Background: Latina pregnant women and mothers of infants in the United States experience elevated risk for perinatal anxiety, stress, and depression alongside persistent barriers to culturally and linguistically responsive care. AI-powered digital health tools offer a potentially scalable approach to address these gaps, yet evidence on their acceptability and effectiveness for this population remains limited. Objective: We aimed to evaluate the feasibility, acceptability, and preliminary outcome changes of Rosie, a Spanish-language AI-powered chatbot designed with and for Latina mothers, on maternal mental health and healthcareuse outcomes. Methods: We conducted a mixed methods pilot randomized controlled trial with 30 Spanish-speaking Latina participants who were pregnant or parenting an infant younger than 6 months. Participants were randomized 1:1 to the Rosie intervention or a comparison book club condition that provided monthly children’s board books. Surveys administered at baseline and 3-month follow-up assessed depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale), and health care use. Quantitative analyses examined within- and between-group changes, and qualitative feedback assessed acceptability and user experience. Results: Baseline mental health scores were low in both groups; however, several baseline demographic differences were observed between study arms, including age, pregnancy vs parenting status, marital status, education, and country of origin. Over 3 months, participants in the Rosie group demonstrated statistically significant within-group reductions in anxiety (mean baseline 3.27, SD 2.89; mean change −2.00, SD 2.94; =.02) and perceived stress (mean baseline 30.00, SD 5.53; mean change −12.20, SD 12.99; =.003). Depression scores declined modestly in both groups, with no significant between-group differences. No significant differences were observed in maternal emergency department use or adherence to well-baby visits. Engagement with Rosie was high, and qualitative feedback indicated that participants found the chatbot useful and supportive. Conclusions: This pilot study suggests that a culturally and linguistically tailored AI-powered chatbot is feasible and acceptable among Latina mothers during the perinatal period. Although anxiety and perceived stress decreased within the Rosie group, no significant between-group differences were observed. Within-group reductions in anxiety and perceived stress among Rosie participants are preliminary and should be interpreted cautiously because the trial was not powered to detect between-group effects and no statistically significant between-group differences were observed. Larger, adequately powered trials are needed to evaluate effectiveness.
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ADHD-related mental health and school impairments across educational stages: sex-specific patterns in Japanese youth
IntroductionWhile ADHD-related challenges are well-documented internationally, understanding of how these manifest across educational stages and sexes remains limited. This study examined mental health symptoms and school functioning in Japanese children with and without ADHD across elementary, junior high, and senior high school.MethodsIn this comparative cross-sectional study, parents of 1,594 Japanese children (797 with ADHD, 797 without ADHD) aged 6–18 years completed questionnaires assessing ADHD symptoms (ADHD-RS-IV), depression (SMFQ), anxiety (SCAS), irritability (ARI), bullying victimization, academic achievement, and social support. Three-way ANOVAs examined interactions between ADHD status, child sex, and educational stage, with Cohen’s d effect sizes calculated for group comparisons.ResultsChildren with ADHD demonstrated significantly poorer outcomes across nearly all domains, except for teacher support, with effect sizes ranging from moderate to very large (d = 0.35–1.44). Contrary to expectations, the largest group difference for girls’ depression emerged in elementary school (d = 1.44) rather than junior high school, and girls’ anxiety differences were comparably large in elementary (d = 1.25) and junior high school (d = 1.30). Girls with ADHD showed consistently larger effect sizes than boys for depression (mean d: 1.14 vs. 0.84), anxiety (1.13 vs. 0.73), and irritability (1.32 vs. 0.90) across all stages. Significant ADHD × sex interactions emerged for depression, anxiety, and irritability. Bullying victimization affected 31.0% of children with ADHD compared to 7.5% of non-ADHD children, with peak effects in elementary school. Academic difficulties showed the anticipated pattern of increasing impairment from elementary to junior high school, particularly for boys (d = 0.65 to 1.07).DiscussionThese findings reveal pronounced sex differences in ADHD-related mental health burden, with girls experiencing what may be a “hidden burden” of greater internalizing symptoms across development. The smaller group differences for internalizing symptoms in adolescence may partly reflect decreased parental awareness of adolescent internalizing symptoms. These results underscore the need for sex-specific, developmentally-informed interventions with particular attention to early identification and support for girls with ADHD who may be overlooked in clinical and educational settings.
Incorporating Data From Text Messages and Email Into Psychotherapy: Randomized Controlled Trial
Background: As digital communication becomes central to daily life, psychotherapy increasingly has access to patients’ electronic media data. Although digital phenotyping has been widely studied, less is known about whether incorporating personal communication data, such as text messages, improves clinical outcomes in psychotherapy. Objective: This study aimed to determine whether integrating personalized text message data into psychotherapy improves depression, anxiety, health-related quality of life, and therapeutic alliance and to examine whether increased access to collateral information influences clinical decision-making. Methods: The Electronic Media and its Impact on Psychotherapy (EMAP) study was a randomized controlled trial conducted in adult and geriatric outpatient and partial hospitalization settings at an academic psychiatric hospital. Participants receiving psychotherapy for primary depression or anxiety (n=101) were randomized to electronic media–enhanced therapy (EME; n=52) or treatment as usual (TAU; n=49). In EME, research staff reviewed participants’ text messages prior to sessions using personalized mood-related key terms and presented aggregated findings on a Health Insurance Portability and Accountability Act (HIPAA)–compliant clinician dashboard. TAU participants received standard care without message review. Outcomes included change scores for the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the 36-item Short Form Health Survey (SF-36), and the Working Alliance Inventory–Short Revised (WAI-SR). Linear regression and nonparametric tests compared groups. Moderation analyses assessed whether the frequency of information access influenced treatment changes. Results: No statistically significant between-group differences were observed in anxiety or working alliance. Among participants with SF-36 follow-up data (n=65), EME participants demonstrated greater improvement in the pain subscale. Greater frequency of information access was associated with increased treatment-related changes in the EME group. Access to additional collateral information was associated with more clinical actions but not with improved distal outcomes. Conclusions: Integrating personalized text message data into short-term psychotherapy did not significantly improve depression or anxiety, and it neither improved nor worsened therapeutic alliance. However, access to greater amounts of collateral information, including electronic media, influenced clinical decision-making, suggesting nuanced and context-dependent effects. Trial Registration: ClinicalTrials.gov NCT03712267; https://clinicaltrials.gov/study/NCT03712267
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Symptom Trajectories and Attendance in Face-to-Face and Online Psychiatric Follow-Up for Major Depressive Disorder and Anxiety Symptoms: Prospective Observational Cohort Study
<strong>Background:</strong> Major depressive disorder is a leading cause of disability, and access to specialist psychiatric follow-up remains limited in many settings. Telepsychiatry may reduce logistical barriers to care, but data on video-based follow-up under routine outpatient conditions in Türkiye are scarce, and comparisons of delivery modalities are frequently limited by baseline imbalance between self-selected groups. <strong>Objective:</strong> The aim of the study is to describe symptom trajectories and attendance over 6 months of routine psychiatric follow-up delivered either face-to-face or online and to examine whether outcomes differed between modalities after adjustment for baseline severity. <strong>Methods:</strong> In this prospective, nonrandomized observational cohort study, 120 adults with <i>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</i> (DSM-5) major depressive disorder were followed for 6 months at a university hospital psychiatry department in Ankara, Türkiye (September 2021 to May 2022). Participants entered face-to-face (n=60) or online (n=60) follow-up according to their own preference. Seven sessions were scheduled at approximately 4-week intervals; the Hamilton Depression Rating Scale (HAM-D; primary outcome), the Hamilton Anxiety Rating Scale, and DSM-5 Level 1 and Level 2 measures were administered at baseline and at sessions 1, 2, 4, and 6. Attendance was recorded at all sessions. Between-group comparisons used analysis of covariance adjusted for the corresponding baseline score and for prespecified covariates. Linear mixed models incorporating a group-by-time interaction were fitted to all available observations, and multiple imputation (<i>m</i>=20) was performed as a sensitivity analysis. <strong>Results:</strong> Depressive symptoms decreased substantially in both groups: mean HAM-D fell from 26.6 to 5.0 in the face-to-face group (81.2% reduction; Cohen <i>d</i>=4.86; <i>P</i><.001; n=43) and from 24.1 to 3.3 in the online group (86.3% reduction; Cohen <i>d</i>=6.06; <i>P</i><.001; n=49). Response rates were 41 of 43 (95.3%) and 48 of 49 (98%; <i>P</i>=.60), and remission rates were 32 of 43 (74.4%) and 43 of 49 (87.8%; <i>P</i>=.11). Unadjusted between-group differences at sessions 4 and 6 did not persist after adjustment for baseline severity (session 4: –0.47, 95% CI –1.71 to 0.77; <i>P</i>=.46; session 6: –0.79, 95% CI –2.22 to 0.65; <i>P</i>=.28), and the group-by-time interaction was not significant (<i>χ</i><sup>2</sup><sub>3</sub>=1.9; <i>P</i>=.59). Anxiety scores did not differ at any time point. Findings were unchanged under multiple imputation, and prescribing patterns were comparable. Attendance across all 7 scheduled sessions was higher in the online group overall (373/420, 88.8% vs 319/420, 76%; <i>P</i><.001), with differences at sessions 2 through 5. <strong>Conclusions:</strong> Both modalities were followed by large reductions in depressive symptoms, and between-group differences did not persist after adjustment for baseline severity. The study was not designed as an equivalence trial and cannot establish equivalence. The most consistent difference favoring online follow-up was attendance, although its reasons could not be determined. These findings characterize online psychiatric follow-up as a feasible means of maintaining continuity of routine care rather than as a more effective one.
In-person UCLA-PEERS® program for adolescents with autism spectrum disorder in Italy: study protocol for a pilot and feasibility randomized controlled trial with pragmatic features and exploratory EEG markers of treatment response
BackgroundAdolescents with Autism Spectrum Disorder (ASD) Level 1 frequently experience persistent difficulties in peer relationships and social functioning that become more evident as social demands increase. Group-based social skills trainings represent a key evidence-based intervention for this population, yet its availability in routine clinical services is still limited. The Program for the Education and Enrichment of Relational Skills (PEERS®) is one of the most empirically supported interventions for autistic adolescents. In Italy, telemedicine delivery has shown promising results, but the effectiveness and implementation of the in-person format in real-world services have not yet been evaluated. In addition, predictors of individual response to psychosocial interventions remain largely unknown.MethodsThis study is designed as a two-arm pilot and feasibility randomized controlled trial incorporating pragmatic features, including delivery within a routine tertiary clinical service, comparison with Treatment as Usual (TAU), and allowance for ongoing concomitant clinical, educational, and pharmacological treatments. It will compare the in-person Italian adaptation of UCLA PEERS® with Treatment as Usual (TAU) at IRCCS Fondazione Stella Maris (Pisa, Italy). Thirty-six adolescents aged 11–13 years with ASD (DSM-5-TR) and Full-Scale IQ >85 will be assessed at baseline (T0) and after the 16-week intervention (T1). Randomization will use block allocation with allocation concealment until completion of baseline assessments; outcome assessors and independent ADOS–BOSCC video coders will remain blind to group assignment. The intervention includes sixteen weekly 90-minute group sessions delivered by certified providers, with parallel caregiver sessions and structured teacher contacts to promote generalization. The primary focus of this pilot trial is feasibility, assessed through recruitment, retention, session attendance, and treatment fidelity. Clinical outcomes will be examined exploratorily to provide preliminary estimates of treatment effects. The QSQ-R will serve as the prespecified principal clinical outcome for estimating change in social functioning from baseline to T1. Parent- and adolescent-report versions will be analyzed separately, considering the Social Initiative and Social Reciprocity dimensions as distinct outcomes rather than deriving a composite total score. Key secondary outcomes include social knowledge (TASSK-R), autism-related social responsiveness (SRS-2), social motivation (SSDS), social anxiety (SAS), and observational change in social-communication behaviors (ADOS–BOSCC). Emotional–behavioral functioning (CBCL; YSR) will be explored as additional secondary outcomes. Baseline electroencephalography (EEG) recorded during a gesture–word integration task will be used to derive the N400 congruency effect and to explore whether individual differences in this measure are associated with treatment response. As a pilot and feasibility trial, the study is not powered for definitive efficacy testing and will estimate feasibility, acceptability, fidelity, and preliminary effect sizes to inform future multicenter trials.DiscussionThis study will provide the first evaluation of in-person PEERS® in the Italian clinical context and test the generalizability of previous telemedicine findings in routine care. The integration of clinical and behavioral outcomes may contribute to mechanism-informed, personalized psychosocial interventions for autistic adolescents and guide the design of future confirmatory studies.Trial registration(ClinicalTrials.gov – NCT07207213 – October, 3, 2025).
Adapted Group Therapy Compared With Usual Care for Anxiety and Depression in Adults With an Autism Diagnosis
Conditions: Autism Spectrum Disorder (ASD); Anxiety; Depression
Interventions: Behavioral: Autism-adapted group cognitive behavioral therapy
Sponsors: Lovisenberg Diakonale Hospital; Helse Sor-Ost
Not yet recruiting
Interventions: Behavioral: Autism-adapted group cognitive behavioral therapy
Sponsors: Lovisenberg Diakonale Hospital; Helse Sor-Ost
Not yet recruiting
Understanding anxiety disorders among Iranian mothers and their children exposed to conflict using an extended transactional model of stress and coping
ObjectiveThe psychological impact of war on families is profound. However, the mechanisms linking war-related stressors to anxiety among mothers and their children remain insufficiently understood, particularly in Middle Eastern contexts. Grounded in an extended transactional model of stress and coping, this study examined the direct and indirect relationships between war-related stressors, cognitive appraisal, coping strategies, and anxiety among Iranian mothers and their children following a recent military conflict. The study also investigated the mediating roles of appraisal and coping processes and the moderating roles of religiosity and social support.MethodA cross-sectional design was employed approximately three months after a major military escalation. A stratified proportional sample of 343 Iranian mothers (aged 24 years and older) with at least one child aged 5–10 years living in conflict-affected areas completed validated self-report measures. Data were analyzed using partial least squares structural equation modeling (PLS-SEM).ResultsThe extends model explained substantial variance in maternal anxiety (R² = .80) and child anxiety (R² = .72). War-related stressors were significantly and positively associated with both maternal anxiety and child anxiety. In addition, maternal anxiety was significantly associated with child anxiety. Challenge appraisal, problem-focused coping, and cognitive restructuring mediated the relationship between war-related stressors and maternal anxiety. Emotion-focused coping positively mediated the relationship between war-related stressors and child anxiety. Religiosity and social support were found to buffer the association between war-related stressors and maternal anxiety, such that higher levels of religiosity and social support weakened the positive relationship between war-related stressors and anxiety among mothers.ConclusionsThis study extends the transactional model of stress and coping by supporting an integrated framework within a conflict-affected Middle Eastern population. The findings indicate distinct pathways linking war-related stressors to maternal and child anxiety and highlight the importance of interventions that address cognitive appraisal, strengthen adaptive coping strategies, and mobilize spiritual and social resources in conflict-affected families.
Kamishoyosan reduces anxiety-like behavior by modulating GABAA receptor subunit expression in a premenstrual syndrome rat model
IntroductionPremenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve psychological symptoms that impact women’s quality of life. PMS pathogenesis is characterized by fluctuations in steroid hormones and γ-aminobutyric acid type A receptor (GABAAR) subunits. Kamishoyosan (KSS) is a Kampo medicine typically used to treat menstrual-related symptoms. This study aimed to elucidate the anxiolytic effect of KSS and its underlying mechanisms in a progesterone withdrawal (PWD)-induced PMS rat model.MethodsKSS was administered via feed mixing, and elevated plus maze test and molecular biological analysis were conducted.ResultsPWD rats showed increased anxiety-like behavior and expression of GABAAR α4 and δ subunits mRNA in the hippocampal CA1 region, suggesting that decreased inhibitory GABA synaptic signaling contributes to anxiety-like behavior. KSS administration reduced anxiety-like behavior and the expression of GABAAR α4 and δ subunits, but no significant effect was observed on steroid hormone levels.DiscussionThese findings suggest that KSS exerts anxiolytic effects by reversing changes in α4 and δ subunit expression without affecting steroid hormone fluctuations. The different mechanism of action of KSS compared with GABAAR agonists may provide a novel therapeutic strategy for PMS.
Anxiety and depressive symptoms and health-related quality of life in girls with central precocious puberty versus isolated premature thelarche: a comparative cross-sectional study
IntroductionPrevious studies have examined psychological symptoms and health-related quality of life (HRQoL) in girls with central precocious puberty (CPP) and isolated premature thelarche (IPT), but findings from direct comparisons have been inconsistent. We aimed to compare anxiety and depressive symptoms and HRQoL between girls with CPP and IPT and to examine associations between psychological symptom burden and HRQoL.MethodsThis comparative cross-sectional study included 50 girls (mean age, 8.33 ± 0.23 years), including 18 with idiopathic CPP and 32 with IPT. Breast development had first been recognized before 8 years of age in all participants. Psychological questionnaires were administered on the same day as the endocrinological evaluation. Anxiety and depressive symptoms were assessed using SCARED, RCADS-CV, and CDI, and self-reported HRQoL was assessed using PedsQL 4.0. Between-group comparisons incorporated Benjamini–Hochberg false-discovery-rate correction. Spearman correlations and exploratory hierarchical linear regression were performed.ResultsNo between-group differences in anxiety, depressive symptoms, or HRQoL remained statistically significant after FDR correction. Clinically elevated SCARED scores occurred in 38.9% of girls with CPP and 53.1% with IPT (p=0.333), while CDI scores ≥19 occurred in 11.1% and 18.8%, respectively (p=0.694). In the combined sample, psychological symptom scores were inversely correlated with PedsQL total scores (Spearman’s rs=−0.568 to −0.720; all p<0.001). In exploratory regression adjusted for endocrine phenotype, BMI SDS, and symptom duration, SCARED (β=−0.382, p=0.003) and CDI (β=−0.481, p<0.001) scores were associated with lower PedsQL total scores.DiscussionHigher anxiety and depressive symptom scores were associated with lower HRQoL in this clinical sample. The absence of statistically significant CPP–IPT differences does not establish equivalence or exclude a contribution of endocrine factors. Larger longitudinal studies are needed to confirm these associations.
A Digital Tool for Culturally Responsive Reflection and Case Conceptualization in First-Line Services to Support Children With a Refugee Background: Development and Usability Study
Background: In 2023, over 117 million people were forcibly displaced worldwide, 40% of them children. Refugee children are at higher risk for posttraumatic stress disorder, depression, and anxiety, while professionals may struggle to address mental health and trauma-related concerns across unfamiliar cultural contexts. The Psychiatry Assisting the Culturally Diverse Community in Creating Healing Ties (PACCT) approach supports culturally responsive care for culturally diverse families, but first-line professionals often lack practical support to apply such an approach in routine care. Objective: The study aimed to (1) identify professionals’ support to inform the development of Implementing PACCT through a Culturally Contextualized Tool (IMPACCT), a digital decision-support tool; (2) map these needs onto the initial IMPACCT conceptualization; and (3) gather initial feedback from professionals to guide further refinement. Methods: We conducted a qualitative descriptive study in 3 phases. First, we analyzed 905 anonymized help desk questions submitted between May 2021 and November 2023 to Solentra, a Belgian center of expertise providing transcultural mental health support and consultation for refugees and other vulnerable migrant populations. Questions were coded using a predeveloped framework to identify recurrent professional needs. Second, we mapped all help desk question categories onto the different components of the first conceptualization of IMPACCT to ensure that its content reflected users’ questions and expectations. Third, 19 professionals working with refugee and migrant populations in Belgium were recruited through an open call between December 2024 and February 2025 using convenience sampling. After hands-on experience with a first iteration of IMPACCT, they provided feedback during semistructured interviews. These interviews were subsequently analyzed using deductive qualitative content analysis. Results: In the help desk questions, trauma-related concerns were the most common, followed by anxiety/stress and depressive symptoms. Acculturation was the most dominant culture-migration category. Most contexts were family- and school-oriented, and professionals were primarily asking for supervision or concrete next-step guidance. The interviews (N=19) found that the professionals thought that IMPACCT provided them with better-structured and early reflection, lessened some of the decision-making burden, and enabled a more structurally informed understanding of culture in the context of migration. Reported barriers included the time required and a lack of adaptation in workflow, with more experienced professionals reporting less perceived value. Additionally, participants suggested using IMPACCT as a training and/or supervision aid in first-line services and as standard decision support in ambulatory and inpatient care. Conclusions: The study offers first insights into the possible conceptualization of a digital decision-support tool for first-line professionals to help them support children with a refugee background. Further technical optimization of the tool, also taking into account first-user feedback, is, however, necessary before subsequently exploring its efficacy as well as effectiveness in strengthening first-line professionals’ competencies in working with the vulnerable population.
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