Recurrent Flooding and Household Food Access in Central Java, Indonesia.

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life.

BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms. METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology. RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms. CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

Momentary displays of compassion and the relationship between psychosis, mood and risk incidents on inpatient wards: An experience sampling study.

OBJECTIVES: Psychosis can be thought of as a threat-based experience. Compassion has been shown to be effective in reducing threat, although highly distressed individuals may struggle to be self-compassionate. This study explored the effects of compassionate interactions with staff on inpatients with psychosis. METHOD: Experience Sampling Method (ESM) was used to investigate the relationships between compassion from staff and paranoia, voice hearing, distress related to psychosis experiences, affect and risk incidents in daily life. Twenty-two service users residing on inpatient mental health wards took part. Baseline measures of compassion, fears of compassion and affect were taken. Participants completed ESM assessments 10 times per day, over 6 days. RESULTS: Compassion from staff was associated with a small increase in voice hearing, but was not associated with paranoia, paranoia-related distress, voice-related distress, negative affect, positive affect, or risk incidents in daily life. Baseline fears of compassion moderated the relationships between compassion from staff and some of the service user outcomes. For inpatients scoring low on fears of compassion, compassionate interactions were associated with increased positive affect and lower paranoia. However, for those scoring high on fears of compassion, this relationship was reversed, and compassionate interactions were associated with higher paranoia and lower positive affect. CONCLUSION: People with psychosis who have fears of compassion may benefit from receiving support to address these fears in order to experience the benefit from the compassion of staff. The results should be interpreted with caution due to the low number of observations and limited statistical power.

Differences in alcohol-related variables between individuals who engage in food and alcohol disturbance (FAD) behaviors and those who only use alcohol: The role of FAD motives.

OBJECTIVE: Food and alcohol disturbance (FAD) is the use of any compensatory behavior (e.g., skipping meals) within the context of a drinking episode. FAD has two underlying motives: to enhance the effects of alcohol (FAD-AE) and/or compensate for calories consumed from alcohol (FAD-CC). Prior work finds that FAD is positively associated with alcohol-related outcomes; however, it is unclear whether FAD confers increased risk above alcohol use alone, and whether there are differences in alcohol outcomes by FAD motive. Thus, the present study evaluated alcohol use patterns (i.e., past-month quantity/frequency, binge use, consequences, and drinking motives) by FAD status and FAD motives. METHOD: Data were from the Stimulant Norms and Prevalence 2 (SNAP2) study, which included 5,809 undergraduates from six US universities. Participants were grouped into four categories: Alcohol-Only, FAD-AE, FAD-CC, and FAD-both (i.e., both FAD-AE and FAD-CC motives). Ordinary least squares regression was used for drinking motives and quasi-Poisson regressions were used for other outcomes. RESULTS: Alcohol use quantity, frequency, binge use, and consequences were all greatest in the FAD-both group and lowest in the alcohol-only group, with the FAD-AE and FAD-CC groups intermediate and not significantly different from each other. To illustrate, the FAD-both group had 47%, 33%, and 25% greater alcohol-related consequences than the Alcohol-Only, FAD-CC, and FAD-AE groups, respectively. This stepwise pattern held for drinking motives, with fewer significant differences. CONCLUSIONS: Engagement in FAD is linked to increased likelihood of poor alcohol outcomes versus alcohol use alone, and FAD for both motives represents the highest risk group.

Gender Differences in Normative Misperceptions of Food and Alcohol Disturbance Among a Multi-Site Sample of College Students.

Background: Engagement in food and alcohol disturbance (FAD; e.g., restricting caloric intake in the context of using alcohol to quicken/increase intoxication [FAD-intoxication] and/or to offset calories consumed from alcohol [FAD-calories]) confers risk to college students. Much research suggests that students overestimate the frequency of high-risk drinking among their peers, leading to greater participation in personal high-risk drinking. However, limited work has examined social norms related to FAD and their association with FAD behaviors. Objectives: The present study investigated: (a) whether normative misperceptions exist for FAD, (b) whether FAD norms are associated with FAD behaviors, and (c) whether gender moderates the association between FAD norms and FAD behaviors. Participants were 1,499 college students from six universities who consumed alcohol in the last month and identified as a woman or man. A plurality of participants identified as being White, non-Hispanic (59.5%) and female (68.1%), with a mean age of 19.66 (SD = 2.09) years. Results: Analyses revealed that students overestimated the frequency and approval of both FAD-intoxication and FAD-calories behaviors among their same-gender peers. Notably, these misperceptions were greater for FAD participators compared to FAD abstainers. Moreover, the associations between FAD norms and FAD behaviors were generally stronger for women compared to men. Conclusions: Our preliminary findings identify social norms as a potential target for interventions aiming to reduce FAD among college students. Further, our results provide preliminary evidence that college women, especially those who engage in FAD, may reap the greatest benefit from interventions targeting normative misperceptions (e.g., personalized normative feedback) related to FAD.

Improved constructs for bait RNA display in a bacterial three-hybrid assay.

We have previously developed a transcription-based bacterial three-hybrid (B3H) assay as a genetic approach to probe RNA-protein interactions inside of E. coli cells. This system offers a straightforward path to identify and assess the consequences of mutations in RBPs with molecular phenotypes of interest. One limiting factor in detecting RNA-protein interactions in the B3H assay is RNA misfolding arising from incorrect base-pair interactions with neighboring RNA sequences in a hybrid RNA. To support correct folding of hybrid bait RNAs, we have explored the use of a highly stable stem ("GC clamp") to isolate regions of a hybrid RNA as discrete folding units. In this work, we introduce new bait RNA constructs to 1) insulate the folding of individual components of the hybrid RNA with GC clamps and 2) express bait RNAs that do not encode their own intrinsic terminator. We find that short GC clamps (5 or 7 bp long) are more effective than a longer 13bp GC clamp in the B3H assay. These new constructs increase the number of Hfq-sRNA and -5'UTR interactions that are detectable in the B3H system and improve the signal-to-noise ratio of many of these interactions. We therefore recommend the use of constructs containing short GC clamps for the expression of future B3H bait RNAs. With these new constructs, a broader range of RNA-protein interactions are detectable in the B3H assay, expanding the utility and impact of this genetic tool as a platform to search for and interrogate mechanisms of additional RNA-protein interactions.

Unification of the food and alcohol disturbance literature: A systematic review.

Food and alcohol disturbance (FAD) reflects the functional relationship between disordered eating and alcohol use. There are two motivations underlying FAD - to enhance the effects of alcohol and/or to compensate for alcohol-related calories. Yet, most FAD studies have failed to adequately measure the motives underlying these behaviors, leading to inconsistent and imprecise findings. The aim of the current systematic review was to thematically consolidate FAD research findings by motive, identify limitations of the existing literature, and highlight next steps for FAD researchers. Eighty-one publications, presenting data from 38,536 participants, were included in the current review. Prevalence rates for the caloric compensation and alcohol enhancement motives range from 5.6% - 88.7% and 4.7% - 81.7%, respectively. Alcohol use and disordered eating were the primary correlates of FAD for both motives, and alcohol-related consequences were positively associated with both FAD motives cross-sectionally. Major limitations of the literature include inconsistent operationalization and imprecise measurement of FAD. Primary recommendations include adopting the terminology of and operationalization of FAD presented here, ensuring attention to FAD motive in developing and testing research questions, and moving beyond cross-sectional studies. Findings from this review can be used to contribute to more rigorous and unified FAD research.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students.

BACKGROUND AND OBJECTIVES: Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students. METHODS: Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes. RESULTS: About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms. DISCUSSION AND CONCLUSIONS: It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other. SCIENTIFIC SIGNIFICANCE: Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

How can we measure psychological safety in mental healthcare staff? Developing questionnaire items using a nominal groups technique.

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psychological safety that is suitable for use in inpatient mental health settings. Edmondson (1999) is the most commonly used measure of psychological safety, but it was designed for use in general physical healthcare settings. As inpatient mental health settings are unique environments, transferability of knowledge from physical to mental healthcare settings cannot be assumed. We sought to develop questionnaire items that capture psychological safety among healthcare staff working in acute inpatient mental healthcare settings. We used the nominal group technique, a consensus method involving rounds of discussion, idea generation, and item rating/ranking to identify priorities. Twenty-eight stakeholders participated, including 4 who had lived experience of mental health problems, 11 academics and 18 healthcare professionals (8 participants identified with more than 1 category). The study involved a workshop with three parts: (i) an overview of current research and limitations of the Edmondson (1999) measure as outlined above, (ii) discussion on what items should be retained from the Edmondson (1999) measure, and (iii) discussion on what items should be added to the Edmondson (1999) measure. Twenty-one items were generated and retained to capture psychological safety in inpatient mental health settings. These measure professionals' sense of being valued by their team and organization, feeling supported at work, feeling physically safe and protected from physical harm, and knowing they can raise concerns about risk and safety. This is the first study to generate questionnaire items suitable for measuring staff psychological safety in mental health settings. These have been generated via a consensus method to ensure stakeholders' views are reflected. Further research is needed to evaluate factor structure, internal reliability, and convergent validity.

Reflections on working as and supervising trial therapists on trials of psychosocial interventions.

This editorial provides an overview of the challenges and benefits of working as and supervising trial therapists from the perspective of investigators and trial therapists. Key differences between trial therapy and standard care are considered, with recommendations for best practice.

A Systematic Review of Momentary Social Predictors of Positive Psychosis Experiences.

BACKGROUND: Social factors can play an important role in the development and maintenance of psychosis. Clarifying this relationship is vital for advancing theoretical understanding and development of targeted interventions. Psychosis is increasingly researched with an experience sampling methodology (ESM), which provides an ecologically valid approach, that reduces recall biases. Studies examining momentary associations between social factors and psychosis have not yet been summarised. METHOD: We identified 29 ESM studies investigating associations between social factors and positive psychotic experiences through a pre-registered systematic search of the published literature. RESULTS: Being alone did not predict increase in psychosis; however, appraisals and feelings associated with being alone such as feeling socially disconnected, lonely and unwanted did. Being with familiar company was found to reduce psychosis experiences but feeling stressed by the current company increased psychosis. CONCLUSIONS: While issues with sample size and generalisability mean these results should be interpreted with caution, some putative conclusions can be made. Individuals with psychosis or emerging symptoms should be offered interventions that improve social networks such as peer support, community participation and engagement skills training. These individuals may also benefit from virtual reality or compassion-based interventions which aim to dampen perceived social threat. Moreover, digital interventions which monitor changes in social variables that predict relapse in symptoms would allow early intervention to prevent mental health crises.

"If You Don't Eat, You Can Get Drunk Faster": A Qualitative Investigation of Food and Alcohol Disturbance (FAD) Expectancies.

Background: Food and alcohol disturbance (FAD; i.e., use of any compensatory behavior within the context of a drinking episode to offset alcohol-related calories and/or enhance the effects of alcohol) is prevalent among U.S. college students and associated with negative consequences. Expectancies for anticipated outcomes of alcohol use and thinness/restriction behaviors, which comprise FAD, serve as promising targets of intervention for these behaviors individually; however, no study to date has identified or examined FAD expectancies, specifically. Objectives: The purpose of this study was to qualitatively examine the positive and negative FAD expectancies described by students experienced with FAD. Methods: Semi-structured open-ended interviews were conducted with 22 undergraduates with a lifetime history of FAD behavior (72.7% female, 77.3% white non-Hispanic, Mage=20.14). Results: Positive FAD expectancy themes included: Mood Improvement, Appearance/Weight-related Benefits, Alcohol Enhancement, and Social Approval and Connectedness. Negative FAD expectancy themes included: Reputational and Social Concerns, Negative Physical Consequences, Negative Psychological Consequences, and Cognitive and Behavioral Impairment. Conclusions: Results suggest that while there are many similarities, FAD expectancies are distinct from existing alcohol and thinness/restriction expectancies. Specifically, the Mood Improvement theme conceptualizes mood-related improvement within the context of both positive and negative reinforcement and both the Social Approval and Connectedness and Social and Reputational Consequences themes focus on the ways in which one's peers may view and interact with others. Findings lay the groundwork for identifying expectancies that underlie FAD behaviors and provide directions for future research and intervention efforts.

Understanding the Factors That Contribute to Creating a Collaborative Psychological Formulation: A Qualitative Systematic Review.

OBJECTIVES: Creating a formulation is one of the key competencies of a clinical psychologist and is understood to be important for guiding therapeutic input and understanding client distress. However, client experience of formulations can vary, with some reporting it is unhelpful and distressing. This novel review explores the experiences of clinicians and clients when creating a formulation, specifically the barriers and facilitators to collaborating on a formulation. This ultimately aims to improve client experience and engagement in formulation. METHODS: A systematic search of PubMed, Web of Science, PsycINFO and EMBASE was conducted using PRISMA guidelines. The protocol was registered on PROSPERO. This search was conducted using terms related to 'psychological formulation' and 'experience'. Nineteen qualitative papers met inclusion criteria and were appraised using the Critical Appraisal Skills Programme. Findings that pertained to formulation were thematically synthesised. RESULTS: Three analytical themes were identified: toleration of the formulation process-'a necessary evil', which highlights the potential emotional impact of formulation on the client and indicates the importance of responding to client readiness and expectations of formulation; development of the therapeutic relationship-'it's like a two way thing, isn't it?', which suggests that client empowerment, adapting to client needs and clinicians creating a safe and containing environment facilitated the formulation process; systemic factors-'walking a tightrope', which highlights the constraints of resources and team dynamics in therapists' ability to engage in collaborative formulation. CONCLUSION: Facilitators to a collaborative formulation include the following: simple formulations, thorough assessment and preparation for formulation, 'doing with' activities such as timelines and diagrams and working environments that include supportive colleagues and time for reflection and training.

Examining the Relation Between Social Anxiety and Cannabis Problems Among College Students Through Coping-Related Expectancies and Motives.

Objective: College students high in social anxiety are at increased risk for cannabis-related problems. This may be particularly true when they hold strong coping-related expectancies and motives for cannabis. However, few studies have examined these constructs together in accordance with the motivational model, which posits that substance use is proximally influenced by motives and more distally influenced by expectancies. Thus, the current study examined whether the relation between social anxiety and cannabis-related problems was indirectly explained through coping-related expectancies, motives, and cannabis use. Method: Past-month cannabis users (N = 660; 71.6% female, 47.3% white non-Hispanic) from seven U.S. universities completed an online survey assessing social anxiety, and cannabis use frequency, problems, expectancies, and motives. A saturated path model examined social anxiety as a predictor of cannabis problems via coping-related expectancies and motives, and cannabis frequency. Results: There was a positive indirect effect of social anxiety on cannabis problems through cognitive and behavioral impairment expectancies, depression coping motives, and cannabis use. Social anxiety also indirectly positively related to cannabis problems via social and sexual facilitation expectancies, social anxiety coping motives, and cannabis use. Further, social anxiety indirectly positively related to cannabis problems through relaxation and tension reduction expectancies, both depression and social anxiety coping motives, and cannabis use. These indirect effects were invariant by sex assigned at birth. Conclusions: Results support using a theory-informed model of coping-related cannabis cognitions to understand the relation between social anxiety and cannabis problems. Interventions that modify coping-related cognitions may reduce cannabis-related problems in college students high in social anxiety.

Effects of Actissist, a digital health intervention for early psychosis: A randomized clinical trial.

Schizophrenia affects 24 million people worldwide. Digital health interventions drawing on psychological principles have been developed, but their effectiveness remains unclear. This parallel, assessor-blinded, randomized clinical trial aimed to investigate whether a cognitive behaviour therapy-informed digital health intervention (Actissist app) confers added benefit on psychotic symptoms over and above remote symptom monitoring (ClinTouch app). Participants recruited from UK community health services were randomized 1:1 to receive either Actissist plus treatment as usual (TAU) or ClinTouch plus TAU. Eligible participants were adults with schizophrenia-spectrum psychosis within five years of first episode onset meeting a criterion level of positive symptoms severity. The primary outcome was Positive and Negative Syndrome Scale (PANSS) symptoms total score at 12 weeks post-randomization. Intention-to-treat analysis included 172 participants, with 149 participants (86.6 %) providing primary outcome data. Actissist plus TAU was not associated with greater reduction than an active control remote symptom monitoring app (ClinTouch) in PANSS total score at post-randomization. There were no significant effects between groups across secondary measures. There were no serious adverse reactions. Both groups improved on the primary psychotic symptoms measure at primary end-point and on secondary measures over time. The Actissist app is safe but not superior to digital symptom monitoring.

The Effect of the Coronavirus Disease 2019 Pandemic on Pituitary Surgery.

OBJECTIVE: As the coronavirus disease 2019 (COVID-19) pandemic spread to the United States in 2020, there was an impetus toward postponing or ceasing nonurgent transsphenoidal pituitary surgeries to prevent the spread of the virus. Some centers encouraged transcranial approaches for patients with declining neurologic function. However, no large-scale data exist evaluating the effects that this situation had on national pituitary practice patterns. METHODS: Pituitary surgeries in the National Inpatient Sample were identified from 2017 to 2020. Surgeries in 2020 were compared with the 3 years previously to determine any differences in demographics, surgical trends/approaches, and perioperative outcomes. RESULTS: In 2020, there was a decline in overall pituitary surgeries (34.2 vs. 36.3%; odds ratio (OR), 0.88; P < 0.001) yet transsphenoidal approaches represented a higher proportion of interventions (69.0 vs. 64.9%; P < 0.001). Neurosurgical complications were higher (51.9 vs. 47.4%; OR, 1.13; P < 0.001) and patients were less likely to be discharged home (86.4 vs. 88.5%; OR, 0.84; P < 0.001). This finding was especially true in April 2020 during the first peak in COVID-19 cases, when transcranial approaches and odds of mortality/complications were highest. CONCLUSIONS: In 2020, transsphenoidal surgery remained the preferred approach for pituitary tumor resection despite initial recommendations against the approach to prevent COVID-19 spread. Pituitary surgeries had a higher risk of periprocedural complications despite accounting for preoperative comorbidities, COVID-19 infection status, and surgical approach, suggesting that an overwhelmed hospital system can negatively influence surgical outcomes in noninfected patients.

Risk factors for vascular injuries in anterior lumbar interbody fusion: a single-institution retrospective study.

OBJECTIVE: Vascular injuries in anterior lumbar interbody fusion (ALIF) occur due to the vascular manipulation needed to achieve optimal disc space exposure. In this study, the authors aimed to evaluate intraoperative vascular injuries in patients undergoing single- and multilevel ALIF at a large tertiary academic center. METHODS: Prospectively collected data specifically addressing postoperative complications in patients who underwent ALIF by neurosurgery spine faculty working with a specialized vascular surgeon were retrospectively reviewed. Demographic characteristics and intraoperative data were collected. Patients were split into vascular injury and non-vascular injury groups. Outcome comparisons were conducted using the chi-square exact and Wilcoxon rank-sum tests for categorical and continuous data, respectively. Logistic regression was used to investigate associations with vascular injury, with univariate analysis first conducted to identify candidate associations. Based on these results, variables demonstrating a between-groups test statistic of p < 0.10 were included in the multivariate analysis to determine the independent predictors of vascular injuries. RESULTS: In total, 323 patients who underwent ALIF procedures were identified: 51% were male (n = 166) and 49% were female (n = 157). The mean age was 57.1 years, with 56% (n = 182) having undergone prior lumbar surgery. Vascular injuries were encountered intraoperatively in 7.1% (n = 23) of patients, and the majority (91% [n = 21]) involved the left common iliac vein. Patients with vascular injuries were statistically older (mean 63.6 vs 56.6 years), had greater incidence rates of coronary artery disease, opioid use, multilevel ALIF surgery involving the L2-3 level, and surgery involving multiple disc spaces, had more multilevel anterior instrumentation, and experienced greater blood loss during surgery and longer length of stay (all p < 0.05). Overall, there was 1 death (0.3%) secondary to aortic artery injury. Multivariate analysis identified opioid use, multilevel ALIF involving L2-3, and multiple interbodies as statistically independent predictors of vascular injury (all p < 0.05). CONCLUSIONS: Identifying patient risk factors can reduce the risk of vascular injuries in ALIF. Opioid use, multilevel ALIF involving L2-3, and multiple interbodies were independent predictors of vascular injuries in ALIF.

Generation of single-cysteine E. coli ProQ variants to study RNA-protein interaction mechanisms.

ProQ is a FinO-domain protein found in E. coli and other proteobacteria that has a global RNA-binding profile. In order to probe the detailed mechanism of RNA interactions, we have developed a collection of 13 E. coli ProQ variants that possess single-cysteine residues at varied positions on the surface of the N-terminal FinO domain and retain the ability to bind well to RNA. This set of variant ProQ proteins will support future biochemical and biophysical studies to map the orientation of bound RNAs to different sites around the ProQ protein, shedding light on the mechanism of ProQ-RNA interactions.

Co-producing digital mental health interventions: A systematic review.

Objective: Smartphone apps (apps) are widely recognised as promising tools for improving access to mental healthcare. However, a key challenge is the development of digital interventions that are acceptable to end users. Co-production with providers and stakeholders is increasingly positioned as the gold standard for improving uptake, engagement, and healthcare outcomes. Nevertheless, clear guidance around the process of co-production is lacking. The objectives of this review were to: (i) present an overview of the methods and approaches to co-production when designing, producing, and evaluating digital mental health interventions; and (ii) explore the barriers and facilitators affecting co-production in this context. Methods: A pre-registered (CRD42023414007) systematic review was completed in accordance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five databases were searched. A co-produced bespoke quality appraisal tool was developed with an expert by experience to assess the quality of the co-production methods and approaches. A narrative synthesis was conducted. Results: Twenty-six studies across 24 digital mental health interventions met inclusion criteria. App interventions were rarely co-produced with end users throughout all stages of design, development, and evaluation. Co-producing digital mental health interventions added value by creating culturally sensitive and acceptable interventions. Reported challenges included resource issues exacerbated by the digital nature of the intervention, variability across stakeholder suggestions, and power imbalances between stakeholders and researchers. Conclusions: Variation in approaches to co-producing digital mental health interventions is evident, with inconsistencies between stakeholder groups involved, stage of involvement, stakeholders' roles and methods employed.