Background: Evidence suggests increased suicide risk amidst recent social and macroeconomic disruptions. However, prior research has mainly focused on mental health-related risk factors, paying less attention to social determinants of suicide risk. Methods: Using two population-based cross-sectional surveys from Czechia conducted in 2017 ( N = 3,306) and 2022 ( N = 3,063), we examined disparities in suicide risk across a wide range of marginalization dimensions, including mental-health-related, social, and demographic factors. To assess secular changes in suicide risk, we estimated prevalence rates, risk ratios, and relative change in risk difference. We also examined the perception of structural barriers to mental healthcare among these vulnerable groups in 2022. Results: Individuals with mental health conditions had substantially elevated suicide risk in 2017, and, except for people with alcohol use disorders, these groups experienced larger increases in suicide risk between 2017 and 2022 than their counterparts without these conditions. Socially disadvantaged groups showed considerably increased suicide risk in 2017, and these social disparities remained stable over time. By contrast, older adults and people with primary education were at higher suicide risk in 2017, albeit not in 2022. Separately, mental health conditions, young age, and low income were associated with greater levels of perceived structural barriers to mental healthcare. Conclusions: These findings indicate persisting social inequalities and widening of mental health-related disparities in suicide risk. This evidence underscores the complex role of mental health-related, social, and economic factors in shaping suicidal ideation and behaviors, highlighting the need for targeted, multi-sectoral approaches to suicide prevention and intervention.
Background Suicide attempt surveillance commonly focuses on event notification, recurrence and acute risk, while longer-term psychosocial outcomes receive less attention. Recovery-oriented perspectives consider clinical burden together with positive mental health, relational resources and mental health service conditions. Aims This study aimed to characterise multidimensional recovery-related profiles among adults reported to the suicidal behaviour surveillance system in Caldas, Colombia, after suicide attempts occurring between 2023 and 2025. Method This surveillance-based cross-sectional study included 1,044 unique adults with a documented suicide attempt. Recovery-related conditions were represented through three indicators: positive mental health and well-being, clinical-psychosocial risk and mental health service conditions. These indicators included depressive symptoms, loneliness, adverse childhood experiences, subjective well-being, resilience, sense of community, healthy habits, continuity of care, adherence, rights-related experiences, coercive practices and out-of-pocket expenditure. A global recovery-related index was constructed on a 0 to 100 scale. Latent profile analysis was used to identify multidimensional profiles. Results The mean global recovery-related score was 64.08. The index showed a strong positive correlation with positive mental health and well-being and a strong negative correlation with clinical-psychosocial risk. Four profiles were identified: high recovery with favourable services, high recovery with stronger positive resources, intermediate recovery with elevated risk and low recovery with high risk. The low-recovery profile concentrated the highest proportion of persistent suicidal ideation. Conclusions The identified profiles describe multidimensional recovery-related configurations after suicide attempt rather than a validated measure of personal recovery. Post-attempt care may benefit from monitoring positive resources, clinical-psychosocial risk and service conditions alongside acute suicide risk.
Objective: To evaluate an integrated intervention combining convalescent nursing, occupational therapy, and group painting art therapy for medication adherence, quality of life, and related outcomes in patients with schizophrenia. Methods: In this single-center randomized controlled trial, 150 patients with schizophrenia were randomized 1:1 to a control group (routine convalescent nursing) or an observation group (routine nursing plus occupational therapy and group painting art therapy) for 15 weeks; 146 participants (73 per group) completed the intervention. The primary outcomes were medication adherence (MMAS-8) and quality of life (WHOQOL-BREF); secondary outcomes were symptom severity (PANSS), social functioning (SFS), mood (HAMD-17, HAMA-14), and cognition (MoCA). Repeated measures were analyzed with linear mixed-effects models, and an intention-to-treat sensitivity analysis was performed. Results: Group × time estimates favored the observation group for MMAS-8 (β = 1.46, 95% CI [0.98, 1.94]) and the study-defined WHOQOL-BREF composite (β = 12.34, 95% CI [8.77, 15.91]; both FDR p < .001). PANSS, SFS, HAMD-17, HAMA-14, and MoCA also favored the observation group (all FDR p < .001). WHOQOL-BREF domain changes were non-uniform. Recorded adverse-event rates were 16.44% and 19.18% (Fisher exact p = .829). Conclusions: In this single-center trial, the integrated program was associated with greater 15-week improvements in medication adherence, quality of life, and several secondary outcomes than routine nursing alone. Adverse-event rates were similar between groups, but the findings require confirmation in larger multicenter studies using standardized safety assessment.
In developing and lower- and middle-income countries (LMICs) like India, adolescent mental health is influenced by a complex interplay of distinct sociocultural influences, such as caste, class, religion, gender norms, family dynamics, and material inequalities. Although global research increasingly recognises these determinants, evidence from the Indian context has remained fragmented and usually centred on individual or family-based factors. This systematised narrative review aims to synthesise Indian studies to examine the influence of sociocultural factors on adolescent mental health. Peer reviewed English language articles that were published between 2014 and 2025 were identified using PubMed, Scopus, ProQuest, and Google Scholar. A predefined strategy guided the search and was organised around three thematic areas: (a) relational determinants in home and school, (b) sociocultural identity-based determinants, and (c) structural and material determinants. There were 47 studies that were included. Most research focused on family dynamics, parenting, academic stress, and school environments. In comparison, far fewer studies examined structural and sociocultural identity-based factors such as caste, gender identity, religion, sexuality, food insecurity, housing instability, and resource deprivation. Higher distress among adolescents from marginalised communities was frequently reported; however limited research explored how these experiences of social inequality were internalised during adolescence and shaped their mental health over time. Methodologically, the literature was dominated by quantitative, community-based studies, with limited qualitative and clinical research. This review synthesised the existing literature available on sociocultural determinants of adolescent mental health in India. It highlights the gaps present in the existing literature and urges professionals to expand the scope of their clinical work and integrate context-specific social, cultural, and structural factors that shape adolescent mental health. It also encourages institutions to undertake an upstream approach to reduce mental health inequalities and move towards structurally competent, developmentally sensitive, and culturally rooted mental health care.
Background: North Korean refugees (NKRs) are exposed to severe cumulative trauma before and during migration, yet their post-traumatic stress disorder (PTSD) symptoms may also be related to the social environment they encounter after resettlement. Aims: To examine whether post-resettlement social stigma and self-concealment are associated with PTSD symptoms among NKRs after adjustment for pre-migration trauma exposure and post-resettlement socioeconomic conditions, and to explore whether the stigma–PTSD association differs by self-concealment, gender, age, or household income. Methods: This cross-sectional study analyzed data from 410 NKRs who participated in the 2023 Survey on the Family and Social Life of North Korean Refugees in South Korea, designed and conducted directly by the principal investigator and the research team. Hierarchical regression analyses used a refined nine-item stigma score and heteroskedasticity-consistent standard errors. Results: Social stigma was associated with PTSD symptoms (B = 0.257, β = .31, p < .001) after adjustment for gender, age, length of residence, and pre-migration trauma exposure, and the association remained after additional adjustment for household income, education, marital status, and social support. Self-concealment was independently associated with symptoms (B = 0.111, p = .003). The stigma × self-concealment interaction was not significant with the refined score (p = .074) and is reported as an exploratory, measurement-sensitive finding. There was no evidence that the stigma–PTSD association differed by gender or age, but it was tentatively stronger in the lowest income group. Conclusions: Post-resettlement social stigma was associated with PTSD symptoms after adjustment for pre-migration trauma exposure and socioeconomic conditions. Although the cross-sectional design precludes establishing the direction of these associations, the findings provide a rationale for longitudinal and intervention research on stigma in refugee mental health.
