The personal, occupational and psychosocial risk and protection factors associated with social dysfunction in media workers are analyzed. A total of 314 workers were surveyed. Data were collected on personal and occupational variables, and scales were administered to assess coping styles, perceived loneliness, emotional impact of the health emergency, and social dysfunction, which was measured using Scale C of the General Health Questionnaire (GHQ-28). It was found that 19.7% were at risk of social dysfunction. This risk was particularly evident among workers without a formal partner and those performing fieldwork in peripheral cities. Bivariate analyses indicated that workers at risk were more likely to be women, younger, less experienced, with limited training during the crisis, and reported poorer health, lower perceived ability to cover risky events, greater concern about infecting their families with COVID-19 or dying, and a stronger desire to quit their jobs. Psychosocially, they experienced greater emotional impact, higher levels of loneliness, greater use of self-blame and behavioral disengagement, and less use of active coping. The final logistic regression model correctly classified 89.8% of cases. Factors associated with increased odds of social dysfunction included desire to change jobs, perception that health would not improve, concern about infecting their families with COVID-19, hyperconnectivity, and use of planning. Factors associated with lower odds included working in the capital city, seeking emotional support, and employing humor. The importance of preventing social dysfunction to improve the mental health and general well-being of media workers in crisis contexts is discussed. In summary, the social dysfunction in media workers increases with personal or family affectation, the desire to change employment, hyperconnectivity, planning, and self-blame, and decreases among those who work in the capital, seek emotional support, and use humor.
Substance use disorders may arise when individuals use substances to cope with adverse mental health symptoms. Conversely, mental health symptoms can develop because of substance use, a category of conditions called substance-induced disorders. This study used two United States-based datasets, the Mental Health Client-Level Data and the Treatment Episode Data Set Admissions, to summarize the number of cases with "alcohol-induced disorders" and "substance-induced disorders" from both mental health and substance use disorder treatment programs from 2013 to 2022. The primary study aim was to identify the percentage of cases with alcohol-induced disorders or substance-induced disorders in these treatment settings. Among all mental health disorder treatment cases, those with an alcohol or substance-induced disorder totaled N = 439,932, making up 0.7% of total cases over the analytic period. During the same period, alcohol or substance-induced disorders totaled N = 459,817, accounting for approximately 2.7% of all substance use disorder treatment cases. The majority (79%) of cases with an alcohol-induced disorder in substance use disorder treatment were identified as reporting alcohol use, with 68% having alcohol listed as their primary substance. Heroin and other opiates and synthetics accounted for the primary substance among 28.8% of cases with a substance-induced disorder in the substance use disorder treatment data. Approximately 1 in 3 cases with an alcohol-induced disorder and 1 in 4 cases with a substance-induced disorder had a depressive disorder diagnosis in mental health treatment. When considering the primary diagnosis, approximately 1 in 4 cases with an alcohol-induced disorder and 15% of cases with a substance-induced disorder had a depressive disorder as the primary diagnosis in mental health treatment. Substance-induced disorders are a significant public health concern, and more research is needed to better understand the clinical needs of this population.
Psychiatric deinstitutionalisation (PDI) has re-emerged as an important concern in global mental health in response to the persistence of long-term institutionalisation and human rights abuses in institutions. However, contemporary responses continue to frame reform largely in managerial and technocratic terms, prioritising service coverage, bed reductions, workforce expansion, and scalability. We argue that this framing narrows the meaning of reform and its capacity to address the institutional, political, and social conditions through which psychiatric care is organised. Drawing on critical perspectives on PDI and experiences from South America, we show how PDI has developed through distinct relationships between institutional transformation, democratisation, social mobilisation, and citizenship. These trajectories illuminate contemporary dilemmas such as transinstitutionalisation, fragmented systems of care, and the persistence of segregationist and custodial logics within community settings. We propose three lenses for re-engaging with PDI as an ongoing political and ethical project: attending to context and history, decentring dominant geographies of reform, and foregrounding lived experience. Together, these lenses shift attention towards the sites where reform is actually produced—across research, policy, training, activism, and governance— and highlight the contribution of South American experiences to ongoing debates on institutional transformation.
The concept of the epistemic stance (i.e., an individual's openness to learning from others) has been increasingly recognized as a key construct associated with mental health. This study validated a six-item short form of the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ-R) in a UK quota-balanced community sample (N = 515). Using stepwise item reduction and confirmatory factor analysis, a three-factor structure with two items per subscale (trust, mistrust, credulity) was identified. The ETMCQ-R-6 showed acceptable fit (scaled χ²(6)=22.13, p = .001; robust CFI = .978; robust TLI = .945; robust RMSEA = .073 [90% CI: .042, .107]; SRMR = .029) and acceptable reliability for the trust (α = .75) and credulity (α = .77) subscales, while the mistrust subscale fell below the conventional threshold (α = ρ = ω = .68). Configural, metric, scalar, and structural invariance across gender and age groups was supported, while strict invariance was not established. Correlations between the long and short form were high (r = 0.83-0.87; φ = 0.95-1.00). Hierarchical regression analyses confirmed significant incremental predictive validity for epistemic mistrust and credulity across psychopathology outcomes, while the trust subscale demonstrated domain-specific incremental validity for attachment avoidance. The ETMCQ-R-6 offers a brief, psychometrically stable assessment of epistemic stance suitable for epidemiological research.
Psychiatrists are trained to evaluate biological, psychological, and social dimensions of illness simultaneously, yet the dominant frameworks governing psychiatric practice remain oriented toward individual symptom management rather than the structural conditions that produce these symptoms. This essay argues that psychiatrists working in global mental health contexts carry an ethical obligation that extends beyond diagnosis and treatment: to practice what Paul Farmer termed pragmatic solidarity, the practice of standing alongside communities to address the upstream drivers of mental distress through structural advocacy, community-led care, and institutional accountability. This essay draws on evidence from three intersecting domains. First, it examines the well-documented global mental health burden, including treatment gaps and the disproportionate impact of conflict, displacement, and structural inequity on psychological wellbeing. Second, it argues that effective global mental health work requires horizontal partnerships, epistemic justice, and the centering of community-defined priorities over externally imposed frameworks. Third, it illustrates what pragmatic solidarity looks like in individual, institutional and policy contexts. Importantly, this essay is a call to action, identifying concrete entry points through which psychiatrists can move from recognition of structural drivers to active participation in dismantling them, including through material redistribution, community partnership, participatory research, and policy engagement. Pragmatic solidarity offers psychiatrists not just a theoretical framework, but a tangible, enactable way of improving global mental health.
Home destruction is a severe traumatic event strongly associated with psychological distress, particularly in conflict settings. Hemodialysis patients face heightened vulnerability due to chronic illness and dependence on continuous medical care. This study examined whether anxiety mediates the relationship between home destruction and post-traumatic stress disorder (PTSD) among hemodialysis patients in Gaza following the military assault on October 7, 2023. A cross-sectional study was conducted across five dialysis centers in Gaza. Anxiety symptoms were measured using the Depression Anxiety Stress Scale (DASS-21), and PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Structural equation modeling with bootstrapped confidence intervals evaluated mediation effects. Among 383 participants, 83.6% reported moderate-to-extreme anxiety, and 58% met the PTSD cutoff. Home destruction was highly prevalent, affecting 66.1%, with 53.5% experiencing total loss of residence. Significant positive correlations were found among home destruction, anxiety, and PTSD. Mediation analysis showed that anxiety fully accounted for the association between home destruction and PTSD (significant indirect effect, non-significant direct effect after adjustment). In adjusted models controlling for gender and current residency, the total effect was no longer significant, consistent with full statistical mediation. The model explained 42% of the variance in PTSD scores, almost entirely through anxiety (R2 = 0.02 for anxiety from home destruction alone). Given the cross-sectional design, this mediation should be interpreted as a statistical association rather than evidence of a causal pathway, and longitudinal studies are needed to confirm temporal relationships. Although causality cannot be determined from this cross-sectional study, the observed indirect association suggests that integrating anxiety-focused mental health support into dialysis services may help reduce PTSD symptoms among conflict-affected hemodialysis patients. Pilot intervention studies are needed to test this hypothesis.
Co-design has become a prominent approach in mental health care innovation, reflecting an increasing recognition of epistemic pluralism as much-needed for participatory change. However, despite its growing adoption, co-design studies frequently offer limited insight into how these exact collaborations influenced the resulting artefacts or change. Drawing on over a decade of co-design practice in mental health care, this essay identifies lessons related to epistemic pluralism, dissensus, serendipity, contextual constraints, participatory approaches, paradigmatic differences, and power relations. We make the argument that these challenges arise from a broader reporting gap: the lack of systematic accounts detailing how various ways of knowing contribute throughout the co-design process. To address this issue, the concept of co-design rationales is introduced, defined as a framework for documenting the development of design decisions through co-learning among stakeholders with experiential, professional, and scientific expertise. Building on established design rationale literature, we develop an architecture that is operationalized through a co-design rationale canvas, enabling the iterative documentation of both the design process and the collaborative production of knowledge. Co-design rationales, as living documents, updated across iterations, discussed with stakeholders, and used to support shared decision-making, clarify who contributed, how decisions were negotiated, which forms of knowledge informed design choices, and how these choices shaped the final artefact or change. Beyond this, we postulate that reciprocity serves as the relational condition, or hallmark, of co-design, enabling epistemic pluralism and collective learning. Without co-design rationales, we may know that stakeholders participated, but not how their ways of knowing shaped the outcome or where reciprocity broke down.
French Guiana is a culturally diverse and socioeconomically heterogeneous territory. We aimed to describe social representations of madness, mental illness, and depression in the general population of the Cayenne area and to explore similarities and differences across sociodemographic subgroups. Cross-sectional data from the 2021 Mental Health in General Population survey were analyzed (N = 881 adults). Open-ended responses to definitions of "mad person," "mentally ill person," and "depressed person" were thematically coded. Perceptions of behaviors, causes, recognition, responsibility, suffering, treatability, and care pathways were assessed. Multivariate generalized estimating equations examined associations with sex, age, education, income, social situation, and country of birth. Representations distinguished depression (linked to sadness, life events, suffering) from madness and mental illness (overlapping, associated with loss of control, danger, brain dysfunction). Violence and delusions were attributed to madness/mental illness; emotional withdrawal to depression. Life events were the leading perceived cause across conditions, with biomedical views for mental illness. Professional help-seeking was widely endorsed, though hospitalization for madness notably. Stigma followed a hierarchy: highest for madness, lowest for depression. Thematic representations were homogeneous across subgroups. Subgroup differences emerged mainly in perceived dangerousness, abnormality, care preferences, and child inclusion, driven by socioeconomic factors (lower education/income associated with higher perceived danger and less formal care endorsement) rather than country of birth. Contrarily to our initial hypothesis that the diverse origins of the population would translate in heterogeneous representations in our sample, shared representations predominated, with socioeconomic inequalities shaping variations in stigma and attitudes more than cultural origins.
Loneliness is common among people diagnosed with a 'personality disorder' and addressing this is a recovery goal. Little qualitative research has explored the experience of loneliness among people with a diagnosis of 'personality disorder'. This study aimed to provide an in-depth understanding of loneliness among people with a 'personality disorder' diagnosis, and approaches used to alleviate it, informing future psychosocial intervention co-production. We conducted semi-structured interviews with 16 people in the United Kingdom from a range of sociodemographic backgrounds via charities and research networks. Data were analysed using reflexive thematic analysis. We identified five overarching themes: 1) the experience of loneliness, 2) the mutually reinforcing relationship between loneliness and mental health difficulties, 3) the perceived origins of loneliness, 4) a unique form of stigma, and 5) recovery rooted in managing to find a sense of belonging. Our findings suggest that loneliness is a painful and enduring experience that participants perceived to originate from invalidating early childhood experiences. These early experiences contributed to ongoing feelings of loneliness, persisting into adulthood. Loneliness was perceived to compound features of 'personality disorder' and vice versa. Experiences of stigma and discrimination related to the diagnosis of 'personality disorder' and any protected characteristics presented another barrier to achieving connections with others, further playing into an apparent mutually reinforcing relationship between loneliness and features of 'personality disorder'. Our findings indicate a clear need to address loneliness in this group. The findings help identify potential targets for psychosocial interventions aimed at reducing loneliness and promoting social connectedness in people with a diagnosis of 'personality disorder'. Psychosocial interventions, combining valued group-based activities and/or safe social relationships alongside developing psychological skills for self-understanding and acceptance, have the potential to reduce feelings of loneliness.
Suicide is a leading cause of preventable death globally with 17 people dying by suicide every day in the United Kingdom (UK). A growing body of research and governmental policies has been devoted to developing and implementing suicide prevention interventions, including training healthcare staff about suicide. However, more research is needed around staff experiences of the training and delivery of these interventions. We aimed to address this gap in the literature in the context of a voluntary 'Suicide Prevention Champion' role trialled in two National Health Service (NHS) Trusts in the UK. The role involves existing inpatient mental healthcare staff receiving specific Applied Suicide Intervention Skills Training and access to a Community of Practice composed of monthly meetings and email support. Semi-structured interviews were conducted with a purposive sample of 10 Champions. Reflexive Thematic Analysis was used to analyse the transcripts of the interviews. We identified seven inductive themes, organised into three deductive domains; 'Driving Factors and Barriers', 'Impacts of Training' and 'Experience of the Role'. The Champions generally spoke highly of the role and training. However, important developments were noted; including a desire for greater clarity around the role and a suggestion that the Champions could inform a more specific NHS training. These findings are hoped to contribute to the ongoing development of the Champion role within the NHS.
Adolescents in American Samoa face a high mental health burden, with many youth experiencing symptoms of depression, anxiety, substance use, and suicidality. Understanding the strategies that adolescents use to cope with stressors can help strengthen existing mental health promotion and psychoeducational resources. We aimed to identify common coping strategies used by adolescents in American Samoa in response to mental distress. Using a two-stage qualitative approach, semi-structured interviews were conducted with a diverse sample of adult community members (N = 28) from American Samoa. Later, five focus groups with adolescent participants (N = 35, aged 13-18 years) were conducted to validate themes identified among adult key informants. Transcripts were coded in duplicate and analyzed using thematic analysis. Coping strategies were characterized as approach or avoidant according to Billings and Moos' (1981) existing framework. Key informants and adolescents identified coping strategies that fell into three major domains: (1) Avoidant coping strategies aimed to divert attention away from the stressor or suppress distress and were sometimes associated with high-risk responses, including self-harm, suicide, and substance use; (2) Approach coping strategies were generally supportive and involved engaging with distress, seeking connection, or expressing emotions, including through social engagement and confiding in peers; and (3) Mixed coping strategies that had characteristics of avoidant and approach depending on the context in which they were used (prayer, social media). Utilizing a collaborative and community-partnered approach, these findings provide a foundation to develop mental health promotion and psychoeducational initiatives to help adolescents better understand their own stress and build healthy coping strategies.
Mental and neurologic disorders are a growing global health concern. Psychotropic medicines are vital for the treatment of these disorders, but issues such as inappropriate prescribing and polypharmacy are prevalent, especially in low- and middle- income countries like Ethiopia. This study assessed psychotropic medicine use patterns in public hospitals of Hadiya zone, Southern Ethiopia. A facility-based cross-sectional study was conducted from June 15 to December 30, 2019, involving the review of 1200 patients medical charts. Data were collected by reviewing the medical charts of patients with mental and neurologic disorders using a data abstraction format. Data were entered and analyzed using SPSS version 26. The results showed that, the most commonly treated mental and neurologic disorders were psychosis (27.50%), followed by schizophrenia (15.67%), epilepsy (13%), and depression (11.92%). Antipsychotics (48.1%) and antidepressants (25.7%) were the most commonly used psychotropic medicines. Chlorpromazine, haloperidol, and thioridazine were the top three most prescribed antipsychotics which constituted 71.34% of antipsychotics use in public hospitals of Hadiya zone. The most commonly prescribed combinations were antipsychotics with antidepressants and antipsychotics with anti-anxiety medicines. Typical antipsychotics were prescribed more often (73.86%) than atypical antipsychotics (26.14%). Among antidepressants, amitriptyline, a tricyclic antidepressant, was most frequently prescribed (74.9%), followed by fluoxetine, selective serotonin reuptake inhibitor (21.5%). Treatment shift was undertaken in 11.5% of patients. The percentage of encounters with two or more psychotropic medicines was 36.1%, which shows a polypharmacy practice. Antipsychotics were the most commonly utilized psychotropic medicines, followed by antidepressants and anticonvulsants. Chlorpromazine, Amitriptyline, and Risperidone showed a higher proportion of utilized medicines. More than one-third of psychiatric patients were prescribed psychotropic polypharmacy. Close to 10% of psychiatric patients had a treatment switch, mostly because of poor improvement, relapse, side effects, and non-adherence. Further prospective continuous studies on both prevalence and use patterns need to be undertaken to get more information.
Cultural competence in working with gender nonconforming clients is a core ethical and professional obligation in counseling, yet predictors of counselors' perceived competence remain insufficiently examined. Guided by the Multicultural and Social Justice Counseling Competencies (MSJCCs), this study examined whether demographic characteristics and prior training experiences predicted self-reported competence in working with gender nonconforming clients. Using a randomized experimental survey design, 83 student and professional counselors were assigned to view images of cisgender men with or without makeup, then completed an adapted 12-item Sexual Intervention Self-Efficacy Scale (SISES). Results indicated no significant difference in perceived competence between groups, suggesting that brief situational exposure to gender nonconforming presentation did not affect self-reported competence. Across the full sample, more hours of diversity training, LGBTQIA + /gender-specific training, identifying as a sexual or gender minority, and holding a master's degree significantly predicted higher self-reported competence. These findings indicate that sustained, targeted professional development contributes to counselor preparedness for gender-affirming practice more than single-exposure interventions.
Despite advances in acknowledging the importance of community, relational and family systems, and social adversities for mental health, responses in research and policy are limited. This calls us to explore methods to reconceptualize social dynamics as they relate to mental health outcomes. In this paper, we map out the potential of one framework, which directs attention to the domains associated with the social determination of poor mental health, the socio-political economy of global mental health. In this essay, we outline the need for such a framework, the theoretical underpinnings that inform it, as well as the potential social domains for inclusion. We conclude by outlining the potential implications of such a framework in shaping new practice in global mental health that is oriented towards a broader social justice lens - beyond emphasis on redistributive approaches, and towards collective and collaborative action to change the conditions that make poor mental health a reality for many - as part and parcel of our care systems.
Caregiving is a common responsibility in the United States, and about 1 in 5 Americans provide unpaid care for older adults or family members with disabilities. Many adults also provide care for their children. Despite substantial evidence about the potential impact of caregiving on caregivers' mental health, most studies focus on middle-aged adults. Less is known about how caregiving affects the psychological well‑being of young adults, particularly college students. This study examined whether spending substantial time on unpaid caregiving (11 or more hours per week) is associated with greater psychological well‑being among students. The study participants were selected using a probability sample and included students aged 18-30 years who were enrolled at a large public university in Florida. A total of 692 participants completed the 2025 Spring American College Health Association-National College Health Assessment. Overall psychological well‑being was assessed using Diener's Flourishing Scale. Statistical methods included Kruskal-Wallis tests and a generalized linear model with a Gamma distribution, controlling for demographic and academic characteristics. Overall, 3.61% of students reported spending substantial time on caregiving. The overall psychological well-being score (mean and median) was significantly higher among students who spent substantial time on caregiving compared to those who did not (p = 0.0177). The model yielded a similar conclusion (mean difference = 3.82, 95%CI = 1.15:6.49, p = 0.0135) and resulted in additional significant differences in mean scores across several characteristics, including sexual minority status (p < 0.0001) and race/ethnicity (p = 0.0020). Findings suggest that spending substantial time on caregiving is associated with greater psychological well-being among college students. Further research is needed to identify the mechanisms underlying this association and to examine whether these findings generalize to other populations.
Early onset substance use and social anxiety are associated with adverse psychosocial outcomes, including impaired academic performance. This study aimed to investigate if problematic substance use is associated with poorer school functioning and if social anxiety is associated with this relationship. Participants (n = 711), aged 8-20, were enrolled in the Texas Youth Depression and Suicide Research Network registry study aiming to characterize youth with depression and/or suicidality. Baseline data from CRAFFT 2.1 + N, MINI-KID, SAS-SR, and PHQ-A were used for multivariate analyses using linear regression to examine the relationship between problematic substance use and school functioning, as well as the interaction between problematic substance use and social anxiety and their association with school functioning. Over 20% of participants met criteria for problematic substance use, with alcohol and marijuana being the two most common reported substances used. Youth with problematic substance use were on average two years older and had significantly greater impairment in school functioning compared to youth without problematic substance use. However, youth with problematic substance use and social anxiety had comparable impairments in school functioning compared to those with problematic substance use that did not have social anxiety. In youth without problematic substance use, having social anxiety was associated with similar levels of impairment in school functioning compared to youth with problematic substance use alone. The significant co-occurrence of problematic substance use, social anxiety, and depression suggests the need for early identification and intervention to prevent and/or mitigate impairment in school functioning. Significant levels of comorbid depression and/or suicidality experienced by our participants may have impacted our findings. Future research comparing youth with and without depression will help elucidate this.
Military-connected children and young people face unique stressors, such as relocations, educational disruptions, loss of friendships and parental deployments, which can contribute to Adverse Childhood Experiences (ACEs). However, Benevolent Childhood Experiences (BCEs) and Positive Childhood Experiences (PCEs) can act as protective factors. The military community offers stability, support, and strength, which may help buffer the effects of ACEs. Research into BCEs and PCEs for military-connected children is crucial to promoting positive outcomes and mitigating negative impacts over time. A scoping review was conducted to map literature regarding ACEs, BCEs and PCEs of Military Connected Children and Young People (MCCYP). Seven databases were searched (ASSIA, PsychARTICLES, PubMed, SAGE, Science Direct, Scopus and Web of Science), using key words and strategic search criteria. The Critical Skills Appraisal Program (CASP) tool was used for quality appraisal of the articles. Six papers met the inclusion criteria, of which five were USA based and one from the UK. All included articles focused on ACES, with one paper reporting PCEs in conjunction with ACEs. None were found regarding BCEs. Included articles contained research pertaining to current military connected children and the impact of ACEs on their current or future wellbeing. By undertaking the first scoping review explicitly examining ACEs, BCEs and PCEs among MCCYP, a significant gap in the evidence base was found.
