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Online jurors as attentive, engaged as those in courtroom

Caring for grandchildren may protect against cognitive decline, study finds

Background Epistemic trust describes the capacity to appropriately identify others as reliable and relevant sources of information, an ability closely linked to attachment and social learning. Epistemic disruption can manifest as heightened suspicion (mistrust) or excessive reliance (credulity) vis-à-vis others, affecting mentalizing abilities and increasing vulnerability to psychopathology and maladaptive traits. These interdependent and multidirectional dynamics are pivotal to therapeutic learning, and thus to therapeutic change. Objective This study examined associations between epistemic trust and disruption, markers of psychopathology, therapeutic relationship quality and treatment-seeking behaviour. Method A naturalistic sample of 912 participants, recruited via a mental health app, completed the Epistemic Trust, Mistrust and Credulity Questionnaire, along with self-reports capturing internalising symptoms, personality functioning, maladaptive traits and the perceived therapeutic relationship within the previous 6 months. Treatment-seeking behaviour and the number of sessions utilized in the past year were further explored—both in psychotherapeutic and psychiatric contexts. Findings Epistemic mistrust and credulity showed consistent relationships with markers of psychopathology. Higher epistemic (mis)trust correlated with more positive (negative) ratings of various aspects of the therapeutic relationship, including genuineness, realism, expectations, congruence and responsivity—over the past 6 months. Epistemic trust positively predicted the amount of psychotherapy sessions, while epistemic mistrust negatively predicted treatment-seeking, both controlled for personality dysfunction. Epistemic credulity predicted mental health app use—all assessed retrospectively (past year). Conclusion The results encourage further in-depth exploration of trust-related aspects of the therapeutic alliance and investigation of mechanisms of change in therapeutic processes that may facilitate the transition from mistrust and credulity to trust. Clinical implications Even though the magnitude and direction of effects remain to be clarified, patients with epistemic mistrust may enter a self-reinforcing cycle of reduced openness and ineffective mentalizing, potentially impacting therapeutic effectiveness. Interventions targeting epistemic disruption and impaired personality functioning seem to be crucial for improving therapeutic outcomes, including psychopharmacological treatment effectiveness.

Background Many countries have introduced restrictive smartphone policies in schools, aiming to improve adolescent health and educational outcomes. However, whether these policies represent value for money to schools remains unclear. Objective The aim of this study was to estimate the costs and quality of life and mental well-being outcomes associated with restrictive and permissive phone policies in secondary schools in England, and conduct an economic evaluation to determine whether restrictive phone policies are cost effective for schools. Methods A cost–utility analysis was conducted as part of a cross-sectional study on school smartphone policies in England (SMART Schools), comparing schools with restrictive (recreational phone use not permitted) and permissive (recreational phone use permitted) policies. Outcomes were valued using quality-adjusted life years (QALYs) and mental well-being adjusted life years (MWALYs). Costs were estimated from the school’s perspective and comprised staff time spent on policy implementation. Mixed effects and linear regression models were used to estimate incremental differences in outcomes and per pupil costs. Findings 815 pupils (aged 12–15) from 20 schools (13 restrictive, 7 permissive) were included in a complete case analysis. Differences between restrictive and permissive schools in incremental QALYs (0.009, 95% CI –0.014 to 0.032) and MWALYs (–0.004, 95% CI –0.044 to 0.036) were minimal. Time implementing and enforcing policies was equivalent to 3.1 FTE staff in restrictive and 3.3 FTE staff in permissive schools. The incremental difference in per pupil school year cost was –£94 (95% CI –£229 to £41). The cost-effectiveness acceptability curve indicated a 90% probability of restrictive policies being cost effective at a threshold of £20 000 and £30 000 per QALY. Conclusions Restrictive school policies were associated with minimal differences in quality of life or mental well-being of pupils. However, they may offer some cost savings to schools by reducing staff time spent managing phone-related activities. Clinical implications School policies and practices require development to address the significant amount of time teachers spend managing phone use.

Background Currently available cardiovascular disease (CVD) risk prediction tools may underestimate the risk in individuals with schizophrenia. Objective To develop and externally validate 5-year CVD risk prediction models for people with schizophrenia using large-scale register data in Sweden and Denmark with a machine learning (ML) approach. Methods Individuals with a diagnosis of schizophrenia, aged 30 and older and without prior CVD, were followed for up to 5 years. We investigated whether adding additional health-related and socio-demographic predictors to the established CVD risk factors improved predictions and compared ML models with logistic regression. External validation was performed across countries. Findings A lasso penalised logistic regression including additional predictors achieved the highest predictive performance, both on Swedish and Danish data, while complex ML models with interaction terms did not provide additional improvements. The area under the receiver operating characteristic curve (AUC) on the internal validation data was 0.745 (95% CI (0.742 to 0.749)) in the Swedish model, and 0.722, 95% CI (0.719 to 0.726) in the Danish model. External validation showed similar performance, yielding an AUC of 0.746, 95% CI (0.741 to 0.751) using the Danish model on the Swedish data, and an AUC of 0.720, 95% CI (0.712 to 0.726) using the Swedish model on the Danish validation data. Conclusions Incorporating additional health-related information, such as psychiatric comorbidities and medication use, improved 5-year CVD risk prediction for people with schizophrenia in both countries. Clinical implications The models can be deployed between Denmark and Sweden without loss of performance compared with training a model on each country.

Objectives Bipolar disorder (BD) often begins in adolescence, a period marked by dynamic neurodevelopment. However, the neurobiological basis from genetic risk and subthreshold symptoms to diagnosed BD remains unclear. Methods We conducted a cross-sectional analysis using data from the Recognition and Early Intervention of Prodromal Bipolar Disorders cohort (NCT01863628), including 392 participants aged 12–25 years with a balanced sexual distribution, stratified into five groups: offspring of patients with BD with (OBDs, n=48) or without (OBDns, n=62) subthreshold symptoms, individuals without BD family history but with subthreshold symptoms (nOBDs, n=63), patients diagnosed with BD (n=133) and healthy controls (HCs, n=86). Cortical thickness relative to HC was assessed using high-resolution T1-weighted images and FreeSurfer V.7.3.2. Gene expression patterns were derived from the Allen Human Brain Atlas, and partial least squares regression, along with gene enrichment analyses, were applied to link cortical alterations with underlying transcriptomic profiles. Findings Cross-sectional analyses revealed graded cortical thickness differences across the BD risk spectrum, with patients with BD showing the most pronounced deviations and high-risk individuals with subthreshold symptoms displaying intermediate features relative to HCs. Cortical changes were significantly associated with spatial gene expression patterns, particularly in genes involved in mitochondrial ATP production, oxidative phosphorylation and synaptic signalling. Gene set enrichment revealed that BD-specific cortical thinning correlated with downregulation of excitatory synaptic pathways and excitatory neuron-related gene expression. Conversely, high-risk individuals exhibited upregulation of both excitatory and inhibitory neuronal markers. Developmental transcriptomic enrichment further linked significant genes to mid-childhood and adolescence. Discussion By identifying distinct transcriptomic signatures associated with cortical thinning at different stages, our findings underscore the potential of transcriptomic markers for early detection and intervention in BD. Clinical implications The findings highlight the potential for using transcriptomic markers for early detection and intervention, suggesting that identifying these markers could lead to improved outcomes for at-risk adolescents. This research has the potential to inform clinical practices and policies aimed at early screening and preventive strategies for BD.

Background Non-suicidal self-injury (NSSI) among adolescents is linked to adverse outcomes for youth and their families. While parental involvement is considered essential in treating adolescent NSSI, the effects on parents remain unclear. Objective To evaluate if Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA) adjunctive to treatment as usual (TAU) is superior to TAU alone in improving parental coping with adolescents’ negative emotions, the durability of potential effects and whether reductions in parents’ minimising of their adolescent’s emotions mediate adolescent outcomes. Methods 166 adolescents with NSSI disorder (93% female; mean (SD) age=15.0 (1.2) years) and their parents (83% female; mean (SD) age=46.5 (5.1) years) were randomised to IERITA plus TAU (n=84) or TAU-only (n=82). IERITA is a 12-week, therapist-guided emotion regulation behavioural therapy, including both adolescents and parents. In parallel to the adolescent, parents participate in a separate internet-delivered course designed to provide skills for understanding and supporting their adolescent. The outcomes were parental coping measured by the Coping with Children’s Negative Emotions Scale-Adolescent version, including minimisation (primary outcome), distress, punitive and expressive encouragement responses at baseline, post-treatment (primary endpoint) and 3 months post-treatment. Parental minimisation was tested as a mediator of adolescent NSSI absence and emotion regulation difficulties. Findings There were statistically significant treatment effects on parental minimisation and distress responses at post-treatment and 3 months post-treatment, and punitive responses at 3 months post-treatment, favouring IERITA. Parental minimisation did not mediate adolescent NSSI absence or emotion regulation difficulties. Conclusion IERITA shows promise for supporting parents of youth with NSSI. Further studies are needed to understand how parental improvement may impact youth with NSSI. Clinical implications Online family treatment for NSSI can improve how parents handle their adolescents’ emotions. Trial registration number NCT03353961.

Background Severe anorexia nervosa (AN) represents a subgroup of individuals with AN with prolonged illness duration and poor prognosis. Previous research has reported increased medication use in AN, but prescription patterns in severe AN remain unexplored. Objectives This study aimed to: (1) compare medication prescriptions between individuals with severe and less-severe AN; (2) explore the heterogeneity of prescription patterns among individuals with severe AN across different comorbidity profiles. Methods Using Danish registers, this cohort study included 7654 individuals diagnosed with AN. We assigned cases to severe or less-severe groups based on their AN Register-based Severity Index scores. First, we examined trajectories of medication prescriptions and compared patterns between groups using logistic regression models. Second, common comorbidity profiles among individuals with severe AN were identified by latent class analysis for further between-group comparisons. Sensitivity analyses were conducted to test alternative definitions of severe AN. Findings Compared with individuals with less-severe AN, those with severe AN were more likely to be prescribed various medications, including drugs targeting alimentary tract (OR 1.4, 95% CI 1.3 to 1.6), cardiovascular drugs (OR 1.1, 95% CI 1.0 to 1.3), analgesics (OR 1.2, 95% CI 1.1 to 1.3) and psychotropic drugs (OR 2.4, 95% CI 2.1 to 2.7). Notably, this pattern persisted even among individuals without diagnosed comorbidities. Within the severe group, five clusters with distinct comorbidity profiles emerged, and we consistently observed greater prescription rates than in the comorbidity-free cluster. Sensitivity analyses confirmed that our severity classification reliably distinguished severe from less-severe AN across multiple definitions. Conclusion These findings indicate that severe AN is associated with substantially higher prevalence of prescribed medications, while specific comorbidity patterns further influence prescribing patterns. This diverse and prolonged pharmacological treatment in severe AN reflects the complexity of clinical management in this population. Clinical implications Considering the widespread medication prescription in severe AN despite the lack of specific approved pharmacotherapy for the disorder, evidence-based treatment guidelines are urgently needed. Clinicians should recognise the substantial heterogeneity in severity and comorbidity burden within this population and develop comprehensive and specialised treatment strategies that evaluate risks and treatment needs across all individuals with AN, irrespective of comorbid conditions.

Background Undisturbed circadian rhythms of rest/activity are crucial to health and well-being. There is growing evidence to suggest that circadian rhythm disruptions are also associated with adverse mental health outcomes (and vice versa), but important questions about the relationship between circadian rhythms and mental health remain unanswered. Objective To determine future priorities for research in the area of mental health and circadian rhythms, a James Lind Alliance Priority Setting Partnership exercise in collaboration with a steering group comprising individuals with lived experience, carers and clinicians was undertaken. Methods An initial survey among UK residents provided a set of 964 questions supplied by 247 respondents (227 lived experience, 44 carers (including 40 carers with lived experience), 41 clinicians (including 37 clinicians with lived experience)). Responses were processed into 171 summary questions by the steering group. Reviews of published research and existing clinical guidelines reduced this to 63 unanswered summary questions. A ranking survey of these 63 questions asked respondents to select their 10 most important research questions, from which the most highly ranked would be taken to the final stage. This was completed by 222 respondents (200 lived experience, 33 carers (including 29 carers with lived experience), 38 clinicians (including 30 clinicians with lived experience)). Findings In a final face-to-face workshop, 19 individuals, including individuals with lived experience, carers and clinicians, discussed and ranked a list of questions to produce a ranking of the top 25 research questions/priorities, with a particular focus on the Top 10. Discussion The final research questions are presented to inform researchers and funding bodies when setting future research priorities across the fields of mental health and circadian rhythms. Clinical implications Addressing the priorities identified here should lead to greater understanding of the relationships between mental health and circadian rhythms and will have longer-term impacts on research, healthcare innovation and public health policy.

Background Clozapine is highly effective for treatment-resistant schizophrenia but has been associated with an increased risk of agranulocytosis. As a result, until 2025, the Food and Drug Administration required patients receiving clozapine to undergo regular blood testing to monitor for neutropenia as part of a Risk Evaluation and Mitigation Strategy (REMS) programme. Objective This study sought to compare the risk of neutropenia-related hospitalisations between clozapine and olanzapine initiators. Methods The study cohort was nested in claims data from Medicaid and two commercial health insurance databases and consisted of adults initiating clozapine or olanzapine who had a recorded diagnosis of schizophrenia or schizoaffective disorder and ≥1 dispensing of a different antipsychotic in the 6 months before initiation. Propensity score matching (1:1) was used to mitigate confounding. The primary outcome was hospitalisation with a neutropenia diagnosis in the primary position. Both as-treated and intention-to-treat analyses were implemented. Findings After propensity score matching, there were 16 873 initiators in each group. At 6 months postinitiation, there were 12 neutropenia-related hospitalisations among the clozapine cohort (incidence rate: 2.21 per 1000 person-years; 95% CI 1.25 to 3.89) and <11 among the olanzapine cohort (0.18; 95% CI 0.03 to 1.29), corresponding to an incidence rate ratio (IRR) of 12.18 (95% CI 1.58 to 93.71). The IRRs were 5.77 (95% CI 1.29 to 25.76) at 1 year, 5.50 (95% CI 1.23 to 24.55) at 2 years and 5.40 (95% CI 1.21 to 24.13) at 3 years postinitiation. Associations remained but were attenuated in intention-to-treat analyses. Conclusions Clozapine initiators had an elevated risk of neutropenia-related hospitalisation, especially during the first 6 months of treatment, although the absolute risk was low. Clinical implications Despite removal of the REMS programme, it is important for prescribers to monitor patients for neutropenia after initiating clozapine.

Background Loneliness is highly prevalent among Chinese older adults. Mindfulness-based interventions for older adults (MBOA) have demonstrated potential in alleviating loneliness. However, few studies have employed active controls with long-term follow-up. Objective This study aimed to assess the efficacy of MBOA in reducing loneliness compared with social contact control (SCC). Methods This parallel, randomised controlled trial (RCT) assigned community-dwelling lonely Chinese older adults (≥60 years) in Hong Kong to MBOA or SCC. Both interventions comprised 8 weekly 1.5-hour group-based face-to-face sessions. Assessments were conducted at baseline, postintervention and at 6-month and 12-month postrandomisation. The primary outcome was loneliness score at 12 months, analysed using analysis of covariance under the intention-to-treat approach. Secondary outcomes included depression, anxiety, health-related quality of life and healthcare utilisation. Changes in psychological measures were analysed using linear mixed models. Findings A total of 245 eligible participants were randomised to MBOA (n=123) or SCC (n=122). No significant between-group difference in primary outcome was found (mean difference=–0.14, p=0.52, effect size=–0.21), although both groups showed improvement in loneliness (within-group effect size: MBOA=–0.58, SCC=–0.31). MBOA participants reported reduced depressive symptoms and a decreasing trend in anxiety at 6 months compared with SCC. Conclusion This is the first RCT examining efficacy of MBOA in alleviating loneliness among Chinese older adults using an active control with long-term assessments. MBOA is not superior to SCC in reducing loneliness, although it may reduce psychological symptoms. Clinical implication Clinicians could consider prioritising mindfulness-based interventions for lonely older adults when depressive or anxiety symptoms are prominent.

Background Although transcranial magnetic stimulation (TMS) protocols are safe and efficacious therapies for treatment-resistant depression (TRD), they remain inaccessible for many people in the UK and internationally. One of the main reasons for this is a lack of evidence demonstrating their value-for-money to commissioners. Objective To assess the cost-effectiveness of repetitive transcranial magnetic stimulation therapy (rTMS) and intermittent theta-burst stimulation (iTBS) versus treatment-as-usual (TAU) for treating TRD in UK mental health care services, and to evaluate operational circumstances underpinning cost-effectiveness. Methods This economic evaluation used data from the BRIGHTMIND trial (n=255), the SMD trial (n=187) and a study-specific structured expert elicitation exercise (n=7) to model the cost and consequences for each alternative. All findings were produced on a probabilistic basis from a Markov model using Monte Carlo simulation methods. Cost-effectiveness was assessed via incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained over an 18-month time horizon from the perspectives of the UK’s NHS and personal social services and from a broader societal perspective recognisant of informal care hours and productivity costs. Scenario analyses and an operational sensitivity analysis explored the impacts alternative methodologies, service delivery cases and perspectives had on base case findings. Findings From a health service perspective, rTMS and iTBS had pairwise ICERs of £12 093 and £12 959 per QALY compared to TAU, respectively. When incrementally compared, iTBS had an ICER of £16 621 versus rTMS. From a broader societal perspective, both rTMS and iTBS reduced informal care hours and were cost-saving compared with TAU. Study findings were particularly sensitive to service delivery, with the probability of being cost-effective ranging from 98% with high throughput and prompt delivery to approximately 4% with low throughput and prolonged delivery. Conclusions TMS therapies improve health, reduce informal care requirements, reduce health service utilisation and offset their costs when considered in terms of productivity losses to society. rTMS and iTBS are cost-effective and should be considered for wider clinical implementation provided they are delivered at sufficient scale and in a time-efficient manner. Clinical implications TMS can serve as a cost-effective alternative for treating moderate to severe depression after second-line treatment failure with non-psychological therapies.

Background Rates of intimate partner violence (IPV) and HIV in South Africa are among the highest globally. IPV is associated with a range of adverse mental health and HIV outcomes. The Common Elements Treatment Approach (CETA) is a transdiagnostic, evidence-based intervention delivered by lay providers. Objective To compare the effectiveness of CETA to active attention control in reducing IPV, depression, post-traumatic stress disorder (PTSD) and substance use among women at risk of poor HIV outcomes who have experienced IPV. Methods Women living with HIV with an unsuppressed viral load or at risk for poor adherence and experienced past 12-month IPV were recruited from Johannesburg-area clinics and randomised 1:1 to CETA or control (SMS HIV appointment reminders plus safety checks and planning). The primary trial outcome was HIV retention and viral suppression, under review elsewhere. This paper reports secondary outcomes, evaluated at 3 and 12 months: IPV, depression, PTSD and substance use. Findings Participants were enrolled between 11 November 2021 and 19 July 2023 and randomised to CETA (N=202) or control (N=197). In the intent to treat analysis, the Cohen’s d treatment effect for depression at 3 months was 0.24 (difference in mean change –3.1; 95% CI –6.1 to 0.1) and 0.48 at 12 months (–6.2; 95% CI –9.5 to –2.8). The PTSD treatment effect was 0.39 at 3 (–0.3; 95% CI –0.5 to –0.1) and 0.47 at 12 months (–0.3; 95% CI –0.5 to –0.2). Effect sizes were larger in a subgroup of participants with the top 50% of baseline symptom scores (depression: d=0.50, d=0.74; PTSD: d=0.58, d=0.94, at 3 and 12 months, respectively). There were no statistically significant differences in change for substance use or IPV. At baseline, only 12% of participants had past 3-month substance use and 32% had past 3-month or ongoing experiences of IPV, which made these outcomes challenging to evaluate. Conclusions CETA was effective for reducing depression and PTSD, including among high severity participants and at an extended follow-up. Future studies with increased power for substance use and IPV outcomes are warranted. Clinical implications CETA is a recommended treatment for depression and PTSD among this population. Trial registration number NCT04242992.

Objective Suicide is a leading cause of maternal mortality, with many cases considered preventable. The Edinburgh Postnatal Depression Scale (EPDS) item 10 screens for self-harm thoughts in the past 7 days. This study aimed to investigate whether a positive response (‘hardly ever’, ‘sometimes’ or ‘quite often’) is associated with subsequent hospital-registered intentional self-harm, non-suicidal or suicidal, among postpartum women. Methods We conducted a population-based cohort study of 170 218 childbirths (38% of the source population) from 142 795 unique women in Denmark by linking nationwide registers with the HOPE cohort. Self-harm thoughts were defined as any non-zero response to EPDS item 10. The primary outcome was a hospital-recorded episode of intentional self-harm within 365 days after childbirth. To account for confounding, we applied inverse propensity-score weighting, and we used Firth’s penalised logistic regression to estimate ORs. Results Of the 170 218 childbirths, 2935 (1.7%) reported self-harm thoughts. During a mean (SD) follow-up of 303.0 (11.2) days, eight women (0.27%) with self-harm thoughts were hospitalised due to intentional self-harm, demonstrating a 24-fold higher crude rate compared with women without self-harm thoughts (0.01%). After applying weighting, the adjusted OR remained significantly elevated at 10.91 (95% CI 7.03 to 17.99). Conclusion This is the largest study to date on this topic. We found that postpartum women reporting self-harm thoughts had a low absolute risk of intentional self-harm, but the relative risk was 11-fold higher. These results highlight the importance of further assessment and timely support for mothers identified as being at risk.

Background Antidepressants are among the most prescribed medications in the USA, yet challenges in access to mental health treatment persist. Objective To assess current and lifetime antidepressant and psychotherapy use among American adults, and examine attitudes towards potential federal restrictions on antidepressant prescribing. Methods We conducted a cross-sectional survey study using data from a national non-probability internet-based panel weighted to approximate national demographics (age, gender, race and ethnicity, education, US census region, and urbanicity) based on 2020 US Census data. Data were collected between 10 April and 27 May 2025 from 30 810 adults residing in the USA. The primary outcomes were self-reported current and past antidepressant and psychotherapy use, and support for or opposition to potential federal restrictions on antidepressant prescribing. Logistic regression models estimated demographic and treatment-related features associated with these outcomes. Findings Among 30 115 respondents with complete antidepressant data, 16.6% reported current antidepressant use, and of 30 098 respondents with psychotherapy data, 10.4% reported current psychotherapy. Use of both treatments was significantly greater among White respondents compared with all other racial groups. When asked about potential federal restrictions on doctors prescribing antidepressants, 16.4% of respondents supported and 48.0% opposed such regulation, with lesser opposition among those of male gender (OR 0.69, 95% CI 0.65 to 0.73), and greater opposition among those with lifetime antidepressant treatment (OR 2.37, 95% CI 2.21 to 2.54). Conclusions Antidepressant and psychotherapy use remains unevenly distributed across demographic groups. A significant proportion of adults in every US state oppose efforts to restrict access to antidepressant prescribing, reflecting broad public support for maintaining access to treatment. Clinical implications Findings from this study suggest that restrictive policies on antidepressant prescribing are unlikely to align with public sentiment and may risk exacerbating existing inequities in care.

Mental health clinical trials in the UK face significant recruitment barriers, with mental health studies comprising just 3.3% of approved interventional medicinal product trials. Challenges include the limited numbers of trials and clinician gatekeeping—where clinicians decide whether or not to inform patients about research opportunities, limiting patient awareness and recruitment. The ‘Count Me In’ (CMI) approach, an opt-out recruitment model launched in Oxford in 2021 and then in Liverpool City Region in 2024, aimed to address these issues by directly contacting patients to discuss research opportunities, empower them in the shared decision process and embed participation in research into real-world clinical care. In this paper, we discuss the need for advancing beyond the original CMI model, including the requirement for enhanced data capture, mechanism for patient outreach that prioritises inclusive practices for improving participation and ensuring diverse, representative trial populations.

The National Institute for Health and Care Excellence (NICE) guideline for self-harm advises against the use of risk assessment tools to predict future occurrence of repeat self-harm or suicide in individuals who have self-harmed, or to inform decisions regarding their treatment and discharge. In this perspective article, we discuss shortcomings in the process of developing this guideline, including: (1) limitations in the NICE evidence review underpinning these recommendations, which resulted in very minimal evidence being included; (2) developing definitive recommendations and drawing strong conclusions regarding the limited predictive ability and potential harms of tools, which were almost entirely based on the committee’s expertise and experience and (3) not acknowledging the uncertainty and gaps in the evidence base, particularly around model impact, acceptability and feasibility. We highlight new evidence since this 2022 guideline, including examples of international work assessing model implementation and cost-effectiveness. We propose that there is an urgent need for more rigorous primary research assessing model impact, feasibility and acceptability, as well as empirical work addressing concerns about potential harms and misuse of tools, notably the denial of care. While prediction models should not be prematurely implemented in clinical practice without adequate validation and impact assessment, well-developed and validated tools in this area have the potential to improve clinical care for individuals who self-harm. Future updates to the guideline should be informed by emerging higher quality evidence in the field.

The accelerating climate crisis is reshaping not only the physical world but also the psychological landscapes in which individuals and communities attempt to live, learn and adapt.1 2 However, a paucity of psychiatric studies on mental disorders associated with climate change is evident, highlighting a need for climate–mental health research and policy that is contextually grounded, culturally inclusive and scientifically robust.3 4 The collection of articles featured in this special collection illuminates this rapidly evolving terrain from multiple vantage points—educational, cultural, clinical, methodological and epidemiological—revealing a shared urgency. Across school systems in the Global North, climate change education remains an underdeveloped domain despite young people expressing high levels of concern about the future. Mottishaw and MacQuarrie remind us that preparing youth for a destabilised climate requires more than scientific literacy: it demands recognising and constructively engaging with the complex emotional responses...

Psychological Science, Volume 37, Issue 2, Page 125-135, February 2026. This is a registered report to directly replicate the primary finding in Hecht and Proffitt (1995). Hecht and Proffitt found that those with occupational experience handling liquid in containers performed worse at solving a water-level problem than those ...

Psychological Science, Volume 37, Issue 2, Page 136-149, February 2026. Pretending not to know requires appreciating how one would behave without a given piece of knowledge and acting accordingly. Here, two game-based experiments reveal a capacity to simulate decision-making under such counterfactual ignorance. English-...

Psychological Science, Volume 37, Issue 2, Page 83-105, February 2026. Do individuals possess a “gaze fingerprint” that reveals how they uniquely look at the world? We tested this question by examining intra- and intersubject gaze similarity across 700 static pictures of complex natural scenes. Independent discovery (n= 105)...

Psychological Science, Volume 37, Issue 2, Page 106-124, February 2026. Metacognition involves second-order judgments about first-order judgments. It remains unclear whether an individual’s confidence in being correct is generated by the same system across tasks (domain generality) or whether it is computed independently in ...

Psychological Science, Ahead of Print. Conspiracy mentality is conceptualized as a continuum. Research on this topic has focused on unwarranted conspiracy claims and the upper end of the conspiracy-mentality continuum—people seeing conspiracies everywhere. This focus neglects warranted ...

Psychological Science, Ahead of Print. Nedergaard and Lupyan (2024) presented four studies aimed at validating anendophasia (i.e., experiencing no inner speech).1However, Lind (2025) held that no one, including Nedergaard and Lupyan, has demonstrated that anendophasia exists. In both articles,...

Legal analysis of Iran’s January 2026 crackdown across 220 cities; assessing widespread repression, civilian targeting and state policy indicators. Crimes Against Humanity?

In the 109th week of their activities, members of the “No to Execution Tuesdays” campaign, expanding the scope of their protests to 56 prisons across the country, once again went on hunger strike to condemn the issuance and implementation of death sentences. While expressing solidarity with university students and the families of the victims of […]

Weaponization of the Death Penalty Analysis of the Killing Pattern in the January 2026 Protests Extrajudicial Executions in a State of Incapacity (Hors de combat): According to the official confession of Javad Tajik, CEO of the Behesht-e Zahra Organization, on February 18, 2026 (ISNA News Agency), it has been confirmed that “more than 70 percent […]

The Islamic Republic not only violated the fundamental principle of the right to life during the January 2026 uprising, shocking the global community, but continues to perpetrate gross violations of universal human rights in detention within its prisons. The authorities are not only seeking vengeance against detained protesters through torture, forced confessions, and "expedited" summary trials—resulting in severe sentences including the death penalty—but are also abusing judicial power to eliminate the most basic rights of political prisoners, namely the freedom of expression and belief.

This report documents the pre-judicial phase of repression by the ruling regime in Iran during the Dey 1404 protests (December 2025–January 2026), detailing violent arrests, secret detention centers, enforced disappearances, prison overcrowding, denial of legal counsel, deaths in custody, and systematic forced confessions. It analyzes patterns of human rights violations committed by the Iran regime against political prisoners and protesters, including arbitrary detention, torture, and denial of due process under international law. The findings indicate a coordinated security–judicial strategy aimed at suppressing dissent through intimidation, coercion, and structural abuse within detention and prison systems.

Accelerated trials, death sentences, mass arrests of students, children and doctors reveal a systematic post-uprising crackdown by Iran’s ruling regime.

While only about 40 days have passed since the January 2026 uprising, the judicial apparatus of the Islamic Republic knows no mercy. Gholam-Hossein Mohseni-Eje’i, the Head of the Judiciary, delivered a chillingly clear message during his recent trip to Isfahan (February 16, 2026): “Speed in Slaughter.” He claimed: “The people rightfully expect and demand that […]

The UN Children’s Fund (UNICEF) has called for the immediate release of all children detained during the recent public unrest in Iran, expressing deep concern that minors arrested in connection with the protests remain behind bars. The unrest erupted in late December 2025 in cities across Iran over soaring inflation, rising food prices and the […]

This report documents the lethal suppression of the December 2025 protests in Kermanshah, Iran. It details concentrated killings over 48 hours, the use of live ammunition against unarmed civilians, systematic post-protest arrests, pressure on families, internet shutdowns, and the potential legal qualification of events under international criminal law as crimes against humanity

Isfahan case file documents 201 confirmed deaths, direct shootings, eye injuries, secret burials, and detention abuse during Iran’s 2026 protests.