OBJECTIVES:Loneliness is a critical psychosocial factor associated with mental health and wellbeing in later life. Although prior research has documented its prevalence, less is known about how loneliness has changed over time at a global level or how broader societal conditions shape these trends. This study examined long-term changes in loneliness among older adults and their associations with macro-level indicators. METHODS:A systematic search of 10 databases identified 125 studies (N = 107,304) published between 1997 and 2025. Cross-temporal meta-analysis was conducted to assess trends in loneliness and its associations with societal indicators. RESULTS:Overall loneliness among older adults showed a modest decline over time (d = -0.331), with significant regional variation. Loneliness decreased in Asia and North America but increased in Europe, where levels were highest. No significant overall gender differences were observed, although women showed a slightly greater decline. Higher GDP per capita, life expectancy, and old-age dependency ratio were associated with lower loneliness, whereas unemployment was associated with higher loneliness. The influence of female labor force participation changed over time. DISCUSSION:Over the past three decades, loneliness among older adults has generally improved, though regional and gender disparities persist in this trend, which remains closely linked to multiple macro-level social indicators. Future policy formulation must account for regional variations and the long-term effects of social change, promoting more targeted psychological support systems for older adults to effectively enhance their mental wellbeing and quality of life.
Adolescence is considered a period of heightened risk for suicidal behavior (SB), and previous studies suggest that bullying experiences (BE) and family functioning (FF) are important associated factors. This study examined the associations of BE and FF with SB in adolescents. A total of 468 adolescents aged 12 to 17 years participated in the study (50.8% female; M = 14.4, SD = 1.6). The European Bullying Intervention Project Questionnaire (EBIPQ), the Family APGAR Questionnaire, and the abbreviated Suicidal Behavior Assessment Scale (SENTIA-Brief) were administered. School victimization was positively associated with SB with a moderate magnitude (β = .45, p < .001), whereas FF showed a small inverse association with SB (β = -.24, p < .001); together, both variables accounted for 30.3% of its variability. The two variables were also negatively related to each other (β = -.19, p < .01). Additional findings revealed differences according to sex and history of psychological care: males and adolescents without previous psychological care showed stronger associations between victimization and SB. The results suggest partial consistency with certain assumptions of Joiner's interpersonal theory of suicide, providing evidence that proxy contextual variables, namely victimization and family dysfunction, are associated with suicidal behavior. However, the use of indirect indicators, the cross-sectional design, and the lack of measurement of acquired capability limit the evaluation of the model as a whole and preclude the establishment of temporal directionality or causality.
BACKGROUND:Climate change is an undeniable reality that is increasingly discussed globally. While eco-anxiety has been extensively studied in Europe and other developed countries, there is a lack of data from Latin America. AIMS:To identify and describe the factors associated with eco-anxiety in Latin America. METHOD:A cross-sectional, multicenter study used a validated scale to measure eco-anxiety, adjusted for sex, age, education level, and country of residence. Descriptive and analytical statistics were employed to interpret the data. Among 3,320 participants, a significant portion expressed eco-anxiety, particularly when it was mentioned to affect an important place, interfere with concentration, disrupt work or studies, or cause difficulty sleeping (12%, 5%, 3%, and 3% strongly agreed with these statements, respectively). RESULTS:Multivariate analysis revealed higher scores of eco-anxiety in Argentina (aRP: 2.06; 95% CI [1.45, 2.94]; p < 0.001), Colombia (aRP: 1.66; 95% CI [1.21, 2.29]; p = 0.002), and Ecuador (aRP: 1.40; 95% CI [1.01, 1.94]; p = 0.042). Conversely, eco-anxiety was lower among men (aRP: 0.88; 95% CI [0.81, 0.96]; p = 0.003) and those with postgraduate education (aRP: 0.72; 95% CI [0.59, 0.88]; p = 0.001), after adjusting for age. CONCLUSIONS:This is the first large-scale study to report significant eco-anxiety in Latin America, which is linked to factors such as country of residence, sex, and educational level.
BACKGROUND:Loneliness is the emotional experience arising from the discrepancy between an individual's desired and actual social relationships. Despite a solid rationale for expecting high levels of loneliness in eating disorders (EDs), this construct has been relatively underexplored. AIMS:The present study aimed to compare levels of loneliness between people with EDs and healthy controls (HCs), assess the possible differences according to predominant pathological eating behaviors, and explore the variables associated with loneliness. METHODS:A total of 124 individuals with EDs and 134 HCs completed the UCLA Loneliness Scale-3 (LS-3) and measures of ED psychopathology (EDI-3), general psychopathology (SCL-90-R), functional impairment (WSAS), quality of life (EQ-5D), wisdom (SD-WISE), hopelessness (BHS-20), and temperament (TEMPS-A). Within the ED sample, participants were compared according to their predominant pathological eating behaviors. Associations with loneliness were examined using stepwise multiple linear regression analyses. RESULTS:Individuals with EDs reported higher levels of loneliness compared to HCs. No differences emerged based on the specific eating behaviors, and loneliness was not associated with BMI, illness duration, or frequency of pathological eating behaviors. In the clinical sample, loneliness was most strongly associated with ED-related interpersonal problems, global psychological distress, and lower wisdom. In the control group, the associations of loneliness replicated those identified in the clinical sample. DISCUSSION:Higher levels of loneliness were observed among individuals with EDs irrespective of behavioral subtype and clinical severity. These findings support the conceptualization of loneliness as a transdiagnostic dimension rather than a feature linked to specific eating behaviors.
Psychomotor agitation is a common mental emergency that requires immediate, safe treatment. Intramuscular haloperidol is frequently used; however oral alternatives may be safer and more tolerated. In many low- and middle-income settings, resource constraints, cultural norms, and emergency department coercion shape agitation prescribing. This study compared the efficacy and safety of oral risperidone plus clonazepam versus injectable haloperidol for psychomotor agitation in primary psychotic patients. In this single-blind, randomized comparative trial, 260 patients (mean age 32.38; 95% CI [31.13-33.64], 119 males and 141 females) with severe psychomotor agitation in a general hospital emergency room were randomly assigned oral risperidone 3 mg plus clonazepam 3 mg (RC) or intramuscular haloperidol 5 mg. Behavioral Activity Rating Scale (BARS) agitation was measured at 30, 1, and 2 hr. The primary outcome was the percentage of patients reported as tranquil (BARS = 4) or tranquil/asleep (BARS = 2-4) at all time points, with an equivalency margin of ±20%. Secondary outcomes included tranquil/tranquil or asleep after 2 hr, restraint use, adverse effects (during the 2 hr of assessment), and necessity of additional medication after 1 hr. RC and IH were equally tranquil or sleeping at all time points for primary outcomes (adjusted ARR 9 percentage points, 95% CI -1.8 to +19.8). Neither tranquility at 2 hr nor extra medication were equal for secondary outcomes (adjusted ARR 15 p.p., 95% CI [1.35, 28.65]). At 2 hr, tranquil or asleep, restraint utilization, and side effects were equivalent. In conclusion, besides oral risperidone plus clonazepam met the prespecified criterion for equivalence to intramuscular haloperidol for the primary composite outcomes of maintaining tranquility or tranquility/asleep at all time-points during the 2-hr observation period, the equivalence was not demonstrated for all secondary outcomes. The oral regimen was associated with a greater need for additional medication. Therefore, the two regimens should not be considered fully interchangeable in all emergency presentations. We found that oral techniques may enable more humane, less invasive, and culturally acceptable emergency care in LMICs due to the social burden of injectable medication, which typically requires restraint.
BACKGROUND:Negative attitudes toward immigrants represent an important psychosocial and public mental health issue, particularly in countries hosting large immigrant and displaced populations such as Türkiye. Understanding the ideological, cognitive, and contextual factors underlying these attitudes is essential for developing effective social and mental health interventions. AIMS:This study aimed to examine the relationship between social dominance orientation (SDO) and negative attitudes toward Syrian immigrants, and to investigate the mediating role of perceived threat in this association. Additionally, the associations between anti-immigrant attitudes and contextual factors, including contact with Syrians, economic vulnerability, perceptions of immigrant population size, and media consumption, were explored. METHOD:Data were collected via an online survey from 576 participants in Türkiye. Participants completed measures assessing negative attitudes toward immigrants, social dominance orientation, and perceived threat. Information regarding contact with Syrians, economic vulnerability, perceived proportion of immigrants in the population, and media consumption patterns was also obtained. Mediation and correlational analyses were conducted. RESULTS:Social dominance orientation was significantly associated with negative attitudes toward Syrian immigrants; however, this relationship was largely mediated by perceived threat. Perceived threat emerged as the strongest predictor of anti-immigrant attitudes. Greater contact with Syrians was associated with lower levels of negative attitudes, whereas higher economic vulnerability, overestimation of the immigrant population, and exposure to multiple media sources were associated with more negative attitudes. CONCLUSIONS:The findings indicate that negative attitudes toward immigrants are shaped by the interplay of ideological orientations, cognitive appraisals, and contextual factors, with perceived threat playing a central role. These results highlight the importance of multidimensional intervention strategies targeting threat perceptions and cognitive distortions to reduce anti-immigrant attitudes and promote social cohesion.
BackgroundExposure to parental problematic alcohol use (PPAU) during childhood represents a common form of early adversity with potential long-term consequences for mental health. While childhood adversity is well established as a risk factor for later psychological difficulties, the specific association between childhood exposure to PPAU and anxiety and depression in adulthood remains insufficiently understood.AimsThis study aimed to systematically review and quantitatively synthesize existing evidence on the association between childhood exposure to PPAU and anxiety and depression outcomes in adulthood.MethodA systematic search was conducted in Medline, PsycINFO, Web of Science, and the Cochrane Library. Studies were screened using predefined inclusion criteria. Thirty-two studies met eligibility criteria, of which twenty-nine were included in the meta-analyses. Random-effects models were used to calculate pooled standardized mean differences (SMDs) and odds ratios (ORs) for anxiety and depression outcomes.ResultsThe findings indicated a significant association between childhood exposure to PPAU and increased risk of anxiety and depression in adulthood. For anxiety, the pooled SMD was 0.37, and pooled ORs indicated a 73% higher likelihood of anxiety among individuals exposed to PPAU. For depression, the pooled SMD was 0.29, with pooled ORs suggesting a 65% increased likelihood of depressive symptoms. Although effect sizes were attenuated in studies adjusting for confounding variables, associations remained statistically significant.ConclusionsChildhood exposure to PPAU is associated with an increased risk of anxiety and depression in adulthood. However, the available evidence suggests that these associations may be partly explained by co-occurring childhood adversities and broader family dysfunction. Consequently, PPAU may represent one component of a broader constellation of childhood risk factors associated with adverse adult mental health outcomes. Taken together, these findings underscore the importance of early identification and family-focused preventive interventions for children exposed to parental alcohol problems.
There is a pressing need to address the unique challenges of managing Schizophrenia Spectrum Disorders (SSD) in Low- and Middle-Income Countries (LMICs), where mental health resources are scarce and unevenly distributed. To develop this evidence-based guideline, we conducted a systematic review of the literature, followed by three rounds of Delphi surveys with experts from LMICs. The first two Delphi rounds identified and refined priority topics, while the third assessed their practical applicability in resource-limited contexts. The guideline emphasizes early intervention, continuity of care, and the integration of psychosocial interventions with pharmacological treatment, while explicitly tailoring recommendations to the realities of LMICs. Antipsychotic medications remain central, with second-generation agents recommended as first-line treatment for acute psychosis where available, but with recognition that first-generation agents are often the only accessible option. The guideline also discourages mega-dosing and unnecessary polypharmacy-common practices in some LMICs-in favor of rational monotherapy at the lowest effective dose. Psychosocial interventions are positioned as critical but are reframed for scalability: psychoeducation for patients and families, task-sharing to community health workers and trained lay providers, and reliance on peer support and faith-based networks where specialist services are lacking. The guideline stresses comprehensive care addressing physical, mental, and social needs, including vocational rehabilitation and housing support, while acknowledging barriers such as stigma, insecurity, and climate-related disruptions. Cultural adaptation is emphasized throughout, aligning interventions with local beliefs, social norms, and community structures to promote engagement, adherence, and sustainable outcomes.
BACKGROUND:Perceived stigma in Major Depressive Disorder (MDD) is a well-established barrier to help-seeking, social functioning, and quality of life. However, little is known about how stigma is shaped by cultural context and which psychosocial resources may buffer its effects. AIMS:This study aimed to examine the relationship between perceived stigma and key protective factors - spirituality, resilience, quality of life, and social functioning - in patients with MDD from Austria and Japan. METHOD:A total of 101 patients diagnosed with MDD (51 from Austria, 50 from Japan) completed validated measures of perceived stigma, spirituality, resilience, quality of life, and social functioning. Correlational analyses, multiple regression, and interaction term models were used to assess the predictive value of psychosocial variables and country moderation effects. RESULTS:Spirituality and resilience were negatively associated with perceived stigma across both samples, though only spirituality significantly predicted stigma in regression analyses, increasing to 48% after controlling for age and depression severity. Country-specific models revealed a stronger predictive power in the Japanese sample. While stigma correlated strongly with reduced quality of life in both groups, its association with social functioning varied by stigma dimension and country. The relationship between resilience and financial insecurity was stronger among Japanese study participants than among Austrian participants. CONCLUSIONS:In summary, spirituality emerged as a central protective factor against stigma in MDD patients, particularly in Japan, underscoring its cultural significance. Additionally, our findings reveal a context-specific relationship between economic stress and psychosocial coping strategies. Despite differences in how stigma is expressed across countries, its adverse impact on quality of life was universal. These results suggest that culturally informed approaches can effectively reduce stigma associated with depression.
BACKGROUND:Depressive and anxiety symptoms (depression and anxiety hereafter), and suicidality are common among psychiatric patients. This study examined the network structure of depressive and anxiety symptoms and suicidality among psychiatric patients across Asia. METHODS:Data were drawn from the Research on Asian Psychotropic Prescription Patterns for Antidepressants Phase 3 study (REAP-AD3), which included 2,455 psychiatric patients from 11 Asian countries and territories. Depression and anxiety were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively, while suicidality (i.e., suicidal thoughts or acts) was assessed by a clinical interview. Expected Influence (EI) and Bridge EI were used as centrality indices in the symptom network to characterize the structure of the symptoms. RESULTS:The point prevalence of suicidality was 30.1% (95% confidence interval [CI] = 28.2, 31.9) among the psychiatric patients. The network analysis identified PHQ2 ("Sad mood") as the most central symptom, followed by GAD2 ("Uncontrollable worry"). Additionally, PHQ8 ("Motor disturbances") and S ("Suicidality") were identified as bridge nodes linking depression and anxiety with suicidality. The flow network indicated that PHQ6 ("Guilt") and PHQ2 ("Sad mood") had the strongest positive associations with suicidality. CONCLUSIONS:Suicidality was common among psychiatric patients across Asia. The central and bridge symptoms might represent potential clinical markers and generate hypotheses for longitudinal and interventional research on depression, anxiety, and suicidality in the future.
Refugees and migrants experience disproportionately high rates of depression, anxiety, and post-traumatic stress disorder due to pre-migration trauma and post-resettlement challenges. Although the World Health Organization (WHO) QualityRights framework emphasizes person-centered and rights-based mental health care, its practical application in migrant and refugee mental health settings remains underexplored. This scoping review maps existing evidence on person-centered mental health care (PCC-MH) for migrants and refugees, identifies key barriers and facilitators, and describes existing interventions and care models through the lens of the WHO QualityRights framework. Following PRISMA-ScR guidelines, six academic databases and relevant gray literature sources were searched for studies published between 2004 and 2025. Included studies addressed PCC domains such as dignity, autonomy, communication, privacy, stigma reduction, and cultural sensitivity. Data were synthesized and interpreted using the WHO QualityRights framework. Forty-four studies met the inclusion criteria. The evidence consistently showed high mental health needs among migrants and refugees alongside low service utilization. Key barriers included language difficulties, stigma, restrictive policies, and limited cultural competence within health systems. Facilitators comprised culturally adapted interventions, interpreter services, peer- and trauma-informed care, and rights-based approaches, though implementation was often fragmented and inconsistent. Achieving equitable and sustainable mental health care for migrants in humanitarian settings requires systematic integration of PCC principles within national mental health policies and primary-care systems. Core PCC principles must include privileging the rights, lived experience, and voice of migrant groups to effectively promote the mental health and well-being of diverse migrant groups in humanitarian settings. This can include co-designing mental health services and supporting migrants.
Background: Stigma toward mental health problems is now being understood as a context-dependent, multidimensional concept. Nonetheless, empirical research continues to study stigma as a monolithic aspect, obscuring meaningful within-group variations. Such inquiries often obscure the people-centered patterns of stigma within the population. Recognizing such patterns aids in better understanding how stigma differentially influences help-seeking and resilience in the context of mental health. Aims: Accordingly, the present study seeks to identify latent profiles for stigmatizing attitudes and their correlates among Indian adults. The study also explores how these profiles potentially differ in resilience and help-seeking attitudes. Methods: The data were collected via a cross-sectional survey with 564 Indian adults. Standardized self-report measures like the Attitudes Toward Mental Health Problems Scale, the Connor-Davidson Resilience Scale – 10-item version, and the Inventory of Attitudes Toward Seeking Mental Health Services were used. Results: Latent Profile Analysis revealed a four-profile model that differed significantly in resilience and help-seeking attitudes. Further, a multinomial logistic regression revealed attitudes toward seeking mental health services, accessibility, reliance on religion, and mental health awareness as correlates of profile membership. Conclusion: The findings indicate the presence of multiple patterns of stigmatizing attitudes among Indian adults. The results of this study could inform practice, policy, and context-sensitive interventions to reduce stigma and promote the use of mental health services.
Background: Frequent psychiatric rehospitalizations, commonly referred to as revolving door (RD) pose major challenges to community mental healthcare system and may reflect patients’ bio-psycho-social (BPS) complexity. Aims: The aim of the current study was to investigate the association between BPS complexity and RD in an acute psychiatric hospital ward, located in a Northern Italy province serving around 500,000 inhabitants. Methods: A retrospective cohort study design was implemented to review all adult admissions between December 2021 and March 2023. Sociodemographic, clinical, and service-related data were extracted from the electronic clinical records. BPS complexity was assessed using the INTERMED tool. RD was defined as ⩾3 hospitalizations within 12 months. Survival analyses estimated hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs) for time-to-RD, under the assumption of proportional hazards. Results: A total of 322 patients were analyzed, and 31 (9.63%) met RD criteria. Compared to non-RD, RD patients displayed higher INTERMED scores, especially in psychological (HR: 1.28, 95% CI [1.06, 1.54]) and social (HR: 1.15 [1.05, 1.26]) domains. Living in a residential facility compared to a private house (HR: 7.14 [3.31, 15.38]), previous compulsory admissions (HR: 4.27 [1.73, 10.54]), long-acting injectable antipsychotic use at the first admission (HR: 3.46 [1.63, 7.35]), and receiving an individualized treatment plan at the community mental health center compared to not receiving it at the time of the first admission (HR: 5.30 [1.25, 22.42]) were all associated with an increased risk of RD during the follow-up. Conclusions: Higher complexity in psycho-social domains and history of coercive treatments increased the risk of RD. Addressing psychological distress, social disconnection, and agency in community care may support clinicians in recognizing and anticipating risk factors for RD.
This clinical cross-sectional study investigated psychosocial factors associated with social withdrawal (hikikomori) in 417 adolescent psychiatric outpatients (aged 13-19 years). Participants were assessed during their initial visit using the 25-item Hikikomori Questionnaire (HQ-25), the Quick Inventory of Depressive Symptomatology, Tarumi's Modern-Type Depression Trait Scale (TACS-22), and the Bidimensional Resilience Scale. Hierarchical multiple regression analyses revealed that higher social withdrawal severity was significantly associated with greater depressive symptoms, lower resilience, and higher modern-type depression (MTD) traits. Notably, lower resilience exhibited the strongest independent association with social withdrawal across all models (β = -40, p < .001), while suicidal ideation was not an independent associated factor. These findings suggest that social withdrawal in clinical adolescents primarily reflects a depletion of psychological resources and maladaptive coping rather than depressive severity alone. Clinical interventions should prioritize transdiagnostic, resilience-focused strategies that address internal psychosocial disengagement beyond traditional symptom-based diagnoses or behavioral markers like school attendance.
The present study examines the associations between social support, social inclusion and suicidal behaviors among young people. This quantitative study is situated within the analytical-interpretative paradigm. A total of 539 individuals participated (mean age 20.64 ± 3.61 years). The evaluation instruments used were: a questionnaire assessing suicidal behaviors (SBQ-R), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Social Inclusion Scale (SIAS). Results showed a significant association between suicidal behaviors and levels of perceived social support and social inclusion; individuals with lower suicidal tendency reported higher levels of family, friends', and partner support, as well as more positive perceptions of their social relationships, community belonging, school acceptance, and self-image. Together, these variables accounted for 70.4% of the variance in suicidal behavior. Therefore, it is essential to approach youth suicide prevention beyond individual factors by considering social inequalities and relational ties.
