IntroductionSchool-based interventions can improve adolescent health outcomes and tackle the growing burden of non-communicable diseases (NCDs) in low-and-middle-income countries (LMICs). Results to date are variable, partly due to lack of cultural adaptation of Westernised models and limited focus on implementation processes. The aim of the ISOBAR project is to develop, implement, and test a school-based intervention to address the emergence of mental and physical (i.e., nutritional, physical inactivity) health problems in LMICs. The three-stage intervention comprises (1) assessment for mental and physical health problems, (2) universal health literacy, and (3) indicated counselling.Methods and analysisThe ISOBAR multi-site project comprises three phases: (1) pre-intervention (co-development and cultural adaptation of the intervention); (2) implementation of the intervention; and (3) post-intervention evaluation. The intervention will be delivered using a staggered roll-out design to introduce the intervention sequentially to three schools per site (nine in total) in Chennai, Gujarat (India), and Ibadan (Nigeria). Each school will receive the intervention by the end of the study period. Local teams will recruit 200 adolescents per school (Total n=1, 800). All adolescents (in intervention and control conditions) will be assessed for mental health/behavioural problems and nutritional/weight problems at baseline. Adolescents in the intervention school will receive the universal health literacy intervention (main cohort), and those adolescents reaching pre-determined thresholds on mental health and/or nutritional indices (sub-cohort) will be referred to school-based counselling support. A suite of assessments will be conducted throughout the study period including: (1) intervention effectiveness (e.g., impact on help-seeking, weight, and mental health and behavioural outcomes); (2) implementation processes (e.g., facilitators and barriers) and outcomes (e.g., acceptability, appropriateness, sustainability); and (3) cost-effectiveness.Ethics and disseminationThe study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (BSREC 36/23-24) and the institutional ethics committees of all participating sites. Research findings will be disseminated through peer reviewed scientific publications, public announcements in local communities, policy briefings, print and online media, and institutional and professional social media accounts and websites.
Coping styles and mental health outcomes in partners who have experienced a perinatal loss: a longitudinal study
Perinatal loss is common, but little is known about its impact on partners during the grieving process. This study examined psychological outcomes and coping strategies among recently bereaved partners (≤6 months post-loss; N = 73) at baseline (T1) and six-month follow-up (T2) via online survey. Participants were predominantly male (78%) and typically aged 25–44 (90%), and had experienced a range of perinatal losses (<20 weeks’ gestation to 28 days of life). Grief and depression symptoms were assessed using the Perinatal Grief Scale (PGS) and PHQ-9 respectively, and multivariate regression analyses examined the role of coping styles, demographic characteristics, and loss-related factors. Participants reported varying levels of grief and depression symptoms, with 38% displaying moderate-to-severe depression symptoms at follow-up. Across the cohort, participants reported using a range of coping strategies; however, avoidant coping was uniquely associated with higher grief and depression scores at baseline (PHQ-9: β = .30, p = .007; PGS: β = .49, p <.001). Avoidant coping also predicted poorer grief and depression outcomes at follow-up, although these relationships were no longer significant after controlling for baseline symptoms. Additionally, stillbirth, female gender, and younger age were associated with greater psychological distress at baseline across outcomes (β = .21–.32, p ≤.05). Associations between gender, stillbirth, and psychological outcomes remained at follow-up, although these did not reach conventional levels of statistical significance (β = .24–.40, p ≤.073). These findings highlight the psychological impact of perinatal loss on partners and underscore the importance of improving access to support for this group. Avoidant coping may represent a key target for intervention. Future research should further investigate factors influencing grief trajectories and identify effective forms of support for bereaved partners.
Occupational burnout and risk of suicidality in healthcare professionals: a PRISMA-guided systematic review
BackgroundBurnout, an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed, is increasingly recognized as a critical threat to the mental health of healthcare professionals. Prolonged exposure to work-related stressors may increase the risk of suicidality, including suicidal ideation, suicide attempts, and suicide deaths. This systematic review aimed to synthesize existing evidence on the association between burnout and suicidality in healthcare professionals and to identify vulnerable subgroups and intervention priorities.MethodsWe conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO registration: CRD420251037488). PubMed, Scopus, Web of Science, and PsycINFO were searched for studies published between January 2005 and December 2024. Eligible studies included healthcare professionals and, where methodologically relevant, closely related high-stress occupational populations used as comparator cohorts assessed with validated burnout instruments and reporting suicidality or closely related suicide-proximal psychological outcomes. Data were extracted independently by two reviewers, and risk of bias was evaluated using the Newcastle–Ottawa Scale. Where appropriate, findings were synthesized narratively and through meta-analysis.ResultsA total of 29 studies met the inclusion criteria and 10 studies were included in the meta-analysis. Strong associations were consistently observed between burnout and suicidality, with emotional exhaustion and depersonalization emerging as the most robust predictors. Reduced personal accomplishment demonstrated weaker or inverse associations. Nurses and physicians were identified as particularly vulnerable, with pandemic-era studies reporting higher effect sizes compared to pre-pandemic research. Overall methodological quality was moderate to high, and heterogeneity was partly explained by profession, region, and burnout instrument used.ConclusionsBurnout, particularly emotional exhaustion and depersonalization, is consistently associated with increased suicidality among healthcare professionals, with supporting evidence from related high-stress occupational populations. Vulnerable groups include women clinicians, younger professionals, and those engaged in rotating or night-shift work. These findings highlight the need for systematic burnout surveillance, confidential access to mental health support, and organizational reforms such as safe staffing ratios and workload regulation. Integrating suicide-prevention strategies into occupational health frameworks is urgently required to protect clinician wellbeing and sustain healthcare system resilience.
TeleABA for Hospitalized Adolescents and Young Adults With Autism Spectrum Disorder
Conditions: Autism Spectrum Disorder (ASD)
Interventions: Behavioral: Standard Hospital Care; Behavioral: Telehealth Applied Behavior Analysis (TeleABA)
Sponsors: Caring Technologies, Inc.; National Institute of Mental Health (NIMH); Hackensack Meridian Health; Center for Social Dynamics; Rutgers University
Not yet recruiting
Interventions: Behavioral: Standard Hospital Care; Behavioral: Telehealth Applied Behavior Analysis (TeleABA)
Sponsors: Caring Technologies, Inc.; National Institute of Mental Health (NIMH); Hackensack Meridian Health; Center for Social Dynamics; Rutgers University
Not yet recruiting
A Web-Based Self-Management Intervention for Return-to-Work Among Persons With Common Mental Disorders on Sick Leave: Case Study of mWorks
Background: mWorks is a co-designed, web-based self-management intervention developed to empower persons with common mental disorders who are on sick leave during the return-to-work process. However, limited knowledge of how mWorks is delivered and engaged with in real-world settings constrains further development and implementation. In line with the Medical Research Council framework for complex intervention evaluation, such an approach is required to examine (1) contextual factors influencing implementation, (2) fidelity and variation in delivery, and (3) how service users and professionals experience and respond to the intervention. Objective: This study aimed to evaluate the process of implementing mWorks, specifically focusing on assessing the intervention’s delivery in relation to the context, implementation process, and mechanisms of impact. Methods: This single-case study was bounded by the delivery period of 10 weeks in a primary and specialist mental health service context. During this period, return-to-work professionals (n=2) and service users (n=6) collaborated to initiate mWorks usage. Both qualitative and quantitative methods were used to triangulate multiple data sources. Results: The pandemic and mental health problems posed contextual barriers, particularly during recruitment. However, perceptions of mWorks as a credible and relevant intervention facilitated its implementation. The delivery was performed according to plan, with minimal adaptations. All users adhered to the intervention, and dialogue meetings were highly valued. mWorks was used flexibly according to users’ needs, both during sick leave and at work. The potential impacts included a transformative process for users, fostering acceptance, self-esteem, self-compassion, and a sense of control. It also had the potential to prevent mental ill health, transform negatives into positives, facilitate disclosure of mental health, and support goal setting. The use of quantitative measures for empowerment, engagement, self-efficacy, depression stigma, and quality of life proved feasible and supported the assumptions and direction of results. Conclusions: The recruitment stage of the implementation program encountered significant contextual barriers. However, once the delivery stage began, the implementation of mWorks proved to be feasible. Despite the limited scope of this study, with its small number of participants, the triangulation of data suggests that both users and professionals benefited from mWorks.
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AI Agents Are Coming: 5-Stage Taxonomy of Language-Based AI Systems for Psychiatry, Psychotherapy, and Counseling
The rapid evolution of large language models has accelerated the development of agentic artificial intelligence (AI) systems capable of pursuing autonomous goals, creating an urgent need for structural frameworks in psychiatry and psychotherapy. While existing classifications often draw parallels to autonomous driving, this paper argues that the mental health domain requires a distinct, domain-specific theoretical foundation, as the 2 domains differ fundamentally in their semantic, ideographic, and epistemological demands. Furthermore, they differ in their end goals, for which we introduce terms such as agentic guidance capability. To guide clinicians and researchers through these developments, we propose a 5-stage taxonomy for language-based AI systems that differentiates technical functionality from clinical effectiveness. The taxonomy progresses from level 1 (knowledge level), in which systems perform static benchmark tasks, to level 2 (elementary level), characterized by dynamic engagement in specific therapeutic microskills. At level 3 (integration level), systems achieve consistency across and within modules, as well as basic case-level conceptualization suitable for blended therapy under human oversight. Level 4 (saturation level) describes therapist-in-the-loop systems capable of autonomous functioning with minimal supervision, whereas level 5 (mastery level) represents AI systems that are technically capable of performing autonomous therapy. By distinguishing technical functionality from clinical effectiveness, we conclude that level 4 or level 5 performance does not automatically translate into full treatment effectiveness, even if high treatment fidelity can be achieved. We conclude by emphasizing the need to shift benchmarking from static knowledge tests to dynamic evaluations of therapeutic capabilities in order to safely navigate the transition toward autonomous care.
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Family caregivers’ involvement in home-based recovery for patients with schizophrenia: a qualitative study in Beijing, China
BackgroundFamily caregivers play critical roles in supporting the home-based recovery of patients with schizophrenia, but they often encounter substantial challenges and receive insufficient systemic support. Understanding caregivers’ involvement in home-based recovery is essential for aligning community mental health services with families’ capacities and needs. This study aimed to explore family caregivers’ involvement and adaptive processes in supporting home-based recovery of patients with schizophrenia in China.MethodsA qualitative study using interpretative phenomenological analysis was conducted through semi-structured interviews. Family caregivers were purposively recruited from four community health service centers (CHSCs) across urban and rural areas of Beijing. All interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed iteratively to identify themes and subthemes.ResultsA total of 20 family caregivers were recruited, including 11 from two urban districts and 9 from a rural district in Beijing. Five themes were identified: Caregivers’ redefinition of recovery as stability rather than cure; Routine recovery involvement in medication management and symptom monitoring; Experienced tensions between the patient’s independence and relapse prevention; Bearing family obligation and personal strain in sustained caregiving involvement; and Uncertainty in sustaining caregiving and the patients’ future stability. Caregivers reported persistent challenges in supporting patients’ independent living, participation in family activities, communication, and social interaction.ConclusionFamily caregivers gradually develop their capacity to support home-based recovery, but continue to encounter complex challenges while receiving limited support from CHSCs. Strengthening recovery-oriented family support within community mental health services, particularly through accessible psychoeducation and rehabilitation guidance, may enhance caregivers’ capacity to support patients’ independence and social participation, thereby promoting sustainable home-based care and long-term functional recovery.
Case Report: A novel de novo heterozygous truncating mutation in MED12L identified in a Chinese autistic boy
BackgroundAutism spectrum disorder (ASD) is a highly heterogeneous neurodevelopmental disorder. A previous study by Nizon et al. indicated that some children with intellectual disability (ID) carrying de novo MED12L mutations exhibited mild to moderate autistic features. However, the relationship between MED12L and ASD remains unclear.Case presentationHere we reported a male child with severe autistic features carrying a novel de novo heterozygous truncating mutation of MED12L (NM_053002.5:c.586C>T, p.(Arg196Ter)). He was diagnosed with ASD according to ICD-11 and DSM-5 criteria. Clinical examination indicated that this child exhibited severe autistic features and several dysmorphic features, including a flat nasal bridge, bulbous nasal tip, thin upper lip, and triangular face. Magnetic resonance imaging (MRI) of the brain revealed an enlarged perivascular space in the right temporal lobe.ConclusionThis case demonstrates that this de novo heterozygous truncating mutation in MED12L may be involved in the development of ASD, and haploinsufficiency of MED12L may be associated with severe autistic features. Obvious clinical manifestations and dysmorphic features in this child with a truncating mutation in MED12L expand the phenotypic spectrum of MED12L-related cases and warrant further functional studies to elucidate the relationship between MED12L and ASD.
STAT+: HHS presses ahead with effort to curb antidepressant use
WASHINGTON — Health secretary Robert F. Kennedy Jr. is pressing forward with his effort to help Americans stop taking psychiatric drugs, a medical practice known as deprescribing.
Earlier this month, dozens of mental health professionals met with federal health officials to map out forthcoming clinical guidance they hope will help providers instruct patients on how to come off of antidepressant medications. While the Department of Health and Human Services has discussed plans to hold such a meeting, the outlines of the discussion haven’t been reported.
During those talks, they reviewed guidance from European nations and worked on recommendations for nonmedication-based options for patients to address their mental health, such as therapy. A senior HHS official said they discussed gaps in the research around deprescribing SSRIs, including the side effects a person may experience, which vary depending on the drug and how long the person was on it, and how to recognize the difference between those side effects and a return of a patient’s depressive symptoms.
HALO-TRIAL: High, Medium And LOw Intensity Psychotherapy for Binge Eating Disorder
Conditions: Binge Eating Disorder; Binge Eating Episodes; Binge Eating/Loss of Control Eating; Binge Eating Disorders; Binge Eating; Binge Eating Behaviour; Binge Eating Disorder Associated With Obesity; Eating Disorder Binge; Eating Disorders
Interventions: Behavioral: Cognitive Behavioral Therapy Enhanced – Individual; Behavioral: Cognitive Behavioral Therapy Enhanced – Group; Behavioral: Cognitive Behavioral Therapy – Guided Self Help; Behavioral: Systemic Narrative Therapy – Group
Sponsors: Herlev and Gentofte Hospital; Jascha Fonden; BETA-HEALTH Foundation; Mental Health Centre Ballerup; Region Capital Denmark; University of Copenhagen
Recruiting
Interventions: Behavioral: Cognitive Behavioral Therapy Enhanced – Individual; Behavioral: Cognitive Behavioral Therapy Enhanced – Group; Behavioral: Cognitive Behavioral Therapy – Guided Self Help; Behavioral: Systemic Narrative Therapy – Group
Sponsors: Herlev and Gentofte Hospital; Jascha Fonden; BETA-HEALTH Foundation; Mental Health Centre Ballerup; Region Capital Denmark; University of Copenhagen
Recruiting