Tag: Academic research

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Implementation Strategies for a Technology-Based Bullying Bystander Intervention (STAC-T): Mixed Methods Study

<strong>Background:</strong> Nearly 1 in 5 students aged 12-18 years report being bullied in the United States. Both targets and students who witness bullying experience negative mental health outcomes. School-based programs are effective in decreasing negative outcomes associated with bullying; however, significant implementation barriers associated with in-person programs limit program adoption, fidelity, and sustainability. STAC-T (Stealing the Show; Turning it Over; Accompanying Others; Coaching Compassion; Technology Version), an interactive bullying bystander app, was developed to reduce implementation barriers. However, little is known about what will be required to successfully translate STAC-T into routine practice in schools. As a first step, we examined school personnel perspectives on school-specific implementation strategies that would be both highly important and feasible (“go-zone” strategies) for delivering STAC-T. Identifying specific implementation strategies can further support implementation and program outcomes. Although researchers have developed a taxonomy of 33 school-specific “go-zone” implementation strategies, there is no research examining these strategies specifically for STAC-T. <strong>Objective:</strong> The aim of this study was to identify implementation strategies for STAC-T using “go-zone” methodology. “Go-zone” methodology categorizes implementation strategies into four zones: (1) zone 1: high importance, high feasibility; (2) zone 2: low importance, high feasibility; (3) zone 3: low importance, low feasibility; and (4) zone: 4 high importance, low feasibility. Objectives included (1) identifying “go-zone” strategies for STAC-T and (2) identifying zone 4 strategies for STAC-T and understanding how to increase the feasibility of these strategies. <strong>Methods:</strong> A self-selected convenience sample of school counselors and school social workers (N=195) recruited from national professional organizations completed an online survey. A subsample (n=14) completed qualitative interviews. “Go-zone” methodology was used to identify zone 1 (“go-zone”) and zone 4 strategies. Thematic analysis was used to extract themes related to increasing the feasibility of zone 4 strategies. <strong>Results:</strong> Fifteen implementation strategies were classified as “go-zone” strategies. The three most important strategies were (1) <i>make implementation easier by removing burdensome documentation tasks</i>, (2) <i>develop a detailed implementation plan or blueprint</i>, and (3) <i>obtain and use student and family feedback</i>. The most feasible strategy was <i>distribute educational materials</i>. Four strategies were classified in zone 4: (1) <i>develop instruments to monitor and evaluate core components of the innovative or new practice</i>, (2) <i>conduct educational meetings</i>, (3) <i>build partnerships to support implementation</i>, and (4) <i>provide ongoing consultation</i>. Qualitative data revealed that feasibility of zone 4 strategies can be increased by keeping evaluative assessments short and simple, using various modes of communication for educational meetings, building partnerships with support from school administration, and enhancing consultation through hybrid or virtual meetings and appointing a leader. <strong>Conclusions:</strong> Findings represent a first step in identifying implementation strategies that can be used to inform STAC-T implementation. Directions for future research include testing the efficacy of these strategies on improving both implementation and program outcomes.
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Clinimetric properties of the Chinese version of the subjective incompetence scale: an extended paradigm

ObjectivesThis is the first validation study to evaluate the measurement properties (i.e., construct, concurrent, incremental, and relative validity) and determine the clinical utility of the Chinese version of the 12-item subjective incompetence scale (SIS-12) based on the science of clinimetrics.MethodsConsecutive general hospital inpatients (n= 232) in the Departments of Neurology and Obstetrics & Gynecology were assessed for SIS-12, along with measures of anxiety, depression, stress levels, and demographic information. Mokken analysis was employed to evaluate construct validity, while relative validity was assessed through relative weight analysis.ResultsMokken analysis indicated inadequate construct validity for items 1, 4, 8, and 10, leading to the development of an 8-item version of the scale (SIS-8), which was found to have optimal scalability. The SIS-8 also entailed the clinimetric properties of concurrent validity, incremental validity, and relative validity.ConclusionThe findings of the present clinimetric validation indicate that the SIS-8 can potentially be used both as a screening measure for the early detection of individuals at increased risk for demoralization and as a dimensional measure to assess the severity of feelings of subjective incompetence. This dual utility suggests its relevance in both clinical research and practice, particularly in managing inpatients suffering from psychological distress.
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Association between platelet-to-albumin ratio and major depressive disorder: findings from a Chinese clinical cohort supported by population-based evidence

BackgroundPlatelet dysfunction has been increasingly implicated in the pathophysiology of major depressive disorder (MDD), yet conventional platelet indices have shown inconsistent associations with the disease. The platelet-to-albumin ratio (PAR), a composite biomarker integrating inflammatory and nutritional status, has not been comprehensively investigated in relation to MDD across different populations. This study aimed to examine the association between PAR and depression using two independent cross-sectional cohorts.MethodsWe analyzed data from a population-based NHANES cohort (n = 34,068) and a Chinese clinical cohort (n = 735). Depression in the NHANES cohort was assessed using the Patient Health Questionnaire-9 (PHQ-9), whereas MDD in the clinical cohort was diagnosed by psychiatrists according to DSM-5 criteria. Multivariable logistic and linear regression, subgroup analyses, and restricted cubic spline (RCS) models were used to examine the associations of platelet count (PLT), mean platelet volume (MPV), and PAR with depression. Bonferroni correction was applied to account for multiple comparisons in the regression analyses.ResultsPAR was consistently and positively associated with depression across both cohorts after adjustment for potential confounders and Bonferroni correction. In the fully adjusted model, each unit increase in PAR was associated with higher odds of depression in both the NHANES cohort (OR = 1.047, 95% CI: 1.013–1.081, P = 0.006, Bonferroni-adjusted P = 0.018) and the clinical cohort (OR = 1.446, 95% CI: 1.267–1.659, P < 0.001, Bonferroni-adjusted P < 0.001). In contrast, PLT and MPV showed no consistent associations across the two cohorts. PAR was positively associated with depressive symptom severity in NHANES, whereas no significant association was observed in the clinical cohort. RCS analyses suggested an approximately linear association in NHANES but a nonlinear association in the clinical cohort. Stronger associations were observed among smokers, alcohol drinkers, and individuals without a partner in the clinical cohort.ConclusionsAcross two independent cross-sectional cohorts with different population characteristics and outcome assessments, PAR showed a consistent positive association with depression, whereas conventional platelet indices did not. These findings suggest that PAR may provide additional information on depression-related inflammatory and nutritional alterations beyond individual platelet parameters. Prospective studies are warranted to clarify the temporal relationship and evaluate its potential clinical utility.
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Integrated bioinformatics analysis identifies a ubiquitination-related gene signature in schizophrenia with peripheral clinical validation

BackgroundDysregulation of the ubiquitin proteasome pathway is implicated in the pathogenesis of schizophrenia (SCZ). The objective of this study is to identify the dysregulation of the ubiquitin-proteasome pathway and the potential mechanisms associated with SCZ by comprehensive analysis using integrated GEO datasets.MethodsWe integrated three SCZ related datasets containing 1847 ubiquitination-related genes (URGs) from GeneCards and PubMed, addressing batch effects and normalization with R packages. Subsequent Gene Ontology enrichment analysis was applied to the identified URGs, and an 8-gene molecular signature was constructed to distinguish schizophrenia from control brain tissues, and the discriminatory performance was evaluated by the area under the Receiver Operating Characteristic curve. SCZ samples were categorized into high-risk and low-risk groups based on median Risk Scores, followed by gene set enrichment analysis.ResultsA total of 13 SCZ-associated ubiquitin-related differentially expressed genes were significantly identified, with eleven being extremely statistically significant and two highly statistically significant. An 8-gene LASSO-derived molecular signature was constructed and validated, effectively discriminating SCZ patients from controls and classifying SCZ patients into high-risk and low-risk subgroups. The study also constructed protein-protein interaction and regulatory networks and conducted immune infiltration analysis, indicating statistically significant differences in six types of immune cells between the SCZ group and the control group, including CD56bright natural killer cells and central memory CD4+ T cells. ELISA validation in an independent clinical cohort confirmed elevated plasma S100A8 in SCZ patients versus controls, with no significant correlation to PANSS five-factor scores, suggesting S100A8 as a candidate peripheral biomarker reflecting disease state rather than current symptom severity.ConclusionsTogether with the identification of 13 ubiquitination-related DEGs and an eight-gene LASSO signature demonstrating moderate discriminative accuracy for stratifying SCZ patients, this multi-faceted analysis reveals altered ubiquitination patterns in SCZ and provides a hypothesis-generating foundation for future prospective studies incorporating drug-naïve first-episode patients, longitudinal sampling, and appropriate disease controls.
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Longitudinal trajectories of benefit finding and its associations with emotion regulation, social connectedness, depression, and anxiety among Chinese college students following the removal of COVID-19 restrictions. a multivariate latent growth curve analysis

BackgroundBenefit finding may be associated with better mental health after the pandemic, but its longitudinal trajectory and its associations with psychosocial resources and mental health symptoms during recovery remain unclear.ObjectiveThis study examined trajectories of benefit finding among Chinese college students from approximately 3 to 15 months after COVID-19 restrictions were lifted. We also examined its associations with emotion regulation, social connectedness, depressive symptoms, and anxiety symptoms, together with indirect association patterns involving benefit finding.MethodsA three-wave longitudinal study was conducted among 1,155 Chinese college students. Data were analyzed using parallel-process latent growth curve modeling.ResultsSocial connectedness and benefit finding increased linearly over time, whereas depressive and anxiety symptoms decreased. Cognitive reappraisal was positively associated with the benefit finding intercept but negatively associated with its slope, whereas expressive suppression was not significantly associated with either growth factor. Social connectedness showed stronger associations with benefit finding trajectories than the emotion regulation variables. Benefit finding was negatively associated with depressive and anxiety symptoms at both the intercept and slope levels. Indirect association patterns through benefit finding were supported for social connectedness and both depressive and anxiety symptoms at the intercept and slope levels when inference was based on bias-corrected bootstrap confidence intervals.ConclusionsBenefit finding increased during the post-pandemic recovery period and was associated with lower depressive and anxiety symptoms. Social connectedness showed relatively strong associations with benefit finding trajectories, while cognitive reappraisal was associated with higher initial benefit finding but a slower subsequent increase. The indirect association patterns linked social connectedness with both symptom domains through benefit finding at the intercept and slope levels. These findings highlight psychosocial resources that merit further study in campus mental health research, while the observational design does not establish causal direction or temporal precedence.
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Connectedness as a candidate pathway linking psilocybin retreat experiences to sustained wellbeing: a prospective naturalistic study

BackgroundPsychedelic retreats are increasingly used to promote wellbeing outside clinical settings, yet the psychological processes associated with sustained improvements in wellbeing remain poorly understood. From a public mental health perspective, identifying mechanisms that support positive mental health beyond symptom reduction is of growing importance.MethodsThis naturalistic longitudinal study followed 173 participants attending guided psilocybin retreats conducted within a structured framework of preparation, dosing, and integration. Mental wellbeing was reported before the retreat and across a 12-month follow-up period. Longitudinal changes were examined using linear mixed-effects models. Mediation analyses investigated whether changes in connectedness, neuroticism (anxiety facet), spiritual transcendence, and absorption were associated with changes in wellbeing. Mystical-type experiences were examined as potential predictors of these psychological changes.ResultsParticipants reported substantial and sustained improvements in mental wellbeing over 12 months, moving from levels below Swedish population norms at baseline toward comparable levels at follow-up. Connectedness showed the strongest statistical association with improvements in wellbeing and accounted for the largest proportion of variance in wellbeing change, followed by reductions in the anxiety facet of neuroticism and absorption. Spiritual transcendence was associated with wellbeing improvements when examined separately but did not retain unique effects in the multiple mediation model. More intense mystical-type experiences predicted greater increases in connectedness, spirituality, and absorption, as well as greater reductions in neuroticism (trait anxiety). The association between mystical experiences and wellbeing was substantially attenuated when connectedness was included in the model, suggesting that connectedness may act as a candidate mediator linking mystical-type experiences to longer-term wellbeing, though the observational design precludes causal inference.ConclusionsThese findings extend prior work on psychedelic-assisted therapy to naturalistic retreat settings, suggesting that connectedness may represent a key psychological process linking psychedelic retreat experiences to sustained improvements in mental wellbeing. From a public mental health perspective, the results highlight the potential importance of social and relational factors in promoting wellbeing beyond the treatment of mental illness. Future controlled studies are needed to clarify the relative contributions of psychedelic, social, and contextual components.
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Pediatric psychotropic prescribing and polypharmacy, 2019-2022: a retrospective electronic health record study in Qatar

BackgroundReal-world evidence on pediatric psychotropic prescribing and polypharmacy in Gulf health systems remains limited. Characterizing medication-class patterns and multi-class prescribing is essential for medication safety surveillance in children and adolescents. This study examined psychotropic prescribing, potential polypharmacy, and recorded medication combinations among children and adolescents using public-sector electronic health records in Qatar.MethodsA retrospective observational study used electronic health record data from Hamad Medical Corporation and the Primary Health Care Corporation, Qatar’s principal public healthcare providers, from January 2019 to December 2022. Children and adolescents aged 0–17 years with at least one psychotropic prescription were included. Medications were classified as antidepressants, antipsychotics, anxiolytics, mood stabilizers, or attention-deficit/hyperactivity disorder (ADHD) medications. Potential cross-class polypharmacy was assessed as the recording of two or more medication classes per patient during the study period; available duration information did not permit confirmation of concurrent exposure. Logistic regression examined patient-level associations with this outcome.ResultsThe dataset included 2,941 eligible prescription records corresponding to 2,221 unique patients. The proportion of prescriptions for ADHD medications decreased from 28.7% in 2019 to 13.7% in 2022, whereas the proportion assigned to anxiolytics increased from 26.0% to 37.5%. ADHD medications predominated among prescriptions for children aged 5–11 years, while antidepressants and antipsychotics predominated among those for adolescents aged 12–17 years. The potential-polypharmacy criterion was met by 322 patients (14.5%), reaching 21.6% among adolescents. In a gender-adjusted model restricted to patients aged 1–17 years, each additional year of age was associated with higher odds of meeting the criterion (adjusted OR 1.13, 95% CI 1.10-1.16). After excluding patients with prescription-linked seizure disorder or cerebral palsy, the corresponding proportion was 16.96% (259/1,527). Among patients meeting the criterion, antidepressant-antipsychotic and ADHD medication-antipsychotic pairs were most frequent; methylphenidate-risperidone was the most common recorded individual-drug pair.ConclusionsThis study characterizes pediatric psychotropic prescribing and potential polypharmacy in Qatar’s public healthcare records and helps address the limited regional evidence from Gulf health systems. The observed patterns identify potential medication-safety surveillance priorities, particularly among adolescents and patients with antipsychotic-containing medication histories. Further assessment incorporating exposure duration and clinical outcomes is needed to establish concurrency and clinical significance.
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Social Media Use Motives and Mental Health Among Adolescents: Cross-Sectional Study

Background: Social media use is ubiquitous among young people, yet its relationship with mental health may depend on why it is used. Understanding the motives underlying social media engagement may provide greater insights into its potential risks and benefits than considering overall use alone. Objective: This study aimed to identify latent dimensions of motives for social media use and examine their associations with anxiety, depression, well-being, and resilience in a sample of older adolescents. Methods: Cross-sectional data were drawn from the BrainWaves study (N=6820; mean age 16.72, SD 0.74 years). Social media use motives were assessed using 10 items and exploratory factor analysis identified 2 latent dimensions: avoidant-escapist use (boredom, addiction, distraction, and procrastination) and social-recreational use (socializing, communication, entertainment, and observation). Confirmatory factor analysis was used to estimate factor scores, which were examined using linear regression. Structural equation modeling estimated associations with anxiety, depression, well-being, and resilience, with secondary analyses accounting for gender and deprivation. Results: Linear regression analyses showed that avoidant-escapist motives were associated with higher anxiety and depressive symptoms, whereas social-recreational motives were associated with lower symptoms. No interactions with gender or deprivation were observed. The structural equation model showed acceptable model fit (comparative fit index=0.945; root mean squared error of approximation=0.057; standardized root mean squared residual=0.054). Avoidant-escapist motives were associated with higher anxiety (β=0.543) and depressive symptoms (β=0.629) and lower well-being (β=−0.610) and resilience (β=−0.469). Conversely, social-recreational motives were associated with lower anxiety (β=−0.228) and depressive symptoms (β=−0.342) and higher well-being (β=0.362) and resilience (β=0.242; <.001 in all cases). These patterns remained consistent after accounting for gender and deprivation. Conclusions: Social media use shows different associations with older adolescent mental health depending on underlying motives. Focusing on why young people engage with social media rather than on overall use alone may provide a more informative framework for understanding potential risks and benefits. Given the cross-sectional design, causal inferences cannot be made.
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Psychosocial distress is a stronger correlate of psychiatric symptom burden than cannabis dependence in young adults: a functional connectome and structural equation modeling study

IntroductionCannabis is widely used among young adults and often viewed as a primary driver of adverse psychiatric and neural outcomes, yet the psychosocial and socioeconomic context in which use occurs is rarely modeled jointly with neural and behavioral measures.MethodsUsing the Human Connectome Project young-adult sample (analytic N = 1,010–1,016), we employed structural equation modeling to estimate the relative contributions of cannabis, latent psychosocial distress, socioeconomic status, and familial psychiatric risk to three indices of psychiatric symptom burden, while adjusting for polysubstance, alcohol, and nicotine exposure and for family clustering. Cannabis exposure was operationalized in parallel as DSM-IV dependence and as heavy use. Resting-state functional connectomes were examined using graph metrics and network-based statistics, and finite mixture models were used to test for discrete vulnerable subgroups.ResultsPsychosocial distress was the dominant predictor of psychiatric symptom burden across all three outcomes (standardized β = 0.41–0.70), substantially exceeding that of cannabis (total β = 0.05–0.19), which reached significance for only one outcome under the dependence definition. Larger unadjusted group differences (Cohen’s d = 0.28–0.75) attenuated sharply once distress and demographic factors were modeled. Lower socioeconomic status and greater familial psychiatric risk were each associated with elevated distress, whereas cannabis was not (all indirect β ≤ 0.01, all confidence intervals spanning zero). Neither graph metrics nor the network-based statistic revealed an association between cannabis dependence and the functional connectome, despite approximately 80% power to detect d≈ 0.30, and the fitted finite mixture models did not identify a robust and interpretable cannabis-vulnerable subgroup.DiscussionIn a large young-adult sample, psychosocial context rather than cannabis exposure accounted for most of the explained variance in psychiatric symptom burden, and no cannabis-related signature was detectable in the functional connectome. The cross-sectional design cannot establish causal ordering, and because the distress and symptom measures share self-report method variance that the coarse binary exposure measures do not, the relative magnitudes should not be interpreted as a comparison of aetiological importance. These findings nonetheless suggest that risk models and neuroimaging analyses that omit psychosocial context may attribute to cannabis variance shared with distress, disadvantage, and familial risk.