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A recent study by Thomas et al. (2022) showed that 8.5- to 10-month-olds use saliva sharing as an indicator of relationship closeness: infants expect that someone who previously shared saliva with a partner will also comfort that partner during times of distress. The current paper offers a mechanistic explanation for this finding. We propose that through everyday experiences, saliva sharing and comforting become integrated into an enriched representation that contains information about both events. Across five simulations, we show that when this proposal is implemented in a connectionist computational model, the model reproduces infants' looking behaviors in the study by Thomas et al. (2022) (Simulation 1), captures the finding that infants' responses were specific to comfort (Simulation 2), predicts bidirectional expectations about saliva sharing and comforting (Simulation 3), and shows that these expectations strengthen with experience and can shift in response to changes in environmental statistics (Simulations 4 and 5). Taken together, our findings suggest that domain-general associative learning can explain how infants come to understand the social meaning of saliva sharing. How do infants know who will help when someone is upset? Recent research shows that infants expect people who share saliva to comfort one another. The current study uses computer simulations to explain how infants develop this understanding. We propose that infants learn these social rules through everyday observations. By seeing people share saliva and provide support, infants learn to connect these two actions. Our simulations successfully explained infant behavior and showed that these expectations not only grow stronger with more experience but can also be reversed in extreme cases. This suggests that infants use general learning abilities to build an understanding of close relationships based on the patterns they observe in their daily lives.

Patient advocates increasingly serve as voting members of Scientific Review Committees (SRCs) charged with evaluating the scientific merit and feasibility of clinical trial protocols. In principle, this gives advocates a seat at the table when the scientific architecture of a trial is most malleable. In practice, a recurring pattern undermines that promise. When advocates raise concerns about visit frequency, procedural invasiveness, or restrictive eligibility criteria, those concerns are often deflected on the grounds that they are ethical rather than scientific, and therefore properly the province of the Institutional Review Board. This Comment names that pattern jurisdictional dismissal and argues that it rests on a category error. Patient burden is a primary determinant of accrual, retention, data completeness, and generalizability. These are scientific concerns by any reasonable definition. When SRCs decline to engage with them, they let an unsuccessful trial proceed to ethics review with a fixed design that the IRB cannot meaningfully alter. I describe how jurisdictional dismissal operates, distinguish the scientific feasibility question that belongs to the SRC from the ethical acceptability question that belongs to the IRB, and propose four concrete changes to SRC practice that recognize feasibility as a scientific criterion in its own right. When patients and former research participants join clinical trial review committees, they bring firsthand experience of what it can be like to live through the demands of a trial. They can often tell whether weekly clinic visits are realistic for an older patient who no longer drives, whether three additional biopsies might deter people from enrolling, or which eligibility rules could quietly exclude the people most likely to benefit. No single advocate speaks for every patient, and lived experience is not the same as representative data. It is a vantage point that a committee made up only of clinicians and scientists can easily miss.But here is what often happens when a patient advocate raises one of these concerns at a Scientific Review Committee meeting: someone gently redirects the conversation. “That sounds like an ethics question. The Institutional Review Board will look at that.” The advocate’s concern gets handed off, and by the time it reaches the ethics review, the trial design is already locked in.This article argues that this handoff is a mistake. Patient burden is not only an ethics question. It is also a scientific question, because trials that ask too much of patients fail to enroll enough people, lose participants partway through, and produce results that do not apply to the wider patient community. When committees treat burden as someone else’s problem, they miss the chance to fix the trial when it is still possible to fix.I offer a name for this pattern: jurisdictional dismissal. I describe how it shows up in practice, why it weakens science, and what review committees can do about it. The fix is straightforward: treat patient burden as a scientific feasibility question, recognize advocates as scientific reviewers rather than ethics consultants, and weigh their concerns seriously, alongside concerns about statistical power or biological plausibility. The patient voice belongs in the room where the trial is designed, not only in the room where it is approved.Clinical trial number Not applicable.

There is much excitement about the potential for dementia prevention by targeting modifiable risk factors, yet sociodemographic disparities in dementia-related knowledge, stigma, and risk factor awareness remain underexplored. This study examines these differences among minoritised ethnic communities in the UK. As part of a project by the NIHR Dementia and Neurodegeneration Policy Research Unit at Queen Mary (DeNPRU-QM), dementia knowledge, stigma, and risk factor awareness of 3500 participants were assessed in a secondary analysis of data from two national surveys conducted in 2023 by Alzheimer's Research UK. Linear regression models were used to examine associations between ethnicity and knowledge-related outcomes, while ordinal logistic regression was used for stigma, adjusting for age, sex, education, social grade, chronic conditions, and knowing someone with dementia. Compared to White participants, South Asian (Coef.&#xa0;=&#xa0;-0.45, 95% CI [-0.55, -0.34], p&#xa0;<&#xa0;0.001) and Black participants (Coef.&#xa0;=&#xa0;-0.17, 95% CI [-0.27, -0.06], p&#xa0;<&#xa0;0.005) had lower knowledge about dementia. Compared to White participants, Black participants had higher odds of reporting greater stigma (OR&#xa0;=&#xa0;2.55, 95% CI [2.10, 3.09], p&#xa0;<&#xa0;0.001), as did South Asian participants (OR&#xa0;=&#xa0;1.62, 95% CI [1.34, 1.97], p&#xa0;<&#xa0;0.001) and participants from Other ethnic groups (OR&#xa0;=&#xa0;1.55, 95% CI [1.17, 2.07], p&#xa0;=&#xa0;0.003). Black individuals also had lower knowledge of dementia risk factors compared to White participants (Coef.&#xa0;=&#xa0;-0.655, 95% CI [-1.110, -0.200], p&#xa0;=&#xa0;0.005). Education level, chronic health conditions, gender, profession, and knowing someone with dementia were also associated with some outcomes, although associations varied by outcome. Ethnic disparities exist in dementia knowledge, stigma, and dementia risk factor awareness. Any future public information campaign around dementia risk reduction and timely diagnosis should ensure cultural competency and include strategies to reach minoritised ethnic communities. Policymakers should consider how prevention might be promoted in all health and social care encounters, since people with chronic conditions who may not be eligible for primary health checks had lower levels of knowledge about dementia.

The disease burden of malignant brain tumours poses significant challenges to both patients and their family caregivers. Even years post-bereavement, neuro-oncology caregivers can suffer serious and long-lasting adverse outcomes. A previous quantitative survey (reported separately) highlighted significant challenges experienced by bereaved neuro-oncology caregivers. This current work explored these issues further through focus groups. To identify opportunities to enhance support, we investigated caregiver experiences during the patient's end-of-life phase, the dying process, and post-bereavement outcomes. Focus groups as a component of a sequential mixed-methods study designed together with bereaved caregivers. We performed online focus groups covering the end-of-life phase, the period surrounding the patient's death, and their post-bereavement outcomes. Sampled from survey respondents, caregivers who were &#x2265;6 months post-bereavement were invited to take part in online focus groups. Following audio transcription, data were analysed using reflexive thematic analysis. In three groups, 7 female (64%) and 4 male (36%) caregivers (55% partners of patients) of deceased patients diagnosed with glioblastoma were interviewed. Themes covered 1) care experiences in the end-of-life phase (covering communication, information, support needs, and balancing family dynamics), 2) caregiver experiences surrounding patient death, and 3) immediate and longer-term post-bereavement outcomes (covering complex and conflicting emotional responses, expectations and strategies to cope with grief, and the value of formal and informal support). Findings highlight ongoing significant and unmet emotional support needs of bereaved neuro-oncology caregivers. Caregivers want and deserve to be proactively offered adequate and timely support which could limit the long-lasting adverse impact of providing care. Brain tumours place a heavy emotional and practical burden on family caregivers. Many caregivers experience lasting difficulties that can continue after the patient&#x2019;s death. This study explored caregivers&#x2019; experiences during the patient&#x2019;s end of life phase, the dying process, and life after bereavement, with the aim of identifying opportunities to improve support. We did online focus groups following a survey (reported elsewhere). Caregivers who were at least six months post&#x2011;bereavement were invited to participate. In total, 11 caregivers took part across three focus groups; most were women, and over half were partners of the patient. All had cared for someone diagnosed with glioblastoma. Discussions were audiorecorded, transcribed, and analysed using thematic analysis. Three main themes were identified. First, caregivers described their experiences during the end of life phase, highlighting challenges related to communication, access to information, unmet support needs, and managing family relationships alongside caregiving responsibilities. Second, caregivers shared their experiences surrounding the patient&#x2019;s death, which was often described as intense and emotionally challenging. Third, caregivers reflected on their immediate and longer term bereavement experiences, including complex and sometimes conflicting emotions, expectations around grief, personal coping strategies, and the perceived value of both formal and informal support. Overall, the findings demonstrate substantial and ongoing emotional support needs among bereaved neurooncology caregivers. Caregivers emphasised the importance of being proactively offered timely and appropriate support, which may help reduce the long term negative effects associated with caring for someone with a brain tumour.

Carers of individuals with eating disorders (EDs) often experience high levels of psychological distress, which can lead to anxiety and depressive symptoms. While several interventions have been developed to support carers, the effectiveness on their mental health remains unclear. We performed a systematic review of randomized controlled trials (RCTs) assessing mental health interventions for carers of individuals with EDs, with anxiety and depressive symptoms defined as outcomes of interest. Searches were performed across major electronic databases up to 31 October 2025. Twelve RCTs met the inclusion criteria. Structured narrative synthesis indicated that statistically significant effects were infrequent, outcome-specific, and generally small in magnitude. Interventions based on the Cognitive-Interpersonal Maintenance Model (CIMM) were the most frequently evaluated. However, only one trial demonstrated significant improvements in depressive symptoms (p&#x2009;=&#x2009;0.010), with no significant effect on the Depression Anxiety Stress Scale (DASS-21) total scores (p&#x2009;=&#x2009;0.06) or on the anxiety subscale (p&#x2009;=&#x2009;0.50). In addition, Cognitive Behavioural Therapy (CBT)-based interventions showed some promising effects on the Hospital Anxiety and Depression Scale (HADS) total score (p&#x2009;=&#x2009;0.033), but these results were not consistently replicated across guided and unguided formats. Among the other approaches, a video-based skills-training intervention produced a measurable reduction in carer distress, but this effect was observed only when combined with professional support (p&#x2009;=&#x2009;0.030). Overall, interventions incorporating professional or peer support appeared more promising than fully self-directed approaches, although direct comparisons between guided and unguided formats did not consistently show statistically significant differences. Quality assessment showed at least an average standard of quality for all the included trials. Interventions for carers of individuals with EDs are conceptually well-founded, yet current evidence provides only limited support for their effectiveness in reducing anxiety and depressive symptoms. Future research should prioritize interventions that combine more structured mental health strategies with guided self-help programmes and workshops, providing tailored support to address the various needs of carers. Caring for someone with an eating disorder can be emotionally overwhelming and may affect the carer&#x2019;s own mental health. This review looked at whether support programmes for carers can help reduce feelings of anxiety, low mood, and emotional strain. We examined studies that tested different kinds of support for carers, including online programmes, workshops, guided self-help, and skills-based training. Overall, these interventions were often helpful in giving carers information, practical strategies, and a better understanding of how to support their loved one. However, the evidence that they improve carers&#x2019; own anxiety and depression was limited. Indeed, only a few studies showed significant benefits, and these were usually small, specific to one outcome, or observed only when additional professional support was provided. Programmes that included guidance from a professional or trained supporter seemed more helpful than those completed alone. This suggests that carers may benefit most from support that is not only informative, but also personal and interactive. More research is needed to develop programmes that directly support carers&#x2019; mental health, while also helping them care for someone with an eating disorder.

Emergency department (ED) nurses care for patients during critical times: violence, trauma, death, etc. Continuous exposure increases risk for secondary traumatic stress (STS): negative reaction experienced by someone with an indirect exposure to trauma. This impairs their ability to cope, increases levels of anxiety/depression, and increases attrition. Using a phenomenological design, the researcher interviewed 23 bedside ED nurses in Missouri and/or Illinois, USA. Five themes emerged: patient care, relationships at work, life outside the hospital, impacting on a personal level, and residual stress. Three themes emerged related to coping strategies: positive, dysfunctional, and debriefing as a coping strategy. Nurses are impacted by STS in numerous areas of their lives and rely on both positive and negative coping strategies to help mitigate the negative effects. Hospitals should introduce the concept of STS during nursing orientation so nurses may be able to implement coping strategies before negative effects are experienced.

Many trauma survivors mentally create alternative scenarios to the factual past (i.e., "what could have happened"), referred to as counterfactual thoughts (CFT). However, to date, research on the phenomenology of post-trauma CFT is sparse. We aimed to systematically explore the characteristics and content of CFT reported by young survivors of a terrorist attack. Approximately 8.5&#x2009;years after the terrorist attack on Ut&#xf8;ya island in 2011, 220 survivors (52.3% females, M age&#x2009;=&#x2009;27.5, SD&#x2009;=&#x2009;3.65) described their most common CFT related to the attack. The characteristics (e.g., direction, structure, social focus, and timing) and content of the survivors' CFT were analyzed using thematic analysis. The participants provided rich and highly detailed descriptions of their CFT. Most antecedents ("if&#x2026;") were additive (action), self-referent, related to events occurring during the attack (e.g., if they had helped others, been located differently, or tried to overpower the perpetrator). The majority of the consequents ("then&#x2026;") were upward and other-referent, particularly related how someone who was killed could have survived. Of note, many described CFT involving self-blame. Findings may have implications for clinicians in terms of understanding and alleviating psychological distress among survivors' post-trauma. It is important that clinicians are aware of this phenomenon, so that they better can identify and help patients cope with their CFT.

Given growing concern about maternal loneliness in Japan, this secondary analysis of municipal evaluation data suggests that the nationwide Universal Home Visit Program for Families with Infants ("Hello Baby") may serve as an initial point of contact and an entry point for expanding parenting support networks, with most mothers receiving a visit and reporting encouragement to talk with someone afterward.

Empathy is a cognitive and affective construct that involves understanding and feeling someone else's pain and suffering. Empathy is fundamental to effective physical therapy practice, a basis for therapeutic relationships that enhances patient concordance to recovery. Physical therapists working with populations experiencing heightened psychological distress, such as injured servicemembers, may face greater empathetic requirements. Limited research has examined how physical therapists' empathy levels vary across different patient populations. Therefore, this study aimed to map empathy levels among physical therapists treating injured servicemembers and identify personal and professional characteristics associated with those levels. This study employed a cross-sectional, anonymous online survey of 85 physical therapists who were actively treating injured servicemembers. Participants were identified through physical therapy social media forums and dedicated groups, and at a professional conference. Empathy levels were assessed using the Interpersonal Reactivity Index (IRI), a multidimensional tool measuring four subscales: Perspective Taking, Fantasy, Empathic Concern, and Personal Distress. Personal and professional characteristics were assessed using a sociodemographic questionnaire. Associations between empathy subscales and personal and professional characteristics were analyzed. Physical therapists demonstrated mean Perspective Taking levels of 25.46&#x2009;&#xb1;&#x2009;1.01, Fantasy levels of 21&#x2009;&#xb1;&#x2009;1.32, Empathic Concern levels of 26.93&#x2009;&#xb1;&#x2009;1.02, and Personal Distresslevels of 19.16&#x2009;&#xb1;&#x2009;1.24. Age approached significance for Empathic Concern (p&#x2009;=&#x2009;.074). Longer clinical experience was significantly associated with higher Empathic Concern (p&#x2009;=&#x2009;.023), and participation in post-degree courses on psychological aspects of physical therapy treatment was significantly associated with lower Personal Distress (p&#x2009;=&#x2009;.003). This study establishes initial empathy benchmarks for physical therapists treating injured servicemembers. Findings indicate the need for enhanced support for younger physical therapists, aged 20-40, and less experienced physical therapists, with 0-5&#x2009;years of experience, and emphasize the importance of encouraging participation in courses on psychological aspects of physical therapy treatment to mitigate Personal Distress.

Remembering faces and their associated contexts is important for healthy social cognition. We used a social opinion paradigm to assess whether the valence and relevance (about the self or other) of expressed opinions influenced memory for faces and who the opinion was about. Participants (N&#x2009;=&#x2009;144) read opinions varying in reference and valence (e.g. "She thinks your/his smile is beautiful/crooked") followed by neutral faces said to hold the opinion. Participants rated their feelings of valence and arousal, followed by a surprise old/new face recognition test. Face recognition was not influenced by the type of opinion. We also assessed accuracy of "reference attribution" for the social opinion. Participants reported whether the opinion was in reference to themselves or someone else. Reference attributions were more accurate for opinions directed toward others than oneself. Moreover, higher endorsement of symptoms of depression was linked to enhanced reference attribution accuracy for self-related contexts, while higher endorsement of anxiety symptoms was associated with lower attribution accuracy. Results suggest the influence of social context on memory depends on context valence and personal relevance, as well as participants' trait symptoms.

"Ogres are like onions."1 This one phrase from the movie Shrek has always stuck with me, and not just because I can't stand onions. As I went through training, working with kids who have been through trauma or dealt with medical illness or other social stressors, it became even more apparent that people can be like onions as well. Different experiences can add layer upon layer, shaping how one interacts with the world. Someone might have been through experiences that have built defense mechanisms that make them seem like an ogre on the outside, when inside, they are just hiding from the traumas that they have seen. As child psychiatrists, much of our job is to help peel back these layers to better understand why the external layers exist. Why is a child refusing to do work? Is it just defiance, or a lack of motivation related to feeling depressed? Is it because they are struggling with focus due to ADHD and getting behind, so they just shut down? Building a safe space where children and adolescents can start to peel away these layers is an essential part of our jobs, and important in helping those around see and support the child moving forward.

This study examined verbal irony comprehension in monolingual and bilingual autistic children, focusing on irony recognition, intention understanding, cue use while deciphering ironic meanings, and error patterns. A low-verbal, multimodal task was used to minimize linguistic and metalinguistic demands. Measures of language ability, Theory of Mind (ToM), executive functions, and cue use were included. Results showed that bilingualism did not negatively affect irony comprehension, as bilingual autistic children performed comparably to monolingual autistic children and showed no disadvantage relative to bilingual typically developing peers. Across groups, ironic criticism was understood more accurately than ironic praise. Irony recognition was associated with executive functioning, specifically inhibition. In autistic children, intention understanding was primarily predicted by second order verbal ToM and, to a lesser extent, sentence comprehension. Cue analyses revealed that contextual information and facial expressions were the most frequently used sources of information, whereas facial cues were predominantly used by bilingual autistic children in ironic praise. Prosodic cues were rarely reported across groups. No group differences emerged in error patterns. Overall, the findings indicate that bilingualism is not detrimental to irony comprehension in autism and highlight the importance of socio-cognitive, language, and executive mechanisms in pragmatic processing. Understanding verbal irony (e.g., saying &#x201c;Great job&#x201d; after someone makes a mistake) can be difficult for autistic children because it requires recognizing what a speaker really means rather than what is literally said. This study examined whether bilingualism affects irony comprehension in autistic children, and which abilities support successful understanding. Monolingual and bilingual autistic children completed a picture&#x2010;based task involving ironic criticism and ironic praise, together with language, Theory of Mind, and executive&#x2010;function assessments. The findings showed that bilingualism did not hinder irony comprehension. Bilingual autistic children performed similarly to their monolingual peers and showed no disadvantages in understanding ironic meanings. Recognizing a speaker's intentions was more challenging than recognizing that the speaker did not mean the literal words. Successful intention understanding was mainly associated with Theory of Mind abilities and, to a lesser extent, sentence comprehension. Furthermore, children relied primarily on contextual information and facial expressions, whereas prosodic cues were rarely used. These findings suggest that bilingualism is not detrimental to pragmatic language development in autism.

Given the increasing demand for primary healthcare services and the importance of understanding consumer perceptions and preferences for who delivers those services, our study aimed to elicit relative, value-based consumer preferences for community pharmacist-led prescribing services, their willingness-to-pay and trade-offs, and compare these to a similar general practitioner (GP)-led service. A discrete choice experiments survey was conducted with Australian consumers on the management of hypertension. Participants considered a series of hypothetical choices and selected between pharmacist- and GP-led services based on six attributes: provider type, relationship with the provider, consultation time, cost, service availability, and travel time. A conditional logit model was used to analyse consumer preferences. Surveys were completed by 803 participants. Consumers placed the greatest value on services delivered by a GP or a pharmacist with prescribing rights similar to GPs. Respondents also discriminated between services based on cost, having same-day availability, and being provided by someone they know. Pharmacist prescribing services are likely to contribute to meeting healthcare demands. Services tailored to meet consumer preferences can increase uptake. Therefore, services should be designed to lower consumers' out-of-pocket expenses, provide early and flexible appointment times, and enhance consumer-provider rapport.

Although urinary incontinence (UI) is highly prevalent among women, treatment seeking remains low, in part due to limited knowledge of the condition. Awareness and knowledge of pelvic floor dysfunction (PFD) among young women in the United States remains poorly characterized despite growing interest in early pelvic floor health education. This study aimed to assess baseline knowledge of UI, identify sources of information, and evaluate predictors of higher knowledge among female undergraduate students. We administered an online survey to 175 female undergraduates at a single institution that included year in school, background knowledge items, and the validated Prolapse and Incontinence Knowledge Quiz (PIKQ-UI). Responses were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), and multivariable linear regression. Although 54.9% of respondents reported prior awareness of PFD, we found that overall knowledge was poor (57.7% correct), significantly below the 80% competency threshold (p&#x2009;<&#x2009;0.001). Online and social media platforms were the most reported sources of information (42.9%). Prior knowledge of UI was independently associated with higher PIKQ-UI scores (p&#x2009;=&#x2009;0.03), whereas advancing year in school, personal UI history, and familiarity with someone affected by UI were not associated with higher performance. Knowledge gaps were most pronounced regarding age-related risk, treatment, and diagnostic testing (43%, 49%, 48% correct, respectively). Nearly all participants (91.4%) expressed interest in learning more about PFD. Despite widespread exposure to pelvic floor health information through online and social media sources, knowledge of UI among female undergraduate students remained low. Although prior awareness of UI was associated with higher knowledge scores, substantial gaps persisted, suggesting that exposure alone does not translate into understanding. Leveraging online platforms to deliver accurate, evidence-based education may improve pelvic floor health literacy and reduce the burden of untreated UI.

This article uses semi-structured individual and focus group interviews to understand scientists' experiences receiving communication support with a specific focus on the type of help that can enable evidence-based risk communication decision-making. Using qualitative thematic analysis, it draws on a primary sample of environment-focused scientists alongside additional interviews with practitioners (n&#xa0;=&#xa0;46) to explore what might lead scientists to obtain help with tasks such as identifying goals and creating evidence-based strategies to achieve those goals. We find that the communication support scientists tend to receive is often limited to tactical-level tasks and that few scientists have had opportunities to work with someone with expertise in helping identify and pursue concrete communication goals.

Media portrayals of people with mental illness have the power to mitigate or perpetuate stigma related to mental health. This study aimed to investigate reported real-world exposure to news media portrayals about people with mental health problems in the past 12&#x2009;months and the impact of these. Data were from a nationally representative survey of 6032 Australians exploring attitudes towards people with mental health problems. Participants were asked about their exposure to positive news stories about a person with a mental health problem, as well as negative portrayals, in which someone was harmed by a person with a mental health problem. Further questions covered the sources (traditional or social media) and impact of these exposures. Regression models were used to explore sociodemographic predictors of impact. Most participants reported exposure to negative news portrayals (68.4%, 95% confidence interval = [66.9, 69.8]), while fewer reported exposure to positive news stories (33.7%, 95% confidence interval = [32.3, 35.2]). Most people exposed to the negative news stories reported a negative impact (69.0%, 95% confidence interval = [67.2, 70.7]), and most exposed to positive news stories reported a positive impact (80.2%, 95% confidence interval = [77.6, 82.5]). Age and gender were associated with reported impact but not lived experience of mental illness. Exposure to negative news stories about mental health problems was prevalent. Given their impact on news audiences broadly, negative news stories need to be accurate and responsible to mitigate negative impacts. A renewed focus on generating and promoting positive and stigma-challenging news stories is needed to increase subsequent positive impacts.

Caribbean countries are among the most heavily burdened by both human immunodeficiency virus (HIV) and cancer, with prevalent stigmatization of both illnesses. This novel pilot study responds to the need to examine and understand both cancer- and HIV-related stigma among cancer survivors living with HIV (CSLWH). Data were collected via quantitative surveys and administered in person in Trinidad and Tobago. The survey used in this pilot study included an HIV stigma scale and a cancer stigma scale. Descriptive analyses were conducted using IBM SPSS Statistics 29.0.0. For most stigma items, HIV stigma is higher than cancer stigma, especially for personal and relational self-stigma: 95% vs 28% of participants reported that they feel telling someone is risky for their HIV status and cancer status, respectively. HIV-related societal/community stigma is also higher than cancer-related stigma: 87% of participants reported that they feel most people believe a person who has HIV is dirty, vs 18% reported the same stigma for cancer. Most CSLWH believed HIV is more stigmatized than cancer by the community/society (90.6% vs 9.4%) and family/friends (93.8% vs 6.3%). However, cancer-related stigma exists in health outcome beliefs: 57% of CSLWH believed that once having cancer, a person will never be 'normal' again, while 45% of CSLWH felt the same for HIV. Our preliminary findings suggest greater HIV-related personal and relational self-stigma and societal/community stigma compared to cancer-related stigma among CSLWH. However, more cancer-related health outcome beliefs are stigmatizing compared to HIV-related stigma among CSLWH.

Mental health disorders including depression, anxiety, and substance use disorders affect an estimated 150&#xa0;million people across Africa, yet services remain grossly under-resourced and largely inaccessible. In many settings, including Nigeria, limited awareness, stigmatizing attitudes, and suboptimal mental health practices further compound the burden. This study assessed knowledge, attitudes, and practices (KAP) toward mental health among adults in northwest Nigeria. We conducted a community-based cross-sectional study in Jigawa State, northwest Nigeria, guided by the classical Knowledge-Attitude-Practice (KAP) framework. A total of 398 adults were recruited using a multistage sampling technique. Data were collected through a combination of online surveys and interviewer-administered questionnaires. Statistical analyses were performed using IBM SPSS version 22.0, with significance set at p&#x2009;&#x2264;&#x2009;0.05. Participants had a mean age of 34.5&#x2009;&#xb1;&#x2009;8.2 years (range: 18-65), with 83.9% aged 25-45 years. Although 70.9% demonstrated adequate mental health knowledge, attitudes and practices were considerably poorer. Less than half expressed willingness to interact comfortably with individuals living with mental illness (43.2%), believed they could lead productive lives (44.2%), or had ever sought professional help for mental or emotional concerns (43.7%). Only 34.7% rejected the notion that individuals with mental illness are inherently dangerous, and just 20.4% would permit their children to interact with someone experiencing mental illness. Overall, 48.5% exhibited positive attitudes, and 46.7% reported satisfactory practices. Female sex independently predicted both knowledge and attitudes. Females were twice as likely as males to have adequate knowledge (aOR&#x2009;=&#x2009;2.0; 95% CI: 1.1-3.6) and nearly twice as likely to demonstrate positive attitudes (aOR&#x2009;=&#x2009;1.9; 95% CI: 1.1-3.5). Prior hospitalization and known family history of mental illness were significantly associated with more favorable attitudes. Residence in the southwest senatorial zone independently predicted satisfactory practices (aOR&#x2009;=&#x2009;0.4; 95% CI: 0.2-0.9), while absence of prior mental illness was associated with lower odds of appropriate practices (aOR&#x2009;=&#x2009;0.4; 95% CI: 0.2-0.9). Knowledge scores demonstrated moderate positive correlations with both attitudes (r&#x2009;=&#x2009;0.4, p&#x2009;<&#x2009;0.001) and practices (r&#x2009;=&#x2009;0.4, p&#x2009;<&#x2009;0.001). Despite relatively adequate levels of knowledge, attitudes and practices toward mental health remain suboptimal among adults in northwest Nigeria. Consistent with the classical KAP framework, knowledge was positively associated with both attitudes and practices. Strengthening community-level mental health literacy, reducing stigma, and expanding accessible services are urgently needed to translate knowledge gains into improved behavioral outcomes.