Homelessness is increasing and associated with poor mental health (MH). Few studies have examined how experiences of homelessness and sexual identity intersect to effect MH. We used an intersectional approach to examine MH inequalities related to sexual identity and past homelessness in a nationally representative private household sample, and whether associations were explained by discrimination.

Analysis of the 2007 and 2014 Adult Psychiatric Morbidity Surveys included 10,428 individuals aged 16–64 (58% female/3.8% non-heterosexual). The Clinical Interview Schedule-Revised (CIS-R) identified common mental disorders (CMDs). Self-harm, attempted suicide, alcohol dependence, substance use, sexual identity, discrimination/bullying, past homelessness and health behaviours were self-reported. Associations between sexual identity and homelessness were examined using multivariable Poisson regression. Prevalence ratios (PRs) for MH and health behaviours by intersectional sexual identity-past homelessness were examined using Poisson regression and adjusted for age, sex, area-level deprivation and further for discrimination/bullying.

Bisexual (adjusted PR [aPR]: 2.52, 95% CI: 1.48–4.29) and gay/lesbian (aPR: 1.76, 0.97–3.19) individuals were more likely to report past homelessness than heterosexual peers. Sexual minority (SM) and heterosexual individuals with past homelessness had higher prevalence of all MH outcomes compared to heterosexual peers without homelessness, with associations strongest in the SM-homelessness group (e.g., CMD: aPR: 2.67 [2.37–3.01] for heterosexual-homeless, aPR: 4.11 [3.00–5.63] for SM-homeless, aPR: 1.82 [1.45–2.28] for SM-not homeless groups), and similarly for depression/self-harm/attempted suicide. Likewise, the SM-homeless group had highest prevalence for drug dependence (aPR, 7.38 [3.15–17.29]) compared to the heterosexual-homeless (aPR, 4.03 [3.00–5.42]) and SM-not homeless (aPR, 2.19 [1.27–3.79]) groups. Adjustment for discrimination and bullying substantially attenuated point estimates, with the greatest attenuation (30–50%) in the SM-homeless compared to the heterosexual-homeless groups.

Individuals with past experiences of homelessness have significantly worse MH than heterosexuals without homelessness, with associations highest in the SM-homeless group. Considering experiencing homelessness and SM identity together identifies a group facing particular adversity, which is often lost when examined separately. Discrimination and bullying explained much of the worse MH in SM- and heterosexual-homeless groups, but especially the former. Investigation into the mechanisms leading to MH inequalities is needed, alongside policies and services to support this group.

This study explored how end-of-life (EOL) care practitioners in Hong Kong engaged in emotional labor while fulfilling their professional roles in a Chinese cultural context.

A sequential explanatory mixed-methods design was employed. A quantitative survey (n = 32) using validated scales that measured emotional job demands and emotional labor strategies was followed by in-depth interviews (n = 11) with EOL care practitioners from diverse disciplines. Survey data were analyzed using descriptive statistics, while interview transcripts underwent thematic analysis.

EOL care practitioners reported high emotional job demands, with deep acting being their preferred emotional labor strategy over surface acting. Three key themes emerged related to: (1) balancing emotional involvement and professional boundaries; (2) employing strategic emotional engagement; and (3) navigating cultural beliefs and family dynamics. This multidisciplinary workforce developed sophisticated practices to manage their emotions authentically while establishing protective psychological boundaries. These practices integrated the provision of emotional support with the navigation of tensions between Chinese cultural values and professional responsibilities.

This study used mixed-methods to explore how traditional values were integrated into the everyday care practices of EOL practitioners in Hong Kong. The findings contribute to an innovative and culturally sensitive framework for exploring emotional labor in EOL care contexts. This is useful in both Chinese and multicultural care contexts.

In recent years, a significant number of Farsi-speaking refugees and asylum seekers have sought asylum in Germany. This group often suffers from emotional distress, which can significantly impact their mental health. The present study aimed to assess the general mental health status and emotional distress among Farsi-speaking refugees, while also exploring the relationship between resilience, psychological flexibility, perceived social support, and meaning in life with posttraumatic growth.

The study involved 230 Farsi-speaking refugees living in refugee camps in Berlin and Brandenburg, Germany. Participants completed several questionnaires, including the RHS-15 screening questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Acceptance and Action Questionnaire (AAQ-2), the Multidimensional Scale of Perceived Social Support (MSPSS), the Meaning in Life Questionnaire (MLQ), and the Posttraumatic Growth Inventory (PTGI). Data collection took place from August to November 2022. Data analysis was conducted using descriptive methods and linear regression.

The study revealed high levels of emotional distress among Farsi-speaking refugees. More than two-thirds of refugees (n = 159, 69.13%) were at high risk for depression, anxiety, and PTSD symptoms. In addition, there were potential factors that were strongly linked to posttraumatic growth.

The findings emphasize the importance of providing psychosocial care in refugee camps after resettlement and, at the same time, focusing on posttraumatic growth by clinicians.

Empathy relies on distinct but interacting processes for representing others’ states and regulating self-oriented affect. Neuroimaging studies implicate the right temporoparietal junction (rTPJ) in perspective-taking and the left dorsolateral prefrontal cortex (lDLPFC) in emotion regulation, yet causal evidence from neuromodulation remains limited. This study compared the effects of rTPJ- and lDLPFC-targeted transcranial direct current stimulation (tDCS) on empathy across multiple contexts and modalities.

In Study 1, participants performed a static pain empathy task following anodal or sham tDCS over the rTPJ or lDLPFC, with electroencephalography recorded. In Study 2, participants viewed autobiographical videos depicting positive, negative, and neutral events before and after stimulation, while heart rate variability (HRV) was assessed. Machine learning-based decoding integrated behavioral and physiological data to evaluate the ‘readability’ of empathic states.

rTPJ-tDCS enhanced cognitive empathy across tasks, increasing empathic ratings and late positive potential amplitudes in the pain empathy task, and enhancing the subjective sense of content and emotion understanding in the video task. lDLPFC-tDCS selectively increased HRV in the video task, consistent with greater autonomic flexibility, without altering explicit ratings. Decoding analyses converged with these findings: rTPJ stimulation increased classification accuracy of targets’ emotional states, indicating stronger alignment between empathic responses and others’ emotional cues, whereas lDLPFC stimulation reduced accuracy, suggesting regulation-related attenuation of overt emotional signals.

These findings provide causal evidence for rTPJ supporting cross-context cognitive empathy and lDLPFC modulating autonomic regulation. Multi-context, multimodal assessment delineated distinct target-specific profiles, informing precision neuromodulation strategies for empathy-related deficits and regulation needs.

Previous taxometric studies have yielded inconsistent findings regarding the empirical support for the common clinical practice of categorizing patients into discrete suicide risk groups (low versus high risk). Furthermore, potential sex differences in these latent structures have not been adequately explored. This study aimed to investigate the latent structure of suicide risk based on motivational and volitional phase symptoms from the ideation-to-action framework, and to explore potential sex differences in these latent structures, in order to determine whether the clinical practice of categorizing patients into low versus high suicide risk categories is empirically valid.

We employed taxometric procedures to examine whether suicide risk should be understood as dimensional or categorical. Our analysis distinctly evaluated motivational and volitional phase symptoms across separate samples of male and female outpatients with mood disorders.

Our research revealed significant sex differences in the latent structure of suicide risk. For motivational phase symptoms, an ambiguous structure was revealed in the male group, whereas a clearly dimensional latent structure was observed in the female group. For volitional phase symptoms, a categorical structure emerged in males, while a dimensional structure was found in females.

Given the ‘gender paradox’ in suicidal behavior, which highlights higher rates of fatal suicide attempts among males, early identification of the high-volitional-risk group and focused allocation of intervention resources are particularly crucial for males. Our findings underscore the necessity for sex-specific approaches to suicide risk assessments, research applying the ideation-to-action framework, and targeted intervention development.

Unnecessary urine cultures contribute to inappropriate antibiotic use, antimicrobial resistance, and Clostridioides difficile infection, particularly when asymptomatic bacteriuria (ASB) is misclassified as infection. We evaluated the diagnostic stewardship impact of an algorithm-based best practice alert (BPA) embedded in the electronic medical record (EMR) to guide urine testing in hospitalized adults.

This prospective quality improvement study was conducted at a 740-bed tertiary care hospital. The BPA triggered when urinalysis with reflex to culture (UACC) was ordered for patients admitted ≥48 hours, guiding clinicians through an algorithm-based ordering workflow. Monthly rates of UACC and pan-culturing were compared between a 12-month pre-intervention period and a 12-month post-intervention period using interrupted time series (ITS) and Mood’s median two-sample test. Gram-negative rod (GNR) bacteremia rates were monitored for safety.

Urine testing decreased from 6.45 to 4.41 tests per 1,000 patient-days (31.6% reduction; P < .01), and pan-culturing decreased from 3.47 to 2.70 per 1,000 patient-days (22.2% reduction; P < .01). ITS showed declining trends both before and after implementation, without significant immediate changes in level or slope following the intervention. CAUTI rates remained stable (0.91 vs 0.82 per 1,000 catheter-days; P = .68), as did rates of gram-negative rod bacteremia (0.47 vs 0.70 per 1,000 patient-days; P = .22). Algorithm adherence averaged 63.9% and increased over time (P < .01). CAUTI cases classified as potential asymptomatic bacteriuria declined from 31.8% to 25.0% (P = .68).

An EMR-integrated, algorithm-based BPA coincided with sustained lower urine testing and pan-culturing rates without adverse safety signals within the context of existing downward trends. Ongoing monitoring is needed to sustain adoption and appropriate use.

Antimicrobial Stewardship in the intensive care unit setting is a difficult task due to diagnostic uncertainty and perceived high-risk of poor outcomes in case of delayed or inappropriate treatment. Although novel diagnostics and other strategies have been proposed to improve antimicrobial use, their clinical effectiveness in real-world settings has been suboptimal.

We designed a critical interpretative synthesis of the literature, which allows the combination of quantitative and qualitative studies to revise and critique concepts used in Antimicrobial Stewardship efforts in the ICU setting. We searched the literature in duplicate with a sensitive strategy to identify main concepts, and we developed a main theme and conceptual framework after identifying the main concepts and strategies.

After screening 41,192 titles and abstracts and reviewing 1,335 full-text manuscripts, we selected 29 main manuscripts for this synthesis. We identified that classical concepts, such as the use of broad-spectrum antibiotics followed by de-escalation and the use of biomarkers of infection and novel diagnostics, although with face validity and supported by efficacy studies, carry a high risk of being ineffective in real-world settings. We argue that this discrepancy is due to cognitive biases in antimicrobial decision-making in the ICU setting, including risk-aversion behavior, diagnostic momentum, premature closure, therapeutic momentum, hyperbolic discounting, commission bias, and anchoring bias, among others, which drive intensivists towards overdiagnosis and overtreatment of infection.

Incorporation of the cognitive theory of decision-making in future stewardship efforts is necessary in the ICU setting along with traditional stewardship interventions.

Cognitive impairment in first-episode schizophrenia (FES) is a major contributor to functional decline, but antipsychotics provide limited cognitive improvement, and few repetitive transcranial magnetic stimulation (rTMS) studies have targeted the orbitofrontal cortex (OFC). This study investigated whether right OFC rTMS enhances specific cognitive functions in FES and its relationship with symptom reduction.

Ninety drug-naive FES patients were enrolled, with 48 receiving active right OFC rTMS and 42 sham stimulation for 20 sessions over 8 weeks, while all patients took olanzapine (10–20 mg/day). Cognitive function was assessed using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) at baseline and week 4, and psychotic symptoms were rated with the Positive and Negative Syndrome Scale (PANSS).

Repeated-measures analysis of variance (RMANOVA) demonstrated a significant Time×Group interaction for visuospatial memory (assessed via the Brief Visuospatial Memory Test-Revised, BVMT; F = 5.079, df = 1, 83, p = 0.027, η2 = 0.058). Post hoc tests revealed significant BVMT improvement in the active group (p < 0.001) but not in the sham group (p = 0.312). In the active group, improvements in BVMT and Neuropsychological Assessment Battery (NAB) scores were significantly correlated with lower PANSS total scores after Bonferroni correction.

These findings indicate that right OFC rTMS improves specific cognitive functions in FES, with cognitive benefits associated with symptom alleviation, supporting the right OFC as a promising target for cognitive intervention in FES.