Social Psychiatry and Psychiatric Epidemiology

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

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.

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.

Childhood peer victimization is increasingly recognized as an adverse childhood experience (ACE) with long-term consequences for population health. Most existing research treats bullying as a binary exposure, obscuring the dose-response mechanisms through which cumulative victimization generates escalating health risks. This methodological gap is particularly consequential for prevention, and evidence from the Gulf Cooperation Council (GCC) region remains systematically sparse. This study conducts a national dose-response analysis of childhood bullying and adult health outcomes in Saudi Arabia using the WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ), administered to a nationally representative sample of 10,156 adults by the King Abdullah International Medical Research Center (KAIMRC) and the National Family Safety Program (NFSP), Ministry of National Guard Health Affairs (2013). We conducted a cross-sectional secondary analysis examining associations between bullying frequency and five adult health outcomes: physician-diagnosed anxiety disorder, suicidal ideation, sleep disturbance, tobacco smoking, and substance use. The analytical sample comprised 4,632 adults reporting any childhood peer victimization. Binary logistic regression models adjusted for socioeconomic status, gender, age cohort, parental supervision, and family structure were estimated separately for each outcome. Three pre-specified hypotheses were tested: (H1) any bullying exposure is associated with higher odds of adverse adult health outcomes; (H2) increasing frequency follows a dose-response gradient; and (H3) associations are amplified among socioeconomically disadvantaged respondents and attenuated among those reporting higher parental attention. A consistent dose-response gradient was observed. Frequent victims showed substantially higher adjusted odds of tobacco smoking (OR = 6.55, 95% CI 5.81-7.32) and substance use (OR = 2.71, 95% CI 2.26-3.31) compared to those never bullied. Internalizing outcomes showed significant gradients for anxiety disorder (OR = 0.37, 95% CI 0.16-0.86) and sleep disturbance (OR = 0.39, 95% CI 0.20-0.76). Religion-targeted verbal victimization was the strongest independent predictor of suicidal ideation (OR = 3.01, 95% CI 1.83-4.97) and substance use (OR = 3.24, 95% CI 1.92-5.46), independent of bullying frequency. Bullying-health associations were significantly amplified among socioeconomically disadvantaged respondents, consistent with fundamental cause theory. Parental supervision was protective against substance use (OR = 0.45, 95% CI 0.30-0.67) but showed a paradoxical positive association with suicidal ideation, interpreted as a reactive parenting effect in the cross-sectional design. These findings establish childhood bullying as a cumulative, graded public health risk whose consequences are amplified by structural disadvantage. Prevention strategies must extend beyond school-level programs to address structural inequalities and integrate family-based and community-level protective factors. This study contributes population-level ACE evidence from the underrepresented GCC region and provides a foundation for integrating bullying prevention into Saudi Arabia's Vision 2030 national health agenda.

Background: Trauma-informed approaches (TIAs) are increasingly implemented across public-sector settings to improve support for young people affected by adverse childhood experiences (ACEs). However, practitioners often report difficulties translating broad trauma-informed principles into everyday practice, and young people are rarely involved in developing resources intended to support implementation. Aim: To co-design, implement and undertake a preliminary evaluation of a youth-led trauma-informed resource for professionals working with young people in public-sector settings in England. Methods: The study formed part of the UKRI-funded Attune programme and employed Accelerated Experience-Based Co-Design (AEBCD). Eighteen adolescents with lived experience of ACEs and 16 professionals from nine public-sector settings participated in three regional co-design workshops. Findings from a prior arts-based lived experience study informed the workshops. Participants collaboratively developed Validating Voices, a low-cost resource designed to increase validating interactions between professionals and young people. The resource was subsequently introduced into nine organisations and evaluated using staff surveys and semi-structured interviews. Results: Co-design participants identified professional invalidation of young peoples experiences, identities, needs and emotions as an under-recognised contributor to mental health. The resulting resource combined discussion cards, creative activities, role-play and organisational reflection exercises to promote validating practices. Five organisations implemented the resource and reported it to be feasible. Flexible local adaptation was common, while more participatory role-play elements proved harder to implement consistently. Staff observed increased opportunities for disclosure, reflection, peer connection and professional curiosity about young peoples experiences. Staff reported listening differently to young people and, in some settings, implementing changes in response to young people's recommendations. Conclusions: Youth-led co-design identified validation as a practical and meaningful mechanism for operationalising trauma-informed principles in everyday professional practice. With refinements, Validating Voices shows promise as a resource to support more relational, collaborative and trauma-informed responses to young people in public sector settings.

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.

Adverse experiences in childhood (AEs) typically refer to undesirable events, including child maltreatment and household challenges. Various survey measures and linked routine data in the Born in Bradford Birth Cohort (BiB) datasets can provide a contemporary understanding of the distribution of AEs in the population and the factors related to their occurrence. This study aimed to identify relevant survey data on AEs collected from BiB families and to summarise the prevalence of AEs from birth to early adolescence (ages 12-15) among BiB children. We included BiB children who participated in the follow-ups - Growing Up (GUp, n=5253) and Age of Wonder (AoW, n=2662). Four AEs were identified - parental mental illness, parental substance use, children not living with both parents in the same home, and being bullied by peers. The survey data included 1) health, substance use, living arrangements, and children's bullying experience reported by parent(s) at baseline (2007-2011, around birth) and/or GUp (2017-2022, during mid-childhood), and 2) bullying experience and living arrangements self-reported by children at AoW (2022-2024, during early adolescence). Additionally, we included parents' primary care records regarding any mental illness or substance use. Overall, 3371 (64.2%) children experienced at least one of the four AEs between birth and early adolescence. The most common AE was parental mental illness, whereas parental substance use was the least common. Children across all sociodemographic groups experienced AEs. Asian children, or those whose mothers were not materially deprived, appeared less likely to experience AEs. Conversely, children of White or Mixed ethnicities, or whose mothers were materially deprived, were more likely to experience AEs. Consistent with similar studies, our findings show that AEs are widespread but disproportionately affect certain sociodemographic subgroups among BiB children. These disparities can be reduced by early-years policies that provide practical family support, guided by continuously collected AE data.

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.

Background: High rates of young people who are not in education, employment or training (NEET) are a major societal concern in the UK. Whilst other studies have highlighted that adolescent health can predict NEET status in young adulthood, robust and recent longitudinal evidence remains limited. Methods: This study used data from the Millennium Cohort Study, a longitudinal study of people born in the UK in the early 2000s, to estimate the extent to which mental health conditions, physical health conditions and health behaviours during adolescence predict NEET status in early adulthood (median age: 23). Co-occurrence of exposures was also considered and population attributable fractions were calculated to account for differences in exposure prevalence. Results: Among 8,374 young people, 12.5% were NEET at age 23; approximately two thirds were seeking work and one third were economically inactive. Estimates adjusted for demographic factors indicated that multiple health exposures increased risk of being NEET at age 23, with mental health conditions predicting greater risk than physical health conditions and health behaviours. For instance, a longstanding mental health condition more than doubled the risk of being NEET (adjusted relative risk [aRR] = 2.39, 95% CIs = 1.85, 3.09), while autism (aRR = 3.60, 95% CIs = 2.69, 4.83) and ADHD (aRR = 3.25, 95% CIs = 2.38, 4.44) more than tripled the risk. A greater number of reported adolescent mental health conditions was associated with greater risk of being NEET in young adulthood. Obesity predicted being NEET at age 23 (aRR = 1.54, 95% CIs = 1.18, 2.01) and obesity accompanied by a mental health condition further increased risk (aRR = 2.01, 95% CIs = 1.38, 2.93). Follow-up analyses indicated that associations between adolescent mental health and young adult NEET status were more pronounced for females than males and for the economically inactive than those seeking work. Conclusions: Findings indicate that adolescent health, especially mental health, strongly predicts being NEET in early adulthood. Early, integrated health and education interventions may help reduce later educational and labour market disengagement.

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.

IMPORTANCE With a growing global user base of 3.5 billion and users spending nearly as much time gaming as on social media, video gaming's effects on mental well-being have attracted scholarly and public interest. Despite the WHO's inclusion of gaming disorder in ICD-11 and government-mandated restrictions in multiple countries, the causal evidence supporting such policies remains limited. OBJECTIVE To investigate the causal effect of video gaming on mental well-being in the post-COVID period. DESIGN A natural experiment of game console lottery was used to identify the causal effect of video gaming on mental well-being. The intention-to-treat effect was estimated using multivariate regression and propensity score matching. Causal effects of game engagement were estimated using the instrumental variable method (two-stage least squares) and a causal machine learning algorithm, instrumental forest. SETTING Online surveys were conducted between September 2022 and March 2023, covering all 47 prefectures in Japan. PARTICIPANTS A total of 71,435 participants aged 10-69 answered the surveys. 6,911 individuals participated in the natural experiment. EXPOSURES Video game engagement, including video game console ownership, use of the console in the last 30 days, and video gaming duration. MAIN OUTCOMES AND MEASURES Psychological distress and life satisfaction. RESULTS The intention-to-treat effects of winning game console lotteries on mental well-being were positive (0.1 SD). Game console ownership improved mental well-being by 0.1-0.2 SD, and past-month play improved it by 0.2-0.3 SD. An extra hour of daily video game play led to 0.3-0.5 SD improvements in mental well-being. CONCLUSIONS AND RELEVANCE This study found that video gaming had a positive effect on mental well-being in the post-COVID period. The consistency of the effect size with that of a related COVID-period study adds robustness to our findings. Our findings add to the growing evidence that digital media screen time has diverse effects on well-being and support public health policies that recognize the potential mental well-being benefits of appropriate levels of video gaming.

Depression has become a serious concern for students worldwide. Aligned with the WHO Helping Adolescents Thrive (HAT) Guidelines and the Social Determinants of Health (SDoH) model, this study isolates five academically relevant factors academic pressure, work/study hours, study satisfaction, sleep duration, and financial stress from a dataset of 27,880 university students in India and quantifies their associations with depression. Unlike prior work that maximises classification accuracy, this study prioritises interpretability: logistic regression provides odds ratios (OR) with 95% confidence intervals, Random Forest (RF) and XGBoost rank predictors by feature importance, and SHAP (SHapley Additive exPlanations) values extend the analysis to individual-level risk explanation. SMOTE oversampling was applied exclusively to the training set, and performance was evaluated on the original imbalanced test set (n = 5,576). Both ensemble models achieve approximately 77-78% accuracy and an AUC of 0.845, confirmed by 5-fold pipeline cross-validation (CV AUC [~] 0.843). Academic pressure is the dominant risk factor (OR = 2.271; RF importance = 0.481; mean |SHAP| = 0.174), while study satisfaction (OR = 0.796) and sleep duration (OR = 0.835) are protective. The RF model yields a tipping point at academic pressure > 4.02, and interaction plots reveal how depression risk is amplified by low sleep, high financial stress, and extended study hours. These findings provide data-driven thresholds aligned with WHO-endorsed modifiable determinants to support early detection and institutional counselling.

Background: Young people who are Not in Education, Employment, or Training (NEET) represent a major public health and societal challenge. Existing evidence has linked adolescent mental health problems and health risk behaviours to NEET but has largely treated NEET as a static, rather than longitudinal outcome and overlooked the combined effects of multiple health conditions. Methods: Using data from 5,262 participants born between 1993 and 2000 in the UK Household Longitudinal Study, this study examined the independent and combined associations of adolescent mental health problems (emotional symptoms, conduct problems, hyperactivity) and health risk behaviours (regular smoking, drug use, alcohol use, and high social media use) with ever-NEET status, NEET chronicity, and NEET trajectories from ages 16 to 24, using modified Poisson, proportional odds, and multilevel logistic regression models, respectively. Findings: All mental health problems were associated with ever-NEET status (RRs 1.24-1.27) and NEET chronicity (ORs 1.41-1.98); emotional symptoms showed a widening disadvantage with age, while the disadvantages associated with conduct problems and hyperactivity remained stable. Among health risk behaviours, regular smoking showed the strongest and most persistent relationships with NEET (ever-NEET RR 1.54; chronicity OR 1.64); drug use was related to ever-NEET status (RR 1.37) and an increasing disadvantage after age 21-22, while alcohol use and social media use showed limited associations. NEET risk generally increased with the number of co-occurring conditions, but for recurrent NEET (three or more occasions), risk was only elevated at three or more co-occurring conditions. Interpretation: Adolescent health exposures were associated with NEET risk during ages 16-24, but the strength and pattern varied by exposure and outcome, offering potential insights into the timing and emphasis of any interventions.

Background: Posttraumatic stress disorder (PTSD) has been associated with advanced biological age in DNA methylation data, but results have been inconsistent. This study evaluated PTSD in association with epigenetic age in the largest cohort to date (by about 20 fold). Methods: Participants were 45,091 US Veterans (92.76% male) enrolled in the VA Million Veteran Program, with VA electronic health record (EHR), self-report PTSD severity (n = 22,835), and DNA methylation and genotype data. PTSD diagnoses predated the blood draw for obtaining DNA by > = one year. Results: PTSD diagnosis, severity, and duration were associated with age-adjusted metrics of epigenetic age (age residuals) per the Horvath, Hannum, PhenoAge, GrimAge, and DunedinPACE epigenetic age algorithms after multiple testing adjustment. The strongest and most robust effect (to additional covariates) was evident for PTSD severity in association with GrimAge residuals (B = .029, adjusted-p = 2.48e-53, up to 2 years advanced age). The relationships between PTSD severity and GrimAge and PhenoAge residuals were stronger among younger vs. older Veterans. In stratified analyses, all PTSD variables were associated with all epigenetic age residuals in the European ancestry subgroup (n = 27,578), but significant associations only emerged for GrimAge and DunedinPACE in the African ancestry participants (n = 11,690). Conclusions: PTSD was associated with advanced epigenetic aging in the largest study to date to evaluate this question. Effects were generally small in magnitude, though meaningful when considering the personal and healthcare system impact of advanced aging in the large population of VA users with PTSD.

Stress-related disorders are among the most common and burdensome mental health conditions worldwide, yet the mechanisms that allow most trauma-exposed individuals to maintain or regain mental health remain poorly understood. Decades of research have focused on identifying risk factors for psychopathology rather than the active processes that promote resilience and recovery. Here, we present the study protocol for Stress and Trauma Resilience: Opportunities for National Growth (STRONG), a multi-tiered, multi-domain, multi-level investigation of resilience conducted in Israel in the aftermath of the October 7, 2023 attack and the prolonged national adversity that followed. STRONG uses a nested design that integrates nationally representative longitudinal data with in-depth neurobehavioral assessment. STRONG-1 is a longitudinal, population-based study of approximately 4,600 Israeli adults assessed across five waves over three years, characterizing individual, social, and societal predictors of resilience trajectories. STRONG-2 is a controlled laboratory study of highly resilient and highly vulnerable individuals selected from STRONG-1, assessing behavioral and physiological mechanisms alongside cognitive tests and ecological momentary assessment. STRONG- 3 examines a subset of these individuals in the MRI scanner, capturing structural and functional neural markers with synchronized physiological and eye-tracking data. Advanced computational approaches will integrate data across tiers, levels, and domains into predictive models of resilience. STRONG will establish Israel's first nationally representative dataset on stress resilience and provide a rare opportunity to study human adaptation at scale and in a real-world context. These findings will inform early detection strategies and the development of empirically grounded, modifiable targets for intervention.

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: Autistic Chronic Energy Depletion Syndrome, commonly referred to as Autistic Burnout, is a debilitating condition characterized by exhaustion, loss of function, and reduced tolerance to stimuli. While several instruments attempt to measure it, validation studies have only used cross-sectional designs and/or convenience samples with low support needs, limiting understanding of their performance across heterogeneous, autistic populations and over time. Methods: Using a community-based participatory research (CBPR) approach, we revised the 27-item AASPIRE Autistic Burnout Measure (AABM) into a 14-item AASPIRE Autistic Burnout Measure-Revised (AABM-R) and tested it in a longitudinal study of 835 autistic adults recruited from healthcare systems, disability services, and the community. Participants completed surveys directly (with or without support) or via a caregiver. We assessed structural validity and measurement invariance using exploratory and confirmatory factor analysis, tested construct validity through a priori hypothesis testing, examined discriminant validity from depression using longitudinal factor analysis and cross-lagged panel models, and assessed criterion validity using ROC analysis. Results: The AABM-R demonstrated a clear single-factor structure among direct reporters, with and without support, and measurement invariance across these groups; findings were less conclusive for the smaller caregiver-report subsample. Autistic burnout correlated as hypothesized with stressors (e.g., discrimination, masking, adverse childhood experiences), supports (e.g., social support, receiving needed help with daily living activities), and broader outcomes (e.g., quality of life, depression, anxiety). Longitudinal modeling supported autistic burnout as empirically distinct from, though related to, depression. ROC analysis (AUC = 0.89) supported cut-offs distinguishing probable (33-56, LR 7.38), unsure, and unlikely (0-22, LR 0.15) burnout. Conclusions: The AABM-R is a brief, accessible, psychometrically sound measure of autistic burnout suitable for heterogeneous autistic populations, with preliminary clinical cut-offs to guide screening. Further research is needed on the caregiver-report version and on longitudinal predictors and outcomes of burnout.

AVATAR therapy is an effective relational therapy for persistent distressing auditory verbal hallucinations (voices). A digital representation of the embodied persecutory voice (avatar) is created and used in a series of dialogues in which the voice hearer is supported to be more assertive and the avatar concedes power. In the first mediation analysis of AVATAR therapy examining the role of power-related constructs, we investigate whether treatment effects on total severity, frequency, and distress of voices are mediated by changes in beliefs about voices and the self, voice relationship appraisals and anxiety. Mediation effects were evaluated in relation to decomposing treatment offer and treatment receipt effects using both Intention to treat (ITT) and Complier Average Causal Effect (CACE) analyses. One hundred and fifty participants from AVATAR1, a randomised control trial (RCT) comparing AVATAR therapy to Supportive Counselling took part in this study, with their baseline and end of treatment (12 weeks) data used. As hypothesised, across both ITT and CACE analyses, reductions in perceived voice omnipotence and increased assertiveness in relation to voices emerged as consistent mediators of AVATAR therapy on reductions in overall severity, frequency and distress of auditory hallucinations compared to SC, whereas voice malevolence, perceived power differential, self-esteem and anxiety did not. Exploratory analysis also indicated that increases in acceptance and autonomy in relation to voices mediated the impact of AVATAR therapy on overall voice severity and distress. This mediation analysis refines our understanding of AVATAR therapy and highlights agency, voice omnipotence and acceptance as intervention targets.

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.

Background: Rising rates of young people Not in Education, Employment, or Training (NEET) in the UK have recently coincided with declining youth physical and mental health but no study has asked whether this reflects a growing proportion of young people with health problems (prevalence) or those with health problems becoming more likely to be NEET (penalty). Methods: Using 15 years of Understanding Society data (2009-23), we analysed 15,242 respondents aged 16-24 (66,160 observations). We employed three complementary approaches: descriptive trends, Blinder-Oaxaca-Kitagawa (BO) probit decomposition comparing 2009-2013 and 2019-2023 against a 2014-2018 reference period, and fixed-effects (FE) Poisson models with lagged health status. Exposures included self-reported health conditions or disability (SRHD), psychological distress , diagnosed conditions and socio-demographic factors. Findings: NEET rates were lowest in 2014-18 (10.5-11.5%) and higher in 2009-13 (12-15%) and 2019-23 (15-16%). Higher prevalence of SRHD, psychological distress, diagnosed depression and multimorbidity explained changes in NEET prevalence across both the 2009-13 to 2014-2018 and 2014-18 to 2019-23 periods. No change in penalty was observed for any health variable across periods, except for an increase in the penalty for SRHD between the 2009-13 to 2014-18 periods. Interpretation: Rising NEET rates among UK youth are driven largely by more young people having physical and psychological ill health. Whilst labour market and education accommodations remain important, reducing NEET rates will require reversing the decline in youth health, not just accommodating it.