Tag: Academic research

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Psychometric properties of the Chinese version of the school refusal assessment scale–revised in a clinical sample of adolescents and their caregivers with depressive disorders

School refusal behavior (SRB) is a prevalent and functionally heterogeneous problem among children and adolescents that can lead to serious academic, social, and psychological consequences. The School Refusal Assessment Scale–Revised (SRAS-R) is the most widely used instrument for identifying the functional motivations underlying school refusal, yet its psychometric properties have not been examined in Chinese clinical populations. The present study aimed to translate and culturally adapt the SRAS-R into Chinese and to evaluate its psychometric properties in a clinical sample of adolescents with depressive disorders. A total of 171 adolescent outpatients (age range 12–19 years; M = 15.5, SD = 1.90; 67.3% female) diagnosed with DSM-5 depressive disorders and meeting criteria for school refusal behavior completed both child and parent versions of the Chinese SRAS-R. Confirmatory factor analysis (CFA) using diagonally weighted least squares estimation was conducted. After removing Items 20 and 24, the four-factor model yielded strong CFI and RMSEA values for both parent (CFI = 0.99, RMSEA = 0.021, SRMR = 0.094) and child reports (CFI = 0.98, RMSEA = 0.028, SRMR = 0.097), although SRMR values were marginally above the prespecified threshold. Internal consistency reliability ranged from marginal to good across subscales (Cronbach’s α: parent = 0.664–0.815; child = 0.700–0.864), with parent-reported Factor 4 showing the weakest reliability. Factor 1 (avoidance of aversive school situations) obtained the highest mean scores for both informants, consistent with the depression-related negative affectivity characteristic of this clinical sample. Cross-informant discrepancy analyses revealed that children reported significantly higher scores than parents on Factor 2 (escape from social/evaluative situations; p = .017, d = 0.18) and Factor 4 (pursuit of tangible reinforcement; p <.001, d = 0.27), suggesting that parents may underestimate internally driven motivations. Intraclass correlation coefficients indicated fair to good parent–child agreement (ICC = 0.45–0.62), with the highest agreement for Factor 1 and the lowest for Factor 4. The findings provide initial internal-structure and reliability evidence for the Chinese SRAS-R in this single-site clinical sample and underscore the need for multi-informant assessment, while future studies should examine convergent, discriminant, criterion-related, and predictive validity in more diverse samples.
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Structuring Digital Mental Health Care Navigation: Co-Design Nominal Group Technique Study to Develop the MChart Definition and Typology of the Characteristics of Digital Mental Health Care Navigation Tools

<strong>Background:</strong> Australia’s mental health care system has been characterized by complexity and fragmentation, as highlighted by numerous reports, commissions, and inquiries. In response, digital mental health care navigation tools have emerged as a promising solution to help individuals locate appropriate mental health services. The rapid proliferation of these tools—without a clear understanding of their definitions and characteristics—risks creating confusion rather than clarity for users. Terms such as “navigation” and “navigators” are often used interchangeably, further complicating the landscape. <strong>Objective:</strong> This study addressed the need for a standardized definition and typology of the characteristics of digital mental health care navigation tools. <strong>Methods:</strong> This study was part of the development of a digital mental health care navigation tool for navigators and planners (MChart). It used a co-design approach using expert-based cooperative analysis, which is a nominal group technique to develop a definition and typology of the characteristics of digital mental health care navigation tools. This process was guided by the Technology Readiness Level for Implementation Sciences framework. The co-design process involved two 2-hour sessions with an expert panel comprising 28 participants, including representatives from mental health planning, primary health care, health care financing and delivery, community-managed organizations, clinical settings (psychiatrists, psychologists, and general practitioners), and consumers. <strong>Results:</strong> The expert panel collaboratively developed a consensus definition of digital mental health care navigation tools, outlining their scope and intended targets. Through the co-design process, the panel identified 157 characteristics of digital mental health care navigation tools. These characteristics were organized into 5 primary domains: type, management, content, design, and quality. The definition and typology characteristics provide a structured framework for understanding and evaluating the diverse range of digital mental health care navigation tools currently available. <strong>Conclusions:</strong> The co-designed definition and typology offer a foundational step toward reducing confusion in the digital mental health care navigation space. This study supports the development of quality standards that can be used to assess and compare existing and future tools. This framework has the potential to guide developers, end users, and policymakers in creating more effective, user-centered navigation solutions within Australia’s mental health care system and internationally.
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Mobility Patterns and Mental Health During the COVID-19 Pandemic: Longitudinal Observational Study Using Smartphone Mobility Data

<strong>Background:</strong> The COVID-19 pandemic disrupted mobility globally, but its mental health implications remain difficult to characterize because most studies relied on lockdown status, population-level mobility indicators, or self-reported mobility. These approaches may miss individual differences in actual movement patterns and cannot fully examine bidirectional relationships between mobility and mental health. Individual-level smartphone geolocation data may provide a more objective and temporally aligned measure of mobility during periods of societal disruption. <strong>Objective:</strong> This study aimed to use individual-level Google location history (GLH) data and population-level Google community mobility reports (GCMRs) to examine concurrent and longitudinal relationships between pandemic-era mobility patterns and mental health symptoms in Hong Kong. <strong>Methods:</strong> This study analyzed data from the CU-COVID19 cohort study, an online longitudinal survey study of the psychological impact of the pandemic in Hong Kong. Mental health symptoms over the previous 14 days were assessed at baseline, 6 months, and 12 months using the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, and the 4-item PTSD Checklist for DSM-5. Participants provided retrospective GLH data reflecting their mobility during the corresponding 14-day survey periods. The analytic sample included 145 participants with baseline GLH data, of whom 110 had 6-month follow-up data and 49 had data available at all 3 assessment waves. GLH data were used to derive mobility factors representing journey diversity, immobility, and remoteness. Population-level mobility during the same 14-day periods was measured using Hong Kong GCMR residential stay data. Concurrent mediation models examined whether individual mobility mediated associations between population-level residential stay and mental health symptoms. Longitudinal models examined bidirectional associations between changes in individual mobility and mental health across 6-month intervals. <strong>Results:</strong> Population-level residential stay was not directly associated with mental health. In concurrent mediation models, higher population-level residential stay was associated with lower individual journey diversity (β=–0.36; <i>P</i>&lt;.001), and lower journey diversity was associated with higher depression (β=–0.29; <i>P</i>=.02) and posttraumatic stress disorder (PTSD) (β=–0.35; <i>P</i>=.002). Bootstrapped indirect effects suggested mediation through journey diversity for depressive symptoms (β=0.11, 95% CI 0.02-0.25) and PTSD symptoms (β=0.13, 95% CI 0.05-0.27), although the depression-related indirect effect became less robust after adjustment for local and individual COVID-19 infection indicators. Longitudinally, higher baseline depressive symptoms predicted subsequent reductions in journey diversity (β=–0.15; <i>P</i>=.02), and reductions in journey diversity predicted higher subsequent depressive symptoms (β=–0.43; <i>P</i>=.008). <strong>Conclusions:</strong> Individual-level mobility patterns, particularly lower journey diversity, showed more consistent associations with mental health symptoms than population-level residential stay. Findings suggest bidirectional relationships between mobility and mental health and demonstrate the potential of smartphone geolocation data for digital phenotyping. However, the modest and self-selected sample, limited GCMR availability, and observational design require cautious interpretation.
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MapLight’s Schizophrenia Candidate Has Mixed Results at Phase II

MapLight Therapeutics announced this week that its candidate drug for treatment of schizophrenia had achieved its primary endpoint in a Phase II trial, but only at the twice daily dose tested in the trial.

As reported by the California-based company, while participants of the trial who were given the candidate drug, ML-007C-MA, once a day did show some signs of improvement it was not statistically significant.

ML-007C-MA is a combined muscarinic agonist (betovumeline) and peripherally acting anticholinergic (fesoterodine). It acts by turning on two receptors in the brain, M1 and M4.

M1 is the main receptor the drug is trying to stimulate in the brain cortex and hippocampus, where it is linked to cognition, attention, and possibly some aspects of psychosis. Turning on M4 also helps by acting like a brake on the overactive signaling that contributes to hallucinations and delusions. Betovumeline activates both M1 and M4 centrally, while fesoterodine is there mainly to block unwanted side effects outside the brain, like gastrointestinal issues.

In this study, MapLight randomized 307 adults with an acute exacerbation of schizophrenia to treatment with either a twice daily or once daily treatment with ML-007C-MA or placebo for five weeks.

At five weeks, patients given the twice daily dose had a statistically significant and clinically meaningful reduction in Positive and Negative Syndrome Scale (PANSS) total score of 4.5 points compared to placebo. Cognitive scores were also better in the twice daily group versus placebo.

While this result is positive overall, the non-statistically significant result for the once daily dose proved unpopular with investors and company shares on the Nasdaq fell 40% after the announcement.

In September 2024, Cobenfy, the first muscarinic M1/M4 agonist drug for treatment of schizophrenia was approved by the FDA. Now owned by BMS, Cobenfy will be the main competitor for ML-007C-MA if approved.

Cobenfy was groundbreaking because it was the first new mechanism of action for schizophrenia in decades, moving beyond dopamine blockade to a muscarinic approach and targeting both hallucinations and delusions as well as the more cognitive aspects of the disease, which are not well treated with other drugs.

Despite the approval of Cobenfy, a number of other competitors developing treatments for schizophrenia have failed in recent years. Whether MapLight can succeed at Phase III with ML-007C-MA—which is also being tested as a treatment for psychosis linked to Alzheimer’s disease—and compete with Cobenfy, remains to be seen.

The post MapLight’s Schizophrenia Candidate Has Mixed Results at Phase II appeared first on Inside Precision Medicine.

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Synaptic mechanisms for differential severity of social preference deficits in male and female mice induced by diminished activity-dependent BDNF

Males are more commonly diagnosed with autism spectrum disorder (ASD) than females with a ratio of about 4–1. However, the neural mechanisms underlying the sex differences in ASD are unknown. Social deficits are the core symptoms of patients with ASD. Previous studies showed that diminished activity-dependent brain-derived neurotrophic factor (BDNF) signaling induced differential severity of autism-like social preference deficits in male and female mice by using a mouse model with genetic knock-in of human BDNF methionine (Met) allele, which significantly decreased activity-dependent BDNF release without affecting basal BDNF secretion. Here, we investigated the synaptic mechanisms for diminished activity-dependent BDNF-induced differential severity of social preference deficits in males and females. The prefrontal cortex (PFC) is a critical brain region for social behaviors. Whole-cell patch-clamp brain slice recordings showed that diminished activity-dependent BDNF signaling differentially increased the frequency of spontaneous action potentials (sAPs) of pyramidal neurons in the PFC of male and female BDNF+/Met mice. The frequency of sAPs in male BDNF+/Met mice was higher than in female BDNF+/Met mice. Diminished activity-dependent BDNF signaling differentially enhanced excitatory synaptic transmission and dampened inhibitory synaptic transmission of pyramidal neurons at pre- and post- synapses in males and females, which were mediated by dysregulated transcriptional levels of key synaptic genes. Chemogenetic inhibition of pyramidal neurons in the PFC of BDNF+/Met mice was sufficient to ameliorate autism-like social preference deficits in males and females. This study reveals synaptic mechanisms underlying the differential severity of social preference deficit in male and female BDNF+/Met mice, which provides a potential neural basis for sex differences in male and female ASD patients with and without the BDNF Val66Met SNP.
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Historical trauma as a contributor to postpartum depression among Indigenous mothers

IntroductionPostpartum depression (PPD) is a significant public health concern. Moreover, research suggests that American Indian/Alaskan Native (AI/AN) mothers experience postpartum depression at higher rates than the general population (Heck, 2021; Ko et al., 2017). As a result, understanding the potential causes of higher PPD among AI/AN mothers is helpful to the development of better interventions to reduce PPD among AI/AN mothers. A potential cause of higher PPD symptoms among AI/AN mothers is historical trauma (HT). HT refers to the cumulative psychological wounding experienced across generations due to systemic oppression, colonization, slavery, and other traumatic events experienced by a group of individuals.MethodsTo test the theorized relationships between HT and PPD symptoms, we conducted an online survey of adult women who both identified as Indigenous and who give birth in the past five years (N = 56). The survey consisted of the psychometrically suitable measures of the Historical Loss Scale (HLS: Whitbeck at al, 2004) and the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). .ResultsThe results indicated that a model of HLS scores as a predictor of PPD symptoms over and above the controls of income, mental health diagnosis, and the total number of children of the birth mother fit the data well (χ2 = 13.60; df = 10; p = .192; RMSEA = .081 [90% CI: .000, .178]; CFI = .949). Moreover, of all the predictors, the dimension of the HLS measuring mothers’ endorsement of the presence of oppressive governmental and institutional policies toward AI/AN was the strongest predictor of greater PPD (β = .28, p < .05). A Bollen Stine bootstrap test was also used to confirm the stability of the model. The Bollen Stine operates by comparing the theorized model to a model that perfectly fits the data. The results of the Bollen Stine test indicated that the theorized model was not significantly different than a model of perfect fit. .DiscussionSuch results suggest that a potential explanation of higher PPD symptoms among AI/AN mothers is the effects of HT. Future interventions to reduce PPD symptoms among AI/AN mothers may benefit from an additional focus on treating HT.
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Immersive wearable virtual reality for autism: a systematic review of current evidence

IntroductionImmersive and wearable virtual reality (VR) is an emerging technology with growing potential to support assessment and intervention ifor autistic people. The methodological heterogeneity of existing studies limits the interpretation and generalization of current evidence.MethodsA systematic review with a narrative synthesis was conducted in accordance with the PRISMA guidelines. Electronic searches were performed in PubMed, Scopus, IEEE Xplore, Web of Science, and Google Scholar, identifying studies published between 2015 and August 2025. Twenty-two studies investigating wearable and immersive VR interventions in children and adults with ASD met the eligibility criteria.ResultsThe included studies demonstrated that wearable VR interventions may improve social communication, joint attention, emotional regulation, daily living skills, executive functioning, and user engagement. Innovative technologies, including eye-tracking and artificial intelligence-based systems, also enabled objective assessment of gaze behaviour, social interaction, and physiological responses. Nevertheless, the evidence was characterized by considerable methodological heterogeneity, predominantly small sample sizes, limited use of randomized controlled designs, and scarce long-term follow-up, reducing the generalizability of the findings.DiscussionWearable VR represents a promising tool for personalized assessment and intervention in ASD. Based on the current evidence, we propose a structured pre-intervention assessment integrating sensory, cognitive, emotional, and VR tolerance profiles to support individualized intervention planning. Future research should prioritize standardized outcome measures, rigorous study designs, and longitudinal investigations to strengthen the clinical translation of VR-based interventions in autism.
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Resting-state functional connectivity of the sensorimotor network in medication-naïve Chinese children with ADHD: cross-sectional associations with hyperactivity/impulsivity and executive function

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, often—but not always—characterized by inattention, hyperactivity/impulsivity, and deficits in executive functions (EFs); some individuals may also exhibit sensorimotor dysfunction. While SMN dysfunction has been implicated in ADHD, the patterns of SMN functional connectivity (FC) and their relationships with clinical symptoms and EFs remain inconsistent, partly due to methodological heterogeneity.MethodsThe study included 62 medication-naïve patients with ADHD (aged 6–15 years) and 46 healthy controls matched for age, sex, and IQ. Clinical symptoms and EFs were assessed using CPRS, IVA-CPT, and Stroop tests. Resting-state fMRI data were acquired, and ROIs within SMN, SN, DMN, and FPN were selected from the Dosenbach atlas. FC was analyzed using Network-Based Statistics (NBS). Partial correlations explored FC–behavior relationships in the ADHD group, controlling for age, sex, and IQ.ResultsThe ADHD group showed significantly higher CPRS hyperactivity/impulsivity scores and poorer IVA-CPT and Stroop performance. Compared to controls, ADHD showed increased FC within SMN (right posterior insula to left precentral gyrus/parietal lobe), between SMN–DMN (precentral gyrus, dorsal frontal cortex, temporal lobe, angular gyrus, posterior cingulate cortex, and precuneus), and SMN–SN (middle insula, superior parietal lobule, superior temporal gyrus, basal ganglia, and fusiform gyrus). Enhanced intra-SMN FC was negatively correlated with impulsivity/hyperactivity and hyperactivity index scores. Enhanced SMN–DMN FC was negatively correlated with hyperactivity symptoms and positively correlated with control quotients in IVA-CPT. Enhanced SMN–SN FC was negatively correlated with Stroop correct responses and positively correlated with omission errors.ConclusionsIn this medication-naïve pediatric sample, distinct SMN connectivity patterns differentially related to ADHD symptoms and executive function. However, given the cross-sectional design and modest sample size, these associations cannot establish causality; they require replication in longitudinal studies and larger cohorts to clarify whether they reflect developmental variation, neurobiological subtypes, or epiphenomena.