To identify dyadic patterns of family resilience among adolescents and young adults (AYAs) with cancer and their caregivers, and to explore associated factors and their relationships with quality of life (QoL) in both parties. This cross-sectional study recruited 202 AYA patient-caregiver dyads from four tertiary hospitals in Wuhan and Taiyuan between July 2022 and March 2024. Data were collected through a self-designed general information questionnaire and validated instruments assessing family resilience, individual resilience, social support, and QoL. Family resilience clusters were identified using K-means clustering in R 4.4.3, followed by regression analyses in SPSS 20.0. Two family resilience clusters were identified: the low and high family resilience clusters. High resilience clusters were characterized by having an only child, a shorter disease course (1 3 months), having a smaller family size (≤ 3 family members), and shorter daily caregiving hours. Caregiver QoL was associated with family resilience cluster, caregiver employment changes, and social support, whereas patient QoL was primarily influenced by their individual resilience. This study identified heterogeneity in family resilience among AYA patient-caregiver dyads, with smaller family size, a shorter disease course, and shorter caregiving hours associated with membership in the high resilience cluster. Caregiver well-being was closely linked to family resilience and social-contextual factors, while patient QoL depended more on individual resilience. These findings advance understanding of family resilience in AYA oncology and underscore the importance of family-centered psychosocial support to strengthen family functioning, alleviate caregiver burden, and foster patient resilience.

Generative artificial intelligence (GenAI) chatbots are increasingly used for mental health support, but trust in these emotionally vulnerable and relationally sensitive interactions remains poorly understood. This study aims to synthesize empirical evidence on how trust is conceptualized, shaped, and associated with outcomes in GenAI-based mental health support, with attention to differences across AI roles. This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Peer-reviewed empirical studies were identified by searching five electronic databases. Two reviewers independently screened records, selected eligible studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool. Data were synthesized descriptively and thematically. Of 1180 citations retrieved, 28 studies were included. Trust was rarely explicitly defined and was most often operationalized through affective and relational indicators, including emotional comfort, perceived empathy, and psychological safety, rather than technical competence alone. Trust-related antecedents involved user vulnerability and attitudes, system reliability and emotional responsiveness, interactional continuity, and contextual constraints. Trust was associated with engagement and emotional relief, but also with relational and safety concerns, including excessive reliance on AI support, blurred role boundaries, and inadequate responses to crisis-related disclosures. Role-based synthesis suggested that lower-engagement roles (eg, functional assistants and structured facilitators) mainly involved cognitive trust, whereas more emotionally engaging or autonomous roles (eg, empathetic co-therapists and therapeutic companions) involved broader affective and alliance-like trust, together with greater relational and safety risks. Trust in GenAI-based mental health support should not be treated as a uniform or inherently desirable outcome. Role-sensitive evaluation and governance are needed to align user trust with system capability, safety boundaries, and responsibility.

Anhedonia is a common problem among patients with depression. Negative life events have been associated with the severity of anhedonia, potentially through insomnia and dysfunctional attitudes. This study aimed to investigate whether insomnia and dysfunctional attitudes mediate the relationship between negative life events and anhedonia among patients with major depressive disorder (MDD). This study involved 979 participants with MDD in a public hospital from December 2019 to December 2021. The Life Events Scale (LES), Insomnia Severity Index (ISI), Dysfunctional Attitude Scale (DAS), Snaith-Hamilton Pleasure Scale (SHAPS) were used to assess participants’ negative life events, insomnia, dysfunctional attitudes and anhedonia. Five hundred and twenty-three participants reported symptoms of anhedonia (SHAPS > 33, 53.4

Cognitive Behavioral Therapy (CBT) serves as a powerful tool in addressing and resolving irrational thoughts, especially when related to mental illness. Therefore, accurate identification of cognitive pathways is essential for its successful application in providing psychological support. Today, people’s negative emotional expressions on social media about certain topics (such as “depression”) often contain cognitive distortions and follow incorrect cognitive paths. However, there is a distinct lack of data to analyze cognitive pathways, as well as tools to help psychotherapists identify them effectively. In this study, we defined the cognitive path extraction task as a hierarchical text classification task based on cognitive behavioral therapy, which contains four parent categories and nineteen subcategories. We collected a total of 5,282 sentences from social media and then annotated the data to create a cognitive path extraction dataset. We proposed an interpretable tree structure model and explored three different hierarchical classification strategies. It was verified that our model outperformed five other encoder-based models and far outperformed four decoder-based models while maintaining interpretability. On another public comparison dataset, it also achieved better performance than the other seven models. We have released the code publicly: https://github.com/liuhanfei0426/Hierarchical-Text-Classification-wise2025 .

BackgroundWith the increasing integration of simulation-based education in healthcare, the role of simulation facilitators has become pivotal. This study aimed to compare the effectiveness of online versus onsite training for simulation facilitators.MethodsA quasi-experimental design was employed. Participants were assigned to either an online training group or an onsite training group based on their availability and preference, with both groups receiving identical and synchronized training content. Data were collected at baseline and immediately post-intervention.ResultsOf 219 recruited participants, 100 completing the intervention and evaluation (78 online, 22 onsite). Both groups improved significantly in core competencies, with no significant difference in the percentage change between the groups. The online training group demonstrated significant enhancements in debriefing skills and simulation-based education self-efficacy, whereas the onsite group showed improvements that did not reach statistical significance. However, adjusted analyses revealed no statistically significant between-group differences in the percentage change from baseline for simulation facilitator core competency, debriefing skills, simulation-based education self-efficacy, or willingness to use simulation-based education.ConclusionThe findings of this study indicate that online training is as effective as onsite training in improving simulation facilitator core competency and willingness to use simulation-based education. This suggests that online training could be a viable alternative to onsite training.

Purpose: Depression, anxiety and Insomnia are common among middle school students. Non-suicidal self-injury (NSSI) has become an important mental health issue in this group. This study explores the comorbid relationship between depression, anxiety, and insomnia symptoms among junior high school students from a network perspective and investigates the associations between these symptoms and NSSI. Patients and Methods: This study was a cross-sectional design with convenience sampling, and students from junior high schools in Wuhan, China, were selected in October 2023 (N=8244) as survey respondents. An online questionnaire was used to collect data. The Patient Health Questionnaire, Generalized Anxiety Disorder Scale and Insomnia Severity Index were used to assess depression, anxiety and insomnia. Whether NSSI behaviors occurred in the last 1 year was obtained by self-report. Network analysis was used to assess core and bridge symptoms of the depression, anxiety and insomnia co-morbidity network and associations with NSSI. Results: The results revealed that GAD2 "Control Worry", GAD3 "Excessive Worry" (EI = 1.040), ISI2 "SleepMaint" (EI=1.025) and PHQ2 "Hopeless" (EI=1.018) were the central symptoms of the network, exhibiting the highest expected influence values. GAD5 "restlessness" (BEI=0.376) and PHQ4 "Lack of Energy" (BEI=0.351), PHQ6 "self feeling" (BEI=0.325) and GAD1 "Nervous" (BEI=0.296) were the bridge symptoms. PHQ9 "Suicidal Ideation" (edge weight = 0.33) showed the strongest connection to NSSI. The network comparison test results indicated a more densely connected symptom network in the NSH group than in the NSSI group. Conclusion: Symptoms related to worry are core factors in the network of depression, anxiety, and insomnia among junior high school students. Suicidal ideation is directly and closely associated with NSSI. These symptoms may serve as key targets for early screening and intervention, while the strong link between suicidal ideation and NSSI underscores the need for timely prevention efforts in this vulnerable population.

ABSTRACT Background and Aims High fasting blood glucose (FBG) ranks fifth among the global risk factors for disease burden, influenced by both individual and environmental factors. However, the roles of social and neighborhood environmental factors remain underexplored in China. This study aimed to estimate the relationship between neighborhood environment, social factors, and FBG among adult residents, and explore potential interaction. Methods This cross‐sectional study included 440 participants from two public hospitals in China. We collected data on social factors, FBG, and participant characteristics using electronic questionnaires, anthropometric measurements, and physical examination. The neighborhood environment features were measured using the geographic information systems (GIS) methods. Linear regression analysis was used to examine associations between neighborhood environment features and social factors and FBG. Results This study found that marital status (married VS unmarried; β = 0.21, p < 0.001) and the highest quartile of residential housing density (Q4 vs Q1, β = 0.16, p = 0.03) had significant associations with higher FBG levels. The quartiles of the normalized difference vegetation index (NDVI) (Q2, β = −0.14, p = 0.04; Q3, β = −0.19, p = 0.004; Q4, β = −0.21, p = 0.003) and sports facility density (Q2, β = −0.18, p = 0.002; Q3, β = −0.20, p = 0.008; Q4, β = −0.30, p < 0.001) were significantly associated with lower FBG. Furthermore, the second, third, and fourth quartiles of sports facility density and the fourth quartile of residential housing density showed stronger associations with FBG by the interaction with educational level (high vs low). There were also significant interaction effects between residential housing density and subjective economic status, and between NDVI and marital status on FBG. Conclusion This study suggests that marital status, residential greenness, and densities of sports facility and residential housing are associated with FBG, and demonstrates potential interaction. Future research is necessary to further clarify these relationships and explore the underlying mechanisms.

Background Anxiety is a prevalent mental health issue among junior high students, significantly impacting their physical and psychological well-being. This study aimed to investigate the developmental trajectory of anxiety in this population and its underlying causes and outcomes, providing support for adolescent mental health interventions. Methods A total of 1479 junior high students participated in a three-wave longitudinal study over two years. Latent Growth Curve Modeling was employed to examine the developmental trajectory of anxiety, and analyze the effects of gender and family functioning on the trajectory and the trajectory's predictive role for Non-Suicidal Self-Injury (NSSI). Additionally, Latent Class Growth Modeling was used to explore heterogeneous subgroups within the anxiety trajectory. Multivariate logistic regression analyzed the predictive validity of gender and family functioning for trajectory class membership and the predictive effect of anxiety trajectory classes on NSSI. Results The overall anxiety trajectory exhibited a linear increasing trend. Female students showed higher initial anxiety levels and faster increases. Family functioning significantly negatively predicted anxiety levels. The anxiety trajectory predicted the occurrence of NSSI.Three distinct latent classes of anxiety trajectories were identified: High/ Increasing, Moderate/Increasing, and Low/Decreasing. Gender and family functioning significantly predicted class membership. Individuals in the High/Increasing and Moderate/Increasing classes were more likely to engage in NSSI. Conclusions Anxiety levels in junior high students show an overall linear increase. Gender and family functioning significantly influence the trajectory and predict subgroup membership. The anxiety trajectory predicts subsequent NSSI. Therefore, adolescent mental health interventions should address multiple factors and anxiety-specific risk profiles.

BackgroundExtensive research has focused on the top-down intergenerational transmission of psychopathological symptoms (ITP). However, little is known about the bidirectional and transactional dynamics of ITP between primary caregivers and their adolescent offspring in community-based samples. In particular, the moderating roles of caregiver and adolescent gender in these intergenerational associations remain underexplored.MethodsBetween 2021 and 2022, a total of 1414 primary caregiver-adolescent dyads completed two waves of surveys assessing sociodemographic characteristics, as well as depressive and anxiety symptoms. The actor-partner interdependence model (APIM) was applied to examine the bidirectional transactional patterns of psychopathological symptoms within these dyads. Multiple-group comparison tests were conducted to evaluate the moderating effects of caregiver and adolescent gender on these associations.ResultsAdolescents' depressive and anxiety symptoms significantly predicted subsequent depressive and anxiety symptoms in their primary caregivers. In contrast, only caregivers' anxiety symptoms were found to predict subsequent adolescents' depressive and anxiety symptoms. Multiple-group comparison tests indicated no significant moderating effects of caregiver or adolescent gender on the ITP.ConclusionThese findings suggest that depressive and anxiety symptoms may be mutually reinforced between adolescents and primary caregivers over time. A family-based approach to early identification and prevention could be a promising direction for interrupting escalating cycles of negative emotions across generations.

ObjectiveFamily resilience plays a vital role in coping with cancer. However, little research has explored how adolescents and young adults (AYAs) with hematological malignancies and their families adapt to cancer, particularly during this critical developmental stage.AimsThis study aims to explore how AYAs with hematological malignancies and their families experience the dynamic process of family resilience.MethodsUsing a descriptive phenomenological approach, semi-structured interviews were conducted with 40 participants from 26 families, including 19 AYAs with hematological malignancies and 21 family caregivers. Data were collected between April 2023 and March 2025 at two general hospitals in central China. Interviews were analyzed using Colaizzi's method.ResultsFour themes and 11 subthemes emerged. Theme 1: challenges faced by families: (a) multiple challenges for patients, (b) intense family caregiver burden, and (c) shared fear of relapse and uncertainty. Theme 2: internal adaptation within families: (a) flexible role and responsibility adjustment, (b) fostering shared decision-making and autonomy through communication, and (c) emotional suppression and coping strategies. Theme 3: external social support and resources: (a) received social support, and (b) limitations in the social support system. Theme 4: self-transcendence and growth: (a) personal growth, (b) gratitude toward family and society, and (c) maintaining hope and adjusting plans.ConclusionsThis study reveals that family resilience among AYAs with hematological malignancies is a dynamic and cyclical process shaped by continuous adaptation to evolving challenges. While family resilience supports personal growth, families remain under ongoing stress. These findings highlight the need for culturally sensitive and developmentally tailored interventions to better support both patients and caregivers throughout the illness trajectory.

RATIONALE:China's floating population has grown significantly due to rapid economic development and urbanisation. However, this population faces substantial barriers to accessing and utilising health services. Identifying factors affecting health service coverage and access among the floating population is essential for guiding targeted interventions to improve overall population health. AIMS AND OBJECTIVES:This study aims to explore the trends and socio-demographic factors influencing health insurance and public health service coverage among the floating population in Hubei Province from 2014 to 2017. METHODS:We performed a trend and regression analysis on data collected from 2014, 2015, 2016 and 2017 in Hubei Province from the China Migrant Population Dynamics Monitoring Survey. The data included socio-demographic and economic characteristics and health insurance coverage. Local health care record establishments and health education access were measured as indicators of basic public health service coverage. RESULTS:From 2014 to 2017, 89.01%, 93.45%, 88.49% and 93.37% of respondents, respectively, were covered by at least one type of basic health insurance. During the same period, the establishment of local health records increased from 45.36% in 2014 to 64.52% in 2016, before declining to 36.90% in 2017. Additionally, 83.24%, 90.95%, 89.11%, and 64.11% of respondents, respectively, received health education. While progress was made in improving health service infrastructure, its growth was inconsistent and lacked sustainability. Factors associated with higher local health record coverage included long floating time, individual household employment status, willingness for long-term residence, and medical insurance coverage. Factors influencing access to health education varied annually. CONCLUSIONS:Efforts should be directed towards optimising health insurance policies, adjusting the allocation of medical resources, and strengthening community health services to enhance health care capacity in areas with a high concentration of floating populations. These measures can help improve local public health service coverage and health information access among the floating population.

PurposeThis study aims to understand healthcare providers' (HCPs) perspective and clinical practices regarding fertility preservation in young hematologic patients, particularly from hematology, reproductive medicine, and ethics committee professionals.MethodsAn empirical phenomenological approach was employed. HCPs were recruited from the hematology, reproductive medicine, and ethics committee professionals of eight tertiary hospitals in China using purposive sampling. They participated in semi-structured, in-depth face-to-face individual interviews. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method.ResultsA total of 33 HCPs were recruited, including 12 hematology physicians, two pediatric hematology physicians, six hematology nurses, nine reproductive medicine physicians, two reproductive medicine nurses, and two ethics committee members. The analysis revealed three major themes and associated subthemes: (1) HCPs' overall perspectives of fertility preservation: all recognized its importance and feasibility in young patients with hematologic diseases, though interdepartmental differences; (2) Fertility preservation practice status: still in its early stages, communication strategies are crucial, and balancing the urgency of disease treatment with fertility preservation remains a challenge; and (3) Multi-level challenges and recommendations: challenges exist across the medical system, patient-related factors, and sociocultural levels, with recommendations proposed to address some barriers.ConclusionsHCPs recognized the importance and feasibility of fertility preservation for hematologic patients. However, its implementation faces challenges at multiple levels, including the medical system, patient-related factors, and sociocultural influences. To facilitate early discussions and informed decision-making about fertility preservation, it is crucial to enhance multidisciplinary collaboration, provide better support for patients and their families, and strengthen legal and policy frameworks.

Objective: The objective of this study was to investigate the current state of insomnia among secondary vocational school students, identify its influencing factors, and explore potential mechanisms of action. Methods: The study population consisted of 2150 students (968 male and 1182 female) enrolled in a secondary vocational school in Wuhan, China. A cross-sectional research design was employed to analyze the data using descriptive statistics, correlation analysis, structural equation modeling, and bootstrapping. Results: Adolescents with poorer family functioning, higher levels of paranoid personality traits, and higher levels of anxiety are more likely to experience insomnia. There was a significant direct association between family functioning and insomnia (β = −0.153, p < 0.001). Paranoid personality traits and anxiety were not only significant independent mediators in the relationship between family functioning and insomnia (paranoid personality traits: β = 0.021, 95% CI: [−0.035, −0.008]; anxiety: β= 0.173, 95% CI: [−0.204, −0.114]) but also chain mediators (β = 0.059, 95% CI: [−0.073, −0.048]). Conclusions: Managing insomnia in secondary vocational school students requires familial and individual strategies, including reducing family conflict, improving family functioning, and addressing cognitive biases and anxiety.

The intergenerational transmission of psychopathology has been well documented, but limited studies have examined the link at the symptomatic level accounting for these associations. This study aimed to identify the central symptoms that bridge adolescents and parental psychopathological symptoms and the specific symptom pathways by using a novel network approach. From September to October 2021, a cross-sectional study was conducted in Wuhan, China. A total of 8,032 adolescent-primary caregiver dyads completed a questionnaire reporting their depression and anxiety symptoms. Network analysis was used to identify central symptoms and the network pathways between adolescents' and parental psychopathological symptoms. Three robust networks were identified in this study: adolescent, parent, and integrated network. The nervous was the most central symptom in the adolescent network, while the parental fatigue was the most central symptom in both the parent and integrated network. Adolescents' suicidal ideation and parental fatigue had the most bridge strength that linked the adolescents' and caregivers' psychopathological symptoms. Parental and adolescents' suicidal ideation had the strongest association in the integrated network. Significant gender differences were found in the link between adolescents' and caregivers' psychopathological symptoms. Network analysis revealed the distinctive core psychopathological symptoms across each network and the specific pathways between adolescents' and caregivers' psychopathological symptoms. Family-based interventions or therapies targeting the resolution of central and bridge symptoms may have potential to reduce the co-occurrence of psychopathological symptoms within families. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:Existing studies primarily examine the relationship between childhood maltreatment (CM) and bullying behaviors from an accumulative perspective. However, there is limited understanding of this relationship when adolescents experience combined forms of childhood maltreatment, particularly in the context of varying residential environments. OBJECTIVES:This study aimed to identify latent patterns of childhood maltreatment and examine their association with bullying behaviors among Chinese adolescents. Additionally, residential area differences in these associations were explored. PARTICIPANTS:There were 13,029 Chinese adolescents (mean age = 14.4 years) who completed self-report questionnaires between October and November 2023. METHODS:Data on childhood maltreatment and school bullying were collected through self-report measures. Latent class analysis (LCA) was employed to identify distinct patterns of maltreatment. Multiple logistic regression was employed to explore the relationship between maltreatment patterns and bullying behaviors, with stratified analysis conducted by residential areas after propensity score matching (PSM). RESULTS:Three childhood maltreatment patterns were identified: low-abuse-low-neglect (class 1, 75.7 %), low-abuse-high-neglect (class 2, 20.9 %), and high-abuse-high-neglect (class 3, 3.5 %). Compared to class 1, class 2 was associated with elevated risks for being an only victim (OR = 1.68), only bully (OR = 1.57), or bully-victim (OR = 1.85). Class 3 showed even higher risks (only victim: OR = 3.71; only bully: OR = 4.79; bully-victim: OR = 7.95), with a clear gradient in risk severity. Stratified analyses revealed that adolescents in rural areas who primarily experienced neglect were more likely to be both bullies and victims compared to the urban adolescents (OR = 2.05, 95 % CI = 1.17-3.58, p < 0.05). CONCLUSIONS:Childhood maltreatment influences bullying behaviors among adolescents significantly, with distinct maltreatment patterns providing critical insights for risk stratification. Residential area differences further modulate these associations. Intervention strategies should account for diverse maltreatment patterns and contextual factors such as rural-urban disparities to effectively address bullying behaviors.

This study provides a comprehensive bibliometric analysis of the development and current status of digital and intelligence education in medicine over the past decade, with a focus on the integration of digital technologies in professional training. Using bibliometric methods, we analyzed publications between 2015 and 2024, identifying key research themes, emerging technologies, and the contributions of leading institutions and countries. The results show a steady increase in publications, particularly from 2022 to 2024, reflecting a growing global interest in digital and intelligence education in medicine, driven by technological advancements and the COVID-19 pandemic. Key themes identified include artificial intelligence-powered personalization, virtual reality in training, deep learning for medical imaging, and the use of language models for interactive teaching. However, challenges such as disparities in global research capacity, data privacy concerns, ethical issues, and resource inequality are also highlighted. Notably, the integration of intelligent digital platforms in education has been found to be transformative, particularly in clinical training, adaptive learning, and medical diagnostics simulation. The study concludes that while digital and intelligent technologies have the potential to revolutionize medical education, addressing ethical, technical, and resource-based challenges is crucial for equitable global implementation. Future research should focus on fostering international collaboration, developing standardized frameworks, and creating inclusive, low-cost digital tools to democratize medical education, thereby improving healthcare outcomes worldwide.

Adolescent non-suicidal self-injury (NSSI) is a major public health concern. Digital and family-based psychological interventions have shown promise for addressing NSSI; however, evidence for the effectiveness and accessibility of blended family-based interventions that combine face-to-face and digital components remains limited. To evaluate the effectiveness of a family-based blended psychological intervention in reducing NSSI behaviors and improving emotional and family outcomes among adolescents with NSSI. A quasi-experimental controlled design was conducted in the psychiatric inpatient unit of a mental health center in Wuhan, China. Sixty adolescents with NSSI and their primary caregivers were recruited and sequentially assigned to either the intervention or control group according to admission order. The 6-week blended intervention, grounded in cognitive behavioral therapy and dialectical behavior therapy for adolescents, combined therapist-led face-to-face sessions with digital modules delivered via a WeChat mini-program. The control group received routine care and equivalent attention. Primary outcomes were adolescents’ NSSI behaviors; secondary outcomes included emotion regulation, depression, anxiety, family function, and caregivers’ depression and anxiety. Outcomes were assessed at baseline and post-intervention by blinded evaluators. Between-group differences were analyzed using analysis of covariance (ANCOVA), controlling for baseline scores. Forty-eight participants completed the study (intervention n=23; control n=25). Compared with routine care, the blended intervention resulted in significantly greater reductions in adolescents’ NSSI behaviors (adjusted mean difference = −5.16, P = 0.03), emotion regulation difficulties (P = 0.003), depressive symptoms (P = 0.01), and anxiety symptoms (P < 0.001). Caregivers in the intervention group also showed greater improvements in depressive symptoms (P = 0.036) and anxiety symptoms (P = 0.001). The family-based blended intervention demonstrated significant effectiveness in reducing NSSI and emotional symptoms among adolescents, while also improving caregiver emotional states. Findings provide empirical evidence supporting the effectiveness and accessibility of blended family-based interventions for adolescent NSSI in real-world clinical settings. Chinese Clinical Trial Registry ChiCTR2400088438; https://www.chictr.org.cn/showproj.html?proj=205243

Background Large language models (LLMs) are increasingly applied in health care. However, concerns remain that their nursing care recommendations may reflect patients’ sociodemographic attributes rather than clinical needs. While this risk is acknowledged, there is a lack of empirical evidence evaluating sociodemographic bias in LLM-generated nursing care plans. Objective To investigate potential biases in nursing care plans generated by LLMs, we focused on whether outputs differ systematically based on patients’ sociodemographic characteristics and assessed the implications for equitable nursing care. Methods We used a mixed methods simulation study. A standardized clinical vignette experiment was used to prompt GPT-4 to generate 9600 nursing care plans for 96 patient profiles with varying sociodemographic characteristics (eg, sex, age, income, education, and residence). We first conducted a quantitative analysis of all plans, assessing variations in thematic content. Subsequently, a panel of senior nursing experts evaluated the clinical quality (eg, safety, applicability, and completeness) of a stratified subsample of 500 plans. Results We analyzed 9600 LLM-generated nursing care plans and identified 8 consistent themes. Communication and Education (99.98%) and Emotional Support (99.97%) were nearly universal, while Nurse Training and Event Analysis were least frequent (39.3%). Multivariable analyses revealed systematic sociodemographic disparities. Care plans generated for low-income patient profiles were less likely to include the theme Environmental Adjustment (adjusted relative risk [aRR] 0.90). Profiles with lower education were associated with an increased likelihood of including Family Support (aRR 1.10). Similarly, plans generated for older patient profiles were more likely to contain recommendations for Pain Management (aRR 1.33) and Family Support (aRR 1.62) but were less likely to mention Nurse Training (aRR 0.78). Sex and regional differences were also significant. Expert review of 500 plans showed high overall quality (mean 4.47), with strong interrater reliability (κ=0.76‐0.81). However, urban profiles had higher completeness (β=.22) and applicability (β=.14) but lower safety scores (β=–0.09). These findings demonstrate that LLM-generated care plans exhibit systematic sociodemographic bias, raising important implications for fairness and safe deployment in nursing practice. Conclusions This study identified that LLMs systematically reproduce sociodemographic biases in the generation of nursing care plans. These biases appear in two forms: they shape the thematic content and influence expert-rated clinical quality. These findings reveal a substantial risk that such models may reinforce existing health inequities. To our knowledge, this is the first empirical evidence documenting these nuanced biases in nursing. The study also contributes a replicable framework for evaluating LLM-generated care plans. Finally, it underscores the critical need for robust human oversight to ensure that artificial intelligence serves as a tool for advancing equity rather than perpetuating disparities.