Background: Young adults in the United States experience high rates of suicidal thoughts and behaviors (STB) but low engagement with traditional care, highlighting the need for accessible and scalable digital interventions. Self-guided digital safety planning interventions (SPIs) can expand access to support but introduce important decisions about what content to deliver, when systems should intervene, and how users retain control over system actions. Personalization, defined as system-initiated adaptation, and customization, defined as user-initiated control, may offer complementary approaches to these decisions. However, how they should be coordinated to preserve autonomy and reduce burden during periods of distress remains unclear. Objective: This study aims to identify key decision points in self-guided digital SPIs and characterize what, when, how, and by whom (system or user) safety planning functions should be controlled. We further examined how personalization and customization can jointly support autonomy, reduce burden, and promote safety. Methods: Nine young adults (ages 18‐24) with lived experience of suicidal thoughts and behaviors were recruited from an asynchronous remote community comprising individuals who had engaged with the Mental Health America (MHA) website. Participants completed semistructured individual interviews via Zoom. Three coders analyzed interview transcripts using codebook thematic analysis. One coder open-coded all transcripts to develop a preliminary codebook. Two additional coders then applied the codebook to overlapping transcripts, after which all coders revised the codebook and resolved discrepancies by consensus before coding the remaining transcripts. Themes were interpreted using the 5W1H (Who, What, Where, When, Why, and How) framework as an organizing lens for identifying and structuring decision points. Results: Participants identified 3 classes of decision points for self-guided digital SPIs: (1) system-level decisions about what content and actions are automatically provided; (2) user-level decisions about when and at what pace safety planning unfolds; and (3) shared decisions requiring coordination between users and the system. Participants favored system personalization of decision aids, coping suggestions, brainstorming prompts, example messages for contacting trusted others, affirmations, and relevant resources. In contrast, participants wanted control over the timing and pacing of safety planning and the representation and organization of their safety plans. Participants also emphasized that systems should obtain explicit permission before taking safety-relevant actions, such as contacting trusted others or connecting users with crisis counselors in response to increases in detected risk. Conclusions: Personalization and customization can function as complementary mechanisms for allocating decision authority within self-guided digital SPIs. The findings support a model of permissioned automation in which systems reduce cognitive and emotional burden through adaptive support while users retain control over safety-relevant actions. This decision-point framework provides a foundation for designing and evaluating self-guided suicide prevention technologies that balance adaptation, autonomy, and safety.
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STAT+: FDA adcomm members’ ties to industry under scrutiny
Good morning. Yesterday, we got the devastating news that STAT’s infectious disease correspondent, Helen Branswell, passed away. She was a reporter I always looked up to and was also an incredibly generous colleague. Please take the time to read this tribute to her.
The need-to-know this morning
- Liquidia and United Therapeutics reached a settlement agreement that resolves their ongoing patent litigation over Liquidia’s treatment for pulmonary arterial hypertension.
New trial to test effect of GLP-1s on social outcomes
Researchers in Pittsburgh are launching a novel type of GLP-1 trial — testing not only if the drug will help people with addiction, but also if it will help reduce recidivism while improving other employment, health, and housing outcomes.
The Center for Addiction Science, Policy and Research (CASPR), a non-profit organizing the effort, and the Allegheny County Department of Human Services are planning to launch the trial in early 2027. They will enroll up to 1,200 adults with alcohol use disorder, opioid use disorder, or both, who are also at high risk of criminal-justice involvement. Half will be randomly assigned to take Novo Nordisk’s Wegovy, according to a press release issued yesterday.
Translation, contextual adaptation, and preliminary evaluation of INCRESE-Norwegian Young
BackgroundThe mental health of young people is a global concern. Norway has seen a rise in mental health challenges among young individuals in recent decades, including both Sámi and non-Sámi youth. Culturally responsive and accessible mental health interventions are needed. The NEON Young Norway Study investigates the use of mental health recovery narratives as a low threshold intervention. To engage in recovery narratives mostly have beneficial impact, however, there is also a risk of triggering harmful behavior, which is why safe use of narratives requires careful analysis. For this reason, the Inventory of the Characteristics of REcovery StoriEs (INCRESE) has been developed in English. Our aim was to translate, contextually adapt, and to preliminary evaluate INCRESE for use among young people in Norway.MethodsINCRESE was translated into Norwegian using the UPSIDES proportionate translation methodology. Contextual adaptation was carried out in collaboration with cultural experts and young individuals with lived experience. For reliability assessment, five coders independently coded 32 narratives (whereof 6 Sámi) twice, with a two-week interval between assessments. Test-retest reliability was assessed with Cohen’s kappa and interrater reliability with Gwet’s AC1, with scores above 0.40 considered acceptable. Feasibility and acceptability were assessed qualitatively.ResultsMultiple adaptations were required to ensure contextual fit for both general Norwegian and Sámi youth. Test–retest reliability (Cohen’s K) was moderate, with a mean κ = 0.59 (SD = 0.27; range –0.02 to 1.00). Mean percentage agreement between the two rating rounds was 90.7% (SD = 10.03). Interrater reliability (Gwet’s AC1) ranged from 0.36 (fair) to 1.00 (perfect) per item, mean AC1 0.86 (SD = 0.14), and with a mean percentual agreement of 72.8% (SD = 26.64). Reliability varied considerably between items. Coders generally found INCRESE-NY feasible and acceptable and provided suggestions for further refinement.ConclusionsINCRESE-NY showed overall acceptable reliability for characterizing recovery narratives produced by young Norwegians, including Sámi youth. The adapted inventory appears promising as a tool that can support the safe and systematic use of recovery narratives in youth mental health contexts. However, further refinement is needed to examine its conceptual, cultural and practical applicability.
Emotional regulation ability and depressive symptoms among Chinese junior high school students: a cross-sectional analysis of the role of stress coping styles
BackgroundWhile emotional regulation and coping styles influence adolescent depression, the mediating role of coping styles in the link between emotional regulation ability and depressive symptoms remains underexplored among junior high school students-a critical developmental stage marked by immature coping patterns.ObjectivesThis study explores the correlations among emotional regulation ability, stress coping styles (problem-focused and emotion-focused coping), and depressive symptoms among junior high school students and examines the mediating effect of stress coping styles on the relationship between emotional regulation ability and depressive symptoms.MethodsA total of 600 junior high school students were recruited between September and December 2024 through a multi-school convenience sampling approach involving five junior high schools across three cities in Henan Province. A self-designed general information questionnaire, the Patient Health Questionnaire Depression Scale (PHQ-9), the Adolescent Coping Style Scale and the Emotional Regulation Ability Questionnaire were used in the investigation. Pearson correlation analysis was used to examine the associations among problem-focused coping, emotion-focused coping, emotional regulation ability, and depressive symptoms, and a cross-sectional indirect association analysis was conducted to examine whether the two coping styles statistically accounted for indirect associations between emotional regulation ability and depressive symptoms.ResultsAmong the 471 valid responses received, emotional regulation ability was significantly negatively associated with depressive symptoms (r = -0.523, P < 0.001). In the parallel mediation analysis, emotional regulation ability was significantly associated with problem-focused coping (B = -0.0733, P = 0.023) and was directly and negatively associated with depressive symptoms (B = -0.1283, P < 0.001), but was not significantly associated with emotion-focused coping (B = -0.0465, P = 0.067). The total indirect effect was not significant (effect = -0.0002, 95% CI: -0.0038-0.0033]), thus indicating that neither coping style significantly mediated this association.ConclusionThis study demonstrated that emotional regulation ability is significantly and negatively associated with depressive symptoms among junior high school students. However, neither problem-focused coping nor emotion-focused coping significantly mediate the relationship between emotional regulation ability and depressive symptoms. These findings indicate that greater emotional regulation ability is associated with fewer depressive symptoms in early adolescence, whereas stress coping styles may not function as stable mediators at this developmental stage. These results support prioritizing the evaluation of developmentally appropriate emotional regulation programs for junior high school students in school and community settings.
Feasibility of Online and On-Site Physical Activity Delivery Among Older Adults: Mixed Methods Pilot Randomized Controlled Trial
<strong>Background:</strong> Physical activity (PA) is central to healthy aging, yet interventions targeting older adults often report substantial attrition and variable adherence. Although digital and internet-based exercise programs broaden accessibility and flexibility, their ability to sustain engagement compared with traditional on-site formats remains unclear. Understanding how delivery mode influences attrition and adherence—and why participants persist or withdraw—is essential for designing inclusive and sustainable PA interventions. <strong>Objective:</strong> This pilot study evaluates the feasibility of delivering a 26-week PA intervention to older adults through 2 modes: online or on-site. Feasibility was assessed primarily by attrition, adherence, and participants’ experiences of factors influencing continued participation or withdrawal. Additionally, the study explores preliminary patterns in PA levels and physical and mental health outcomes to inform the design of a future definitive trial. <strong>Methods:</strong> This 26-week pragmatic pilot trial used an embedded convergent mixed methods design. Community-dwelling adults aged 60 years or older (N=35) from 3 residential areas in Sweden were cluster-randomized, without blinding, by site to an online (prerecorded video-based Otago exercises; n=12) or on-site (group-based, in-person Otago exercises; n=23) delivery mode. Feasibility outcomes included attrition and adherence. Exploratory outcomes included PA level (Godin-Shephard Leisure-Time Exercise Questionnaire), lower-body strength (Chair Stand Test), depressive symptoms (Geriatric Depression Scale), and health-related quality of life (EQ-5D-3L), assessed at baseline, midintervention (14 weeks), and postintervention (26 weeks). Exploratory quantitative analyses included t tests, chi-square tests, analysis of covariance, and mixed-design ANOVAs. We analyzed semistructured interviews with completers (n=17) and dropouts (n=7) using qualitative content analysis. Findings were integrated using the COM-B (Capability, Opportunity, Motivation-Behavior) framework. <strong>Results:</strong> The overall attrition rate was 37% (13/35), with no significant difference between delivery modes (<i>P</i>=.29). Most dropouts occurred within the first 2 weeks. Mean adherence appeared higher in the online delivery mode (mean 17.0, SD 6.7) than in the on-site delivery mode (mean 12.1, SD 10.1) but did not differ significantly (<i>P</i>=.15). Qualitative findings indicated that attrition was primarily driven by physical health issues and a perceived lack of fit, whereas adherence was supported by appeal and reward, routine and commitment, flexibility, feedback and PA overview, and (often) social presence. Mixed methods findings suggest that capability, opportunity, and motivation supported participation across both delivery modes. No intervention-related adverse events were reported. <strong>Conclusions:</strong> Both online and on-site delivery modes for PA interventions appeared feasible for many older adults. Although no statistically significant between-group differences were observed, the study was not powered to evaluate effectiveness. Feasibility may depend more on supporting capability, opportunity, and motivation than on delivery mode. Larger, adequately powered trials are needed to test effectiveness, identify optimal formats for different populations, and evaluate strategies to reduce early attrition. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT05885308; https://clinicaltrials.gov/ct2/show/NCT05885308
X-Chromosome Gene Linked to Increased Autism Diagnosis in Males
Researchers at Baylor College of Medicine, the Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital, and collaborating institutions have identified new genetic candidates that help explain why autism is diagnosed about four times more often in boys than it is in girls. The study, involving tests in induced pluripotent stem cell (iPSC)-derived neurons (iNeurons), revealed that small changes in the gene MECP2 on the X chromosome might help explain part of this difference.
Huda Zoghbi, MD, Distinguished Service Professor at Baylor, director of Duncan NRI, and a Howard Hughes Medical Institute investigator, is senior and corresponding author of the team’s published paper in The American Journal of Human Genetics, titled “A massively parallel reporter assay of MECP2 cis-regulatory elements reveals genetic candidates for male-biased autism.” In their paper, the team concluded, “These findings suggest noncoding MECP2 variants can cause idiopathic, male-biased autism and provide a framework for uncovering regulatory variants in other X chromosome neurodevelopmental genes that may contribute to autism’s missing heritability.”
“Autism is a common, heritable neurodevelopmental trait that affects how a person communicates, interacts with others, and experiences the world, and is characterized by altered social interactions and restricted, repetitive behaviors or interests,” Zoghbi explained. “It is diagnosed about four times more in male individuals than in female individuals, suggesting sex-specific factors may increase male vulnerability,” the researchers added in their paper.
In the current study, the researchers drew from their long experience with gene MECP2, which is on the X chromosome and has been associated with neurodevelopmental conditions, including autism. “We tested the idea that the predominance of autism in males could be explained in part by mild mutations in an X chromosome gene’s regulatory regions,” commented Rebecca Meyer-Schuman, PhD, a postdoctoral associate in the Zoghbi lab. “Females might be protected from such a mild mutation because of their second X chromosome, but males, who have only one copy, would be more vulnerable. The regulatory regions are like dials that control whether a gene will be expressed and by how much. And what better place to start looking at these regulatory regions than the gene MECP2, where brain health depends on how much of the gene is expressed, and where mutations can cause neurodevelopmental disorders that include autism.”
Previous murine studies by Zoghbi lab and others have taught researchers that MECP2 produces a Goldilocks protein, meaning that it must maintain a “just right” concentration or activity level for a healthy brain. Having too little—about 50% or less of the normal levels—leads to Rett syndrome, and having twice the normal levels causes a different neurodevelopmental condition called MECP2 duplication syndrome. “Both loss-of-function and gain-of-function variants lead to severe neurodevelopmental conditions—Rett syndrome (MIM: 312750) and MECP2 duplication syndrome (MDS; MIM: 300260[intellectual developmental disorder, X-linked, syndromic, Lubs type (MRXSL)]), respectively,” the authors commented. “Because MECP2 is on the X chromosome, hemizygous male individuals have a more severe phenotype than heterozygous female carriers with the same variant.”
Meyer-Schuman also noted, “Previous studies in mice also showed us that milder changes in MECP2 levels, for instance reducing the expression by 30% or increasing it by 50%, do not cause the more severe features of Rett syndrome or MECP2 duplication syndrome like seizures or motor problems, but lead to autism-like behaviors.”
For their current study the team used a massively parallel reporter assay (MPRA) to screen the regulatory regions of the MECP2 gene in induced pluripotent stem-cell (iPC)-derived neurons. “This allowed us to identify and manipulate the regulatory regions and determine what kinds of changes would alter their function,” Meyer-Schuman said. The researchers also screened MECP2 regulatory regions in autistic individuals and tested the genetic variants they identified using the MPRA assays.
“We identified two regulatory regions where male autistic individuals inherited a variant from their unaffected mother that altered regulatory activity,” Meyer-Schuman said. “One of these variants reduced MECP2 expression by approximately 30% in human neurons, a magnitude that produces social deficits, hyperactivity and anxiety-like characteristics in mice. As predicted by the mouse model, this individual was diagnosed with autism and ADHD but had none of the defining characteristics of Rett syndrome.”
In their paper, the authors commented that their work supports a broader hypothesis that altered dosage or expression of sex chromosome genes are a major source of the male bias observed in autism. Zoghbi added, “These findings, a result of integrating human and animal studies, suggest that MECP2 regulatory variants can contribute to male-biased autism and reveal just the tip of the iceberg, providing a framework for uncovering regulatory variants in other X chromosome neurodevelopmental genes that may contribute to autism’s missing heritability.”
The post X-Chromosome Gene Linked to Increased Autism Diagnosis in Males appeared first on GEN – Genetic Engineering and Biotechnology News.
Associations Between Daily EMA of Emotional Exhaustion and Monthly Burnout Symptoms During Work Reintegration: Longitudinal Multilevel Study
Background: Burnout is increasingly conceptualized as comprising both stable, slowly changing features and more dynamic, fluctuating features, with emotional exhaustion widely regarded as one of burnout’s core components. Traditionally, burnout has been assessed using retrospective self-report questionnaires, such as the Burnout Assessment Tool (BAT), administered at sporadic intervals. In contrast, ecological momentary assessment (EMA) enables high-frequency assessment of daily experiences while reducing recall bias. However, it is not well understood how EMA-based measures fluctuate and develop longitudinally within individuals or how they relate to retrospective burnout measures. Objective: This paper examined the relationship between 30-day aggregates of daily EMA-assessed emotional exhaustion, specifically the within-person mean level and variability (SD), and monthly burnout symptoms measured with the BAT. Methods: Eighteen participants undergoing work reintegration after stress- or burnout-related sick leave completed daily EMAs of emotional exhaustion (N=3157) and monthly BAT questionnaires over 6 months (N=94). For each monthly BAT assessment, EMA data from the preceding 30 days were aggregated into within-person mean and SD values. Linear mixed-effects models with random intercepts and time effects were fitted separately for each BAT subscale. Additionally, intraclass correlation coefficients (ICCs) were calculated to quantify the proportion of variance attributable to between-person differences. Results: ICCs indicated that a large proportion of variance in the BAT subscales was attributable to between-person differences, whereas daily EMA emotional exhaustion showed relatively greater within-person variability. Significant time-related changes were observed for the BAT subscales of Cognitive Impairment, Mental Distance, and Emotional Impairment. Within-person increases in the EMA mean of emotional exhaustion were significantly associated with higher scores on BAT Exhaustion (=0.073; =.001) and BAT Cognitive Impairment (=0.041; =.04). EMA-based variability (SD) and between-person mean levels were not significantly associated with any BAT subscale. Conditional values were high (0.667-0.777), whereas marginal values were modest (0.056-0.121). Consistent with the ICC findings, these results suggest that most explained variance in BAT scores reflects between-person differences and time-related changes, with EMA-derived predictors accounting for only a limited additional proportion of explained variance. Conclusions: EMA-based aggregates showed partial correspondence with monthly burnout scores. Within-person increases in mean daily emotional exhaustion were associated with higher subsequent scores on the BAT Exhaustion and Cognitive Impairment subscales, but EMA-based variability was not associated with any BAT subscale. Together with the ICC results, these findings suggest that EMA-based aggregates of emotional exhaustion can reflect short-term fluctuations and longer-term changes in symptom severity of exhaustion and cognitive impairment. Retrospective questionnaires remain useful for global symptom assessment or diagnoses at specific time points but appear less well suited for tracking within-person changes and supporting personalization. These results highlight the importance of aligning the choice of assessment with temporal and clinical goals.
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Which classroom anxiety experience should teachers target first? A network-simulation study of foreign language classroom anxiety and enjoyment
BackgroundForeign language classroom anxiety and enjoyment are moderately negatively related, but this relationship has been examined almost entirely at the total score level, and to our knowledge, no published study has asked which specific anxiety experiences are most closely coupled to enjoyment.MethodsUsing item-level psychological network analysis and the GGMNIRA simulated node-manipulation framework, we estimated the joint network of eight anxiety items and nine enjoyment items in 3,957 Chinese non-English-major college students and simulated the alleviation of each anxiety node in turn.ResultsRank-based stability was high (case-dropping correlation stability coefficient ≥ 0.75 for EI, BEI, and the KL rankings). The highest expected influence nodes were shared jokes and topics and teacher support; among anxiety items, panic without preparation speaking ranked highest. The simulations applied two complementary criteria that answer different questions: panic without preparation produced the largest distributional reconfiguration of the enjoyment construct, whereas alleviating nervousness when speaking predicted the largest signed enjoyment gain, the largest model-implied gain among the eight anxiety items. The highest bridge-centrality anxiety node showed negligible simulated effects.ConclusionsSpeaking-related anxiety, particularly the fear of speaking without preparation, is the anxiety experience most closely coupled to enjoyment. Simulated conditioning offers a principled, model-implied complement to centrality when researchers generate hypotheses about which anxiety experiences classroom practice might target first.
Network analysis of trauma-related mental health comorbidities under continuous traumatic stress: a comparative study of South African and Ukrainian adolescents
BackgroundAdolescents living under conditions of continuous traumatic stress (CTS) are exposed to ongoing, persistent, unpredictable threats that differ from past discrete traumatic events and are associated with high levels of CTS symptoms, posttraumatic stress disorder (PTSD), depression, and anxiety. Despite growing evidence that CTS functions as a risk factor for trauma-related disorders, little is known about how specific CTS symptoms are embedded within broader psychopathology networks across diverse contexts of chronic violence.AimThis study applied item-level network analysis to examine the structural role of individual CTS symptoms within PTSD, depression, and anxiety symptom networks among adolescents exposed to CTS in South Africa (n = 600) and Ukraine (n = 485).MethodAdolescents (aged 12 to 18 years) completed standardised measures of CTS, PTSD, depression, and anxiety symptoms. Item-level network models were used to examine within- and cross-domain symptom associations, identify central and bridging CTS symptoms, assess their predictive value for overall symptom severity, and test network invariance across countries.ResultsIn both samples, strong within-domain clustering was observed alongside robust cross-domain connections linking CTS symptoms with PTSD, depression, and anxiety symptoms. In Ukraine, CTS symptoms were represented by symptoms reflecting loss of meaning, intense fear or horror, and episodes of rage, while in South Africa, CTS symptoms were represented by difficulty controlling emotions, feelings of betrayal, and perceived life threat. The findings also suggest that CTS symptoms were more tightly interconnected and more evenly distributed across PTSD, depression, and anxiety symptoms in the Ukrainian sample, whereas the South African sample demonstrated a broader and more diffuse symptom pattern, with anxiety-related symptoms appearing to be more prominently expressed.ConclusionFindings suggest that CTS symptoms may potentially operate as a transdiagnostic process – cutting across, and contributing to shared variance in PTSD, depression, and anxiety symptoms – among adolescents exposed to ongoing violence. Interventions targeting core CTS bridge symptoms may reduce comorbidity and improve mental health outcomes in chronically threatened youth across diverse conflict settings.
Longitudinal reference data for the German D-AMI in major depression and healthy controls: implications for future ECT research
BackgroundElectroconvulsive therapy (ECT) is an effective treatment for major depressive disorder (MDD). Retrograde autobiographical memory impairment is considered one of the clinically relevant adverse effects of ECT; however, no validated German instrument is available to assess autobiographical memory. Although longitudinal autobiographical memory data are available from previous studies of patients with depression not receiving ECT, corresponding reference data for the German-language AMI-SF have not been established. This study evaluated the feasibility and interrater reliability of the German Autobiographical Memory Interview-Short Form (D-AMI) and established longitudinal reference data in MDD and healthy controls.MethodsSixty participants (30 patients with MDD and 30 healthy controls), none of whom received ECT during the observation period, completed the D-AMI at baseline and after a 6-week interval. Feasibility was assessed by completion rates and missing data. Interrater reliability was evaluated in a subset (n = 10) using a two-way random-effects intraclass correlation coefficient (ICC). Longitudinal performance was quantified using D-AMI score change and its baseline-normalized expression, retrieval consistency. Associations between autobiographical memory measures and depressive symptom severity were explored.ResultsThe D-AMI demonstrated a 100% completion rate with no missing data. Interrater reliability was ICC[2,1] = 0.71 (95% CI = 0.17-0.92), indicating considerable uncertainty. The magnitude of longitudinal inconsistency was greater in patients with MDD than in healthy controls, although this between-group difference should be interpreted cautiously because study site and rater were confounded with group.ConclusionsThe D-AMI is a feasible instrument for assessing autobiographical memory in German-speaking populations, while the preliminary interrater reliability estimate requires confirmation in larger samples. The observed magnitude of longitudinal D-AMI inconsistency provides reference information for repeated assessments in the absence of ECT; however, the between-group difference requires cautious interpretation because group, site, and rater effects could not be separated. These findings provide the first longitudinal reference data for the German D-AMI and indicate that changes in autobiographical memory scores should not automatically be interpreted as evidence of ECT-related memory impairment. Rather, such changes should be considered in the context of test-retest variability and retrieval consistency.