics grows.

Background Alcohol is a leading modifiable risk factor for non-communicable disease. Zambia's National Alcohol Policy and the World Health Organization's target of a 10% relative reduction in the harmful use of alcohol both require that the trend be monitored. Alcohol items appear in four rounds of the Zambia Demographic and Health Survey (ZDHS), and those rounds are widely treated as a trend series, although whether they are one has never been tested. Methods Secondary analysis of ZDHS 2007, 2013-14, 2018 and 2024 (women aged 15-49, men aged 15-59). A direct current-use item is available in three rounds, with three different instruments for men and two for women. Four identification strategies were applied in ascending order of assumption: nesting bounds, which exploit the fact that a seven-day window falls within a thirty-day window and that within undated current status; restriction to the fieldwork months common to both rounds; a lifetime-use analogue available in 2024; and an instrument-constant partner-report series available in all four rounds, validated by linking each woman to her co-resident husband. Estimation throughout was design-based. Results The conventional series suggests a fall in current drinking among men from 42.0% (95% CI 39.9-44.1) in 2007 to 28.2% (95% CI 27.0-29.3) in 2024, and among women from 11.1% (95% CI 9.9-12.4) to 8.8% (95% CI 8.0-9.6). Neither change is sign-identified. Placed on a common thirty-day basis with matched fieldwork months, the 2013-14 to 2024 change lies between -7.6 and +1.2 percentage points for men and between -0.2 and +3.7 for women. The instrument-constant proxy fell from 53.7% in 2007 to 37.7% in 2018, then plateaued at 37.0% in 2024; a constant-decline model is rejected (Q = 15.9, 2 df, p = 0.0003). Sensitivity of the proxy against husbands' own reports fell from 86.0% to 66.8%. The 2024 cross-section is unaffected and is reported in full. Conclusions These data do not establish the apparent national decline in alcohol use. Differences in reported prevalence across ZDHS rounds substantially reflect instrument change, reference-period shift, fieldwork seasonality and decay in proxy reporting. On present evidence Zambia cannot monitor its alcohol commitments from national survey data. Trend monitoring would require a consistent alcohol module restored to the questionnaire, an occasion-based heavy-drinking item, and the reporting of fieldwork month.

Background Floods are among the most devastating natural disasters worldwide and are increasingly associated with adverse mental health outcomes, particularly Post-Traumatic Stress Disorder (PTSD). In December 2023, Hanang District in northern Tanzania experienced catastrophic mud floods that resulted in extensive loss of life, destruction of property, displacement of households, and disruption of livelihoods. While emergency humanitarian responses focused primarily on physical needs, limited evidence exists regarding the long-term psychological consequences among survivors. Therefore, this study aimed to determine the patterns of PTSD manifestations and assess cognitive factors associated with PTSD symptoms among flood victims in Hanang District, Tanzania. Methods A community-based cross-sectional study was conducted among 360 flood victims one year after the disaster. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics summarized PTSD severity, while chi-square tests and regression analyses examined associations between socio-demographic characteristics and PTSD manifestations. Cognitive factors were assessed based on participants' exposure to traumatic experiences and perceptions of traumatic events. Results The mean PCL-5 score was 39.2 (SD = 20.6), indicating a high burden of psychological distress. Approximately 45% of respondents had severe PTSD symptoms (PCL-5 [&ge;]45), while another substantial proportion demonstrated moderate symptom severity. PTSD manifestations varied significantly by geographical location (p < 0.001), household income (p = 0.011), and marital status (p = 0.002). Age positively predicted PTSD severity ({beta} = 0.019, p = 0.001), whereas household income negatively predicted symptom severity ({beta} = -0.297, p = 0.001). Exposure to natural disasters constituted the predominant cognitive factor, with 45% directly experiencing the flood and 38.3% witnessing the event. Exposure to secondary traumatic experiences through witnessing or learning about violent events was also common. Cognitive trauma exposure demonstrated a significant association with PTSD symptoms ({chi}2, p < 0.001). Conclusion PTSD remains highly prevalent among flood survivors in Hanang district. Both direct and indirect trauma exposure significantly contributed to PTSD manifestations. Comprehensive disaster recovery programmes should integrate trauma-focused psychological services, cognitive behavioural interventions, routine PTSD screening, and community-based psychosocial support alongside socioeconomic recovery initiatives.

Ayahuasca use has expanded beyond its traditional Amazonian contexts, yet prospective longitudinal data examining depressive symptoms following naturalistic use in the United States remain limited. We conducted an interim analysis of an ongoing prospective observational cohort of adults participating in naturalistic ayahuasca use in Las Vegas, Nevada. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), with higher scores indicating greater depressive symptom severity, at baseline and approximately 48 hours, 30 days, 60 days, and 90 days following exposure. At interim analysis, PHQ-9 data were available for 87 participants at baseline, 61 at 48 hours, 41 at 30 days, 33 at 60 days, and 26 at 90 days. Mean PHQ-9 scores decreased from 8.06 (SD 5.96) at baseline to 4.39 at 48 hours, 3.76 at 30 days, 3.97 at 60 days, and 3.65 at 90 days. Among participants with matched baseline and follow-up assessments, mean changes were -3.58 points at 48 hours, -4.47 at 30 days, -4.48 at 60 days, and -4.76 at 90 days. In a mixed-effects model accounting for repeated observations, PHQ-9 scores remained significantly lower than baseline at 48 hours ({beta}=-3.70; 95% CI -5.09 to -2.31), 30 days ({beta}=-4.34; 95% CI -6.01 to -2.67), 60 days ({beta}=-3.97; 95% CI -5.77 to -2.18), and 90 days ({beta}=-4.25; 95% CI -6.18 to -2.33; all p<0.001). Among participants with baseline PHQ-9 scores [&ge;]5 and matched follow-up data, 69.2% demonstrated a reduction of at least 5 points at 90 days. These interim findings provide preliminary evidence of a sustained longitudinal association between naturalistic ayahuasca exposure and lower depressive symptom scores through 90 days in a U.S.-based cohort. The observational design, self-selection, incomplete follow-up, and absence of a control group preclude causal inference. Continued longitudinal follow-up is needed to determine the durability of this association.

Objectives: To estimate the prevalence of Post-Exertional Malaise (PEM) among adults with prior COVID-19 and associated mental health and disability outcomes. Methods: We conducted a cross-sectional analysis of data from a survey of 9,620 adults with prior COVID-19 in New York City, collected May - June 2024. PEM was measured with the DePaul Symptom Questionnaire - Post Exertional Malaise, categorized by symptom duration (< 14 vs. [&ge;]14 hours). Weighted prevalence estimates were stratified by socio-demographic and clinical characteristics. Modified Poisson regression was used to assess the association of PEM with depression, anxiety, and disability. Results: The prevalence of PEM symptoms was 20.9% overall and 4.0% with symptom duration [&ge;]14 hours, representing over 800,000 New Yorkers affected and over 150,000 who meet a diagnostic criterion for ME/CFS. PEM prevalence was higher among women, transgender and non-binary adults, people of color, and lower educational attainment, chronic comorbidities, or disabilities. PEM was associated with 3 - 4 times higher prevalence of mental health outcomes and 4 - 5 times higher disability scores. Conclusions: PEM symptoms were common and strongly associated with disability and adverse mental health. Screening, pathways to care, and supportive policies are needed to mitigate long-term consequences, particularly among marginalized populations.

Background: Adolescent suicide is a leading cause of death in Australia, arising from multiple determinants. Psychological distress, lifestyle behaviours and socioeconomic factors are associated with adolescent suicidality. Existing research has predominantly employed cross-sectional designs, limiting our understanding of how these factors interact over time. Longitudinal and data-driven approaches are needed to help identify the factors associated with the emergence of suicidality throughout adolescence. Method: Participants aged 12-17 years completed longitudinal measures of suicidal ideation, psychological distress, sleep quality, mindfulness, physical activity, eating habits, and social connectedness. Subgroups were determined via hierarchical cluster analysis, based on average scores across later timepoints (9-15). ANOVA and pairwise effect size calculations were used to compare clusters across variables, and their preceding developmental trajectories were examined using generalised additive mixed models (across earlier timepoints; 1-8). Clusters were also compared on self-reported wellbeing, long-term suicidality, and socioeconomic status. Result: Three clusters characterised by low-, moderate-, and high-severity of suicidal ideation and psychological distress, and poorer sleep, social connectedness, physical activity, mindfulness, and eating habits were identified. Across earlier timepoints, the high-severity group showed consistently elevated suicidality and deteriorating wellbeing and lifestyle scores. Conclusion: Youth with high levels of suicidality had greater psychological distress, lower wellbeing, lower socioeconomic status, and poorer lifestyle behaviours. This subgroup was also found to have poorer scores on wellbeing and lifestyle factors in their early adolescence. Findings highlight the importance of early, preventative interventions targeting both mental health and lifestyle factors to reduce suicidality in adolescents.

Purpose Despite the high documented prevalence of hunger and poor mental health in adolescent girls and young women (AGYW) in South Africa, this relationship remains understudied, with existing studies limited by their cross-sectional designs. This longitudinal study aimed to identify the association of hunger trajectories with anxiety and depressive symptoms, and hope in AGYW. Methods We used secondary data from the HIV Prevention Trials Network (HPTN) -068 conducted in rural Agincourt, South Africa. Complete data from 1779 AGYW collected at baseline (2011/12) and three annual follow-up visits were used. Hunger trajectories, measured using the Household Hunger Scale, were estimated via Group-Based Trajectory Modelling. Self-reported incident anxiety and depressive symptoms and hope were assessed based on AGYWs last two follow-up visits. Covariate adjusted modified Poisson regression models estimated the association between hunger trajectories and incident anxiety symptoms, incident depressive symptoms, and hope. Results Moderate-severe hunger was prevalent in 11.0%, 10.8%, and 6.0% of the households at baseline, follow-up 1, and 2, respectively. Incident anxiety symptoms were reported by 4.5%, incident depressive symptoms by 20.0% and hopelessness by 52.8% of the AGYW. Two hunger trajectories were identified- no hunger (82%) and marginal hunger (18%). Hunger trajectories were not associated with incident anxiety symptoms [RR:1.09, 95% CI: 0.55, 2.18], incident depressive symptoms [RR: 0.97; 95% CI: 0.72, 1.33] nor hope [RR: 1.00; 95% CI: 0.81, 1.23] in AGYW. Conclusion Better understanding of the factors that promote resiliency and mental health of AGYW in this setting is warranted to inform the design of interventions.

Depressive disorders are one of the most common psychiatric conditions worldwide. We systematically screened a prespecified exposure panel for associations with depressive symptoms and evaluated cross-wave replication among Brazilian adults. This preregistered exposure-wide association study used independent, nationally representative cross-sectional samples from the 2013 (n=60,202) and 2019 (n=88,531) Brazilian National Health Surveys. 31 general exposures were assessed with survey-weighted regression; four occupational exposures were analysed separately. The primary outcome was a positive Patient Health Questionnaire-9 screen (PHQ-9 >=10); continuous PHQ-9 score was secondary. Discoveries required a Benjamini-Yekutieli-adjusted p<0.05 in 2013; replication required the same coefficient direction and raw p<0.05 in 2019. 21 general exposures were primary discoveries, and all replicated. Associations spanned health status/health care (n=11), behaviour/participation (n=5), and social/material context (n=5). Poor or very poor vs very good self-rated health showed the largest association (adjusted prevalence ratio 10.97, 95% CI 8.79-13.69 in 2013; 12.33, 10.19-14.92 in 2019). Replicated correlates also included morbidity, smoking, prolonged television viewing, diet, group activities, education, income, sanitation, and nearby public space. All 25 continuous-outcome discoveries replicated. All four occupational associations retained the same direction and raw p<0.05 in 2019. This recurrent profile provides a reproducible map for prioritizing longitudinal research but, because both waves were cross-sectional and exposures were modelled separately, does not establish temporality, causality, or independent effects.

Objectives Emergency department (ED) crowding is recognised as an important public health concern internationally, and is driven principally by exit block, the shortage of inpatient beds for patients requiring admission. This study aimed to evaluate whether a complex intervention targeting hospital occupancy improved ED patient flow, and quantified the change in attendances. Methods A controlled interrupted time series using weekly, publicly reported Public Health Scotland data from 1 January 2022 to 1 February 2026. The multi-component intervention focused on reducing hospital occupancy and included additional adult social care funding; engagement with regional social care providers; accelerated implementation of the Discharge without Delay programme; re-evaluation of whole-hospital escalation thresholds and response; resource and data supporting inpatient department reductions in length of stay; and additional investment in remote clinical assessment. The intervention commenced at a large tertiary ED on 01 February 2025. Primary outcomes were the proportions of attendances spending [&ge;]4, [&ge;]8 and [&ge;]12 hours in the ED. The secondary outcome was attendance volume. Segmented regression was fitted with a contemporaneous control series, seasonal terms and autoregressive moving average errors. Long waits were additionally illustrated as potentially avoided deaths. Results The analysis covered 161 pre-intervention and 52 post-intervention weeks. Relative to pre-intervention levels, the proportion of attendances waiting over 4 hours fell by 10.4% (95% CI 1.6 to 19.2%), by 16.4% (95%CI 1.3 to 31.5%) over 8 hours and by 24.3% (95%CI 2.6 to 46.1%) over 12 hours. Using established associations between long ED waits and excess mortality, by one-year the intervention was potentially associated with 54 fewer excess deaths (95%CI 19 to 93). Attendances rose by 3.8% (95%CI 1.3 to 6.4%) against the counterfactual. Conclusions A complex intervention targeting hospital occupancy was associated with a reduction in long ED waits despite rising attendances. Interventions addressing hospital occupancy can meaningfully improve ED crowding.

The forced displacement of medical students due to armed conflict presents a profound disruption to the global medical education continuum. Existing research predominantly evaluates individual psychological trauma, leaving a critical gap in measuring the structural and institutional friction displaced learners face when transitioning into host medical schools. This study details the development, structural refinement, and psychometric validation of the Displaced Medical Student Scale (DMSS), a novel 38-item instrument theoretically grounded in Pierre Bourdieus Theory of Practice. Utilising an exploratory sequential mixed-methods design adhering to COSMIN guidelines, initial qualitative items generated from a transnational cohort underwent content validation by an expert panel (Scale-Level Content Validity Index Average = 0.96) and pilot face validation (N = 29) to eliminate linguistic barriers. Subsequent psychometric testing with 156 displaced Gazan medical students confirmed a robust six-factor latent structure: Mechanisms of Conflict, Hysteresis and Dislocation, Agential Coping, The Agents Toolkit, The Institutional Field, and Transition Outcomes. Confirmatory factor analysis using diagonally weighted least squares demonstrated excellent model fit (, Comparative Fit Index = 0.925, Tucker-Lewis Index = 0.918, Root Mean Square Error of Approximation = 0.058, Standardised Root Mean Square Residual = 0.064) and exceptional internal consistency (Cronbachs , McDonalds ). Structural equation modelling proved that institutional symbolic violence negatively impacts transposed clinical capital () and that structural hysteresis mathematically mediates the path between symbolic violence and professional attrition fatigue (). Furthermore, agential coping significantly moderates identity crisis outcomes (). The DMSS provides medical faculties with an evidence-based metric to transition from deficit frameworks to targeted structural interventions that preserve displaced clinical capital.

Background: Previous trauma research includes many limitations, such as the scarcity of pretraumatic health measurements and assessment of traumatic experiences with a broad scope across the lifespan. To respond to these gaps, we aimed to develop a new, prospective, population-based trauma dataset from childhood to middle age. Methods: We used the Young Finns Study that is a population-based, multi-generational, prospective study (n = 3596 for the main generation). It has started in 1980 (baseline assessment) and includes follow-ups in 1983, 1986, 1989, 1992, 1997, 2001, 2007, 2011/2012, and 2018-2020. From the 38-year follow-up and ten measurement points of the YFS, we collected all relevant trauma variables, including both free-format and structured questions that both the participants and their parents responded to. By a data-driven case-to-case analysis, we developed a scale to numerically capture variation in the quality of the experiences. Results: Our final dataset captured a total of 7769 traumatic experiences. We also developed the Traumatic Experience Severity Scale (TESS), including six subscales such as shamefulness, rarity, danger to life or health, effects on everyday life, human-made physical threat, and whether the target person was within or outside one's household. We also preprocessed the dataset to be later easily interleaved with other psychological, cardiovascular, and epigenetic variables of the YFS. Conclusions: We believe this new trauma dataset with thousands of experiences across the lifespan provides new opportunities to multidisciplinary, lifelong trauma research.

Background Children of parents with schizophrenia (SZ) or bipolar disorder (BP) show elevated rates of mental disorders. Longitudinal studies comparing offspring at familial risk with the background population are lacking. Method This study is an eight-year follow-up of the Danish High Risk and Resilience study. We examined four-year prevalence from age 11 to age15 (n=416), cumulative incidence by age 15 (n=516), persistency of mental disorders from age 11to age 15 (n=396) and global functioning in 15-year-old adolescents with familial high risk of SZ (FHR-SZ) or BP (FHR-BP) compared to population-based controls (PBC). We assessed mental disorders and global functioning with the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (K-SADS-PL) and the Childrens Global Assessment Scale (CGAS). Results Four-year prevalence of any mental disorder was higher in FHR-SZ (51.3%, OR=2.39, 95% CI 1.49-3.83) and FHR-BP (45.9%, OR=1.98, 95% CI 1.16-3.37) compared with PBC (30.5%). Cumulative incidence of mental disorders by age 15 was higher in FHR-SZ (67.2%, OR=3.19, 95% CI 2.11-4.82) and FHR-BP (64.4%, OR=2.82, 95% CI 1.75-4.54) than in PBC (39.1%). Adolescents with FHR-SZ showed the highest rate of persistent mental disorders (33.3%), followed by FHR-BP (24.5%), and PBC the lowest (12.9%). Global functioning at age 15 was lower in FHR-SZ than in both FHR-BP and PBC, and FHR-BP showed lower scores compared with PBC. Between-group differences in cumulative incidences of mental disorders and in global functioning scores remained stable across ages 7,11 and 15. Conclusion Adolescents at FHR-SZ or FHR-BP show elevated risks of a range of mental disorders, psychiatric comorbidity, and lower global functioning from childhood to mid-adolescence, not confined to the disorders for which they carry familial risk. This vulnerability underscores the need for early detection and support for FHR offspring and their families.

Background: Generative AI is evolving at a rapid pace, and many individuals are utilizing chatbots for mental health support. The safety of chatbots amid suicide disclosures is a major public health focus. However, the rate and correlates of intentions to seek help from chatbots for suicide thoughts is unknown. Objective: We sought to understand intentions to seek help from chatbots for suicide thoughts, compared to informal, formal, and anonymous online sources. Methods: Participants with clinically significant depression or anxiety (N=58) completed the General Help Seeking Questionnaire regarding help-seeking intentions for suicide thoughts and general emotional problems. Two questions were added to assess intentions to seek help from chatbots and anonymous online sources. Wilcoxon tests were used to compare intentions to use chatbots with intentions to use anonymous online sources and with groupings of informal (e.g., friends, family) and formal (e.g., therapist, general practitioner) sources. Kendall's correlations were used to examine correlations among groupings and individual informal and formal sources, and regression models further examined individual source associations adjusting for general help-seeking intentions. Exploratory analyses assessed whether demographic characteristics, mental health symptoms, and suicide risk were associated with help-seeking intentions for chatbots. Results: Participants endorsed lower help-seeking intentions for suicide thoughts from chatbots than from informal and formal sources. Intention to use chatbots for suicide thoughts was not correlated with informal and formal sources but was correlated with anonymous online sources. At the individual source level, chatbot intentions were positively associated with intimate partners but negatively associated with outreach to friends after adjustment for general help seeking tendency. Anxiety symptom severity was positively correlated with chatbot use intentions, but not with other sources of support. Conclusions: While preliminary, intentions to use chatbots for suicide thoughts appear mostly disconnected from intentions to seek help from other informal and formal supports. Future studies should evaluate the dynamics of help seeking for suicide thoughts via chatbots amidst and, perhaps in place of, other sources of support.

Background: Post-displacement stressors affect mental health among refugees and asylum-seekers, yet the behavioral mechanisms underpinning this relationship remain understudied. Objective: To examine the role of physical activity in the relationship between post-displacement stressors and mental health outcomes among Farsi/Dari speaking refugees and asylum-seekers in Australia. Methods: Data were drawn from a longitudinal community-based cohort study of 343 Farsi and Dari speaking refugees and asylum-seekers (80 female, 23.3%) in Australia conducted between 2017 and 2019. Data from post-displacement stressors measured at the baseline, physical activity at one-year follow-up, and mental health outcomes (symptoms of posttraumatic stress disorder (PTSD) and depression and personal mastery) at two-year follow-up were included in the study. Longitudinal path analyses were conducted to test the mediating role of moderate-to-vigorous physical activity and sedentary behaviour in the associations between post-displacement stressors and mental health outcomes. Results: After controlling for baseline levels of depression and PTSD, traumatic events, and key demographic characteristics, post-displacement stressors significantly predicted less moderate-to-vigorous physical activity (MVPA) ({beta} = -0.18, 95% CI [-0.292, -0.056]) and more sedentary behavior ({beta} = 0.13, 95% CI [0.011, 0.243]) at one-year follow-up. Less MVPA, in turn, significantly predicted greater symptoms of depression ({beta} = -0.21, 95% CI [-0.353, -0.060]) and lower level of personal mastery ({beta} = 0.19, 95% CI [0.033, 0.327]) while greater time spent in sedentary behavior predicted greater symptoms of depression ({beta} = 0.21, 95% CI [0.060, 0.359]), PTSD ({beta} = 0.24, 95% CI [0.096, 0.386], and lower personal mastery (({beta} = -0.18, 95% CI [-0.336, -0.011]). Significant indirect associations were observed between post-displacement stressors and depressive symptoms and personal mastery through MVPA, and between post-displacement stressors and depressive and PTSD symptoms through sedentary behaviour. Conclusion: These findings provide the first longitudinal evidence that moderate-to-vigorous physical activity and sedentary behavior partially explain the relationship between post-displacement stressors and subsequent mental health outcomes among refugees and asylum-seekers. Addressing these modifiable behaviors may represent targets for future intervention research to promote mental health during resettlement. Keywords: refugees; physical activity; post-displacement stressors; mental health

Insomnia is a transdiagnostic risk factor for depression and anxiety and frequently co-occurs with both conditions. Sleep restriction therapy (SRT) is considered a key active component of cognitive behavioural therapy for insomnia (CBT-I), is now delivered without therapist involvement via digital platforms such as SleepFix. Existing meta-analytic evidence suggests that digital behavioural therapy for insomnia (dBT-I) may improve anxiety and depression, but participant-level evidence remains limited. This individual participant data meta-analysis pooled data from two Australian randomised controlled trials (dBT-I n=220; control n=270; 78.3% female; mean age 66.0 years) to examine whether dBT-I, with SRT as the central component and delivered through the SleepFix program, reduces depressive and anxiety symptoms in adults with insomnia disorder, who were not specifically selected for anxiety and depression. We measured anxiety using the Generalised Anxiety Disorder 7-item scale and depression using the Patient Health Questionnaire-9 or Geriatric Depression Scale-15, with depression scores standardised to a common scale assuming a shared standard deviation of 4. We fitted linear mixed-effects models with random intercepts for participants and trials at Weeks 8 and 16, including baseline GAD-7 (mean 6.1, SD 4.8) in the anxiety model. dBT-I significantly reduced anxiety at Week 8 (mean difference -0.94 GAD-7 points, 95% CI -1.80 to -0.09, p=.030) and Week 16 (-0.94 GAD-7 points, 95% CI -1.86 to -0.02, p=.044), and depression at Week 8 (-0.40 SDs, 95% CI -0.66 to -0.14, p=.003) and Week 16 (-0.44 SDs, 95% CI -0.72 to -0.17, p=.002), with no evidence effects diminished between timepoints. However, the reductions were less than the smallest detectable difference for these questionnaires (i.e., 1 point). These findings support dBT-I as a scalable intervention with modest mental health benefits extending beyond insomnia.