Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 43 appraisals
British journal of sports medicine
Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial
OBJECTIVE: To evaluate the effectiveness of Concussion Essentials (CE), a symptom-targeted, multidisciplinary treatment for persisting post-concussion symptoms (PPCS). METHODS: This single-site, open-label, assessor-blinded, parallel-group randomised clinical trial recruited 8-18-year-olds within 17 days of concussion from the emergency department of a tertiary paediatric hospital and from community referrals. Participants who endorsed ongoing PPCS on review at 14 (±3) days post-injury were invited to a baseline assessment at 3 weeks post-injury, where symptoms were re-assessed. Symptomatic participants were randomised to CE or usual care (UC). CE participants received individualised, multidisciplinary treatment modules (education, psychological, physiotherapy) for up to 8 weeks, while UC participants received weekly monitoring. Primary outcome was full recovery at intervention completion, defined as <1 symptom of increased severity compared with pre-injury on the Post-Concussion Symptom Inventory, parent version (PCSI-P). RESULTS: Participants were recruited between August 2019 and July 2024. Outcomes were analysed for 158 participants (CE=78; UC=80, mean age 13±2.5 years, 57.6% male). Pre-treatment PCSI-P total mean scores were: CE 36.7 (95% CI 31.0 to 42.4) and UC 33.5 (95% CI 28.4 to 38.7). Proportions with full resolution were CE 62.5% and UC 37.0% (adjusted risk difference=25.5%, 95% CI -10.0 to 41.0%). Post-treatment mean scores were CE 8.5 (5.9-11.2), UC 21.8 (95% CI 15.6 to 27.9) (p<0.0001). Seven adverse events, unrelated to trial factors, were recorded. CONCLUSION: Individualised, multidisciplinary treatment is associated with accelerated recovery in young people with PPCS. Implementation of such approaches should be considered in routine clinical care of concussion. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (number: ACTRN12617000418370).
14 June 2026
Read appraisal →JMIR mental health
Prevalence and Predictors of Self-Reported Adverse Experiences in Digital Meditation Training: 2 Randomized Controlled Trials
BACKGROUND: Digital meditation-based interventions (MBIs) reach vast global audiences with millions of active users, yet concerns persist about the frequency and nature of adverse experiences (ie, AExs) occurring during meditation training. Some researchers have argued that AExs are substantially underdetected and reflect iatrogenic harm caused by meditation (ie, adverse effects [AEfs]). Others contend that these experiences largely reflect common stressors that would be experienced without meditation. These competing perspectives underscore the need for further research, particularly in the context of digital MBIs, the most widely used form of meditation training. OBJECTIVE: This study examined the prevalence, predictors, and subjective evaluations of AExs during a digital MBI and tested whether reported experiences may be caused by meditation practice via comparisons between meditation-exposed and nonexposed participants. METHODS: Data were drawn from 2 trials of the Healthy Minds Program. Exploratory study 1 (n=315) consisted of a sample of distressed US undergraduate students to estimate the prevalence of AExs and identify baseline predictors. Preregistered confirmatory study 2 (n=594) sampled distressed US adults from all 50 states to replicate findings from study 1 and to examine participants' subjective evaluations of AExs. Study 2 additionally compared AEx rates between participants who did and did not complete guided meditations to assess whether AExs could be caused by meditation exposure. Study 3 (n=87) used qualitative methods to analyze study 1 participants' responses to an open-ended question regarding their strategies for coping with AExs. RESULTS: In studies 1 and 2, 27.9% (88/315) and 10.1% (40/396) of participants, respectively, reported at least one AEx during the study period, with 6.7% (21/315) and 3% (12/396) reporting functional impairment, largely aligning with previous research. Critically, in study 2, rates of AExs did not significantly differ between participants who did and did not complete guided meditations, suggesting that these experiences were not caused by meditation practice. Higher baseline depression, anxiety, loneliness, experiential avoidance, and perceived barriers to meditation predicted more frequent AExs. In studies 1 and 2, 89.8% (79/88) and 90% (36/40) of participants who reported AExs, respectively, indicated that they were glad to have learned to meditate. Qualitative analyses showed that participants used diverse coping strategies, often using skills learned through the Healthy Minds Program. CONCLUSIONS: AExs were relatively common but occurred at comparable rates among participants who did and did not meditate, challenging claims that such experiences were caused by meditation practice in distressed individuals. Although a small subset of participants reported some degree of functional impairment, most evaluated their AExs as tolerable and described their overall MBI experience as positive. Together, these findings highlight the importance of distinguishing AExs that likely reflect epiphenomena of preexisting distress or symptoms from iatrogenic harm attributable to MBIs.
14 June 2026
Read appraisal →PloS one
Effects of a school-based ACT program on motivation, physical activity participation, motor competence, and physical performance in physically inactive female adolescent students
Adolescents face internal barriers like low self-confidence and psychological discomfort that limit physical activity. Adolescence offers a key window to enhance intrinsic motivation. Acceptance and Commitment Therapy (ACT) may effectively improve physical activity and motor competence through psychological flexibility and value-based behavior. This study examined the effects of an ACT-based intervention on physical activity participation, motivation, motor competence, and physical fitness in physically inactive adolescent girls. A randomized controlled trial involved 132 inactive girls aged 13-18, randomly assigned to either an ACT intervention or a control group. Intervention included seven sessions targeting six core ACT processes. Pre-and post-intervention assessments used standardized questionnaires and tests for physical activity participation, motivation, physical activity, motor competence, and fitness. ACT group showed significant improvements in intrinsic motivation, identified regulation, autonomy, and reduced amotivation and external regulation (p ≤ 0.05). Introjected regulation did not show a significant change (p > 0.05). Physical activity participation and fitness performance also improved significantly, along with both perceived and actual motor competence (p ≤ 0.05). ACT-based intervention effectively enhanced motivation, physical activity engagement, motor competence, and fitness. These findings support integrating ACT into school or community programs to promote sustainable physical activity habits in adolescent girls.
13 June 2026
Read appraisal →BMJ global health
Systematic review and meta-analysis of interventions for mental health in extreme weather events
INTRODUCTION: Climate change leading to extreme weather events (EWEs) poses critical threat to human health, including mental well-being. As the effects of climate change are becoming more pronounced, there is a need to identify effective interventions to mitigate the mental health impacts. METHODS: The aim of this review was to synthesise the existing literature on interventions to prevent and manage mental health symptoms in people affected by EWEs. We conducted a comprehensive literature search in MEDLINE, EBSCO CINAHL and Cochrane till 7 February 2024 and in Web of Science and EMBASE till 20 February 2024. Randomised controlled trials (RCTs), quasi-experimental studies and before-after study designs were included. Our search yielded 11 083 potentially relevant papers, which were screened by titles and full texts and 33 studies were finally included in the review. We recorded the study, participants, intervention, disaster and other relevant data on Excel in duplicate. We conducted a meta-analysis separately for intervention-control and before-after studies using Review Manager 5.4. The Cochrane Risk of Bias tool II was used to assess risk of bias in RCTs and the risk of bias in non-randomised studies of interventions tool for quasi-experimental and before-after designs. Main outcomes were symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, stress, general functioning and well-being. RESULTS: There was significant improvement in mental health symptoms following implementation of various interventions, leading to a decrease in PTSD symptoms (standardised mean difference (SMD) -2.92, 95% CI (-4.53 to -1.31), six intervention-control studies and SMD -0.71, 95% CI (-0.95 to -0.48), five before-after studies), depression symptoms (SMD -0.28, 95% CI (-0.53 to -0.03), three intervention-control studies and SMD -1.00, 95% CI (-1.41 to -0.59), 11 before-after studies), anxiety symptoms (SMD -0.38, 95% CI (-0.69 to -0.06), two studies and SMD -0.35, 95% CI (-0.47 to -0.23), eight before-after studies), stress symptoms (SMD -0.82, 95% CI (-1.10 to -0.53), two before-after studies), general functioning impairment (SMD -1.22, 95% CI (-1.73 to -0.70), three before-after studies) and an improvement in well-being (SMD 0.29, 95% CI (0.15 to 0.42), three intervention-control studies and SMD 0.67, 95% CI (0.25 to 1.09), two before-after studies). CONCLUSION: There are existing interventions to improve mental health after an EWE, and these should be integrated into all relevant disaster management plans.
30 May 2026
Read appraisal →The Cochrane database of systematic reviews
Pharmacotherapy for post traumatic stress disorder (PTSD)
BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment. OBJECTIVES: To assess the effects of medication for reducing PTSD symptoms in adults with PTSD. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 11, November 2020); MEDLINE (1946-), Embase (1974-), PsycINFO (1967-) and PTSDPubs (all available years) either directly or via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR). We also searched international trial registers. The date of the latest search was 13 November 2020. SELECTION CRITERIA: All randomised controlled trials (RCTs) of pharmacotherapy for adults with PTSD. DATA COLLECTION AND ANALYSIS: Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity. MAIN RESULTS: We include 66 RCTs in the review (range: 13 days to 28 weeks; 7442 participants; age range 18 to 85 years) and 54 in the meta-analysis. For the primary outcome of treatment response, we found evidence of beneficial effect for selective serotonin reuptake inhibitors (SSRIs) compared with placebo (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.59 to 0.74; 8 studies, 1078 participants), which improved PTSD symptoms in 58% of SSRI participants compared with 35% of placebo participants, based on moderate-certainty evidence. For this outcome we also found evidence of beneficial effect for the noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine: (RR 0.45, 95% CI 0.22 to 0.94; 1 study, 26 participants) in 65% of people on mirtazapine compared with 22% of placebo participants, and for the tricyclic antidepressant (TCA) amitriptyline (RR 0.60, 95% CI 0.38 to 0.96; 1 study, 40 participants) in 50% of amitriptyline participants compared with 17% of placebo participants, which improved PTSD symptoms. These outcomes are based on low-certainty evidence. There was however no evidence of beneficial effect for the number of participants who improved with the antipsychotics (RR 0.51, 95% CI 0.16 to 1.67; 2 studies, 43 participants) compared to placebo, based on very low-certainty evidence. For the outcome of treatment withdrawal, we found evidence of a harm for the individual SSRI agents compared with placebo (RR 1.41, 95% CI 1.07 to 1.87; 14 studies, 2399 participants). Withdrawals were also higher for the separate SSRI paroxetine group compared to the placebo group (RR 1.55, 95% CI 1.05 to 2.29; 5 studies, 1101 participants). Nonetheless, the absolute proportion of individuals dropping out from treatment due to adverse events in the SSRI groups was low (9%), based on moderate-certainty evidence. For the rest of the medications compared to placebo, we did not find evidence of harm for individuals dropping out from treatment due to adverse events. AUTHORS' CONCLUSIONS: The findings of this review support the conclusion that SSRIs improve PTSD symptoms; they are first-line agents for the pharmacotherapy of PTSD, based on moderate-certainty evidence. The NaSSA mirtazapine and the TCA amitriptyline may also improve PTSD symptoms, but this is based on low-certainty evidence. In addition, we found no evidence of benefit for the number of participants who improved following treatment with the antipsychotic group compared to placebo, based on very low-certainty evidence. There remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.
30 May 2026
Read appraisal →JMIR research protocols
Development of a Digital Multimodal Pain Intervention (CHRONIC): Protocol for a Randomized Controlled Trial Study
BACKGROUND: Chronic pain affects approximately 12 million individuals in Germany and significantly impairs quality of life. Although multimodal treatment approaches-combining physical, psychological, and behavioral strategies-are considered the gold standard, access to specialized multidisciplinary pain treatment, including physiotherapy and psychological interventions, is often hampered by long waiting times, which highlights the need for scalable, low-threshold treatment options. Digital health interventions, particularly those grounded in established therapeutic models, offer a promising solution to bridge this treatment gap. The German Digital Health Care Act has opened pathways for reimbursable digital applications, such as CHRONIC, which is grounded in acceptance and commitment therapy as a third-wave cognitive behavioral therapy framework and integrates selected cognitive behavioral techniques, mindfulness-based strategies, and physiotherapy into a structured web-based program. OBJECTIVE: This study protocol outlines a randomized controlled trial (RCT) aimed at evaluating the effectiveness of CHRONIC, a 12-week web-based, multimodal self-help program for individuals with chronic pain, with a focus on reducing pain intensity, reducing pain-related interference, and improving quality of life. METHODS: This is a monocentric, 3-arm RCT with assessments up to 6 months after baseline. A total of 200 participants with chronic nonmalignant pain will be randomized into one of three groups: (1) intervention with individualized psychological feedback, (2) intervention with standardized computer-generated feedback, and (3) treatment-as-usual waitlist control. Weekly modules in the intervention arms include psychotherapeutic video sessions, interactive acceptance and commitment therapy-based and cognitive behavioral therapy-based exercises, mindfulness practices, and physiotherapeutic training. Outcomes will be assessed via validated self-report instruments: West Haven-Yale Multidimensional Pain Inventory for pain intensity and interference, Assessment of Quality of Life-8 Dimensions for quality of life, German version of Chronic Pain Acceptance Questionnaire for pain acceptance, Patient Health Questionnaire-9, German version for depression, and Generalized Anxiety Disorder 7-item Scale for anxiety. Data will be analyzed using mixed models for repeated measures based on the matched ~6-month assessment. Missing data will be addressed using multiple imputation. RESULTS: Recruitment started in January 2026 and is projected to end in July 2026. As of January 22, 2026, 18 participants had been enrolled. Primary end point data collection is expected to be completed in January 2027, with primary analyses and dissemination planned for 2027. CONCLUSIONS: This study protocol describes an RCT designed to evaluate the clinical utility of CHRONIC as a scalable, low-threshold intervention for chronic pain. CHRONIC aims to address the multifactorial nature of chronic pain by integrating psychotherapeutic, physiotherapeutic, and mindfulness-based strategies into a single digital program. Future studies will be required to determine how this multimodal format compares to unimodal interventions. The findings aim to inform future digital health developments and contribute to the implementation of biopsychosocial care models in routine practice.
28 May 2026
Read appraisal →European journal of psychotraumatology
Biological and neurocognitive correlates of comorbid post-traumatic stress disorder and alcohol use disorder: a systematic review
Background: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur, leading to greater clinical burden than either disorder alone. Despite this, little is known about the biological pathways linking these two disorders.Objective: We conducted a systematic review to synthesize evidence on molecular, genetic, neural, and cognitive mechanisms contributing to comorbid PTSD & AUD.Method: Following PRISMA guidelines, we performed a comprehensive search of five databases using PTSD-related, AUD-related, biological, and neurocognitive terms. Participants had to meet diagnostic criteria for both PTSD and AUD, and studies were required to have a comparator including controls, PTSD only, or AUD only. A critical appraisal was completed for all studies.Results: From 3904 identified papers, 14 met the inclusion criteria. Four studies examined the same molecular marker, with three papers derived from the same cohort, investigating baseline and stress-induced cortisol and adrenocorticotropic hormone, and found no differences unique to PTSD & AUD. One study linked low brain-derived neurotrophic factor and hazardous drinking to PTSD onset over 2 years following hospital admission. Genetic studies showed considerable overlap (72%) between PTSD and AUD in female twins, whereby the DRD2 A1 allele and the absence of the APOE ϵ2 allele were strongly associated with PTSD and drinking. Studies also reported lower neurometabolites, white matter integrity, and hippocampal volume in PTSD & AUD. Critical appraisal of these studies highlighted prominent selection bias (predominantly male and veterans) and limited justification of sample size.Conclusions: These findings suggest that PTSD & AUD may be characterized by distinct neurobiological alterations and genetic vulnerabilities relative to comparator groups. However, as there are currently insufficient data to support or refute these findings, this highlights the need for further research. PTSD and AUD frequently co-occur, leading to greater clinical burden than either disorder alone. Despite this, little is known about the biological pathways linking these two disorders.The current study aimed to review the existing molecular, genetic, neural, and cognitive evidence, and suggests similar impacted stress regulation across PTSD-only, AUD-only, and PTSD & AUD, yet distinct neural and genetic substrates among individuals with PTSD & AUD.Future research should include more female participants and a broader range of trauma types (currently dominated by veteran samples), and use large-scale neuroimaging and genetic datasets to help to identify mechanisms underpinning PTSD & AUD.
27 May 2026
Read appraisal →Journal of medical Internet research
Virtual Reality Interventions for Stress Reduction in the General Population: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Increasing mental demands across multiple life domains underscore the importance of effective individual stress management to mitigate the adverse health consequences of chronic stress. Growing evidence suggests that virtual reality (VR) interventions constitute an effective approach to stress reduction. OBJECTIVE: This systematic review and meta-analysis aimed to examine and compare application areas of VR interventions for stress reduction in the general population and to identify potential predictors of effectiveness based on sample characteristics and intervention design. METHODS: Five databases (MEDLINE, CINAHL, CENTRAL, PsycInfo, and Web of Science) were systematically searched for randomized controlled trials investigating the effectiveness of VR interventions for stress reduction in the general population. Studies were included if they primarily focused on stress reduction, included a neutral control condition, and reported a validated measurement of perceived stress. Trials targeting mental disorders or those conducted in the context of medical procedures were excluded. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias using the Cochrane Collaboration's tool. Effects were synthesized using pooled standardized mean differences, and relevant predictors were evaluated through subgroup analyses and meta-regressions. RESULTS: A total of 55 relevant studies met the inclusion criteria, with 37 investigating single-session and 18 multisession interventions (ranging from 1 to 42 sessions over 2 days to 6 months). The meta-analysis included 39 studies with 4024 participants (sample sizes 24-409; mean ages 19.2-70.6 years). Intervention types included VR-based nature exposure (21), biophilic architectural elements (6), guided meditation (9), interactive tasks (4), and other approaches (1). On average, VR interventions significantly reduced perceived stress level (-0.55, 95% CI -0.70 to -0.40; P<.001; I2=76%; 95% prediction interval [PI] -1.32 to 0.23), anxiety (-0.88, 95% CI -1.23 to -0.54; P<.001; I2=87%; 95% PI -2.07 to 0.31), and depression (-0.34, 95% CI -0.47 to -0.21; P<.001; I2=0%; 95% PI -0.47 to -0.21), and enhanced positive emotion (-0.64, 95% CI -0.84 to -0.46; P<.001; I2=62%; 95% PI -1.28 to -0.02). In addition, the decrease in systolic blood pressure was significant (-0.20, 95% CI -0.37 to -0.04; P=.02; 95% PI -0.37 to -0.04). Univariate linear regression analyses identified multiple sessions (R²=15%, P=.02) as a significant predictor of VR-based stress reduction. Further analyses of technical and content-related characteristics revealed that a higher image refresh rate (t15=-2.36, 2-tailed; P=.04) was associated with stronger intervention effects. CONCLUSIONS: This review highlights the considerable potential of VR interventions for reducing psychological stress in the general population and extends recent evidence by quantifying the effects of a broad range of VR-based stress reduction approaches and, for the first time, comparing diverse intervention characteristics. VR represents a promising alternative, particularly in contexts where access to real-life nature or conventional relaxation methods is limited or resource-intensive.
26 May 2026
Read appraisal →Medicine
Effects of a psychological capital intervention on emergency nurses' work engagement and turnover intention: A randomized controlled trial
BACKGROUND: Emergency nurses are exposed to high occupational stress, which leads to decreased psychological capital, reduced work engagement, and high turnover intention. Evidence on targeted psychological capital intervention (PCI) for this population remains limited. METHODS: A parallel randomized controlled trial was conducted. A total of 122 emergency nurses from a tertiary hospital in Zhejiang Province were randomly assigned to the intervention group (6-week PCI, n = 61) or the control group (routine training, n = 61). Outcomes were measured at baseline (T0), post-intervention (T1), 1 month (T2), and 3 months (T3) using the Psychological Capital Questionnaire, Utrecht Work Engagement Scale, and Turnover Intention Scale. RESULTS: Baseline characteristics and outcome scores were comparable between groups (all P > .05). At T1 to T3, the intervention group had significantly higher Psychological Capital Questionnaire and Utrecht Work Engagement Scale scores and lower Turnover Intention Scale scores than the control group (all P < .001). Psychological capital was positively correlated with work engagement (R = 0.604, P < .001) and negatively correlated with turnover intention (r = -0.624, P < .001). CONCLUSION: This 6-week PCI program significantly improves psychological capital and work engagement, and reduces turnover intention among emergency nurses, with effects sustained for at least 3 months. These findings support the utility of PCI as a psychological management strategy for emergency nursing staff.
25 May 2026
Read appraisal →Behavior research methods
Automating data extraction in meta-research: A multi-model benchmark in network psychometrics papers
Manual data extraction in meta-research is often tedious, time-consuming, and error-prone. In this paper, we investigate whether the current generation of large language models (LLMs) can be used to extract accurate information from scientific papers. Across the meta-research literature, these tasks usually range from extracting verbatim information (e.g., the number of participants in a study, effect sizes, or whether a study is preregistered) to making subjective inferences. Using a publicly available dataset containing a wide range of metascientific variables from 43 network psychometrics papers, we tested five LLMs (Claude 4.6 Opus, Claude 4.5 Sonnet, Claude 4.5 Haiku, GPT-5.2, and GPT-5 mini). We used an automated API-based pipeline to extract variables from the documents. This approach allows batch processing of research papers. As such, it represents a more efficient and scalable way to extract metascientific data than the default chat interface. The extraction accuracy ranged from 79.6% to 91.3% across the models. The extraction performance was generally higher for more explicit, verbatim information and worse for variables that required more complicated inference. Furthermore, most models were able to convey uncertainty in more contentious cases. We provide a comparison of the accuracy and cost-effectiveness of the individual models and discuss the characteristics of variables that are and are not suitable for automatic coding. Furthermore, we describe some of the common pitfalls and best practices of automated LLM data extraction. The proposed procedure can substantially reduce the time and costs associated with conducting meta-research.
25 May 2026
Read appraisal →Reproduction & fertility
Patient characteristics and lifestyle determinants of quality of life among women with endometriosis: a systematic review
ABSTRACT: Endometriosis is a chronic inflammatory disease presenting with debilitating symptoms strongly impacting patients' quality of life (QoL). Assessing QoL is crucial for understanding the full patient experience beyond clinical symptoms. This narrative systematic review specifically aimed to identify and describe non-pharmacological and non-surgical factors associated with QoL in women with endometriosis as reported in the literature. Following PRISMA guidelines, we systematically searched PubMed, MEDLINE, Web of Science, and Embase up to January 15, 2025, for case-control, cohort, randomized controlled trials, and cross-sectional studies. This study was registered in PROSPERO (registration number: CRD42023438457) Eligible studies assessed socio-demographic characteristics, lifestyle factors, symptoms, comorbidities, or coping strategies in relation to QoL among women with endometriosis. Twenty-one studies with a low risk of bias were included. A better QoL was related to favorable socioeconomic profiles (n = 3), high care satisfaction (n = 2), partner involvement (n = 1), healthier lifestyle habits (n = 1), and the use of coping therapeutic strategies. Poor QoL was associated with poor health (n = 5), more severe symptoms (n = 5), unhealthy lifestyle habits (n = 2), and ineffective use of coping strategies (n = 2). This review highlights a broad range of non-medical determinants of QoL, underscoring that clinical measures alone fail to capture the full patient experience. By consolidating evidence across diverse study designs, it offers a comprehensive overview of modifiable factors that could inform holistic, patient-centered approaches to endometriosis care. Further prospective and interventional studies are needed to clarify causal pathways and evaluate the effectiveness of targeted strategies to improve QoL. LAY SUMMARY: Endometriosis is a chronic disease affecting around 10% of women of reproductive age, associated with pain, infertility, and significant impacts on daily life. Because clinical measures alone fail to capture the full patient experience, assessing QoL is essential to understand the real burden of the disease. This review examined non-pharmacological and non-surgical factors that may be associated with QoL, such as lifestyle habits, socioeconomic conditions, health status, and coping strategies. Across 21 studies, we found that a better QoL was linked to good healthcare access, healthy habits, and effective coping mechanisms. Conversely, severe symptoms, poor health, and unhealthy lifestyles (smoking and alcohol use) were associated with worse QoL. The findings highlight the need for a more holistic approach to endometriosis care, combining psychological support, lifestyle guidance, and improved access to quality healthcare. Future research should use standardized QoL tools and robust study designs to develop evidence-based strategies that can meaningfully enhance patient well-being.
23 May 2026
Read appraisal →Psychological medicine
Global prevalence of prolonged grief disorder during the COVID-19 pandemic under standardized diagnostic frameworks: A systematic review and meta-analysis
Prolonged grief disorder (PGD), recently classified in ICD-11 and DSM-5-TR, is characterized by persistent and functionally impairing grief lasting beyond 6-12 months. The COVID-19 pandemic was accompanied by widespread mortality, social isolation, disrupted mourning rituals, and social disconnection, raising concerns about a potentially high burden of PGD during the pandemic period. We conducted a systematic review and meta-analysis, following PRISMA guidelines and PROSPERO registration (CRD42023463720), to estimate PGD prevalence under standardized ICD-11 and DSM-5-TR diagnostic frameworks and to examine potential moderators during the COVID-19 pandemic. PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2024. Eligible studies included adults who experienced bereavement during the pandemic and were assessed using validated PGD instruments (PG-13-R, ICG, BGQ). Random-effects models were applied to pool prevalence estimates, with subgroup and meta-regression analyses. Thirteen studies comprising 5,766 participants were included. The pooled prevalence of PGD during the pandemic period was 24% (95% CI: 13%-36%), with the highest estimates observed in China (43%, 95% CI: 33%-54%). In the overall pooled analysis, studies applying DSM-5-TR criteria yielded lower prevalence estimates than those using ICD-11 criteria (18% vs.26%, p = 0.41). Digital interventions showed no statistically significant pooled effects (Hedges' g = -0.38, 95% CI: -0.90 to 0.14). The high and geographically heterogeneous prevalence of PGD observed during the COVID-19 pandemic underscores the need to strengthen mental health surveillance, standardized assessment, and service accessibility in large-scale public health emergencies, and provides important evidence to inform population-level interventions and resource allocation strategies.
22 May 2026
Read appraisal →JMIR mental health
Efficacy of a World Health Organization-Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial
BACKGROUND: Common mental health disorders are highly prevalent among refugees. There is an urgent need to address the mental health burden in this population. OBJECTIVE: This study tested the efficacy of an individually supported self-help stress-management intervention developed by the World Health Organization-Doing What Matters in Times of Stress (DWM)-in reducing psychological distress and improving functioning among refugees in Indonesia, a major transit country in the Asia-Pacific region. METHODS: A single-blind randomized controlled trial with 303 Farsi-speaking refugees was conducted between June 2024 and June 2025. Participants with moderate to high psychological distress (Kessler Psychological Distress Scale [K10] score≥20) were randomly allocated to the facilitator-guided individual DWM condition (n=202) or a repeated assessment control condition (n=101). The primary outcome was psychological distress (K10 score) at the posttreatment assessment. Secondary outcomes were posttraumatic stress disorder symptoms, functional impairment, social functioning, and personally identified problems. RESULTS: Intent-to-treat analysis indicated that participants in the DWM condition showed greater reductions in K10 scores than those in the repeated assessment control condition (posttreatment: β=-.563, SE=0.124; P<.001; Cohen d=0.56; 1-month follow-up: β=-.447, SE=0.140; P=.002; Cohen d=0.45). Similarly, those participants in the DWM condition reported greater improvements in posttraumatic stress disorder symptoms, well-being, social functioning, functional impairment, and personally identified psychological problems. No serious adverse events were reported. CONCLUSIONS: The findings provide the first evidence for the effectiveness of DWM in reducing psychological distress and improving overall functioning among urban refugees living in a transit setting. Individually supported self-help interventions such as DWM mayoffer an effective, feasible, and scalable approach to improving mental health for refugees.
21 May 2026
Read appraisal →JMIR formative research
Impact of Restriction-Resumption Protocols on Mood and Anxiety in Healthy Adults: Randomized Controlled Trial
BACKGROUND: Simple behavioral and cognitive actions can reduce symptoms of anxiety and depression. However, there is limited research investigating whether restricting those same actions increases symptoms and whether resuming those actions reduces symptoms. OBJECTIVE: The primary aim was to examine the impact of restricting, then resuming (the "restriction-resumption protocol"), 5 groups of actions called the Things You Do (TYD), on symptoms of depression and anxiety. Participant satisfaction with life and perceptions of changes in behavior and mental health were also evaluated. METHODS: In total, 70 adults were randomly allocated to an intervention group (IG) or a control group (CG). IG participants completed a 3-phase protocol over 8 weeks: a 2-week baseline period (phase A), 2 weeks of restricted TYD actions (phase B), and a 4-week resumption phase (phase C). CG participants were instructed to maintain their usual activities and routines. Primary outcomes included symptoms of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and frequency of TYD actions. Secondary outcomes included satisfaction with life and perceived changes in mental well-being. Outcomes were measured weekly throughout the 8-week trial and again after the trial at week 9. RESULTS: Scores on outcome measures did not differ between groups during phase A and after the trial. However, by the end of phase B, IG participants showed significantly increased symptoms of depression and anxiety compared to CG participants (Ps<.001). Large within-group effect sizes were observed on the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 from baseline to the end of phase B (Cohen d>1.8) and from phase B to after the trial (Cohen d>1.9). Changes in satisfaction with life and evaluations of mental health corresponded with symptom changes. CONCLUSIONS: These findings demonstrate a relationship between the frequency of performing specific actions and symptoms of depression and anxiety. The restriction-resumption protocol has the potential to increase our understanding of causal mechanisms underlying common mental disorders and may lead to the development of new models of prevention and treatment. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12624001491550; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=388828&isReview=true.
21 May 2026
Read appraisal →Current oncology reports
Mind-Body Therapies for Depression and Anxiety Symptoms in People with Cancer: A Systematic Review with Network Meta-Analysis
INTRO: Mind-body therapies (MBTs) are promising forms of treatment for depression and anxiety symptoms in people with cancer, however, their effectiveness has not been compared. The objective of this study is to rank the effectiveness of MBTs for depression and anxiety symptoms in people with cancer. METHODS: EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI were searched until February 2025 for randomised controlled studies in which MBTs were tested in a cancer population. Network meta-analyses were used on the selected studies to rank the reduction in depression and anxiety symptoms compared with usual care. RESULTS: A total of 182 studies which involved 16,835 participants were included. The network meta-analysis showed a statistically significant large effect compared with usual care for biofeedback (standardised mean difference, SMD = -1.18, p = 0.038), spiritual interventions (SMD = -0.98, p = 0.047), and mindfulness-based interventions (MBIs; SMD = -0.87, p < 0.001) for depression symptoms and yoga (SMD = -1.13, p < 0.001), MBIs (SMD = -1.02, p < 0.001), physical relaxation (SMD = -0.93, p < 0.001), qigong/Tai Chi (QTC; SMD = -0.90, p = 0.004) and music therapy (SMD = -0.90, p < 0.001) for anxiety symptoms. CONCLUSIONS: The MBTs that should be prioritised are biofeedback, spiritual interventions, and MBIs for depression symptoms and yoga, MBIs, physical relaxation, QTC, and music therapy for anxiety symptoms in people with cancer.
20 May 2026
Read appraisal →Journal of affective disorders
Sociodemographic and clinical predictors of digital mental health intervention engagement among treatment-seeking psychiatric outpatients
BACKGROUND: Digital mental health interventions (DMHIs) have shown promise improving depression, anxiety, and psychiatric distress, yet real-world engagement remains low. Increasing engagement has great potential to improve the impact of DMHIs, but little is known about the drivers of engagement in naturalistic settings. To better understand predictors of engagement, we examined sociodemographic and clinical characteristics associated with DMHI usage among a large clinical sample of adults. METHOD: 1223 adults (74% White, 68% women, Mage = 36.8 years) with scheduled intake appointments for outpatient psychiatric services were randomized to either a mindfulness-based app (Headspace) or a CBT-based app (SilverCloud). Usage data were automatically collected, and participants were neither required nor compensated to use the apps. RESULTS: Participants engaged with their assigned DMHIs a median of 8 days, with 88.2% of participants using their assigned DMHI at least once. Participants engaged with Headspace for more than twice as many days [IRR (95% CI) = 2.4 (2.1, 2.7)] as SilverCloud. Female sex, white race, a college degree, and older age up to 60 predicted greater engagement. Further, depression severity was associated with engagement in a non-linear manner for those assigned to Headspace, with less engagement at minimal/mild and severe symptoms compared to moderate and moderately-severe symptoms. CONCLUSIONS: These findings indicate meaningful differences in engagement between DMHIs based on sociodemographic and clinical characteristics. There may be opportunities to improve engagement by tailoring DMHI offerings, with a particular emphasis on meeting the needs of less-engaged populations.
16 May 2026
Read appraisal →Philosophical transactions. Series A, Mathematical, physical, and engineering sciences
Goals and the structure of experience
Purposeful behaviour is a hallmark of natural and artificial intelligence. Its acquisition is often believed to rely on world models, comprising both descriptive (what is) and prescriptive (what is desirable) aspects that identify and evaluate state of affairs in the world, respectively. Canonical computational accounts of purposeful behaviour, such as reinforcement learning, posit distinct components of a world model comprising a state representation (descriptive aspect) and a reward function (prescriptive aspect). However, an alternative possibility, which has not yet been computationally formulated, is that these two aspects instead co-emerge interdependently from an agent's goal. Here, we describe a computational framework of goal-directed state representation in cognitive agents, in which the descriptive and prescriptive aspects of a world model co-emerge from agent-environment interaction sequences, or experiences. Drawing on Buddhist epistemology, we introduce a construct of goal-directed, or telic, states, defined as classes of goal-equivalent experience distributions. Telic states provide a parsimonious account of goal-directed learning in terms of the statistical divergence between behavioural policies and desirable experience features. We review empirical and theoretical literature supporting this novel perspective and discuss its potential to provide a unified account of behavioural, phenomenological and neural dimensions of purposeful behaviours across diverse substrates. This article is part of the theme issue 'World models in natural and artificial intelligence'.
15 May 2026
Read appraisal →Journal of medical Internet research
Stimulating Future-Oriented Thinking and Goal-Achievement Through the Future Self Using Virtual Reality and a Smartphone App: Randomized Controlled Trial
BACKGROUND: Research suggests that identification with one's future self-encompassing vividness, connectedness, and valence-plays a key role in motivating future-oriented choices and goal pursuit. Interventions aiming to strengthen future self-identification have been shown to reduce maladaptive behaviors and promote well-being, but traditional approaches often rely heavily on imagination. Emerging technologies offer novel opportunities to make the future self more vivid and tangible, potentially reducing cognitive burden, and enhancing intervention effectiveness. OBJECTIVE: This randomized controlled trial evaluated the effectiveness of a digital intervention on the following primary outcomes: future self-identification, future orientation, consideration of future consequences, self-defeating behavior, goal commitment, and goal achievement. METHODS: In this parallel, 3-arm randomized controlled trial, 321 first-year students from a large public university in the Netherlands were randomized (1:1:1) with blocks of 9 to a smartphone app-based future-self intervention, an immersive virtual reality (VR) version of the same intervention, or an active goal-setting control condition. Participants assigned to the smartphone or VR condition engaged with the intervention over a 3-week period, during which they interacted with their 10-year-old self, their future self. Participants in the control condition received no further support. Each of the 3 conditions consisted of 107 participants, who were all included in the analyses following the intention-to-treat principle. Due to the nature of the intervention, blinding was not possible. RESULTS: Compared to the goal-setting control condition, both intervention conditions yielded significant short-term improvements on all 3 aspects of future self-identification (smartphone: dvividness=0.49; dvalence=0.44; dconnectedness=0.43; VR: dvividness=0.35; dvalence=0.44; dconnectedness=0.43), and a small decline in vividness (smartphone: d=-0.36; VR: d=-0.23) and connectedness (smartphone: d=-0.36; VR: d=-0.32) at 6-month follow-up. Additionally, the intervention buffered declines in future orientation during the study period (smartphone: d=.16; VR: d=0.18), and VR delivery led to significantly higher weekly goal achievement (d=0.88). However, effects on future orientation were not sustained over time (smartphone: d=-0.18; VR: d=-0.25), resulting in similar levels across conditions at 6-month follow-up. Furthermore, no significant effects emerged for other primary or secondary outcomes, such as self-defeating behavior (smartphone: doverall=-0.10; VR: doverall=-0.03), impulsivity (smartphone: doverall=-0.07; VR: doverall=-0.09), or academic performance (η2partial=0.00). No adverse events were reported in any of the conditions. CONCLUSIONS: This randomized controlled trial innovatively compares smartphone and immersive VR future-self interventions. Findings suggest that digital interventions leveraging visual and interactive representations of the future self can strengthen future self-identification and future orientation, and support (short-term) goal pursuit. Together, they highlight the potential of scalable digital future self approaches for educational and preventive health contexts.
15 May 2026
Read appraisal →Behavior research methods
A stroke-level large-scale database of Chinese character handwriting and the OpenHandWrite_Toolbox for handwriting research
Understanding what linguistic components (e.g., phonological, semantic, and orthographic systems) modulate Chinese handwriting at the character, radical, and stroke levels remains an important yet understudied topic. Additionally, there is a lack of comprehensive tools for capturing and batch-processing fine-grained handwriting data. To address these issues, we constructed a large-scale handwriting database in which 42 Chinese speakers each handwrote 1200 characters in a handwriting-to-dictation task. Additionally, we enhanced the existing handwriting package and provided comprehensive documentation for the upgraded OpenHandWrite_Toolbox. This toolbox allows users to easily modify the experimental design, capture the stroke-level handwriting trajectory, and batch-process handwriting measurements (e.g., latency and duration). Analysis of our large-scale database indicates that orthographic predictors affect handwriting preparation and execution at the character, radical, and stroke levels. Phonological factors influence handwriting at character and radical levels. Importantly, these lexical effects demonstrate hierarchical attenuation: they were most pronounced at the character level, followed by the radical, and weakest at the stroke level. These findings demonstrate that handwriting preparation and execution at the radical and stroke levels are closely intertwined with linguistic components. This database and toolbox offer valuable resources for future psycholinguistic and neurolinguistic research on the handwriting of characters and sub-characters across different languages.
14 May 2026
Read appraisal →PloS one
Narrative-affect discrepancy as a regulated degree of freedom in 351,734 relationship narratives
In naturalistic emotional narratives, the intensity of expressed affect does not scale proportionally with narrative structure. Using 351,734 English-language relationship narratives from online support communities (the ANEST Narrative-Affect Dataset, ANAD v1.1.0), we constructed a two-dimensional expressive space defined by narrative complexity (N) and linguistically inferred affective intensity (A), with their signed discrepancy ([Formula: see text]) treated as a derived coordinate. Rather than converging toward low discrepancy, human narratives occupied a broad but structured space consistent with trade-offs between relational exposure and cognitive effort. We identified four empirically separable regimes of expressive organization: coupled expression (non-extreme discrepancy; the complement of the extreme regimes), strategic understatement (high A, low N, D < 0), strategic overstatement (high N, low A, D > 0), and collapse (high A with limited narrative scaffolding). A data-anchored cost model (NCS) formalized these regimes as arising from the interaction of exposure risk and cognitive effort, not from discrepancy minimization per se. Coupled expression dominated the corpus (91.3%), while the remaining regimes formed smaller but non-negligible subpopulations (Understatement: n = 20,223; Collapse: n = 8,040; Overstatement: n = 2,223), indicating that extreme discrepancy configurations occur systematically rather than as isolated outliers. As a comparative probe, we projected an RLHF-aligned large language model into the same space using matched prompts and identical feature extraction. Because D is a deterministic function of N and A, expressive extent was quantified as convex hull area in the clipped [Formula: see text] plane. Under this procedure, the model occupied a markedly smaller region (approximately [Formula: see text] smaller hull area; bootstrap 95% CI [1.68, 1.70]; permutation p < 0.0001) and concentrated near low-discrepancy configurations, with sparse occupancy of extreme under- and overstatement regimes. Together, these findings suggest that narrative-affect discrepancy is a measurable and regulated dimension of emotional expression and provide a reproducible geometric basis for comparing expressive degrees of freedom across populations and systems.
14 May 2026
Read appraisal →Sleep
Testing affect regulation theories of dreaming
STUDY OBJECTIVES: Dreaming is theorized to regulate waking affect via fear extinction learning, similar to exposure therapy. We tested whether fear in dreams was associated with lower negative affect (NA) and higher positive affect (PA) on subsequent mornings and whether these effects were moderated by emotion regulation strategies or mixed dream emotion states. Additionally, we examined whether individuals with higher average dream fear showed more adaptive emotion regulation. METHODS: We employed a natural language processing tool and Bayesian multilevel modeling using online daily survey data in a community sample (n = 536; 85.6% women; Mage = 39.3 ± 17.3; days = 4715). RESULTS: Frightening dreams were associated with more negative affect the following morning (+7% NA, pd = 100%), which was amplified for individuals with more adaptive emotion regulation (+3% NA, pd = 98.69). Dreams concurrently high in fear and joy were related to 20% higher odds of zero NA the next morning (pd = 97.82%). Higher average dream joy was related to 9% higher morning PA (pd = 98.79%). Individuals with higher average dream fear showed greater adaptive emotion regulation (β = 0.18, pd = 99.93%). CONCLUSIONS: Findings supported affect continuity from dream to wake, yet affect regulation at the individual level. Frightening dreams were related to worse morning affect, with a more pronounced effect among high-regulation individuals. High-regulation individuals tended to experience more fearful dreams. Mixed dream emotions were related to mornings without NA, and dream joy was related to higher morning PA. Our findings suggest adaptive, though dynamic, effects of dream emotions on psychological functioning.
14 May 2026
Read appraisal →JMIR mental health
Therapeutic Interventions Targeted at Problematic Use of Digital Technology: Systematic Review and Meta-Analysis of Evidence
BACKGROUND: Problematic use of digital technology has increased across the world. Despite growing research, evidence on treatment effectiveness across digital behaviors remains fragmented. OBJECTIVE: This study aimed to systematically evaluate and compare the effectiveness of therapeutic interventions targeted at problematic use of digital technology across various behavioral domains. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines (PROSPERO: CRD420251052442). Electronic searches of PubMed, Scopus, and Embase (up to April 2025) were conducted. It identified 125 eligible studies, including 73 randomized controlled trials (RCTs), 32 non-RCTs, 14 pre-post studies, and 6 pilot studies. The interventions that were assessed in these studies included psychological therapies, digital or web-based programs, exercise-based interventions, pharmacological treatments, neuromodulation, parent-focused programs, virtual reality-based interventions, educational programs, and multicomponent approaches. Random-effects meta-analyses using standardized mean differences (SMDs) were performed. RESULTS: For problematic internet use, psychological treatments showed a strong effect (effect size=-2.68; P<.001). Digital interventions also showed significant benefit (effect size=-1.16; P<.001). For smartphone addiction, psychological treatments (effect size=-1.49; P<.001) and exercise-based programs (effect size=-3.07; P=.001) showed significant improvement. For gaming disorder, psychological treatments showed improvement (effect size=-1.01; P=.02), but results were mixed. There were limited studies to calculate pooled results for social media addiction, pornography use, gambling, screen time, and over-the-top content watching. No treatment studies were found for problematic over-the-top content watching. High heterogeneity and evidence of small-study effects were observed in several studies. CONCLUSIONS: Overall, structured psychological therapies showed the most consistent benefit. These findings support structured interventions that aim for control of use and reduce cues linked to high use. Evidence remains limited for several emerging digital behaviors. More high-quality studies are needed in clinical settings and for less-studied forms of digital addiction.
14 May 2026
Read appraisal →Archives of women's mental health
Influences of adverse childhood experiences and weekly pregnancy stress on postpartum mental health symptoms: a machine learning examination
PURPOSE: The goal of this study was to understand how the timing, level, and fluctuation of pregnancy stress affected women's postpartum mental health while also considering their experiences of early life stress (adverse childhood events; ACEs). We hypothesized that overall stress level, as well as stress during particular pregnancy weeks, would influence postpartum mental health. We further hypothesized that fluctuations in weekly perceived stress levels across pregnancy would influence postpartum mental health among women who had experienced ≥ 4 ACEs. METHODS: We collected information on ACEs and weekly stress data from our participants during pregnancy (15 weeks until parturition). Women's depressive and anxiety symptoms were assessed at six-months postpartum. We employed a machine learning approach to explore the predictive utility of timing, level, and fluctuation of pregnancy stress on postpartum mental health symptoms. RESULTS: For all women, higher average stress level across all weeks of pregnancy predicted greater postpartum depressive and anxiety symptoms. Additionally, women with a history of ≥ 4 ACEs were susceptible to stress levels in weeks 20 of pregnancy (depressive symptoms only) and 26 (depressive and anxiety symptoms). Lastly, greater variability in stress levels across pregnancy was also associated with greater depressive symptoms for the women with ≥ 4 ACES. CONCLUSION: In addition to overall stress level, timing of pregnancy stress and fluctuations in stress levels across pregnancy are associated with postpartum mental health for women with a history of substantial ACEs, with implications for focused mental health interventions during pregnancy for these women.
13 May 2026
Read appraisal →Scientific reports
Hypnotic safety suggestions reduce cortisol awakening response and morning heart rate in daily life.
With stress being causally linked to the most frequently occurring mental and physical health problems, effective coping with acute stress is essential for promoting overall well-being and building long-term stress resilience. However, most interventions aimed at improving stress regulation require extended periods of training and practice. In a previous study, we demonstrated that the Jena Safety Anchor-a brief, hypnosis-based intervention-effectively reduced subjective stress responses in a controlled laboratory setting using the Trier Social Stress Test (TSST). The present study examined whether this effect extends to everyday life. A total of 80 participants (n = 40 female) were randomly assigned to either a hypnosis group or a control group (n = 40 per group). Over the course of two weeks, all participants collected saliva samples at home to assess their cortisol awakening response (CAR), an indicator of anticipatory stress, reflecting the body's preparation for expected demands upon waking. Additionally, all participants continuously recorded their heart rate via smartwatches during the two data collection weeks. The hypnosis group received a single guided session of the Jena Safety Anchor at the end of the first week, while the control group came to the laboratory but received no intervention. CAR was measured via three saliva samples taken within one hour after waking on specified days. Morning heart rate was measured between 6 and 9 a.m. Results revealed a significant reduction in CAR and morning heart rate in the hypnosis group during the second week, following the intervention. In contrast, no change in CAR and morning heart rate was observed in the control group. These findings show that a single session of the Jena Safety Anchor can effectively reduce physiological stress anticipation in the morning. This points to its potential as a rapid, low-effort intervention for enhancing stress coping and fostering resilience. It offers a promising approach to mental health promotion that is both time-efficient and easily integrated into everyday routines.
12 May 2026
Read appraisal →Journal of epidemiology and community health
Children's views of obesity, body size and weight: systematic review of UK qualitative evidence
BACKGROUND: Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap. METHODS: Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data. RESULTS: We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities. CONCLUSION: Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health. PROSPERO REGISTRATION NUMBER: CRD42025650306.
12 May 2026
Read appraisal →Social science & medicine (1982)
Imaginaries of digital health: Unpacking the platformization of mental health through users' practices
The platformization of healthcare is reshaping the organization of mental health services, redefining access, relationships, and meanings of care. This paper examines how users experience and negotiate the platformization of mental health through the case of Unobravo, an Italian digital platform offering online psychotherapy. Drawing on Science and Technology Studies and digital health literature, the study explores how platform imaginaries of efficiency, accessibility, and personalization are enacted and contested in everyday practices. Adopting a mixed-methods design, the research combines qualitative interviews (N = 12) with a quantitative survey (N = 3870) to analyse users' narratives and patterns of engagement. Findings reveal a persistent tension between the promise of algorithmic efficiency and the realities of situated practice. While users value the flexibility and accessibility provided by digital infrastructures, they also encounter infrastructural misalignments, such as unstable connections and opaque algorithmic matching processes. These challenges are addressed through practices of domestication that reconfigure the therapeutic setting, integrating care into mobile and domestic environments. By analysing user practices, the paper investigates how mental health is domesticated through digital platforms and shaped by platform imaginaries, reconfiguring the therapeutic setting as a datafied and everyday space.
4 May 2026
Read appraisal →Behavioural brain research
Influences of high-definition transcranial direct current stimulation (HD-tDCS) and cognitive reappraisal on emotions and aggression following social exclusion
Social exclusion can trigger negative emotions and aggressive behavior, while emotion regulation strategies and neuromodulation techniques may mitigate these effects. This study employed a 2 × 2 factorial design to investigate the impacts of high-definition transcranial direct current stimulation (HD-tDCS) and cognitive reappraisal on emotions and aggression following social exclusion. Thirty-two university students were randomly assigned to four groups: active HD-tDCS + cognitive reappraisal, sham HD-tDCS + cognitive reappraisal, active HD-tDCS + no reappraisal, and sham HD-tDCS + no reappraisal. Results showed that active HD-tDCS significantly reduced aggressive behavior in both the Competitive Reaction Time Task and Job-relevant Evaluations Task, likely by enhancing prefrontal regulatory control. Cognitive reappraisal significantly decreased negative emotions but did not directly reduce aggressive behavior, suggesting a dissociation between emotional and behavioral regulation pathways. No significant interaction was found between HD-tDCS and cognitive reappraisal, possibly due to their independent neural mechanisms. These findings highlight the potential of HD-tDCS and cognitive reappraisal as interventions for social exclusion-induced aggression and emotional dysregulation.
1 May 2026
Read appraisal →The Cochrane database of systematic reviews
Cognitive behavioural therapeutics for insomnia symptoms in the perimenopause through to the early postmenopausal period
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary Objective i) To assess the effects of cognitive behavioural therapy for insomnia (CBT-I) and cognitive behavioural therapy for menopausal symptoms (CBT-M) on sleep disturbances in women in perimenopause through to the early postmenopausal period. Secondary Objectives i) To assess the effects of CBT-I and CBT-M on vasomotor symptoms in women in perimenopause through to the early postmenopausal period. ii) To assess the impact of socioeconomic status on the effectiveness of CBT-I and CBT-M, in order to determine the interventions' impact on health equality.
28 Apr 2026
Read appraisal →PloS one
Protocol for a randomized pilot trial of COMPASS, an open‑source, culturally adapted cognitive behavioral therapy program for forcibly displaced Venezuelan adults in Peru
Task-sharing approaches have shown promise in low-resource settings, yet few culturally adapted interventions have been systematically evaluated for forcibly displaced populations. Since 2016, over 1.7 million Venezuelans have migrated to Peru, facing significant barriers to healthcare and elevated risks of anxiety, depression, and post-traumatic stress disorder (PTSD). This protocol describes COMPASS (Cognitive-behavioral Open-source Mental-health Program Adapted for migrants, Sustainably delivered by lay providers and Supported by evidence). COMPASS is a transdiagnostic, open-source cognitive behavioral therapy program co-designed with forcibly displaced populations. This protocol describes the procedures for an ongoing randomized pilot trial with n = 90 forcibly displaced Venezuelan people (Clinicaltrials.gov: NCT06635486). COMPASS guides, or lay providers, trained through an intensive apprenticeship model, will deliver 6-12 weekly remote sessions. Primary outcomes include changes in anxiety, depression, and PTSD symptoms, assessed with validated Spanish-language measures. Secondary outcomes include feasibility (recruitment, retention, fidelity) and acceptability (therapist and participant ratings). Exploratory outcomes will examine integration, migration experiences, and demographic moderators of intervention effectiveness. Analyses will follow the intention-to-treat principle, using descriptive statistics and regression models to evaluate symptom trajectories across baseline, post-intervention, and 3- and 6-month follow-ups. This study represents the first effectiveness evaluation of an open-source, lay-delivered CBT program tailored for forcibly displaced people in Peru. Findings will inform feasibility, acceptability, and preliminary effectiveness of COMPASS, with potential to expand scalable, culturally relevant mental health services for forcibly displaced populations in resource-constrained settings worldwide.
27 Apr 2026
Read appraisal →PloS one
Comparison of deep learning-based three-dimensional human pose estimation methods with motion capture for gesture research
Humans often make gestures while speaking. These gestures have been extensively researched in psychology and cognitive science, revealing their functions and roles in communication. Despite being produced in three-dimensional (3D) space, gestures and gesture space have primarily been measured and analyzed using two-dimensional planes. Optical motion capture (MoCap) is commonly used for 3D gesture measurement. However, MoCap is expensive, requires a large space, and the attachment of retroreflective markers can interfere with the natural generation of gestures by the speaker. Recent advances in deep learning-based human pose estimation (HPE) offer promising alternatives by enabling 3D keypoint estimation from standard video cameras. This study investigates the accuracy of four HPEs-two monocular and two stereo with triangulation methods-in estimating upper-body keypoints commonly used in natural scenarios for gesture research. Ten participants were recorded performing gesture-rich speech by both a MoCap system and three video cameras. We compared 13 keypoints, including the wrists, elbows, shoulders, fingers, and face, with MoCap data, using Euclidean distance as an error metric. Statistical analyses revealed that stereo methods significantly outperformed monocular methods across all keypoints. The most accurate method achieved an average error of 49.4 mm with respect to MoCap, suggesting sufficient accuracy for practical gesture analysis. Additionally, we visualized 3D gesture spaces and found a 75.4% overlap between HPE and MoCap at a voxel size of 50 mm, indicating high spatial agreement. Our findings demonstrate that stereo HPE methods are viable, cost-effective alternatives to MoCap in gesture-related applications. Our ultimate objective is to create a toolbox that is accurate and easy to use for measuring human gestures in 3D space by exploiting the recent advances in HPE as an alternative to MoCap. Such a toolbox will be suitable for non-experts in machine learning, and these results lay the foundation for it.
27 Apr 2026
Read appraisal →JMIR mental health
Effectiveness of a Fully Automated Mobile Therapeutic Versus a General Chatbot in Reducing Depression and Anxiety and Improving Well-Being: Feasibility Randomized Controlled Trial
BACKGROUND: Given the increasing prevalence of depression and anxiety disorders and enduring barriers to care, there is a critical need for alternative treatment options. Generative artificial intelligence (AI) chatbots show promise for increasing access to mental health care, though more direct research is needed to establish their efficacy. OBJECTIVE: This pilot study aimed to test the efficacy of a generative mental health chatbot rooted in solution-focused therapy compared to the general-purpose ChatGPT and an assessment-only control (AOC) group on depression, anxiety, and well-being. METHODS: A total of 185 English-speaking adults were recruited online and randomly assigned to one of three groups: AI therapy, ChatGPT, or AOC. Of these, 147 eligible participants filled out a pretreatment assessment. Over a 3-week period, the AI therapy group (n=44) was instructed to complete 3 structured, fully automated app-based sessions per week (9 total), while the ChatGPT group (n=60) was instructed to engage in 9 unstructured conversations with ChatGPT (GPT-4o-based models). The control group (n=43) received no intervention. In the AI therapy group, 39% (n=17) completed all sessions, as did 62% (n=38) of those in the ChatGPT group. Primary outcome measures, self-assessed online at baseline and postintervention, included the Patient Health Questionnaire-9 (PHQ-9), Overall Depression Severity and Impairment Scale (ODSIS) (depression), 7-item Generalized Anxiety Disorder Scale (anxiety), and World Health Organization Well-Being Index (5-item version) (well-being). Linear mixed effects models were used for data analysis. RESULTS: Compared to AOC, both the AI therapy group (d=-0.47; P=.01) and the ChatGPT group (d=-0.44; P=.02) demonstrated significant reductions in depression scores measured by PHQ-9. The AI therapy group showed nonsignificant reductions in anxiety (d=-0.37; P=.11) and ODSIS depression scores (d=-0.25; P=.22) and an increase in well-being (d=0.12; P=.53) compared to AOC. Similarly, a nonsignificant reduction in anxiety (d=-0.27; P=.22) and ODSIS depression scores (d=-0.12; P=.53) and an increase in well-being (d=0.20; P=.29) were observed in the ChatGPT group compared to AOC. The AI therapy group did not significantly outperform the ChatGPT group on any outcomes (PHQ-9: b=-0.19; d=0.03; P=.87; 7-item Generalized Anxiety Disorder Scale: b=-0.57; d=-0.11; P=.62; ODSIS: b=-0.59; d=-0.13; P=.50; and WHO: b=-0.38; d=-0.07; P=.69). CONCLUSIONS: Both the structured generative AI chatbot and ChatGPT showed a significant reduction in depression scores compared to the control group. No significant effects were observed across other outcomes, although descriptive trends indicated improvements in anxiety. While the AI therapy group showed descriptively better outcomes for depression and anxiety, differences between groups were not significant. A larger sample and longer intervention may be needed for the emerging trends to yield clinically meaningful effect sizes.
26 Apr 2026
Read appraisal →PloS one
The journey to diagnosis and care of functional neurological disorder (FND).
PURPOSE: Functional neurological disorder (FND) is a common condition, associated with high disability and healthcare costs, and poor treatment access. This qualitative study aimed to explore participants' experiences of being diagnosed with functional neurological disorder (FND), accessing treatment, and navigating life after diagnosis. Participants were drawn from a randomised feasibility study of eye movement desensitisation and reprocessing therapy for people with FND (MODIFI, Trial Registration: NCT05455450 (www.clinicaltrials.gov)). METHODS: Reflexive thematic analysis was used to analyse the data from eighteen semi-structured interviews with participants diagnosed with FND. RESULTS: Six main themes were identified: (1) the process of seeking a diagnosis and initial relief from the physical struggles, (2) receiving a diagnosis of FND, (3) treatment for FND, (4) the burden of FND in day-to-day life, (5) the need to assert agency and return to normal, and (6) hopes for the future. CONCLUSION: The findings emphasize the need for personalised and compassionate care for individuals suffering from FND, underpinned by increased service provision within the healthcare system.
25 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Beyond breast cancer: mapping unmet needs and advancing an evidence-based framework of survivorship care
PURPOSE: The growing population of breast cancer survivors (BCS) underscores the need to address ongoing challenges that persist beyond active treatment. This scoping review aimed to systematically map the unmet needs of BCS and inform the development of an evidence-based survivorship care framework. METHODS: A systematic search of databases identified 13,401 studies, of which 170 met the inclusion criteria. Data were analyzed using qualitative content analysis and descriptive statistics to categorize unmet needs across studies. RESULTS: Six major categories of unmet needs were identified: physical symptom burden, psychosocial/emotional needs, informational needs, healthcare support needs, relational/sexual needs, and financial/occupational needs. Physical symptoms (33.5% of studies) and psychosocial/emotional concerns (32.4%) were most frequently reported. Based on these domains, a three-phase conceptual framework was developed: (1) universal needs screening, (2) targeted, multidisciplinary interventions tailored to individual survivors, and (3) ongoing evaluation through patient-reported outcomes to optimize care. CONCLUSIONS: Unmet needs among BCS are widespread and multifaceted, particularly regarding chronic physical symptoms and persistent psychosocial distress. Existing care frameworks are fragmented and insufficient. The proposed three-phase framework provides a structured approach to delivering proactive, patient-centred survivorship care. IMPLICATIONS FOR CANCER SURVIVORS: Implementing this framework can improve identification and management of unmet needs, enhance quality of life, support long-term physical and emotional recovery, and foster resilience throughout survivorship.
17 Apr 2026
Read appraisal →Pediatric surgery international
Anorectal malformation in adulthood: a systematic review of biological, psychological, and sociological outcomes and experiences
PURPOSE: Anorectal malformations are congenital anomalies involving the rectum, anus, genital, and urinary tracts, and occur in approximately one in 5000 live births. A lack of transition from pediatric to adult health services means little is known about how this condition is experienced in adulthood. The purpose of this review was to discover biopsychosocial challenges and supports experienced by adults living with anorectal malformation. MATERIALS AND METHODS: A systematic quantitative literature review was the preferred method to collect and analyze data. Articles included in the review were sorted into purpose-built datasets, with data coded into biopsychosocial themes and patterns. RESULTS: The most frequently reported biological challenge was surgical intervention; the most frequently reported support was positively framed continence management. The most common psychological challenges were psychosexual concerns such as sexual anxiety, and the most common supports were interventions focused on improving self-perception. The most reported sociological challenge was navigating complex health systems, and the most reported support was forming meaningful relationships. CONCLUSION: Biopsychosocial outcomes experienced by adults born with anorectal malformation remain largely unknown. Social work and psychology can provide therapeutic interventions that enhance emotional wellbeing, psychosocial functioning, and patient-led care.
17 Apr 2026
Read appraisal →Epidemiology and psychiatric sciences
Cross-cultural validity of the generalized anxiety disorder 7-item scale (GAD-7): a systematic review and standardized assessment
AIMS: The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7. METHODS: We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively. RESULTS: Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible. CONCLUSIONS: The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.
14 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Discourse, Secondary Victimization, and Psychological Harm: Mixed-Methods Analysis of System Justification in the #MeToo Movement
BACKGROUND: The #MeToo movement, initiated in 2006 and amplified on social media in 2017, mobilized women worldwide to share experiences of sexual harassment and assault online. While the movement increased awareness, it also revealed deep social divisions in digital spaces. Supportive discussions promoted solidarity and healing, whereas antagonistic responses reinforced backlash and secondary victimization. In India, the Indian Entertainment Industry (IEI) became a focal point where survivors' disclosures highlighted structural gender inequalities. These polarized reactions function as digital-health signals, reflecting stigma, psychosocial distress, and conditions that shape women's safety and mental well-being. Examining these narratives as indicators of public health risk helps identify patterns of structural inequity and secondary mental health burdens among survivors. OBJECTIVE: This study examined online discourse surrounding #MeToo to identify forms of system-justifying narratives on social media and to assess how #MeTooIndia exposed institutional inequities within the IEI. METHODS: This mixed-methods study comprised 2 components. In study 1, natural language processing was applied to analyze global #MeToo Twitter (subsequently rebranded X) discourse. From an initial corpus of 350,000 tweets, 205,082 were preprocessed, and sentiment and stance detection analysis identified 18,416 tweets expressing negative attitudes toward the movement. Latent Dirichlet allocation topic modeling extracted 22 topics, 12 of which aligned with system-justification categories, revealing distinct lexical and semantic patterns related to gender, institutional, and power dynamics. Two trained coders manually annotated a subsample to ensure conceptual clarity and interrater reliability. Study 2 involved qualitative, semistructured interviews with 20 academic experts in film, gender, and media studies to gather opinions on how #MeTooIndia influenced institutional discourse in the IEI and how these dynamics translate into digital and mental health risks. RESULTS: Analysis of #MeToo Twitter discourse in study 1 identified 4 primary forms of system justification: by gender, by the institutional system, by backlash, and by victim-blaming. Gender and institutional system justifications were the most prevalent. Study 2 reinforced these findings, revealing how experts perceived #MeTooIndia as both empowering and constrained by entrenched institutional and cultural barriers. Together, our findings highlight the dual function of social media in promoting collective advocacy while reproducing conditions linked to gender-based violence, psychological stress, and reduced help-seeking-key digital and mental health concerns. CONCLUSIONS: This mixed-methods study reveals that digital discourse surrounding #MeToo often sustains existing gender and institutional hierarchies rather than dismantling them. Across Twitter data and expert interviews, gender and institutional system justifications emerged as dominant narratives, highlighting how online spaces can reinforce structural inequities while appearing progressive. Although #MeToo amplified visibility and awareness, its potential for lasting institutional change remains limited. These findings underscore the need for trauma-informed digital governance, public health recognition of online hostility as a psychosocial risk, and frameworks that situate digital activism to institutional reforms that support safety and mental well-being.
11 Apr 2026
Read appraisal →JMIR human factors
Evaluation of Wellby, a Cocreated Mobile App and Wearable to Support Stress Management and Overall Well-Being: Mixed Methods Acceptability and Usability Study
BACKGROUND: Digital well-being support tools can offer adolescents tailored interventions embedded in their digital environments. However, there is a lack of high-quality, evidence-based digital interventions specifically designed for young people's well-being needs. Wellby is a mobile app and wearable device cocreated with Irish secondary school students to support stress management and overall well-being. OBJECTIVE: This study aimed to evaluate the acceptability and usability of the Wellby system using the technology acceptance model, focusing on ease of use, perceived usefulness, and behavioral intention among Irish secondary school students. METHODS: A mixed methods acceptability and usability study was conducted with Irish secondary school students (n=43) across 3 schools: 2 mainstream secondary schools and 1 Youthreach center for early school leavers. Students accessed the Wellby mobile app for 8 weeks and received the custom wearable device for the final 4 weeks (April-May 2024). Wellby included mood tracking, to-do lists, educational resources, text-based health coaching, and heart rate variability biofeedback with guided breathing exercises. Acceptability and usability were evaluated using the user version of the Mobile App Rating Scale (uMARS), structured focus groups, and app engagement analytics. Secondary measures included baseline well-being questionnaires (Perceived Stress Scale, Pittsburgh Sleep Quality Index, and EPOCH Measure of Adolescent Well-Being). RESULTS: Among survey respondents (n=29), uMARS subscale scores were high: information quality (mean 4.2/5.0), functionality (4.1/5.0), and aesthetics (4.1/5.0). The perceived impact subscale showed the highest scores for well-being awareness (3.8/5.0) and help-seeking intention (3.9/5.0). Of survey respondents who participated in prior co-design sessions, 88% (21/24) and 83% (20/24) felt the wearable and app, respectively, aligned with their co-design feedback. App engagement more than doubled following the introduction of the wearable and revealed that the wearable tab was most accessed (643/1688, 38% of interactions), followed by the home (430/1688, 25%), resources (338/1688, 20%), and coaching (277/1688, 16%) tabs. Focus group feedback highlighted the mood tracker as the most valued feature and identified technical improvements, including better battery life, enhanced Bluetooth connectivity, and more personalization options. CONCLUSIONS: This study demonstrates that cocreated digital well-being tools can achieve high acceptability and usability with Irish secondary school students. Applying the technology acceptance model effectively captured student experience through mixed methods feedback. Students particularly valued self-tracking and personalization features over coaching or educational features. These findings highlight the importance of aligning digital technologies with adolescents' needs and preferences, such as features that encourage increased autonomy and identity formation. Future iterations of Wellby should address the technical limitations while continuing the involvement of students to adapt to their developmental needs and maintain high acceptability.
11 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Digital and AI-enhanced psychosocial interventions in breast cancer patients: a systematic review and meta-analysis
PURPOSE: Digital and AI-supported psychosocial interventions are increasingly implemented to address psychological distress among women with breast cancer. However, their effectiveness and sustainability remain uncertain. This review aimed to systematically evaluate randomised controlled trials (RCTs) assessing the impact of digital and AI-enhanced psychosocial interventions on stress, anxiety, depression, and health-related quality of life (HRQoL). METHODS: Following PROSPERO registration and PRISMA 2020 guidelines, comprehensive searches of multiple databases were conducted up to June 2025. Eligible studies included RCTs involving breast cancer populations and reporting validated psychosocial outcomes. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses using standardised mean differences (Hedges' g) were conducted to pool outcomes measured with different instruments. RESULTS: Thirty-five RCTs (n ≈ 7551 participants) met inclusion criteria. Pooled analyses indicated modest but consistent reductions in stress, anxiety, and depressive symptoms, alongside improvements in HRQoL. Interventions grounded in cognitive behavioural therapy, mindfulness, or psychoeducation produced the most reliable outcomes. AI-assisted and blended formats tended to show stronger effects compared with static or minimally interactive platforms. However, heterogeneity in intervention design, short follow-up periods, reliance on self-reported outcomes, and small single-centre samples limited certainty. Cultural adaptation and representation from low- and middle-income countries were minimal. CONCLUSION: Digital and AI-supported psychosocial interventions show promise in reducing distress and improving HRQoL among women with breast cancer. Evidence certainty remains moderate, constrained by methodological limitations. Larger, multicentre trials with longer follow-up and diverse populations are needed to establish sustainability, generalisability, and clinical integration. RELEVANCE: These findings suggest that digital and AI-enhanced psychosocial interventions may serve as adjuncts to conventional care, with potential to improve access to supportive oncology services. Further high-quality, long-term studies are needed before informing guidelines, policy, or widespread implementation. TRIAL REGISTRATION: PROSPERO (CRD420251074813; registered 16 June 2025).
9 Apr 2026
Read appraisal →Psychological medicine
Joint effects of childhood adversity and genetic risk for psychosis on psychopathology in the UK Biobank
BACKGROUND: The individual effects of genetic factors and adverse childhood experiences (ACEs) on risk of psychosis, including schizophrenia (SCZ) and bipolar disorder (BIP), have been widely acknowledged, but their interaction effects on individual psychopathological symptoms remain unclear. METHODS: Based on data from 163,704 individuals in the UK Biobank, we investigated the joint effects of polygenic risk scores (PRSs) of SCZ and BIP and ACEs on psychopathology. ACEs status and 55 psychopathological symptoms from seven domains were measured retrospectively using an online mental health questionnaire in 2016. Recent genome-wide association studies for SCZ and BIP were combined with genotype data to generate PRSs. Logistic regression analyses were then conducted to explore univariate and joint main effects of PRSs and ACEs on psychopathological symptoms, as well as their additive and multiplicative interaction effects. RESULTS: The interaction mechanisms for PRSs and ACEs varied across symptom domains: additive interactions were observed on the depression (RERIBIP-ACEs = 0.20-0.25), anxiety (RERISCZ-ACEs = 0.20; RERIBIP-ACEs = 0.22-0.26), help-seeking (RERISCZ-ACEs = 0.24; RERIBIP-ACEs = 0.23), and cognition domains (RERISCZ-ACEs = -0.23 to -0.17), whereas multiplicative interactions were only detected on the psychotic (betaSCZ-ACEs = -0.543; betaBIP-ACEs = -0.181), mania (betaBIP-ACEs = -0.195), self-harm or suicide (betaSCZ-ACEs = -0.118), and cognitive domains (betaSCZ-ACEs = -0.204 to -0.157). CONCLUSIONS: The interplay mechanisms for genetic liability to SCZ and BIP and ACEs vary across symptom domains. This study reveals heterogeneity in gene-ACEs interaction mechanisms underlying psychosis and may provide personalized guidance for psychological care after ACEs.
8 Apr 2026
Read appraisal →Psychological medicine
Maternal communication and attachment following a group singing intervention for postnatal depression: findings from the SHAPER-PND trial
BACKGROUND: Postnatal depression (PND) can disrupt maternal communication during early interactions, affecting infant socioemotional development. Singing is a natural form of caregiver-infant communication and a promising intervention to enhance maternal well-being and bonding. However, its effects on observed communication and perceived attachment in clinical PND populations remain underexplored. METHODS: Within the Scaling-Up Health-Arts Programs: Postnatal Depression trial, 199 mothers with PND were randomized 2:1 to a 10-week group singing intervention (Breathe Melodies for Mums) or a non-singing community activity. One hundred participants (singing = 70; control = 30) completed video-recorded interactions at baseline, week 10, and week 36. Maternal speech was coded using the Parental Cognitive Attributions and Mentalization Scale (PCAMS) for mentalization, affective tone, and attentional focus. Perceived maternal attachment was assessed separately via self-report using the Maternal Postnatal Attachment Scale. RESULTS: At week 10, singing mothers showed greater improvement in communication with their infants than controls, with about 1.7-fold higher proportions of mentalizing comments (p = 0.01), 1.4-fold more infant-focused speech (p < 0.001), 2.4-fold less parent-focused speech (p < 0.001), and fivefold less negative speech (p < 0.001). These effects were maintained at week 36. Perceived attachment improved significantly across both groups (p < 0.001), but only singing mothers showed further gains from week 10 to week 36 (p = 0.02), indicating continued strengthening of attachment perceptions. CONCLUSIONS: Group singing enhanced maternal communication and perceived attachment in mothers with PND. Findings support community-based, arts-informed interventions as accessible approaches to strengthen early relational health and complement perinatal mental healthcare.
8 Apr 2026
Read appraisal →PloS one
Vision Transformer attention alignment with human visual perception in aesthetic object evaluation
Visual attention mechanisms play a crucial role in human perception and aesthetic evaluation. Recent advances in Vision Transformers (ViTs) have demonstrated remarkable capabilities in computer vision tasks, yet their alignment with human visual attention patterns remains underexplored, particularly in aesthetic contexts. This study investigates the correlation between human visual attention and ViT attention mechanisms when evaluating handcrafted objects. We conducted an eye-tracking experiment with 30 participants (9 female, 21 male, mean age 24.6 years) who viewed 20 artisanal objects comprising basketry bags and ginger jars. Using a Pupil Labs eye-tracker, we recorded gaze patterns and generated heatmaps representing human visual attention. Simultaneously, we analyzed the same objects using a pre-trained ViT model with DINO (Self-DIstillation with NO Labels), extracting attention maps from each of the 12 attention heads. We compared human and ViT attention distributions using four complementary metrics-Kullback-Leibler divergence, Structural Similarity Index (SSIM), Pearson's Correlation Coefficient (CC), and Similarity (SIM)-across varying Gaussian parameters ([Formula: see text]), yielding 1,152,000 distance evaluations. Additionally, we performed Areas of Interest (AOI) analysis to quantify ViT attention concentration within object regions. Statistical analysis revealed optimal correlation at [Formula: see text], with attention head #12 showing the strongest alignment with human visual patterns across all metrics. Significant differences were found between attention heads, with heads #7 and #9 demonstrating the greatest divergence from human attention ([Formula: see text]), Tukey HSD test). AOI analysis confirmed that all ViT heads concentrated attention significantly more within object regions than background areas ([Formula: see text]), with heads #12, #1, and #3 achieving lift values of +30 to +40 percentage points. Results indicate that while ViTs exhibit more global attention patterns compared to human focal attention, certain attention heads can approximate human visual behavior, particularly for specific object features like buckles in basketry items. These findings suggest potential applications of ViT attention mechanisms in product design and aesthetic evaluation, while highlighting fundamental differences in attention strategies between human perception and current AI models.
6 Apr 2026
Read appraisal →Journal of behavioral addictions
When rejection backfires: Social exclusion and economic decision-making in gamblers
BACKGROUND AND AIMS: Economic decision-making deviates from rational choice models and is influenced by social factors, particularly fairness considerations and belonging needs. Social exclusion and altruistic punishment are intended to promote behavioral conformity, yet paradoxically may exacerbate rather than correct targeted behaviors among individuals with addictions already experiencing chronic rejection. Several preliminary studies show that social exclusion increases money desirability in general populations, however, the interaction between acute social exclusion and economic decision-making among individuals with gambling disorders (PGs)-marked by aberrant financial decision-making-remains unexplored. METHODS: In a field study, 203 gamblers were recruited outside gambling venues and randomized to experience either social inclusion or exclusion via Cyberball, a virtual ball-tossing paradigm. Participants then completed an ultimatum game, making accept/reject decisions on fair and unfair monetary offers, followed by the Problem Gambling Severity Index. RESULTS: Social exclusion increased unfair offer acceptance among PGs but had no effect on low- and moderate-risk gamblers. PGs accepted more unfair offers following exclusion than inclusion. Gambling severity had no effect on unfair offers acceptance. Neither social exclusion nor gambling severity affected fair offer acceptance. DISCUSSION AND CONCLUSIONS: Social exclusion triggered utilitarian decision-making only among PGs. This selective effect suggests rejection compromises PGs' economic decision-making processes, shifting priorities toward immediate monetary gains over equitable outcomes. These findings reveal how social punishment creates self-reinforcing cycles where exclusion triggers the utilitarian mindset characterizing problematic gambling. Treatment and societal approaches relying on social consequences may inadvertently strengthen harmful patterns, highlighting the need for inclusion-based interventions.
5 Apr 2026
Read appraisal →BMJ paediatrics open
Impact of parent education programmes on confidence and self-efficacy in parents of preterm infants: a systematic review
OBJECTIVE: Families of preterm infants can experience high stress during neonatal intensive care unit (NICU) hospitalisation, which interferes with the development of parenting confidence and self-efficacy through active engagement with their infants. Parent NICU support programmes provide guidance and education to build this connection. This systematic review examined the effects of parent education programmes on confidence and self-efficacy among parents of preterm infants. DESIGN: Systematic review in PubMed/Medline, PsycINFO, CINAHL, Google Scholar and Web of Science. SETTING: NICU. PARTICIPANTS: Parents of preterm infants. INTERVENTION: Education programmes offered to parents in the NICU. MAIN OUTCOME MEASURES: Quantitative surveys measuring parent confidence or self-efficacy. RESULTS: 14 studies met inclusion criteria from an initial 220 identified. Five were randomised controlled trials and nine were non-randomised studies. Programmes combining information delivery with opportunities for parent-infant engagement were most effective. Infant access and time to practise skills were key factors in transferring programme knowledge to increase parent confidence and self-efficacy. While 6 of the 14 studies did not show statistically significant differences between groups, all interventions demonstrated improvements in parental confidence or self-efficacy from baseline. Vast variability in duration of intervention, proper descriptions of facilitator trainings, methodological limitations and potential confounding factors reduced the overall quality of evidence to a low level. CONCLUSION: Both unit-specific programmes developed within individual NICUs and commercially available, copyrighted parent education programmes hold value. They are generally effective in building parent confidence and self-efficacy among parents of preterm infants. Integrating either type of programme into standard NICU care may hold promise for strengthening parental competence and promoting family-centred outcomes. Clarity on content/topics of programmes, duration and level of facilitator trainings can strengthen the process of supporting parents in the NICU, even in low resource settings. PROSPERO REGISTRATION NUMBER: CRD42024524063.
4 Apr 2026
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