Nature-based health interventions (NBHIs) are increasingly used in the healthcare system to support people with anxiety, depression and/or stress, highlighting the need for systematic development and evaluation. This study aims to identify target group, professionals, mechanisms, and outcomes of NBHIs for people with mild to moderate anxiety, depression, and/or stress. A Delphi-based study was conducted to explore core components of NBHIs in healthcare settings. Thirteen vs. eleven researchers with expertise related to the target group responded in two rounds. Respondents rated statements on a 7-point Likert scale and prioritised core components regarding target group, professionals, mechanisms, and outcomes. A thematic analysis was applied to synthesise qualitative responses. Consensus was achieved on 12 of 21 items across the four domains. Highest agreement concerned core mechanisms (nature interaction, social community, and physical activity), outcome priorities (mental wellbeing and quality of life), and professional competencies. Greater variation was observed regarding group composition and team delivery. Analysis of qualitative expert responses highlighted four key themes: (1) Balancing Group Composition, (2) Adapting Competencies to Context, (3) Core Mechanisms for Change, and (4) Weighing Perspectives in Outcome Selection. By setting out guiding principles for a programme theory, the study lays the foundation for the design and implementation of context-adapted NBHIs. The study underscores the need to approach NBHIs as complex interventions, thus contributing to a paradigm shift towards a new era of a bio-psycho-social health perspective.

Background: Non-suicidal self-injury (NSSI) is a significant public health issue that threatens the physical and mental well-being of adolescents. Identifying associated factors is a crucial step toward effective intervention. Methods: This study analyzed data from 463 adolescents (42.12% boys; mean age = 16.21 years, range 12–18) to explore the relationships between NSSI, parental psychological control, self-disgust, and resilience. Results: Multivariate logistic regression indicated that parental psychological control, self-disgust, and resilience were significantly associated with NSSI. Furthermore, in the chain mediation model, self-disgust and resilience significantly mediated the relationship between parental psychological control and NSSI. Conclusions: This study examines the relationships between parental psychological control, self-disgust, resilience and NSSI in adolescents, providing theoretical insights and practical implications for developing intervention and prevention strategies.

Objectives This study aimed to evaluate the implementation of specific recommendations for providers caring for pediatric Ukrainian refugees new to Switzerland, including the care provided and the challenges faced. Methods Pediatricians were invited via newsletters to participate in an online questionnaire. Results A total of 111 primary care pediatricians (PCPs) were eligible for participation. Of these, 91% reported providing care for Ukrainian refugees. The vast majority (88.6%) were aware of the mentioned recommendations. The reported care included treating acute conditions (94.8%), ensuring vaccination coverage (89.7%), and performing new-arrival check-ups regardless of age (60.8%). The psychosocial situation of the child (67.0%) and the mental wellbeing of both the child and main caregiver (47.4%) were assessed, and preventive information (29.9%) was provided to a lesser extent. Tuberculosis risks were discussed or screened for by 73.2% of the participants, HIV by 58.3%, and Hepatitis C by 57.3%. The main challenges faced included lack of time (77.9%), language barriers (81.1%), organizing mental health care (65.5.%), different health(care) perceptions (65.6%), demanding attitudes (68.4%), and refusals of check-ups (30.8%) and vaccines (38.6%). Conclusion Despite high levels of awareness of the recommendations, their implementation varied. Preventive care and mental health support require improvement. Care-enabling policies have been identified and are warranted.

BackgroundLoneliness exacerbates symptom burden and reduces quality of life in serious illness. Social prescribing-linking patients to non-clinical community activities-offers a novel approach to address loneliness in palliative care.ObjectivesTo describe demographic, clinical, and psychosocial characteristics of oncology patients identified as lonely and referred to Art Pharmacy, an arts-based social prescribing program, within a palliative care setting.MethodsA retrospective chart review was conducted for 48 patients referred to Art Pharmacy's social prescribing services at the Georgia Cancer Center of Excellence at Grady Memorial Hospital. Demographics, mental and physical well-being scores, social determinants of health, and healthcare utilization data were analyzed.ResultsMost patients were older, non-Hispanic Black women experiencing financial strain, food insecurity, and transportation barriers. Anxiety exceeded depression severity; mood disorders, loneliness, and social isolation were leading referral reasons.DiscussionFindings characterize loneliness in a safety-net palliative oncology population. Social prescribing may help alleviate this burden, warranting further evaluation.

Background: Polycystic ovary syndrome (PCOS) is commonly associated with psychological disorders, including depression and anxiety. Women with PCOS also tend to experience poorer sleep quality and greater daytime sleepiness than healthy individuals. To the best of our knowledge, no systematic reviews have investigated the impact of probiotic supplementation on mental health and sleep patterns in women with PCOS. Emerging evidence indicates that probiotic therapy may be a promising adjunct for enhancing mental well-being and sleep quality within this population. Objectives: This systematic review aimed to evaluate the effects of probiotic supplementation on depression, anxiety, and sleep quality in adult women with PCOS. Methods: PubMed, Cochrane, and Scopus were searched for randomized controlled trials (RCTs) involving women aged 18–45 years old, with diagnosed PCOS, who received probiotic/synbiotic supplements and enriched foods compared with placebo. Studies had to assess mental health, depressive symptoms, or sleep disorders using validated questionnaires. Five publications met the Population, Intervention, Comparison, and Outcome inclusion criteria (PICO) and were included in the final analysis. Results: Probiotic supplementation was associated with significant improvements in sleep quality (assessed by Pittsburgh Sleep Quality Index, PSQI), depressive symptoms (assessed by Depression, Anxiety and Stress Scale, DASS 21) and quality of life (measured by Polycystic Ovary Syndrome Health Related Quality of Life Questionnaire, PCOSQ-26). Conclusions: Although probiotic supplementation may benefit mental health and sleep parameters in women with PCOS, this evidence is limited due to the small number of studies, modest sample sizes, and methodological variability. Further research with larger, more rigorous studies is needed to confirm these findings.

Firefighting is a career characterized by significant physical effort and continuous psychological challenges. This study qualitatively examines a link between Body Mass Index (BMI) and mental health among firefighters, emphasizing how body composition may affect psychological stability and job efficiency. A total of 37 firefighters, with an average of 9 years of experience, took part in the survey using a questionnaire exploring the connection between BMI and workplace mental well-being. Findings revealed that 65% of the participants were overweight or obese, 27% reported mental or emotional difficulties, and 19% experienced anxiety or depression symptoms in the previous year. Sleep problems were frequent, with 38% mentioning poor or insufficient rest, along with recurring emotional fatigue and mood changes. Although most participants remained calm during emergencies, hidden stress and unhealthy coping behaviors, such as smoking, were noted. Implementing supportive strategies can enhance resilience, promote overall wellness, and improve operational readiness, ensuring a healthier and more efficient firefighting workforce. Keywords: Body Mass Index (BMI), Firefighters, Mental Health, Occupational Health, Psychological Well-being

BACKGROUND Approximately 30% of patients with head and neck cancer experience adverse effects caused by anxiety and depression. Considering the high prevalence, implementing customized interventions to ease adverse emotional states is imperative. AIM To evaluate the efficacy of cognitive behavioral therapy (CBT)-based psychological interventions in improving the psychological well-being and quality of life (QoL) of patients with laryngeal carcinoma. METHODS This study enrolled 120 patients admitted from February 2022 to February 2024. The control group, comprising 50 participants, received standard supportive psychological care, while the research group, consisting 70 participants, underwent CBT-based interventions. Several clinical outcomes were systematically assessed that included postoperative recovery metrics (duration of tracheostomy and nasogastric tube dependence and length of hospitalization), psychological status (Self-Rating Anxiety Scale and Self-Rating Depression Scale), nutritional markers (serum albumin and hemoglobin levels), sleep quality (Self-Rating Scale of Sleep and Athens Insomnia Scale), and QoL (Functional Assessment of Cancer Therapy-Head and Neck). RESULTS The results demonstrated that the research group experienced superior outcomes, with significantly reduced durations of tracheostomy and nasogastric tube dependence, as well as shorter hospital stays, compared with the control group. Additionally, the research group exhibited markedly lower post-intervention Self-Rating Anxiety Scale, Self-Rating Depression Scale, Self-Rating Scale of Sleep, and Athens Insomnia Scale scores, along with minimal but higher change in serum albumin and hemoglobin levels compared with the control group. All five domains of Functional Assessment of Cancer Therapy-Head and Neck showed notable improvements in the research group, exceeding those observed in the control group. CONCLUSION CBT-based psychological support positively affects the mental well-being and QoL of patients with laryngeal carcinoma, highlighting its potential for broader clinical application.

Poor mental well-being is common among healthcare workers, affecting individual health, patient safety, and organisational performance. Mobile app-based self-care interventions are promising due to their accessibility, low cost, and ease of use. This study aimed to assess the feasibility of a self-monitoring mobile app called MYARKEO, to improve mental well-being among healthcare workers and healthcare trainees in the United Kingdom (UK). The study evaluated recruitment and retention rates, variability of key outcomes to inform a future randomised controlled trial (RCT), intervention engagement, barriers and facilitators to engagement, and potential refinements to the mobile app. A mixed-method feasibility RCT was conducted with two groups: an intervention group using MYARKEO to monitor mental well-being over 6 weeks, and a non-intervention control group. Data were collected at baseline and post-intervention and included the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression Anxiety and Stress Scale (DASS-21), and the mHealth App Usability Questionnaire (MAUQ). Qualitative data were collected through semi-structured interviews (n = 13) and analysed using thematic analysis. Forty-nine participants (32 workers, 17 trainees; aged 18–60+) were included in the trial, with a 20.5% dropout rate. Daily app usage averaged 64.5%. Participants frequently monitored mood, sleep, food, and exercise. Interviews identified themes of “Usefulness,” “Enablers of engagement,” “Barriers to engagement,” and “Suggested intervention improvements.” This study demonstrates the feasibility of using a mobile app to monitor and promote mental well-being among healthcare workers and trainees. While app engagement was promising, challenges were identified, highlighting the need for refinements to the app’s content, interface, and design for future trials.

Adverse social and economic conditions negatively impact mental health and well-being. To the best of the authors' knowledge, the present systematic review is the first to investigate the association between housing insecurity and mental health outcomes among renters, with a focus on housing affordability and instability. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in December 2022 across four databases (MEDLINE, PsycINFO, Web of Science, and ASSIA). Quantitative studies from OECD (Organisation for Economic Co-operation and Development) member countries were eligible for inclusion if they investigated housing insecurity by examining at least one independent variable related to housing affordability and/or instability, and included at least one mental health-related outcome among adult renters. Studies needed to specifically distinguish effects for renters, not simply adjust for tenure or include an interaction. Studies were excluded if they analyzed other forms of housing insecurity, examining residential satisfaction and general health outcomes, or populations other than adult renters (< 15 years of age). The methodological quality of the included studies was rated with the JBI Critical Appraisal Tools, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Due to heterogeneity of the identified studies, we performed a narrative synthesis. Twenty-two studies with sample sizes ranging from n = 89 to n = 179,037 met the inclusion criteria (resulting in a total sample size of at least N = 336,775), of which 14 applied a longitudinal design, five a cross-sectional design, and three a quasi-experimental design. Based on the JBI ratings, the overall methodological quality of the included studies was good. The overall ratings of certainty of evidence, based on the GRADE ratings, were between low and very low - mainly due to the non-controlled study designs of included studies. Among the nine studies examining housing affordability, six reported significant associations between unaffordable rent and poor mental health in low-income renters. Regarding housing instability, 12 out of 14 studies reported significant associations between unstable housing and renters' mental health issues. Measures of housing insecurity varied, with rent-to-income ratio and forced moves being most commonly employed. Mental health outcomes focused primarily on overall mental health, well-being, and depressive symptoms, while few studies explored other mental health outcomes. Despite methodological limitations due to the non-controlled studies included in the review, the findings suggest overall that experiencing unaffordable or unstable housing has a negative impact on renters' overall mental health and depressive symptoms. Housing insecurity poses a significant challenge for renters in OECD countries, highlighting the need for policymakers to implement supportive housing policies and tenure protection measures in order to improve renters' housing security and ultimately public health. Nevertheless, more research with robust study designs is needed to draw further conclusions. The systematic review has been conducted without external funding. It has not been pre-registered and no study protocol has been published.

Adverse social and economic conditions negatively impact mental health and well-being. To the best of the authors’ knowledge, the present systematic review is the first to investigate the association between housing insecurity and mental health outcomes among renters, with a focus on housing affordability and instability. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in December 2022 across four databases (MEDLINE, PsycINFO, Web of Science, and ASSIA). Quantitative studies from OECD (Organisation for Economic Co-operation and Development) member countries were eligible for inclusion if they investigated housing insecurity by examining at least one independent variable related to housing affordability and/or instability, and included at least one mental health-related outcome among adult renters. Studies needed to specifically distinguish effects for renters, not simply adjust for tenure or include an interaction. Studies were excluded if they analyzed other forms of housing insecurity, examining residential satisfaction and general health outcomes, or populations other than adult renters (< 15 years of age). The methodological quality of the included studies was rated with the JBI Critical Appraisal Tools, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Due to heterogeneity of the identified studies, we performed a narrative synthesis. Twenty-two studies with sample sizes ranging from n = 89 to n = 179,037 met the inclusion criteria (resulting in a total sample size of at least N = 336,775), of which 14 applied a longitudinal design, five a cross-sectional design, and three a quasi-experimental design. Based on the JBI ratings, the overall methodological quality of the included studies was good. The overall ratings of certainty of evidence, based on the GRADE ratings, were between low and very low – mainly due to the non-controlled study designs of included studies. Among the nine studies examining housing affordability, six reported significant associations between unaffordable rent and poor mental health in low-income renters. Regarding housing instability, 12 out of 14 studies reported significant associations between unstable housing and renters’ mental health issues. Measures of housing insecurity varied, with rent-to-income ratio and forced moves being most commonly employed. Mental health outcomes focused primarily on overall mental health, well-being, and depressive symptoms, while few studies explored other mental health outcomes. Despite methodological limitations due to the non-controlled studies included in the review, the findings suggest overall that experiencing unaffordable or unstable housing has a negative impact on renters’ overall mental health and depressive symptoms. Housing insecurity poses a significant challenge for renters in OECD countries, highlighting the need for policymakers to implement supportive housing policies and tenure protection measures in order to improve renters’ housing security and ultimately public health. Nevertheless, more research with robust study designs is needed to draw further conclusions. The systematic review has been conducted without external funding. It has not been pre-registered and no study protocol has been published.

Background/Objectives: Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities. A significant proportion of patients with obesity who undergo bariatric surgery could exhibit suboptimal mid-term outcomes. This study aims to comprehensively assess anthropometric, clinical, biochemical, nutritional, and quality of life parameters in patients with severe obesity undergoing bariatric surgery, with a particular focus on outcomes at 24 months post-surgery to capture mid-term effects that may not be apparent during the first year of follow-up. Methods: A prospective study was conducted in 95 patients with obesity undergoing bariatric surgery (Roux-en Y gastric bypass; RYGB) at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between 2020 and 2023. Participants were followed up at 6, 12, and 24 months after RYGB. The study incorporated anthropometric assessments (BMI, body composition via bioelectrical impedance), full biochemical profiling, dietary analysis (using a validated food frequency questionnaire), and quality of life assessment (SF-36 questionnaire). Results: Our results showed significant weight loss after the intervention, accompanied by improvements in metabolic parameters, and dietary habits. Regarding quality of life, significant improvements were observed in both the physical (baseline: 39.62%; 6 months: 52.40%; 12 months: 53.12%) and mental components (baseline: 42.08; 6 months: 53.40; 12 months: 52.14%) at 6 and 12 months post-surgery. However, our prospective 24-month follow-up revealed that, despite these initial benefits, mental health significantly declined compared with the 12-month follow-up (24 months: 46.85%). In contrast, the physical component remained relatively stable at 24 months (24 months: 50.91%). However, our prospective 24-month follow-up revealed that, despite these initial benefits, there was a decline in mental health compared to the 12-month follow-up. Conclusions: While bariatric surgery is associated with improvements in anthropometric measures and some aspects of quality of life, our findings underscore the need for continued mid-term support to address emerging challenges in mental well-being.

Abstract Aim Adolescence is a critical period during which health behaviors and school participation intersect, influencing long-term health outcomes. This study examines the associations between health behaviors, mental well-being, health outcomes, and reading and writing difficulties (RWDs) among Danish adolescents. Subject and methods This cross-sectional study analyzed data from the 2017 Future Occupation of Children and Adolescents (FOCA) cohort, including 13,100 ninth-grade students across Denmark. All data except sex were self-reported. Logistic regression models estimated odds ratios (ORs), adjusted for socioeconomic status and sex. Results Poorer self-rated health (OR = 1.50; 99% confidence interval [CI] 1.25–1.80), poor mental health (OR = 1.99; 99% CI 1.57–2.52), increased smoking (OR = 1.14; 99% CI 1.02–1.28), lower life satisfaction (OR = 1.15; 99% CI 1.10–1.19), lower self-efficacy (OR = 1.08; 99% CI 1.05–1.12), higher body mass index (BMI) (OR = 1.06; 99% CI 1.04–1.08), and lower levels of leisure-time physical activity (OR = 1.05; 99% CI 1.03–1.08) were all associated with higher odds of reporting having RWDs. No associations with alcohol use were found. Socioeconomic status and sex did not substantially confound the results, except for regular drug and hash use. Conclusion RWDs and health-related outcomes appear to be associated among adolescents. Prospective studies are needed to determine whether the associations imply a causal relation that could inform the development of targeted interventions addressing both educational challenges and health risks.

Objective: Pediatric primary care providers are increasingly asked to care for their patients’ behavioral health needs, but few models of behavioral health integration emphasize practical strategies that are widely applicable to practices regardless of resources or size. A pilot cohort of pediatric primary care practices participated in a regional quality improvement (QI) project focused on improving each practice’s levels of behavioral health integration using the Comprehensive Healthcare Integration (CHI) Framework ( National Council for Mental Wellbeing, 2022 ) as a guiding framework. Method: Five practices joined the 10-month QI project pilot cohort. Each practice chose one subdomain from the CHI Framework’s Multidisciplinary Teamwork domain as their project’s focus. Participants attended monthly meetings and educational sessions, completed QI deliverables while implementing their identified interventions, and completed surveys and interviews pre- and post-project. Results: Four of the five practices (80%) reported increasing their behavioral health integration by at least one level on a subdomain of Multidisciplinary Teamwork CHI Framework domain. All practices (100%) reported increased satisfaction with their practice’s level of behavioral health integration, with an average 60% increase from pre- to post-project. Conclusions: Practices made notable improvements to their behavioral health integration during the project. The CHI Framework was useful in structuring practices’ behavioral health goals and assessing improvements. Elements of the QI project process, such as having access to content experts, the cohort format, and accountability provided by the project, appeared valuable to participants. Insights are shared for organizations aiming to support pediatric primary care providers in their behavioral health integration efforts.

To report the prevalence of mental health symptoms and influencing factors in retired professional high contact team sport (HCTS) athletes. Mixed-methods systematic review. PsycINFO, Embase, Medline, SPORTDiscus and Scopus were searched in July 2023 and March 2025. Studies that investigated mental health and/or influencing factors within retired professional HCTS athletes were included. Studies that were non-peer-reviewed, could not obtain full text, used secondary data or focused on non-elite/individual/low-contact sports were excluded. 85 studies were included in the final review, comprising 53 996 participants (females; n=247, 0.46%) from six sports (Australian Football League, Canadian Football League, football/soccer, ice hockey, National Football League and rugby). Prevalence ranges varied for each condition; smoking (0.9%-16%), depression (3%-49%), anxiety (4.3%-42%), cannabis use (5%-15.7%), adverse alcohol use (6.4%-68.8%), opioid use (7%-23.6%), stress (8.7%-26.9%), illicit drug use (10%-63.2%), anxiety/depression (10.2%-39%) and adverse nutritional behaviour (23.8%-64.5%). Of the studies including M and SD of validated scales, scores for depression, anxiety and sleep disturbance were equivalent to population norms, whereas mild or higher scores were reported for stress and adverse alcohol use. Concussion, pain, injury, neurological factors and declined physical function were shown to have a negative influence on mental health. Both negative and positive influences were observed for: athletic identity, psychosocial support, retirement autonomy, life events, osteoarthritis, retirement and cognitive function. 48% of studies had good methodological quality; however, most studies were cross-sectional, relied on self-report measures and lacked follow-up data and female athletes. Retired HCTS athletes experience high levels of psychological distress and adverse alcohol use, but depression, anxiety and sleep disturbance were similar to population norms. These results call for greater support measures for retired athletes. CRD42023449114.

Background The COVID-19 pandemic served as a global, uncontrolled social isolation experiment, with especially pernicious effects on the wellbeing of young adults. We sought to understand how the COVID-19 pandemic impacted the wellbeing of university undergraduate students, distinguishing between factors related to infection prevalence and those linked to social restriction. Methods 277 total U.S. undergraduate students enrolled in a course on mental wellbeing and resilience that was offered once each year from 2020 to 2024. Students anonymously completed surveys assessing anxiety, depression, and subjective wellbeing on a weekly basis. These behavioral data were aggregated and investigated for associations with local COVID-19 case levels and a university social gathering meter. Results Subjective wellbeing declined a few months into the COVID-19 pandemic in Fall 2020, remaining low in Fall 2021 and Spring 2022, with 63.7% of students at-risk for poor wellbeing over these three semesters based on the standard cutoff. Depression and anxiety peaked during Fall 2021 with 39.0% and 34.5% of students at-risk for anxiety and depressive disorders, respectively. Wellbeing gradually improved following the return to in-person learning in mid-Spring 2022. Over all five semesters, survey questions reflecting anhedonia associated with social gathering restrictions whereas questions assessing acute anxiety associated with local COVID-19 case levels. Conclusions Our findings highlight the negative impact of the COVID-19 pandemic on university student wellbeing and suggest that COVID-19 infection prevalence and associated social isolation measures may have uniquely influenced different aspects of wellbeing. More research is needed to assess causality, while accounting for other potential socio-economic and academic factors.

Background and objective Childhood, adolescence, and emerging adulthood represent critical transitional periods characterized by rapid biological, psychological, and social development, each of which may distinctly influence diet–mood interactions. To date, no study has concurrently examined the association between dietary diversity and depressive symptoms across the full developmental spectrum spanning these life stages. As a result, age-specific vulnerabilities and potential windows for intervention remain poorly understood. Using a large and diverse sample of Chinese children, adolescents, and university students, this cross-sectional study aimed to explore the relationship between dietary diversity and depressive symptoms across these key developmental periods. The findings may help inform the design of targeted, developmentally appropriate nutritional strategies for depression prevention. Materials and methods In this cross-sectional investigation, a total of 11,856 Chinese college students and 1,281 children and adolescents were enrolled. All participants completed self-administered questionnaires assessing demographic characteristics, lifestyle behaviors, dietary diversity, and depressive symptoms [evaluated with the Patient Health Questionnaire-9 (PHQ-9) and the 20-item Zung Self-Rating Depression Scale (SDS)]. Multivariable logistic regression analyses were employed to examine the associations between dietary diversity and depressive symptoms, with adjustment for relevant confounding factors. Results The prevalence of depressive symptoms was 18.9% (2,245/11,856) among college students and 4.7% (60/1,281) among children and adolescents. Among college students, a significant inverse relationship was observed between dietary diversity scores and depressive symptoms. Compared to participants with a score of 0, the adjusted odds ratios decreased progressively with higher scores, ranging from OR = 0.94 (95% CI: 0.39, 2.30) for a score of 1 to OR = 0.33 (95% CI: 0.13, 0.81) for a score of 9. Similarly, among children and adolescents, higher dietary diversity was associated with markedly lower odds of depressive symptoms, with ORs declining from 0.164 (95% CI: 0.007, 3.837) for one food score to 0.026 (95% CI: 0.002, 0.390) for seven food scores, relative to the zero-score reference group. In analyses of specific food groups, college students showed significant inverse associations between depressive symptoms and consumption of vegetables (OR = 0.67, 95% CI: 0.55, 0.81), fruits (OR = 0.78, 95% CI: 0.70, 0.88), red meat (OR = 0.85, 95% CI: 0.75, 0.95), and soy products (OR = 0.89, 95% CI: 0.80, 0.99). Among children and adolescents, significant associations were observed for multiple dietary factors, with inverse associations for fruit intake ( P = 0.019) and breakfast consumption ( P &amp;lt; 0.001), and positive associations for sugar-sweetened beverages ( P = 0.025), fried foods ( P &amp;lt; 0.001), fast food ( P &amp;lt; 0.001), and processed foods ( P = 0.033). Conclusions This study establishes a significant inverse relationship between dietary diversity and depressive symptoms. The results support the integration of dietary diversity into public health recommendations and behavioral interventions. Specifically, fostering diverse and healthy eating patterns emerges as a promising, practical strategy for the prevention of depressive symptoms, underscoring the role of nutrition in mental well-being.

Cognitive fatigue has emerged as a critical concern in educational settings that require sustained mental effort, particularly in Islamic boarding schools implementing dual-curriculum systems. Santri are required to balance intensive Qur’anic memorization with formal general education, creating substantial cognitive demands that may affect learning effectiveness and mental well-being. This study aims to examine the level of cognitive fatigue among santri and to identify key contributing factors within a dual-curriculum pesantren context. A quantitative descriptive design was employed involving 120 students aged 13–18 at Darul Iman Islamic Boarding School, North Lombok, Indonesia. Data were collected using the Pediatric Cognitive Fatigue Scale (PCFS), supported by classroom observations and analysis of study duration, sleep patterns, and memorization load. The findings indicate that most students experience moderate to high levels of cognitive fatigue. Fatigue levels were strongly associated with prolonged daily study time exceeding ten hours, reduced sleep duration, and high Qur’anic memorization intensity, while gender and age were not significant predictors. These results highlight the cumulative cognitive risks of extended academic engagement without adequate rest. This study contributes to the limited empirical literature on student cognitive fatigue in religious education environments. The findings imply the need for pesantren administrators and policymakers to redesign learning schedules by incorporating structured rest periods, balanced memorization targets, and sleep protection strategies to promote healthier and more sustainable learning environments for adolescents in dual-curriculum Islamic boarding schools.

ObjectivesDiabetes is highly prevalent in older women worldwide. This study explores the associations of psychosocial factors with both health service utilisation and self-management in older women aged 68 to 73 years with type 2 diabetes (T2D) or pre-diabetes.Design and settingThis cross-sectional study used data from the Australian Longitudinal Study on Women’s Health (ALSWH), which is a national population-based cohort study that has collected information on factors related to women’s health and well-being over 20 years.ParticipantsWomen aged 68–73, born between 1946 and 1951, participated in ALSWH and self-reported their diagnosis of T2D or pre-diabetes.Outcome measuresResilience, dispositional optimism and perceived control were the measures of psychosocial factors. The associations between these factors and diabetes self-management behaviours, healthcare visits and preventive service use were examined by numerous regression models.ResultsThere were 939 women aged 68–73 years with T2D or pre-diabetes. Women with T2D who exhibited higher dispositional optimism had significantly higher odds of participating in moderate/vigorous physical activity (OR: 1.06), visiting a dentist (OR: 1.07) and a lower rate of general practitioner (GP) visits (rate ratio (RR): 0.99). Women with T2D with greater resilience were likely to have a lower rate of consulting with mental health professionals (RR: 0.63) and higher odds of blood sugar level checks (OR: 1.68). The rate of GP visits within a year decreased by 16% for women with pre-diabetes who had a higher resilience score (RR: 0.84), and women with pre-diabetes with greater resilience had a 13% lower rate of visits to a nurse (RR: 0.87).ConclusionsPsychosocial aspects of diabetes care may be important for supporting the physical and mental well-being of older women with T2D or pre-diabetes. Healthcare providers may consider whether integrating assessments of resilience and optimism into routine diabetes management might help identify older women who could benefit from targeted psychosocial support.

Urban green space and mental well-being of older adults: participatory action research in Hong Kong

The accelerating demographic transition has brought the mental health of older adults to the forefront of public health concerns. Middle-aged and older adults (aged 50–69 years), often described as the “young-old,” are particularly vulnerable to early-stage psychological distress as they navigate shifts in social roles and community participation. Traditional approaches such as pharmacological treatment, counseling, and organized activities provide partial relief but lack personalization, scalability, and sustainable engagement. This study examined how immersive multisensory therapeutic spaces influence mental health among 1,897 community-dwelling adults in China. Participants experienced community-based immersive environments before completing a structured survey. Structural equation modeling showed that social participation significantly reduced psychological distress, which in turn increased acceptance of immersive environments. Acceptance further exerted a significant positive effect on mental health improvement, highlighting its role as a proximal mechanism of change. Cluster analyses identified distinct psychosocial profiles and sensory preferences, offering insights into subgroup-specific intervention strategies. These findings provide large-scale empirical evidence on the behavioral and psychosocial pathways through which multisensory environments support mental health in later life. Social participation and acceptance jointly emerged as critical drivers, suggesting that community-based immersive spaces can function as scalable, person-centered, and culturally relevant non-pharmacological interventions that complement existing public mental health strategies.