Loneliness is a complex and usually unpleasant emotional response to isolation, which has been considered the latest global health epidemic exacerbated by the coronavirus disease 2019 pandemic, affecting nearly two-thirds of older adults. Some profound health implications carried by loneliness include depression, cognitive impairment, hypertension and frailty. Across the world, there is no consensus definition of loneliness, and its measure is based on the phenomenological perspective of the individual. The 20-item University of California Los Angeles Loneliness Scale version 3 (UCLA-20) is the most common measure. This scale demonstrates acceptable psychometric properties but is too long and complex for a phone interview. This paper addresses the increasing need to shorten this scale by adopting classical item response theory and network psychometrics to advance scale development. Through an item reduction analysis, we trimmed the original scale into an effective short form, which is as valid as the original one. With respondents’ time at a premium in most research nowadays, this short-form scale is an efficient and practical alternative to the original UCLA-20.

Rarer dementias are associated with atypical symptoms and younger onset, which result in a higher burden of care. We provide a review of the global literature on longitudinal decline in activities of daily living (ADLs) in dementias that account for less than 10% of dementia diagnoses. Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (Embase), Excerpta Medica Care (Emcare), PsycINFO, and Cumulative Index in Nursing and Allied Health Literature (CINAHL). The search criteria included terms related to 'rarer dementias', 'activities of daily living' and 'longitudinal or cross-sectional studies' following a predefined protocol registered. Studies were screened, and those that met the criteria were citation searched. Quality assessments were performed, and relevant data were extracted. 20 articles were selected, of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum, while one addressed posterior cortical atrophy. Four studies were cross-sectional and 16 studies were longitudinal, with a median duration of 2.2 years. The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies. The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity. Most studies used Alzheimer's disease staging scales to measure decline, which cannot capture variant-specific symptoms. To enhance care provision in dementia, ADL scales could be deployed postdiagnosis to aid treatment and planning. This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life. PROSPERO registration number: CRD42021283302.

Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent. The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions. The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates. The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases. The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.

Pain sensitivity is critical for preventing non-suicidal self-injury (NSSI) behaviours; however, individuals engaging in such behaviours often exhibit decreased pain sensitivity, which may undermine this natural safeguard. The dorsolateral prefrontal cortex (DLPFC) is a key region involved in pain regulation, and recent approaches using transcranial direct current stimulation (tDCS) to target the DLPFC have shown potential for modulating pain processing and restoring normal pain perception for individuals engaging in NSSI behaviours. This study aimed to explore the immediate and short-term effects of a single session of tDCS on pain sensitivity in individuals with NSSI, as well as its secondary effects on mood and NSSI-related factors. In this randomised, double-blind, parallel, sham-controlled clinical trial, participants with a history of NSSI were randomly assigned to receive either active or sham tDCS. The intervention consisted of a single 20 min tDCS session targeting the left DLPFC. The primary outcome was pain sensitivity, measured by the pressure pain threshold (PPT) and heat pain score (HPS). Secondary and additional outcomes included NSSI urges, NSSI resistance, self-efficacy in resisting NSSI, mood-related variables and exploratory cognitive-affective processes such as rumination, self-criticism and self-perceived pain sensitivity, assessed at baseline, immediately post-intervention, and at 24 hours, 1 week and 2 weeks follow-ups. For the primary outcomes, no significant differences between groups were observed for pain sensitivity (PPT, padj=0.812; HPS, padj=0.608). However, an exploratory sensitivity analysis treating each trial as an individual observation revealed a significant effect on HPS (padj=0.036). For the secondary and additional outcomes, although there were initial improvements in joyful feelings and reductions in negative affect at 2 weeks post-intervention, these effects did not remain significant after multiple comparison corrections. Notably, reductions in rumination were statistically significant at both 1-week and 2-week follow-ups (1 week, padj=0.040; 2 weeks, padj=0.042). There were no significant effects on NSSI urges, NSSI resistance, self-efficacy in resisting NSSI or self-criticism. A single session of tDCS over the left DLPFC did not produce significant changes in pain sensitivity in individuals with NSSI. A sensitivity analysis indicated an effect on heat pain sensitivity, possibly reflecting changes in brain activity, warranting confirmation through neuroimaging. These findings suggest that tDCS warrants further investigation for its potential to influence pain-related cognitive-affective processes in individuals with NSSI.

Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories. However, most RC research has been conducted in Western countries with similar cultural characteristics, limiting understanding of how RCs can be culturally adapted. The 12-item Recovery Colleges Characterisation and Testing (RECOLLECT) Fidelity Measure (RFM) evaluates the operational fidelity of RCs based on 12 components, but cultural influences on these components remain underexplored. To assess associations between Hofstede's cultural dimensions and RFM items to identify cultural influences on fidelity components. A cross-sectional survey of RC managers was conducted across all 221 RCs. Mixed-effects regression models examined associations between Hofstede's country-level cultural dimensions and item-level RFM scores, adjusted for healthcare expenditure and income inequality. Four cultural dimensions, obtained from Hofstede, were analysed: individualism (prioritising personal needs), indulgence (enjoyment-oriented), uncertainty avoidance (preference for predictability) and long-term orientation (future-focused). The RFM was completed by 169 (76%) RC managers. Seven RFM items showed associations with cultural dimensions. Equality was linked to short-term orientation, while learning was associated with individualism and uncertainty avoidance. Both individualism and indulgence influenced co-production and community focus. Commitment to recovery was shaped by all four cultural dimensions, with the strongest associations seen for individualism and indulgence. Individualism enhanced explicit focus on strengths-based practice, while uncertainty avoidance influenced course distinctiveness. This study demonstrates how culture shapes RC fidelity components, providing actionable insights for cultural adaptation. Incorporating under-represented dimensions, such as collectivism and restraint, could improve the RFM's global applicability, facilitating implementation. Future research should explore cultural nuances, engage diverse stakeholders and refine fidelity measures to enhance RC inclusivity and effectiveness worldwide.