Abstract Background Prolonged war-related adversity places Ukrainian university students at heightened risk of psychological distress. Scalable, low-intensity interventions such as WHO Self-Help Plus (SH+) show promise, yet evidence of their implementation and short-term effectiveness during active conflict is limited. Methods A multicenter longitudinal study was conducted across five universities. Students with mild-to-moderate distress (PSS-10) joined a 5-week offline Acceptance and Commitment Therapy-based SH+ course led by trained non-specialist facilitators. Outcomes included psychological distress (PHQ-9, GAD-7, PCL-5), well-being (WHO-5), daily functioning (WHODAS 2.0), and resilience (CD-RISC-10), assessed at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). Analyses used non-parametric longitudinal tests on 297 completers. Results SH+ participation significantly reduced perceived stress, depression, anxiety, and post-traumatic stress from T1 to T2. Well-being and daily functioning improved, with all gains sustained at T3. Resilience remained stable. Implementation barriers included security threats, power outages, and exam overlaps, contributing to attrition. Conclusions WHO SH+ is an effective, scalable first-line psychosocial intervention for university students in wartime. It alleviates distress, enhances functioning, and maintains benefits over 3 months. SH+ can be rapidly deployed by non-specialists within stepped-care university frameworks during humanitarian crises. Flexible delivery and alignment with academic schedules are essential to overcome conflict-driven barriers.
Objective: In cutaneous squamous cell carcinoma (cSCC) of the auricle or external auditory canal entrance, involvement of the external auditory meatus (EAM) is associated with an unfavorable prognosis. The aim of this study was to evaluate oncologic outcomes as well as immunosuppressive comorbidities as potential risk factors. Methods: A total of 137 patients treated between 2007 and 2017 were included (31 cSCCs of the auricle or external auditory canal entrance with EAM involvement, 60 auricular cSCCs, 9 lip cSCCs, and 37 nasal cSCCs). Oncologic characteristics and immunosuppressive comorbidities were analyzed retrospectively. Results: The cSCCs with EAM involvement presented with significantly more advanced T and N stages than all other subgroups. Whereas EAM involvement was associated with a 1.2-fold increased risk of tumor recurrence (p = 0.016), advanced T and N stage were associated with a 1.8- and 2.5-fold increased risk of tumor-related death, respectively. After adjustment for T and N stage, the overall survival of patients with EAM involvement was comparable to that of patients with other tumor locations. Immunosuppressive comorbidities were identified in 25% of patients, most commonly diabetes mellitus, hematologic disorders, and a history of heart or kidney transplantation. However, Cox regression analysis revealed no significant association between immunosuppressive comorbidities and either recurrence-free or overall survival. Conclusion: Patients with cSCC of the auricle or external auditory canal entrance involving the EAM presented with significantly more advanced T and N stages at diagnosis, underscoring the need for more aggressive treatment strategies, including consideration of adjuvant therapy. After adjustment for T and N stage, overall survival was comparable to that of other tumor locations, suggesting that the poorer prognosis associated with EAM involvement is primarily attributable to more advanced disease at presentation rather than to distinct tumor biology.
Abstract Background Childhood maltreatment (CM) has been linked to poor emotional intelligence (EI) and psychosocial functioning (PSF) in patients with bipolar disorder (BD). However, no study has investigated whether EI mediates the relationship between CM and PSF in patients with BD. Here, we aimed to assess the association of CM with EI and PSF in euthymic patients with BD compared with healthy controls (HCs). Methods We assessed 124 euthymic participants with a BD diagnosis and 124 HCs by means of the Mayer–Salovey–Caruso Emotional Intelligence Test, the Functioning Assessment Short Test and the Childhood Trauma Questionnaire. Linear regression models were constructed using CM categorized as no-CM, low/moderate-CM and high-CM. We subsequently assessed whether EI mediates the relationship between CM and PSF. Results Compared with HCs, patients with BD reported higher rates of CM and lower rates of PSF and EI. In the BD group, subjects who exhibited low/moderate CM obtained lower levels of PSF and EI than those with no-CM and high-CM levels. The regression models demonstrated that, compared with the no-CM category, the low/moderate CM category was inversely associated with EI strategic area scores in patients with BD. However, EI did not mediate the relationship between CM and PSF. Conclusions Low/moderate-CM was associated with the worst EI scores in BD. However, we did not observe any mediating effect of EI on the relationship between CM and PSF. Our results emphasize the importance of assessing CM in mental health and suggest that targeted therapies should be administered to affected patients.
Abstract Background The European Psychiatric Association (EPA) undertook a study to investigate treatment preferences of European psychiatrists towards Bipolar Disorder (BD), as part of the Ambassador programme series of surveys. Methods We conducted a cross-sectional online survey among psychiatrists and psychiatry trainees from 40 European countries. The questionnaire contained clinical vignettes of different phases of BD including manic, rapid cycling, mixed, hypomanic, and depressive episodes, for both initial and subsequent treatment strategies. Results The final sample consisted of 654 participants, from Central and Eastern Europe (CEE), Southern Europe (SE), Northern Europe (NE), and Western Europe (WE). The majority preferred pharmacotherapy, most commonly as a combination of two or three drugs to treat all phases of the BD, with lithium being the most preferred option in all phases. Among antipsychotics, olanzapine and quetiapine were the most commonly chosen. Antidepressants were applied in almost 20% of responses for the depressive phase. Psychosocial interventions were not systematically implemented, particularly during manic and mixed episodes, but when recommended, the most common approaches included psychoeducation, cognitive behavioural therapy (CBT) in up to 40% in depressive phase, and lifestyle recommendations. However, latent class analysis identified four different classes of prescribers. Conclusions Psychiatrists showed broadly similar pharmacological treatment preferences for BD, with frequent use of lithium-based combination therapies and limited implementation of psychosocial interventions, although latent class analysis revealed distinct prescribing profiles. These findings support the need for enhanced dissemination of evidence-based guidelines and greater integration of psychosocial approaches in BD care.
Abstract Despite the existence of effective public mental health (PMH) interventions, only a minority across the European region receive treatment for mental health conditions (MHCs). Even fewer receive interventions to prevent MHC-associated impacts, with negligible coverage of interventions to prevent MHCs, or promote mental well-being and resilience. Various reasons account for implementation failure which breaches the right to health and results in population scale preventable suffering, broad impacts and associated economic costs. Public mental health involves a population approach to improve coverage, outcomes and coordination of PMH interventions. Required actions to scale up PMH implementation include effectively making the case through assessment of PMH need, highlighting economic impacts of PMH implementation failure and improved coverage, and coordinated advocacy and leadership. Public mental health practice involves the use of PMH needs assessment to inform choice of interventions, policy development, and required coverage and resources for effective PMH intervention delivery by different sectors. This is supported by the collection of PMH-relevant data. Further actions to scale up PMH implementation include adopting human rights-based approaches and legislation, PMH training to different sectors and improved population PMH literacy, maximizing existing resources, settings-based and integrated approaches, use of digital technology, prioritizing interventions with large population impact, and implementation-focused research. Scaled up PMH implementation results in broad population impacts, achievement of a range of policy objectives, sustainable reduction in impacts of MHCs and promotion of mental well-being across the population of the European region. Associated economic savings also make PMH practice an essential part of sustainable economic development.
