One of the main challenges in clinical psychotherapy is disseminating effective psychological treatments to the millions who need them but lack access. Transdiagnostic interventions, particularly those delivered online, can help bridge this treatment gap. However, these interventions, often provided as a “one-size-fits-all” approach, do not tailor to individual patient needs. Therefore, it is essential to identify which patients benefit from these treatments and who require more intensive interventions. This randomized controlled trial (RCT) aims to evaluate the effects of an Internet-based transdiagnostic intervention (UJI Online Transdiagnostic Protocol/Transversal) for emotional disorders, adapted to patients’ response. Three hundred sixty-six adults with clinically significant symptoms of anxiety and depression (ODSIS ≥ 7 and/or OASIS ≥ 8) and without suicidal ideation or a severe mental disorder participated. After having completed the first three modules, patients will be randomized based on their symptomatic response. Early responders will either continue with the original intervention—12 self-administered modules—or discontinue treatment. Non-early responders will receive a blended format—including two therapist-led videoconference sessions—or continue with the original intervention. Multilevel models will be used to analyze the data. The primary expected result is that the blended format will improve treatment outcomes for non-early responders compared to the self-applied format. Moreover, it is expected that discontinuing treatment for early responders will be as effective as continuing it until completion. The findings are expected to inform clinical practice by highlighting the importance of assessing symptomatic response throughout treatment, especially in its early phases, to better tailor interventions to the needs of different patient groups.Clinical trial registrationhttp://www.chictr.org.cn, identifier NCT07051148.
Body image dissatisfaction and emotional eating across age and weight status: a comparative cross-sectional study
BackgroundObesity in older adults is associated with significant medical, functional, and psychological consequences, including body image dissatisfaction and maladaptive eating behaviors such as emotional eating. Although these associations have been extensively studied in younger populations, limited evidence is available in older adults with obesity. This study aimed to examine differences in body dissatisfaction by age and weight status and its association with emotional eating in adults and older adults with obesity.Methods108 participants were included and divided into four subgroups based on age and weight status. Body dissatisfaction was assessed using the Body Uneasiness Test (BUT-A). Emotional eating was evaluated using the Emotional Eating subscale of the Dutch Eating Behaviour Questionnaire (EE-DEBQ). Two-way ANOVAs were conducted to examine the effects of age, weight status, and their interaction on body dissatisfaction, while Pearson correlations were used to assess associations between body dissatisfaction and emotional eating.ResultsThe analysis showed significant main effects of both age and weight status on global body dissatisfaction, with higher BUT-GSI scores observed in adults than in older adults and in participants with obesity compared with normal-weight individuals. Across all BUT dimensions, participants with obesity reported higher levels of body image concerns, avoidance, compulsive self-monitoring, and depersonalization. Significant age × weight status interactions emerged for weight phobia and body image concerns. Age significantly affected body image concerns and avoidance. Positive correlations between body dissatisfaction and emotional eating were found in adults with obesity (r=0.443, p=0.024) and older adults with obesity (r=0.480, p=0.004), as well as in normal-weight adults (r=0.573, p=0.001).ConclusionThe findings highlight the significant role of both ageing and obesity in shaping body image experiences.
A comparative study of traditional Chinese mind-body therapies on sleep quality, mental health, and quality of life in patients with sleep disorders: a network meta-analysis based on randomized controlled trials
BackgroundSleep disorders are a common clinical condition characterized primarily by difficulty falling asleep, trouble maintaining sleep, and impaired daytime functioning, with a high prevalence among adults. This condition can lead to a persistent decline in sleep quality, trigger mental health issues such as anxiety and depression, and ultimately reduce overall quality of life. Traditional Chinese mind-body exercise therapies are considered potentially effective non-pharmacological interventions due to their low risk, high accessibility, and dual mind-body regulation effects. However, the relative efficacy of different exercise therapies on sleep quality, mental health, and quality of life in patients with sleep disorders remains unclear. This study employed a web-based meta-analysis to systematically evaluate the effects of three interventions—Tai Chi, Baduanjin, and Tai Chi combined with transcranial magnetic stimulation—on three outcome measures and to rank their efficacy, aiming to provide evidence-based support for clinical decision-making.MethodsThis study conducted a systematic search of the PubMed, Embase, Web of Science, Cochrane, EBSCO, and CNKI databases and included 18 randomized controlled trials that met the inclusion criteria. Outcome measures included sleep quality, mental health, and quality of life. A network meta-analysis using a random-effects model was performed to calculate standardized mean differences and 95% confidence intervals, and the cumulative ranking probability curve area was used to rank the efficacy of the interventions.ResultThis study included a total of 18 randomized controlled trials. Regarding sleep quality, TCCWTMS yielded the best results (SMD = −1.15, 95% CI [−2.07, −0.22]). Regarding mental health, only the Tai Chi intervention achieved statistical significance (SMD = 0.64, 95% CI [0.07, 1.21], P = 0.03); although Baduanjin ranked first in the SUCRA ranking (92.6%), pairwise comparisons did not reach statistical significance (P = 0.07). Regarding quality of life, both Tai Chi (SMD = -0.47, 95% CI [-0.71, -0.24], P < 0.0001) and Baduanjin (SMD = -0.57, 95% CI [-0.91, -0.23], P = 0.001) were significantly effective. There were significant heterogeneous differences in the efficacy of the three interventions across different outcome measures.ConclusionThis study indicates that the TCCWTMS is the most effective intervention for improving sleep quality in patients with sleep disorders. Regarding quality of life, both Baduanjin and Tai Chi demonstrated significant effects, with Baduanjin showing superior efficacy. Regarding mental health, the current evidence is insufficient to determine the optimal intervention strategy. There are significant differences in the efficacy of the three interventions across various outcome measures; clinical decisions can be made by selecting the appropriate intervention based on the patient’s score needs.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261415202, identifier CRD420261415202.
School refusal behavior in children and adolescents: a concept analysis
School refusal behavior (SRB) is increasingly recognized across educational, pediatric, and mental health settings, yet its conceptual boundaries remain unclear, and the term is frequently conflated with school refusal, truancy, school withdrawal, school exclusion, and broader school attendance problems. This study used Walker and Avant’s concept analysis method to clarify the meaning, defining attributes, antecedents, consequences, and empirical referents of SRB. PubMed, Web of Science, Scopus, and PsycINFO were searched for English-language literature published through January 2026, supplemented by Google Scholar and manual citation searching. A total of 100 sources were included and analyzed through iterative comparison of conceptual definitions, recurrent characteristics, contextual conditions, outcomes, and indicators used in research and practice. The analysis showed that SRB has evolved from earlier anxiety-centered descriptions toward a broader behavioral and functional construct. Four defining attributes were identified: difficulty initiating, sustaining, or completing school attendance or participation; young person–expressed attendance difficulty; aversive school-related experiences or emotional distress; and heterogeneous avoidance- or reinforcement-related maintaining functions. Antecedents were distributed across individual, family, peer and interpersonal, and school-contextual domains, while consequences extended across academic, psychological, social, family, and service-related domains and may accumulate over time. Empirical identification requires the integration of observable attendance patterns, emotional, behavioral, and somatic responses, functional assessment, and contextual information from young people, caregivers, and school personnel. Moving beyond the summary of existing definitions, this analysis proposes an integrative framework that distinguishes the observable form of attendance difficulty from its emotional presentation, maintaining functions, and ecological context. SRB is therefore best understood as a persistent or recurrent, young person–expressed pattern of disrupted school attendance or participation that is clinically meaningful but cannot be reduced to a single diagnosis, cause, or attendance threshold. By clarifying what constitutes SRB and how it differs from other forms of school attendance problems, this framework may support earlier recognition of emerging attendance difficulties, more comprehensive assessment of underlying needs, and better coordination among mental health professionals, families, and schools.
Predicting multiple mental health outcomes in adolescents using explainable machine learning models
IntroductionAdolescent mental health problems, including depression, anxiety, and stress, are an increasing public health concern, yet the factors associated with different mental health outcomes may vary across domains. This study investigated shared and outcome-specific predictive features of depression, anxiety, perceived stress, and psychological well-being using explainable machine learning models.MethodsA cross-sectional study was conducted among 1,088 adolescents aged 13–18 years recruited from secondary schools in Wuhan, China, using multistage cluster sampling. Participants completed validated measures of emotional dysregulation, loneliness, social media addiction, self-esteem, sleep quality, academic stress, family support, physical activity, and mental health outcomes. Four algorithms—linear regression, support vector regression, Random Forest, and XGBoost—were trained using an 80/20 train-test split with five-fold cross-validation, and model performance was evaluated using test-set R², RMSE, and MAE. SHapley Additive exPlanations (SHAP) were used to examine feature contributions. To minimize target leakage, outcome-specific feature sets were used, with PSQI and RSES excluded from the depression model because of direct or substantial conceptual overlap with PHQ-9 content, and PSQI excluded from the well-being model because of overlap with WHO-5 content.ResultsXGBoost showed the strongest out-of-sample predictive performance across all four outcomes, explaining 49% of the variance in depression (R² = 0.49, 95% CI: 0.44–0.53; RMSE = 3.52; MAE = 2.81), 55% in anxiety (R² = 0.55, 95% CI: 0.50–0.59; RMSE = 3.04; MAE = 2.47), 60% in perceived stress (R² = 0.60, 95% CI: 0.56–0.64; RMSE = 3.71; MAE = 2.87), and 50% in psychological well-being (R² = 0.50, 95% CI: 0.45–0.54; RMSE = 3.38; MAE = 2.68).DiscussionEmotional dysregulation and loneliness were consistently among the most influential features, while academic stress, family support, social media addiction, self-esteem, and sleep quality showed outcome-specific contributions. SHAP rankings for the depression model were stable across five-fold cross-validation, with emotional dysregulation and loneliness consistently occupying the highest ranks.
PROMATER: protocol for a randomized controlled trial of a digital self-guided intervention to promote perinatal mental health and reduce self-criticism
BackgroundPerinatal mental health represents a significant public health concern given the high prevalence of mental disorders during pregnancy and the postpartum period and their impact on maternal well-being, mother-infant bonding, and child development. Emerging evidence identifies self-criticism as a transdiagnostic vulnerability factor associated with psychological distress in this period, while self-compassion has been recognized as an important protective factor. In Brazil, access to preventive perinatal mental health interventions remains limited. This paper describes the protocol of a randomized controlled trial (RCT) evaluating PROMATER – an online program designed to promote perinatal mental health by targeting self-criticism and self-compassion.MethodsA total of 130 pregnant women between 28 and 34 weeks of gestation will enroll in a two-arm RCT with a dismantling design. Participants will be randomized (1:1 ratio) to either the PROMATER intervention or to an active control group. Participants and data analysts will be blinded to group allocation. PROMATER consists of a 3-week program (6 modules) addressing maternal expectations, self-criticism, perinatal mental health, social support, self-compassion, and mindfulness and mother-infant bonding. The active control offers a structurally equivalent program covering the same topics, except for the modules specifically targeting these transdiagnostic processes. Primary outcomes are self-compassion, assessed via the compassionate self-responding (CSR) score of the Self-Compassion Scale, and self-criticism, operationalized through the uncompassionate self-responding (USR) score. Secondary outcomes include postpartum depression, anxiety, quality of life, social support, and mother-infant bonding. Assessments occur at baseline (T1), post-intervention (T2), and 3-month postpartum follow-up (T3). Data will be analyzed using Linear Mixed Models (LMM) following the Intention-to-Treat (ITT) principle.DiscussionEvaluating the effectiveness of a brief, accessible, online intervention has the potential to address the need for an evidence-based approach designed to promote maternal well-being during pregnancy and the postpartum period. The intervention is designed to maximize reach and minimize cost, with the potential to scale up and incorporate in routine perinatal care. The active control condition will allow examination of whether directly targeting self-criticism and self-compassion confers incremental benefit over structured perinatal psychoeducation alone.Systematic review registrationhttps://ensaiosclinicos.gov.br/, identifier RBR-99tjfz5.
Association between first-trimester serum 25(OH)D and EPDS-positive postpartum depressive symptoms in women with gestational diabetes mellitus: a retrospective cohort study
IntroductionGestational diabetes mellitus (GDM) has been associated with an increased risk of postpartum depressive symptoms, while maternal vitamin D status may also be related to perinatal mood disturbances. This study investigated the association between first-trimester serum 25-hydroxyvitamin D [25(OH)D] concentrations and Edinburgh Postnatal Depression Scale (EPDS)-positive postpartum depressive symptoms in women with GDM.MethodsThis retrospective cohort study included 242 women with GDM. Prenatal depressive and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Sequential logistic regression models were adjusted for baseline maternal characteristics, prenatal PHQ-9 and GAD-7 scores, and glycated hemoglobin A1c (HbA1c).ResultsAmong 242 women, 69 had EPDS-positive postpartum depressive symptoms. Each 5-ng/mL increase in 25(OH)D was associated with lower odds of EPDS-positive symptoms in the crude model (OR 0.35, 95% CI 0.25–0.48) and after adjustment for baseline characteristics (adjusted OR 0.36, 95% CI 0.25–0.50). After additional adjustment for prenatal PHQ-9 and GAD-7 scores, the association was attenuated and was no longer statistically significant overall (adjusted OR 0.69, 95% CI 0.43–1.12; P = 0.134). Additional adjustment for HbA1c produced similar results. Exploratory stratified analyses using the full Model 2 covariate set showed no statistically significant associations within strata defined by pre-pregnancy BMI, hypertensive disorders of pregnancy, or insulin use, and no significant interactions were detected.DiscussionThese findings suggest that the overall association between first-trimester 25(OH)D and postpartum depressive symptoms was substantially influenced by prenatal mental health status and was not consistently demonstrated after comprehensive covariate adjustment.
Perinatal mental health equity: patient perspectives on virtual collaborative care providing what women need now in the post-COVID era
IntroductionThe COVID-19 pandemic increased perinatal mental health needs and disrupted routine obstetric care, disproportionately affecting Black and economically disadvantaged communities. Michigan’s Perinatal Collaborative Care Model (Peri CoCM), a publicly funded virtual program, launched during the pandemic and continued after the public health emergency. This qualitative study examined participant experiences with Peri CoCM, including perceived usefulness, acceptability, and barriers/facilitators to engagement, particularly among marginalized perinatal people to inform post-COVID service delivery.MethodsEligible participants were pregnant or up to one year postpartum Peri CoCM patients recruited from a May–July 2025 referral cohort. Nine women ages 27–42 completed one-hour, semi-structured Zoom interviews between August and September 2025; the sample intentionally overrepresented self-identified Black women. Interviews were recorded, transcribed, verified against audio, and analyzed by a coding team using grounded-theory–informed thematic analysis with constant comparison.ResultsParticipants reported positive experiences with Peri CoCM across four thematic areas: (1) Pathways to care, (2) Perceived impacts of program, (3) Importance of culturally responsive care, and (4) Recommendations for program optimization. Trusted referrals from obstetric and other providers facilitated entry into care, often for anxiety, depression, grief, or first-time mental health support. Participants described Peri CoCM as accessible, supportive, and valuable during pregnancy and postpartum. Virtual options, flexible scheduling, compassionate behavioral health clinicians, and consistent follow-up reduced barriers and promoted openness. The short-term model helped some transition to longer-term therapy, while clinicians supported insurance navigation, medication decisions, and community resource connections. Participants gained coping skills, validation, and self-understanding. They emphasized culturally responsive provider fit and recommended longer continuity, broader wraparound services, and sustained no-cost access to reduce stress and improve engagement.ConclusionMichigan’s Peri CoCM was perceived as a low-barrier, relationship-centered, culturally responsive virtual pathway supporting perinatal wellbeing and systems navigation in the post-COVID era. Cost transparency and flexible delivery were central to acceptability and expanded access to equitable care.
Problematic Reliance on Generative AI in an Anxious Young Adult: Case Report
Generative Artificial Intelligence (AI) tools are increasingly integrated into daily life, offering cognitive support across domains such as writing, decision-making, and social interpretation. While beneficial, excessive reliance may contribute to diminished confidence in one’s own thinking. This report describes a woman in her mid-20s with Generalized Anxiety Disorder and Major Depressive Disorder who developed a pattern of functional dependence on generative AI tools- specifically ChatGPT. She historically had strong social, academic and occupational functioning. Psychiatric consultation did not suggest the presence of a personality disorder, and although she was a high-achieving individual, clinically significant perfectionistic traits were not evident. Despite this, she increasingly relied on AI for routine cognitive and interpersonal tasks including composing emails, interpreting social interactions, predicting the future and making decisions and felt increasingly uncomfortable completing such tasks independently. This case highlights the potential danger of generative AI tools in reassurance seeking behavior and how it might compound anxiety. These behaviors were observed across both professional and personal contexts, suggesting that AI use was not limited to task-specific assistance but reflected a generalized strategy for managing uncertainty and self-doubt. This behavioral pattern is characterized in this case by cognitive offloading, reduced confidence in independent judgment, and reinforcement of externalized thinking processes. This led to the subjective belief of declining skill and compromised functional autonomy. The Interaction of Person-Affect-Cognition-Execution (I-PACE) model was used to describe this pattern of behavior. While repeatedly turning to a family member or friend for validation and reassurance might lead to interpersonal fatigue, AI tools have no such limits and are infinitely accessible. This might ultimately worsen a patient’s ability to tolerate uncertainty. Given the ubiquity of AI tools and the prevalence of anxiety disorders, clinicians may need to be aware of the role AI tools potentially play in reassurance seeking and thus perpetuation of anxiety.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/b5b1c680b8f330c90144ec99278fd88a" />
Transcutaneous auricular vagus nerve stimulation targets the brain-gut axis to treat functional dyspepsia: a scoping review of clinical evidence and mechanistic research
BackgroundFunctional dyspepsia (FD) is a common gut–brain interaction disorder with suboptimal response to pharmacotherapy. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulation targeting the vagus nerve, has emerged as a promising brain–gut axis therapy. This scoping review (PRISMA-ScR, JBI methodology) synthesizes clinical and preclinical mechanistic evidence on taVNS for FD.MethodsPubMed, Embase, Web of Science, and Cochrane Library were searched up to December 20, 2025, following PRISMA-ScR. Using PICOS (adults with FD; taVNS; sham/non-vagal/active controls; symptoms, gastric function, psychological outcomes, biomarkers; RCTs/clinical trials and controlled animal studies), two reviewers independently screened, extracted data, and assessed bias (RoB2 for RCTs, SYRCLE for animal studies). A narrative synthesis was performed due to heterogeneity.ResultsFour RCTs (n = 480) and eight preclinical rodent studies met inclusion. All RCTs showed significant improvements in dyspeptic symptoms, gastric accommodation, slow-wave normalization, and comorbid anxiety, depression, sleep disturbance versus sham/non-vagal control, sustained for 4–12 weeks. Stimulation parameters varied (10–30 Hz; 0.5–10 mA; 2–4 weeks); risk of bias low-moderate. Preclinical rodent evidence supported five interconnected candidate mechanisms: (i) autonomic balance and cholinergic modulation; (ii) α7nAChR/NF-κB anti-inflammatory pathway with duodenal barrier restoration; (iii) NGF/TrkA/PLC-γ/TRPV1-mediated visceral hypersensitivity suppression; (iv) HPA axis inhibition; (v) rebalancing of brain-gut peptides (motilin, CCK, GLP-1).ConclusionThis review characterizes taVNS as a safe, well-tolerated, mechanistically plausible non-invasive neuromodulation for FD acting on multiple brain–gut axis nodes. However, the small number of trials, parameter heterogeneity, and limited follow-up constrain definitive conclusions. Adequately powered, multicenter RCTs with standardized protocols and long-term follow-up are needed to confirm efficacy and define optimal regimens.