“Failure to Launch” Syndrome: How to Stop Enabling Your Grown Child

When Zeke was in high school, he struggled with anxiety and substance use problems, and he left college after the first semester. Now 25, he is living at home, and his mom Carol is frustrated. While she’s pushed him to go back to school or work, he has only held one part-time job at a local smoothie shop and quit after a few months, embarrassed that high school classmates would see him working there. Another attempt at trade school to become an electrician also didn’t take — it didn’t feel like the right fit. Now he rarely leaves the house, stays up all night playing video games or scrolling online, and sleeps most of the day.

Failure to launch syndrome, highly dependent adult children, boomerang kids — there’s no standard term or definition, but if you’re a parent in this situation you recognize it. You are worried and frustrated about your adult child’s difficulty in leaving the nest, and you don’t know what to do because everything you’ve tried so far hasn’t worked. 

“These aren’t kids who come back home because they finished school, and the first job they get doesn’t pay enough for them to afford rent on an apartment,” says Theresa Welles, the Shapiro Family Director of the Bubrick Center for Pediatric OCD at the Child Mind Institute. “We’re talking about young adults who functionally have hit a wall, so to speak. They’re caught in a loop of dependency.”

What is failure to launch syndrome?

It’s not uncommon for adult children to live with their parents: According to Pew Research Center, 18 percent of adults ages 25 to 34 lived in their parents’ home in 2023, with young men more likely than young women to do so (20 percent vs. 15 percent). Young adults might leave home for a period of time and then move back in with their parents because they can’t find a job. Or for religious or cultural reasons, some adult children expect to live in the family home until they get married. Living at home is not the main criterion for determining a “failure to launch.”

While there is no official clinical definition, researchers who study this group of young adults generally categorize someone as a highly dependent adult child if they are:

  • Not in school, working, or actively looking for work (though physically capable of doing so)
  • Financially dependent on their parents for housing and other necessities
  • Emotionally reliant on parents (i.e., needing constant reassurance that they are okay)  

They usually have very limited social interactions other than online. Often, they have mental health challenges such as anxiety, depression, or OCD, which is a contributing factor, Dr. Welles says.

“They’re at the developmental stage of early adulthood, they’re figuring out who they are,” Dr. Welles says. “The fancy term in psychology is ‘individuation,’ but it’s essentially who you are, both as part of your family and separate from your family.” Highly dependent adult children haven’t made much progress in this stage for several years. Many of them want to change their life path and become more independent, but they struggle with anxiety or fear of failure and don’t follow through on the necessary steps. “Reliance on parents reduces opportunities to build autonomy, which in turn maintains that reliance,” she says. So, they remain stuck.  

Dependent behaviors and parental accommodations

Young adults who are highly dependent often fall into certain patterns of behavior. They don’t do their own laundry, cook, clean, or help out around the house. They rarely leave the home and often shut themselves in their bedroom or live in the basement, avoiding talking to others in person. As a result, they rely on their parents to act as an intermediary with the outside world, such as making doctor’s appointments. They might blame their parents for their difficulties in life.

While parents may not like the situation, they struggle to get their adult child to change. So instead, they accommodate them — especially when they are concerned about their child’s mental health challenges.

“In the world of neurodiversity, accommodations are a good thing — we want accommodations for testing and sensory environments,” says Natalia Aíza, LPC, the author of the forthcoming Anxious to Launch: Parenting Strategies to Help Your Adult Child Move On. “But in the anxious-to-launch world, accommodations are actually interfering with your child becoming independent.”

Aíza gives some examples of unhelpful family accommodations: You make sure there’s food in the fridge, don’t ask them to contribute to paying bills, and may give them spending money. When they get angry or upset, you accept the behavior and feel guilty, thinking you are to blame for the situation. If they are anxious when you aren’t nearby, you don’t travel because it causes them stress. Instead of expecting them to take steps to find a therapist, you do the legwork.

“The number one behavior of the highly dependent adult child is avoidance. I cannot emphasize this enough,” Aíza says. “If your child has a full-on virtual life, that’s their social outlet. They are avoiding real-life challenges. They are avoiding working at jobs that are unpleasant. They are probably avoiding adulting tasks that should fall on them at this point. So, we swoop in and take care of those tasks for them.”

A modern version of an old problem

While adult children have lived with their parents in past generations, researchers argue that phenomenon of highly dependent adult children is on the rise, and young people today seem particularly susceptible. Adolescence is more prolonged now in many cultures, and there’s an emphasis on finding a fulfilling career, not just a job that pays the bills.

Technology contributes to the problem. Playing video games, watching videos, scrolling through social media — “these activities don’t help matters because they can do things that feel like they’re accomplishing something,” Dr. Welles says.  

How to stop enabling your grown child

In Dr. Welles’s practice, she has worked with families where she initially treated the teen for anxiety or OCD, then involved the parents more deeply when the young adult had trouble launching. In one case, the son was in the habit of playing video games late at night and would sleep through class the next day. He had anxiety and depression, and his parents didn’t want to take away video games because it was the one thing he enjoyed doing. But they started turning off the Wi-Fi in the house at a certain time at night.

“It sounds so extreme, like he’s being punished,” Dr. Welles says. “But it’s about saying to him, ‘We’re going to pull back on ways we’ve accommodated that may have unintentionally made your anxiety worse.’” It was important that the parents validated his feelings, saying things like, “You feel like you’re in danger, as if you’re standing in front of a bear, and that’s really hard. But that’s the anxiety lying to you, and it won’t go away if we keep accommodating things that allow you to avoid what you need to do in order to overcome this anxiety.”

And tactics like these made a difference over time. The son is now attending college part-time and working as a server at restaurant. He has a girlfriend and has plans to save enough to move into an apartment with a friend.

Setting boundaries with your adult child

If the adult child doesn’t seem motivated to find a job, Aíza has recommended that parents take them off the family cellphone plan, giving them warning that this will happen by the next month’s bill. “This is not necessarily the most strategic financial choice” because it’s often much cheaper per person on a family plan, she acknowledges. “But it is a perfect first accommodation to remove because it is telling your adult child, ‘This is something you can handle. You can be responsible for it financially and logistically. It is something that I control, and I want to stop controlling parts of your life.’” And it’s often the motivation they need to find a job — something that can earn them $100 for the monthly cell phone bill is small enough that it feels doable.

When families take steps like these, the adult child will likely get angry or upset. “That’s hard. But think about when your kids were toddlers, and they wanted to touch a hot stove,” Dr. Welles says. “They were mad when you said, ‘No, you can’t touch that stove,’ but that didn’t mean you let them do it.”

“The good news is, generally speaking, even if there’s unhappiness in the beginning,” she continues, “pretty quickly, once they start to feel better and are doing the things that they actually care about, it can really help.”

Supporting without enabling adult children

Highly dependent adult children might accuse parents of not being supportive when they pull back on accommodations. Dr. Welles suggests communicating that you hear them and validate their feelings: “You can say things like, ‘Hey, I know this is tough or ‘I know that this makes you really nervous.’ But you combine it with the confidence that they can do it, like ‘I also know you can do it, as hard as it is.’”

Sometimes, you might think you are being supportive when you are actually enabling — like filling out a job application on behalf of the child. “Even if it works and they get an interview, you’re accommodating their anxiety,” Dr. Welles says. “But also, there’s going to be a point when you can’t do something for the child — the interview or the job itself — so the earlier that you can pull back the better.”

If your adult child has both ADHD and anxiety, you can support their executive functioning skills without accommodating the anxiety. “Maybe you sit down with them on Mondays and look at their schedule to help them determine if there’s a way you can help them organize, as opposed to you stepping in and letting them avoid things they need to do because they’re anxious about it,” Dr. Welles says.

Aíza encourages giving the adult child the minimum amount of help needed, to avoid creating another form of dependency. “It’s about noticing, ‘Am I working harder at this than they are?’” she says. “A lot of times the answer is ‘yes,’ and that’s a signal to back off and put more expectations on the child.”

Treatment for highly dependent adult children

While there is no standard treatment for highly dependent adult children, early evidence has shown a form of therapy called SPACE-FTL (Supportive Parenting for Anxious Childhood Emotions – Failure to Launch) to be promising. A variation on an effective treatment for anxiety and OCD, SPACE-FTL involves only the parents, since the adult child is often resistant to seeking help. The program helps parents reduce accommodations step by step and engage extended family and friends to help de-escalate conflict. 

One tactic is to make a plan to deliver a change in accommodation in writing — for instance, explaining that you will stop paying the cellphone bill at the end of the month and why. Doing it in writing (on paper or in a text) makes the message clear and helps you remain calm and non-reactive. If you are expecting an angry or violent response, they can ask a grandparent, uncle, or family friend be in the house when you deliver the letter, since that might make the response less extreme. The relative or friend may even spend the night if the adult child is more likely to cool off when others are present.

Asking for others’ help also helps you stop blaming yourself for the situation. “A lot of parents of highly dependent adults feel shame, but this is not something happening to only one family,” Aíza says. “We need to build on our social supports and get other people on our team so that we don’t feel so isolated in this process. Your adult child may be resisting change, but you don’t have to. It might sound cruel, but our central mandate as parents is making sure our child is okay after we’re gone. We brought them on earth to survive us — that is the design.”

Frequently Asked Questions

What is “failure to launch syndrome”?

“Failure to launch” isn’t a formal diagnosis but describes young adults who are stuck in a pattern of dependence. They’re typically not working or in school, rely on parents financially and emotionally, and struggle to move forward with adult responsibilities.

How can I motivate my adult child to become independent?

Change often starts with parents gradually pulling back on accommodations while staying supportive and calm. Set clear expectations, validate their feelings, and shift responsibility back to them in manageable steps so they can build confidence and autonomy.

The post “Failure to Launch” Syndrome: How to Stop Enabling Your Grown Child appeared first on Child Mind Institute.

Anxiety and Depression Associated With the Dependent Use of Generative AI in Medical Students: Cross-Sectional Study

Background: The growing integration of artificial intelligence (AI) in higher education has transformed learning processes but also raised concerns about potential mental health risks. Medical students represent a particularly vulnerable group due to high academic stress and increasing reliance on generative AI tools for study and decision-making tasks. Despite this, the relationship between AI dependence and psychological distress remains underexplored in Latin American contexts. Objective: This study aimed to evaluate the association between generative AI dependence and levels of stress, anxiety, and depression among medical students. Methods: A cross-sectional study was conducted with 187 human medicine students from a Peruvian university during the first academic semester of 2025. The Dependence on Artificial Intelligence Scale and the Depression, Anxiety, and Stress Scale–21 were applied. Negative binomial regression models, both crude and adjusted for sex, age, income, and year of study, were used to assess associations, reporting rate ratios (RRs) and 95% CIs. Results: Participants had a median age of 22 (IQR 19‐24) years, and 58.8% (110/187) were female. The median Dependence on Artificial Intelligence Scale score was 10 (IQR 7‐14). Generative AI dependence showed significant correlations with anxiety (ρ=0.336, 95% CI 0.22‐0.44) and depression (ρ=0.316, 95% CI 0.20‐0.43) and a smaller correlation with stress (ρ=0.277, 95% CI 0.16‐0.39). In the adjusted regression models, each 1-point increase in generative AI dependence was associated with a 5% higher expected anxiety score (RR 1.05, 95% CI 1.01‐1.09; =.01) and a 4% higher depression score (RR 1.04, 95% CI 1.01‐1.08; =.03), whereas the association with stress was positive but nonsignificant (RR 1.03, 95% CI 1.00‐1.07; =.08). Fifth-year students had significantly greater anxiety levels than their sixth-year peers (RR 1.82, 95% CI 1.09‐3.01; =.02). No significant effects were observed for sex, age, or income. Conclusions: This study empirically examined generative AI dependence as a distinct behavioral construct and its association with mental health symptoms in medical students. Unlike prior research, this study evaluated psychological dependence on generative AI and modeled its relationship with anxiety and depression using appropriate count-based regression techniques. By providing early evidence from a Latin American context, it contributes to the emerging field of digital mental health and medical education research. These findings underscore the need for universities to promote balanced and responsible AI use, integrate digital literacy with mental health support strategies, and develop preventive policies that mitigate potential maladaptive reliance on generative AI tools.
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Psilocybin-Induced Brain Changes May Explain Therapeutic Effects

Researchers at University of California, San Francisco and Imperial College London have shown that a single dose of psilocybin, the psychedelic compound found in magic mushrooms, causes likely anatomical brain changes that last for up to a month after the experience.

The study, involving healthy volunteers who had never taken a psychedelic, links temporary shifts in brain “entropy”—which is the diversity of neural activity occurring in the brain—to insight. This suggests the psychedelic trip itself is important to the drug’s longer term therapeutic effects.

The researchers found that a high dose of psilocybin led to increased entropy in the minutes and hours after taking the drug. The degree of entropy predicted how much insight, or emotional self-awareness, the participants felt the next day; and this, in turn, forecasted improvements in their sense of wellbeing a month later.

The findings may help to explain psilocybin’s therapeutic effects on conditions such as depression, anxiety, and addiction. “Psychedelic means ‘psyche-revealing,’ or making the psyche visible,” said senior author Robin Carhart-Harris, PhD, the Ralph Metzner distinguished professor of neurology at UCSF. “Our data shows that such experiences of psychological insight relate to an entropic quality of brain activity and how both are involved in causing subsequent improvements in mental health. It suggests that the trip—and its correlates in the brain—is a key component of how psychedelic therapy works.”  Carhart-Harris is senior and corresponding author of the team’s published paper in Nature Communications, titled “Human brain changes after first psilocybin use.”

“Psychedelics have robust effects on acute brain function and long-term behavior but whether they also cause enduring functional and anatomical brain changes is largely unknown,” the authors wrote. Psilocybin is the precursor of the compound psilocin, a serotonin receptor agonist. “Converging evidence supports a role for serotonin 2A receptor  (5-HT2AR) agonism in eliciting the characteristic brain and subjective effects of this and related psychedelics in humans,” the team continued.

For their newly reported study, Carhart-Harris and colleagues carried out an exploratory, placebo-controlled, within-patient study in 28 psychedelic-naïve participants who each received a single, high-dose (25 mg) of psilocybin. The researchers used an assortment of brain imaging and brain measurement techniques, some of which were carried out during the peak of the psychedelic experience, as well as before and one-month after drug administration. “This was an exploratory, hypothesis-generating mechanistic study in healthy volunteers,” the authors noted. None of the 28 people in the study had a diagnosed mental health condition, which gave the scientists greater freedom to do more testing.

In the first part of the experiment the subjects were given a 1 mg dose of psilocybin, which the researchers regarded as a placebo, and were then monitored with EEG, which records brain activity from electrodes on the scalp.  Over the next few weeks, the researchers measured their subjects’ psychological insight, wellbeing, and cognitive ability. They examined brain activity with functional MRI (fMRI) and brain connectivity with diffusion tensor imaging (DTI).

One month after the placebo, the subjects were given 25 mg of psilocybin, a dose capable of eliciting a strong psychedelic trip. During the experience, researchers again measured the subjects’ brain activity with EEG, and in the following weeks they repeated the same tests they had given after the 1 mg dose.

This enabled the scientists to compare the effects of the psychedelic trip on the brain and mind to the effects of the placebo. “The multimodal neuroimaging design allowed us to observe changes in brain function and (potential) anatomy from 1-h (EEG) to 1-month (DTI) after high-dose psilocybin,” they explained.

The investigators found that within 60 minutes of taking the 25 mg dose of psilocybin, EEG revealed higher entropy, suggesting that the brain was processing a richer body of information under the psychedelic. A month later, the researchers looked at their subjects’ brains using DTI, which measures the diffusion of water along neural tracts in the brain, and found that they were denser and had more integrity. This is the opposite of what happens in aging, which makes these tracts more diffuse.

The researchers cautioned that more work needs to be done to better understand the meaning of this finding, but the result is a never-before-seen sign of how psychedelics can change the brain. ”The inclusion of DTI enabled us to test for long-term changes in the integrity of white matter tracts post psilocybin,” the authors stated. “Results revealed decreased axial diffusivity in prefrontal-subcortical tracts 1-month post 25mg psilocybin.”

The day after the 25 mg dose, all but one of the 28 subjects rated the trip as the “single most” unusual state of consciousness they had ever experienced. The remaining person rated it as among their top five. The study participants said they had experienced more psychological insight after taking the 25 mg of psilocybin than they had after the 1 mg placebo.  The subjects also reported increased wellbeing two and four weeks after the study. This was measured from responses to statements such as, “I’ve been feeling optimistic about the future,” and “I’ve been dealing with problems well.”

As the scientists noted in their paper, “A predictive relationship was also found between brain entropy and longer-term mental-health changes—namely, improved wellbeing. Improved wellbeing could be predicted directly from acute increases in brain entropy as early as 1-h post dosing.”

A month after the study the study individuals also scored better on a test of cognitive flexibility.  “Psilocybin seems to loosen up stereotyped patterns of brain activity and give people the ability to revise entrenched patterns of thought,” said first author Taylor Lyons, PhD, a research associate at Imperial College London. “The fact that these changes track with insight and improved well‑being is especially exciting.”

The scientists found that the subjects who had experienced the largest increases in brain entropy in the minutes to hours after taking psilocybin were the most likely to have increased insight the next day and increased wellbeing a month later. The researchers concluded that improved wellbeing was driven by the experience of insight.

The authors suggest that the study findings could improve treatment for people with mental illness using psilocybin, for example, by ensuring that the right dosage is used to produce the right amount of brain entropy to promote insight. “We already knew psilocybin could be helpful for treating mental illness,” Carhart-Harris said. “But now we have a much better understanding of how.”

In their paper the team concluded, “The present multi-modal neuroimaging study in healthy participants sheds light on the brain effects of first-time high-dose psychedelic use and the therapeutic action of psilocybin-therapy, suggesting that therapeutically relevant changes—i.e., improved wellbeing—can be forecast via an acute human brain action, i.e., an entropic brain effect, that is well-known to relate to the psychedelic experience … Results support a role for psychological insight in mediating the causal association between the entropic brain effect and potentially enduring improvements in wellbeing.”

The post Psilocybin-Induced Brain Changes May Explain Therapeutic Effects appeared first on GEN – Genetic Engineering and Biotechnology News.

Brief report: joint trajectories of anxiety and depression symptoms in an inception cohort of autistic youth

Background and AimsAnxiety and depression symptoms are common among autistic youth, yet little is known about the pattern and relationship of their trajectories from childhood into adolescence, a period of increasing social and academic demands.MethodsThis study used parallel process latent growth curve models to examine joint trajectories, including initial levels and rate of change in caregiver-reported depression and anxiety symptoms across age 7–16 within an inception cohort of autistic youth with varied communication abilities. We also examined autistic traits, sex assigned at birth, emotional reactivity and communication ability as potential predictors. Child anxiety and depression symptoms were estimated from Child Behavior Checklist Anxiety and Affective Problems subscales, completed by caregivers approximately annually.ResultsWhereas anxiety symptoms were relatively stable from childhood into adolescence, depression symptoms increased on average; significant heterogeneity of individual trajectories underlaid these overall trends. Findings indicated cross-sectional and longitudinal co-occurrence of anxiety and depression symptoms. Greater autistic traits and emotional reactivity correlated with greater initial anxiety and depression symptoms, but not their trajectories. Stronger communication ability correlated with more initial anxiety, but decreasing anxiety symptoms over time.ConclusionsFindings indicate group-level changes in depression symptoms and synchronous evolution of anxiety and depression symptoms in autistic youth across childhood and adolescence. This indicates the importance of joint monitoring of anxiety and depression symptoms in this period, with changes being potentially informative for early detection and intervention. Considering how anxiety symptom presentation may evolve across development may be a helpful next step to identifying at-risk subgroups.

Older Adults’ Experiences Navigating Setup of Digital Health Technology: Implementation Report

<strong>Background:</strong> Digital health and connected technologies may support better health outcomes among older adults, including those with multiple chronic conditions or low engagement in health behaviors. However, initial experiences with technology, including during unboxing, setup, and first use, can influence emotional reactions and perceptions and can ultimately determine sustained, meaningful use. Older adults with low technology experience or poor health may be particularly vulnerable to frustration, stress, or abandonment of devices when early interactions are negative. <strong>Objective:</strong> The purpose of this implementation study was to closely observe the initial engagements with a telehealth treatment app and connected blood pressure monitor (BPM) among a group of older adults with low prior technology use and reported low health behavior engagement. The goal was to identify setup “pain points” that may influence initial impressions and intention to use the technology over time. <strong>Methods:</strong> A total of 24 older adults (aged ≥65 years) were recruited for a 4-week trial of a telehealth app. Participants were provided with a box containing a tablet preloaded with the app, paper instructions, and a BPM and cuff. Researchers first conducted in-home ethnographic interviews with participants to observe the unboxing and setup process, documenting experiences with reading instructions, using the BPM, and engaging with customer support. Weekly check-in calls and a final exit interview captured ongoing experiences and likelihood of continued use. Interview recordings were transcribed and independently coded, guided by the unified theory of acceptance and use of technology. <strong>Results:</strong> Most of the sample were White (20/24, 83%) and female (14/24, 58%). Negative experiences with the app’s customer support were the top challenge for participants, with representatives providing confusing steps or conflicting terminology. Other common challenges were understanding instructions, connecting to Bluetooth, and correctly using the BPM. While 67% (16/24) of the participants indicated that they were likely or very likely to continue to use the app after the study ended at the end of week 1, this number dropped to 54% (13/24) by the end of the 4 weeks. Participants who reported lower technology self-efficacy at the beginning of the study also experienced frustration, anxiety, and embarrassment as friction with the setup process continued. <strong>Conclusions:</strong> First impressions of digital health apps play a critical role in influencing older adults’ emotions and perceptions regarding the technology and may impact the likelihood of longer-term engagement. Those with lower technology self-efficacy are particularly susceptible to experiencing negative emotions such as frustration, stress, or shame. Mobile health apps and interventions targeting older adults should incorporate simplified instructions with clear, consistent terminology and well-trained customer support staff to improve the onboarding experience.

Curiosity in a Novel Virtual Reality Scenario and Its Association With Symptoms of Depression: Observational Pilot Investigation

Background: Curiosity plays a fundamental role in human learning, development, and motivation, and emerging evidence suggests that reduced curiosity is linked to poorer mental health outcomes, including depressive symptoms (DS). However, to date, the majority of curiosity research relies on self-report assessments and thus risks biased reporting. Virtual reality (VR), a novel tool increasingly used within mental health research and treatment, might represent a potent tool for offering ecologically valid insights into curiosity-driven behaviors while circumventing issues related to self-report assessments, including demand characteristics and recall bias. Objective: The study aimed to enhance the assessment of curiosity by using a novel VR environment and to examine its relevance to DS. Specifically, we tested 2 hypotheses using a novel VR environment: first, that curiosity, as assessed through spontaneous exploratory interactions and behaviors in VR, positively correlates with self-reported curiosity, and second, that VR-based curiosity is inversely associated with DS. Methods: This exploratory study used an observational design that included 100 volunteers. All participants completed self-reported assessments of DS and curiosity before engaging in a novel VR scenario. Although progression in the virtual environment required solving cognitive tasks, these were embedded as structural elements rather than framed as the primary objective. Instead, participants’ free explorations and interactions with objects formed the basis for the 4 curiosity metrics used in this study. After VR exposure, participants completed a questionnaire assessing cybersickness symptoms. Results: Hypothesis 1 was not supported, as only one curiosity metric, namely object interactions, was positively associated with one aspect of curiosity relating to motivation to seek new knowledge and experiences. Further, diminishing significance after correction for multiple testing warranted caution. Results relating to hypothesis 2 indicated partial support, in that object interaction was significantly associated with DS while controlling for age, sex, and cybersickness levels. Sensitivity analyses showed no associations between object interactions and self-reported anxiety and stress symptoms. Conclusions: VR may be a potent tool for assessing exploratory behaviors in a controlled, yet ecologically valid, environment that avoids issues related to self-report. However, whether such motivations translate to established curiosity constructs warrants further research. This study also provided preliminary insights into how assessing exploratory interactions in VR may be a promising avenue that could enhance the understanding of the etiology and assessment of DS—particularly its early stages.
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Excessive Internet use and depressive symptom levels in adolescents with depressive disorders: chain mediation of social anxiety and sleep quality

BackgroundAdolescents with depressive disorders are at elevated risk for adverse mental health outcomes, and excessive Internet use has been increasingly linked to greater symptom severity. Therefore, this study aimed to examine the chain mediating roles of social anxiety and sleep quality in the association between excessive Internet use and depressive symptoms among adolescents with depressive disorders.MethodsA cross-sectional design was used. A total of 266 Chinese adolescents with clinically diagnosed depressive disorders (M = 15.79 years, SD = 1.85; 71.4% female) were assessed using the Internet Addiction Test, Zung Self-Rating Depression Scale, Social Anxiety Scale for Children, and Pittsburgh Sleep Quality Index. Correlation analyses and bootstrapping methods were conducted using SPSS and the PROCESS macro to examine the chain mediating effects of social anxiety and sleep quality.ResultsThe total indirect effect of excessive Internet use on depressive symptoms accounted for 65.66% of the total effect. Specifically, the indirect effects via social anxiety and sleep quality accounted for 24.10% and 26.51% of the total effect, respectively. In addition, the chain mediating effect of social anxiety and sleep quality was significant, accounting for 14.76% of the total effect.ConclusionExcessive Internet use was positively associated with more severe depressive symptoms among adolescents with depressive disorders, both directly and indirectly through the chain mediating effects of social anxiety and sleep quality. These findings highlight potential targets for preventing and intervening in excessive Internet use among this population.

Adverse childhood experiences and non-suicidal self-injury in adolescents: the roles of depressive symptoms and teacher care

BackgroundNon-suicidal self-injury (NSSI) has become an increasingly prominent mental health problem during adolescence and often co-occurs with depressive symptoms, anxiety, personality-related difficulties, and experiences of childhood trauma, forming a complex psychosocial risk structure. From a risk and protective factor perspective, the present study examined the associations among adverse childhood experiences (ACEs), depressive symptoms, perceived teacher care, and NSSI among Chinese adolescents.MethodsThe participants were 2,221 junior high school students from three schools in China. Data were collected using the Childhood Trauma Questionnaire, the Adolescent Non-Suicidal Self-Injury Questionnaire, a depression scale, and a teacher care scale.ResultsAdverse childhood experiences and depressive symptoms were significantly positively associated with NSSI, whereas perceived teacher care was significantly negatively associated with NSSI. Higher levels of ACE exposure and more severe depressive symptoms were associated with higher levels of NSSI, while higher levels of teacher care were associated with lower levels of NSSI. Moreover, among adolescents reporting higher levels of perceived teacher care, the positive associations between ACEs and NSSI and between depressive symptoms and NSSI were attenuated, suggesting that teacher care, as an external support resource in the school context, may play an important protective role.ConclusionsAdverse childhood experiences and depressive symptoms are important risk factors for adolescent NSSI, whereas teacher care plays a significant protective role in the school context. School-based prevention and intervention efforts should prioritize adolescents with high levels of ACE exposure and pronounced depressive symptoms, while strengthening teacher care to enhance protective resources. Future research should further explore how specific dimensions and timing of ACEs, trajectories of depressive symptoms, and multiple sources of social support jointly influence the development and maintenance of NSSI in adolescents.

OTX-202 Smartphone App to Reduce Suicidal Ideation Among High-Risk Transition-Age Youth: Open-Label, Single-Arm, Phase 1 Clinical Trial

<strong>Background:</strong> The transition from adolescence to adulthood (18 to 25 years) is associated with an increased risk of suicidal ideation and behaviors. Suicide-focused cognitive behavioral therapies (CBTs) have been shown to significantly reduce suicidal ideation and behaviors but are not widely available to high-risk individuals. Digital therapeutics could improve access to these treatments. <strong>Objective:</strong> This study aimed to evaluate the acceptability, safety, and potential efficacy of OTX-202 among transition-age youth (18 to 25 years) receiving mental health care outside an inpatient hospital setting. <strong>Methods:</strong> In this phase 1 single-arm clinical trial, 59 transition-age youth with recent suicidal ideation or suicide attempts used OTX-202, a smartphone app designed to deliver suicide-focused CBT, concurrently with usual outpatient mental health care. After baseline, eligible patients completed 12 weekly assessments of suicidal ideation, depression, and anxiety. <strong>Results:</strong> From baseline to week 12, participants reported statistically significant, large reductions in suicidal ideation (mean difference –5.1, 95% CI –6.5 to –3.7; <i>d</i>=0.95). In total, 3 (5.1%; 95% CI 0%-11.2%) participants reported suicide attempts. Reductions in suicidal ideation and suicide attempt rates were consistent with results from previously published randomized clinical trials of suicide-focused CBTs. Participants rated OTX-202 in the 97th percentile of usability and completed a mean of 9.0 (SD 3.5) of 12 app modules, supporting the app’s acceptability. There were no patient deaths, device-related events, or severe adverse events, supporting the app’s safety. <strong>Conclusions:</strong> Results support the safety, acceptability, and potential efficacy of OTX-202 for reducing suicide risk among transition-age youth. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT06008132; https://clinicaltrials.gov/study/NCT06008132

Timing of exercise differentially modulates fear memory and hippocampal neurotransmitters in male rats

Exercise promotes neurogenesis and enhances memory consolidation while reducing the retention of aversive memories and anxiety-like behaviors. While our previous work found that acute exercise alters neurotransmitter concentrations, including dopamine and serotonin, in a time-of-day-dependent manner, the long-term effects of chronically timed exercise on neurotransmitter dynamics and behavioral phenotypes remain unclear. To examine whether the daily timing of a chronic exercise intervention modulates its impact on neurotransmitter profiles and fear responses, male rats were conditioned using a Pavlovian contextual fear approach, then assigned to a 4-week treadmill exercise intervention performed during the early (ZT14) or late (ZT22) active phase or a time-matched sham-exercise control group. One day after completing training, rats underwent a context retrieval test in the middle of active phase (ZT18), and hippocampal neurotransmitters were quantified using UPLC–MRM/MS. Rats subjected to sham-exercise at ZT22 exhibited higher freezing than sham-exercised rats at ZT14, whereas exercise interventions at ZT22 selectively attenuated freezing. Histamine, acetylcholine, and GABA exhibited significant exercise × time interactions. Direct neurotransmitter–freezing correlations were weak after false discovery rate control, consistent with a network-level reorganization rather than a single transmitter driver. These findings suggest that vulnerability to aversive memory expression can be buffered by exercise, if timed appropriately, and that exercise reshapes hippocampal neuromodulatory tone in a circadian–phase–dependent manner, supporting the potential of exercise timing as a chronotherapeutic strategy to enhance stress resilience and mental wellbeing.