Black Dog Institute

The macula is a pigmented area located at the centre of the retina, responsible for central, high-resolution colour vision. Previous research has demonstrated that oral carotenoid supplementation can enhance contrast sensitivity (CS) in European populations. This study aims to investigate whether carotenoid supplementation can also improve visual function in the Chinese population. The Contrast Sensitivity Vision (CSV) trial is a double-blind, randomised controlled trial conducted at the Zhongshan Ophthalmic Center in Guangzhou, China. 220 eligible Chinese adults will be randomised in a 1:1 ratio to receive either oral supplementation of 10 mg lutein, 10 mg meso-zeaxanthin and 2 mg zeaxanthin in a formula-based oil suspension (administered as one soft gel capsule) or a placebo oil soft gel capsule daily for 1 year. Participants in both groups will undergo ophthalmological study procedures including best-corrected visual acuity (BCVA), contrast sensitivity, optical coherence tomography, fundus photography and skin carotenoid examinations at baseline and at 3-month, 6-month and 12-month follow-up visits. Blood tests and a Dietary Carotenoid Screening Questionnaire will be administered at baseline and at the 12-month follow-up. Subjective visual function questionnaire interviews will be administered at baseline and at the 3-month, 6-month and 12-month follow-ups. The primary outcome will assess change in CS at 6 cycles per degree (cpd) over the 1-year study intervention. Secondary outcomes will examine CS at 6 cpd at the 3-month and 6-month follow-up, CS at other cpd, BCVA, subjective visual function and skin carotenoid levels as measured at baseline, 3-month, 6-month and 12-month follow-ups. The CSV trial was approved by the Ethics Committee of the Zhongshan Ophthalmic Center, Guangzhou, China (No. KYPJ141-4). Participants will have the opportunity to ask questions about the trial, and written informed consent will be obtained from all participants prior to their involvement in the study. Results will be disseminated through peer-reviewed publication and conference presentations. NCT06098677.

There is a paucity of research that has examined how significant health, social, and environmental crises impact suicidal ideation, particularly where these events co-occur and have potentially synergistic adverse effects. The aim of this study was to identify the unique and cumulative contributions of mental health, social, and environmental risks on 12-month trajectories of suicidal ideation. A community-based sample of 1928 Australians (aged ≥ 16 years) completed online surveys measuring mental health, social, and environmental risk factors, and suicidal ideation at baseline, and the suicidal ideation measure was repeated at four follow-up timepoints. Growth mixture modelling identified suicidal ideation trajectories and multinomial logistic regression analyses examined associations between baseline risk variables and the trajectories. Analyses showed five different trajectories of suicidal ideation (one stable low ideation trajectory; four vulnerable trajectories). A different set of risk factor variables predicted each vulnerable trajectory relative to the low trajectory. A cumulative risk index representing the combined effects of the mental health, social, and environmental risk factors also predicted each vulnerable trajectory relative to the low trajectory. While adversity resulting from exposure to health and environmental crises was associated with suicidal ideation, the heterogeneity in how patterns of mental health, social, and environmental factors related to trajectory classes suggests that people experience these events differently. A cumulative risk index may be a potentially useful indicator of risk.

Abstract Workers in the construction industry are at heightened risk of mental ill-health and suicide; however, a more nuanced understanding of risk factors is needed to inform prevention efforts. The current study aimed to identify workers most at risk of poor mental health and offer unique insights into both the prevalence and impact of workplace psychosocial risk factors among less commonly examined subgroups of workers. A nationwide survey was conducted with 710 workers from an Australian construction company. Differences in psychological distress (K10) were tested between demographic groups. Both the presence of psychosocial risk factors and their impact on distress were assessed and compared across various occupational roles. Women, younger, part-time/casual, and newer workers were particularly vulnerable to distress. Some of the most prevalent workplace risk factors were also among the most impactful on mental health (job role ambiguity/conflict; lack of job control). Others were less prevalent but highly impactful (bullying/harassment) or highly prevalent but less impactful (high job demands; long hours; lack of reward/recognition). Tradespeople, technical/analytical workers, office workers, and managers were equally at risk of poor mental health; however, each occupational category (and especially tradespeople) appeared disproportionately impacted by particular workplace risk factors. Prevention efforts should focus on particularly vulnerable industry subgroups and target risks with the potential to have the greatest impact. Various occupational groups appear equally in need of preventative action, although such efforts should account for the distinct risks experienced by these groups.

• Existing research on linguistic markers of depression has focused on content-based features, with fewer studies examining structural aspects of written language. • Structural linguistic markers such as syntactic complexity and referential cohesion are theoretically relevant to depression but remain empirically underexplored. • Evidence from related clinical populations shows that structural language measures can capture cognitive vulnerability, providing proof-of-concept for future depression research. • Current findings on structural markers in depression are preliminary, and further empirical work is required before clinical applications can be established. • A range of Natural Language Processing tools and pipelines are available for extracting structural linguistic features, offering practical pathways for advancing this research area. The study of ‘linguistic markers’ has gained prominence as a method of exploring how depressive symptoms are reflected in language use. In the context of depression, existing research has predominantly focused on perspectives of analysis related to language meaning and thematic content (e.g., semantics). In contrast, techniques that examine the underlying structure and grammatical composition of language (e.g., syntax) remain a novel application for identifying text-based markers of depression. Digital phenotyping enables the efficient collection of written text samples through digital, remote, and low-cost methodologies, making written language a practical and scalable target for research. Coinciding with advancements of natural language processing, this creates the timely opportunity to conduct the automated analysis of text samples. As such, this paper provides an overview of language analysis techniques for the examination of linguistic markers of depression. In particular, we focus on perspectives of structural language analysis, highlighting syntactic complexity and referential cohesion as potential markers, and the insight these features may provide into the linguistic manifestations of depressive symptoms. We discuss the clinical translation of content-based markers of depression through digital phenotyping and just-in-time adaptive interventions, and the potential benefit of incorporating structure-based markers of language. Finally, we discuss automated language analysis tools for their use in clinical and research settings.

Gender- and sexuality-diverse (GSD) youths are at increased risk of depression and anxiety compared with their cisgender and heterosexual counterparts. Little is known about the risks for younger GSD adolescents (<15 years). To estimate the prevalence and odds of depression and anxiety for younger GSD adolescents. This cross-sectional study collected baseline data across 3 separate cohorts of year (grade) 8 students (August through September 2019; August through November 2020; and April 2021 through March 2022) in the Future Proofing Study, an Australian prospective study. All year 8 students from 134 secondary participating schools across Australia were invited to participate in the survey. Data were analyzed in April 2025. Gender diversity and sexuality diversity status. Self-reported depression symptoms were assessed using the Patient Health Questionnaire for Adolescents, and anxiety symptoms were assessed using the Spence Children's Anxiety Scale. The sample comprised 6388 adolescents (mean [SD] age, 13.9 [0.5] years); 5842 (91.5%) were born in Australia, 5982 (93.7%) spoke English at home, and 5009 (78.4%) lived in a 2-parent home. Sex at birth included 3329 (52.1%) female, 2968 (46.5%) male, 33 (0.5%) unsure, 51 (0.8%) prefer not to report, and 6 (0.1%) another. There were 6019 cisgender respondents (95.0%), 209 gender-diverse respondents (3.3%), and 109 prefer not to report about gender (1.7%); sexuality identity included 4472 heterosexual respondents (70.0%), 767 sexuality-diverse respondents (12.0%), 559 respondents (8.8%) unsure, 296 prefer not to report (4.6%), and 294 respondents (4.6%) missing these data. Of the 6388 adolescents in the sample, 3745 (58.6%) reported depression (2780 [43.5%] mild to moderate, 965 [15.1%] clinical levels), and 1888 (29.6%) reported anxiety (958 [15.0%] mild to moderate, 930 [14.6%] clinical levels). Larger proportions of GSD adolescents reported clinical levels of depression (gender diverse: 59.3% vs 13.3%, P < .001; sexuality diverse: 43.4% vs 10.1%, P < .001) and anxiety (gender diverse: 48.8% vs 13.1%, P < .001; sexuality diverse: 35.3% vs 10.9%, P < .001) than cisgender and heterosexual counterparts, respectively. Larger proportions of GSD adolescents faced greater demographic individual, psychosocial, and contextual adversities. In multivariable multinomial logistic models, GSD status was associated with higher odds of clinical-level depression (gender-diverse odds ratio [OR], 5.68 [95% CI, 3.46-9.33]; sexuality-diverse OR, 6.49 [95% CI, 4.66-9.03]) and anxiety (gender-diverse OR, 3.49 [95% CI, 2.46-4.95]; sexuality-diverse OR, 3.07 [95% CI, 2.40-3.93]) compared with cisgender and heterosexual peers. In this cross-sectional study, higher prevalence and risk of greater depression and anxiety symptoms were evident among younger GSD adolescents. To improve their mental health, prevention and interventions addressing identity-specific stressors and broader contextual risk and protective factors should be initiated by early adolescence.

Adolescence is a period of rapid physical, psychological, and social change. Older adolescents (15-19years) experience key transitions; successfully navigating these can reduce the risk of stress and may mitigate subsequent impacts in adulthood, given that stress and depression in young people are highly correlated with behavioural risk factors such as alcohol and substance use, physical inactivity, and poor dietary behaviours. The Adolescent Resilience-Building In Urban Slums-A Multifaceted Implementation Trial of Life Skills Education in India (ANUMATI 2.0) will be undertaken in 105 slums across New Delhi and Hyderabad/Secunderabad in India among older adolescents. The hypothesis is that life skills administered either in-person or through social media will improve wellbeing, depression symptoms, and lead to a reduction in other non-communicable disease risk factors (smoking, alcohol and substance use, physical inactivity) relative to enhanced usual care. A secondary hypothesis is that the social media-based programme will be more cost-effective than the in-person programme. The Life Skills Education Programme (LSEP) was co-designed with adolescents from slums and comprises four modules delivered over 8months, with refresher sessions being carried out in the remaining 4months of the 12-month implementation period. It will be implemented and evaluated in a 3-arm, hybrid type 2 cluster randomised controlled trial with process and economic evaluations. Older adolescents will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Adolescents with a PHQ-9 score ≥ 10 and/or a score ≥ 2 on the self-harm/suicide risk question of the PHQ-9 will be included in the trial. Arm 1 will receive the in-person LSEP, arm 2 will receive the LSEP delivered through social media platforms, and arm 3 will be provided with enhanced usual care. Life skills education is an evidence-based approach to enhance young people's resilience to stressors. It focusses on improved communication, assertiveness, self-awareness, decision-making, problem solving, and creative thinking. The findings from this study will generate evidence on scalable strategies to enhance resilience and reduce non-communicable disease risk factors for young people living in resource-limited settings both in India and elsewhere. Clinical Trial Registry India, CTRI/2024/08/072338. Registered on August 12, 2024.

There is a paucity of quality appraisal tools specific to determine cultural validity. Cultural validity measures the appropriateness and applicability of a construct for a specific cultural group. It is often discussed in reference to determining if a construct developed in one cultural group is applicable, meaningful and equivalent in another cultural group. First Nations people conceptualise mental ill-health in vastly different ways than the biomedical models most used. Thus, research that does not consider cultural validity can have harmful effects. A specific tool to assess cultural validity in First Nations communities is required to address this significant gap in the literature. The First Nations Cultural Validity Assessment Tool was developed to assess cultural validity in a meaningful way for First Nations people in Australia. The tool was designed by First Nations researchers with guidance from cultural and lived experience experts and pilot-tested by clinicians and researchers. The First Nations Cultural Validity Assessment Tool includes 10 criteria within three overarching factors (Psychometric properties, Cultural Psychometric properties and Cultural competency of staff/ethics). The First Nations Cultural Validity Assessment Tool is scored from 0 to 15, with higher scores indicating greater cultural validity. Pilot testing demonstrated excellent inter-rater reliability between scorers. This is the first tool to assess the cultural validity of measurement tools from the perspective of First Nations frameworks. The First Nations Cultural Validity Assessment Tool prioritises First Nations research values using a methodological approach that is acceptable within both non-Indigenous and Indigenous research practices.

Purpose Self-harm risk is highest between ages 12–19, making it essential for schools to have clear, evidence-based practices for identifying and responding to self-injurious thoughts and behaviours (SITBs). This scoping review summarises best-practice responses in primary and high school settings, focusing on non-clinical staff. It provides a foundation for developing consistent, evidence-based whole-school guidelines. Methods PubMed, CINAHL and Embase were systematically searched (1 January 2000–31 March 2024) for English-language, peer-reviewed studies examining school staff responses to student SITBs. Studies reporting only prevalence or trends were excluded. Final studies were selected through a blinded, multistage screening process by paired reviewers. Data were analysed using narrative synthesis. Results Forty-one articles met inclusion criteria. Most were published after 2005, conducted in the USA (n = 17), used qualitative designs (n = 15), involved mixed school staff (n = 14) and were based in high schools (n = 23). Overall study quality was fair to low. Findings indicated that effective school responses rely on whole-school approaches, strong leadership support, clearly defined roles and procedures, crisis response teams, and regular staff training. Conclusions Despite gaps in the evidence, this review consolidates current best practice and can inform future guidelines to strengthen school staff capacity and confidence in supporting students experiencing SITBs.

A large proportion of college students report experiencing psychological distress. Smartphone app-based interventions may alleviate distress, but their effectiveness across severity levels is unclear. Artificial intelligence (AI)-enhanced response-adaptive randomized clinical trials may offer an efficient method to evaluate competing interventions. To compare the effectiveness of 3 brief, 2-week self-guided smartphone application-based interventions (physical activity, mindfulness, sleep hygiene) or an active control (ecological momentary assessment [EMA]) for reducing psychological distress among college students with mild, moderate, or severe distress. This population-based AI-enhanced response-adaptive randomized clinical trial included 1282 participants with distress scores of 20 or more on the 10-item Kessler Psychological Distress Scale in 12 minitrials from November 9, 2021, with final follow-up on February 17, 2023. Participants' distress was categorized as mild, moderate, or severe based on their normalized 21-item Depression Anxiety Stress Scale (DASS-21) scores at screening. After a 2-week onboarding period of daily EMA, participants were assigned by a contextual multi-armed bandit algorithm to 1 of 4 two-week self-guided app interventions: physical activity, mindfulness, sleep hygiene, or a control that continued EMA. The primary outcome was change in psychological distress (DASS-21 total score) from week 2 (before intervention) to week 4 (after intervention). The primary end point was after the intervention (4 weeks). Secondary outcomes included DASS-21 subscale scores, self-reported physical activity, mindfulness, sleep quality, and app engagement, usability, and satisfaction. Analysis was performed on an intention-to-treat basis. A total of 1282 individuals (mean [SD] age, 23.5 [5.2] years; 950 women [74.1%]) participated: physical activity (n = 305), mindfulness (n = 453), sleep hygiene (n = 431), or a control that continued EMA (n = 93). Among 349 participants with severe distress, physical activity (n = 79) and mindfulness (n = 180) were significantly more effective than the EMA control (n = 29) in reducing DASS-21 total scores (physical activity vs control: standardized mean difference [SMD], 0.62 [95% CI, 0.23-1.02]; mindfulness vs control: SMD, 0.53 [95% CI, 0.19-0.87]) and sleep hygiene (n = 61) (physical activity vs sleep hygiene: SMD, 0.50 [95% CI, 0.16-0.84]; mindfulness vs sleep hygiene: SMD, 0.41 [95% CI, 0.13-0.69]). Among 494 participants with mild distress, physical activity (n = 161) and sleep hygiene (n = 224) were significantly more effective than control (n = 37) in reducing DASS-21 total scores (physical activity vs control: SMD, 0.58 [95% CI, 0.30-0.86]; sleep hygiene vs control: SMD, 0.47 [95% CI, 0.20-0.73]). No significant group differences were observed among participants with moderate distress (n = 439). In this AI-enhanced response-adaptive randomized clinical trial among college students, physical activity and mindfulness were most effective for severe distress, while physical activity and sleep hygiene were most effective for mild distress. These findings can guide personalized mental health interventions for college students. This trial improved efficiency by minimizing control group allocation but had reduced power to detect significant group differences. http://anzctr.org.au Identifier: ACTRN12621001223820.

What do we learn when we invite others to make and create? How can drawing, cutting and pasting, repurposing objects, and photography enable us to explore complex, or hard-to-talk about experiences? What do we miss when we ask only with words, and not with action? This article explores these questions, demonstrating how to enact different arts-based research methods in practices of inquiry to open the process of thought and care in research related to public health. With reference to one line of inquiry as an exemplar – namely, how to promote care – this article reveals the complementary value of several arts-based research methods – these include: found objects; body mapping; collective collage making; and photography. This article: presents an overview of arts-based research methods, explaining what they are (and are not) and their purpose; demonstrates how arts-based research might be used to promote care; clarifies the benefits, limitations, and ethical considerations associated with arts-based research; and invites readers to consider how they might incorporate arts-based research in their scholarship, highlighting particular questions that warrant consideration.