BackgroundBrain and body metabolic disruptions have been suggested in several studies as a mechanism underlying posttraumatic stress disorder (PTSD). Therapies targeting metabolic pathways might provide new treatment options. This review explores the potential of ketogenic therapies, such as the ketogenic diet and ketone supplementation, as novel metabolic treatments for PTSD.MethodsAn integrative review was conducted. We searched PubMed, Scopus, PsycINFO, PsycArticles, PSYNDEX, MEDLINE, ClinicalTrials.gov, International Clinical Trials Registry Platform, and EU Clinical Trials Register for clinical, preclinical, observational, mechanistic, and review studies that reported outcomes or mechanisms on the intersection of ketogenic therapy and PTSD. Methodological quality of included studies was assessed independently by two reviewers based on predefined criteria.ResultsSixteen articles (9 human, 4 animal studies, 3 reviews) were eligible and included in the present review. Several metabolic and signaling pathways through which ketogenic therapies could impact PTSD pathophysiology were identified. Preclinical data suggestive of potential efficacy were identified, while only minimal reliable information is available from human studies.DiscussionImportantly, the absence of larger clinical trials and the reliance on low-level evidence substantially limit current interpretations. High-quality randomized and adequately powered clinical trials are required to examine the potential role of ketogenic therapies in treating PTSD.
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.
ObjectiveThis study aimed to examine the non-linear associations of body mass index (BMI) and body dissatisfaction with depressive symptoms among Chinese university students, and to explore how the indirect association between BMI and depressive symptoms through body dissatisfaction varies across the BMI range.MethodsA cross-sectional design was used, and 7,928 full-time students were recruited from eight universities in China. Depressive symptoms were assessed with the Zung Self-Rating Depression Scale (SDS); body dissatisfaction was operationalised as the absolute difference between measured BMI and self-reported ideal BMI. Analyses comprised restricted cubic spline (RCS) models, an exploratory non-linear decomposition of the indirect association, generalised additive models (GAM) as a sensitivity analysis, a supplementary receiver operating characteristic (ROC) analysis, and k-means clustering. Because measured BMI enters the calculation of body dissatisfaction, the exposure and the proposed mediator are not mathematically independent; all decomposition results are therefore reported as exploratory.ResultsBoth BMI and body dissatisfaction were non-linearly associated with depressive symptoms (both P < 0.01). In the exploratory decomposition, the estimated indirect association between BMI and depressive symptoms through body dissatisfaction attenuated progressively as BMI increased. In the supplementary ROC analysis, the BMI value maximising the Youden index was 23.11 kg/m² (AUC = 0.768); this is a sample-specific, internally derived discrimination point rather than a screening threshold. A five-stratum descriptive matrix combining BMI groups with body-dissatisfaction clusters was constructed, and the observed prevalence of depressive symptoms ranged from 14.4% to 100.0% across strata.ConclusionBMI and body dissatisfaction were non-linearly associated with depressive symptoms in this sample, and the magnitude of the indirect association through body dissatisfaction varied across the BMI range. Because the body-dissatisfaction indicator is mathematically derived from measured BMI and the design was cross-sectional, these results describe statistical associations and should not be read as evidence of a causal mediating mechanism. The risk-stratification matrix was developed and evaluated in the same dataset without internal or external validation; it is therefore exploratory and requires independent validation before any screening application.
BackgroundChildhood trauma may influence clinical presentation in first-episode schizophrenia (FES), but its specific associations with cognitive function and clinical symptoms remain unclear.MethodsSeventy-one FES participants and 62 healthy controls were assessed using the Childhood Trauma Questionnaire (CTQ-SF), MATRICS Consensus Cognitive Battery (MCCB), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale (CDSS). Group comparisons, Spearman correlations, hierarchical regression, and mediation analyses (PROCESS macro) were performed.ResultsFES participants reported significantly higher childhood trauma (except physical abuse) and performed worse on all MCCB domains (all *p* < 0.00625). Within the clinical group, those with childhood trauma (71.8%) showed nominally lower MCCB total scores (*p* = 0.042) and a trend toward higher negative symptoms (*p* = 0.083). Exploratory analyses indicated that physical neglect was associated with attention/vigilance (r = -0.54) and overall cognition (*r* = -0.69); physical abuse with social cognition (*r* = -0.54); sexual abuse with general psychopathology (*r* = 0.56). No independent associations of trauma subtypes were found in regression analyses. Attention/vigilance was significantly associated with negative symptoms (β = -0.43, *p* = 0.002) but did not mediate the trauma-symptom relationship.ConclusionFES participants report more childhood trauma and exhibit widespread cognitive impairment, with physical neglect most strongly linked to attentional deficits. Attention/vigilance was associated with negative symptoms, suggesting that trauma-informed cognitive rehabilitation may have potential value.
Moral injury is at a critical juncture in its conceptualization. Current dominant approaches to conceptualizing and assessing moral injury are rooted in syndromal frameworks with implicit medical model assumptions. In these approaches, painful moral emotions and cognitions are often conceptualized as pathological symptoms to be reduced or corrected. Such approaches risk pathologizing deeply human moral responses and may inadvertently position clinicians as arbiters of which moral appraisals or emotional reactions are appropriate, proportionate, or adaptive. In this paper, we present Contextual Behavioral Science (CBS), the philosophical foundation of Acceptance and Commitment Therapy for Moral Injury (ACT-MI), as an alternative framework for conceptualizing and treating moral injury without pathologizing moral pain or requiring clinicians to adjudicate the validity of clients’ moral judgments. Drawing on CBS, Relational Frame Theory (RFT), and evolutionary science, we examine the social functions of moral emotions, the human capacity to construct verbal moral narratives, and the implications of these processes for intervention. Building on these foundations, ACT-MI is described as an approach aimed at disrupting the behavioral patterns that maintain moral injury at both individual and group levels. Rather than targeting moral pain to reduce symptoms, using ACT-MI can facilitate transforming the individual’s relationship to it. Through functional assessment, clients’ efforts to avoid, control, or resolve moral pain are identified and addressed with core ACT processes, including acceptance, defusion, contact with the present moment, self-as-context, values, and committed action. Within this framework, individuals learn to hold moral pain while continuing to engage in values-based living and meaningful social functioning at individual and group levels of treatment. Assessment targets, methods, and hypotheses are identified to support testing the mechanisms and impacts of ACT-MI in future research.
ObjectiveThis study aimed to compare emotional and behavioral problems in the offspring of parents with schizophrenia, the offspring of parents with bipolar disorder, and healthy controls using the Child Behavior Checklist for ages 6–18 years (CBCL/6–18).MethodsThis cross-sectional controlled study was conducted in the Child and Adolescent Psychiatry Outpatient Clinic of Karabük Training and Research Hospital. The sample included 62 children and adolescents aged 6–18 years: 21 offspring of parents with schizophrenia, 20 offspring of parents with bipolar disorder, and 21 healthy controls. Parental diagnoses were established according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and confirmed with the Structured Clinical Interview for DSM-5. Emotional and behavioral problems were assessed using CBCL/6–18 T-scores. Group comparisons were performed using one-way analysis of variance and chi-square tests, with Bonferroni correction applied for multiple CBCL comparisons. Multivariable linear regression analysis was used to identify factors independently associated with total problems scores.ResultsThe groups did not differ significantly in age, sex, or educational status. Compared with healthy controls, both clinical groups had higher rates of previous child psychiatry visits and less favorable family-related sociodemographic characteristics. After Bonferroni correction, significant group differences remained for withdrawn/depressed, anxious/depressed, internalizing problems, aggressive behavior, externalizing problems, social problems, attention problems, and total problems. In these domains, both offspring groups scored significantly higher than controls, whereas the schizophrenia and bipolar disorder groups did not significantly differ from one another. In adjusted regression analysis, both schizophrenia-group status and bipolar-disorder-group status remained independently associated with higher total problems scores.ConclusionOffspring of parents with schizophrenia or bipolar disorder show elevated emotional and behavioral problems compared with healthy controls, supporting the importance of early screening and family-oriented preventive interventions.
BackgroundThe introduction of innovative oncological therapies, such as immune checkpoint inhibitors (ICIs) and multikinase inhibitors (TKIs), has improved the prognosis of many malignancies but has introduced complex neuropsychiatric adverse events. This case report describes the management of a complex psycho-organic syndrome occurring in a patient treated with the combination of pembrolizumab and lenvatinib.Case presentationA 69-year-old woman, with a history of anxious-depressive disorder and recurrent endometrial carcinoma, was admitted for the onset of a sub-confusional state, severe psychomotor retardation, akathisia, and tremors. These symptoms appeared in temporal relationship with the initiation of combined pembrolizumab-lenvatinib therapy. Diagnostic investigations (CT, MRI, FDG-PET, and CSF analysis) excluded brain metastases or primary neuroinflammatory processes, revealing diffuse cortical hypometabolism consistent with metabolic-iatrogenic encephalopathy.ManagementThe therapeutic strategy involved a multidisciplinary approach based on the precautionary suspension of oncological drugs and a structured pharmacological washout. Flumazenil was administered with diagnostic-therapeutic success to correct GABAergic redundancy, and pramipexole was introduced to treat extrapyramidal manifestations and akathisia.ConclusionsThis case highlights how overlapping immunological, vascular, and neuropharmacological effects can generate reversible encephalopathic patterns in complex oncological patients. Symptom resolution through psychopharmacological modulation and suspension of targeted treatment alone underscores the critical importance of active neuropsychiatric surveillance and close interdisciplinary collaboration between oncologists and psychopharmacologists.
BackgroundThe etiology of many chronic pain conditions is still poorly understood. According to the perception-filter model, amplification (stage I.) and insufficient filtering (stage II.) of afferent bodily signals results in the increased perception of physical sensations (stage III.).MethodsFocusing on cardiac interoception, we tested if these hypothesized alterations in stages I.-III. apply to a sample of 76 in-patients with chronic pain (Mage = 50.7, 53 females). Heart rate (HR) and heart rate variability (HRV) were assessed as indicators of afferent bodily signal strength (stage I.). The difference between heartbeat-evoked potentials (HEPs) during a resting phase and a heartbeat counting task (HCT), i.e., ΔHEP, was used as an indicator of filter system activity. Interoceptive accuracy (IAcc) in the HCT and a heartbeat discrimination task (HDT) served as indicators of perception of afferent bodily signals.ResultsHR did not predict either indicator of IAcc. LF HRV was a positive predictor of IAccHCT and HF HRV positively predicted both IAccHCT and IAccHDT. HEP amplitudes did not differ between the HCT and the resting period and ΔHEP did not moderate any of the relationships between indicators of bodily signal strength (stage I.) and IAcc (stage III.). Neither indicator of IAcc (stage lll.) was significantly associated with measures of symptom report.ConclusionAlterations in the processing of bodily signals as suggested by the perception-filter model do not apply to chronic pain conditions. Future studies should focus on investigating pain-specific processing of bodily signals.
IntroductionParents play a pivotal role in a child’s or adolescent’s recovery from anorexia nervosa (AN). However, they often experience substantial psychological distress that may limit their ability to support treatment effectively. Structured psychoeducation may help parents understand the illness and treatment process and may support treatment engagement in young people with AN. This uncontrolled pre-post evaluation examined parental psychological distress, self-perceived knowledge and competence, and post-intervention satisfaction with a brief psychoeducational group program.MethodsFifty-five parents were screened and 53 consented to participate. Thirty-nine parents of children and adolescents with typical or atypical AN returned complete pre-post data and were included in the analyses. The program consisted of four-session psychoeducational program (90-minute weekly sessions) covering etiology, treatment concepts, nutritional principles, and relapse prevention. Psychological distress was assessed before and after the program using the Brief Symptom Inventory (BSI). Program satisfaction and perceived benefit were evaluated at program completion.ResultsParticipants showed high psychological distress at baseline, with significantly lower distress scores after the intervention period. Program satisfaction and attendance were high, with 87% completing all sessions. Parents reported feeling better informed about anorexia nervosa and its treatment, reported high perceived competence in supporting their child and described the material as accessible and understandable.ConclusionIn this single-center uncontrolled pre-post evaluation, participation in guideline-based psychoeducation was associated with lower parental psychological distress at post-intervention and high acceptability. Because of the uncontrolled design and the absence of patient-level outcomes, these findings should be interpreted as preliminary associations rather than evidence of a causal intervention effect.
ObjectivesThe October 7 attacks and ensuing war created conditions of sustained, multidimensional trauma. This systematic review synthesizes studies from the first two years of the war to clarify early prevalence of post-traumatic stress symptoms (PTSS), anxiety, depression, and addiction-related outcomes in the Israeli population.MethodsFollowing PRISMA 2020 guidelines, PubMed, PsycINFO, Scopus, and Web of Science were searched identifying studies published between October 7, 2023 and October 7, 2025 (final search date December 30, 2025). Guided by the PICOS framework, eligible studies assessed psychiatric outcomes among Israeli populations exposed to the October 7 attacks or subsequent war. Outcomes of interest included posttraumatic stress, anxiety, depression, and addiction-related outcomes, and observational quantitative and qualitative studies were included. Risk of bias was assessed using Joanna Briggs Institute tools. Findings were synthesized narratively, with attention to exposure characteristics, subgroup differences, and time of assessment.ResultsSixty-eight studies met inclusion criteria. Symptom trajectories were heterogeneous and varied with exposure intensity and contextual vulnerability. Elevated PTSS was associated with direct, cumulative, and role-related exposure. Anxiety and depression were widely documented and persisted among individuals facing sustained threat, socioeconomic strain, or displacement. Addiction-related outcomes, an emerging and comparatively understudied domain, were examined in only three studies, with preliminary evidence suggesting exposure and distress-associated increases in substance use and gambling.ConclusionsPsychiatric responses following October 7 were domain-specific and associated with exposure, ongoing stress, and structural and individual vulnerabilities, underscoring the need for targeted, longitudinal monitoring in prolonged crisis contexts.
BackgroundSecond-generation antipsychotics (SGAs) are widely utilized as first-line agents for several pediatric psychiatric and neurodevelopmental conditions, raising critical safety concerns. Although their cardiometabolic risks are well recognized, evidence on their long-term evolution in routine pediatric clinical practice remains limited. This study investigated the longitudinal cardiometabolic trajectories associated with SGA treatment in a real-world pediatric population.MethodsIn this prospective, naturalistic, multicenter observational study, 82 children and adolescents initiating SGA treatment were followed for up to 24 months. Anthropometric, metabolic, and cardiovascular parameters were assessed longitudinally, and linear mixed-effects models were used to evaluate time-dependent changes and differences between treatment groups.ResultsRetention rates and a low incidence of adverse event-related discontinuations suggested acceptable overall tolerability. Longitudinal analysis revealed significant increases in BMI, insulin and HOMA-IR whereas aggregate cardiovascular parameters did not exhibit statistically significant changes. Risperidone was associated with greater increases in waist circumference, prolactin, total cholesterol and ALT levels compared with aripiprazole. Furthermore, patients with Autism (ASD) exhibited significantly greater increases in BMI, waist circumference, and systolic blood pressure compared to non-ASD youth.ConclusionWhile demonstrating an acceptable tolerability profile, risperidone and aripiprazole were associated with different cardiometabolic and endocrine variations over a 24-month period in this real-world pediatric cohort. These findings should be interpreted within the context of the study’s observational nature and of potential confounding factors (e.g., unmeasured dietary, physical activity, and pubertal factors), highlighting the clinical necessity of longitudinal monitoring in children and adolescent patients.
BackgroundDue to structural and socioeconomic barriers to accessing the healthcare system, individuals are increasingly turning to online platforms to obtain health-related information. With the advancement of artificial intelligence (AI), the use of AI for this purpose is also on the rise. It can also be said that seeking information from AI regarding psychotherapies is increasingly common.ObjectiveThis study aimed to assess the informational quality and readability of AI-generated psychoeducational content about psychotherapy. To this end, we evaluated the informational quality and readability of LLM-generated Eye Movement Desensitization and Reprocessing (EMDR) psychoeducational content across different models.MethodsIn this cross-sectional content analysis, EMDR-related search queries were identified through Google Trends, converted into patient-facing questions, and subsequently organized into four thematic categories, with five questions selected from each category for evaluation using ChatGPT (GPT-4o), Gemini (1.5 Pro), and DeepSeek (V3). Each question was entered in three separate sessions, yielding 180 responses. The informational quality was assessed by two blinded psychiatrists using the Ensuring Quality Information for Patients (EQIP) instrument. Readability was evaluated using the Flesch–Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) indices. Statistical analyses included linear mixed-effects models and ANOVA.ResultsThe overall mean EQIP score was 56.08 (SD = 4.43). Informational quality differed significantly across the models (p < 0.001), and no significant differences were observed across EMDR-related question categories. The highest informational quality scores were obtained by Gemini, followed by DeepSeek and ChatGPT. DeepSeek generated the most readable responses. Higher EQIP scores were seen to be associated with greater readability and longer response length. All the evaluated models produced responses that exceeded the commonly recommended readability levels for patient education materials. Overall inter-rater consistency was high for the total EQIP scores.ConclusionAlthough all the LLMs evaluated were able to generate psychoeducational information about EMDR, substantial differences were observed between the models in respect of informational quality and readability. The findings suggest that psychoeducational quality depends more strongly on the language model used than on the specific EMDR-related topic being addressed. LLMs may serve as supplementary psychoeducational resources but should not be considered as substitutes for professional psychotherapy or individualized clinical care.
Introduction Drawing on the Job Demands-Resources (JD-R) theory, this study examines the associations between psychological safety, trust in leadership, and workplace flourishing within the high-pressure, hierarchical context of the Ghana Armed Forces. Methods Using a cross-sectional quantitative research design, data were collected from 292 military personnel stationed at a single military hospital through stratified sampling (response rate = 78.9%). Structural Equation Modeling (SEM) with bootstrapped indirect effects was employed to test the hypothesized model, with Confirmatory Factor Analysis confirming construct validity. Results The results reveal significant direct associations between trust in leadership (β = .296, p <.001) and psychological safety (β = .111, p <.05) with workplace flourishing. Critically, serial mediation analysis revealed that psychological safety is indirectly associated with workplace flourishing through trust in leadership (Indirect Effect = .0781, 95% CI [.0137,.0939]), suggesting that in hierarchical military contexts, psychological safety function as a climate resource that enables trust development, which in turn is associated with flourishing. While trust demonstrates a stronger statistical association, this does not imply causal precedence. Discussion The findings extend the JD-R framework to military settings by demonstrating the sequential resource pathway from psychological safety through trust to flourishing at work. Organizations should prioritize creating psychologically safe environments first, as this appears to enable trust development, which then contributes to flourishing. The study offers insights for leadership development in high-stakes environments, while acknowledging that the cross-sectional and self-reported design precludes causal conclusions and limits generalizability.
IntroductionTransitioning from oral to long-acting injectable (LAI) antipsychotics may improve adherence and reduce healthcare resource utilization (HCRU) in patients living with bipolar I disorder (BP-I), with potentially greater improvements with LAIs with dosing intervals longer than 1 month. Aripiprazole monohydrate is available as LAI formulations administered once-monthly [aripiprazole once-monthly (AOM)] or once every 2 months (aripiprazole 2-month ready-to-use [Ari 2MRTU]). This pre-post analysis described adherence, HCRU, and costs over 6 months in adults diagnosed with BP-I who transitioned from oral antipsychotics or AOM to Ari 2MRTU.MethodsThis retrospective, noninterventional study used Kythera Labs United States closed claims to identify adults diagnosed with BP-I, commercially or Medicaid-insured, and who transitioned from oral antipsychotics or AOM to Ari 2MRTU from April 2023–September 2024 (index date = Ari 2MRTU transition). Continuous enrollment for 12 months pre- and 6 months post-index was required. Study outcomes were compared 6 months prior to and following the index date.ResultsAmong those who transitioned from oral antipsychotics to Ari 2MRTU (n = 371),mean proportion of days covered (PDC) increased from 0.60 to 0.76 (26.2% relative increase), mean medication possession ratio (MPR) increased from 0.67 to 0.85 (26.8% relative increase), and proportion of patients with MPR ≥ 0.8 increased from 41.2% to 72.0% (74.5% relative increase) (all P < 0.0001). Notable reductions in all-cause inpatient visits and length of stay (LOS) were observed, along with reductions in BP-I–related LOS and emergency department (ED) visits. All-cause inpatient, ED, and total medical (inpatient, outpatient, ED) costs declined. Among those who transitioned from AOM to Ari 2MRTU (n = 1,096), mean PDC increased from 0.56 to 0.81 (45.3% relative increase), mean MPR increased from 0.62 to 0.89 (43.7% relative increase), and proportion of patients with MPR ≥ 0.8 increased from 51.2% to 79.0%) (54.4% relative increase) (all P < 0.0001). Inpatient visits (all-cause, BP-I–related), and all-cause LOS decreased, along with all-cause ED and total medical costs.DiscussionTransitioning to Ari 2MRTU was associated with improved treatment adherence and reduced selected HCRU measures and total medical costs, supporting its value as a treatment option for BP-I.
Insomnia symptoms in major depressive disorder (MDD) are clinically heterogeneous, ranging from presleep rumination and prolonged sleep latency to repeated nocturnal awakenings and early-morning awakening. Their clinical significance and treatment implications may also differ between active MDD and residual insomnia symptoms during partial remission. This narrative review examines how these presentations may inform the use of sedating antidepressants and dual orexin receptor antagonists (DORAs). Sedating antidepressants, including mirtazapine, trazodone, doxepin, and other tricyclic antidepressants, differ in dose-dependent antidepressant activity, receptor profile, and adverse-effect burden. DORAs directly target orexin-mediated wake drive and have the strongest evidence for insomnia disorder, particularly sleep-maintenance outcomes, although evidence in active MDD remains limited. Because clinical presentations neither establish an underlying mechanism nor reliably predict treatment response, the proposed framework should be used as a hypothesis-generating aid rather than a validated treatment algorithm. Pharmacological selection should also consider suicide risk, substance-use history, comorbid sleep disorders, concomitant central nervous system depressants, and next-day functioning.
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.
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.
BackgroundWith the increasing integration of artificial intelligence (AI) technologies into daily life, the underlying mechanisms of emotional interactions between users and AI have emerged as a critical research topic in the field of human-computer interaction (HCI). Existing studies have predominantly adopted traditional technology acceptance models or satisfaction scales, which lack targeted applicability in capturing unique features of AI interactions, such as parasocial relationships and emotional dependence. The present study aims to develop a self-report instrument, the AI Emotional Engagement Scale (AEES), and examine its psychometric properties for assessing users’ level of AI Emotional Engagement with AI systems.MethodsThis study was conducted based on Norman’s three-level theory of emotional design. Study 1 (N = 24) extracted core information from interview data using qualitative analysis, and generated an initial item pool through multiple rounds of expert review. Study 2 (N = 103) conducted a pre-test of the initial items to examine indicators including item quality and relevance, optimized the item design, and developed the formal item set. Study 3 (N = 924) verified the factor structure of the AEES via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), conducted reliability and validity tests of the scale, and finalized the factor structure of the 28-item, three-dimensional scale.ResultsResults of EFA indicated that AI Emotional Engagement consists of three dimensions: the visceral level, behavioral level, and reflective level, which was consistent with the theoretical framework, with a cumulative variance contribution rate of 68.32%. Results of CFA demonstrated that the three-factor model had a good fit (χ²/df = 3.765, CFI = 0.91, TLI = 0.90, RMSEA = 0.077, SRMR = 0.0496). The overall AEES and its three dimensions exhibited good internal consistency reliability, with reliability coefficients ranging from 0.90 to 0.97.ConclusionThe AEES has favorable psychometric properties, and can serve as a reliable instrument for researchers and practitioners to assess users’ AI Emotional Engagement with AI systems.
IntroductionBoredom proneness is a relatively stable dispositional vulnerability associated with adolescents’ problematic social media use (PSMU). However, it remains unclear whether this association reflects stable between-person differences, within-person temporal dynamics, or both. This study examined the reciprocal longitudinal associations between boredom proneness and PSMU among Chinese adolescents.MethodsFour-wave data were collected from 2020 to 2022 from 2,163 adolescents aged 12–19 years at baseline (mean age = 14.54 years, SD = 1.49; 47.4% female) attending four secondary schools in Guangzhou, China. A random-intercept cross-lagged panel model (RI-CLPM) was used to separate stable between-person differences from occasion-specific within-person deviations while controlling for gender, age, paternal education, and maternal education. Ethical approval and written informed consent were obtained.ResultsAt the between-person level, the stable components of boredom proneness and PSMU were positively associated (B = 0.195, p < 0.001). At the within-person level, an asymmetric prospective pattern emerged. Higher-than-expected boredom-proneness scores predicted higher-than-expected PSMU only from T1 to T2 (B = 0.073, p < 0.05), whereas higher-than-expected PSMU consistently predicted higher-than-expected boredom-proneness scores across all three adjacent intervals (B = 0.074, 0.108, and 0.103; all p < 0.05). Both constructs also showed significant autoregressive effects.DiscussionThe association between boredom proneness and PSMU comprised both stable between-person co-occurrence and asymmetric within-person temporal dynamics. PSMU consistently preceded subsequent elevations in boredom-proneness scores, whereas the reverse pathway was interval-specific. These findings do not establish causality or indicate that PSMU causes momentary state boredom or enduring personality change. They may help inform time-sensitive prevention and support strategies by distinguishing stable vulnerability from occasion-specific variation. Because all waves occurred during the COVID-19 pandemic, replication in post-pandemic cohorts is needed.
