Medication non-adherence affects nearly half of patients with schizophrenia spectrum disorder and is associated with relapse and hospitalization. Long-acting injectable (LAI) antipsychotics may improve adherence, but their effectiveness likely depends on interactions between specific psychiatric symptom patterns and medication attitudes. This study, a secondary analysis of published data from the Dryad repository, examined how configurations of psychiatric symptoms factors influence adherence via medication attitude among patients receiving LAI. This secondary analysis included 304 patients with schizophrenia spectrum disorder (mean age 45.64 years; 63.16

Shared decision-making (SDM) is recommended for preference-sensitive treatment decisions in severe mental illness, but its routine use in psychiatric services remains inconsistent. This systematic review synthesized evidence published between 2014 and 2024 and examined clinical, cultural, and organizational factors associated with SDM implementation. We searched PubMed, Embase, CINAHL, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP for studies published from January 2014 to November 2024. Forty-two studies involving 8798 participants were included. Reporting followed PRISMA 2020 and SWiM guidance. Study quality was assessed with design-specific Joanna Briggs Institute tools, and certainty of key findings was appraised using a combined GRADE-CERQual approach. Because of heterogeneity in study design, interventions, outcomes, and settings, findings were synthesized narratively using Popay et al's framework. Patient decision aids were generally associated with lower decisional conflict, greater readiness, satisfaction, involvement, or autonomy, with little evidence of meaningful consultation-time extension. Clinician training and SDM interventions improved short-term engagement and information sharing, but evidence for sustained improvements in adherence, decisional conflict, and clinician behavior was mixed or low certainty. Family-mediated or triadic decision-making was prominent in East and Southeast Asian studies and may support adherence and participation, although it can also create tension between patient autonomy and family preferences. Across studies, clinicians and patients often emphasized different treatment priorities, particularly symptom control versus side-effect tolerability. Evidence was concentrated in Europe and East Asia, with limited data from low-resource regions. SDM in psychiatric care appears most reliable for improving immediate decision processes rather than long-term outcomes. Future implementation should test culturally adapted triadic decision aids, workflow-integrated prompts, and interprofessional decision coaching while using cautious, context-sensitive outcome evaluation.

Schizophrenia (SCZ) is associated with a high relapse rate, but objective electrophysiological correlates of relapse-related clinical vulnerability remain insufficiently understood. Event-related potential (ERP) components, such as P3 and N2, have been widely investigated as markers of cognitive dysfunction in SCZ. However, relatively few studies have examined ERP characteristics in clinically stable patients stratified according to early warning signs of relapse. The present study investigated ERP characteristics in clinically stable patients with SCZ classified according to the Early Signs Scale-Chinese version (ESS-C), aiming to explore whether ERP components are associated with ESS-C-defined relapse-risk status. A cross-sectional study design was adopted. A total of 70 patients with SCZ and 35 healthy controls (HCs) were initially recruited. After electroencephalography (EEG) preprocessing, 90 participants were included in the final analysis, comprising 30 HCs, 30 patients in the non-relapse-risk group (NR), and 30 patients in the relapse-risk group (RR). Patients with SCZ were classified into the NR and RR groups according to the ESS-C cutoff. ERP data were recorded using a three-stimulus visual oddball paradigm. The amplitudes and latencies of N2 at Cz and P3 at CPz were extracted, and their associations with negative symptoms were analyzed. A significant overall group effect was observed for P3 amplitude (F = 9.914, P < 0.001), with Bonferroni-corrected post hoc comparisons showing significantly higher P3 amplitude in the RR group than in the HC group (P < 0.001), while the NR group showed intermediate values. Sensitivity analysis restricted to patients with SCZ showed that ESS-C-defined relapse-risk status was significantly associated with P3 amplitude after adjustment for available clinical variables. N2 amplitude was positively correlated with negative symptom severity (r = 0.278, P < 0.05). Clinically stable patients with SCZ still exhibit abnormal neural information processing. P3 amplitude may be associated with ESS-C-defined relapse-risk status in clinically stable SCZ, whereas N2 may be related to negative symptom severity. These findings provide preliminary evidence that ERP components may be associated with relapse-risk status in clinically stable SCZ. NA.

BACKGROUND:Time poverty refers to the condition where individuals struggle to secure sufficient free time due to overwhelming responsibilities. This phenomenon has significant physical and mental health implications. Clinical nursing interns are particularly susceptible to time poverty due to demanding schedules, long shifts, and irregular hours during clinical placements. Despite its relevance, limited research explores the subjective experiences of clinical nursing interns regarding time poverty and its implications for their professional development and well-being. AIMS:This study aimed to understand the experiences and coping strategies of clinical nursing interns facing time poverty, identify factors that exacerbate time poverty, and provide suggestions to mitigate its negative impact on these interns. METHODS:Interpretive phenomenological analysis (IPA) was used to capture the lived experiences of 12 clinical nursing interns. Participants were selected through purposive and snowball sampling, ensuring diverse experiences from different clinical environments. Semi-structured, in-depth interviews were conducted, focused on: perceptions and experiences of time poverty, emotional and career impacts of insufficient free time, and coping strategies among interns. All interviews were audio-recorded, transcribed verbatim, and subjected to a thematic analysis to identify recurring patterns and themes. RESULTS:Four primary themes emerged from the data analysis: "Life on the Treadmill"; "The Emotion of Being Chased"; "Professional Shake"; and "Adaptation and Coping Strategies". CONCLUSION:The findings highlight that time poverty significantly affects clinical nursing interns' emotional well-being, professional growth, and motivation. Addressing this issue requires institutional reforms and supportive measures, including: formal training in effective time management; structured mentorship programs to guide interns through challenging schedules; enhanced emotional support systems to foster resilience. Such interventions are critical to promoting the health, academic success, and professional identity of clinical nursing interns, ultimately strengthening the future nursing workforce and overall healthcare delivery.

Background Mild cognitive impairment (MCI) is a transitional state between normal cognitive aging and dementia, representing a critical window for intervention. However, older adults with MCI often lack accurate illness perceptions, which may impede early intervention and self-management behaviors. Understanding how older adults perceive their condition is essential for developing patient-centered care strategies. The objectives of this review were (1) to systematically synthesize qualitative evidence on illness perceptions in older adults with MCI using the Common-Sense Model (CSM) as a theoretical framework, and (2) to identify key dimensions of illness representations that influence older adults' coping and management strategies. Methods Eleven databases (i.e., PubMed, Medline, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, CNKI, VIP, Sinomed, and Wanfang) and Google Scholar were used to conduct the searches. We included qualitative studies examining illness perceptions in older adults aged 60 and above with MCI diagnoses. The quality of literature was assessed using the Critical Appraisal Skills Programme (CASP). Results Twenty-three studies were included. older adults experience varied symptoms, attribute conditions to different causes, and have diverse beliefs about the illness's timeline and consequences. The effects extend beyond cognitive changes to personal identity, social interactions, daily life, physical health, and family dynamics. older adults employ various control and management strategies, with attitudes toward recovery ranging from active control to passive acceptance. older adults predominantly exhibit negative emotional responses to potential outcomes. Conclusion This qualitative synthesis shows heterogeneity in illness perceptions. These findings should inform healthcare providers in developing more targeted and efficient individualized education and self-management interventions to correct misconceptions about MCI, enhance self-management capabilities, and improve intervention adherence in older adults with MCI.

BACKGROUND:Socio-economic changes and evolving family structures have created unique caregiving challenges in China, highlighting the need for tools to systematically measure child care deficits. This study aims to develop and preliminarily validate the Inadequate Child Care Scale (ICCS), a culturally relevant instrument designed to measure deficits in child care specific to the Chinese context. METHODS:The development and validation of the Inadequate Child Care Scale (ICCS) were conducted through a three-phase process. Phase One involved the generation of an initial item pool informed by a prior grounded theory study. Phase Two included nationwide data collection via a structured survey administered to participants across diverse regions in China. Phase Three focused on evaluating the psychometric properties of the ICCS using Exploratory Factor Analysis (EFA; n = 468) and Confirmatory Factor Analysis (CFA; n = 702), with an emphasis on assessing convergent validity, discriminant validity, and composite reliability. RESULTS:The initial item pool comprised 32 items, 30 of which were retained following expert evaluation for content validity. EFA revealed a four-factor structure underlying the scale: Inadequate Daily Life Care, Inadequate Psychological and Emotional Care, Inadequate Safety Care, and Inadequate Educational Care, encompassing 30 items in total. CFA supported the factorial validity of the ICCS, yielding favorable model fit indices (GFI = 0.929, CFI = 0.977, TLI = 0.975, RMSEA = 0.038, χ²/df = 2.025). The scale demonstrated strong internal consistency (Cronbach's alpha > 0.80) and acceptable test-retest reliability. CONCLUSION:The ICCS is a psychometrically sound tool for assessing child care deficits in China. Its development fills a critical gap in child care research and provides a foundation for targeted interventions and policy reforms. Future studies should refine the scale further and explore its applications in broader caregiving contexts.

Psychiatric disability in schizophrenia may reflect the combined effects of clinical symptoms, cognitive impairment, individual resources, and environmental support rather than the influence of a single risk factor. This study used fuzzy-set qualitative comparative analysis to identify configurations associated with higher and lower psychiatric disability states among patients with stable-phase schizophrenia. A cross-sectional study was conducted among 482 patients with stable-phase schizophrenia. Psychiatric disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Seven conditions were examined: negative symptoms, depressive symptoms, neurocognition, social cognition, psychological resilience, family functioning, and social support. Necessary condition analysis showed that no single condition reached the necessity consistency threshold. Sufficiency analysis identified five configurations associated with higher psychiatric disability and five configurations associated with lower psychiatric disability. For higher psychiatric disability, the overall solution consistency was 0.935 and coverage was 0.724; for lower psychiatric disability, the overall solution consistency was 0.932 and coverage was 0.695. Low social cognitive functioning appeared in all higher-disability configurations, whereas the absence of negative symptoms and the presence of social cognitive ability appeared in all lower-disability configurations. These findings indicate equifinality and configurational asymmetry, suggesting that psychiatric disability in schizophrenia should be assessed and addressed through combined consideration of symptoms, cognition, especially social cognition, and resource conditions.

Background Intrinsic capacity decline (the age-related reduction in the composite of physical and mental capacities) is prevalent among Chinese rural older adults.This study aimed to describe the perceptions of intrinsic capacity decline and the corresponding intervention needs among older adults residing in a rural village in northern China. Methods A descriptive qualitative study was conducted. Semi-structured interviews were used to collect detailed accounts of the lived experiences of intrinsic capacity decline among 14 older adults in a rural Chinese village. Data were collected from September to December 2023 and were analyzed using NVivo 12 software. Inductive analysis was used to identify key themes. Results Three main themes were identified: (1) Normalizing decline, which reflected participants' acceptance of capacity loss as an inevitable part of aging, coupled with low awareness and perceived need for intervention; (2) The social embeddedness of health behaviors, highlighting how engagement in health practices was profoundly facilitated or hindered by family dynamics and peer networks; and (3) Navigating a support vacuum, underscoring the expressed need for accessible, credible information and professional guidance in the absence of systemic support. Conclusion This study provides a detailed description of the multifaceted challenges faced by older adults in this specific rural northern Chinese setting. Participants described a process of intrinsic capacity decline that was often normalized due to a lack of knowledge, deeply influenced by social relationships, and occurred within a context of scarce systemic support. The findings underscore the necessity for interventions that are responsive to the described personal, social, and systemic contexts.

BackgroundThe participation rate of prenatal healthcare in China has increased slowly, and the imbalances and inadequacies in the development of maternal and child health between urban and rural areas are particularly prominent. A key reason for this is that a comprehensive understanding of rural women’s utilization of prenatal healthcare services and their needs has not been fully established, thus failing to fully leverage pregnant women’s agency in prenatal healthcare. The study aimed to identify the multi-dimensional needs of rural women in the process of utilizing prenatal healthcare services through constructing a journey map, so as to optimize the full pregnancy cycle management of this group.MethodsThe study population consists of rural pregnant women who attended obstetric clinics at healthcare institutions in Northeast China from January to May 2024. A qualitative multi-method design was adopted, integrating non-structured field observation and descriptive phenomenological qualitative interviews to comprehensively gather rural women’s emotions, perceptions, experiences, and needs regarding prenatal care services. Field observation provided contextual, behavioral, and environmental insights into service delivery processes and stakeholder interactions, while qualitative interviews delved deeply into the subjective lived experiences, emotional responses, and contextual factors shaping care utilization. The collected data were systematically analyzed and synthesized to construct a detailed journey map that delineates the sequential stages of prenatal care, key touchpoints, behavioral patterns, needs, pain points, and opportunities for improvement. Ethical approval was obtained from the Ethics Committee of Harbin Medical University, Daqing, No. HMUDQ20230330001.ResultsThe journey comprises five phases. The first stage marks the initiation of prenatal care services. Pregnant women are often unfamiliar with the procedures and have various concerns and anxieties about their upcoming pregnancy journey. In the second stage, pregnant women begin participating in non-invasive prenatal screening and start focusing on long-term nutrition and gestational weight management. In the third stage, maternal-fetal interaction increases, and ultrasound screenings for congenital anomalies become a critical task. Lifestyle changes and management pose significant challenges during this period. The fourth stage emphasizes proactive prevention and screening for pregnancy-related complications. Guiding pregnant women in self-monitoring is essential, and their needs for postpartum care for both mother and baby gradually increases. In the fifth stage, pregnant women frequently engage with prenatal care services, experiencing both anticipation and anxiety as they prepare for delivery.ConclusionThis exploratory qualitative multi-method study conducted in rural Northeast China developed a five-stage journey map of prenatal healthcare service utilization. The findings are context-specific to rural Northeast China and do not imply broad generalizability; they highlight key optimization points for prenatal care management for rural pregnant women in similar regional settings.

Background:Family dysfunction and insecure attachment are established risk factors for adolescent depressive symptoms, yet individual differences in sensory processing may influence vulnerability to these environmental stressors. Objective:To explore the mediating role of insecure attachment and the moderating effect of sensory processing sensitivity (SPS) in the relationship between family functioning and adolescent depressive symptoms. Methods:This study employed a cross-sectional design, with 503 adolescents recruited via convenience sampling in October 2023. Participants completed self-report questionnaires assessing family functioning, insecure attachment, SPS, and depressive symptoms. SPSS 26.0 was used to conduct moderated mediation analyses to examine the complex interactions among these variables. Results:The results showed that family functioning was directly associated with adolescent depressive symptoms and also was indirectly associated with depressive symptoms through insecure attachment. Additionally, SPS was found to statistically moderate both the direct and indirect pathways. Specifically, the negative association between poor family functioning and depressive symptoms and the statistical mediating pathway through insecure attachment were more pronounced in adolescents with higher SPS. Conclusion:Impaired family functioning and insecure attachment were associated with higher levels of depressive symptoms in adolescents. SPS appeared to strengthen these associations, highlighting the importance of considering individual differences in sensory sensitivity when addressing adolescent mental health. Tailoring interventions to strengthen family support and attachment security, especially for adolescents with heightened SPS, may help mitigate the risk of depressive symptoms. This study emphasizes the need for family-centered interventions to foster resilience against adolescent depressive symptoms.

BACKGROUND:Currently, studies on the lifetime prevalence of schizophrenia in the general population have not been updated or limited to a single country or region. The lifetime prevalence of schizophrenia may differ in other populations with certain relevant influencing factors or conditions. Globally, there is a lack of meta-analyses focusing on the lifetime prevalence of schizophrenia in specific populations. This study aims to determine the lifetime prevalence of schizophrenia in the general population, homeless populations, offenders, populations with comorbid mental disorders, populations with comorbid physical illnesses, populations at high genetic risk, populations exposed to stress, low-income populations, and indigenous populations, and to identify relevant factors. METHODS:Meta-analysis was used to estimate the combined lifetime prevalence of schizophrenia in the general population and eight other groups. To explore the sources of heterogeneity and identify factors associated with changes in prevalence, we conducted subgroup analyses of the general population, the homeless population, and the criminal population, examining geographic regions, sociodemographic factors, and methodological characteristics. Meta-regression in the general population examined the relationship between schizophrenia and mean age, publication year, and bias risk. RESULTS:109 articles were included. Among them, 60 reported results from a sample of 20,910,871 individuals from the general population across 24 countries, 21 involved 6,605 individuals from the homeless population in 11 countries, there were 36 studies involving seven different population groups. The lifetime prevalence of schizophrenia is 0.62% (95% CI [0.51%-0.76%]) in the general population and 10.02% (95% CI [7.38%-13.47%]) in the homeless populations. Asia has the lowest lifetime prevalence of schizophrenia in both the general population and the homeless population, at 0.47% (95% CI [0.35%-0.64%]) and 4.68% (95% CI [2.11%-10.07%]). CONCLUSIONS:Findings indicate that schizophrenia is more prevalent in special populations than in the general population. Understanding and addressing the risk factors contributing to elevated prevalence in vulnerable populations is essential for developing targeted prevention strategies and improving early intervention efforts.

Enhancing and maintaining the intrinsic capacity of the elderly is crucial for preventing and mitigating disability and promoting healthy aging. This study explore the current status of intrinsic capacity among elderly individuals in rural areas and analyze the influencing factors. This study included 592 participants who were ≥60 years in rural areas of China. Investigations were conducted using a general information questionnaire, the UCLA Loneliness Scale, the Perceived Stress Scale, the abbreviated version of the Lubben Social Network Scale, the Family Caregiving Index Scale, the Health-Promoting Lifestyle Scale, the ICOPE intrinsic capacity screening tool, and a grip strength dynamometer. We used correlations, regressions, and random forest model for the analyses. The random forest algorithm results indicate that the minimum error occurred when the lambda (λ) value was set at 0.8978, corresponding to nine influencing factors. The results of multiple stepwise regression analysis indicate that health-promoting lifestyle, family functioning, sense of loneliness, perceived stress, grip strength, social network, number of chronic diseases, educational level, and economic income are the main factors affecting intrinsic capacity (p < 0.05) among rural elderly individuals. Health service personnel can identify high-risk groups early and implement effective interventions based on the factors influencing the intrinsic capacity of rural elderly individuals.

BACKGROUND:Virtual reality (VR) has been increasingly applied in psychiatric rehabilitation and shows promise for improving outcomes in schizophrenia. However, the evidence base remains fragmented, leading to uncertainty regarding its overall efficacy across symptom and functional domains. OBJECTIVE:To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating VR interventions for the treatment of schizophrenia. METHODS:Five databases (PsycINFO, Pubmed, EMBASE, Cochrane Library, and Web of Science) were searched in December 2024. Eligible studies included RCTs of VR interventions in individuals with schizophrenia. Risk of bias was assessed using the Cochrane tool. Random-effects meta-analysis was conducted to synthesize effect sizes given study heterogeneity. RESULTS:Fourteen studies (n = 678) were included, covering five VR approaches: Virtual Reality Social Skills and Vocational Rehabilitation Training, Virtual Reality Cognitive Rehabilitation Training, Virtual Reality Theory of Mind Intervention, Virtual Reality-Assisted Mindfulness Intervention, and Avatar Virtual Therapy. VR significantly improved overall psychiatric symptoms, positive symptoms, negative symptoms, and cognitive function. The effect on negative symptoms was moderate (SMD = -0.52, p < 0.05). Subgroup analysis further indicated that virtual cognitive interventions were particularly effective in improving negative symptoms. No significant improvement was observed in social functioning. CONCLUSIONS:VR interventions effectively reduce core symptoms, VR-based cognitive interventions may confer greater benefits for negative symptoms, while evidence for social functioning remains inconclusive. Given methodological heterogeneity, small sample sizes, and short follow-up durations, further large-scale, multicenter randomized controlled trials with standardized protocols of VR and extended follow-up are warranted to confirm these findings and facilitate clinical translation.

Background Treatment adherence is crucial in managing schizophrenia, as nonadherence leads to relapse and increased societal burden. However, validated tools for assessing treatment adherence in Chinese patients with schizophrenia are lacking. Objective This study aimed to adapt the Treatment Adherence Questionnaire (TAQ) for the Chinese population and evaluate its psychometric properties. Methods A cross-sectional study was conducted with 252 Chinese patients diagnosed with schizophrenia. The TAQ was culturally adapted, and its structural validity was assessed through item analysis, structural equation modeling, and multigroup confirmatory factor analysis. Reliability, convergent validity, and content validity were also examined. Results We enrolled 252 patients (mean age 46.69 years; 46.8 % female; 19.8 % married). The Treatment Adherence Questionnaire demonstrated a three-factor structure. Content validity was excellent (0.960), and scale scores were positively correlated with the Medication Adherence Rating Scale, supporting construct validity. The questionnaire demonstrated high internal consistency, with Cronbach’s alpha of 0.931 and split-half reliability of 0.842. Group confirmatory factor analysis confirmed measurement invariance across gender, age, and disease course at the scalar level. Conclusion The Chinese version of the TAQ is a reliable and valid tool for assessing treatment adherence in Chinese patients with schizophrenia. Its use could improve clinical assessment and support better management outcomes for this population.

Adolescence is a critical developmental period during which parental involvement, parent-child relationships, emotional and behavioral problems, and social media addiction may interact in complex ways. This study aims to explore the network structure of these factors to identify key domains and their interconnections. A total of 668 adolescents participated in this study, with data collected in October 2024 through surveys. The Parental Involvement Scale, Strengths and Difficulties Questionnaire (SDQ), Parent-Child Closeness Scale, and Bergen Social Media Addiction Scale (BSMAS) were used to assess parental involvement, emotional and behavioral problems, parent-child relationships, and social media addiction, respectively. Two network analysis approaches were applied: Regularized Partial Correlation Network (RPCN) and Directed Acyclic Graph (DAG). In the RPCN, 'emotional and leisure' emerged as the central domain, playing a crucial role in the network structure. Additionally, 'Social media addiction' is the strongest bridging symptom, followed by 'Parental-child relationship'. The DAG analysis revealed that 'emotional and leisure' acted as the activation domain, with high probabilities of influencing conduct problems (0.92) and social media addiction (0.85), highlighting its key role. Conduct problems and social media addiction were identified as more dependent on other symptoms in the network. The findings highlight the key domains influencing adolescent emotional and behavioral issues and social media addiction. Understanding these network structures provides valuable insights for developing targeted interventions to promote adolescent well-being and healthy parent-child interactions.

Background: Schizophrenia exhibits the most prolonged diagnostic delay among mental disorders. Deficits or misalignment in help-seeking motivation contributes to delayed help-seeking behaviors and missed critical intervention windows. Nevertheless, research gaps persist regarding the systematic investigation of diagnostic delay, and the mechanistic role of help-seeking motivation within the diagnostic process. Study design: This study adopted a convergent mixed study design. During the quantitative phase, 520 clinically stable individuals with schizophrenia were consecutively recruited from outpatient and inpatient psychiatric settings across three specialized psychiatric hospitals in China. Standardized instruments assessed help-seeking motivation, perceived social support, stigma, diagnostic delay. Data analysis utilized SPSS26.0 and Mplus8.0 for measurement modeling and path validation. Concurrently, in-depth interviews explored help-seeking experiences during diagnostic processes with 12 patients and 11 caregivers. Final integration applied methodological triangulation to converge findings. Study results: Quantitative and qualitative analyses identified distinct correlates of diagnostic delay, with quantitative findings revealing mode of initial onset (OR = 0.311, P < 0.001), perceived social support (OR = 0.979, P < 0.001), stigma (OR = 1.054, P < 0.001), and help-seeking motivation (OR = 0.945, P < 0.001) as core predictors of diagnostic delay, while qualitative thematic analysis identified three barriers in the process of seeking diagnosis: deficient illness insight, inadequate medical information, and inaccessible psychiatric services. Path modeling confirmed that perceived social support could negatively affect diagnostic delay through stigma and help-seeking motivation, accounting for 15.71% and 45.98% of the total effect. Perceived social support could also affect diagnostic delay through the chain-mediated effect of stigma and help-seeking motivation, accounting for 9.96%. Qualitative evidence synergistically showed that multifaceted collaboration (family emotional support and community informational support) jointly elevated perceived support levels while concurrently diminishing stigma and fortifying help-seeking motivation, thereby mitigating diagnostic delay. Integration revealed that multifaceted barriers compromise patients' help-seeking motivation, and the relationship between help-seeking motivation and diagnostic delay is not a singular linear, but follows a core pathway: perceived social support→ stigma→ help-seeking motivation→ diagnostic delay. These factors require multifaceted collaboration to primarily reduce diagnostic delay. Conclusion: Diminishing stigma and fortifying help-seeking motivation are essential for enhancing perceived social support and reducing diagnostic delay in schizophrenia. Moreover, this study highlights the critical need to focusing on providing patients with schizophrenia with family emotional support and community informational support, thereby increasing their help-seeking motivation to effectively address delay in diagnosis.

Introduction: The extended duration of untreated psychosis (DUP) in individuals with schizophrenia represents a significant challenge in mental healthcare delivery, potentially compromising treatment outcomes and recovery trajectories. Understanding the critical incidents that influence help-seeking behaviours remains crucial yet understudied from patients' perspectives. Aim: To identify and analyse the critical incidents that influence help-seeking behaviours and duration of untreated psychosis in individuals with schizophrenia, and to examine the factors associated with these turning points. Method: In a qualitative study, 21 individuals in remission from schizophrenia participated in semi-structured interviews based on the critical incident technique. The COREQ guidelines were followed for reporting qualitative research. Interviews were analysed using reflexive thematic analysis to identify key themes and patterns. Results: Analysis revealed two primary domains: internal turning points (self-recognition of symptoms, personal coping strategies) and external catalysts (family intervention, crisis events). Family members emerged as crucial facilitators in the help-seeking process, with their involvement significantly reducing DUP. Educational background, cultural beliefs, and previous mental health awareness were identified as key factors influencing the timing of help-seeking behaviours. Discussion: These findings illuminate the complex interplay between personal, familial and social factors in determining when and how individuals with schizophrenia seek professional help. The results emphasise the critical role of family support systems in facilitating earlier intervention. Implications: Mental health professionals can utilise these insights to develop targeted early intervention strategies and family education programs, potentially reducing DUP and improving treatment outcomes for individuals experiencing first-episode psychosis.

This review aims to systematically examine the survival dilemmas faced by older adults with severe mental illness (SMI) in rural areas and to provide a theoretical foundation and practical guidance for improving their health and well-being. Adopting the scoping review framework proposed by Arksey and O'Malley, the study systematically searched CINAHL, Embase, PubMed, Web of Science and Cochrane databases and screened literature according to predefined inclusion criteria. Key information-including research questions, study design, sample characteristics and main findings-was extracted and synthesised through thematic analysis. A total of 30 eligible studies were included. The results revealed that older adults with SMI in rural areas experience multiple, interrelated challenges, including a marked decline in quality of life, limited access to healthcare services, significant economic burden, insufficient social support, increased caregiving pressure on families and cultural as well as cognitive barriers related to mental illness. These multidimensional dilemmas are mutually reinforcing and collectively pose a substantial threat to older adults' survival and overall well-being. Addressing these issues requires the establishment of a multi-level, systematic intervention framework, including strengthened policy support, optimised healthcare delivery models, improved accessibility and appropriateness of services, targeted health education, enhanced community support networks and the promotion of interdisciplinary collaboration. Future research should focus on the specific needs of this population and conduct high-quality empirical studies to provide robust, evidence-based recommendations for improving their quality of life and promoting social inclusion.

BACKGROUND: Schizophrenia is a chronic mental illness that often necessitates lifelong treatment. the long-term follow-up process can impose negative impacts on these caregivers that are challenging to evaluate. This study investigates the experience of time-related toxicity among primary caregivers in China during long-term follow-up visits. METHODS: This study was conducted in a tertiary hospital in China from January to April 2025. Through purposive sampling, 15 primary caregivers of patients with schizophrenia were recruited for face-to-face semi-structured interviews. The collected data were analyzed using Colaizzi’s method. RESULTS: Three main themes were extracted: (1) The Impact of Time Toxicity on Caregivers’ Lives; (2) Multiple Factors Exacerbating Time Toxicity; (3) Adaptive Outcomes of Time Toxicity. CONCLUSION: This study clarifies the time-toxicity experiences of primary caregivers of schizophrenia, aiming to provide insights for healthcare workers and policymakers who aim to improve the overall mental health and quality of life of affected families.