Background: Digital mental health tools (DMHTs) offer scalable support, but engagement varies. Understanding the shapes of initiation and ongoing use is essential for effective design and implementation. Objective: This study aims to synthesize determinants of adults’ initiation and engagement with DMHTs, organized through two lenses: (1) psychological factors aligned with the theory of planned behavior (TPB) and (2) design and access features. Methods: A systematic search of 9 databases (June 2025) identified qualitative and mixed methods primary studies reporting end-users’ experiences with DMHTs. Studies were screened and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal used quality assessment with diverse studies (QuADS). Data were synthesized using a framework-guided thematic approach, mapping findings to TPB constructs and complementary design and access domains. Results: A total of 22 studies met inclusion criteria. Findings clustered into 2 interdependent domains. TPB constructs explained how beliefs, social expectations, and perceived control shaped decisions to start and persist with DMHTs. Design and access features frequently acted through these same pathways, especially by altering perceived behavioral control (PBC), with cost, connectivity, device constraints, and time flexibility affecting feasibility, with content design and privacy shaping perceived value and trust. Perceived fit (goals, cultural or linguistic relevance, and routine alignment) consistently influenced both initiation and continuation. Several features operated bidirectionally; depending on context, the same feature could facilitate or hinder engagement. Conclusions: Engagement with DMHTs is jointly determined by users’ beliefs and the design and access conditions within which tools are offered. Implementation should pursue a dual strategy, strengthening willingness to seek support (addressing attitudes, norms, and perceived control) while engineering low-effort, trustworthy, and context-appropriate experiences. Priorities include equity-focused policies (data costs, devices, and connectivity), transparent data practices, co-design with diverse communities, and consistent, theory-informed outcome measures.
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Reducing Intrusive Trauma Memories Using a Brief Mental Imagery Competing Task Intervention: Case Series of Trauma-Exposed Women in Iceland
Background: There is a need for scalable and simple interventions for trauma-exposed people. In this case series, we built on our previous case study and case series findings and further explored the use and potential effectiveness of a brief novel intervention to reduce the number of past intrusive memories of trauma. The imagery competing task intervention consists of a memory reminder and the visuospatial task Tetris played with mental rotation, targeting 1 intrusive memory at a time. Here, we test remote delivery of the intervention, including guidance from researchers without specialist mental health training, in a sample of women in Iceland with current intrusive memories from trauma. Objective: In a case series of trauma-exposed women, we aimed to explore whether this brief novel intervention reduces the number of established intrusive memories (primary outcome) and improves general functioning and symptom reduction in posttraumatic stress, depression, and anxiety (secondary outcomes). The acceptability of the intervention along with adaptations, that is, delivery by psychology students without specialist mental health training and digital delivery, was explored. Methods: Participants (N=8) monitored the number of intrusive memories from an index trauma (occurring 3‐16 years previously) in a daily diary at baseline, during the intervention, and postintervention at 1-month and 3-month follow-ups. The intervention was delivered digitally with guidance from clinical psychologists or psychology students. A repeated AB design was used (“A”: preintervention baseline, “B”: intervention phase). Intrusions were targeted one by one, creating repetitions of an AB design (ie, length of baseline “A” and intervention “B” varied for each memory). Results: The number of intrusive memories reduced for all participants from the baseline phase compared with the intervention phase, although the reduction was minimal for 2 participants (6.3%‐93%). The number of intrusive memories continued to reduce for 6 out of 8 participants (58%‐100% reduction at 1-month follow-up; 72%‐100% reduction at 3-month follow-up). Symptoms of posttraumatic stress, depression, and anxiety were reduced for most participants postintervention and continued to decrease during the follow-up periods. Functioning was improved for 7 of the 8 participants from baseline to postintervention and continued to improve at the follow-up assessments for 3 participants. The intervention delivered digitally and partly by students was perceived to be an acceptable way to reduce the frequency of intrusive memories by all participants (mean rating 9.5 out of 10). Conclusions: Data from this case series of traumatized women provide preliminary evidence for the effectiveness of this novel brief intervention in reducing intrusive memories of trauma occurring several years ago and in improving functioning and reducing core symptom burden. This study will inform a randomized controlled trial of this novel intervention, which may have considerable implications for large-scale clinical management of traumatized populations. Trial Registration: ClinicalTrials.gov NCT04209283; https://clinicaltrials.gov/study/NCT04209283 International Registered Report Identifier (IRRID): RR2-10.2196/29873
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Large Language Models and Their Applications in Mental Health: Scoping Review
Background: Large language models (LLMs) are poised to transform mental health care, offering advanced capabilities in diagnosis, prognosis, and decision support. Since their inception, numerous mental health-focused LLMs have emerged in the scientific literature, reflecting the growing interest in leveraging these models across various clinical applications. With a broad range of models available, diverse optimization strategies, and multiple use cases, reviewing the current landscape is critical to understanding where future impact lies. Objective: This study aimed to conduct a scoping review investigating the use of LLMs in mental health across diagnostic, prognostic, and decision support tasks. Methods: We screened 3121 papers from PubMed, Scopus, and Web of Science for studies published between January 2023 and October 2025, using terms related to LLM and mental health. After removing duplicates, 2 reviewers (MCL and WWBG) independently screened the studies, with a third (JJK) to resolve conflicting opinions. We extracted and synthesized information on the models, use cases, datasets, and adaptation methods from selected papers. Results: In total, 41 papers were selected. Many studies included evaluations on OpenAI’s GPT series applications: GPT-4 (24 studies, 58.5%) and GPT-3.5 (16 studies, 39%). Others included Bidirectional Encoder Representations from Transformers-derived models (9 studies, 22%), LLaMA (8 studies, 19.5%), and RoBERTa-derived models (6 studies, 14.6%). While all studies initially applied out-of-the-box LLMs, several adapted them through few-shot learning or fine-tuning to better align with specific research goals. The most common use case was in diagnostics (31 studies, 75.6%), while the most common target condition was depression (11 studies, 26.8%). While many studies reported superior performance of LLMs, only a minority of studies (13 studies, 31.7%) validated LLM performance against clinician assessments using real patient data, with the majority relying on proxy outcomes such as clinical vignettes, examination questions, or social media posts. Conclusions: Despite rapid growth and diversity of LLM applications in mental health, the field remains nascent and exploratory. Future developments must emphasize consistent model adaptation procedures to ensure safety and clinical workflow alignment. Models must also be evaluated on robust evaluation criteria by using standardized protocols and real clinical outcome measures.
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Exosome-based therapy for epilepsy: a systematic review and meta-analysis of preclinical studies
ObjectiveThis study aims to quantitatively assess the efficacy of exosome therapy for epilepsy through a systematic review and meta-analysis of preclinical animal experiments. We seek to clarify its overall effects on seizure reduction, cognitive function preservation, and neuroinflammation suppression.MethodsA systematic search was conducted across four English-language and four Chinese databases to include epilepsy animal studies. Continuous outcomes were synthesized using standardized mean differences (SMD) and 95% confidence intervals (CI), with fixed or random effects models selected based on heterogeneity.ResultsA total of eight preclinical studies were included. The overall meta-analysis revealed that exosome treatment significantly reduced the duration of seizures (SMD = −2.30, 95% CI −4.24 to −0.36), decreased the frequency of spontaneous recurrent seizures (SMD = −1.38, 95% CI −2.17 to −0.58), and prolonged the seizure latency (SMD = 1.49, 95% CI 0.08–2.90). In terms of cognitive function, exosomes significantly shortened the escape latency in the Morris water maze (SMD = −1.38, 95% CI −2.17 to −0.58), increased the percentage of time spent in the target quadrant (SMD = 3.69, 95% CI 0.30–7.08), and enhanced the number of platform crossings (SMD = 1.41, 95% CI 0.60–2.21), with no significant changes in swimming speed. Neuropathological analysis indicated that exosome treatment significantly increased the number of hippocampal neurons (SMD = 4.48, 95% CI 1.46–7.49) and markedly reduced levels of glial fibrillary acidic protein (GFAP) (SMD = −3.61, 95% CI −7.08 to −0.14), ionized calcium-binding adaptor molecule 1 (IBA-1) (SMD = −10.27, 95% CI −20.29 to −0.25), tumor necrosis factor-alpha (TNF-α) (SMD = −2.95, 95% CI −4.21 to −1.69), and interleukin-1 beta (IL-1β) (SMD = −7.39, 95% CI −14.64 to −0.13). Although some outcomes exhibited heterogeneity and publication bias, the corrected primary effects remained statistically significant. The source of exosomes, administration route, and dosage may be critical variables influencing their efficacy.ConclusionExosome therapy improves seizure phenotypes and protects cognitive function in epilepsy models by suppressing neuroinflammation to promote neuronal survival, providing evidence for further mechanistic and clinical translation studies.
Protracted encephalopathy and subacute combined degeneration associated with chronic nitrous oxide use: a case report
Nitrous oxide is a dissociative hallucinogen that is increasingly used recreationally, in part due to its widespread availability. Its use is known to cause subacute combined degeneration via inactivation of vitamin B12; it may also result in acute delirium and chronic progressive encephalopathy. Though current practice guidelines call for treatment of neurological sequelae of nitrous oxide use with vitamin B12 supplementation, a paucity of long-term outcome data limits our ability to guide extended courses of treatment. In this report, we discuss a case of protracted encephalopathy associated with nitrous oxide use. We track the response to vitamin B12 supplementation in the hospital setting using the Mini-Mental Status Exam to assess the severity and improvement of cognitive impairment. We also review the patient’s comorbid medical and psychiatric conditions, which complicate diagnosis and treatment planning in this patient population.
Built to Hook: Holding Platforms Accountable for Mental Wellbeing | Lunch & Learn
The conversation about social media and mental health keeps circling back to the same question: Should we ban children from these platforms? It is an important question. But it is not the only one, and it shouldn’t be.
The post Built to Hook: Holding Platforms Accountable for Mental Wellbeing | Lunch & Learn appeared first on Mental Health Europe.
[Comment] Applying a quality lens to strengthening WHO European region child and youth mental health services
Child and youth mental health is a growing area of concern across the WHO European region. However, evidence on how to strengthen the quality of child and youth mental health care is lacking,1 and governance mechanisms, such as quality standards, treatment guidelines, and protocols for child and youth mental health, exist in only a few countries across this region.
[Comment] Perinatal psychiatry: thinking in threes—before, during, and after pregnancy
Perinatal psychiatry is a recent specialty. Only a few countries offer specific training and specialised care, even though it is considered a major public health issue worldwide.1 Perinatal psychiatry remains ill-defined and has often been reduced to women’s mental health during pregnancy and postpartum. However, the World Psychiatric Association recognises that perinatal mental health is both a maternal (if not parental) and an infant mental health issue.2 Peripartum depression is considered the most common health risk for parents and their offspring.
[Editorial] Maternal depression: improving estimates and care
The first Wednesday of May marks World Maternal Mental Health Day, now celebrating a decade of advocacy to prioritise maternal mental health. Maternal depression is a prevalent illness that increases the risk of maternal morbidity and mortality, and contributes to adverse outcomes for offspring and family. Despite its substantial burden, maternal depression remains underdetected and undertreated.
[Comment] From policy to practice: implementing China’s measures to strengthen student mental health
In October 2025, China’s Ministry of Education issued ten national measures to strengthen mental health work in primary and secondary schools.1 These measures target major school-linked stressors such as academic pressure, physical activity, sleep, and internet use, and they call for whole-staff responsibility and cross-department collaboration. The policy signals a shift from episodic crisis response towards a public mental health agenda spanning prevention, early identification, supportive school environments, and referral pathways.