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This study aimed to describe the prevalence and determinants of financial precarity and examine its associations with mental health, healthcare avoidance and academic outcomes among French health students. Nationwide cross-sectional study based on an online self-administered questionnaire. Multivariate logistic regression models were used to identify factors associated with financial precarity. All 34 French health universities. A total of 12 565 health students participated, including medical (56%), paramedical (21%), midwifery, odontology, pharmacy or physiotherapy students (12%) and first-year health students (11%). Financial precarity was defined as an indicator combining financial insecurity, frequent overdrafts and foregoing essential purchases. Primary outcomes included depressive symptoms, anxiety and emotional exhaustion. Secondary outcomes included healthcare avoidance and academic outcomes. Among 12,565 respondents, 56% were medical students, 21% were paramedical, 12% midwifery, odontology, pharmacy or physiotherapy and 11% first-year health students. Financial precarity varies by academic fields of health, ranging from 4.6% in first-year health students to 12% in paramedical students. Adjusted analyses showed lower odds of precarity among medical (aOR=0.69; 95% CI 0.52 to 0.83), midwifery, odontology, pharmacy or physiotherapy (aOR=0.55; 95% CI 0.43 to 0.72) and first-year health students (aOR=0.54; 95% CI 0.38 to 0.77) than paramedical students. Risk factors included very low parental socio-economic status (aOR=2.96; 95% CI 2.33 to 3.89) and student loans (aOR=2.78; 95% CI 2.33 to 3.32). Financial precarity was strongly associated with depressive symptoms (aOR=4.90; 95% CI 4.13 to 5.80), anxiety (aOR=3.84; 95% CI 3.13 to 4.52), emotional exhaustion (aOR=8.49; 95% CI 5.98 to 12.06), renouncing healthcare (aOR=6.21; 95% CI 5.01 to 7.70) and repeating a year (aOR=1.80; 95% CI 1.54 to 2.10). Financial precarity among health students is shaped by economic and academic factors, with family support protective of and low socio-economic background increasing vulnerability, and is associated with poorer mental health, reduced healthcare access and academic difficulties.

This study aimed to describe the factors influencing mental health and wellbeing from the perspective of Moroccan youth. This is a descriptive cross-sectional survey. All 12 regions in Morocco. Perceived priority drivers of mental health and well-being among youth. A total of 1182 participants were included (mean age 20.5 years, 68.2% female, 85.7% from urban settings). Regarding health and nutrition, 46.3% valued sleep, 59.7% emphasised physical health, 53.1% highlighted access to quality healthcare and 56.5% prioritised clean air. In terms of connectedness and contribution, 75.7% rated family relationships as critical to their well-being, while 42.5% emphasised positive peer relationships. Regarding safety and supportive environments, 64.7% considered personal safety essential, 70% prioritised the fulfilment of basic needs and 63.7% valued personal information protection. For education and competence, 54.4% emphasised learning opportunities and 62.2% identified self-confidence as key drivers. Regarding agency and resilience, 59.4% valued independence, 68.5% stressed having a sense of purpose and 55% identified hope and optimism as key to their well-being. In digital well-being, 37.7% believed social media helped maintain connections, 38% viewed it as a learning tool while 31.6% reported it as a source of stress and anxiety CONCLUSIONS: This study provides valuable insights into priority drivers of youth mental health in Morocco from the perspective of Moroccan youth which should be the target for future interventions aiming to promote youth well-being. The findings contribute to the limited data on youth mental health in low and middle-income countries, highlighting the urgency for comprehensive mental health services and further research on subjective well-being.

Active learning strategies, including case-based learning (CBL), problem-based learning (PBL) and team-based learning (TBL), have been extensively studied in clinical and basic science education; however, their application in public health programmes remains under-explored. Public health professionals address population-level challenges that differ substantially from clinical practice, making it necessary to evaluate whether these pedagogies are effective in this field. This review examines how CBL, PBL and TBL have been used in public health education and what outcomes have been reported. Scoping review was conducted using the Levac and Colquhoun framework, an adaptation of Arksey and O'Malley's approach. PubMed, Scopus and Google Scholar were searched for studies published between 2000 and 2025. Eligible studies included those involving students enrolled in undergraduate or postgraduate public health programmes, such as bachelor's or master's programmes in public health, epidemiology and biostatistics, global health, community medicine or health policy as well as employees working in public health-related fields. Data were extracted using a predefined template capturing study characteristics, population characteristics, student satisfaction and study objectives. All articles were thematically analysed.ResultsOverall, 22 studies were included. Of these, 11 focused on PBL, 2 on CBL, 3 on both CBL and PBL and 6 on TBL. Public health topics addressed included general public health practice (n=5), global health (n=3), health literacy or education (n=3) and occupational health or medicine (n=2); remaining studies covered leadership, nutrition, health behaviour, climate and health, ageing and mental health. Six themes emerged: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges. Key challenges for PBL included cognitive overload and implementation constraints; for CBL, inequitable participation and resource-intensive implementation; and for TBL, increased student time burden and difficulty adapting to complex simulations. Active learning methods enhance critical thinking and problem-solving in public health education but face implementation barriers, including faculty training requirements and resource constraints. Future research should examine long-term outcomes and the integration of emerging technologies.

To systematically synthesise evidence on the associations between presence of a mental health condition and chronic obstructive pulmonary disease (COPD) outcomes in people diagnosed with COPD, including lung function, symptom burden, functional status and clinical events. A systematic search of MEDLINE, Embase, PubMed, PsycINFO and CINAHL identified studies comparing COPD outcomes in adults (≥18 years) with and without comorbid mental illnesses. Eligible studies reported at least one relevant outcome comparing these groups. The protocol was pre-registered and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 58 studies including 707 037 participants were included. Comorbid mental illness was associated with worse outcomes: lower forced expiratory volume in 1 s (mean difference (MD)=-2.92%, 95% CI -4.35% to -1.48%), lower diffusing capacity of the lungs for carbon monoxide (MD=-3.79%, 95% CI -5.72% to -1.86%), reduced 6-minute walking test distance (MD=-30.42 m, 95% CI -41.03 to -19.82) and higher modified Medical Research Council scores (MD=0.64, 95% CI 0.45 to 0.84). Quality of life was worse (higher St George's Respiratory Questionnaire (MD=15.23 points, 95% CI 13.25 to 17.22), COPD Assessment Test (MD=7.28, 95% CI 5.81 to 8.74)). Mental illness increased exacerbations (MD=0.87, 95% CI 0.24 to 1.50; adjusted risk ratio=1.58, 95% CI 1.05 to 2.37; incidence rate ratio (IRR)=1.64, 95% CI 1.38 to 1.96), hospitalisations (adjusted OR=1.61, 95% CI 1.43 to 1.81; adjusted IRR=2.22, 95% CI 1.30 to 3.78) and mortality (adjusted HR=1.34, 95% CI 1.07 to 1.69). Depression and anxiety showed the strongest associations; evidence for severe mental illness was limited. Comorbid mental illness in COPD is linked to worse lung function, greater symptom burden, higher risks of exacerbation, hospitalisation and possibly mortality. Addressing the causes of this and integrating mental healthcare into COPD management may improve outcomes and reduce preventable admissions. CRD42024567680.

Climate change has an increasing physical and mental health toll on young people globally. In this Perspective, we suggest that the extent of mental health impacts is likely to be underestimated in the low- and middle-income countries which are most vulnerable to the effects of climate change. We highlight a strong global inverse relationship between internet connectivity and climate vulnerability, which poses significant challenges for understanding climate change's worldwide mental health impacts and for developing effective mitigation strategies. Inclusive methodologies that enable engagement with offline but climate-vulnerable communities are therefore needed. Such locally grounded mental health research is essential to ensure that climate policies are informed by the lived experiences of populations on the frontlines of the crisis, many of whom remain digitally disconnected and excluded from much current research.

This study aimed to estimate the spatial accessibility of inpatient mental health services in Kerala, India. We also aimed to calculate bed-to-population ratios for these services for each district in the state. We used a Geospatial Information System (GIS)-based travel time isochrone analysis to estimate potential spatial accessibility. Kerala, India. A list of all mental health facilities licensed to admit patients was obtained from data published by the Kerala State Mental Health Authority in 2025. The facilities were geocoded and mapped. Population data were also obtained using satellite-based estimates from 2020 at a resolution of 100 m. Information on Road Networks was obtained using OpenStreetMap through the OpenRouteService plugin in 2025. We calculated the proportion of people who could access facilities within 15 min, 30 min and 45 min. We also calculated beds per population for each of the 14 districts. Kerala has an average of 21 mental health beds per 100 000 people, ranging from 0.75 in Kasargod to 68 in Idukki. In terms of bed-to-population ratios, one district was ideal, three met the basic requirements, two experienced slight shortages, four faced moderate shortages and four encountered severe shortages. Across the state, 67.95% of the population could access psychiatric services within 15 min, increasing to 96.85% within 45 min. GIS-based isochrone analysis indicated that 96.85% of the population could reach a facility by car within 45 min. Bed-to-population ratios varied substantially between districts.

Children and young people (CYP) with neurodevelopmental diagnoses such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have high child and adolescent mental health service (CAMHS) needs. Mood instability is a common and impairing emotion dysregulation-related symptom linked to increased adult psychiatric service use; however, its role in CAMHS trajectories remains unclear. We aimed to examine whether baseline mood instability was significantly associated with time to discharge and annual CAMHS use in CYP with ASD and/or ADHD. We applied natural language processing (NLP) to extract mentions of mood instability within 3 months of ASD or ADHD index diagnosis from electronic health records of 21 906 CYP referred to CAMHS between 2008 and 2022. We used accelerated failure time models and negative binomial regression to assess associations between baseline mood instability and time to discharge and annual CAMHS use, adjusting for clinical and sociodemographic confounders. Mood instability was associated with increased annual CAMHS use across ASD (adjusted incidence rate ratio (aIRR) 1.24, 95% CI 1.08 to 1.42), ADHD (aIRR 1.47, 95% CI 1.30 to 1.67) and ASD+ADHD (aIRR 1.27, 95% CI 1.12 to 1.44) groups. While mood instability had no significant effect on discharge timelines in autistic children with or without ADHD, it was linked to reduced time to discharge in the ADHD group (aTR 0.76, 95% CI 0.69 to 0.84). Associations were most pronounced in those not receiving ADHD medication in the ADHD group (aIRR 1.67, 95% CI 1.47 to 1.89; aTR 0.70, 95% CI 0.61 to 0.79). Mood instability was significantly associated with elevated CAMHS use in CYP with neurodevelopmental conditions, with differential effect across diagnostic groups. This may reflect both variations in clinical expression of mood instability and configuration of neurodevelopmental CAMHS provision. These findings suggest the importance of assessing emotion dysregulation in care planning and pathway allocation in neurodevelopmental CAMHS. NLP offers a time- and cost-efficient approach to surface and structure clinical data from electronic CAMHS records for scalable clinical research on complex constructs such as mood instability.

The Healthy Early Life Moments in Singapore (HELMS) programme was developed by a multidisciplinary team to improve metabolic and mental health outcomes in women/mothers and to promote healthy growth and development in their children. Despite increasing interest in preventive life-course care, evidence on the long-term economic impact of these life-course interventions remains limited. This protocol outlines the economic evaluation of the HELMS integrated lifestyle intervention, supported by a mobile health (mHealth) app, across the reproductive continuum from preconception to postpartum. The HELMS programme is conducted at KK Women's and Children's Hospital, recruiting overweight or obese women and planning to conceive. The economic evaluation comprises a within-trial costing study and a cost-effectiveness analysis. We will develop a Markov model for mothers and children to simulate maternal-child health outcomes over a 10-year horizon from the healthcare provider's perspective. Primary data will be sourced from the HELMS programme and supplemented by local mother-child cohorts and published literature. The cost analysis will include direct medical, direct non-medical and programme-related costs incurred through the HELMS intervention. We will measure health outcomes in quality-adjusted life-years (QALYs) using the EuroQol-5 Dimension utility scores. We will conduct both deterministic and probabilistic sensitivity analyses to assess model uncertainty. The evaluation will estimate total and incremental costs, QALYs and incremental cost-effectiveness ratios for HELMS versus standard care. We will present cost-effectiveness acceptability curves and perform subgroup analyses to explore heterogeneity by maternal age, ethnicity and body mass index. A willingness-to-pay threshold appropriate for the Singapore context, based on recently published estimates, will be used to determine cost-effectiveness. We will also identify key cost drivers and examine the intervention's scalability. The study has been approved by the Centralised Institutional Review Board of SingHealth (2021/2247). Written informed consent will be obtained from all participants. The findings will be published in peer-reviewed journals and disseminated to international and national policy makers. NCT05207059.

The rapid expansion of artificial intelligence (AI) and work digitalization is transforming occupational environments, introducing new psychosocial risks while also creating potential opportunities for improving workplace well-being. However, current evidence remains fragmented and heterogeneous. This scoping review aimed to map and synthesize the existing scientific and grey literature on the impact of AI and work digitalization on mental health, well-being, and psychosocial risks among adult workers. A scoping review was conducted following the Arksey and O'Malley framework and reported according to PRISMA-ScR guidelines. A comprehensive search was performed across multiple databases (PubMed, Scopus, Web of Science, ScienceDirect, Scielo, LILACS, Dialnet, and Google Scholar) and grey literature sources from international occupational health organizations. Studies published between 2016 and 2026 in English and Spanish were included. A total of 43 sources (23 scientific articles and 20 grey literature documents) were analyzed using thematic synthesis. The review explicitly distinguishes between AI-specific occupational exposures and broader digitalization processes to improve conceptual clarity. AI and digitalization were consistently associated with multiple psychosocial risks, including technostress, work intensification, job insecurity, reduced autonomy, and blurred work-life boundaries. Algorithmic management and digital monitoring emerged as key drivers of stress, anxiety, and burnout. However, potential benefits were also identified, such as increased efficiency, flexibility, and professional development, particularly when supported by adequate training and organizational resources. The impact of digitalization was context-dependent and unevenly distributed, disproportionately affecting older workers, lower-skilled employees, and vulnerable groups. Digital and AI literacy emerged as key protective factors. AI and work digitalization represent complex and context-dependent determinants of occupational mental health, with both risks and opportunities depending on organizational, technological, and individual factors. These findings highlight the need for human-centered implementation strategies, strengthened regulatory frameworks, and targeted preventive interventions to mitigate psychosocial risks in digitalized work environments. Given the heterogeneity of the available evidence, findings should be interpreted as exploratory.

This study analysed perceptions of barriers to primary healthcare (PHC) access in a socially vulnerable and violence-affected community in Rio de Janeiro. A cross-sectional survey was conducted in the Manguinhos community, with approximately 1000 residents interviewed face to face in 2024. Data were collected using a structured questionnaire via REDCap, including sociodemographic variables, self-reported health conditions and Patient Health Questionnaire-2 and Generalised Anxiety Disorder-2 scales. Adapted narrative vignettes were used to describe profiles of individuals with or without mental health problems and socially stigmatised behaviours, allowing the assessment of perceived difficulty in accessing health services. Results showed no significant differences in perceived difficulty of access between Black and non-Black participants. However, men reported greater perceived difficulty in scenarios involving common mental disorders, suggesting the influence of internalised stigma. Younger participants perceived greater barriers in situations involving socially marginalised behaviours, reflecting a lack of trust in the responsiveness of health services. Conversely, formal diagnoses and medication use for diabetes and hypertension were associated with lower perceived barriers, indicating that prior engagement with the health system fosters greater familiarity and lower perceived difficulty. Item response theory analysis demonstrated good psychometric performance of the vignettes, confirming their methodological utility. The findings highlight the need to strengthen PHC to address mental health and social vulnerability demands and to reduce subjective barriers, particularly for men and younger individuals. They also underscore the importance of targeted strategies to promote equity in access to care in vulnerable settings.

Idiopathic pulmonary fibrosis (IPF) is a progressive debilitating lung disease which affects physical and mental well-being. The IPF Patient-Reported Outcome Measure (IPF-PROM) scale is a validated and reliable tool for the self-report of physical and psychological well-being in IPF. This study aimed to validate a Greek version of the IPF-PROM scale and further investigate its correlation with clinical features of IPF patients and its interrelation with depressive symptoms and health-related quality of life (HRQoL). This was a two-centre, observational, cross-sectional study, in which IPF patients completed three scales: IPF-PROM, Patient Health Questionnaire-9 (PHQ-9), an index of depressive symptoms, and Health Survey Questionnaire Short Form-12 (SF-12), an index of HRQoL, at the IPF Outpatient Clinics of two University Hospitals in Greece during 2023-2024. Logistic regression analysis was conducted to assess severe status of IPF-PROM compared with mild/moderate status. The study involved 136 IPF patients (87.9% males) with a mean age of 73.5&#xb1;7.9 years. Patients were classified overall with moderate disease according to IPF-PROM mean scores (41.7&#xb1;31.3), particularly in the combined Breathlessness/Fatigue and the Psychological well-being components (40.1 and 43.8, respectively, p>0.050). Patients with severe symptoms, as measured by IPF-PROM, scored higher levels of depressive symptoms on PHQ-9 compared with those with moderate or mild symptoms (17.1, 12.3 and 1.4, respectively, p<0.001) and lower levels of HRQoL in physical (32.6, 34.7 and 47.9, p<0.001) and mental health on SF-12 (23.9, 34.5 and 50.3, p<0.001). Patients with incrementally higher levels of oxygen saturation had lower odds for severe health status according to IPF-PROM (OR=0.83, p=0.018). A significant percentage of IPF patients present with impaired health status and symptoms suggestive of depression. The IPF-PROM scale represents a useful tool that may predict impairment of mental health and HRQoL in IPF, with potential utility for clinical practice and research.

This study aimed to determine the associations between adherence to the 24-hour movement guidelines and symptoms of anxiety and depression among Colombian university students. Cross-sectional study. 1125 individuals (mean age 20.2&#xb1;2.5 years; 56.7% female). Students sampled from a single public university. Participants completed validated self-report instruments: the International Physical Activity Questionnaire-Short Form to assess physical activity (PA), sedentary behaviour (SB) and the Pittsburgh Sleep Quality Index to assess sleep duration. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale, with a score of &#x2265;11 used to classify elevated symptoms. Binary logistic regression models were used to estimate associations between adherence to the 24-hour movement guidelines (meeting all three, two, one or none) and mental health outcomes, adjusting for potential confounders. Only 15.5% of students met all three components of the 24-hour movement guidelines. Meeting a greater number of components was significantly associated with lower odds of depressive and anxiety symptoms. In fully adjusted analyses, students who met all three guidelines were less likely to report anxiety symptoms (OR=0.26; 95%CI 0.13 to 0.54)&#x2009;and depressive symptoms (OR=0.42; 95%CI 0.22 to 0.79) compared with those who met none. Among individual behaviours, sufficient PA and adequate sleep were independently associated with lower odds of both outcomes, whereas high SB was associated with higher odds of elevated symptoms. In this cross-sectional study, adherence to a greater number of 24-hour movement guideline components was associated with lower levels of anxiety and depressive symptoms in a graded manner. However, the cross-sectional design precludes inference regarding directionality or causality, and bidirectional associations or residual confounding remain possible. Longitudinal and interventional studies are needed to determine whether integrated daily movement behaviours influence mental health outcomes in young adults, particularly in Latin American populations.

To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups. Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups. Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle). Adults aged &#x2265;18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18-49 years (74-75%), female (66-67%), white (86.6-87.5%) and non-Hispanic (86.6-87.5%). Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1&#x2009;week vs &#x2264;1&#x2009;week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol. LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1-7 class models; significant demographic differences (&#x3c7;2 p<0.001 for gender, age, race, ethnicity, education and income distributions)). Sensitivity analysis using four age groups (18-29, 30-49, 50-64, &#x2265;65 years) yielded higher BIC (45 430.8) than three groups (18-49, 50-64, &#x2265;65 years; BIC=42&#x2009;150.9), confirming the primary model. Class 3 (middle-aged, high-income non-Hispanic; n=599 (15.8%)) was the reference group. Compared with Class 3, Class 1 (lower-income, predominantly Hispanic young to middle-aged adults; n=499 (13.2%)) and Class 2 (lower-income, older, predominantly Black non-Hispanic; n=1828 (48.2%)) exhibited significantly worse outcomes across physical and mental health domains (eg, Class 1 3-month anxiety &#x3b2;=4.41 (95% CI 3.25 to 5.56, p<0.001); Class 2 3-month depression &#x3b2;=3.58 (95% CI 2.53 to 4.64, p<0.001)). Classes 1 and 2 also reported significantly worse cognitive function at both time points (eg, Class 1 3-month &#x3b2;=-3.29 (95% CI -4.77 to -1.82, p<0.001)) and Class 2 had significantly higher odds of missed workdays at 6 months (OR=1.853 (95% CI 1.192 to 2.880, p=0.006)). In contrast, Class 4 (young to middle-aged, highly educated, high-income non-Hispanic; n=865 (22.8%)) consistently reported the most favourable outcomes, including better physical function (3-month &#x3b2;=2.04, p<0.001) and lower pain interference compared with the reference group. In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery. NCT04610515.

The prevalence of common mental disorders in resettled refugee populations is nearly three times higher than in the general population. The WHO recommends Problem Management Plus (PM+), a brief non-specialist delivered intervention for reducing common mental disorders. To identify key factors to optimise implementation, we conducted a qualitative cross-sectional study to investigate contextual determinants shaping PM+ implementation during a nationwide scale-up of PM+ in Switzerland. We conducted in-depth key informant interviews in the German-speaking and French-speaking parts of Switzerland (September 2023 and January 2025). Design and analysis of interviews was guided by the Consolidated Framework for Implementation Research (CFIR). Themes were added both inductively and deductively and categorised into challenges and opportunities for widespread PM+ service delivery. We interviewed 30 stakeholders: 12 policymakers, 5 government leaders, 5 specialists and implementers and 8 non-specialist peer-providers. Whilst stakeholders were enthusiastic about the value of PM+, several limitations to its routine delivery were noted. These related to limited quality standards and control for non-specialist delivered interventions that prevented formal categorisation within the health system. Endorsement by professional associations including best-practice standards was thought to facilitate such formalised recognition. Prioritising mental health indicators within Cantonal integration programmes was perceived to facilitate funding via the national integration agenda. All stakeholders pointed towards blended co-financing pathways to ensure the longer-term sustainability of PM+ in Switzerland. The routine delivery of PM+ within health and integration systems presented substantial challenges and opportunities. Longer-term sustainability of PM+ may be feasible with blended financing, tailored Cantonal health and integration agendas, and established quality control standards for PM+ delivery&#x2009;that include formal recognition of non-specialists within the mental health system.

School-aged children frequently experience psychological distress due to academic pressures, a challenge that is often more severe for those from underserved and minority communities. This study aims to evaluate the effectiveness of mental health interventions implemented in school and community settings for children aged 5 to 19. It also seeks to compare the outcomes between children from minority and underserved populations and their peers. This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant studies. Major databases will be searched using a structured search strategy developed by the research team. The review will include randomised controlled trials (RCTs) that assess the impact of interventions conducted in school or community settings to prevent psychological distress-specifically depression, anxiety and stress. To minimise bias, two reviewers will independently select studies and extract data at various stages. The quality of included studies will be assessed. A meta-analysis will be conducted to compare intervention outcomes between children from underserved/minority communities and other children. Pooled prevalence rates and subgroup analyses will be used to explore differences in effectiveness. Heterogeneity among studies and publication bias will also be assessed. Meta-analyses of proportions, ORs and relative risks will be conducted using a random-effects model to estimate effect sizes from multivariate analyses. Ethical approval was not required, as this study involved secondary analysis of published literature and did not involve human participants. To date, no systematic review has comprehensively compared school-based and community-based interventions in terms of their effectiveness in addressing anxiety, depression and stress among school-aged children. This review aims to fill that gap by providing clinical insights into the comparative effectiveness of various intervention types and settings. CRD42023479389.

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Individuals with mental disorders face excess morbidity and premature mortality. Accelerated ageing has been proposed as a contributing mechanism but population-scale evidence across diverse diagnoses is limited. To examine whether metabolomic ageing differs across mental disorders and whether associations vary by sex, age group and genetic liability. Using plasma metabolomic profiles from UK Biobank participants, we applied a metabolomic ageing clock (MileAge) to estimate disorder-specific differences between metabolite-predicted and chronological age. Mental disorders were ascertained from health records and self-reported physician diagnoses. We analysed nine diagnostic groups and 45 individual disorders and assessed sex and age group differences and associations with polygenic scores. Among 225&#x2009;212 participants (54% female; mean age 56.97), 38&#x2009;524 had a diagnosis preceding baseline. Substance use, psychotic, affective and neurotic disorders were associated with a metabolite-predicted age older than chronological age, largest for psychosis (&#x3b2;=0.556, 95% CI 0.250 to 0.861, p<0.001). Obsessive-compulsive and eating disorders were associated with a metabolite-predicted age younger than chronological age. Several associations were stronger in males and in individuals aged <65 years. Higher genetic liability to depression, autism and attention-deficit/hyperactivity disorder predicted an older metabolomic age (&#x3b2; range=0.020&#x2009;to 0.047), whereas polygenic scores for psychosis and tobacco use disorder predicted a younger metabolomic age (&#x3b2; range=-0.023&#x2009;to -0.040). For obsessive-compulsive disorder and anorexia nervosa, clinical and genetic associations indicated younger metabolomic ageing. Metabolomic ageing in mental disorders is heterogeneous. While many disorders are associated with an older biological age, some are linked to a younger biological age. Divergence between genetic liability and clinical phenotypes suggests that non-genetic factors shape biological ageing differences. Biological age should not be assumed to uniformly exceed chronological age across mental disorders. Sex and age-specific approaches could improve understanding of biological ageing processes in psychiatry.

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Developmental regression is when children lose one or more skills they have established. Families caring for these children need timely recognition to assist diagnosis and tailored interventions. Families also need support to develop practical skills for caregiving and strategies to promote family well-being and community participation. Given the high caring demands, flexibly delivered approaches are needed to accommodate family routines. Online delivery of health-related interventions that provide coaching, information, or both has been found to be a feasible and effective option for families. Family Focus is a new family-centred online programme, co-designed with parents and family advocates, clinicians, and researchers to support and empower primary carers. This study is a prospective, pragmatic randomised controlled trial comparing the effectiveness of online parent coaching plus Family Focus (Coaching+FF) to Family Focus alone (FF) for primary carers of children experiencing developmental regression. A sample of 56 families will be randomised in a 1:1 ratio. Outcomes are assessed at baseline, post-intervention and 12-month post-randomisation. The primary outcome is parental stress symptoms at post-intervention. Secondary outcomes include parental depressive and anxiety symptoms, parental engagement in health-promoting activities, family empowerment, family quality of life and child global health outcomes. The study will also examine the uptake and acceptability of specific coaching and FF components and explore the facilitators and barriers to their delivery and implementation. Ethics approvals were obtained from the participating organisations (Monash Health HREC/107806). Informed consent is obtained from parents/guardians of children prior to study enrolment. Study findings will be disseminated through peer-reviewed publications, conference presentations and lived experience agencies. ISRCTN25513446.