Early-life inflammation increases the risk of mental disorders later in life by altering the long-term microglial capacity for neuronal spine engulfment, highlighting a tightly regulated neuroimmune interaction. However, how local immune signals modulate microglial function remains unclear. Here, we show that microglia-associated IL-27-IL-27Rα signaling alleviates depression-like behaviors induced by postnatal immune activation (PIA). At the cellular level, IL-27 treatment suppresses excessive microglial phagocytic activity, thereby preserving synaptic density and preventing synaptic loss. Notably, its beneficial effects extend beyond the PIA model, as IL-27 also ameliorates behavioral deficits in prenatal stress-exposed mice. Importantly, animal safety evaluations support the tolerability of IL-27 administration. These effects are mediated, in part, through the STAT1-Trem2-dependent mechanism. Collectively, these findings support IL-27 as a protective immunoregulatory factor and highlight its therapeutic potential for mood disorders associated with neurodevelopmental immune dysregulation.

Depressive symptoms commonly increase during young adulthood and have been associated with disruptions in rest-activity rhythms (RAR), but prospective within-person associations between daily RAR characteristics and depressive symptoms remain unclear. This study examined reciprocal within-person associations between daily RAR parameters and depression among young adults. A total of 319 participants (mean age = 19.16 years; 78.1% female) contributed 3155 analytic person-days during a 14-day wrist-actigraphy and ecological momentary assessment protocol. RAR parameters included acrophase, circadian quotient, intradaily variability, interdaily stability, and relative amplitude. Daily depression mean and daily depression instability were derived from repeated assessments. Bayesian dynamic structural equation models adjusting for prior-day perceived stress and 24-h light exposure, as well as sex, age, and season were used to estimate the cross-lagged associations between depression and RAR. Late acrophase on day t - 1 predicted high depression mean on day t (posterior median = 0.051, 95% credible interval [CrI] [0.002, 0.100]). Great depression instability on day t - 1 predicted low interdaily stability on day t (posterior median = -0.039, 95% CrI [-0.069, -0.008]). No other cross-lagged associations were supported. Exploratory analysis did not provide credible evidence of sex differences. These findings advance our understanding of daily interplay between depression and behavioral rhythmicity and shed light on chrono-interventions for mood problems among young adults.

INTRODUCTION:Nurses face significantly higher rates of workplace incivility and suicide risk than the general population. However, the magnitude of this association remains unquantified empirically. This study aims to determine the association between nurses' experiences of workplace incivility and suicidal ideation, and to explore the independent, cumulative, and pattern-specific associations between incivility from various sources and suicidal ideation. DESIGN:Cross-sectional study. METHODS:This cross-sectional study employed convenience sampling to enroll 2337 eligible nurses, who provided valid responses during July-August 2024. Suicidal ideation was assessed using two items from the National Comorbidity Survey, and the workplace incivility was assessed by the Nursing Incivility Scale. Logistic regression analysis was used to examine overall, independent, cumulative, and latent-profile-analysis-derived associations between workplace incivility experiences and suicidal ideation. RESULTS:Workplace incivility experience significantly elevated risk of suicidal ideation after adjustment for confounders. Nurse-initiated workplace incivility demonstrated the strongest association with elevated suicidal ideation risk, surpassing workplace incivility from other sources including physicians and patients. A dose-response relationship was also observed between cumulative workplace incivility experience among nurses and increased risk of suicidal ideation. Nurses in the "high incivility" pattern and "patient and physician incivility" pattern exhibited a higher risk of suicidal ideation compared to nurses in the "low incivility" pattern. CONCLUSION:Nurses experiencing workplace incivility demonstrate a heightened risk of suicidal ideation. CLINICAL RELEVANCE:Workplace incivility experienced by nurses was associated with an increased risk of suicidal ideation. Medical institutions and nursing managers are encouraged to consider workplace incivility in routine screening and intervention efforts for suicide prevention.

Background: The prevalence of nurse burnout is high, and it has a significant impact on the job performance. However, currently, nurse burnout is evaluated solely based on the overall score, and a single analysis is conducted to examine the relationship between a certain dimension and the nurses' job performance. The Latent Profile Analysis (LPA) can focus on the individual differences, dividing the nursing group into different potential categories. Based on this analysis, we studied the relationship between different potential categories and the work performance of nurses. Methods: A cross-sectional design using a multi-stage stratified cluster random sampling method. From December 2022 to January 2024, eligible nurses were recruited from four Grade-A tertiary hospitals in Shandong Province, yielding 1,877 valid questionnaires. The survey instruments included a self-designed demographic questionnaire, the Maslach Burnout Inventory-Human Service Survey (MBI-HSS), and the Work Performance Scale. Latent Profile Analysis (LPA) was utilized to categorize nurse burnout. Additional statistical analyses included descriptive statistics, one-way ANOVA, general linear regression analysis. Data were processed using SPSS 26.0 and Mplus 7.0. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Through LPA, we identified four distinct burnout profiles: "Low Burnout," "Emotional Exhaustion/Depersonalization," "Reduced Personal Accomplishment," and "Moderate Burnout." Significant differences were observed across these profiles in total job performance scores, task performance. and contextual performance. Post-hoc tests revealed that nurses in the "Low Burnout" group scored significantly higher in task performance, contextual performance, and total job performance than those in the other three categories. Conversely, nurses in the "Reduced Personal Accomplishment" group had significantly lower scores for contextual and total job performance than those in the "Low Burnout" and "Emotional Exhaustion/Depersonalization" groups. General linear regression analysis, controlling for age, gender, marital status, education level, years of service, and monthly night shifts, indicated that compared to the "Low Burnout" group, job performance scores for the "Emotional Exhaustion/Depersonalization," "Reduced Personal Accomplishment," and "Moderate Burnout" groups decreased by 3.814 standard deviations, respectively. Conclusion: The prevalence of burnout among nurses in Grade-A tertiary hospitals is high. Nurse burnout can be categorized into four latent profiles: "Low Burnout," "Emotional Exhaustion/Depersonalization," "Reduced Personal Accomplishment," and "Moderate Burnout." Nurses in the "Low Burnout" group demonstrated the best job performance, whereas those in the "Reduced Personal Accomplishment" group exhibited the poorest performance.

Background: Nurses' work flourishing is vital for healthcare quality, yet how toxic leadership behaviors among nurse managers affect it remains unclear. Aim: We examined the relationship between nurse managers' toxic leadership and nurses' work flourishing from variable-centered and person-centered perspectives, and tested whether occupational burnout mediated this association. We hypothesized that higher toxic leadership would be associated with lower flourishing, and that occupational burnout would mediate this association. Methods: This was a cross-sectional study. Using convenience sampling, 2337 nurses completed an online questionnaire (July-August 2024) including the Work Flourishing Scale, a Nurse Managers' Toxic Leadership Behaviors scale, and the Maslach Burnout Inventory-General Survey (MBI-GS). Data were analyzed with multivariable linear regression, weighted quantile sum regression analysis, cumulative-risk models, latent profile analysis, and mediation analysis (PROCESS). Results: Higher toxic leadership scores were associated with lower work flourishing; among behavior types, intemperate behavior had the largest independent negative effect. A cumulative-risk analysis showed a dose-response pattern. LPA identified three profiles (low, moderate, high), with nurses in the moderate-toxicity and high-toxicity profiles reporting poorer flourishing than those in the low profile. Mediation analysis indicated that occupational burnout mediated the association between toxic leadership and work flourishing. Conclusion: Toxic leadership (nurse managers) is negatively associated with nurses' work flourishing in a dosedependent manner; intemperate behavior shows the largest effect. Cumulative exposure and latent mid/hightoxicity managerial profiles are associated with work flourishing; occupational burnout mediates these relationships.

Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P < 0.001). Identifying subgroups at risk of low adherence may inform targeted strategies to improve engagement and clinical effectiveness. Using data from 71 randomized controlled trials that involve 8,082 participants, the authors of this individual participant data meta-analysis examine individual- and study-level predictors of adherence to internet-based interventions for depression.

OBJECTIVES:Despite the critical roles of maternal-offspring bonding and perinatal depression in maternal-child health, research has predominantly investigated static associations or unidirectional effects, overlooking their dynamic longitudinal interplay. This study aims to investigate the independent and joint developmental trajectories of maternal-offspring bonding and perinatal depression, and clarify their temporal sequence of influences at both between-person and within-person levels. METHODS:A total of 465 women were assessed at six timepoints using the Maternal Antenatal/Postnatal Attachment Scale to measure maternal-offspring bonding and the Edinburgh Postnatal Depression Scale to assess perinatal depressive symptoms. Latent class growth modeling (LCGM) was applied to identify independent trajectories of each construct, followed by parallel process LCGM to characterize their joint trajectories. Finally, random intercept cross-lagged panel modeling clarified temporal relationships between maternal-offspring bonding and depression at both between- and within-person levels. RESULTS:Maternal-offspring bonding and perinatal depression exhibited 4 and 3 heterogeneous trajectories, respectively. The joint trajectories of the two included two classes: "Adaptive maternal-offspring Bonding-Low Depression" (n = 315, 67.7 %) and "Deteriorating Maternal-Offspring Bonding-increasing Depression" (n = 150, 32.3 %). Cross-Lagged Effects show that higher maternal-offspring bonding at one timepoint predicted significantly lower depression at the subsequent timepoint (all p < .05). Conversely, maternal depression did not significantly predict later maternal-offspring bonding (p > .05). CONCLUSIONS:The findings revealed a significant dynamic interplay between the maternal-offspring bonding and perinatal depression, with particular emphasis on the preceding role of maternal-offspring bonding in modulating depressive symptoms over time.

Early life gut microbiota function as biological sensors for maternal prenatal exposure and play a crucial role in infant neurodevelopment. During pregnancy, air pollution and psychological distress are regarded as general and specific external exposures, respectively; however, the joint influence of these two domains on shaping early life gut microbiota remains unexplored. In this study, 309 mother-infant pairs were recruited from the obstetrics departments of two tertiary hospitals. We collected data on maternal prenatal air pollution exposure and psychological distress, obtained meconium samples within 48 h after birth, and assessed infant neurodevelopmental outcomes using the Ages and Stages Questionnaire-3 at 1, 3, and 6 months postpartum. Maternal prenatal air pollution-psychological distress exposure patterns were identified using a self-organizing map (SOM). The differential features of the meconium microbiota in relation to co-exposure patterns were assessed using multivariate association of linear models. Finally, the mediating role of the meconium microbiota in co-exposure patterns and infant neurodevelopment was analyzed using mediation analysis. We observed that the meconium microbiota at both the phylum and genus levels differed among the three patterns. Ruminococcus mediated the relationship between co-exposure patterns and infant neurodevelopment at 3 months of age (IE = 0.181-0.261, pFDR < 0.001). These findings support the inclusion of infant gut microbiota within frameworks assessing the risks of maternal prenatal co-exposure to environmental pollution and psychological distress, providing a scientific basis for policymakers to identify intervention targets for high-risk populations.

Objective This study investigates the association between nurses' exposure to toxic leadership and the co-occurrence of anxiety and depression, applying both categorical and transdiagnostic analytical frameworks. Methods A cross-sectional design was employed among 2337 nurses from 20 tertiary hospitals in China. Toxic leadership was assessed using the Toxic Leadership Behaviours of Nurse Managers scale. Anxiety and depression symptoms were measured with the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. To minimize potential confounding, propensity score matching was performed. A dual-framework analytical approach was adopted: (1) a categorical perspective, defining co-occurrence as concurrent scores of five or higher on both symptom scales; and (2) a transdiagnostic perspective, utilizing a bifactor model to extract a general psychopathology factor. Data were analysed using binary logistic and linear regressions. Results The prevalence of co-occurring anxiety and depression among nurses was 48.4%. Categorical analysis indicated that exposure to toxic leadership was associated with a fivefold increased odd of this co-occurrence. Although the interaction effect between gender and toxic leadership was not statistically significant, the association appeared markedly stronger in male nurses than in females. The transdiagnostic analysis corroborated these findings, showing a strong positive association between toxic leadership and the general psychopathology factor. Conclusions By integrating categorical and transdiagnostic perspectives, this study establishes a significant association between toxic leadership and the co-occurrence of anxiety and depression among nurses. As toxic leadership is a modifiable organizational factor, healthcare institutions should prioritize targeted interventions to safeguard the mental health and sustainability of the nursing workforce.

AIMS:This study aims to investigate whether higher levels of depression predict increased physical frailty over time and whether worsening physical frailty predicts higher levels of depression over time, at both the between-person and within-person levels. DESIGN:A longitudinal study. METHODS:A total of 269 patients who underwent cardiac surgery were included in this study at T1 (admission). We followed up depression and physical frailty at T2 (the seventh day after surgery), T3 (the day before discharge), and T4 (the three-month follow-up). To determine the temporal order of the association between depression and physical frailty at both between-person or within-person levels, we employed the cross-lagged panel model (between-person effects), and random intercept cross-lagged panel model (within-person effects). RESULTS:The cross-lagged panel model findings revealed a time-dependent shift in directionality: physical frailty initially predicted depression between T1 and T2, whereas depression subsequently emerged as a significant predictor of physical frailty from T2 to T4. These between-person effects suggest that the dominant direction of influence may vary across different perioperative stages. Notably, the random intercept cross-lagged panel model results identified a robust unidirectional within-person effect, indicating that increases in depression consistently predicted subsequent increases in physical frailty over time, while the reverse pathway was not statistically significant. This finding underscores the potential causal role of depression in driving physical frailty progression, beyond the influence of stable between-person characteristics. CONCLUSIONS:This study advances understanding of the depression-physical frailty relationship in middle-aged and older cardiac surgery patients by delineating temporal precedence and disentangling within- and between-person effects. Depression emerges as a key driver of physical frailty, underscoring the need to prioritize its management in postoperative care protocols. Future research should explore mechanisms linking intraindividual depression to physical frailty progression and evaluate integrated psychosomatic interventions to optimize recovery outcomes. REPORTING METHOD:We have adhered to the STROBE guideline. PATIENT OR PUBLIC CONTRIBUTION:This study did not include patient or public involvement in its design, conduct, or reporting.

BACKGROUND:Adverse childhood experiences can have adverse health consequences for both mothers and their children. However, the effects of maternal psychological resilience as a positive factor in offspring development are unclear. This study therefore aimed to determine the association between maternal psychological resilience during pregnancy and the neuropsychological development of infants. METHODS:Among 346 mother-infant pairs, mothers were categorized into four groups based on ACE exposure and prenatal psychological distress. Linear regression analysis was conducted to examine the associations with infant outcomes. RESULTS:Compared to the Resilient group, infants of mothers in the Non-resilient group and the group with psychological distress but no adversity had higher (less favorable) scores in Approach and Adaptability (β = 2.124-3.113, ps < 0.05). Infants of mothers in the Non-resilient group and those with psychological distress exhibited lower Gross and Fine motor skills scores (β = -0.23 to -2.41, ps < 0.05). No significant differences were observed between the Resilient group and the group with neither adversity nor psychological distress. CONCLUSIONS:This indicates that psychological resilience during pregnancy may buffer the negative effects of mothers' adverse childhood experiences on healthy developmental outcomes in offspring. These results can help guide the development of early intervention strategies aimed at breaking the intergenerational perpetuation of risk.

Introduction:This study was conducted to review the effectiveness of preventive mental health interventions for adolescents (aged 11-19 years) in reducing depression and suicidal tendencies. Methods:A systematic search was conducted to identify randomized controlled trials (RCTs) from the databases PubMed, CINAHL, EMBASE, and APA PsycINFO for the period 2011-2024. Studies were included based on strict inclusion/exclusion criteria, selecting those that reported preventive interventions addressing depression and suicidal tendencies among adolescents. The systematic review registration number is CRD42023384321. Results:Out of 1,210 studies, 13 RCTs were incorporated. The interventions yielded varied outcomes, with approximately half of the RCTs demonstrating reductions in depression and suicidal tendencies, comparable to the control group. Post-intervention, the majority of interventions exhibited mild to moderate effect sizes; however, further research is warranted to assess their long-term efficacy. Cognitive-behavioral therapy (CBT)-based psychoeducation interventions served as the primary approach, often implemented in school settings. However, these interventions were primarily delivered by specialists rather than teachers. Parental involvement in treatment emerged as a potential factor that could enhance the effectiveness of preventive interventions. Discussion and conclusion:While numerous interventions in this review showed effects comparable to control groups, the diversity in methodology, intervention types, and outcome measures poses challenges in drawing definitive conclusions. Therefore, future research should prioritize addressing these methodological discrepancies within their respective contexts.

We explored the intergenerational transmission effects of maternal adverse childhood experiences (ACEs) and infant neglect from multiple perspectives. The study included a sample of postpartum mothers and infants (N = 550) from the outpatient child health care department of a tertiary hospital in Jinan, Shandong Province, China. Our investigation followed three main lines of inquiry. First, the association of overall maternal ACEs with infant neglect was estimated. Secondly, the cumulative and independent effects of maternal ACEs on infant neglect were explored using the Adverse Childhood Experience Questionnaire-Revised (ACEQ-R) with 14 types of ACEs. Finally, the different patterns of 14 maternal ACEs were identified, and the association between the different patterns and infant neglect was explored. There were three main findings. First, infants born to mothers with ACEs experienced higher levels of neglect compared to those born to mothers without ACEs. Second, infants born to mothers with three or more subtypes of ACEs experienced the greatest levels of neglect, with maternal childhood physical neglect emerging as a particularly influential factor. Third, infants in the "median maternal ACEs" and "high maternal neglect and poor peer relationship" groups experienced more severe neglect than those in the "low maternal ACEs" group. These results suggest that early life experiences substantially shape future parenting behaviors, such as infant neglect.

Background Gynecologic cancer couples have reported high depressive symptom levels. Mindfulness and psychological flexibility are negatively associated with depressive symptoms, but their beneficial effects have rarely been studied beyond the individual level. Few studies address their associations with depression in patient–spouse dyads facing gynecological cancer. Objective Explore dyadic associations among couples regarding mindfulness, its five facets, and psychological flexibility with depressive symptoms. Study design A cross-sectional study. Methods One hundred dyads with one person diagnosed with gynecological (cervix uteri, corpus uteri, or ovary) cancer and their spouses responded to surveys examining depressive symptoms, mindfulness (observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience), and psychological flexibility. The Actor–Partner Interdependence Model was used to explore dyadic associations. Results Patients’ and spouses’ acting with awareness (actor effect: β = −0.440, P < 0.001; β = −0.207, P = 0.045) and Acceptance and Action Questionnaire-II (AAQ-II) scores (actor effect: β = 0.604, P < 0.001; β = 0.370, P < 0.001) were associated with depressive symptoms. Patients’ acting with awareness and AAQ-II scores were associated with spouses’ depressive symptoms (partner effect: β = −0.252, P = 0.015; β = 0.227, P = 0.016). Couple similarity scores in describing and non-judging scores played a significant role in patients’ and spouses’ depressive symptoms (describing: β = 0.197, P = 0.045; β = 0.313, P < 0.001; non-judging: β = 0.336, P < 0.001; β = 0.212, P = 0.033). Conclusions Mindfulness and psychological flexibility can affect couples’ psychological distress. Future research should examine whether couples facing gynecological cancers benefit from programs that foster an awareness of attending to the present moment and psychological flexibility.

OBJECTIVES:Digital health technology (DHT)-based psychological interventions are emerging as a means to enhance psychological outcomes for cancer survivors. This study aims to assess the effects of DHT-based psychological interventions on anxiety, depression, sleep disturbances, fatigue, and quality of life among cancer survivors. METHODS:A systematic search was conducted in PubMed, Web of Science, the Cochrane Library, and Embase. The Cochrane risk-of-bias tool RoB 2 was used to evaluate the quality of the included studies. The Template for Intervention Description and Replication (TIDieR) checklist was used to check if the interventions reviewed were described in detail to be implemented in the clinical setting. Data synthesis was conducted in Review Manager (Version 5.4), and the effect size was calculated by the standardized mean difference and its 95% confidence interval. Sensitivity analysis and subgroup analysis were also conducted. The certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:This meta-analysis encompassed 46 randomized controlled trials, involving 5211 participants. DHT-based psychological interventions significantly reduced anxiety (SMD = -0.41, 95% CI -0.59/-0.24), depression (SMD = -0.26, 95% CI -0.39/-0.13), sleep disturbance (SMD = -0.39, 95% CI -0.64/-0.14), fatigue (SMD = -0.47, 95% CI -0.77/-0.17), and improved quality of life (SMD = 0.42, 95% CI 0.22/0.62). Subgroup analysis indicated that interventions lasting for a duration of ≥ 12 weeks, and integrated interventions might be the most effective in addressing adverse psychological outcomes. And cognitive-behavioral therapy interventions demonstrated significant effectiveness in managing sleep disturbance. CONCLUSION:DHT-based psychological interventions might be effective for improving anxiety, depression, sleep disturbances, fatigue, and quality of life in cancer survivors. We cannot draw definitive conclusions due to intervention and study design heterogeneity. Further rigorous trials are crucial to identify optimal interventions for different types of cancers, determine suitable durations, specify types of DHT-based psychological interventions and validate intervention therapies.

BACKGROUND:Poor sleep quality is a common yet often overlooked complaints among pregnant women. The relationship between adverse childhood experiences (including dimensions of abuse, neglect, and family dysfunction), negative life events during pregnancy (categorized as distant and proximal negative life events respectively), and sleep quality remains ambiguous. This study explores the independent, cumulative, and interaction effects of these factors from a life course perspective, utilizing the cumulative risk model, stress-sensitization and stress-inoculation models. METHODS:We recruited 736 pregnant women from a prenatal clinic in Shandong province. Data on childhood adversity, negative life events during pregnancy, and sleep quality were collected through self-reported questionnaires. The study employed the eXtreme Gradient Boosting, linear regression model and hierarchical regression analysis to examine the relationship between the distant and proximal negative life events on sleep quality. RESULTS:Emotional abuse (gain = 0.184) and changed sleep, diet, or clothing habits (gain = 0.103) were the most strongly associated distant and proximal negative life events related to poor sleep quality respectively. Cumulative scores of distant (β = 0.421, 95%CI, 0.172-0.670) and proximal (β = 0.383, 95%CI, 0.299-0.467) negative life events demonstrated a significant positive correlation with poor sleep quality. The interaction effects of distant (abuse dimension) and proximal negative life events on sleep quality aligned with the stress-sensitization model. CONCLUSION:Distant and proximal negative life events play an important role in sleep quality among pregnant women. Healthcare professionals should consider these factors when providing recommendations and interventions.

BackgroundPrenatal insomnia symptoms are prevalent, debilitating, and largely untreated; yet, there is a lack of empirically supported and accessible interventions. Mindfulness-based interventions have been theoretically hypothesized to alleviate insomnia symptoms by counteracting adverse sleep-related cognitive and behavioral processes, although few studies have tested them. ObjectiveThis study aimed to examine the effectiveness and potential mechanisms of a digital mindfulness-based intervention targeted at prenatal insomnia (dMBI-PI) in reducing insomnia symptoms. MethodsA single-blind randomized controlled trial was conducted from October 2021 to February 2023. A total of 160 eligible pregnant women (mean age 30.54, SD 3.86 years) with subthreshold to clinical insomnia symptoms (corresponding to a score of ≥8 on the Insomnia Severity Index) were recruited from obstetrics clinics and then randomized 1:1 into the intervention group (the 6-week dMBI-PI plus standardized care) or the control group (standardized care). The primary outcome was the insomnia symptoms assessed at baseline, immediately after the intervention, 2 months after the intervention (approximately the third trimester), and 42 days post partum. The secondary outcomes included insomnia remission rates and reliable change rates, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, sleep quality, fatigue symptoms, daytime sleepiness, anxiety, and depressive symptoms. The hypothesized mediators included sleep-specific rumination, sleep-specific worry, presleep arousal, sleep-related attentional bias, and maladaptive behaviors. All outcomes were self-assessed through web-based questionnaires. Linear mixed model analysis was conducted to examine the dMBI-PI’s effects. ResultsCompared with the control group, the intervention group had significantly greater improvements in insomnia symptoms from baseline to the end of the intervention (mean between-group difference –2.02, 95% CI –3.42 to –0.62; P=.005; Cohen d=0.46, 95% CI 0.01-0.92) and from baseline to the third trimester (mean between-group difference –2.02, 95% CI –3.42 to –0.61; P=.005; Cohen d=0.46, 95% CI 0.01-0.92), but a beneficial effect was not observed post partum. The intervention group had a significantly increased likelihood of achieving insomnia remission or reliable change at the third trimester; however, we did not observe significant between-group differences in the changes in most secondary outcomes. The changes in adverse cognitive and behavioral processes (mainly sleep-specific worry and presleep arousal) significantly mediated the dMBI-PI’s effect on prenatal insomnia symptoms. ConclusionsThe dMBIs showed significant short-term benefits for prenatal insomnia symptoms by mitigating sleep-specific worry and presleep arousal and may therefore hold promise as a first-step, pragmatic, and accessible option for pregnant women at risk of insomnia. Trial RegistrationChinese Clinical Trial Register (ChiCTR) ChiCTR2100052269; https://tinyurl.com/4bb8f7ah

BACKGROUND:Maternal psychological distress during pregnancy is associated with unfavorable infant outcomes. Although mindfulness-based interventions can effectively alleviate such distress, barriers often limit access to face-to-face interventions. Psychological distress among partners is also common during pregnancy and affects maternal mental health and the parent-child relationship. However, corresponding research remains scarce. OBJECTIVE:We evaluated the effectiveness of a digital mindfulness-based intervention for expectant parents (dMBI-EP) in reducing parental psychological distress and improving infant neuropsychological performance. METHODS:We recruited 160 couples in this randomized controlled trial who were expecting their first child, with the pregnant women at 12-20 weeks of gestation. The couples were randomized into a dMBI-EP group (n=80) receiving regular perinatal care plus a 6-week intervention delivered through a WeChat mini-program and a control group (n=80) receiving regular perinatal care only. The primary outcomes were parental psychological distress symptoms (depression, anxiety, and perceived stress) assessed at baseline (T1), 2 weeks after completion of the intervention (T2), and 6 weeks post partum (T3). Secondary outcomes included other parental psychological outcomes (fatigue, sleep problems, marital intimacy, and parental-fetal bonding) assessed at T1 and T2, and infant neuropsychological outcomes assessed at T3. RESULTS:The study included 160 pregnant women (mean age 26.89, SD 2.78 years) and their 160 partners (mean age 29.01 years, SD 3.21). For pregnant women in the intervention group, the average levels of depression, anxiety, and perceived stress shifted from 9.28 (SD 5.50), 5.04 (SD 3.39), and 14.85 (SD 5.46) to 6.40 (SD 4.64), 3.90 (SD 3.00), and 11.50 (SD 5.76), respectively. In the control group, the corresponding levels shifted from 10.04 (SD 4.71), 5.84 (SD 3.70), and 14.91 (SD 5.08) to 9.84 (SD 5.86), 5.66 (SD 4.14), and 15.53 (SD 6.23). The mean between-group differences for depression, anxiety, and perceived stress were -3.56 (Cohen d=0.65; P<.001), -1.80 (Cohen d=0.49; P=.002), and -4.01 (Cohen d=0.67; P<.001) at T2, respectively. For intervention group partners, the average levels of depression, anxiety, and perceived stress shifted from 6.94 (SD 5.45), 3.00 (SD 3.20), and 13.46 (SD 5.98) to 5.39 (SD 4.69), 3.11 (SD 3.41), and 11.53 (SD 7.96), respectively, whereas the corresponding levels shifted from 6.13 (SD 4.38), 3.65 (SD 3.09), and 12.95 (SD 5.34) to 7.28 (SD 5.39), 4.17 (SD 3.81), and 12.67 (SD 6.04) in the control group. The mean between-group difference in depression at T2 was -1.95 (Cohen d=0.38; P=.006). Moreover, the average scores of infants' activity level, approach, intensity of reaction, quality of mood, distractibility, and adaptability at 6 weeks post partum were significantly higher in the control than in the intervention group (2-tailed t122=2.330-5.124; all P<.05), with Cohen d ranging from 0.42 to 0.92. CONCLUSIONS:The dMBI-EP reduced the scores of psychological distress in couples, with potentially sustained benefits extending into the early postpartum period, and may contribute to more favorable infant neuropsychological development outcomes. TRIAL REGISTRATION:Chinese Clinical Trial Register ChiCTR2200059598; https://www.chictr.org.cn/showproj.html?proj=162809.