Population ageing and the limited mental healthcare human resources are widening the service gap between older people’s mental healthcare needs and the system’s capacity in Hong Kong. Scaling up services through integration into the primary care system remains the main strategy to address unmet needs. In this study, we co-developed a primary mental healthcare system for older people with common mental health disorders with 33 stakeholders, including representatives from the government, primary healthcare services, charities, professionals, service users, caregivers and researchers. The study had three phases, including (1) rapid situational analysis (RSA) and survey to synthesise key elements and challenges of the existing service, (2) three rounds of theory of change (ToC) workshops (online) with stakeholders and (3) reach consensus and finalise the ToC map. A shared vision of No Wrong Door in Practice was established, operationalised as older adults experiencing improved mental health through integrated services from any entry point. The resulting ToC incorporated two interconnected pathways: (1) medical-social collaboration to provide integrated and person-centred care, and (2) community integration to empower older persons and carers to seek help and navigate the system confidently. Specific interventions, outcomes and outcome indicators were identified in the Hong Kong context for both pathways.

Coronary heart disease (CHD) often coexists with mood disorders (MDs), but research on comorbidity predictors and interventions remains limited. This two‑phase mixed‑methods study enrolled 390 CHD patients diagnosed by coronary angiography. Mood disorders were screened using the HAMD (≥7) and confirmed via DSM‑5 psychiatric evaluation. In the observational phase, 219 CHD patients with MDs and 171 without were compared; 56% had a mood disorder, including 34 with bipolar disorder (BD). The BD group showed a significantly higher LF/HF ratio (2.03 ± 0.38, P = 0.037), indicating autonomic dysfunction. In the intervention phase, 34 BD patients were randomized to 8‑week MBSR (n = 17) or treatment as usual (TAU; n = 17). Compared with TAU, MBSR significantly reduced anxiety (HAMA: 4.31 vs. 7.69, p = 0.010) and improved autonomic function (LF/HF: 1.49 vs. 1.82, p = 0.002). Cardiac function showed no significant between‑group difference, though NYHA class improvement tended to be higher in the MBSR group. Mood disorders, especially BD with autonomic impairment, are highly prevalent in CHD patients. MBSR is a promising intervention for psychological and autonomic improvement and may be integrated into cardiac rehabilitation.

The development and implementation of national suicide prevention strategies (NSPSs) is one policy response to suicide prevention adopted by the World Health Organization (WHO); however, evidence on their effectiveness remains limited and mixed. This study assessed the impact of implementing an NSPS on sex-specific suicide mortality rates in nine countries within the Region of the Americas from 2000 to 2021. Suicide rates were obtained from the WHO Global Health Estimates, and countries with an NSPS and the year it was first implemented were identified using the WHO MiNDbank. A comparative interrupted time-series analysis using linear mixed-effects models was conducted to estimate the effect of NSPS implementation on suicide mortality. The implementation of an NSPS was associated with a gradual and sustained decrease in suicide mortality rates: 3.00% per year among males (95% CI: −5.28%, −0.66%) and 2.55% per year among females (95% CI: −4.62%, −0.44%). No significant difference in effect was observed between sexes. These findings demonstrate an association between NSPS and reduced suicide mortality in countries within the region, emphasizing the value of their ongoing development and implementation. Although the association did not vary by sex, NSPS design should account for sex-specific epidemiological contexts.

Mid-last century, controversy existed around the question whether non-human great apes have culture. To a large degree, this is no longer controversial – apes have their own cultures. However, there remains controversy around how to best study ape culture, given the varying and often dichotomised contributions from captive and field-ape research. Here, we present a historical summary of the ape culture wars since their inception and how this has evolved over time. We then focus on debates surrounding wild versus captive-ape research with an emphasis on culture, detailing major arguments arising from both research domains. Throughout, we critically deconstruct these arguments, illustrating the nuance behind these critiques, while highlighting their assumptions, overgeneralising statements and potential constraints. We further provide potential solutions to help alleviate the issues we describe, when possible. We also offer a metacritique of ape culture research for its scientific and political impact, irrespective of one’s expertise. In closing, we summarise concrete recommendations for a richer and more holistic understanding of ape, and human, culture.

Background: Adolescents and young adults with sickle cell disease (SCD) in Kenya experience psychosocial challenges shaped by developmental transitions and social and health system contexts. Limited research has examined differences across adolescence and young adulthood in low-resource settings. Methods: We conducted a qualitative study using focus group discussions and thematic analysis to explore psychosocial experiences across three stages: early adolescence (10–14 years), middle adolescence (15–17 years) and late adolescence or young adulthood (18–25 years). Participants included 54 adolescents and young adults with SCD, 18 caregivers and 18 healthcare providers recruited from three healthcare facilities in western Kenya. Results: Three themes emerged: (1) emotional and psychological burdens, including fear, uncertainty and identity-related struggles; (2) social challenges, including peer exclusion, family strain and school-related difficulties and (3) healthcare system barriers, including financial hardship, provider-related stigma and limited transition support. Challenges followed a developmental pattern, with younger adolescents emphasizing pain and vulnerability, middle adolescents highlighting social visibility and school participation and older youth focusing on independence and continuity of care. Conclusion: Psychosocial needs vary across developmental stages and are shaped by social and health system contexts. Developmentally responsive support, including pain coping, school engagement, and transition services, is needed in low-resource settings.

Life history theory seeks to understand how organisms distribute energy between physiological functions across the life course. A central assumption is that energy allocation involves ‘trade-offs’ between competing functions relating to defence, maintenance, reproduction, and growth. Constraints on human energy expenditure may produce trade-offs during energetic stress, affecting functions critical for homeostasis, survival, and reproduction. While there is some evidence for binary trade-offs between two functions in humans, no studies have tested physiological resource prioritisation across multiple functions under energetic constraint. This study empirically assessed multiple human life history trade-offs and the proximate biological mechanisms underpinning them. We recruited 147 ultra-endurance athletes (107 male, 40 female) participating in four environmentally diverse multiday ultramarathons and one multiweek ocean rowing event. The severe energetic demands of these competitions provide a valuable opportunity to provoke and observe detectable trade-offs. We found evidence of trade-offs across multiple functions. Specifically, investment in defence (as indexed by immune biomarkers) was broadly prioritised relative to investment in storage, reproduction and maintenance. Our results enhance current understanding of the role of phenotypic plasticity in human adaptability and have implications for athlete health and performance as well as the emerging discipline of evolutionary public health.

Climate change is increasingly recognized as a public health challenge, with emerging evidence linking climate-related factors to suicidality. A search was conducted in PubMed, Scopus, PsycINFO, Web of Science and Google Scholar following the PRISMA guidelines. The studies that assessed the association between climate indicators and suicidality were included, and risk of bias was assessed using MMAT and ROBINS-E. A total of 43 studies met the inclusion criteria, covering various geographic regions and populations. Rising ambient temperatures were the climate variable most frequently studied, with multiple studies showing a significant increase in suicide rates linked to higher temperatures, particularly during the summer months, especially among females. Seasonal variations, including heatwaves and extreme cold, were associated with increased suicidality. Additionally, extreme weather events such as floods, droughts and storms correlated with higher suicide risks, particularly in vulnerable populations, including older adults and individuals with pre-existing mental health conditions. Air pollution, particularly exposure to PM2.5, NO2 and SO2, was also found to contribute to suicidality. Most of the studies originated in high-income countries, highlighting a gap in research from low- and middle-income countries (LAMICs), where the impacts of climate change may be more severe but remain understudied. Although two studies examined suicidal ideation, the overwhelming majority of the evidence focused on suicide mortality, underscoring the marked under-representation of non-fatal suicidality outcomes in the existing literature. The findings suggest that climate change plays an important role in suicidality, with increasing temperatures, extreme weather and air pollution acting as key risk factors. As climate stressors grow, it is crucial to integrate them into mental health and suicide-prevention policies. More research, especially in underrepresented regions, is needed to guide effective interventions.