IntroductionAdolescent mental health is a pressing global concern, and in collectivist societies such as China, family and school contexts are particularly influential. This study examined whether interpersonal self-support mediates the association between family cohesion and self-esteem among Chinese adolescents and whether school attachment moderates the first stage of that mediation pathway.MethodsA cross-sectional survey was conducted with 728 adolescents (mean age = 13.81 years, SD = 0.91, range 12–16; 44.0% male) from five public junior high schools in Hunan Province, China. Confirmatory factor analyses were conducted in Mplus 8.3, and the moderated mediation model was tested with Hayes’ PROCESS macro (Model 7) in SPSS 27 using observed variables and 5,000 bootstrap samples.ResultsFamily cohesion was positively associated with self-esteem and with interpersonal self-support, and interpersonal self-support partially mediated the family cohesion–self-esteem association. School attachment moderated the first stage of the mediation pathway, b = 0.076, 95% CI [0.024, 0.128], ΔR2 = .008: the positive association between family cohesion and interpersonal self-support was significant at all levels of school attachment and was stronger among adolescents reporting higher school attachment, and the conditional indirect effect increased from 0.107 at low to 0.153 at high school attachment.DiscussionThe indirect pathway was secondary to the direct association between family cohesion and self-esteem, and the moderation effect was modest. Because the design was cross-sectional and self-reported, these associations should not be interpreted causally. The findings suggest that schools may support the benefits of family cohesion for adolescent self-esteem by strengthening teacher-student relationships and cultivating a sense of belonging.
Correlation between hypothalamic-pituitary-adrenal function and clinical characteristics in the acute phase of first-episode drug-naive major depressive disorder
BackgroundFirst-episode drug-naïve depressive disorders have high heterogeneity in clinical features, and there is still room for in-depth exploration of the correlation with serum cortisol levels. This study aimed to explore the correlation between hypothalamic-pituitary-adrenal (HPA) function in the acute phase of first-episode drug-naïve major depressive disorder (MDD) and clinical features evaluated by the Hamilton Depression Rating Scale (HAMD-24) and the Zung Self-Rating Depression Scale (SDS).MethodsPatients with first-episode drug-naïve MDD in the acute phase meeting the DSM-V diagnostic criteria were selected as the study group, and healthy individuals matched for gender and age were recruited as the control group. Serum cortisol levels were measured in both groups, and patients in the MDD group were evaluated using HAMD-24 and SDS.ResultsThe serum cortisol level in the MDD group(307.03 ± 77.80 nmol/L) was significantly higher than that in the healthy control group(261.13 ± 58.15 nmol/L) (Z-Value = -3.539, P < 0.05). The serum cortisol level showed a positive correlation trend (ρ > 0) with the anxiety factor, cognitive impairment factor, retardation factor, despair factor, total HAMD score, and SDS score, with statistical significance (p < 0.05). It showed a negative correlation trend (ρ < 0) with the sleep factor, without statistical significance (p > 0.05). It also showed a positive correlation trend (ρ > 0) with the weight factor and diurnal variation factor, without statistical significance (p > 0.05).ConclusionA significant increase in serum cortisol level can serve as one of the biological indicators for predicting the core symptom clusters and disease severity of MDD. Regulation of The HPA axis cortisol pathway may have potential value in alleviating MDD symptoms.
TRIal of PPF3 vs. PlaCEbo in the TReatment of Children and AdolescenTs With NeurOdeveloPmental DisorderS
Conditions: Autism Disorder
Interventions: Drug: PPF3; Drug: Placebo
Sponsors: Holland Bloorview Kids Rehabilitation Hospital; Ontario Brain Institute (Funder); Purposeful
Recruiting
Interventions: Drug: PPF3; Drug: Placebo
Sponsors: Holland Bloorview Kids Rehabilitation Hospital; Ontario Brain Institute (Funder); Purposeful
Recruiting
Human-in-the-Loop Suicide Risk Detection and Clinical Escalation in a Generative AI Mental Health Chatbot: Prospective Implementation Study
<strong>Background:</strong> Mental illness is a leading cause of disability worldwide, affecting more than 1 billion people, and suicide accounts for 720,000-800,000 deaths annually. Although AI-native mental health chatbots have the potential to help address the substantial gap between treatment needs and workforce capacity, their rapid proliferation has outpaced the development of scalable procedures for identifying and responding to suicidal ideation. Although recommendations call for human oversight to support safety monitoring and intervention in AI-based care, research on human clinical oversight and crisis-response procedures remains limited. <strong>Objective:</strong> This study aims to implement a human-in-the-loop (HITL) protocol for suicide risk screening, detection, and clinical escalation in a generative AI (GenAI) mental health chatbot. <strong>Methods:</strong> In this implementation study of a HITL suicide risk detection and escalation protocol, adults were recruited online to participate in a single-arm trial of an AI-native mental health chatbot. Participants completed baseline screening using the 9-item Patient Health Questionnaire (PHQ-9). In phase 1, participants who endorsed suicidal ideation were referred to a human clinician for further assessment, safety planning, and provision of referral resources, as appropriate. In phase 2, escalation was triggered by either PHQ-9 responses or the detection of spontaneous, implicit, or explicit disclosures of suicidality during chatbot interactions. In both phases, the Ask Suicide-Screening Questions guided clinician-led assessment and risk stratification. Outcomes included the prevalence of suicidal ideation, the rate of successful clinician outreach, the time from risk detection to initiation of clinician outreach, and the results of risk stratification. <strong>Results:</strong> In phase 1, 624 participants completed suicide risk screening, of whom 81 (13%) endorsed PHQ-9 item 9 (score ≥1). Clinician outreach was initiated, on average, 11.2 minutes (SD 13.2 minutes; range 1-54 minutes) after the alert, and 25 of the 81 (31%) participants were successfully reached. In phase 2, 650 participants completed screening, of whom 133 (20.5%) screened positive at baseline. During the 30-day postbaseline observation period, 284 risk-alert events were generated among 172 (26.5%) participants, including 50 conversational suicidal ideation alerts. Clinicians successfully reached 73 of the 172 (42.4%) participants. The mean time from risk detection to initiation of clinician outreach was 11.5 minutes (SD 11.7 minutes; range 1-58 minutes). <strong>Conclusions:</strong> Proactive, universal suicide risk screening and conversational detection using a HITL protocol can be operationally implemented in a GenAI mental health chatbot. A subset of participants who were successfully reached by a human clinician described the approach as acceptable and helpful. Given that clinical contact and assessment were not completed for a substantial proportion of alerted participants, further research is needed to optimize assessment and follow-up strategies for individuals who cannot be reached and to characterize the impact of these procedures on clinical outcomes. Nevertheless, the safety procedures described herein provide a framework for developing and refining HITL safety responses and protocols for purpose-built, AI-native mental health chatbots.
Meta Mesh Ontology for Cross-Domain Mental Health Knowledge Integration: Development and Evaluation Study
Background: Psychiatric diagnostic practice faces persistent challenges in adequately capturing the complexity, heterogeneity, and dynamic nature of mental disorders. Conventional categorical classification systems such as the and the rely on rigid symptom-based criteria that often fail to represent multifactorial etiologies, dimensional symptom profiles, and high rates of comorbidity. Although dimensional models, domain-specific ontologies, and alternative taxonomies have been developed to address these limitations, they are typically applied in isolation, resulting in fragmented knowledge representations and limited interoperability. This lack of semantic integration hampers data harmonization and cross-domain analysis. Objective: The objective of this work is to develop and present the Meta Mesh Ontology (MMO) and its Core Domain Framework (CDF) as an integrative approach for mapping heterogeneous psychiatric knowledge bases and evaluating ontology structure, logical consistency, and specified retrieval and inference behavior. Methods: We designed a modular ontology architecture grounded in the Basic Formal Ontology to ensure structural and semantic consistency across biological, psychological, and social domains. Existing psychiatric frameworks and ontologies—including dimensional models, diagnostic taxonomies, and socioenvironmental knowledge systems—were systematically analyzed and represented through domain modules using a documented alignment and mapping procedure. The MMO was implemented using formal semantic web standards, including the Web Ontology Language and the Resource Description Framework (RDF), and aligned with established biomedical ontologies and informatics standards to support explicit mappings and modular extensions across domains. Evaluation used 2 MMO and CDF metric sets and 10 module metric sets to quantify ontology size, semantic alignments, external integration, and dataset readiness. We also assessed Web Ontology Language 2 Description Logic (OWL 2 DL) conformance, logical consistency, and 11 competency questions (including 1 entailment test) and 4 negative controls, in an outpatient scenario with 50 variables. Results: The MMO provides a shared semantic framework for representing links among heterogeneous psychiatric knowledge sources. Its modular design allows domain-specific subontologies to be incorporated under a common architecture. MMO and CDF comprised 2238 triples, 208 classes, 28 properties, 3 individuals, and 103 alignments (100 external) across 5 frameworks. The 10 modules added 967 triples and 171 alignments (116 external), with 21 integrations and complete label coverage (54/54 resources). The ontology resources conformed to OWL 2 DL; HermiT (Information Systems Group) detected no logical inconsistency, and all 11 competency questions and 4 negative controls produced the expected results. All 50 variables were linked to at least 1 CDF anchor, and 47 had an explicit Simple Knowledge Organization System (SKOS) mapping. Conclusions: The MMO provides a modular foundation for representing links among diverse psychiatric knowledge systems and data modalities. The current evaluation characterizes its structure, mappings, and behavior in the specified tests. Further research should assess mapping validity, governed clinical data, operational performance, and clinical utility.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/6c3b7fe74c2a96810832b43505c22eac" />
Attitudes toward treating functional neurological disorders: psychological service provider perspectives
IntroductionFunctional neurological disorders (FND) are characterized by involuntary sensory, motor, and/or other seemingly neurological symptoms lacking expected medical explanation. Once diagnosed, patients often are referred to mental health providers for psychotherapy, which is effective in treating many FND symptom presentations either alone or as part of an integrative approach. Mental health providers may feel reluctant or unprepared to accept these referrals, however.MethodsWe conducted a U.S.-based online survey of 286 practicing psychological service providers (psychologists, psychiatrists, counselors, social workers in private practice, neuropsychologists) to examine knowledge of, attitudes toward, and preparedness to treat FND.ResultsFindings revealed that most of our sample had limited exposure to FND in routine practice. Confidence in treating FND was modest, with neuropsychologists reporting more knowledge of and more confidence in treating FND than other psychologists/mental health providers. Greater perceived adequacy of psychotherapy training for, and more experience working with, FND each were associated with more positive FND attitudes, including greater confidence and enjoyment in treating FND and greater belief that symptoms would improve.DiscussionThis study is novel in its examination of knowledge and attitudes among psychological service providers, who are pivotal in furnishing effective treatment for FND patients but may not be well-versed in their needs. In contrast to existing studies of medical providers that revealed stigma as a major barrier to providing adequate care for FND, our findings suggest lack of knowledge and lack of access to FND patients may limit the ability to gain more training and expertise. Targeted training and consultation for mental health providers may improve confidence and motivation and expand the workforce capable of delivering effective treatment for FND.
Rosie en Español, a Chatbot-Delivered Intervention for Spanish-Speaking, US-Based Latina Mothers: Pilot Randomized Controlled Trial
Background: Latina pregnant women and mothers of infants in the United States experience elevated risk for perinatal anxiety, stress, and depression alongside persistent barriers to culturally and linguistically responsive care. AI-powered digital health tools offer a potentially scalable approach to address these gaps, yet evidence on their acceptability and effectiveness for this population remains limited. Objective: We aimed to evaluate the feasibility, acceptability, and preliminary outcome changes of Rosie, a Spanish-language AI-powered chatbot designed with and for Latina mothers, on maternal mental health and healthcareuse outcomes. Methods: We conducted a mixed methods pilot randomized controlled trial with 30 Spanish-speaking Latina participants who were pregnant or parenting an infant younger than 6 months. Participants were randomized 1:1 to the Rosie intervention or a comparison book club condition that provided monthly children’s board books. Surveys administered at baseline and 3-month follow-up assessed depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale), and health care use. Quantitative analyses examined within- and between-group changes, and qualitative feedback assessed acceptability and user experience. Results: Baseline mental health scores were low in both groups; however, several baseline demographic differences were observed between study arms, including age, pregnancy vs parenting status, marital status, education, and country of origin. Over 3 months, participants in the Rosie group demonstrated statistically significant within-group reductions in anxiety (mean baseline 3.27, SD 2.89; mean change −2.00, SD 2.94; =.02) and perceived stress (mean baseline 30.00, SD 5.53; mean change −12.20, SD 12.99; =.003). Depression scores declined modestly in both groups, with no significant between-group differences. No significant differences were observed in maternal emergency department use or adherence to well-baby visits. Engagement with Rosie was high, and qualitative feedback indicated that participants found the chatbot useful and supportive. Conclusions: This pilot study suggests that a culturally and linguistically tailored AI-powered chatbot is feasible and acceptable among Latina mothers during the perinatal period. Although anxiety and perceived stress decreased within the Rosie group, no significant between-group differences were observed. Within-group reductions in anxiety and perceived stress among Rosie participants are preliminary and should be interpreted cautiously because the trial was not powered to detect between-group effects and no statistically significant between-group differences were observed. Larger, adequately powered trials are needed to evaluate effectiveness.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/4dba3e120037a16d3d0fea2f0626d742" />
What Living With OCD Really Feels Like
By Adolfo Flores-Quilcate
I view having OCD like living inside a glass box while holding the keys to the door, looking out at the world. Everyone around you can come and go inside their own box. Most people have the choice to leave whenever they want. With OCD, it feels like you do not.
One of the main ways it works is rumination: rewinding an old cassette tape over and over with no clear end. I have spent too much time trapped in that box, playing the same tape. The scariest part is how many adults live this way without realizing it. OCD affects roughly 1 in 40 adults in the U.S., yet a lot of people have no idea they are behind that glass.
The most frustrating part is being judged by people who do not understand what it is actually like. They can see you rewinding the tape and call you crazy. The sad part is, so can I. I can see out of the box just fine. I can see the key. I can even put the key in the lock. But OCD holds me back from turning it. I can remember times when I could open the door. I can see my family looking at me from the other side, concerned.
In a sense, having OCD is like being in purgatory without committing any sins, just for existing. It is unfair, and I used to constantly ask, why me? It was unfair enough being the shortest male on my dad’s side. Why did I have to measure myself 45 times a day and keep over 300 lists on my phone of the height I wanted to be? It was unfair enough getting physical headaches and dizziness. Why did I have 150 panic attacks over it and stay in bed all day? It was bad enough when my ex-girlfriend broke up with me. Why did I loop the breakup 500 times a day for ten months? OCD does not care if you are sick or happy. It latches onto anything that catches your attention.
My diagnosis came as a massive surprise in April of this year. At first I told myself I was not sick. That denial eventually gave way to a bigger realization: the diagnosis was a blessing in disguise. My whole life I thought something was wrong with me, that I was defective. Then it clicked. That was not me. That was my OCD. All those days measuring myself and writing lists — that was my OCD. Checking my oxygen levels every 20 minutes during panic attacks over a headache — that was my OCD. Checking her social media and ruminating for hours on what could have been — that was my OCD.
My relationship with OCD is a lot like a long marriage between two people who do not really get along anymore. The arguments are endless and usually petty: ruminating all day on why I did not study harder, or believing that if I drink out of a certain cup my family will die. Most of the time I would rather just think about the cold beer after my shift or watching the game than keep listening to the nagging.
When I walked into therapy on February 22, 2026, the tape was still running on overdrive. Like a lot of people, I was stubborn about getting help. Four months in, three times a week, my therapist helped me see what I was doing to myself. I was like a guy standing under a coconut tree, shaking it until a coconut fell and hit me in the head, then complaining about the headache and going right back to shake the tree again.
I started treating intrusive thoughts like an unwanted knock on the door. Sometimes a knock is good: Aunt Peppy with a pie, a friend wanting to swim, the girl next door. Intrusive thoughts are more like the annoying neighbor complaining about noise, or kids ding-dong-ditching. We cannot control who knocks. We can control who we answer and who we let inside. Now when a thought shows up — “My ex has replaced me” — I label it for what it is: an intrusive thought, a fear of replacement. Then I move on. Leaning into the fear or accepting “maybe, maybe not” became useful tools.
Working on OCD is the hardest thing I have ever done. I have lost 65 pounds and gone to community college with 57-year-old accountants while my friends partied. ERP is no joke. I still remember some of the worst exposures: my therapist describing a detailed scenario of my ex getting a massage from another guy, or making me write my own obituary because I was terrified of getting a colonoscopy. Doing exposures sucks. It can ruin your weekend. But it sucks more to stay trapped in the glass box while the world passes you by.
I am only 19, and this is just the beginning. My goal is to start an OCD awareness club at my university and one day speak to people who feel like there is no hope. If you are struggling, take the first step: therapy, a support group, anything. It takes time and a lot of exposure, but healing is possible.
You are not alone. You are not your OCD. You are uniquely yourself, and you hold the key to that glass box. Do not let your OCD rule you. Rule your OCD.
Adolfo Flores-Quilcate is a 20-year-old college student at FIU who hopes to become an OCD advocate and create an OCD awareness and mental health club at FIU this upcoming semester. He was diagnosed early 2026 and is hopeful for the future of OCD awareness.
The post What Living With OCD Really Feels Like appeared first on International OCD Foundation.
ADHD-related mental health and school impairments across educational stages: sex-specific patterns in Japanese youth
IntroductionWhile ADHD-related challenges are well-documented internationally, understanding of how these manifest across educational stages and sexes remains limited. This study examined mental health symptoms and school functioning in Japanese children with and without ADHD across elementary, junior high, and senior high school.MethodsIn this comparative cross-sectional study, parents of 1,594 Japanese children (797 with ADHD, 797 without ADHD) aged 6–18 years completed questionnaires assessing ADHD symptoms (ADHD-RS-IV), depression (SMFQ), anxiety (SCAS), irritability (ARI), bullying victimization, academic achievement, and social support. Three-way ANOVAs examined interactions between ADHD status, child sex, and educational stage, with Cohen’s d effect sizes calculated for group comparisons.ResultsChildren with ADHD demonstrated significantly poorer outcomes across nearly all domains, except for teacher support, with effect sizes ranging from moderate to very large (d = 0.35–1.44). Contrary to expectations, the largest group difference for girls’ depression emerged in elementary school (d = 1.44) rather than junior high school, and girls’ anxiety differences were comparably large in elementary (d = 1.25) and junior high school (d = 1.30). Girls with ADHD showed consistently larger effect sizes than boys for depression (mean d: 1.14 vs. 0.84), anxiety (1.13 vs. 0.73), and irritability (1.32 vs. 0.90) across all stages. Significant ADHD × sex interactions emerged for depression, anxiety, and irritability. Bullying victimization affected 31.0% of children with ADHD compared to 7.5% of non-ADHD children, with peak effects in elementary school. Academic difficulties showed the anticipated pattern of increasing impairment from elementary to junior high school, particularly for boys (d = 0.65 to 1.07).DiscussionThese findings reveal pronounced sex differences in ADHD-related mental health burden, with girls experiencing what may be a “hidden burden” of greater internalizing symptoms across development. The smaller group differences for internalizing symptoms in adolescence may partly reflect decreased parental awareness of adolescent internalizing symptoms. These results underscore the need for sex-specific, developmentally-informed interventions with particular attention to early identification and support for girls with ADHD who may be overlooked in clinical and educational settings.
Outcome indicators used in recovery college effectiveness studies: a scoping review
IntroductionRecovery Colleges (RCs) are educational, recovery-oriented approaches in mental health. Differences in evaluation purposes and settings may lead to diverse outcome indicators, making it important to map their use and supporting measurement evidence. This scoping review aimed to identify the outcome indicators used in RC evaluations and clarify their measured constructs, patterns of use, and reporting of reliability and validity. Methods: The review followed JBI methodology and PRISMA-ScR reporting guidance. PubMed, Web of Science, CINAHL Ultimate, ERIC, and seven databases accessed through ProQuest were searched. English-language journal articles reporting quantitative RC evaluations, including quantitative components of mixed-methods studies, were eligible. Eligible data included questionnaire scores before and after RC participation and health service utilization indicators, such as hospital admissions and service contacts. Three reviewers independently screened titles and abstracts and assessed full texts. Data were extracted collaboratively by two reviewers and independently checked by a third. Measured constructs were classified using inductive content analysis. Results: Of 336 records identified, 149 remained after deduplication and 22 articles were included. Thirty-nine measure and indicator entries were identified across three domains: intra-personal and psychological changes, behavioral and social changes, and system and environment. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), including its short version (SWEMWBS), appeared in 11 articles (50.0%) and the Questionnaire about the Process of Recovery (QPR) in four (18.2%); 28 entries appeared in one article only. Fifteen articles (68.2%) cited previous psychometric information or identifiable validation literature, two (9.1%) explicitly reported within-study reliability estimates, and six (27.3%) reported neither specific psychometric evidence nor an identifiable validation citation. One article was not applicable to scale psychometrics. Conclusion: RC evaluations used diverse measures, while direct assessment of educational processes and outcomes was comparatively limited. This review mapped measurement choices rather than RC effects. The findings can inform co-produced decisions about outcome selection and study design, alongside further evaluation of existing instruments’ suitability for the intended RC populations. Involving learners and other stakeholders in these decisions can help align evaluation with research purposes and RCs’ educational philosophy while ensuring that participants’ individual goals are also assessed.