Brain disorders impose a major global health burden, yet current pharmacological and neuromodulation therapies are often constrained by invasiveness, limited spatial precision, poor access to deep brain structures, or insufficient long-term efficacy. Non-invasive ultrasound neuromodulation has emerged as a promising approach combining high spatial resolution, deep tissue penetration, and reversible modulation. Its biological effects arise from multiscale mechanotransduction involving membrane deformation, mechanosensitive ion channels, intracellular calcium signaling, glial regulation, and neurovascular coupling. Together, these processes modulate neuronal excitability, synaptic plasticity, network connectivity, neuroinflammation, and cerebral perfusion. Preclinical studies support its therapeutic potential across neurological and psychiatric disorders, while early clinical studies indicate short-term tolerability and preliminary target engagement in Alzheimer’s disease, Parkinson’s disease, and depression. Emerging approaches, including individualized treatment planning, closed-loop stimulation, and sonogenetics, may further improve the precision and cellular specificity of ultrasound neuromodulation. This review summarizes the physical principles and cellular mechanisms of ultrasound neuromodulation, evaluates its therapeutic and clinical applications, and discusses key challenges and future directions, including personalized stimulation, closed-loop systems, sonogenetics, and disease-modifying strategies.
Parental depressive symptoms and shared reading practices among preschool children in western China: cross-sectional study
BackgroundShared reading supports early child development, but parental depressive symptoms may reduce its frequency and quality. Most previous studies assumed linear relationships with small samples. This large cross-sectional study examined linear and non-linear associations between parental depressive symptoms and shared reading practices in Chinese preschoolers.MethodsWe recruited 21,366 parent-child dyads (children aged 3–6 years) from 189 kindergartens in western China. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Shared reading was assessed using the StimQ READ subscale. Multivariable linear regression, piecewise linear regression with threshold estimation, and natural spline analysis were performed, adjusting for sociodemographic covariates.ResultsHigher CES-D scores were linearly associated with lower total reading scores (adjusted β = –0.074 per point, 95% CI: –0.081 to –0.067). Piecewise regression identified a significant estimated breakpoint at CES-D score = 19.0 (95% CI: 11.9–26.1), below this threshold the slope was steeper (β = –0.085) than above (β = –0.051). Natural spline analysis confirmed non-linearity (P = 0.026) and located the point of maximum curvature at CES-D score = 10.9, indicating the most rapid change in slope occurred at subclinical symptom levels. The association was consistent across all subgroups (after Bonferroni correction).ConclusionsParental depressive symptoms are negatively associated with shared reading in a non-linear, breakpoint-dependent manner. Even subclinical symptoms (CES-D score≈ 11) are associated with steeper declines, while the association attenuates at higher levels (CES-D score ≈ 19). Interventions targeting parental mental health, especially at subclinical to moderate symptom levels, may help preserve high-quality home literacy environments.
A comparative study of traditional Chinese mind-body therapies on sleep quality, mental health, and quality of life in patients with sleep disorders: a network meta-analysis based on randomized controlled trials
BackgroundSleep disorders are a common clinical condition characterized primarily by difficulty falling asleep, trouble maintaining sleep, and impaired daytime functioning, with a high prevalence among adults. This condition can lead to a persistent decline in sleep quality, trigger mental health issues such as anxiety and depression, and ultimately reduce overall quality of life. Traditional Chinese mind-body exercise therapies are considered potentially effective non-pharmacological interventions due to their low risk, high accessibility, and dual mind-body regulation effects. However, the relative efficacy of different exercise therapies on sleep quality, mental health, and quality of life in patients with sleep disorders remains unclear. This study employed a web-based meta-analysis to systematically evaluate the effects of three interventions—Tai Chi, Baduanjin, and Tai Chi combined with transcranial magnetic stimulation—on three outcome measures and to rank their efficacy, aiming to provide evidence-based support for clinical decision-making.MethodsThis study conducted a systematic search of the PubMed, Embase, Web of Science, Cochrane, EBSCO, and CNKI databases and included 18 randomized controlled trials that met the inclusion criteria. Outcome measures included sleep quality, mental health, and quality of life. A network meta-analysis using a random-effects model was performed to calculate standardized mean differences and 95% confidence intervals, and the cumulative ranking probability curve area was used to rank the efficacy of the interventions.ResultThis study included a total of 18 randomized controlled trials. Regarding sleep quality, TCCWTMS yielded the best results (SMD = −1.15, 95% CI [−2.07, −0.22]). Regarding mental health, only the Tai Chi intervention achieved statistical significance (SMD = 0.64, 95% CI [0.07, 1.21], P = 0.03); although Baduanjin ranked first in the SUCRA ranking (92.6%), pairwise comparisons did not reach statistical significance (P = 0.07). Regarding quality of life, both Tai Chi (SMD = -0.47, 95% CI [-0.71, -0.24], P < 0.0001) and Baduanjin (SMD = -0.57, 95% CI [-0.91, -0.23], P = 0.001) were significantly effective. There were significant heterogeneous differences in the efficacy of the three interventions across different outcome measures.ConclusionThis study indicates that the TCCWTMS is the most effective intervention for improving sleep quality in patients with sleep disorders. Regarding quality of life, both Baduanjin and Tai Chi demonstrated significant effects, with Baduanjin showing superior efficacy. Regarding mental health, the current evidence is insufficient to determine the optimal intervention strategy. There are significant differences in the efficacy of the three interventions across various outcome measures; clinical decisions can be made by selecting the appropriate intervention based on the patient’s score needs.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261415202, identifier CRD420261415202.
Strategies to enhance engagement in CBT for adult ADHD: an innovation tournament with stakeholders
ObjectiveAdults with ADHD report challenges engaging in cognitive-behavioral therapy (CBT). This study investigates practices that might be applied to improve intervention fit and therapeutic engagement of CBT for adults with ADHD.MethodWe conducted an Innovation Tournament (IT) and member checking with participants (N=102) who were adults with ADHD and mental health practitioners who regularly treat adults with ADHD. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance as well as strategies with low feasibility and/or importance that might be candidates for de-implementation. Barriers to CBT engagement and practitioner implementation of practices were also evaluated qualitatively.ResultsA range of engagement barriers were identified, chief among them practitioner low understanding of ADHD (44.4%) and lack of attention to relevant impairments (33.3%). The highest rated focal areas for CBT were task management, organization, planning, and prioritization, emotion regulation strategies, responding to negative/maladaptive thoughts, anti-procrastination and self-motivation strategies, and long-term goal setting. Top recommendations for engagement strategies include ensuring high therapist knowledge of ADHD and 17 elements consistent with Motivational Interviewing. Some practices commonly found in CBTs for ADHD were rated as unpopular with stakeholders, most notably providing weekly ratings of ADHD symptoms as progress monitoring. Some practices rated as important to adults with ADHD were rated as not feasible to practitioners—most notably reducing shame and nurturing confidence. Implementation barriers identified were primarily related to low practitioner knowledge and skills, but also sometimes systemic constraints on practice.ConclusionsImplementation of recommended practices noted in this study should be tested empirically to understand the extent to which they increase engagement and effectiveness over standard practice.
School refusal behavior in children and adolescents: a concept analysis
School refusal behavior (SRB) is increasingly recognized across educational, pediatric, and mental health settings, yet its conceptual boundaries remain unclear, and the term is frequently conflated with school refusal, truancy, school withdrawal, school exclusion, and broader school attendance problems. This study used Walker and Avant’s concept analysis method to clarify the meaning, defining attributes, antecedents, consequences, and empirical referents of SRB. PubMed, Web of Science, Scopus, and PsycINFO were searched for English-language literature published through January 2026, supplemented by Google Scholar and manual citation searching. A total of 100 sources were included and analyzed through iterative comparison of conceptual definitions, recurrent characteristics, contextual conditions, outcomes, and indicators used in research and practice. The analysis showed that SRB has evolved from earlier anxiety-centered descriptions toward a broader behavioral and functional construct. Four defining attributes were identified: difficulty initiating, sustaining, or completing school attendance or participation; young person–expressed attendance difficulty; aversive school-related experiences or emotional distress; and heterogeneous avoidance- or reinforcement-related maintaining functions. Antecedents were distributed across individual, family, peer and interpersonal, and school-contextual domains, while consequences extended across academic, psychological, social, family, and service-related domains and may accumulate over time. Empirical identification requires the integration of observable attendance patterns, emotional, behavioral, and somatic responses, functional assessment, and contextual information from young people, caregivers, and school personnel. Moving beyond the summary of existing definitions, this analysis proposes an integrative framework that distinguishes the observable form of attendance difficulty from its emotional presentation, maintaining functions, and ecological context. SRB is therefore best understood as a persistent or recurrent, young person–expressed pattern of disrupted school attendance or participation that is clinically meaningful but cannot be reduced to a single diagnosis, cause, or attendance threshold. By clarifying what constitutes SRB and how it differs from other forms of school attendance problems, this framework may support earlier recognition of emerging attendance difficulties, more comprehensive assessment of underlying needs, and better coordination among mental health professionals, families, and schools.
Predicting multiple mental health outcomes in adolescents using explainable machine learning models
IntroductionAdolescent mental health problems, including depression, anxiety, and stress, are an increasing public health concern, yet the factors associated with different mental health outcomes may vary across domains. This study investigated shared and outcome-specific predictive features of depression, anxiety, perceived stress, and psychological well-being using explainable machine learning models.MethodsA cross-sectional study was conducted among 1,088 adolescents aged 13–18 years recruited from secondary schools in Wuhan, China, using multistage cluster sampling. Participants completed validated measures of emotional dysregulation, loneliness, social media addiction, self-esteem, sleep quality, academic stress, family support, physical activity, and mental health outcomes. Four algorithms—linear regression, support vector regression, Random Forest, and XGBoost—were trained using an 80/20 train-test split with five-fold cross-validation, and model performance was evaluated using test-set R², RMSE, and MAE. SHapley Additive exPlanations (SHAP) were used to examine feature contributions. To minimize target leakage, outcome-specific feature sets were used, with PSQI and RSES excluded from the depression model because of direct or substantial conceptual overlap with PHQ-9 content, and PSQI excluded from the well-being model because of overlap with WHO-5 content.ResultsXGBoost showed the strongest out-of-sample predictive performance across all four outcomes, explaining 49% of the variance in depression (R² = 0.49, 95% CI: 0.44–0.53; RMSE = 3.52; MAE = 2.81), 55% in anxiety (R² = 0.55, 95% CI: 0.50–0.59; RMSE = 3.04; MAE = 2.47), 60% in perceived stress (R² = 0.60, 95% CI: 0.56–0.64; RMSE = 3.71; MAE = 2.87), and 50% in psychological well-being (R² = 0.50, 95% CI: 0.45–0.54; RMSE = 3.38; MAE = 2.68).DiscussionEmotional dysregulation and loneliness were consistently among the most influential features, while academic stress, family support, social media addiction, self-esteem, and sleep quality showed outcome-specific contributions. SHAP rankings for the depression model were stable across five-fold cross-validation, with emotional dysregulation and loneliness consistently occupying the highest ranks.
Resting-state frontal theta/beta ratio and psychological symptoms in college students: an EEG study
BackgroundMental health problems are increasingly prevalent among college students and represent an important public health concern. Neurophysiological indicators derived from electroencephalography (EEG) may provide objective markers for identifying psychological vulnerability. The theta/beta ratio (TBR) has been widely associated with attentional regulation and cognitive control; however, its relationship with multidimensional psychological symptoms in non-clinical populations remains insufficiently understood.MethodsResting-state EEG was recorded from 222 undergraduate students aged 18–25 years during an eyes-closed condition. Psychological symptoms were assessed using the Symptom Checklist-90. Theta (4–7 Hz) and beta (14–30 Hz) power were extracted from frontal electrodes (F3 and F4), and the theta/beta ratio was calculated. Group comparisons and correlation analyses were conducted to examine associations between EEG measures and psychological symptom severity.ResultsStudents with higher levels of psychological symptoms showed significantly greater frontal theta and beta power compared with those reporting low-score levels. In addition, the theta/beta ratio was significantly higher in students with greater psychological symptom severity and was positively correlated with the total SCL-90 score as well as several symptom dimensions.ConclusionsThese findings suggest that resting-state frontal TBR is associated with psychological symptom severity in college students. The theta/beta ratio may serve as a potential neurophysiological candidate correlate of mental health vulnerability in non-clinical populations and provide a reference for objective auxiliary assessment of mental health in university populations.
How genes shape personality and experience
Nature Medicine, Published online: 18 September 2026; doi:10.1038/d41591-026-00046-y
A genome-wide association study involving over one million people reveals genetic contributions to personality traits, with potential causal effects on physical and mental health and behaviors.
Dual-task standing in older adults with mild cognitive impairment: postural control complexity, prefrontal activation, and cognitive task performance
BackgroundThis study aimed to quantify prefrontal cortex (PFC) activation and postural control complexity in older adults with mild cognitive impairment (MCI) during single-task standing and dual-task standing balance conditions and to investigate the associations between these measures.MethodsThis secondary analysis included 21 older adults with MCI (71.19 ± 3.36 years) and 19 cognitively intact controls (70.16 ± 4.54 years) from a previously reported cohort. Outcomes included cognitive performance, sample entropy of COP displacement (SampEn-COP), PFC activation across four bilateral functional regions, and exploratory correlations between PFC activation and SampEn-COP.ResultsA significant group effect was observed for SampEn-COPml, with lower values in the MCI group than in the control group (p = 0.002, η2p = 0.217, q = 0.007). SampEn-COPap was significantly higher under the dual-task condition than under the single-task condition (p = 0.005, η2p = 0.187, q = 0.016). Group × Task interactions were observed at the uncorrected level in the dorsolateral prefrontal cortex (DLPFC; p = 0.041, η2p = 0.106, q = 0.073) and orbitofrontal cortex (OFC; p = 0.039, η2p = 0.107, q = 0.073). The MCI group also showed lower cognitive accuracy and response rates than the control group across task conditions (both q < 0.01). An exploratory negative correlation between OFC activation and SampEn-COPap was observed in the MCI group under the single-task condition (r = −0.469, p = 0.032, q = 0.256).ConclusionOlder adults with MCI showed a less complex medial–lateral postural control pattern than cognitively intact older adults. During dual-task standing, changes in postural complexity were accompanied by preliminary evidence of task-related increases in DLPFC and OFC activation in the MCI group, suggesting greater prefrontal involvement in managing concurrent cognitive and postural demands.
PROMATER: protocol for a randomized controlled trial of a digital self-guided intervention to promote perinatal mental health and reduce self-criticism
BackgroundPerinatal mental health represents a significant public health concern given the high prevalence of mental disorders during pregnancy and the postpartum period and their impact on maternal well-being, mother-infant bonding, and child development. Emerging evidence identifies self-criticism as a transdiagnostic vulnerability factor associated with psychological distress in this period, while self-compassion has been recognized as an important protective factor. In Brazil, access to preventive perinatal mental health interventions remains limited. This paper describes the protocol of a randomized controlled trial (RCT) evaluating PROMATER – an online program designed to promote perinatal mental health by targeting self-criticism and self-compassion.MethodsA total of 130 pregnant women between 28 and 34 weeks of gestation will enroll in a two-arm RCT with a dismantling design. Participants will be randomized (1:1 ratio) to either the PROMATER intervention or to an active control group. Participants and data analysts will be blinded to group allocation. PROMATER consists of a 3-week program (6 modules) addressing maternal expectations, self-criticism, perinatal mental health, social support, self-compassion, and mindfulness and mother-infant bonding. The active control offers a structurally equivalent program covering the same topics, except for the modules specifically targeting these transdiagnostic processes. Primary outcomes are self-compassion, assessed via the compassionate self-responding (CSR) score of the Self-Compassion Scale, and self-criticism, operationalized through the uncompassionate self-responding (USR) score. Secondary outcomes include postpartum depression, anxiety, quality of life, social support, and mother-infant bonding. Assessments occur at baseline (T1), post-intervention (T2), and 3-month postpartum follow-up (T3). Data will be analyzed using Linear Mixed Models (LMM) following the Intention-to-Treat (ITT) principle.DiscussionEvaluating the effectiveness of a brief, accessible, online intervention has the potential to address the need for an evidence-based approach designed to promote maternal well-being during pregnancy and the postpartum period. The intervention is designed to maximize reach and minimize cost, with the potential to scale up and incorporate in routine perinatal care. The active control condition will allow examination of whether directly targeting self-criticism and self-compassion confers incremental benefit over structured perinatal psychoeducation alone.Systematic review registrationhttps://ensaiosclinicos.gov.br/, identifier RBR-99tjfz5.