Tag: Mental health

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Association between plasma proBDNF levels and cognitive impairment in patients with alcohol dependence: a case–control and longitudinal study

BackgroundAlcohol dependence is frequently accompanied by cognitive impairment. Brain-derived neurotrophic factor (BDNF) signaling plays a critical role in synaptic plasticity, while the precursor form, proBDNF, has been increasingly implicated in neurodegenerative and psychiatric disorders. However, the association between plasma proBDNF levels and cognitive impairment in alcohol dependence remains unclear.MethodsEighty male patients with alcohol dependence and forty-two matched healthy controls were enrolled. Plasma proBDNF levels were measured via enzyme-linked immunosorbent assay (ELISA). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the Modified Wisconsin Card Sorting Test (M-WCST), and the Verbal Fluency Test (VFT). Forty-one patients were reassessed after four weeks of abstinence. Group comparisons and correlation analyses were performed.ResultsPatients with alcohol dependence exhibited significantly elevated plasma proBDNF levels and impaired cognitive performance compared with controls. Plasma proBDNF levels were positively correlated with alcohol consumption severity, and linked to global cognitive deficits alongside nuanced executive performance variations. After four weeks of abstinence, plasma proBDNF levels decreased and cognitive performance improved; however, changes in proBDNF were weakly associated with cognitive recovery.ConclusionsElevated plasma proBDNF levels are associated with alcohol dependence severity and cognitive impairment, suggesting that proBDNF may serve as a peripheral biomarker reflecting the dynamic neurocognitive status in alcohol dependence.
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The Intersectionality of OCD and the Shame Surrounding Sexuality 

By Mike Vatter

Obsessive-Compulsive Disorder (OCD) is often misunderstood as a condition involving excessive cleanliness, organization, or ritualistic behavior. In reality, OCD is a complex mental health disorder characterized by intrusive thoughts, unwanted images, fears, and compulsive behaviors intended to reduce anxiety. One of the least understood and most painful aspects of OCD occurs when intrusive thoughts intersect with sexuality, creating a profound sense of shame, confusion, and isolation. 

Sexuality is already a deeply personal aspect of human identity. Many people grow up receiving messages, whether from family, religion, culture, or society, that certain thoughts, desires, or identities are inappropriate or unacceptable. When OCD enters this landscape, it can weaponize these fears and vulnerabilities. Intrusive thoughts often target what a person values most or fears most. As a result, individuals with OCD may experience unwanted sexual thoughts that feel completely inconsistent with their values, identity, or desires.

Someone with OCD may become trapped in relentless questioning: “What if I am attracted to someone I shouldn’t be attracted to?” “What if these thoughts mean something about who I really am?” “What if I am secretly a bad person?” These questions are not driven by genuine desire but by overwhelming anxiety and uncertainty. Nevertheless, the individual often feels compelled to seek reassurance, analyze their reactions, or avoid situations that trigger distress. 

The shame surrounding sexuality intensifies this struggle. Society frequently treats sexual thoughts as reflections of character rather than recognizing that thoughts can occur without intent, desire, or meaning. For people with OCD, this misunderstanding can be devastating. Many become terrified that simply having an intrusive thought makes them immoral, dangerous, or fundamentally flawed. As a result, they often suffer in silence, afraid that disclosing their thoughts will lead to judgment or rejection. 

The intersection of OCD and sexuality can affect people of all sexual orientations and gender identities. Some individuals experience obsessions centered on questioning their sexual orientation, regardless of whether they identify as heterosexual, gay, bisexual, or otherwise. Others experience intrusive thoughts involving taboo or unwanted sexual scenarios. In each case, the distress comes not from the thoughts themselves but from the meaning the individual fears those thoughts represent. 

This experience is particularly challenging because shame thrives in secrecy. The more a person attempts to suppress, analyze, or eliminate intrusive thoughts, the stronger and more persistent those thoughts often become. OCD feeds on certainty-seeking, convincing individuals that if they can just think hard enough or find enough reassurance, they will finally feel safe. Unfortunately, the cycle rarely ends that way. 

Recovery begins when individuals learn to separate intrusive thoughts from identity and intention. Evidence-based treatments such as Exposure and Response Prevention (ERP) help people tolerate uncertainty and reduce compulsive responses. Through treatment, many discover that thoughts are not actions, urges are not intentions, and anxiety is not evidence. They learn that having an intrusive thought says far less about their character than the courage it takes to face that thought without engaging in compulsions. 

Understanding the intersectionality of OCD and sexual shame requires compassion, education, and nuance. It demands that we challenge cultural assumptions about thoughts and morality while recognizing the unique suffering OCD can create. When people understand that intrusive thoughts are a symptom of a disorder rather than a reflection of character, shame begins to lose its power. 

Ultimately, healing occurs not when every intrusive thought disappears, but when individuals no longer measure their worth by the thoughts that enter their minds. By replacing shame with understanding and fear with self-compassion, people living with OCD can reclaim both their mental health and their sense of identity.

The post The Intersectionality of OCD and the Shame Surrounding Sexuality  appeared first on International OCD Foundation.

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SleepPathfinder: A Socratic Questioning and Self-Decision–Based Chatbot to Support User Engagement in Digital CBT-I: Usability and Feasibility Study

Background: Chronic insomnia is a highly prevalent sleep disorder that adversely affects quality of life and mental health. Cognitive behavioral therapy for insomnia (CBT-I) is internationally recommended as the first-line treatment, and digital CBT-I (dCBT-I) has been developed to improve accessibility and scalability. While existing dCBT-I systems effectively support structured behavioral training through standardized protocols, they provide relatively limited support for users’ cognitive exploration and meaning-making processes, particularly in helping users reflect on and internalize the rationale behind CBT-I practices in daily life. These limitations may contribute to challenges in sustained engagement and long-term adherence. Objective: This study aimed to examine the usability and feasibility of SleepPathfinder, a conversational CBT-I support chatbot that integrates Socratic questioning and a self-decision mechanism to support users’ understanding of and engagement with CBT-I practices. Methods: SleepPathfinder was designed around a 4-stage conversational flow: education on CBT-I techniques, Socratic cognitive exploration, self-decision, and advice provision. We conducted (1) a single-session pilot usability study (n=45) to assess system stability and user experience and (2) a 5-day condition-based comparative experiment (n=30) consisting of daily sessions, comparing an exploratory dialogue condition with a directive, protocol-guided dialogue condition. Quantitative measures assessed usability, cognitive appraisals related to sleep problems, autonomy-related experiences, and behavioral readiness, while qualitative feedback and conversational log analyses were used to examine interaction patterns and engagement characteristics. Results: In the comparative experiment, the exploratory dialogue condition showed a tendency toward reduced perceived threat and severity appraisal of sleep problems compared with the directive condition, accompanied by moderate effect sizes in cognitive perception measures. Autonomy-related experiences, including perceived choice and engagement, demonstrated suggestive upward trends in the exploratory condition. Behavioral intention changes were comparable across conditions, while overall readiness for change increased across participants. Conversational log analyses indicated that greater depth and volume of user self-narrative were associated with larger shifts in cognitive appraisals, whereas the frequency of chatbot questions alone was not. The pilot usability study indicated generally positive evaluations of system usability and content credibility, while identifying areas for improvement in emotional responsiveness and conversational naturalness. Conclusions: These findings suggest that a Socratic questioning–based and self-decision–based conversational structure is usable and feasible as a supportive interaction layer within dCBT-I systems. Rather than altering the directive behavioral structure of CBT-I, such an approach may complement existing protocols by facilitating cognitive exploration and supporting user-perceived autonomy. This study provides design-oriented evidence to inform the refinement of dialogue-supported digital CBT-I systems aimed at enhancing user engagement with CBT-I practices.
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New national action plan targets gaps at the intersection of mental health and criminal justice.

FOR IMMEDIATE RELEASE

OTTAWA, ON – The Mental Health Commission of Canada (the Commission) today released “Finding New Pathways: An action plan for criminal justice and mental health in Canada”. The plan provides an evidence-based roadmap to address systemic gaps in care, coordination, and community supports, recognizing the impact of mental health on the criminal justice system.

Many are working to improve outcomes but needs remain high and progress is uneven. This action plan is a practical pan-Canadian reference point that seeks to contribute to the mental health and wellbeing of all individuals who interact with the criminal justice and forensic mental health systems, including those who work within them.

Developed through a rigorous five-year process, the action plan was shaped by input from national subject matter experts, research, and the lived and living experiences of justice-involved individuals and system workers. The action plan comes at a critical time, as individuals experiencing mental health challenges currently comprise roughly three-quarters of all federally incarcerated people in Canada.

“Meaningful and sustainable transformation is within reach for Canada,” said Lili-Anna Pereša, President and CEO of the Mental Health Commission of Canada. “While these transformative changes cannot be implemented overnight or by one group alone, this action plan serves as a starting point. It centralizes evidence-based approaches designed to break the cycle of recidivism and prioritize prevention, diversion, end-to-end supports and continuity of care.” The action plan stands on three strategic pillars:

  • Care, not criminalization: Ensuring all people in Canada have access to supports that help prevent involvement with the criminal justice system, and prioritizing diversion for those with mental illnesses.
  • Care during criminal justice involvement: Providing access to high-quality, trauma-informed, and culturally safe health and social supports for those within the system.
  • Care after criminal justice involvement: continuity of care and seamless integration into community-based mental health
    and substance use services upon release.

“Finding New Pathways” identifies 68 specific recommendations across individual, community, institutional, systemic, and societal levels. It pays particular attention to priority populations, including people from First Nations, Inuit, and Métis, and African, Caribbean, and Black, and other equity-deserving groups who are currently overrepresented in the justice system and face distinct mental health needs.

The action plan further highlights the critical importance of supporting the psychological health and safety of workers within the criminal justice and forensic mental health systems, noting that public safety personnel are significantly more likely to experience symptoms consistent with mental disorders than the general population.

Howard Sapers, current executive director of the Canadian Civil Liberties Association, former Correctional Investigator of Canada, and project advisor for the action plan, emphasized the necessity of these reforms: “ or too long, Canada’s criminal justice system has been asked to shoulder responsibilities it was never designed to carry. The over representation of people with mental health needs in police encounters, courts, and correctional facilities is a predictable consequence of systemic gaps in care, coordination, and community supports. The Mental Health Commission of Canada’s National Action Plan offers something we have been missing for years: a coherent, evidence-based roadmap that prioritizes health, human rights, and dignity.”.

Media Contact:

For English requests, please contact Josie Sabatino at jsabatino@summa.ca; 250-649-6856.

For French requests, please contact Carlene Variyan, cvariyan@summa.ca; 613-601-7456.

About the Mental Health Commission of Canada

The Commission is a national organization committed to recognizing and contributing to a new and equitable relationship with First Peoples, with its head office located on the unceded traditional territory of the Algonquin Anishinaabe Nation in Ottawa.

As an independent, not-for-profit with charitable status, the Commission collaborates with leading experts and organizations nationally and internationally, including with people with lived and living experience, to develop national guidelines, standards and strategies, promote innovation and best practices, reduce stigma, increase mental health literacy, develop and deliver training through our Opening Minds division and support all levels of government to improve mental health outcomes for everyone living in Canada.   

The post New national action plan targets gaps at the intersection of mental health and criminal justice. appeared first on Mental Health Commission of Canada.

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Detection of Self-Harm in Electronic Mental Health Records Using Privacy-Preserving Local Language Models: Methodological Study

Background: Self-harm is the strongest risk factor for suicide and an important outcome for mental health care. Although prevalent in clinical populations, it is often imprecisely captured in routinely collected clinical data, where it is often recorded and stored as unstructured free text. Contemporary language models, such as GPT (OpenAI) and Gemini (Google), can analyze free-text clinical notes, but such models may violate data governance of processing sensitive patient data. Objective: This study aimed to evaluate whether a privacy-preserving language model running entirely within an institution’s secure computing infrastructure (here, the UK National Health Service [NHS]) could accurately identify the presence and timing of self-harm using electronic health records from secondary mental health care. Methods: Clinical notes were drawn from Oxford Health NHS Foundation Trust using a multistage workflow: (1) a random sample of 1000 patients with a psychiatric diagnosis, defined according to the (; codes F00–F99); (2) candidate-note identification using a Gemma3-4b language model to flag notes containing self-harm content; and (3) from those candidates, 1352 randomly sampled notes were selected for expert annotation, resulting in gold-standard corpus enriched for self-harm content. Clinical notes were annotated for the presence of self-harm and its timing (≤90 days, >90 days, or unknown). A privacy-preserving locally served 27-billion-parameter Gemma 3 language model (“Gemma3-27b”) was used as the core model. Prompts were systematically developed and refined using a labeled development set to identify self-harm and generate a structured output per clinical record. Gemma3-27b performance was compared against a strong baseline multilabel text classification model based on robustly optimized BERT pretraining approach (RoBERTa), a transformer-based language model architecture. Model performance was evaluated using precision, recall, and the -score (harmonic mean of precision and recall), with 95% CIs estimated from 1000 bootstrap samples with replacement. Results: Gemma3-27b outperformed the RoBERTa classifier across all categories, achieving Precision=0.92, Recall=0.92 (sensitivity), and -score=0.92 for notes containing self-harm, and Precision=0.97, Recall=0.97 (specificity), and -score=0.97 for notes without self-harm. For the 51 notes labeled as recent self-harm in the held-out test set, Gemma3-27b achieved Precision=0.84, Recall=0.75, and -score=0.79. The global weighted -score of Gemma3-27b across all categories was 0.88, compared to 0.85 for RoBERTa. Conclusions: With systematic prompt development on a labeled development set, but no gradient-based fine-tuning, the current Gemma3-27b language model matched or exceeded a fine-tuned RoBERTa classifier for ascertaining self-harm events and their timing. Aggregate gains were modest, while improvements were largest in the most challenging, lower-frequency timing categories. On a simplified binary recent-versus-other task, RoBERTa performed marginally better, indicating that supervised classifiers remain highly effective when the task is simplified and sufficient labeled data exist. This work demonstrates the technical feasibility of privacy-preserving self-harm detection within a secure NHS research environment.
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Mental Health Fitness Through a Youth Perspective 

Insights on building and advancing mental health care solutions through collaboration — from the Global Youth Advisory Council at the SNF Global Center for Child and Adolescent Mental Health at the Child Mind Institute

Mai El Shoush, Partnerships Campaign Manager, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

Tatiana P. Claridad, MBA, Director of Board Affairs and Institutional Strategy, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

Mental health fitness is shaped by lived experience, context, and the systems of care that surround us. During Mental Health Awareness Month, we invited young leaders from the Global Youth Advisory Council (GYAC) at the Stavros Niarchos Foundation (SNF) Global Center at the Child Mind Institute — from Brazil, South Africa, and Greece — to share their unique perspectives.

Their reflections offer insight into how young people define, build, and experience mental fitness globally, highlighting the influence of their environments, communities and everyday realities. Their views are essential to shaping more relevant and effective support for young people everywhere.

From left to right: Delice Lumbu, Mariana Rodrigues Chaves, Spyros Chronis, Faidra Kamperidi, Kayla Coetzer, Denny Oliveira Curini, Jennifer Matibi

From daily habits to systemic change, here’s how young people are reimagining mental health care as mental health fitness:

“By cultivating a practice of self-awareness — through understanding myself and my internal needs better, I’m able to show up for myself in the ways that I need in those moments of struggle.”

Kayla Coetzer, 24, South Africa

“In this fast-paced world, it’s important to take a step back, disconnect from the digital world, and engage with friends…try helping others and don’t be afraid to ask for help if needed.”

Spyros Chronis, 20, Greece

“I honor my journey by normalizing help‑seeking and reminding myself that mental health is an ongoing process that requires care, patience, and the courage to choose growth, even in environments where it is not always encouraged.”

Jennifer Matibi, 24, South Africa

“For me, keeping my mental health fit is about understanding and embracing my talents and weaknesses, and dedicating time to spaces that value my uniqueness.”

Mariana Rodrigues Chaves, 18, Brazil

“I try to find ways to ground myself and do things that people my age typically do. Making mistakes is acceptable and often necessary for personal growth.”

Faidra Kamperidi, 19, Greece

“Young people can build mental health fitness in their everyday lives through self-care, doing things that energize and restore them, practicing self-compassion, and surrounding themselves with supportive people. It’s about creating small, consistent habits that allow you to show up for yourself, even on hard days.”

Delice Lumbu, 20, Director of Youth Engagement, SNF Global Center

These reflections raise a broader question — how can global collaboration strengthen mental health support for children and adolescents?

“Global collaboration in youth mental health means real change to me. When countries unite around one shared goal — safeguarding young people’s mental health — they’re investing in their own future.”

Denny Oliveira Curini, 17, Brazil

“Mental health challenges are deeply influenced by social, economic, and cultural conditions, and real growth happens when solutions are shaped within those contexts. Global collaboration creates opportunities to share lived experiences, exchange practical knowledge, and adapt tools that are both relevant and accessible. It allows us to learn from one another across borders while empowering communities with skills, resources, and frameworks that support mental growth. From my experience, collaboration is not about imposing solutions, but about co‑creating safe, healthy spaces that enable young people to build resilience, develop agency, and flourish even in environments where those opportunities are often limited.”

Jennifer Matibi, 24, South Africa

“To me, global collaboration in youth mental health represents a shift from pockets of innovation to a ‘culture of quality’ that doesn’t stop at a country’s border. It’s the recognition that while mental health struggles are a rising universal problem, the solutions are often trapped in local silos or limited by a country’s wealth. Therefore, global partnership is the bridge that allows solutions to be shaped, shared, adapted, and standardized to ensure that no one is left behind.”

Spyros Chronis, 20, Greece

“Global collaboration in youth mental health means bringing different regions’ perspectives [together] to debate and understand our similarities and differences, to then work on solutions that cross borders and change lives.”

Mariana Rodrigues Chaves, 18, Brazil

“Nowadays, young people tend to feel overwhelmed by the excessive pace of technological evolution. The constant stimuli and the pervasive flow of information put us in a position where we constantly compare ourselves to others, feeling that our efforts are never enough compared to what we see online. Together, let’s set a human example: Progress can be gradual, and it is perfectly okay to feel like you are falling behind.”

Faidra Kamperidi, 19, Greece

“Global collaboration in youth mental health means looking at shared challenges and pooling resources to tackle them together, while keeping cultural uniqueness at the forefront of country-specific solutions and care.”

Kayla Coetzer, 24, South Africa

While these insights from the GYAC members highlight the importance of collaboration, they also reflect a new paradigm of youth leadership.

What continues to inspire you as a young leader about the ideas and perspectives shared through the Global Youth Advisory Council, and what does it say about the future of mental health care?

“What continues to inspire me most is the diversity of perspectives across different countries, yet the shared commitment to improving youth mental health. There is something powerful about young people coming together across contexts, bridging gaps through a global lens while staying rooted in their lived experiences. It reminds me that the future of mental health care will be more inclusive, shaped by real voices, and focused on breaking stigma in ways that feel authentic and meaningful.”

Delice Lumbu, 20, Director of Youth Engagement, SNF Global Center

Contributors: Delice Lumbu, Director of Youth Engagement, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

The post Mental Health Fitness Through a Youth Perspective  appeared first on Child Mind Institute.

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Negative Online Experiences Are Common but Often Go Unreported Among Youth With Mental Health and Neurodevelopmental Concerns

New Child Mind Institute study finds more than one in four youth experienced a negative online experience in the past year, yet only one in five reported the incident through platform tools.

New York, NY — A new study from researchers at the Child Mind Institute finds that negative online experiences are common among children and adolescents with mental health and neurodevelopmental conditions, and that most incidents are not reported through platform reporting tools.

Published in JAACAP Open, the study examined negative online experiences among 1,009 youth ages 9 to 15 with a history of mental health or neurodevelopmental concerns, all of whom were current or previous participants in the Child Mind Institute’s Healthy Brain Network. More than one in four reported at least one negative online experience in the past year. Among those who had such an experience, nearly 69% reported multiple incidents, yet only 20% reported the incident through platform reporting tools.

The study defined “negative online experience” as any unwanted or uncomfortable experience while online, including cyberbullying, cyberstalking, doxxing, impersonation, sexual harassment, and related forms of digital harm. The research used a mixed-methods design, combining a quantitative survey with an in-depth qualitative follow-up involving a three-day moderated online bulletin board with a subset of participants.

“These findings point to a large and often hidden problem,” said Michael P. Milham, MD, PhD, Chief Science Officer at the Child Mind Institute and senior author of the study. “Many young people are encountering harmful or uncomfortable experiences online, but the systems designed to help them often do not receive a report. That creates a major gap for parents, educators, clinicians, and platforms trying to keep children safer online.”

The research team identified three major categories of barriers that prevent youth from reporting negative online experiences: reporting process barriers, such as not knowing how to make a report; reporting policy barriers, including uncertainty about what qualifies for reporting or how platform rules apply; and emotional barriers, such as embarrassment, fear, and worry about consequences.

The study also found that reporting decisions were often shaped by how young people interpreted the incident itself. In the qualitative follow-up, youth considered whether the harmful behavior seemed intentional, how malicious it appeared, and how severe or repeated the harassment was. When those cues were ambiguous, youth were less certain about whether reporting was appropriate.

“Reporting is not simply a matter of telling young people to speak up,” said Mirelle Kass, lead author of the study. “Youth are making complicated judgments about intent, severity, platform rules, and the possible consequences of disclosure. If we want young people to report harmful experiences, the tools and systems around them need to be clearer, safer, and easier to use.”

The findings suggest that online safety efforts should be tailored to the needs of youth who may already be managing mental health, developmental, or social challenges. Social aptitude, mental health symptoms, and parenting style were associated with youths’ likelihood of encountering negative online experiences and with the barriers they faced when deciding whether to report them.

Participants also expressed a clear desire for better tools and guidance. Most youth wanted platforms to provide more information about how to protect themselves online, how to use safety features such as blocking and reporting, and how to access support during and after the reporting process.

“Families, educators, clinicians, policymakers, and technology developers all have a role to play,” said Dr. Milham. “We need reporting systems that children can understand, policies that are transparent, and trusted adults who can respond without blame or overreaction. Safer digital spaces will require more than awareness. They will require systems designed around how young people actually experience online harm.”

The study underscores the importance of developmentally appropriate safety tools, clearer platform policies, and stronger support systems for youth navigating digital spaces. For children and adolescents with mental health and neurodevelopmental conditions, improving reporting pathways may be an important step toward reducing hidden online harms and building safer online environments.

This research was supported by funding from Google LLC’s User Safety team to the Child Mind Institute for work led by Michael P. Milham, MD, PhD.

About the Healthy Brain Network

The Healthy Brain Network is a community-centered research initiative from the Child Mind Institute that collects clinical, cognitive, behavioral, and neurobiological data from children and adolescents in the New York City area. Families who participate receive feedback and diagnostic consultation while contributing to open science research aimed at improving understanding of child and adolescent mental health.

About the Child Mind Institute

The Child Mind Institute is an independent nonprofit organization dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Through cutting-edge research, evidence-based clinical care, and public education, the Child Mind Institute builds open science platforms and digital tools to accelerate discovery and improve youth mental health worldwide.

For press questions, contact cmiscience@ssmandl.com or mediaoffice@childmind.org.

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