Background: Conversational agents (CAs) are increasingly used in mental health care to enhance access and engagement. However, their safe, ethical, and user-sensitive design remains a challenge. Despite growing attention to trauma-informed approaches in human-computer interaction, there is limited work on how the trauma-informed care (TIC) framework could be applied in the design of mental health CAs and no comprehensive synthesis to date. Objective: Guided by the Substance Abuse and Mental Health Services Administration’s TIC framework, this scoping review explored how TIC principles (safety; trustworthiness and transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; and cultural, historical, and gender issues) are currently represented in the design and evaluation of mental health conversational agents (MHCAs) and identified gaps and opportunities to promote more trauma-informed design practices. Methods: Online databases, as well as a secondary survey of citation lists from an initial search, were used to identify English-language journal articles and conference proceedings from 2000 to 2024 that empirically evaluated an independent, web- or app-based, unassisted CA used for mental health and included concepts from TIC. Results: Our analysis included 38 publications (n=28, 73.7%, published in 2020 or later) covering 28 distinct MHCAs. Most studies used experimental methods (n=23, 60.6%) or user studies (n=11, 28.9%), with samples skewed toward female (men: mean 34.92%, SD 18.64%), young in age (mean 32.52, SD 14.6 y), and predominantly nonclinical (n=29, 76.3%). MHCAs were largely rule-based prototypes. No studies explicitly referenced the TIC framework as a guiding lens for MHCA design or evaluation. A total of 26 studies referenced terminology from TIC core principles but rarely defined them, while all 38 included language that could be linked to one or more principles. Overall, TIC-related concepts appeared most often within intervention design descriptions, qualitative assessments, or as items embedded in questionnaires evaluating broader constructs. Trustworthiness and transparency, safety, empowerment, voice and choice, and collaboration and mutuality were comparatively well addressed, while peer support and cultural, historical, and gender issues were largely absent. Design recommendations, where present, were relatively broad and emphasized secure, customizable, reliable, human-like, and context-sensitive MHCAs that offered multimodal interaction, goal setting and tracking, and transparency. Conclusions: Studies did not self-identify as using Substance Abuse and Mental Health Services Administration’s framework for TIC, making it more difficult to identify its elements. The fragmented terms, disciplines, and metrics used make it difficult to draw more systematic conclusions about the current research landscape related to TIC, but our analysis indicates TIC to be a descriptive and potentially unifying framework and provides a starting point for the explicit trauma-informed MHCA research and design.
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Acceptance of mental illness and attitude towards pharmacotherapy among patients hospitalized in forensic psychiatry departments
Aim of the studyThe aim of the study was to assess the level of acceptance of the disease and attitudes towards pharmacological treatment in patients hospitalized in forensic psychiatry departments and to analyze the relationship between these variables and the length of hospitalization.Materials and methodsThe study included 121 patients hospitalized in forensic psychiatry wards. The Acceptance of Illness Scale (AIS) and the Drug Attitude Inventory (DAI) were used. Statistical analysis was performed using nonparametric tests, with a significance level of p < 0.05.ResultsThe mean AIS score was 28 points, indicating moderate to good disease acceptance. A positive attitude toward pharmacological treatment was demonstrated by 74% of respondents. There was no significant correlation between disease acceptance and attitudes toward treatment (p = 0.70), nor was there any effect of hospitalization length on attitudes toward pharmacotherapy (p = 0.317).ConclusionsPatients of forensic psychiatry wards demonstrate a medium or high level of acceptance of the disease and a mostly positive attitude towards pharmacotherapy; the lack of significant correlations between these variables and the independence from the length of hospitalization indicate the need for individualized therapy.
Harsh discipline mediates the association between parenting stress and internalizing problems in children and adolescents: survey-based and online intervention evidence
BackgroundParenting stress evokes harsh discipline and induces internalizing problems in children and adolescents. To test this hypothesis, this study examined the potential mediating role of harsh discipline in the association between parenting stress and internalizing problems in children and adolescents while considering the moderating effect of emotion regulation.MethodsTwo studies were conducted: Study 1 was a cross-sectional survey using questionnaires (N = 971), and Study 2 implemented a three-week online parental intervention training program combining courses and psychological diary recording (N = 123).ResultsBoth studies consistently demonstrated that harsh discipline mediated the link between parenting stress and internalizing problems in children and adolescents. Furthermore, acceptance and cognitive reappraisal reduced the effect of parenting stress on harsh discipline, whereas distraction and rumination enhanced it. Expressive suppression had no significant moderating effect. The intervention enhanced parents’ emotion regulation (increased acceptance), reduced parenting stress and alleviated internalizing problems in children and adolescents, with preliminary evidence of reduced harsh discipline.ConclusionThese findings clarify the psychological mechanisms through which parenting stress influences child adaptiveness and underscore the value of interventions focused on emotion regulation in mitigating parenting stress, harsh discipline and enhancing child mental health.
The Comprehensive Assessment of Social Media Use: Development and Validation Study
Background: Nearly all youth use the internet daily, with many maintaining several social media accounts. As increasing numbers of young people engage online and the ways we communicate fundamentally change, it is increasingly important to ask: how do these shifts influence youth mental health? To better understand how social media may affect mental health, researchers require validated tools that capture young people’s heterogeneous experiences with social media. However, few available measures evaluate the full range of positive and negative behaviors associated with its use, limiting our ability to meaningfully advance interventions promoting online hygiene. Objective: This study aims to develop and validate the Comprehensive Assessment of Social Media Use (CASM). The CASM is a self-report survey measure that moves beyond simple duration or frequency of use and captures how young people engage with social media. Importantly, the CASM assesses both the positive and negative dimensions of social media engagement. Methods: Two studies are outlined in this paper. Study 1 outlines the process of item generation and exploratory factor analysis. Study 2 outlines confirmatory factor analysis and validity testing. Both studies were conducted online and enrolled a convenience sample of college-aged young adults. Study 1 enrolled 260 participants (mean age 19.73, SD 2.91; n=172, 66.2% female; n=164, 63.1% White; n=38, 14.6% lesbian, gay, bisexual, transgender/transsexual, and queer [LGBTQ]). Study 2 enrolled 508 participants (mean age 18.99, SD 1.17; n=323, 63.6% female; n=272, 53.5% White; n=58, 11.4% LGBTQ). Results: Exploratory and confirmatory factor analysis resulted in a 29-item CASM scale that assesses 7 distinct aspects of young adult social media use: self-branding, compulsive use, disruptive use, impulsive sharing, social engagement, induce negative emotions, and induce positive emotions. This model accounted for 61% of the variance in responses. The chi-squared test of model fit was significant (²=941, <.001; root mean square error of approximation=0.064; comparative fit index=0.855; Tucker-Lewis index=0.848; standardized root mean squared residual=0.060). Factor internal consistency reliability ranged from 0.699 to 0.817. Validity testing suggested moderate discriminant, convergent, and criterion validity. Conclusions: The CASM measures a broad range of social media behaviors, enabling researchers to more effectively examine associations between online engagement and mental health outcomes. We hope the CASM will help researchers better understand how young people interact with social media, and that this knowledge will inform the development of more targeted interventions promoting healthy online habits.
Designing and Evaluating Digital Mental Health Interventions: Scoping Review
Background: The ongoing adoption and use of digital interventions offer promising opportunities to meet the growing demand for mental health support. The effectiveness, implementation, and usage of these interventions depend on how well they are designed and evaluated. However, given the emerging nature of design research in this area, there is still no clear consensus on the specific principles and guidelines for developing digital mental health interventions (DMHIs). There seems to be a lack of clarity regarding the best practices for designing and evaluating these tools. Objective: We aimed to investigate and report on the design principles and evaluation approaches used in digital interventions specific to mental health care. Additionally, we sought to outline how these principles and approaches are applied in research. Methods: This scoping review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. The literature search was performed in 2 electronic databases, SCOPUS and Web of Science, across 3 iterations from January 2024 to January 2025. A total of 2 independent reviewers screened and selected papers based on predefined inclusion and exclusion criteria, followed by data extraction from the selected studies. The data were then synthesized by categorizing the papers according to the primary research aim of each study. The inclusion criteria covered studies involving populations with mental health challenges or users of DMHIs, any digital tools for mental health care, and principles or strategies related to the design, evaluation, or implementation of DMHIs. Results: Our search identified 401 papers, of which 17 met the inclusion criteria for this review. Among these, 11 focused on evaluation studies, while 6 covered both design and evaluation studies (mixed). An iterative user-centered development process, expert inclusion, usability testing, specification of design elements, and user tracking and feedback were identified as common design principles used in studies focused on DMHIs. Evaluation approaches were shaped by the evaluation goal, which influenced the chosen methodologies. We also summarize the recommendations for implementation highlighted in some studies. Based on our findings, we propose 8 guidelines emphasizing stakeholder involvement in the development process and the need for clear justifications for design decisions, among other considerations. Conclusions: Design principles used in DMHI development include user-centered development, expert inclusion, and usability testing, while evaluation approaches often rely on randomized controlled trials to assess efficacy. Qualitative and mixed-method approaches are commonly adopted by studies to capture user experience and bridge both process and outcome measures. We recommend that future research explicitly report its design justification and adopt a multiperspective approach in the research and design of DMHIs.
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Errors in AI-Transformed Patient-Centered Mental Health Documentation Written by Psychiatrists: Qualitative Pre-Post Study
Background: Patients’ digital access to their personal health data is becoming increasingly common worldwide. However, medical documentation often contains technical language and sensitive information, which can lead to potential misunderstandings and distress among patients. These issues may be particularly impactful in mental health contexts. Large language models (LLMs) offer a promising approach by transforming clinician-generated health notes into language that is more patient-centered, nonmedicalized, and empathetic. However, risks related to accuracy and clinical safety have not been adequately investigated in psychiatry. Objective: This study aimed to qualitatively analyze the errors introduced by LLMs when transforming notes written by psychiatrists into patient-facing formats. It also highlights the implications for clinical communication and patient safety. Methods: Clinical notes (n=63) written by 19 psychiatrists in an outpatient treatment setting were collected, anonymized, and translated from German to English by humans. OpenAI GPT-3.5 Turbo was used to develop a preprompt that transformed these notes into a patient-centered, lay-readable form through an iterative process. Three psychiatrists qualitatively analyzed the LLM-revised documentation using Kuckartz content analysis. They compared the preconversion and postconversion notes to systematically identify and categorize LLM-induced errors. Results: Five categories of clinically relevant errors were identified: (1) clinical misinterpretations, particularly in critical assessments such as suicidality, where nuanced terminology was oversimplified or inaccurately represented; (2) attribution errors, where behaviors or roles within family dynamics or interactions were incorrectly attributed to different individuals; (3) content distortion errors, which were characterized by speculative additions, emotional exaggerations, and inappropriate contextual assumptions; (4) abbreviation and terminology errors, which resulted from inaccurate expansions of medical abbreviations and terms; and (5) structural and syntax errors, which resulted in ambiguity, particularly when the original notes were brief or bulleted. Despite significant improvements in the readability and overall linguistic fluency of the converted notes, these errors occurred. Conclusions: LLMs have the potential to transform psychiatric notes into patient-friendly formats. However, critical errors remain prevalent and can impair clinical judgment, understanding of patient circumstances, clarity of medication regimens, and interpretation of clinical observations. To safely integrate artificial intelligence–generated documentation into psychiatric care, clinician oversight and targeted model refinement are essential. Future research should explore strategies to mitigate these errors, assess their comprehensive clinical impact, and incorporate patient and provider perspectives to ensure robust implementation.
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Effects of bifrontal-transcranial direct current stimulation combined with music listening on sleep quality, cortical activation and functional connectivity in patients with insomnia: a randomised controlled trial by fNIRS
BackgroundAlthough music listening and transcranial direct current stimulation (tDCS) alone have certain effects in the treatment of insomnia, the sleep regulatory effects and neural mechanisms of the combined treatment in patients with insomnia disorder (ID) are unclear. This study aimed to investigate the efficacy of combined bifrontal-tDCS (F3: anode, F4: cathode) with music listening in patients with ID using functional near-infrared spectroscopy (fNIRS).Methods76 ID patients were randomly divided into an intervention group (n=38) and a control group (n=38), and received 4 weeks of a total of 20 sessions of music + tDCS therapy and music + sham tDCS therapy (30-second stimulation with fade-in/fade-out to mimic somatic sensations), respectively. The Pittsburgh Sleep Quality Index Scale (PSQI), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Perceived Stress Scale (PSS-14) were compared between the two groups before and after treatment. Oxy-haemoglobin (HbO2) concentration and functional connectivity (FC) were assessed during the verbal fluency task using fNIRS.ResultsCompared with the control group, the PSQI total score (mean difference: -2.57 points, 95% CI: -4.43 to -0.71, p = 0.001), PSQI sub-scores except “sleep disturbance and daytime dysfunction”, SDS and SAS scores of the intervention group improved significantly after treatment. It was observed by fNIRS that the HbO2 concentration in the medial prefrontal cortex (mPFC), left dorsolateral prefrontal cortex (DLPFC), right ventrolateral prefrontal cortex, and right superior frontal cortex (SFC) increased significantly after treatment in the intervention group but was not superior to the control group. In addition, the FC enhancement of left SFC-left DLPFC and left SFC-mPFC after treatment was significantly better in the intervention group than in the control group, and the PSQI improvement was positively correlated with the FC enhancement of channel-averaged and left SFC-right DLPFC.ConclusionsCombining bifrontal-tDCS with music listening is more helpful in improving sleep quality and prefrontal functional connectivity in ID patients compared with music listening alone. For ID patients, music electrical stimulation headphones may be a safe, effective, and convenient new treatment strategy.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2400086233.
The long-term psychological processing of an autism spectrum disorder diagnosis in parents
IntroductionA child’s ASD diagnosis represents a critical event for parents, often requiring them to face the loss of their child’s ideal image and reevaluate the family life projects. The aim of this study is to explore how parents retrospectively reconstruct and integrate their child’s ASD diagnosis through autobiographical memories.Methods21 parents, 16 mothers and 5 fathers, that received the ASD diagnosis within five years, were administered the Reaction to Diagnosis Interview (RDI). Interviews were audio-recorded, transcribed verbatim and analyzed using a two levels approach. The first one to explore the patterns of meanings that emerged in the whole parents’ autobiographical memories through the Reflexive Thematic Analysis. The second one is to identify patterns of resolution or non-resolution of the impact of the diagnosis.ResultsFindings show suffering and struggling as main themes and subthemes and a prevalence of unresolved diagnoses; gender differences in the way of managing the child-related care tasks, efforts, and coping strategies emerged.DiscussionIn line with literature, our findings suggest that the availability of supportive resources plays a crucial role in facilitating parents’ adjustment and integration of the ASD experience and harmonizing gender differences. They also emphasize that the impact of ASD diagnosis is not a single event but an ongoing process of meaning-making which changes with the child’s developmental path. Our findings highlight the need for cognitive and emotional reconstruction and reframing of parents’ autobiographical memories. These processes play a kay role in shaping how the diagnosis experience is integrated into one’s narrative identity, creating opportunities for transforming the meaning of the remembered experience.
Acupoint temperature as a biomarker: infrared thermography in the diagnosis of adolescents with major depressive disorder
BackgroundThe prevalence of adolescent major depressive disorder (MDD) is rising; however, diagnosis relies on subjective measures due to a lack of objective biomarkers. This study explored infrared thermography (IRT) as a non-invasive tool to quantify thermal radiation characteristics of acupoints in adolescents with MDD. The objective was to establish diagnostic models based on acupoint temperature-derived biomarkers.MethodsA prospective, multi-center observational study enrolled 108 participants (65 adolescents with MDD and 43 healthy controls [HCs]). We first examined correlations between acupoint temperatures and depression severity using Pearson analysis. Multiple linear and binary logistic regression models were developed to diagnose MDD and assess severity. The diagnostic model for MDD was visualized as a nomogram and validated using Receiver Operating Characteristic (ROC) curves, Hosmer-Lemeshow tests, calibration plots, and decision curve analysis (DCA). Internal validation was performed using the bootstrap method.ResultsAmong 27 acupoints analyzed, adolescents with MDD exhibited altered acupoint temperatures at Taiyang (EX-HN5), Quchi (LI11), Yanggu (SI5), and Waiqiu (GB36). Subsequent Pearson correlation analysis revealed negative correlations between the infrared relative temperatures of Taiyang (EX-HN5), Quchi (LI11), and Waiqiu (GB36) and depression severity (P = 0.001, r = -0.319; P = 0.022, r = -0.229; P = 0.001, r = -0.325) and a weak positive correlation between the infrared relative temperature of Yanggu (SI5) and depression severity (P = 0.043, r = 0.202). Building on these findings, two diagnostic models were developed: a linear regression model for depression severity of adolescents (Y = 52.25-9.52*TEX-HN5-13.07*TGB36) and a logistic regression model for adolescents with MDD diagnosis (P = ex/(1+ex), x = 0.22-1.14*TEX-HN5+0.45*TSI5-2.19*TGB36). The nomogram-based model demonstrated good calibration (Hosmer-Lemeshow P = 0.855), discrimination (AUC = 0.785, 95%CI: 0.693 – 0.876), and clinical utility. Internal validation using the bootstrap method produced a C-index of 0.752 (95% CI: 0.617 – 0.877), further confirming the model’s robustness.ConclusionsIn conclusion, acupoint temperature-based models show promising efficacy for the objective and non-invasive diagnosis and severity quantification of adolescents with MDD, offering valuable tools for early clinical intervention. Future studies should validate these findings across diverse populations and integrate multi-modal biomarkers to enhance diagnostic precision.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT06750640.
Stigma in adults with ADHD: a systematic review of types, experiences, and potential implications for quality of life
BackgroundAttention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactive, impulsive, and/or inattentive symptoms. Adults with ADHD often report reduced quality of life (QoL) across social, educational, and occupational functioning. Part of these deficits may be attributed to stigma, which includes stereotypes, prejudices, discrimination, and negative labelling. While stigma’s effects on QoL have been extensively documented in other mental health conditions, the specific types and impacts of stigma experienced by adults with ADHD remain underexplored in recent reviews.AimsTo identify and describe the different types of stigmas experienced by adults with ADHD, while exploring how stigma may impact QoL’s key domains as defined by WHO (physical domain, psychological domain, level of independence, social relationships, environment, and spirituality/religion/personal beliefs).MethodsA literature search was conducted across APA PsycArticles, Embase, and Ovid MEDLINE(R) for ADHD AND stigma-related keywords. Eligible studies were English, peer-reviewed articles from the past decade involving adults (≥18) and describing or specifying at least one type of stigma.ResultsA total of 17 papers met the inclusion criteria. Stigma types included self-stigma and/or internalized stigma, perceived stigma, public stigma, and structural stigma. QoL domains affected included the psychological domain, social relationships, environment, and level of independence. Greater ADHD symptomatology was positively correlated with more internalized stigma, which in turn was linked to functional impairment, worse self-esteem, and poorer QoL. Self-stigma manifested as self-deprecating labels and ADHD devaluation. Perceived stigma hindered treatment seeking, medication compliance, and diagnostic disclosure, although associations with QoL were insignificant. Public stigma was the most investigated and related to negative societal attitudes, notably in academic contexts. Few studies looked at structural stigma; those that did identified structural barriers to care, though none directly assessed QoL outcomes.ConclusionStigma remains pervasive, though direct effects on QoL domains are less widely investigated. Future studies should investigate structural stigma in more depth and explore causal relationships between stigma and QoL.Systematic Review Registrationhttps://doi.org/10.17605/OSF.IO/Y52HK