Tag: Mental health

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Virtual Care Expansion and Physician Follow-Up Among Youth With First Mental Health Contact Through a Hospital: Population-Based Repeated Cross-Sectional Study

<strong>Background:</strong> Timely follow-up is crucial for youth whose first mental health contact is through a hospital; virtual care could facilitate this. <strong>Objective:</strong> This study aimed to examine the association between the significant expansion of virtual care in Ontario, Canada, and follow-up mental health care rates for these youths. <strong>Methods:</strong> We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified first-contact emergency department (ED) visits or hospital admissions for self-harm, mood disorders, or psychosis from March 1, 2009, to February 29, 2024, among Ontario youth (aged 10-24 years). Virtual care was expanded in March 2020; we examined 2 expansion stages (temporary and permanent). Autoregressive integrated moving average analyses estimated level and slope changes (vs before virtual care) in age- and sex-standardized monthly rates of 7-day mental health follow-up. Subgroup analyses examined rurality and socioeconomic status. <strong>Results:</strong> We identified 42,208 first-contact ED visits and 17,701 first-contact hospital admissions. Pre–virtual care mean follow-up rates were 17.64 (SD 2.97) per 100 first-contact ED visits and 21.90 (SD 5.05) per 100 first-contact hospital admissions. Temporary expansion was associated with immediate increases in follow-up that declined (level changes: 4.81, 95% CI 2.82-6.81 for ED visits and 7.51, 95% CI 4.41-10.60 for hospital admissions; slope changes: −0.31, 95% CI −0.42 to −0.21 for ED visits and −0.32, 95% CI −0.48 to −0.15 for hospital admissions). Permanent expansion was associated only with an immediate decrease in ED visit follow-up (level change: −3.81, 95% CI −6.70 to −0.92) that was significant in rural (−1.06, 95% CI −1.93 to −0.184) but not urban (0.44, 95% CI −0.179 to 1.06) areas; results were otherwise similar between subgroups. <strong>Conclusions:</strong> Virtual care was not associated with sustained changes or equity improvements in mental health follow-up for high-acuity youth, representing a missed opportunity to extend physician reach and address barriers. Further research and quality improvement are needed. <strong>Trial Registration:</strong>
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Video and App-Based Games for Youth Emotion Regulation: Scoping Review

<strong>Background:</strong> Emotion regulation (ER) is a transdiagnostic construct encompassing distinct strategies that can be used to encourage adaptive coping skills in support of youth’s (ages 10 to 24 years) mental health. ER is responsive to training and intervention, such as via video and app-based games. Previous literature shows that video and app-based games impact the psychological well-being of youth and may be an accessible way to help youth learn about and implement emotional regulation strategies in their lives. <strong>Objective:</strong> Previous reviews have not focused on video and app-based games that support ER and how they may be beneficial to youth with and without a mental health diagnosis. This scoping review sought to collect, review, and understand the scope of research on the effects of video and app-based games on ER outcomes in youth, and areas in need of further investigation. <strong>Methods:</strong> We conducted a scoping search of MEDLINE, Embase, and APA PsycInfo from the beginning of the database up to and including December 2025. Studies were included if they were in English, included youth with a mean age between 10 and 24 years, and that evaluated an intervention or an intervention adjunct to help improve their ER skills using a video or app-based game. We extracted population characteristics (for the video game or app), the effectiveness of the intervention, and ER strategies addressed. <strong>Results:</strong> Following the screening of 14,456 studies, we identified 33 studies for inclusion in the final review. Four recurrent outcomes emerged: change in overall ER skills, mood modification, mental health symptom management, and emotion identification. <strong>Conclusions:</strong> While most studies reported improvements in these areas, some studies reported areas of continued difficulty. The results suggest that video and app-based games could serve as beneficial, easy-to-access tools to support youth ER through various strategies, with areas for future research to address mixed results and recommendations for addressing digital health improvement.
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Autistic traits in unaffected first-degree relatives of individuals with schizophrenia and bipolar disorder: implications for shared familial neurodevelopmental vulnerability

BackgroundAutistic traits have increasingly been linked to schizophrenia (SCH) and bipolar disorder (BD) within a shared neurodevelopmental framework. However, whether these traits are similarly expressed in unaffected first-degree relatives of individuals with SCH and BD remains poorly understood.MethodsThis cross-sectional study included 135 participants: first-degree relatives of individuals with schizophrenia (SCH-FDR, n=45), first-degree relatives of individuals with bipolar disorder (BD-FDR, n=45), and healthy controls (HCs, n=45). Autistic traits were assessed using the Autism Spectrum Quotient (AQ). Participants also underwent clinical psychiatric evaluation, including structured diagnostic assessment, to exclude psychiatric disorders and autism spectrum disorder.ResultsSignificant group differences were observed for AQ total score (p=0.002), Communication (p=0.004), and Imagination (p<0.001) subscales. Communication scores were significantly higher in SCH-FDR than in HCs (p=0.003). Imagination scores were higher in both BD-FDR (p=0.016) and SCH-FDR (p<0.001) groups compared with HCs. Total AQ scores were also higher in both relative groups than in HCs (BD-FDR: p=0.015; SCH-FDR: p=0.003). The proportion of participants with AQ scores ≥26 was higher in SCH-FDR (17.8%) and BD-FDR (13.3%) than in HCs (2.2%; p=0.045).ConclusionsAutistic traits were more pronounced in SCH-FDR and BD-FDR than in healthy controls. Differences were most evident in total AQ scores and the Imagination subscale across both relative groups, whereas communication difficulties were specifically elevated in schizophrenia relatives. These findings are consistent with the concept of shared familial neurodevelopmental vulnerability across schizophrenia and bipolar disorder.
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Investigating the DTI-ALPS index and its association with cognitive impairment in Alzheimer’s disease: a diffusion tensor imaging study

ObjectivesWith the global aging population, Alzheimer’s disease (AD) poses a major health challenge. The diffusion tensor image (DTI) analysis along the perivascular space (DTI-ALPS) index has emerged as a noninvasive imaging marker that indirectly reflects glymphatic function. However, its alterations in AD and their associations with cognitive impairment remain incompletely understood. This study primarily aimed to investigate changes in the bilateral ALPS index in patients with AD and to evaluate their associations with cognitive, functional, and emotional measures. Secondary analyses further explored white matter microstructural alterations and their relationships with the ALPS index.Materials and methodsIn total, 35 patients with AD and 21 cognitively normal healthy controls (HC) underwent 3.0T MRI and neuropsychological assessments. Tract-based spatial statistics (TBSS) analysis revealed areas of white matter damage and injured fibers in patients. Bilateral ALPS indices were compared between groups using analysis of covariance (ANCOVA) adjusted for age and gender. TBSS and ROI-based ANCOVA analyses of fractional anisotropy (FA) and mean kurtosis (MK) were performed as secondary analyses. Partial correlation analyses were used to examine associations between ALPS indices, white matter metrics, and neuropsychological scores.ResultsCompared with the HC group, the AD group showed significantly lower bilateral ALPS indices, and these differences remained significant after adjustment for age and gender (left: F = 14.404, P < 0.001; right: F = 28.513, P < 0.001). Bilateral ALPS indices were significantly correlated with cognitive and functional measures, including the Mini-Mental State Examination, Montreal Cognitive Assessment, and Activities of Daily Living (ADL), and were also significantly associated with emotional measures, including the Hamilton Anxiety Scale and Hamilton Depression Scale. Among these, the strongest associations were observed with ADL (left: r = 0.688; right: r = 0.701; both P_FDR < 1 × 10–7). Secondary analyses revealed widespread white matter microstructural alterations in AD. Region-of-interest-based analyses showed that the left hippocampal cingulum exhibited significant differences in both FA and MK, and these metrics were positively associated with the ALPS index as well as with cognitive and functional performance.ConclusionThe glymphatic system of AD patients has a reduced ability to clear waste. The ALPS index was closely associated with cognitive, functional, and emotional status, while white matter abnormalities, particularly in the left hippocampal cingulum, may represent a structural correlate of glymphatic dysfunction in AD.
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Multimodal network alterations in diagnosis-age-defined early- and late-onset Alzheimer’s disease

IntroductionEarly-onset Alzheimer’s disease (EOAD) and late-onset Alzheimer’s disease (LOAD) may differ in large-scale network organization. We compared multimodal MRI markers of diagnosis-age-defined Alzheimer’s phenotypes.MethodsAlzheimer’s Disease Neuroimaging Initiative participants were classified by age at first recorded mild cognitive impairment or Alzheimer’s disease diagnosis: <65 years for EOAD and ≥65 years for LOAD. Retrospective symptom-onset information was consistent with this grouping when available. We assessed resting-state functional measures, graph-theoretical nodal metrics, structural-functional coupling (SFC), structural decoupling, and DTI-derived measures. Primary models adjusted for age and sex; sensitivity analyses examined nonlinear age, covariate overlap, clinical severity, disease stage, atrophy, biomarkers, head motion, regional coverage, and control-group composition.ResultsThe functional cohort included 50 EOAD, 72 LOAD, and 113 healthy controls. Global mean SFC showed only a modest group effect. LOAD showed higher regional SFC than EOAD in four frontal regions after false discovery rate correction. Graph-theoretical effects were predominantly nominal: only the overall three-group effect in Vermis 9 nodal efficiency survived within-family correction, and no EOAD-versus-LOAD nodal contrast survived. DTI-derived regional measures and structural decoupling were less subtype-discriminative. All four frontal effects remained significant after mean Power framewise displacement adjustment and overlap weighting, with bootstrap confidence intervals excluding zero. However, corrected support narrowed to one region in the nonlinear-age model and disappeared in disease- stage-, APOE ε 4-, amyloid PET-, and centiloid-adjusted models; restriction to amyloid-negative controls also retained one region.ConclusionIn the primary model, diagnosis-age-defined LOAD showed higher frontal regional SFC than EOAD. The absence of corrected EOAD-versus-LOAD graph findings, variable sensitivity-analysis support, and lack of corrected SFC–clinical associations indicate a model-sensitive network phenotype rather than a definitive onset-age biomarker or clinically validated subtype marker.
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Pseudo-professional mechanism of collaborative mental health support in low-resource county-level contexts in China

China has made school-family-community collaboration a central policy direction for adolescent mental health, yet low-resource counties often lack the professional workforce, stable interorganizational arrangements, and non-stigmatizing pathways needed to reproduce an institutionalized service model. Existing research on task sharing shows that trained non-specialists can perform selected forms of basic psychological support, but it says less about how such tasks are incorporated into everyday school relationships and linked to professional referral. This community case study examines Suining County, Jiangsu Province, as an information-rich instrumental case. The core evidence consists of semi-structured interviews with 52 principals, school mental health teachers, homeroom teachers, subject teachers, parents, and students, together with non-participant observations conducted in 10 schools between September 2023 and June 2024. County policy documents, training records, and de-identified aggregate administrative screening data were used only to describe the case context. The analysis identifies a pseudo-professional mechanism organized through three related processes. Daily relational embeddedness enables risk signals to be noticed in classrooms, class management, and home-school communication. Bounded task sharing converts listening, basic reassurance, risk inquiry, and referral into limited front-end tasks that existing school actors can perform without assuming diagnostic or therapeutic authority. Tiered networking transfers responsibility from the class to the school and, when necessary, to medical services, while reconnecting students to everyday support after their return to school. This arrangement widens the reach of front-end support but remains constrained by teacher workload, parental refusal, discontinuities across school transitions, uneven supervision, and privacy risks. Pseudo-professionalization therefore does not mean replacing clinical professionals. It denotes a bounded reorganization of support functions whose safety depends on professional gatekeeping, sustained supervision, stable referral channels, informed participation, and disciplined information governance.
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Differentiating the potential of continuum beliefs to reduce the public stigma of schizophrenia, depression, and alcohol dependence: associations with illness recognition and treatment recommendations

PurposePromoting continuum beliefs has been discussed as a strategy for stigma reduction. The current study examines associations of continuum beliefs with stigma aspects (stereotypes, emotions, and social distance) and mental health literacy (illness recognition and treatment recommendations).MethodsIn 2011, a sample of the German population (N = 3,642) completed a vignette-based interview on attitudes regarding schizophrenia, depression, or alcohol dependence. Logistic regression analyses were performed and predicted probabilities were used to calculate prevalence estimates and depict direct effect sizes.ResultsIncreased continuum beliefs were strongly related to a decreased likelihood of social distance and endorsement of some negative stereotypes (e.g., being alien for schizophrenia) and an increased likelihood for endorsement of other negative stereotypes (e.g., lack of willpower for schizophrenia and depression) and emotions (e.g., anger for schizophrenia). Effect sizes indicated a greater reduction in negative stereotypes and desired social distance than increases in negative stereotypes or emotions. Furthermore, continuum beliefs were associated with a decreased probability of illness recognition for schizophrenia and recommending treatment for schizophrenia and depression, but an increased likelihood for illness recognition and recommending treatment for alcohol dependence.ConclusionPotentially harmful associations of continuum beliefs were found for schizophrenia and depression and should be considered by future studies and intervention designs. These potentially harmful associations are likely outweighed by helpful associations based on prevalence estimates and effect sizes. Associations between continuum beliefs and mental health literacy seem to be illness-dependent. Because of the sociocultural context and the time gap between the study and publication, representativeness for current public attitudes is limited.
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The association between obstructive sleep apnea and total cerebral small vessel disease burden—Neurovascular insights of OSA

ObjectiveThis study was conducted to assess the relationship between the severity of obstructive sleep apnea (OSA) and the total burden score of cerebral small vessel disease (CSVD), global cerebral blood flow (CBF), and cognitive function. Moreover, the internal pathway through which OSA induces cognitive impairment by affecting cerebral perfusion, and overall cerebral small vessel lesions was determined in this study.MethodsIn total, 94 patients who received polysomnography (PSG) at the Mental Health Center of Inner Mongolia Autonomous Region from October 2024 to February 2026 were included in this study. Based on the apnea-hypopnea index (AHI), all individuals were classified into the control and the mild group (AHI < 15 times/h, n = 26), the moderate OSA group (15 ≤ AHI < 30 times/h, n = 27), and the severe OSA group (AHI ≥ 30 times/h, n = 41). Demographic information was collected from all patients, and their cognitive performance was evaluated using the Mini-Mental State Examination (MMSE), Trail Making Test (TMT), Choice Reaction Time task (CRT), Digit Symbol Substitution Task (DSST), and the Trails test with a paradigm similar to Part B of the Trail Making Test. Each patient underwent 3.0T magnetic resonance imaging, including conventional sequences, susceptibility weighted imaging (SWI), and arterial spin labeling (ASL). Finally, the total CSVD burden score was assessed.ResultsThe total CSVD burden and perivascular space (PVS) score in the severe OSA group were significantly higher than those in the moderate group and the control group (P < 0.05). The total CSVD burden was significantly positively correlated with the mean global CBF (P < 0.05). After the BMI was adjusted, the severity of OSA remained independently associated with the mean global CBF (P < 0.05). Total CSVD burden, PVS, lacunes, and global CBF were significantly associated with cognitive function domains (P < 0.05), which indicated that CSVD and global CBF abnormalities may jointly participate in OSA-related cognitive function.ConclusionThe severity of OSA might be related to the CSVD burden score. Neuroimaging characteristics strongly related to cognitive function in patients suffering from OSA, and abnormal global CBF may serve as a non-invasive imaging marker for evaluating neurocognitive damage.
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Follow-up attendance and documented reasons for non-attendance in child and adolescent mental health care: a retrospective analysis

BackgroundFailure to continue scheduled follow-up is a common challenge in child and adolescent mental health services and may reduce treatment effectiveness.ObjectiveThe present retrospective study aimed to examine demographic, clinical, and treatment-related characteristics associated with attendance at the last scheduled follow-up appointment among children and adolescents receiving outpatient psychiatric care and to identify characteristics associated with the documented reasons for non-attendance among patients who missed their last scheduled follow-up appointment.MethodsA retrospective study was conducted using medical records of 841 patients aged 1–18 years who attended a tertiary child and adolescent psychiatry outpatient clinic between 2015 and 2026. Demographic, clinical, and treatment-related characteristics were summarized descriptively. Associations between categorical variables were examined using Pearson’s chi-square test, and effect sizes were reported using Cramér’s V.ResultsOf the 841 patients, 142 had no scheduled follow-up appointment and were excluded from the attendance analysis. Among the remaining 699 patients, 56.8% attended their last scheduled follow-up appointment. No significant associations were observed between attendance and the demographic, clinical, or treatment-related characteristics examined. Among the 302 non-attendees, unspecified reasons (36.8%) and scheduling conflicts (17.5%) were most frequent. Documented reasons for non-attendance were significantly associated with medication prescription status (χ² = 9.749, p = 0.008, Cramér’s V = 0.181) and drug class (χ² = 10.202, p = 0.037, Cramér’s V = 0.130).ConclusionsLast scheduled follow-up attendance was not significantly associated with the demographic, clinical, or treatment-related characteristics examined. Among non-attendees, documented reasons for non-attendance were associated with medication prescription status and drug class. Systematic documentation of non-attendance reasons may help identify barriers to continuity of care and inform targeted follow-up strategies.