ObjectiveThis study aimed to examine the non-linear associations of body mass index (BMI) and body dissatisfaction with depressive symptoms among Chinese university students, and to explore how the indirect association between BMI and depressive symptoms through body dissatisfaction varies across the BMI range.MethodsA cross-sectional design was used, and 7,928 full-time students were recruited from eight universities in China. Depressive symptoms were assessed with the Zung Self-Rating Depression Scale (SDS); body dissatisfaction was operationalised as the absolute difference between measured BMI and self-reported ideal BMI. Analyses comprised restricted cubic spline (RCS) models, an exploratory non-linear decomposition of the indirect association, generalised additive models (GAM) as a sensitivity analysis, a supplementary receiver operating characteristic (ROC) analysis, and k-means clustering. Because measured BMI enters the calculation of body dissatisfaction, the exposure and the proposed mediator are not mathematically independent; all decomposition results are therefore reported as exploratory.ResultsBoth BMI and body dissatisfaction were non-linearly associated with depressive symptoms (both P < 0.01). In the exploratory decomposition, the estimated indirect association between BMI and depressive symptoms through body dissatisfaction attenuated progressively as BMI increased. In the supplementary ROC analysis, the BMI value maximising the Youden index was 23.11 kg/m² (AUC = 0.768); this is a sample-specific, internally derived discrimination point rather than a screening threshold. A five-stratum descriptive matrix combining BMI groups with body-dissatisfaction clusters was constructed, and the observed prevalence of depressive symptoms ranged from 14.4% to 100.0% across strata.ConclusionBMI and body dissatisfaction were non-linearly associated with depressive symptoms in this sample, and the magnitude of the indirect association through body dissatisfaction varied across the BMI range. Because the body-dissatisfaction indicator is mathematically derived from measured BMI and the design was cross-sectional, these results describe statistical associations and should not be read as evidence of a causal mediating mechanism. The risk-stratification matrix was developed and evaluated in the same dataset without internal or external validation; it is therefore exploratory and requires independent validation before any screening application.
Virtual Care Expansion and Physician Follow-Up Among Youth With First Mental Health Contact Through a Hospital: Population-Based Repeated Cross-Sectional Study
<strong>Background:</strong> Timely follow-up is crucial for youth whose first mental health contact is through a hospital; virtual care could facilitate this. <strong>Objective:</strong> This study aimed to examine the association between the significant expansion of virtual care in Ontario, Canada, and follow-up mental health care rates for these youths. <strong>Methods:</strong> We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified first-contact emergency department (ED) visits or hospital admissions for self-harm, mood disorders, or psychosis from March 1, 2009, to February 29, 2024, among Ontario youth (aged 10-24 years). Virtual care was expanded in March 2020; we examined 2 expansion stages (temporary and permanent). Autoregressive integrated moving average analyses estimated level and slope changes (vs before virtual care) in age- and sex-standardized monthly rates of 7-day mental health follow-up. Subgroup analyses examined rurality and socioeconomic status. <strong>Results:</strong> We identified 42,208 first-contact ED visits and 17,701 first-contact hospital admissions. Pre–virtual care mean follow-up rates were 17.64 (SD 2.97) per 100 first-contact ED visits and 21.90 (SD 5.05) per 100 first-contact hospital admissions. Temporary expansion was associated with immediate increases in follow-up that declined (level changes: 4.81, 95% CI 2.82-6.81 for ED visits and 7.51, 95% CI 4.41-10.60 for hospital admissions; slope changes: −0.31, 95% CI −0.42 to −0.21 for ED visits and −0.32, 95% CI −0.48 to −0.15 for hospital admissions). Permanent expansion was associated only with an immediate decrease in ED visit follow-up (level change: −3.81, 95% CI −6.70 to −0.92) that was significant in rural (−1.06, 95% CI −1.93 to −0.184) but not urban (0.44, 95% CI −0.179 to 1.06) areas; results were otherwise similar between subgroups. <strong>Conclusions:</strong> Virtual care was not associated with sustained changes or equity improvements in mental health follow-up for high-acuity youth, representing a missed opportunity to extend physician reach and address barriers. Further research and quality improvement are needed. <strong>Trial Registration:</strong>
Video and App-Based Games for Youth Emotion Regulation: Scoping Review
<strong>Background:</strong> Emotion regulation (ER) is a transdiagnostic construct encompassing distinct strategies that can be used to encourage adaptive coping skills in support of youth’s (ages 10 to 24 years) mental health. ER is responsive to training and intervention, such as via video and app-based games. Previous literature shows that video and app-based games impact the psychological well-being of youth and may be an accessible way to help youth learn about and implement emotional regulation strategies in their lives. <strong>Objective:</strong> Previous reviews have not focused on video and app-based games that support ER and how they may be beneficial to youth with and without a mental health diagnosis. This scoping review sought to collect, review, and understand the scope of research on the effects of video and app-based games on ER outcomes in youth, and areas in need of further investigation. <strong>Methods:</strong> We conducted a scoping search of MEDLINE, Embase, and APA PsycInfo from the beginning of the database up to and including December 2025. Studies were included if they were in English, included youth with a mean age between 10 and 24 years, and that evaluated an intervention or an intervention adjunct to help improve their ER skills using a video or app-based game. We extracted population characteristics (for the video game or app), the effectiveness of the intervention, and ER strategies addressed. <strong>Results:</strong> Following the screening of 14,456 studies, we identified 33 studies for inclusion in the final review. Four recurrent outcomes emerged: change in overall ER skills, mood modification, mental health symptom management, and emotion identification. <strong>Conclusions:</strong> While most studies reported improvements in these areas, some studies reported areas of continued difficulty. The results suggest that video and app-based games could serve as beneficial, easy-to-access tools to support youth ER through various strategies, with areas for future research to address mixed results and recommendations for addressing digital health improvement.
Autistic traits in unaffected first-degree relatives of individuals with schizophrenia and bipolar disorder: implications for shared familial neurodevelopmental vulnerability
BackgroundAutistic traits have increasingly been linked to schizophrenia (SCH) and bipolar disorder (BD) within a shared neurodevelopmental framework. However, whether these traits are similarly expressed in unaffected first-degree relatives of individuals with SCH and BD remains poorly understood.MethodsThis cross-sectional study included 135 participants: first-degree relatives of individuals with schizophrenia (SCH-FDR, n=45), first-degree relatives of individuals with bipolar disorder (BD-FDR, n=45), and healthy controls (HCs, n=45). Autistic traits were assessed using the Autism Spectrum Quotient (AQ). Participants also underwent clinical psychiatric evaluation, including structured diagnostic assessment, to exclude psychiatric disorders and autism spectrum disorder.ResultsSignificant group differences were observed for AQ total score (p=0.002), Communication (p=0.004), and Imagination (p<0.001) subscales. Communication scores were significantly higher in SCH-FDR than in HCs (p=0.003). Imagination scores were higher in both BD-FDR (p=0.016) and SCH-FDR (p<0.001) groups compared with HCs. Total AQ scores were also higher in both relative groups than in HCs (BD-FDR: p=0.015; SCH-FDR: p=0.003). The proportion of participants with AQ scores ≥26 was higher in SCH-FDR (17.8%) and BD-FDR (13.3%) than in HCs (2.2%; p=0.045).ConclusionsAutistic traits were more pronounced in SCH-FDR and BD-FDR than in healthy controls. Differences were most evident in total AQ scores and the Imagination subscale across both relative groups, whereas communication difficulties were specifically elevated in schizophrenia relatives. These findings are consistent with the concept of shared familial neurodevelopmental vulnerability across schizophrenia and bipolar disorder.
Investigating the DTI-ALPS index and its association with cognitive impairment in Alzheimer’s disease: a diffusion tensor imaging study
ObjectivesWith the global aging population, Alzheimer’s disease (AD) poses a major health challenge. The diffusion tensor image (DTI) analysis along the perivascular space (DTI-ALPS) index has emerged as a noninvasive imaging marker that indirectly reflects glymphatic function. However, its alterations in AD and their associations with cognitive impairment remain incompletely understood. This study primarily aimed to investigate changes in the bilateral ALPS index in patients with AD and to evaluate their associations with cognitive, functional, and emotional measures. Secondary analyses further explored white matter microstructural alterations and their relationships with the ALPS index.Materials and methodsIn total, 35 patients with AD and 21 cognitively normal healthy controls (HC) underwent 3.0T MRI and neuropsychological assessments. Tract-based spatial statistics (TBSS) analysis revealed areas of white matter damage and injured fibers in patients. Bilateral ALPS indices were compared between groups using analysis of covariance (ANCOVA) adjusted for age and gender. TBSS and ROI-based ANCOVA analyses of fractional anisotropy (FA) and mean kurtosis (MK) were performed as secondary analyses. Partial correlation analyses were used to examine associations between ALPS indices, white matter metrics, and neuropsychological scores.ResultsCompared with the HC group, the AD group showed significantly lower bilateral ALPS indices, and these differences remained significant after adjustment for age and gender (left: F = 14.404, P < 0.001; right: F = 28.513, P < 0.001). Bilateral ALPS indices were significantly correlated with cognitive and functional measures, including the Mini-Mental State Examination, Montreal Cognitive Assessment, and Activities of Daily Living (ADL), and were also significantly associated with emotional measures, including the Hamilton Anxiety Scale and Hamilton Depression Scale. Among these, the strongest associations were observed with ADL (left: r = 0.688; right: r = 0.701; both P_FDR < 1 × 10–7). Secondary analyses revealed widespread white matter microstructural alterations in AD. Region-of-interest-based analyses showed that the left hippocampal cingulum exhibited significant differences in both FA and MK, and these metrics were positively associated with the ALPS index as well as with cognitive and functional performance.ConclusionThe glymphatic system of AD patients has a reduced ability to clear waste. The ALPS index was closely associated with cognitive, functional, and emotional status, while white matter abnormalities, particularly in the left hippocampal cingulum, may represent a structural correlate of glymphatic dysfunction in AD.
Usability, adherence and efficacy of coach-augmented dHealth cognitive behavioural therapy for insomnia in South African sexual assault survivors: a pilot study
IntroductionTreating sleep difficulties – a core symptom of posttraumatic stress disorder (PTSD) – can improve both sleep and broader psychiatric outcomes. Digital health (dHealth) applications offer a scalable way to deliver cognitive behavioural therapy for insomnia (CBT-i), particularly for trauma survivors facing barriers to care. However, adherence to these interventions is often poor and may be improved through human support, especially for more demanding components such as sleep rescheduling. This study evaluated the usability, adherence, and preliminary efficacy of a dHealth application delivering sleep rescheduling both with and without coach support, alongside self-guided stimulus control and sleep hygiene components.MethodsFemale sexual assault survivors were assigned to one of two groups comparing the sleep rescheduling component of the dHealth application: either coach-assisted (n = 27) or self-guided (n = 27). All participants received stimulus control and sleep hygiene information embedded in the application, in the form of a newsletter, including a third comparator group (n = 25), which received this information only. Usability and negative effects were self-reported. Adherence was assessed via dropout rates, application engagement, newsletter openings, and compliance with sleep prescriptions. Efficacy was measured by changes in insomnia, depressive, and PTSD symptoms.ResultsThe self-guided group reported lower satisfaction and more negative effects than controls. Compared to the self-guided group, coach-assisted participants showed better adherence to sleep prescriptions. Across groups, insomnia and depressive symptoms decreased significantly. Preliminary evaluation of efficacy showed that PTSD symptoms improved substantially in the coach-assisted and comparator groups, while improvements in the self-guided group plateaued after initial gains.DiscussionUnguided application use was associated with poorer usability, greater negative effects, lower adherence, and some potential weaker outcomes. Preliminary findings suggest that sleep rescheduling may benefit from human support to be effective. Where coaching is unavailable, simple stimulus control and sleep hygiene education may be preferable.
Pseudo-professional mechanism of collaborative mental health support in low-resource county-level contexts in China
China has made school-family-community collaboration a central policy direction for adolescent mental health, yet low-resource counties often lack the professional workforce, stable interorganizational arrangements, and non-stigmatizing pathways needed to reproduce an institutionalized service model. Existing research on task sharing shows that trained non-specialists can perform selected forms of basic psychological support, but it says less about how such tasks are incorporated into everyday school relationships and linked to professional referral. This community case study examines Suining County, Jiangsu Province, as an information-rich instrumental case. The core evidence consists of semi-structured interviews with 52 principals, school mental health teachers, homeroom teachers, subject teachers, parents, and students, together with non-participant observations conducted in 10 schools between September 2023 and June 2024. County policy documents, training records, and de-identified aggregate administrative screening data were used only to describe the case context. The analysis identifies a pseudo-professional mechanism organized through three related processes. Daily relational embeddedness enables risk signals to be noticed in classrooms, class management, and home-school communication. Bounded task sharing converts listening, basic reassurance, risk inquiry, and referral into limited front-end tasks that existing school actors can perform without assuming diagnostic or therapeutic authority. Tiered networking transfers responsibility from the class to the school and, when necessary, to medical services, while reconnecting students to everyday support after their return to school. This arrangement widens the reach of front-end support but remains constrained by teacher workload, parental refusal, discontinuities across school transitions, uneven supervision, and privacy risks. Pseudo-professionalization therefore does not mean replacing clinical professionals. It denotes a bounded reorganization of support functions whose safety depends on professional gatekeeping, sustained supervision, stable referral channels, informed participation, and disciplined information governance.
From facing fears to experimental frontiers: immersive cinematic virtual reality environments as a catalyst for innovation in behavioral neuroscience
Virtual reality (VR) has gained traction in psychiatric research in exposure-based interventions for phobias, simulations of hallucinations in psychosis, and adaptations of cognitive-behavioral therapy. These applications demonstrate that emotionally immersive digital environments can meaningfully engage pathological processes in controlled settings. Yet VR’s potential in psychiatry goes beyond providing new contexts for well-established therapeutic interventions. Here, we argue that while emotionally rich, interactive VR scenarios can be leveraged to radically improve translational experimental design in behavioral neuroscience, there are not yet clear conceptual frameworks for the incorporation of these elements. Traditional lab tasks with theoretical implications for therapeutic interventions often rely on abstract procedures that fail to capture the immersive, affective dynamics of real-world maladaptive behaviors. Here, we discuss how high-fidelity VR scenarios simulate complex emotional naturalistic contexts while retaining precise experimental control. We illustrate this drawing on our recent work using high-fidelity, game-engine-based VR scenarios and consider how these environments offer a scalable and accessible platform for large-sample studies, as VR hardware becomes more common in the household. We propose a set of dimensions called the Immersive Behavioral Translation Framework (IBTF) that suggest conceptual considerations for VR in neuroscientific research: (i) The controllability of immersive environments; (ii) features of immersive environments that bridge ecological validity gaps; and (iii) the relatability of these emotionally immersive experiments to clinical conditions in translational research. We illustrate this framework with reference to emerging findings in associative learning and threat sensitivity, while emphasizing the broader implications for rethinking how we study cognition, emotion, and psychopathology.
Development and psychometric evaluation of the AI emotional engagement scale
BackgroundWith the increasing integration of artificial intelligence (AI) technologies into daily life, the underlying mechanisms of emotional interactions between users and AI have emerged as a critical research topic in the field of human-computer interaction (HCI). Existing studies have predominantly adopted traditional technology acceptance models or satisfaction scales, which lack targeted applicability in capturing unique features of AI interactions, such as parasocial relationships and emotional dependence. The present study aims to develop a self-report instrument, the AI Emotional Engagement Scale (AEES), and examine its psychometric properties for assessing users’ level of AI Emotional Engagement with AI systems.MethodsThis study was conducted based on Norman’s three-level theory of emotional design. Study 1 (N = 24) extracted core information from interview data using qualitative analysis, and generated an initial item pool through multiple rounds of expert review. Study 2 (N = 103) conducted a pre-test of the initial items to examine indicators including item quality and relevance, optimized the item design, and developed the formal item set. Study 3 (N = 924) verified the factor structure of the AEES via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), conducted reliability and validity tests of the scale, and finalized the factor structure of the 28-item, three-dimensional scale.ResultsResults of EFA indicated that AI Emotional Engagement consists of three dimensions: the visceral level, behavioral level, and reflective level, which was consistent with the theoretical framework, with a cumulative variance contribution rate of 68.32%. Results of CFA demonstrated that the three-factor model had a good fit (χ²/df = 3.765, CFI = 0.91, TLI = 0.90, RMSEA = 0.077, SRMR = 0.0496). The overall AEES and its three dimensions exhibited good internal consistency reliability, with reliability coefficients ranging from 0.90 to 0.97.ConclusionThe AEES has favorable psychometric properties, and can serve as a reliable instrument for researchers and practitioners to assess users’ AI Emotional Engagement with AI systems.
Differentiating the potential of continuum beliefs to reduce the public stigma of schizophrenia, depression, and alcohol dependence: associations with illness recognition and treatment recommendations
PurposePromoting continuum beliefs has been discussed as a strategy for stigma reduction. The current study examines associations of continuum beliefs with stigma aspects (stereotypes, emotions, and social distance) and mental health literacy (illness recognition and treatment recommendations).MethodsIn 2011, a sample of the German population (N = 3,642) completed a vignette-based interview on attitudes regarding schizophrenia, depression, or alcohol dependence. Logistic regression analyses were performed and predicted probabilities were used to calculate prevalence estimates and depict direct effect sizes.ResultsIncreased continuum beliefs were strongly related to a decreased likelihood of social distance and endorsement of some negative stereotypes (e.g., being alien for schizophrenia) and an increased likelihood for endorsement of other negative stereotypes (e.g., lack of willpower for schizophrenia and depression) and emotions (e.g., anger for schizophrenia). Effect sizes indicated a greater reduction in negative stereotypes and desired social distance than increases in negative stereotypes or emotions. Furthermore, continuum beliefs were associated with a decreased probability of illness recognition for schizophrenia and recommending treatment for schizophrenia and depression, but an increased likelihood for illness recognition and recommending treatment for alcohol dependence.ConclusionPotentially harmful associations of continuum beliefs were found for schizophrenia and depression and should be considered by future studies and intervention designs. These potentially harmful associations are likely outweighed by helpful associations based on prevalence estimates and effect sizes. Associations between continuum beliefs and mental health literacy seem to be illness-dependent. Because of the sociocultural context and the time gap between the study and publication, representativeness for current public attitudes is limited.