BackgroundMental health professionals (MHPs) are susceptible to fatigue, particularly during public health crises like the COVID-19 pandemic. This study examined nonlinear relationships between fatigue, post-traumatic stress disorder (PTSD), and fear of COVID-19 (FOC) among MHPs.MethodsA multi-site survey was conducted from January to February 2023. Fatigue was assessed using the Fatigue Visual Analogue Scale (VAS), PTSD with the Post-Traumatic Stress Disorder Checklist for Civilians (PCL-C), and FOC with the Fear of COVID-19 Scale (FCV-19S). Data were analyzed using logistic regression and restricted cubic splines to explore non-linear associations.ResultsOf the 9,858 COVID-recovered MHPs, the prevalence of significant PTSD symptoms (PCL-17 ≥ 50) was 6.85% (95% CI: 6.35% – 7.35%), while significant fear of COVID-19 (FOC ≥ 16) was observed in 61.28% (95% CI: 60.32% – 62.24%). Higher fatigue levels were significantly associated with increased odds for exacerbated PTSD symptomatology (OR = 1.75, 95% CI: 1.65 – 1.86, p < 0.001) and FOC severity (OR = 1.19, 95% CI: 1.16 – 1.21, p < 0.001). Restricted cubic splines analysis revealed nonlinear relationships. Specifically, as fatigue rose towards an inflection point of 5.00, its association with PTSD symptoms strengthened, while its association with FOC showed a decelerating growth.ConclusionThis study underscored fatigue as a factor significantly associated with COVID-recovered MHPs, particularly regarding the presence of PTSD and FOC. However, due to the cross-sectional study design, the direction of causality between fatigue, PTSD, and FOC could not be determined. Regular monitoring and targeted interventions are crucial for managing fatigue during public health crises. Healthcare organizations should provide appropriate work-rest schedules and supportive policies during such periods.
How sports betting apps hook users
For most of the last 80 years, sports betting was limited to Las Vegas. But after a 2018 Supreme Court decision loosened regulations on professional sports wagers, it became possible to place bets on games 24/7 — with nothing more than a smartphone and a bank account.
In 2013, just five years prior to the landmark SCOTUS case, gambling was classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in a new category called “Substance-Related and Addictive Disorders.” This grouped gambling with alcohol use disorder and other addictions. Gambling is also known to have the highest suicide rate of any addiction.
Peer Mentor Training and Supervision for a Digital Adolescent Depression Treatment in South Africa and Uganda: Mixed Methods Evaluation
Background: Blended digital mental health interventions combining technology with human support are more effective than stand-alone treatments. However, limited research has examined how to train and supervise personnel delivering human support components. The Kuamsha app, a gamified digital intervention for adolescent depression based on behavioral activation, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was codeveloped through workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in low- and middle-income countries. Objective: This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters delivering a digital mental health intervention in South Africa and Uganda. Methods: We conducted a mixed methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (n=13, South Africa; n=4, Uganda), as well as training acceptability. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score. Linear mixed-effects regression models with a random intercept for provider and site estimated adjusted marginal means (95% CI). In-depth interviews and focus group discussions explored program acceptability and implementation factors. Results: The peer mentor training and supervision program was feasible and acceptable in both settings, with high recruitment (South Africa: n=13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89%‐92% in South Africa and 100% in Uganda), alongside qualitative reports of high satisfaction. All peer mentors met a minimum posttraining competency threshold (≥50%), with median competency scores of 70.7% (IQR 45.8%‐78.2%) in South Africa and 75.4% (IQR 73.8%‐77.3%) in Uganda. Independent ratings of recorded calls indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3%‐89.0%) and Uganda (87.7%, 95% CI 83.4%‐92.1%). Adherence was higher in Uganda than South Africa (adjusted mean difference [AMD] 13.30 percentage points, 95% CI 8.99‐17.61; <.001), as was competence (AMD 4.88 percentage points, 95% CI 1.23‐8.53; =.009). The AMD in overall fidelity (3.06 percentage points, 95% CI −0.98 to 7.10) was not statistically significant (=.14). The qualitative findings emphasized the value of ongoing supervision and capacity development, interactive training approaches, and blended delivery models. Conclusions: Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to sustain engagement, retention, and fidelity. In settings with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should examine how peer mentor fidelity influences user engagement and mental health outcomes. Trial Registration: Pan African Clinical Trials Registry PACTR202206574814636; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23792 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-065977
In Memoriam: Judith L. Rapoport, MD
Dr. Judith L. Rapoport has left an indelible mark on the field of obsessive compulsive disorder (OCD) — not only through her extraordinary scientific contributions, but through the compassion, curiosity, and humanity she brought to her work. For countless individuals and families, her legacy is not just measured in research breakthroughs, but in hope restored and lives changed.
At a time when OCD was widely misunderstood, often hidden, and rarely discussed, Dr. Rapoport helped bring it into the light. Through her pioneering work at the National Institute of Mental Health, she gave shape and voice to a condition that many struggled to name. She was among the first to recognize that OCD could affect children, and that these young people deserved understanding, accurate diagnosis, and effective care. This insight alone transformed the trajectory of the field and opened doors for earlier intervention and support for families who had long felt alone.
What set Dr. Rapoport apart was not only her intellect, but her deep commitment to the people behind the science. She approached each question with both rigor and empathy, helping to establish treatments that have since become the gold standard, including exposure and response prevention (ERP) and medication. Her work helped shift the narrative—away from blame or misunderstanding, and toward recognition of OCD as a real, treatable medical condition.
Beyond the lab and clinic, Dr. Rapoport had a rare gift for storytelling. Her book, The Boy Who Couldn’t Stop Washing, brought readers into the lived experience of OCD with clarity and care. For many, it was the first time they saw their own struggles reflected with such honesty and dignity. It helped families feel seen, understood, and less alone — an impact that continues to ripple outward today. The Boy Who Couldn’t Stop Washing impacted professionals as well, providing an eye-opening introduction and gateway to the world of working with OCD.
For these accomplishments and more, Dr. Rappaport received the IOCDF’s 2018 Career Achievement Award. Her influence extends through the many clinicians and researchers she has mentored, each carrying forward her dedication to both excellence and empathy. Through them, her work continues to grow, shaping the future of OCD research and care in ways that are both profound and deeply human.
To honor Dr. Judith Rapoport is to honor a career defined not only by discovery, but by kindness and purpose. She helped the world better understand OCD — but more importantly, she helped people living with OCD feel understood. And in doing so, she changed lives in ways that will endure for generations.
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Speech in noise prediction by use of cortical auditory evoked potentials in normal hearing and sensorineural hearing loss: a systematic review
IntroductionSpeech perception in noise (SPiN) is a critical challenge for individuals with sensorineural hearing loss (SNHL), and current behavioral assessments can be unreliable in populations with language barriers or cognitive impairment. Cortical auditory evoked potentials (CAEPs) can serve as a supplementary measurement as they often show strong correlations with SPiN outcomes across diverse hearing profiles.MethodsFollowing PRISMA and SWiM guidelines, this systematic review includes studies from PubMed, Web of Science, and Scopus databases that examined the relationship between non-task related CAEPs and SPiN outcomes in adults with normal hearing, SNHL, or cochlear implants.ResultsSixteen studies were included, encompassing 238 participants with SNHL and 204 participants with normal hearing. Across studies, N1 latency, P2 latency, and N1-P2 amplitude of the onset CAEP and acoustic change complex (ACC) are most consistently correlated with SPiN performance, particularly in sentence-based tests. The mismatch negativity (MMN) showed limited predictive value, as findings varied by age and hearing status. A meta-analysis was not conducted due to methodological heterogeneity.ConclusionOnset CAEP and ACC N1 and P2 latencies together with N1-P2 amplitudes particularly demonstrate potential as electrophysiological indicators of SPiN performance. Their clinical utility is promising for populations where behavioral testing can be unreliable, such as CI users or individuals with cognitive or language barriers. However, standardization of protocols and further longitudinal research are needed to validate their application in clinical settings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023404158, identifier PROSPERO (CRD42023404158).
The Mental Health Commission of Canada is pleased to welcome Shauna Cronin
The Mental Health Commission of Canada is pleased to welcome Shauna Cronin (she/her) as our new Vice President, Programs, effective April 27, 2026.
Shauna brings nearly two decades of national leadership in mental health system transformation, program design, and policy innovation. Her experience spans complex, multi‑partner initiatives across governments, communities, and lived and living experience networks, with notable contributions through organizations such as CAMH, Frayme, Stepped Care Solutions 2.0, and the Global Leadership Exchange.
A widely respected and internationally recognized leader, Shauna is known for turning bold vision into measurable impact. Her work has consistently advanced equity, strengthened service integration, and elevated Canada’s leadership in mental health, while meaningfully valuing First Nations, Inuit, and Métis voices as part of an ongoing reconciliation journey.
Shauna holds advanced degrees in political science, strategic communications, and international affairs, is currently pursuing a Master’s in Nonprofit and Philanthropic Leadership, and holds a Health Leadership designation from the Rotman School of Management. She brings a rare combination of deep policy insight, collaborative systems leadership, and a genuine commitment to people and outcomes.
We look forward to the perspective, care, and leadership Shauna will bring as she joins our exceptional Programs team and helps advance mental health and well-being across Canada.
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Prefrontal and hippocampal microstructural gray matter following cognitive training under moderate hypoxia in mood disorders: a randomized controlled trial
BackgroundCognitive impairment persists during partial or full remission in 50–70% of individuals with mood disorders and impacts daily functioning and clinical prognosis. Preclinical evidence suggests that extended exposure to moderate hypoxia, combined with motor-cognitive learning, may elevate neuroplasticity and improve cognition. In these individuals with remitted mood disorders, we found that cognitive training under repeated moderate normobaric hypoxia improved executive function, and here investigate neurobiological mechanisms.MethodsParticipants with major depressive disorder (MDD) or bipolar disorder (BD) in partial or full remission were randomized to 3 weeks of 3.5-h daily normobaric hypoxia (12% O2) combined with cognitive training five to 6 days per week or treatment-as-usual (TAU). Participants were assessed with cognitive tests and diffusion-weighted MRI at baseline and 1 month after treatment completion (week 8) as part of the ALTIBRAIN trial (ClinicalTrials.gov: NCT06121206). Prefrontal and hippocampal gray matter microstructure were modelled with Neurite Orientation Dispersion and Density Imaging (NODDI).ResultsFifty-seven participants (mean age 39 years, SD: 13, 70% female) with baseline MRI data were included. No significant effects of hypoxia-cognition training vs. TAU on neurite density index (NDI) or orientation dispersion index (ODI) were observed in either the prefrontal cortex or hippocampus (all p-FDR ≥ 0.832). No significant associations were observed between microstructural changes and changes in cognitive function in either region (all p-FDR ≥ 0.721). At baseline, microstructure in both regions was not associated with executive function or global cognition (all p > 0.40).ConclusionThe absence of detectable microstructural changes, despite selective improvements in executive function, indicates that NODDI-derived metrics did not capture structural correlates of the cognitive response to hypoxia-cognition training. Whether this reflects functional neural mechanisms, measurement insensitivity, or the timing of the single follow-up assessment remains to be determined. Future studies should incorporate multiple imaging time points to capture the dynamic trajectories of putative microstructural brain changes.
Telephone-Based Mental Health Promotion for Rural Women in Brazilian Agrarian Reform Communities: Pre-Post Pilot Study
Background: Women living in rural agrarian reform communities face intersecting challenges related to social, economic, racial, and gender vulnerabilities, which significantly increase their likelihood of developing physical and mental health problems. Despite the potential of telephone-based interventions to promote mental health, there is a lack of studies assessing their feasibility and effectiveness among underserved populations in Brazil. Objective: This study aimed to assess the feasibility and effectiveness of a telephone-based intervention on mental health outcomes among women living in a rural agrarian reform community in Brazil. Methods: We conducted a descriptive, prospective pilot study with a pretest and posttest design. Data were collected at 3 time points: baseline, 1 week, and 1 month after the intervention. The outcomes assessed included quality of life, social support, self-efficacy, and common mental disorder symptoms. Nonparametric tests were used to analyze the data. The intervention consisted of 3 phone calls supported by a workbook, with content based on cognitive behavioral and psychiatric nursing principles. Results: Of the 31 women enrolled, 23 (74.2%) completed all 3 phone-based sessions. There was a significant reduction in common mental disorder symptoms (Kendall =0.280; =.002), particularly in the somatic domain (=.02). Moreover, participants reported improved perceptions of the physical domain of quality of life (Kendall =0.131; =.049). All women rated the intervention positively, with more than half emphasizing its practical usefulness. Conclusions: The telephone-based intervention was feasible and showed promising results in improving mental health outcomes among women in a rural setting. These findings support integrating low-intensity, remote psychosocial strategies into primary health care, especially those led by nurses, to increase access to mental health promotion for vulnerable populations.
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Willingness of Patients With Mental Disorders to Engage in Online Psychotherapy: Multicenter Cross-Sectional Survey
<strong>Background:</strong> China faces a high prevalence of mental disorders but low treatment uptake, a gap driven by limited awareness and unevenly distributed mental health resources. While online psychotherapy has the potential to expand access, patient willingness remains insufficiently explored. <strong>Objective:</strong> This study aimed to investigate the willingness of Chinese patients with mental disorders to engage in online psychotherapy and to identify associated factors. <strong>Methods:</strong> A multicenter, cross-sectional survey was conducted using a structured questionnaire to assess the attitudes and willingness of patients with mental disorders in China to engage in online psychotherapy. Willingness to engage in online psychotherapy was assessed using a 0 to 100 rating scale, with higher scores indicating greater willingness. Univariate analysis, correlation analysis, and multivariate linear regression analyses were used to identify factors influencing willingness. <strong>Results:</strong> Among 361 eligible participants, the mean willingness score for online psychotherapy was 70 (SD 28.56). In total, 86.4% (n=312) of participants preferred short-term therapy (1 to 10 sessions), while 92.5% (n=334) expected the cost per session to remain less than CNY ¥400 (US $55.50). Participants most preferred therapist-guided online individual therapy (n=142, 39.3%). Convenience (124/361, 34.3%) and perceived anonymity (“no one will know about the illness”; 119/361, 33.0%) were the 2 most commonly reported perceived benefits of online psychotherapy. The leading barrier was concerns about data security and privacy (108/303, 35.6%), followed by difficulty in establishing therapeutic rapport (60/303, 19.8%). The regression analysis revealed that age, self-stigma, satisfaction with current psychiatric medications, and satisfaction with previous online psychotherapy significantly influenced patients’ willingness to seek online psychotherapy. <strong>Conclusions:</strong> This multicenter study reveals a high level of willingness to engage in online psychotherapy among Chinese patients, with self-stigma as a key barrier. These findings support the development of tailored services, stigma reduction interventions, and infrastructure investment to enhance mental health care delivery.
Strength of Evidence to Support Decision-Making on the Use of Digital Mental Health Technologies in NICE Evaluations: Cross-Sectional Analysis of Studies
Background: Digital mental health technologies (DMHTs) are playing an increasing role in mental health services. The quality of evidence for DMHTs is variable, and there are concerns that evidence is not sufficient to support decision-making. Objective: This study used a cross-sectional analysis of evidence supporting DMHTs included in National Institute for Health and Care Excellence (NICE) evaluations to examine the strength of evidence available for decision-making. Methods: We identified all NICE evaluations relating to DMHTs by reviewing details of published NICE evaluations on the NICE website. From each of these evaluations, we identified included DMHTs and reviewed committee documentation to identify studies that provided supporting evidence for each of these technologies. We extracted information on a series of items relating to study quality and summarized the characteristics of evidence both at the level of individual studies and across the package of evidence from multiple studies supporting DMHTs. We also identified key evidence gaps in available evidence. Results: We included nine NICE evaluations relating to anxiety, depression, psychosis, insomnia, attention deficit hyperactivity disorder (ADHD), and tic disorders. These evaluations included 30 DMHTs and referenced 78 supporting studies. We identified common evidence gaps relating to effectiveness compared to relevant comparators, use of appropriate outcomes, including health-related quality of life, cost of delivery, and impact on resource use, and reporting of adverse events. Conclusions: Our study highlights that some DMHTs have been supported by high-quality studies and that evidence to support DMHTs is likely to be developed across a series of studies. However, there are often key evidence gaps that need to be addressed to provide a stronger case for adoption. Developers should ensure that they consider these gaps while planning evidence generation, and where possible, address them earlier in the product lifecycle.
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