Children’s screen use is an increasingly prominent global public health concern. However, existing guidance has largely focused on immediate caregivers, with limited attention paid to grandparents and other forms of intergenerational co-parenting (ICP). We conducted this scoping review to examine current knowledge about ICP and children’s screen use with four research questions: (1) How have ICP and children’s screen use been measured in existing studies?; (2) How does ICP affect children’s screen use?; (3) Are there any identifiable patterns of ICP that seem to be related to children’s screen use?; and (4) Within an ICP context, what factors have been found to influence children’s screen use? We searched five databases for articles published in English and Chinese between 2000–2025 and included 17 relevant studies. Nine were conducted in Western countries and eight in non-Western contexts such as China and Brazil. Ten were published in the past three years. We found that these studies had several methodological limitations, including inconsistencies in conceptualisation, a lack of methodological diversity, and limited use of multiple informants. Findings on the association between ICP and children’s screen use were mixed, although most studies suggested that ICP was linked to longer children’s screen use time. Different ICP patterns related to children’s screen use were also identified. Finally, five categories of influencing factors emerged: (i) children’s characteristics, (ii) parent’s characteristics, (iii) grandparent characteristics, (iv) media-related characteristics, and (v) family environment characteristics. Future research should prioritise this understudied area to better inform guidance for healthy screen use among children.

This study examines the practices and training needs of clinicians supporting autistic gender-diverse adolescents in Aotearoa New Zealand. A national survey of 43 clinicians revealed moderate confidence (62/100) in providing care. Screening for gender diversity in autistic adolescents was universal, while screening for autism in gender-diverse adolescents was less common (85-92%), showing a gap in bidirectional assessment. Clinicians working across both public and private services had slightly lower screening rates for autism. Key barriers identified were limited clinician knowledge, a lack of formal guidelines, and insufficient funding. Most clinicians (86%) reported no specific care pathways for this co-occurring condition, relying instead on generic interventions. Regional disparities in screening practices were also evident. Clinicians expressed a strong preference for accredited, in-person training and clearer national guidelines to improve care. The findings underscore an urgent need for improved practitioner guidance, interdisciplinary collaboration, and tailored resources to meet the complex needs of autistic gender-diverse youth. The study calls for policy and practice reforms to ensure equitable and affirming care across the country. Plain language summary: This study looked at how clinicians in Aotearoa New Zealand support adolescents who are both autistic and gender diverse. Autism is a neurodivergent way of experiencing the world, and gender diversity means a person's gender identity differs from the sex they were assigned at birth. These adolescents often face unique challenges, such as difficulties accessing care or being misunderstood by families and healthcare providers. Researchers surveyed 43 clinicians working with autistic and/or gender-diverse adolescents to understand their practices, challenges, and training needs. Key findings showed: center dot Screening: Clinicians were more likely to check for gender diversity in autistic adolescents (100%) than for autism in gender-diverse adolescents (85-92%). center dot Care Pathways: Most clinicians (86%) had no specific care plans for autistic gender-diverse adolescents, relying instead on general autism or gender support. Barriers included lack of guidelines, training, and funding. center dot Regional Differences: Auckland clinicians screened more frequently than those in other regions, highlighting uneven access to care. center dot Training Needs: Few clinicians (21%) had formal training in this area. Most wanted accredited in-person or online training (68%) and clearer national guidelines. The study highlights gaps in care, such as inconsistent screening and limited resources, which can leave autistic gender-diverse adolescents without the support they need. Clinicians called for better training, interdisciplinary collaboration, and standardized guidelines to improve care. This research is a first step toward ensuring these adolescents receive affirming, equitable care across Aotearoa New Zealand. Future work should include the voices of autistic gender-diverse adolescents to guide policy and practice changes.

INTRODUCTION:Adolescents in Aotearoa New Zealand (NZ) face rising mental health challenges amidst strained school support systems. Digital mental health interventions (DMHIs) offer scalable and cost-effective support, yet little is known about their real-world implementation in school settings, particularly for culturally diverse populations. METHODS:This study explored qualitative considerations of implementing Whitu for Schools (WFS), a digital wellbeing app, within secondary schools in NZ. A qualitative design using semi-structured interviews was conducted with 12 high school staff across 12 schools from the North Island, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. RESULTS:Participants described escalating student mental health concerns and limited access to timely support. WFS was welcomed as a timely, low-barrier intervention with engaging and culturally affirming content. However, challenges emerged around digital access, policy constraints (eg phone bans), staff digital literacy, and concerns about sustaining engagement. Effective implementation was seen as contingent on flexible, embedded delivery within school routines, tailored training, and ongoing student feedback. Equity was a recurring theme, with concerns that digital divides may reinforce existing disparities. DISCUSSION:WFS holds promise as a school-based digital wellbeing intervention, but successful implementation requires contextual responsiveness, strong staff and leadership buy-in, and equity-driven infrastructure. Findings highlight the importance of co-design, relational engagement, and sustained adaptation to ensure that digital tools meet the dynamic and diverse needs of rangatahi in NZ.

Universal school-based mental health programs for adolescents intend to promote wellbeing, but some evidence suggest that they may also cause harm. This scoping review aimed to map the state of knowledge on potential harms associated with these programs from the recent literature. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, four databases were searched for peer-reviewed studies published between 2019 and 2024. Articles were included if they evaluated a universal school-based mental health program for adolescents (13-18 years) and reported at least one quantitative outcome measure. Potential harms identified were classified into five harm types based on the observed data. Results showed that, of the 58 included studies, 29% (17 of 58) reported at least one type of potential harm. Statistically significant change in the overall sample was examined in all studies, with 16% (nine of 58) showing deterioration in at least one outcome. Statistically significant change by subgroup (e.g., age, gender, and baseline mental health) was examined in 21 studies, with 29% (six of 21) of these showing deterioration in at least one subgroup. Additional harms were identified through clinically meaningful deterioration, qualitative participant feedback, and safety protocols. Our findings confirm that universal school-based mental health programs can be associated with potential harms. Implications for research and practice are discussed.

Problem behaviours exacerbate the challenges associated with the core characteristics of autism during adolescence. Parenting interventions have demonstrated efficacy in addressing such behavioural challenges in younger autistic individuals, however, their evidence for autistic adolescents is sparse, particularly in low-income settings. This systematic review narratively synthesised studies outlining parenting interventions targeting problem behaviours in autistic adolescents. Seven studies were included with three providing comparable quantitatively data for their efficacy in improving problem behaviours. Five out of seven studies reported positive evidence on reducing problem behaviours. Characteristics including fewer sessions, instructional mode of intervention delivery and use of behavioural management skills were most commonly shared among statistically significant studies. Parenting interventions had a positive effect on adaptive behaviours for children, and improved parent wellbeing and knowledge. The overall satisfaction with interventions was high, however, only one study was conducted in a lower- and middle-income country. The findings underscore the encouraging evidence in an understudied area. The results emphasise the need to conduct further research for autistic adolescents and highlight potential parent-mediated interventions carry, given their acceptability and logistically scalable nature.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition for which early identification is essential to provide appropriate support and effective treatment. However, current diagnostic methods are resource-intensive and often inaccessible. Artificial Intelligence offers a promising alternative, but its effectiveness is hindered by algorithmic bias arising from data scarcity and imbalanced, largely unlabeled datasets. Such bias can lead to model overfitting, impaired learning, and poor generalization. While semi-supervised learning (SSL) can reduce reliance on manual labels through pseudo-label generation, conventional SSL approaches perform poorly under severe class imbalance, often amplifying label noise and bias. To address these challenges, we propose a novel Augmentative Semi-supervised Learning (ASSL) framework designed for robust learning in the presence of class imbalance and label scarcity. ASSL first applies pattern-based sampling to construct a balanced labeled dataset. It then employs a Collaborative Decision Labeling (CDL) strategy, where two heterogeneous models assign pseudo-labels using Dynamic Dual Thresholding (DDT), retaining only samples jointly and confidently labeled by both models. The framework was evaluated on the Autism AI dataset, which contains over 12,000 participants, most of whom lack diagnostic labels. Compared with conventional screening approaches, ASSL improved accuracy by 15.9

BACKGROUND:Rising rates of mental health and substance use are significant contributors to illness and disability among adolescents, highlighting a critical area for support and intervention. Existing evidence suggests the physical environment where young people live may impact their mental health. However, research is seldom longitudinal and rarely accounts for the co-location or mixture of potential environmental influences. OBJECTIVE:To assess longitudinal relationships between the physical environment in which young people reside in Aotearoa New Zealand and their mental health outcomes. METHOD:This study follows a population cohort of 957,381 young people (aged 10-24 years in 2018) over six years (2013-2018), linking their mental health outcomes (emotional, externalising, substance problems, and self-harm) and individual-level characteristics derived from administrative linked microdata with environmental data represented by the Healthy Location Index. Longitudinal Generalised Estimating Equations and quantile g-computing examined longitudinal relationships between the physical environments where young people reside and their mental health. RESULTS:We found evidence of longitudinal associations between the mixture of physical environment and young people's mental health for emotional disorders (aORΨ = 1.09 [1.08, 1.10]), substance use (aORΨ = 1.04 [1.02, 1.05]), and self-harm (aORΨ = 1.14 [1.10, 1.17]) (but not externalising conditions (aORΨ = 1.01 [0.99, 1.02])), present even after adjusting for individual-level and socioeconomic characteristics. Modelling emphasised the importance of the mix of the environments and the combined positive influence of natural spaces (bluespace and greenspace) for mental health outcomes. IMPORTANCE:This study provides longitudinal evidence of meaningful associations between exposure to the combined built and natural environment and mental health in young people. Specifically, living in predominantly health-constraining environments was associated with increased odds of emotional disorders, while greater access to and the mixture of greenspace and bluespace contributed to better mental health outcomes. Our findings are strengthened by a robust longitudinal nationwide study design and comprehensive adjustment, underscoring the significance of the environmental mix. These results extend current evidence and offer novel insights into how physical environments shape young people's mental health over time.

Introduction Suicidal ideation is common in young people and increases the risk of suicide. Effective interventions that are relevant and accessible to young people, so-called digital natives, are urgently required. There are key questions regarding the cross-cultural efficacy of suicide prevention applications (apps) for scalability.Methods and analysis This online four-arm parallel randomised controlled superiority trial will enrol 1480 young people aged 16–24 years with current suicidal ideation in New Zealand and Australia. Participants will be randomised to one of three therapeutic apps developed in different countries, Tune In, Bro and LifeBuoy, or to My Mood (attention control). The primary outcome is suicidal ideation severity at 30-day and 90-day post-baseline; secondary outcomes include mental well-being, engagement and acceptability. Emotional regulation will be examined as a mediator of change in suicidal ideation. All outcomes are measured by self-reported scales incorporated in an online questionnaire. Acceptability of the apps for rangatahi Māori (Indigenous youth, New Zealand) will be explored via semi-structured interviews. Linear mixed models with repeated measures analyses, using maximum likelihood estimation, an appropriate covariance structure and consideration of site effects, will be undertaken. Examination of an individual app intervention effects in New Zealand and Australia will highlight the effects of apps developed for a different country.Ethics and dissemination Approval was obtained (26 February 2025) from the Health and Disability Ethics Committees (Ministry of Health ref 2025 EXP 21500). Participants provide informed consent online. Trial results will be submitted for publication in peer-reviewed journals, shared on relevant websites and via presentation at international scientific conferences; Individial Patient Data will only be shared if requested and subsequent to review.Trial registration number ACTRN12625000349448.

PURPOSE:To estimate attention-deficit/hyperactivity disorder (ADHD) prevalence across gender identity, transgender status, and sexual identity using whole-population linked data in Aotearoa New Zealand (NZ). METHODS:A nationwide cohort study using the 2023 NZ Census linked to administrative health data within Stats NZ's Integrated Data Infrastructure. Individuals aged 5 to 24 years were included. ADHD was identified from lifetime diagnosis and treatment records. Modified Poisson regression models estimated adjusted incident rate ratios (IRRs) by gender, transgender status, and sexual identity. RESULTS:Among 1,266,456 individuals, 43,095 (3.4%) had ADHD. ADHD prevalence was higher among those identifying with another gender (10.3%) than males (4.6%) or females (2.0%), and among transgender (9.9%) than non-transgender individuals (3.4%). Among those aged 15 to 24 years, ADHD prevalence was higher in non-heterosexual (8.0%) than heterosexual individuals (3.6%). Adjusted analyses showed similarly elevated rates. CONCLUSION:ADHD prevalence was substantially higher among gender-diverse, transgender, and sexual diverse populations, highlighting the need for inclusive and equitable assessment and care pathways.

Abstract Purpose Asian populations are among the fastest-growing ethnic groups in Aotearoa New Zealand (NZ), yet little is known about the prevalence of neurodevelopmental conditions (NDCs) within these communities. The study compared the prevalence and age of diagnosis of NDCs (Attention Deficit Hyperactivity Disorder [ADHD], autism, communication and language disabilities [CLDs], intellectual disability [ID], motor disabilities [MDs], and specific learning disabilities [SLDs]) between NZ-born Asian and non-Asian populations, and differences across Asian subgroups. Methods A national cross-sectional analysis was conducted using linked administrative microdata from the Integrated Data Infrastructure, covering the 2021/22 estimated resident population aged 0–24 years (N = 1,334,247). Following adjustment for socioeconomic factors, standardized NDC rates were calculated for Asian and non-Asian populations and Asian subgroups (Indian, Chinese, Southeast Asian, and Other Asian). Results Lower standardized rates of NDCs were identified among Asian (2.85%, 95% CI [2.77, 2.94]) compared to non-Asian (4.52%, 95% CI [4.49, 4.56]) participants. Most notably, rates of ADHD (1.1%, 95% CI [1.05, 1.16] vs. 2.94%, 95% CI [2.91, 2.97]) and ID (0.34%, 95% CI [0.31, 0.38] vs. 0.58%, 95% CI [0.57, 0.60]) were significantly lower among Asian participants. Among Asian sub-groups, rates of NDCs were lowest for Chinese children, with particularly low rates of Autism, MDs and SLDs. Conclusion Findings highlight substantial differences in NDC rates between NZ-born Asian and non-Asian ethnicities, suggesting that socioeconomic context, cultural perceptions, and diagnostic pathways may influence identification patterns across and between Asian subgroups. Culturally responsive approaches are critical for equitable NDC identification and support.

Background: Individuals living with type 1 diabetes (T1D) are at an increased risk of experiencing psychological distress; however, there remains a scarcity of scalable and widely accessible support services, particularly for adolescents and young adults. To address this gap, digital mental health interventions are becoming an increasingly important area of innovation in diabetes care. Objective: This study aimed to explore qualitative feedback regarding the "Lift: Thriving with Diabetes" (Lift) well-being app, designed to support emotional well-being among adolescents and young adults with T1D, which was recently tested in a 12-week feasibility trial conducted in New Zealand and the United States. Methods: Of the 59 adolescents and young adults and 22 support people who participated in the main Lift feasibility trial, 13 agreed to participate in this secondary qualitative study. Participants attended a virtual focus group or 1-on-1 interview to discuss their experiences using the app and to explore their perspectives on the app's engagement, functionality, and perceived impact on well-being and diabetes-related coping. Transcribed audio recordings were analyzed using directed content analysis, guided by the Mobile Application Rating Scale end-user framework (with topics of engagement, functionality, aesthetics, and information quality) and interpreted from a realist theoretical position. Results: In total, 9 adolescents and young adults (mean age 21.5, SD 2.06 years; n=5, 56% men) and 4 support people (2 fathers, 1 friend, and 1 partner; mean age 31.3, SD 18.92 years; n=2, 50% men) completed interviews. Overall, participants viewed Lift as engaging, easy to use, and emotionally impactful. The most positive feedback focused on the app's interactive features, particularly a well-being tree that "grew" with increased engagement, and its "calming" visual aesthetics. Users also reported meaningful emotional or behavioral impact, particularly in promoting connection, self-awareness, and practical coping strategies in living with T1D. However, user feedback also highlighted areas for improvement, including the need for improved content pacing, personalization, connection with other digital health tools, and greater gamification to sustain long-term engagement. Participants consistently expressed a desire for content tailored to their age, role (eg, support person vs young person), and personal preferences (eg, voice, pace, tone, and interactivity). Conclusions: Findings underscore the potential of user-driven, emotionally intelligent digital tools to enhance well-being and connection for young people with T1D, as well as their support people. These insights can inform the refinement of Lift and the development of broader digital health interventions aimed at promoting well-being and fostering meaningful, sustained impact.

OBJECTIVES:This study was undertaken to investigate the comparative efficacy of a cognitive behavior therapy and biofeedback-based computer game (Starship Rescue: Vortex of Anxiety [SRVA]) and placebo well-being-focused computer game (Starship Rescue: Voyage of Wellness) for reducing symptoms of anxiety and improving quality of life among children and young people aged 8-18 with long-term physical conditions (LTPCs). MATERIALS AND METHODS:A randomized controlled trial was conducted with 60 participants (30 per arm). Primary outcomes were change in anxiety symptoms on the Generalized Anxiety Disorder 7-item (GAD-7) and Spence Children's Anxiety Scale (SCAS) at 4 weeks. Secondary outcomes were changes in anxiety symptoms at 3 months; changes in quality of life using the Pediatric Quality of Life Inventory (PedsQL) at 4 weeks and 3 months; and acceptability of SRVA recorded at 4 weeks. RESULTS:Participants in both groups experienced reduced anxiety (from a moderate to mild level) and improved quality of life at 4 weeks and 3 months. There were no significant group differences or time-by-group interactions observed for GAD-7, SCAS, or PedsQL. While SRVA was broadly acceptable, some suggestions for improvement of content and design were provided by users. CONCLUSIONS:Although this is the second study to demonstrate that SRVA can reduce levels of anxiety in children and young people with LTPC, previous questions regarding its efficacy and component-related benefits and new questions regarding the clinical value of physical health-oriented eHealth interventions remain unanswered. Further research is needed before SRVA can be recommended for clinical use.

OBJECTIVES:Anxiety disorders affect 20%-50% of youth with chronic medical conditions (CMCs) and can interfere with medical care and treatment outcomes. Psychological therapies are typically designed for youth without CMCs; thus, this systematic review (Open Science Framework preregistration osf.io/a52nd/) assesses the effect of psychological therapies on anxiety, functional impairment and health-related quality of life (HRQOL) in this unique population. METHODS:We included randomized controlled trials of psychological therapies vs. any comparator for youth (ages 24 and younger) with CMCs that assessed child anxiety. We excluded studies of adults and those not in English. Medline, Embase, PsycInfo, and CENTRAL databases were searched, studies were screened using COVIDENCE software, and meta-analysis was undertaken in R. Study quality was assessed using the Cochrane Risk of Bias tool, version 2. Quality of evidence was assessed using the GRADE system. RESULTS:Thirty-three studies with 2676 participants (ages 5-21 years) were included in the meta-analysis. Nearly all had at least some risk of bias. Overall, psychological interventions resulted in lower anxiety (Hedges' g = -0.48 [-0.71; -0.25]), but did not have a significant effect on functional impairment or HRQOL. Based on the GRADE criteria, we have moderate confidence in these results. Treatments with higher risk of bias and those with live therapist components had greater effects on anxiety. CONCLUSIONS:Psychological interventions may be effective for improving anxiety for children and youth with CMCs, particularly those with a live therapist. More high-quality studies are needed to understand what components produce the best outcomes for patients.

OBJECTIVES:Digitally native university students face challenges to their well-being and up to a third develop mental health problems. "Whitu: seven ways in seven days" is an app based on positive psychology, cognitive behaviour therapy (CBT) and psychoeducation principles. METHODS:Ninety-first year university students (45 per arm) participated in a randomised controlled trial of Whitu against a university self-help website ("Be Well"). Primary outcomes were changes in well-being on the World Health Organisation 5-item well-being index (WHO-5) and the short Warwick-Edinburgh mental well-being scale (SWEMWBS). Secondary outcomes were changes in depression, anxiety, self-compassion, stress, sleep and self-reported acceptability of the app. RESULTS:At 4 weeks (primary endpoint), participants in the intervention group experienced significantly higher mental well-being (mean difference: 2.53 (95%CI: 0.53, 4.52); p = 0.013) and significantly lower depression (-4.23 (-8.32, -0.15); p = 0.042), compared to controls. Emotional well-being was greater in the intervention group at 3 months (12.23 (3.93, 20.54; p = 0.004). Other outcomes were similar between groups. User feedback was positive, with 88% saying they would recommend the app to a friend. CONCLUSIONS:Whitu is an acceptable, effective, scalable and multi-modal means of improving some aspects of well-being and mental health among university students. TRIAL REGISTRATION:This study was registered with the Australian New Zealand Clinical Trials Network Registry: ACTRN12622000053729.

The diagnosis of Autism Spectrum Disorder (ASD) can be challenging due to the lack of standardized medical testing and the complexity of behavioral signs. Early identification of autistic traits can positively impact the progression of autism, but current diagnostic methods, while reliable, are time-consuming and costly. Utilizing artificial intelligence (AI) represents a promising approach to expediting autism referrals and diagnosis. The Autism AI project aims to enhance sensitivity in detecting autism by using a diagnostic history of children as early as 18 months. In the first phase of this research, we collected data from over 11,000 participants, primarily indicating autistic traits. However, formal autism diagnosis was reported by only a small proportion, resulting in a predominantly unlabeled dataset challenging for supervised learning approaches. Due to limited formal diagnostic data, the dataset exhibited an imbalance with more autistic samples than non-autistic ones, potentially introducing bias in predictive models. To address these challenges, we implemented a rule-based strategy to assign labels to unlabeled data based on screening scores. Moreover, weight adjustment and augmentation techniques were incorporated to achieve a balanced distribution of autistic and non-autistic samples, thereby reducing bias and optimizing model performance. Our study used an ensemble random forest model rigorously validated across diverse populations and age groups. This approach demonstrated significant enhancements, achieving an accuracy of 73

BACKGROUND:Adolescents and young adults (AYAs) with type 1 diabetes (T1D) have an increased risk of psychological distress. To address this, psychological support provided asynchronously via an app may be feasible. Our study aimed to explore feasibility and safety of the LIFT wellbeing app. METHODS:A 12-week single arm feasibility study was conducted with 59 AYAs aged 16-25 years recruited from New Zealand and the United States, and twenty-two support people (e.g. caregivers). Feasibility outcomes included retention, data completeness, user engagement and safety. Psychosocial and clinical outcomes (HbA1c and time-in-range) were assessed at baseline and 12 weeks. RESULTS:Retention and completion of self-reported outcome measures was > 80 % for AYAs and support people. Users reported good engagement with the app. No adverse events occurred. Psychosocial outcome measures showed promising changes from baseline to 12-weeks. CONCLUSIONS:LIFT was deemed engaging, safe and feasible with promising preliminary changes in psychological outcomes.

The heterogeneity of child maltreatment is linked to depressive symptoms in adolescents. However, the underlying mechanisms concerning interpersonal relationships remain insufficiently explored. This study uses a mixed-methods approach to examine how interpersonal interaction patterns mediate the relationship between maltreatment and depression while exploring coping strategies in adversity through qualitative insights. A total of 2042 Chinese adolescents (Mage = 13.69 years, SD = 1.55; 53.18 % male) participated in this study in October 2023. Latent class analysis was conducted to identify profiles of childhood maltreatment. Mediation analysis examined the roles of affinity for solitude and Deviant Peer Association in linking maltreatment profiles to adolescent depressive symptoms. Thematic analysis further explored key factors that help adolescents with a history of childhood maltreatment navigate challenges. Latent class analysis identified four patterns of childhood maltreatment among Chinese adolescents: Low Maltreatment Exposure (LME; 70.57 %), High Emotional Neglect and Physical Abuse with Moderate Physical Neglect (HENPA-PN; 13.52 %), High Maltreatment Exposure (HME; 6.51 %), and High Emotional Neglect and Physical Abuse with Moderate Emotional Abuse (HENPA-EA; 9.40 %). Mediation analysis revealed that, compared to the LME group, all other groups positively influenced depressive symptoms through affinity for solitude and deviant peer association. Finally, thematic analysis identified five key themes: personal positive personality, coping lifestyle strategies, emotional support and companionship, guidance from others and the power of role modeling. It is crucial to comprehend the heterogeneity of childhood maltreatment, patterns of interpersonal relationships, and potential support networks to enhance adolescent mental health.

Perturbations of the gut microbiome have been associated with anorexia nervosa (AN) suggesting microbiome-modulation treatments, like faecal microbiota transfer (FMT), may offer therapeutic benefits. This open-label feasibility pilot trial evaluated the tolerability and microbiological impact of encapsulated, multi-donor FMT in 18 young women with AN (Registration: ACTRN12621001504808). Participants completed clinical and microbiome assessments at enrolment (3 weeks pre-treatment), baseline, and 3, 6, and 12 weeks post-treatment. Fifteen participants completed FMT, and 11 completed the final follow-up. The primary outcome was the change in gut microbiome composition from baseline to 3 weeks compared with natural variation between enrolment and baseline. FMT produced a significantly greater shift post-treatment (mean ± SD Bray–Curtis dissimilarity 0.36 ± 0.11; p = 0.0007), with participants gaining 38 ± 16 new species. Donor-derived strains comprised 41 ± 12

Objective: To explore the views of psychiatrists (including trainees) regarding the current state and future direction of specialist mental health and addictions services in Aotearoa New Zealand. Methods: Psychiatrists and trainee psychiatrists (registrars) in Aotearoa New Zealand were surveyed in August 2021. Of 879 eligible doctors, 540 participated (83% qualified and 17% trainee psychiatrists), a response rate of over 60%. Data were analysed quantitatively and with content analysis. Results: Psychiatrists thought specialist mental health and addictions services had been neglected during recent reforms, with 94% believing current resourcing was insufficient, and only 3% considering future planning was heading in the right direction. The demand and complexity of on-call work had markedly increased in the preceding 2 years. Ninety-eight percent reported that people needing specialist treatment were often (85%) or sometimes (13%) unable to access the right care due to resourcing constraints. The pressures were similar across sub-specialties. A key theme was the distress (sometimes termed 'moral injury') experienced by psychiatrists unable to provide adequate care due to resource limitations, 'knowing what would be a good thing to do and being unable to do it . . . is soul destroying'. Recommendations were made for addressing workforce, service design and wider issues. Conclusion: Most psychiatrists in Aotearoa New Zealand believe the mental health system is not currently fit for purpose and that it is not heading in the right direction. Remedies include urgently addressing identified staffing challenges and boosting designated funding to adequately care for the 5% of New Zealanders with severe mental health and addiction needs.