Brain science research in China is at an unprecedented moment of opportunity, but existing data silos represent a systemic obstacle that impedes research and limits both scientific innovation and clinical translation. We believe the path ahead must be towards creating a fully standardized national brain health ecosystem. The pillars of this ecosystem are the standardized acquisition of multimodal data, a governance pipeline to translate raw data into secure, shareable knowledge, and large prospective cohorts as important tools for translational research. These components can help ensure that data are no longer just accumulated, but knowledge is actually found, and can enable a strategic shift in brain disease care from reactive, treatment-focused care to proactive, prevention-focused brain health.

The scarcity of normative polysomnographic (PSG) parameters in typically developing (TD) children and adolescents, as well as those with neuropsychiatric disorders, limits sleep research and clinical management. This study aimed to characterize PSG parameters in TD participants from infancy to 18 years and compare them with those observed in pediatric neuropsychiatric disorders. Data were extracted from 135 publications in the Scopus database citing the AASM 2007 scoring manual and subsequent versions, involving 7015 TD children and 3421 neuropsychiatric participants. Among TD children, total sleep time (TST) was 459.44 min, and sleep efficiency (SE) was 87.87%; the proportions of N1, N2, and SWS were 4.94%, 46.73%, and 27.14%, respectively. With increasing age, sleep onset latency (SOL) and wake after sleep onset (WASO) decreased, while SWS and REM increased. SE and N2 were positively correlated with age. Neuropsychiatric children, particularly those with epilepsy, Down syndrome, and autism, showed significant differences in SE. These findings provide a comprehensive profile of PSG parameters in TD children, useful for the differential diagnosis and clinical management of neuropsychiatric disorders.

The mechanisms underlying psychological resilience following childhood trauma remain unclear. This study investigated whether memory suppression—the ability to inhibit unwanted memories voluntarily—serves as a key mechanism promoting resilience, and examined its neural correlates. An online survey of 2914 students assessed childhood trauma, resilience, and memory suppression ability, revealing that suppression ability significantly mediated the trauma-resilience relationship. Subsequently, 91 participants (grouped by trauma exposure and resilience levels) underwent fMRI during a Think/No-Think task. Behaviorally, high-resilience individuals exhibited superior memory suppression. Neuroimaging identified the left intraparietal sulcus (IPS) as a critical neural substrate, showing enhanced suppression-related activity in high-resilience individuals and mediating the association between suppression performance and resilience. Additionally, the left IPS displayed increased functional connectivity with cognitive control regions and decreased connectivity with memory-related regions during suppression, with no significant differences between groups. These results establish memory suppression as a central component of resilience and highlight the left IPS as a key neural adaptor, suggesting its potential as a target for clinical intervention.

OBJECTIVE:Chronic insomnia disorder is common and burdensome, and current treatments remain limited. We conducted a multicenter, randomized, double-blind, placebo-controlled trial to determine whether a fecal microbiota transplantation (FMT)-based treatment protocol improves sleep outcomes in adults with chronic insomnia disorder. METHODS:Participants were randomly assigned 1:1 to receive short-course antibiotic pretreatment followed by donor microbiota capsules (n = 40) or placebo capsules without antibiotic pretreatment (n = 40). Within each group, participants were further randomized to receive synbiotic supplementation or matched placebo for prespecified exploratory subgroup analyses. The primary outcome was polysomnography-measured sleep efficiency (SE) at 1 month after treatment. Secondary outcomes included other polysomnographic parameters, patient-reported sleep outcomes, and safety; microbiota analyses were exploratory. RESULTS:Compared with placebo, the FMT-based treatment protocol improved SE (adjusted between-group difference, 13.9 percentage points; 95% CI 7.29-20.41; p = 0.003) and reduced wake after sleep onset. Synbiotic assignment did not suggest meaningful differences in SE. Insomnia Severity Index and Pittsburgh Sleep Quality Index scores showed sustained improvement from 2 to 6 months. Treatment was well tolerated, with mild, self-limited adverse events and no serious adverse events. The intervention increased microbial richness and diversity and altered community structure; responders and non-responders showed similar posttreatment β-diversity change but differed in baseline microbiota composition. CONCLUSION:In adults with chronic insomnia disorder, an FMT-based treatment protocol incorporating antibiotic pretreatment improved objective sleep continuity and sustained subjective insomnia outcomes. Baseline microbial composition may contribute to treatment heterogeneity and merits further investigation.

BACKGROUND:Non-suicidal self-injury (NSSI) persists as a major public health challenge worldwide. Identifying and strategically targeting risk factors for NSSI constitutes a practical approach to its prevention. We aim to synthesize existing knowledge concerning the range and magnitude of risk factors for NSSI among children and adolescents, and to critically assess the robustness of the available evidence. METHODS:In this umbrella review, six bibliographic databases were systematically searched for articles published from database inception to Dec 2024. For the assessment of evidence credibility, pre-specified criteria for classifying evidence were utilized, categorized as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The Amstar-2 framework was employed to evaluate the quality of the evidence which graded as "high," "moderate," "low," or "critically low" quality. RESULTS:The study included meta-analyses of observational studies in the past 30 years on risk factors for NSSI in children and adolescents. We identified 16 meta-analyses comprising 410 primary studies on 43 risk factors from 38 countries, involving 2,659,156 children and adolescents. Twenty-three (e.g. LGBTIQ) risk factors were categorized as individual, followed by family level (n = 8, e.g. childhood maltreatment), school/peer level (n = 8, e.g. bully victims) and multifactorial level (n = 4, e.g. no religion). Eighteen (41.86%) risk factors provided highly suggestive (Class II) evidence of association with NSSI. Suggestive evidence (class III) indicated that NSSI was associated with adverse childhood experiences (2.31, 1.77-3.01) and being left-behind children (1.37, 1.11-1.69). CONCLUSION:A multitude of risk factors spanning diverse domains were identified, highlighting the multifactorial nature of NSSI in adolescents and children. Comprehensive prevention strategies and measures should be conducted for children and adolescents to decrease the risk of NSSI and associated harms in multilevel approaches.

Purpose:Sleep encompasses multiple dimensions, each potentially involving distinct parameters that collectively capture the complex features of sleep health. However, limited studies focused on the construction of objective sleep multidimensions and its associations with cognitive impairment. Patients and Methods:The study included 2670 community-dwelling older men from the Osteoporotic Fractures in Men study. Wrist actigraphy was used to collect sleep data. Latent sleep dimensions were identified from objectively measured sleep parameters using exploratory factor analysis without prespecified structures. Longitudinal associations between sleep domains and cognitive impairment were evaluated using Cox proportional hazards models over a mean follow-up of 7.4 years. XGBoost with SHapley Additive exPlanations (SHAP) was used to rank the predictive importance of each domain. Results:Five dimensions of sleep health framework were identified: rhythmicity, quality, duration, regularity, and timing. Disrupted rhythmicity was significantly associated with an increased risk of cognitive impairment (HR = 1.21, 95% CI: 1.07-1.37, p = 0.002). Longer duration (HR = 1.13, 95% CI: 1.00-1.28, p = 0.043), poorer regularity (HR = 1.13, 95% CI: 1.00-1.27, p = 0.046) and lower quality (HR = 1.13, 95% CI: 1.01-1.27, p = 0.040) were also linked to elevated risk in fully adjusted model. No significant association was observed between timing and cognitive impairment. SHAP analysis indicated that rhythmicity ranked high in predictive importance compared with traditional risk factors and was the most influential domain among the sleep dimensions. After stratification, disrupted rhythmicity remained significantly associated with cognitive impairment in most demographic and lifestyle subgroups. Conclusion:Our integrative modelling approach provides novel insights into the complex relationships between distinct sleep domains and cognitive impairment, highlighting rhythmicity as a key factor for preserving cognitive health in aging men. These findings suggest that sleep-related interventions, especially for management of rhythmicity, may be a promising approach for the prevention of cognitive impairment.

OBJECTIVES:To examine the relationship between insomnia symptoms and self-injurious behaviors (SIB) among adolescents and young adults, with a focus on the mediation effects of depression and anxiety on this association. METHODS:An online survey among adolescents and young adults was conducted in Xiamen City, Fujian Province, from December 2022 to May 2023. SIB was assessed using two items from Health-Related Risky Behavior Inventory. Insomnia, depressive, and anxiety symptoms were evaluated by Insomnia Severity Index, Patient Health Questionnaire, and Generalized Anxiety Disorder Scale, respectively. A structural equation model was employed to explore the mediating role of depressive and anxiety symptoms in the relationship between insomnia and SIB. RESULTS:A total of 3436 participants (Mage = 18.12 years; 58.4% female) were included in final analysis, with 707 (20.6%) reporting SIB within the past 12 months. Participants with SIB exhibited higher levels of insomnia, depressive, and anxiety symptoms compared to those without SIB. Insomnia symptoms were significantly associated with SIB (β = 0.343, p < .001). Additionally, depressive (β = 0.093, p < .001) and anxiety (β = 0.026, p = .001) symptoms mediated the relationship between insomnia symptoms and SIB. Total indirect effects accounted for 79.33% of the total effects (insomnia → SIB). However, sex did not moderate the mediation effect. Sensitivity analyses yielded similar results. CONCLUSION:Depressive and anxiety symptoms mediate the relationship between insomnia and SIB in adolescents and young adults, suggesting that insomnia may act as a transdiagnostic factor contributing to emotional dysregulation and SIB.

Epidemiological and clinical evidence suggests that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reinfection is a complication in a proportion of patients reporting ongoing health issues. However, most studies in the field of SARS-CoV-2 reinfection have focused only on self-reported symptoms and lacked long-term objective measurements. This study aimed to estimate the pattern of chronic symptoms of Omicron reinfection in patients with original SARS-CoV-2 infection by comprehensively assessments 3 years after recovery. This community-based observational study was conducted in Wuhan, China, between January and April in 2023. All participants were recruited from community and invited to participate the interview and examination in a hospital. The subjective multi-system symptoms were self-reported. The objective radiological features and laboratory data were assessed by measuring blood inflammation and performing chest computed tomography (CT) and pulse oxygen saturation. Among 1438 individuals who participated in the study, 144 were infected with the original variant only in 2020, 980 were Omicron-infected in 2023, 215 were reinfected both in 2020 and 2023, and 99 were never infected. Compared with the non-infection group, the reinfection (odds ratio (OR), 5.15 [95

Fear overgeneralization, defined as the excessive fear response to non-threatening stimuli, is a hallmark of anxiety-related disorders. Sleep has long been recognized as a critical factor in the consolidation and processing of fear memories, with research suggesting that different sleep phases, particularly rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, may have distinct roles. However, how sleep influences fear generalization remains largely unknown. We systematically investigated the dynamic effects of sleep phases and their associated neural oscillations on fear generalization recently after sleep manipulation and remotely 1 week later. In a randomized controlled between-subjects experiment, 126 participants were assigned to the four groups: total sleep deprivation (SD), early-night (dominated by NREM sleep) SD, late-night (dominated by REM sleep) SD, and total sleep. Participants completed the fear conditioning test before the sleep-manipulated night, the recent fear generalization test after sleep, and the remote fear generalization test 1 week later. Both neuroimaging data and behavioral data (subjective risk ratings and objective skin conductance responses) were collected synchronously to analyze brain functional changes during generalized stimuli processing. Sleep, particularly REM sleep phase, inhibits fear generalization, whereas late-night SD, by reducing REM sleep, induces fear overgeneralization comparable to total SD. The percentage of REM sleep was negatively associated with the degree of fear generalization and positively correlated with dorsolateral prefrontal cortex BOLD activity during the recent generalization test. Notably, prefrontal theta oscillations mediated 44

Continuous theta burst stimulation (cTBS) induces long-lasting depression of cortical excitability in motor cortex. In the present study, we explored the modulation of cTBS on resting state electroencephalogram (rsEEG) during wakefulness and subsequent sleep in patients with insomnia disorder. Forty-one patients with insomnia received three sessions active and sham cTBS in a counterbalanced crossover design. Each session comprised 600 pulses over right dorsolateral prefrontal cortex. Closed-eyes rsEEG were recorded at before and after each session. Effects of cTBS in subsequent sleep were measured by overnight polysomnography screening. Power spectral density (PSD) and phase locking value (PLV) were used to calculate changes in spectral power and phase synchronization after cTBS during wakefulness and subsequent sleep. Compared with sham cTBS intervention, PSD of delta and theta bands were increased across global brain regions with a cumulative effect after three active cTBS sessions. PLV of delta and theta bands were enhanced between stimulated frontal area and occipital areas. Efficiency of information communication within frontal-occipital networks was consistently improved through three active sessions. Increased theta power during wakefulness was positively related with that during the first sleep cycle. Active cTBS significantly enhanced the spectral power of delta and theta bands during wakefulness, with a cumulative effect observed over time. This modulation also extended to influence theta power during subsequent sleep onset period. Collectively, these findings provide a robust theoretical foundation for further investigating the therapeutic potential of long-term cTBS in the treatment of insomnia disorders.

Background:Sleep-wake rhythms are critical for the development of Alzheimer's disease (AD). However, the relationship of sleep disturbance, APOE ε4, and amyloid-β (Aβ) accumulation remains unclear. Thus, this study investigated the potential role of APOE ε4 allele in the association between sleep disturbance and brain Aβ burden among cognitively normal (CN) older adults. Methods:In this cross-sectional study, data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNl) Database. The sample consisted of CN individuals aged between 55 and 90 years with Aβ positron emission tomography scan, APOE genotype, and sleep assessment using the Neuropsychiatric Inventory. Results:The study included 1,000 CN participants, including 134 individuals with sleep disturbances and 306 APOE ε4 carriers (APOE ε4+). After adjusting for sex, age, years of education, and marital status, sleep disturbance was not associated with a higher Aβ burden among participants. However, a significant interaction between sleep disturbance and APOE ε4 on regional standardized uptake value ratios was observed, such as in the left hippocampus. Subgroup analysis revealed that sleep disturbance could affect the AD-sensitive brain regions in the APOE ε4 + group. Furthermore, the subjective severity of sleep disturbance was linearly associated with a more significant Aβ brain burden in the APOE ε4 + group. Conclusion:This study demonstrated that CN individuals with both APOE ε4 + status and sleep disturbance exhibited greater Aβ burden. Understanding the relationship between sleep and Aβ in CN older adults may inform sleep interventions that could reduce early Aβ accumulation and delay the onset of cognitive dysfunction associated with early AD.

INTRODUCTION:Although sleep disturbances are widely recognized as risk factors for cognitive decline and Alzheimer's disease (AD), their influence on AD biomarkers remains unclear. This study aimed to clarify whether sleep quality or sleep duration affect amyloid beta (Aβ) and tau levels in plasma, cerebrospinal fluid (CSF), and positron emission tomography (PET) in non-demented populations. METHODS:PubMed, Web of Science, and Embase were systematically searched up to February 2025. RESULTS:In total, 30 studies were included comprising 14,997 subjects. Individuals with poor sleep quality exhibited greater PET Aβ burden and higher Aβ42 levels in plasma than those with good sleep quality. Shorter sleep duration was associated with higher Aβ burden on PET. However, no association between either sleep quality or sleep duration and tau levels was found. DISCUSSION:Sleep may be a modifiable marker of early AD management by modulating Aβ levels. HIGHLIGHTS:lPoor sleep quality and shorter sleep duration were significantly associated with higher amyloid beta (Aβ) burden detected by positron emission tomography (PET) in non-demented populations. Poor sleep quality was also associated with elevated Aβ42 levels in plasma. lNo significant associations were found between sleep quality or sleep duration and tau levels in plasma, cerebrospinal fluid, or PET. lInterventions targeting sleep could serve as a viable and low-cost prevention strategy for early management of Alzheimer's disease.

Extinction is a recognized process for extinguishing threat memories; however, the process of extinction can be emotionally challenging, and the effect is usually short-lived. Animal studies have shown that peer presentation can inhibit freezing behavior and prevent return of the threat memories, suggesting that social support may enhance threat extinction. However, the role of social support in maintaining human threat extinction remains unclear. The present study examined the effect of social support on threat memory extinction in humans, and its underlying neural substrates. Succeeding threat conditioning on Day 1, participants were randomly assigned to the social support and no-support groups using random numbers and experienced either a social support intervention or no intervention before threat extinction procedure on Day 2, subsequently, they underwent spontaneous recovery and reinstatement tests on Day 3. A total of 96 participants completed the three-day threat extinction retention tests; 59 participants completed Day 3 tests within the fMRI scanner; 77 participants returned to the laboratory two weeks later and participated long-term threat extinction retention tests. Results showed that friend interaction significantly increased individuals’ social support perception, which then reduced threat response and prevented the return of threat memories; and the effect was long-lasting. The fMRI results suggested that emotional memory-related brain regions, including the hippocampus, thalamus, and precuneus, were inhibited in the support group. By extracting these differential brain areas between support and no-support groups as regions of interest, connectivity analyses showed a significant difference in the functional connectivity of the thalamo-cortical circuits between the support and no-support group. This research highlights the positive role of social support in human threat extinction retention and related neural activations, which provides a potential strategy for treating threat- and trauma-related disorders.

BACKGROUND:Anxiety and depressive disorders contribute significantly to the global mental health burden. This study focuses and forecasts on the distribution of these disorders across regions, age groups, genders, and time periods. METHODS:We estimated the global burden of anxiety and depressive disorders from 1990 to 2021 using data from the Global Burden of Disease (GBD) 2021 study. Prevalence, disability-adjusted life years (DALYs), and regional trends were analyzed using Joinpoint regression, and projections for 2022-2040 were made with the Autoregressive Integrated Moving Average model. Decomposition analysis examined the impacts of population growth, aging, and epidemiological changes. FINDINGS:In 2021, global prevalence of anxiety and depressive disorders reached 359.2 million and 332.4 million cases, respectively, accounting for 9.1 % of all diseases and 63.1 % of mental health disorders. Middle and low SDI contributed the majority of global cases and DALYs. Between 1990 and 2021, the age-standardised DALY rate (ASDR) for anxiety disorders increased by 18.2 % and for depressive disorders by 13.4 %. Population growth accounted for the majority of this increase. The prevalence of these disorders rises with age, particularly in the 10-24 age group, with females experiencing higher rates. By 2040, global cases are projected to over 515 million for anxiety and over 466 million for depressive disorders, with middle and low SDI contributing the majority of cases. CONCLUSIONS:The global burden of anxiety and depressive continues to grow, with significant increases in middle and low SDI. Urgent mental health interventions are needed, especially in low-resource settings and among youth.

The default mode network (DMN) critically underpins cognitive and affective functions throughout the adult lifespan; however, detailed insights into its complex neuroarchitecture and connectivity patterns across aging remain limited. Leveraging the open-access CamCAN dataset, comprising structural and diffusion magnetic resonance imaging (MRI) alongside magnetoencephalography (MEG) data from 599 adults spanning ages 18 to 88 years, we systematically investigated age-associated changes in multimodal connectomes within the DMN. Our analyses revealed a progressive decline in both structural and functional connectivity among DMN subregions with advancing age. Additionally, MEG-based connectivity assessment demonstrated age-related decreases in high-frequency oscillatory activity (alpha, beta, gamma bands) accompanied by increases in low-frequency oscillations (theta band). Integrating structural data with neurophysiological measures further revealed age-dependent shifts in neurophysiological-structural coupling within the prefrontal cortex, characterized by strengthened coupling at theta frequencies but weakened coupling at higher frequencies. Conversely, coupling within the posterior cingulate cortex consistently declined across all examined frequency bands. Notably, theta-band coupling within the prefrontal cortex significantly correlated with age-related memory performance variations. Collectively, our findings delineate nuanced changes in DMN information transmission dynamics across adulthood, underscoring its promise as a neurobiological biomarker reflective of cognitive aging heterogeneity. ### Competing Interest Statement The authors have declared no competing interest.

This study aimed to elucidate the role of the glymphatic system-a crucial pathway for clearing waste in the brain-in the aging process and its contribution to cognitive decline. We specifically focused on the diffusion tensor imaging analysis along the perivascular space (ALPS) index as a noninvasive biomarker of glymphatic function. Data were drawn from the Alzheimers Disease Neuroimaging Initiative (ADNI) database and a separate validation cohort to analyze the ALPS index in cognitively normal older adults. The relationships among the ALPS index, brain morphometry, and memory performance were examined. As a biomarker of glymphatic function, the ALPS index appeared to decline with age in both cohorts. According to the brain morphology analysis, the ALPS index was positively correlated with the thickness of the left entorhinal cortex (r = 0.258, P false discovery rate (FDR) = 2.96 × 10-4), and it played a mediating role between aging and left entorhinal cortex thinning. The independent cohort further validated the correlation between the ALPS index and the left entorhinal cortex thickness (r = 0.414, P FDR = 0.042). Additionally, in both the primary and validation cohorts, the ALPS index played a significant mediating role in the relationship between age and durable or delayed memory decline. This study highlights the ALPS index as a promising biomarker for glymphatic function and links it to atrophy of the core memory brain regions during aging. Furthermore, these results suggest that targeting glymphatic dysfunction could represent a novel therapeutic approach to mitigate age-related memory decline.

BACKGROUND:Simpler and more feasible light therapy protocols, and objective indicators for assessing its effectiveness is lacking. We aimed to evaluate the efficacy of light therapy on subthreshold depression (SD) among college students and explore facial expressions as an objective biomarker across different treatment groups. METHODS:From September 13, 2021, to January 4, 2022, college students with SD were recruited from a university in Hubei Province, randomly assigned to Bright Light Therapy (BLT) group (10,000 lx), Dim Light Therapy (DLT) group (200 lx), or Waiting List Control (WLC) group (no intervention). Self-reported questionnaire and facial expressions were assessed for all participants before and after intervention. Repeated measures ANOVA and logistic regression were conducted to compare baseline and post-intervention differences among three groups. RESULTS:135 participants were enrolled and 121 participants completed the study. Depression symptom and sleep quality scores significantly decreased in both BLT and DLT groups (P < 0.001), while no significant changes were observed in WLC group. BLT (OR, 4.50; 95 % CI, 1.11-18.27; P = 0.035) and DLT group (OR, 4.17; 95 % CI, 1.04-16.79; P = 0.045) had higher efficacy rates than WLC group. For facial expressions, DLT group showed significant increases in two happy-related facial action units (AU) including AU14 values (positive, negative and neutral stimuli) and AU26 values (neutral and negative stimuli). BLT group showed a significant decrease in fear-related AU20 values under negative stimuli (P < 0.001). CONCLUSION:Light therapy improves depressive symptoms and sleep quality in individuals with SD, and facial expressions can serve as an objective biomarker to support its effectiveness.

BACKGROUND:Increasing evidence suggests that insomnia plays an important role in the development of depression, supporting insomnia intervention as a promising approach to prevent depression in youth. This randomized controlled trial evaluated the effectiveness of app-based cognitive behavioral therapy for insomnia (CBT-I) in preventing future onset of major depressive disorder (MDD) in youth. METHODS AND FINDINGS:This was a randomized, assessor-blind, parallel group-controlled trial in Chinese youth (aged 15-25 years) with insomnia disorder and subclinical depressive symptoms. Participants were randomly assigned (1:1) to 6-week app-based CBT-I or 6-week app-based health education (HE) delivered through smartphones. Online assessments and telephone clinical interviews were conducted at baseline, post-intervention, 6- and 12-month follow-ups. The primary outcome was time to onset of MDD. The secondary outcomes included depressive symptoms and insomnia at both symptom and disorder levels. Between September 9, 2019, and November 25, 2022, 708 participants (407 females [57%]; mean age, 22.1 years [SD = 1.9]) were randomly allocated to app-based CBT-I group (n = 354) or app-based HE group (n = 354). Thirty-seven participants (10%) in the intervention group and 62 participants (18%) in the control group developed new-onset MDD throughout the 12-month follow-up, with a hazard ratio of 0.58 (95% confidence interval 0.38-0.87; p = 0.008). The number needed to treat to prevent MDD at 1 year was 10.9 (6.8-26.6). The app-based CBT-I group has higher remission rates of insomnia disorder than the controls at post-intervention (52% versus 28%; relative risk 1.83 [1.49-2.24]; p < 0.001) and throughout 12-month follow-up. In addition, the CBT-I group reported a greater decrease in depressive (adjusted difference -1.0 [-1.6 to -0.5]; Cohen's d = 0.53; p < 0.001) and insomnia symptoms (-2.0 [-2.7 to -1.3], d = 0.78; p < 0.001) than the controls at post-intervention and throughout 6-month follow-up. Insomnia was a mediator of intervention effects on depression. No adverse events related to the interventions were reported. CONCLUSIONS:App-based CBT-I is effective in preventing future onset of major depression and improving insomnia outcomes among youth with insomnia and subclinical depression. These findings highlight the importance of targeting insomnia to prevent the onset of MDD and emphasize the need for wider dissemination of digital CBT-I to promote sleep and mental health in the youth population. TRIAL REGISTRATION:ClinicalTrials.Gov (NCT04069247).

Background:Accumulating evidence indicates that COVID-19 may cause neurological complications detectable on brain imaging. Yet, the overall prevalence, modality-specific characteristics, and clinical implications of these neuroimaging abnormalities have not been systematically summarized through comprehensive quantitative synthesis. Methods:We searched the PubMed, Web of Science, Scopus, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases, and Wanfang for original articles published up to August 5, 2025. The pooled proportions of brain-imaging findings on computed tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG), including hemorrhage, microbleeds, ischemia, stroke, encephalitis, background activity abnormality, periodic or rhythmic activity, and epileptiform discharge, were estimated using a random-effects model. This study was conducted according to PRISMA guidelines. Results:Eighty-three eligible studies that included 9466 COVID-19 patients were included in the meta-analysis. Pooled results from 27 studies, including 3081 patients, showed that more than two-fifths (42.60%) of patients who underwent CT/MRI had objective brain abnormalities. The most frequently reported abnormalities on CT/MRI were changes in white matter and non-specific stroke. Twenty-five EEG studies, including 1273 patients, reported epileptiform discharges in one-fifth (20.54%) of cases. The systematic review of long-term brain imaging manifestations in COVID-19 survivors also found common changes in brain microstructure and function. Conclusion:While these findings offer insights into the potential pathological mechanisms of neuroimaging abnormalities in COVID-19 patients, the high heterogeneity and variability across studies highlight the need for cautious interpretation. It will be necessary to conduct large-scale longitudinal studies with extended follow-up periods in order to validate these neuroimaging findings and clarify the long-term neuropsychiatric consequences of COVID-19.

Shift work may adversely affect individuals’ health, thus, the current study aimed to investigate the association between shift work and health outcomes in the general population. A total of 41,061 participants were included in this online cross-sectional survey, among which 9612 (23.4%) individuals engaged in shift work and 31,449 (76.6%) individuals engaged in non-shift work. Multiple logistic regression analyses were conducted to explore the association between shift work and health outcomes (psychiatric disorders, mental health symptoms, and physical disorders). In addition, associations between the duration (≤1 year, 1–3 years, 3–5 years, 5–10 years, ≥10 years) and frequency of shift work (<1 or ≥1 night/week) and health outcomes were also explored. The results showed that compared to non-shift workers, shift workers had a higher likelihood of any psychiatric disorders (odds ratios [OR] = 1.80, 95% CI = 1.56–2.09, p < 0.001), mental health symptoms (OR = 1.76, 95% CI = 1.68–1.85, p < 0.001), and physical disorders (OR = 1.48, 95% CI = 1.39–1.57, p < 0.001). In addition, inverted U-shaped associations were observed between the duration of shift work and health outcomes. These results indicated that shift work was closely related to potential links with poor health outcomes. The findings highlighted the importance of paying attention to the health conditions of shift workers and the necessity of implementing comprehensive protective measures for shift workers to reduce the impact of shift work.