Participation in online communities centered around self-harming and suicidal behavior is a complex phenomenon characterized by potentially harmful social dynamics, though it may also involve support. While previous studies have explored peer support within these communities, less is known about how engagement may influence personal recovery and the functions these communities serve. Therefore, this study explored experiences of personal recovery in the context of participating in unmoderated online communities centered around self-harming and suicidal behavior. This qualitative deductive–inductive secondary analysis re-examined interview data originally collected to explore peer support exchanges within online communities centered around self-harm and suicidal behavior, using reflexive thematic analysis informed by the CHIME-D (Connectedness, Hope, Identity, Meaning, Empowerment, and Difficulties) framework to examine personal recovery in this context. The dataset consisted of semi-structured interviews with twelve women and one non-binary participant (aged 21–49 years) from all five Danish regions, all with lived experience of psychiatric disorders and previous psychiatric admissions. Participants described how engagement supported personal recovery through mutual recognition, reciprocity, and shared experience. They also described tensions between their own experiences of these communities as meaningful recovery spaces and professionals’ predominantly risk-oriented interpretations, contributing to stigma and concealment. Recovery was experienced as complex and ambivalent, involving not only support but also ongoing attachment, emotional burden, and difficulty disengaging. Participants also described challenges related to moral responsibility towards others, exposure to distressing content, and balancing recovery with ongoing participation. Examining recovery in digital self-harm networks highlights important nuances in understanding the roles and functions these networks may serve. Applying the CHIME-D framework provided a nuanced understanding of how online communities centered around self-harming and suicidal behavior may contribute to personal recovery, advancing our understanding of the functions they serve and what motivates participation. The findings highlight recovery as a non-linear process shaped by both supportive and challenging dimensions of online engagement and underscore the importance of recognizing these communities as meaningful, though double-edged, contexts for recovery.

INTRODUCTION:Severe mental illness affects bodily experiences, often leading to detachment and dysregulation. While exercise is recognized as a resource in personal recovery, excisting research has mainly focused on psychological and social dimensions, with limited attention to embodied experiences. This study explores the role of the body in personal recovery as it unfolds within community-based exercise for young adults with severe mental illness. METHODS:This qualitative interview study was embedded within a multicenter pragmatic randomized controlled trial. Sixteen participants aged 25-35 were purposively sampled based on study site, attendance, and personal recovery scores. Semi-structured interviews explored participants' bodily experiences of exercise in relation to personal recovery. Data were analyzed using Reflexive Thematic Analysis. RESULTS:The analysis generated the overarching theme Embodied Recovery and three interrelated themes: Bodily Identity, Bodily Regulation, and Bodily Sociality. Exercise supported bodily ownership, regulation, and social connection, while also involving challegens related to bodily unpredictability and social comparison. CONCLUSION:The findings highlight the body as an active agent in personal recovery among young adults with severe mental illness engaging in community-based exercise. Conceptualizing personal recovery as embodied emphasizes the importance of embedding strctured exercise and movement-based pratices as integral components of recovery-oriented mental health services.

Objectives Inflammatory arthritis (IA) profoundly affects not only people diagnosed but also their partners. Gaining a deeper understanding of partners’ experiences is essential for developing strategies that support their well-being. This study explored how partners experience the impact of IA on their daily lives and how they manage their role within the relationship. Methods An exploratory qualitative study was designed together with five couples serving as research partners. Data were collected through 1 focus group and 8 semistructured interviews with a total of 11 partners of people living with rheumatoid arthritis, spondyloarthritis, or psoriatic arthritis. Participants were recruited through three rheumatology departments in Denmark, The Danish Rheumatism Associations, and online groups on Facebook. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Results Four themes were developed: Living with arthritis as a choice- partners described deciding whether to continue the relationship; The emotional distress and helplessness of watching a loved one’s suffering-partners reported sorrow, powerlessness, worry about the future, and impacts on intimacy; Turning love into labour-partners learned to communicate about IA and provide practical help; Finding a way through mental gymnastics-partners found ways to manage through knowledge, acceptance, daily routines, optimism, and negotiation of family needs. Conclusions Partners experienced emotional and relational strain when living alongside a person with IA, yet actively developed ways to manage this over time. Supporting partners through education, skills training, and psychosocial resources may strengthen partner well-being and ability to better manage IA with the person diagnosed.

Background Auditory verbal hallucinations (voices) are common in schizophrenia spectrum disorders (SSD), and cause significant distress, making them a critical target in psychotherapeutic interventions. AVATAR therapy, conducted on a two-dimensional computer screen and its adaptation virtual reality-assisted therapy (VRT), using three-dimensional virtual reality (VR), have shown promise. Despite the potential of VRT, research exploring how specific VR characteristics can simulate voices experiences and affect therapy outcome remains scarce. Addressing this gap is key to refining VRT for persistent voices.Objective This qualitative substudy of the CHALLENGE trial explored patient perspectives on modified VRT versions (VRT-Emotions, VRT-Environment, and VRT-Whiteboard) and their therapeutic impact, with the aim to inform intervention refinement and development.Methods Semistructured interviews were conducted with 15 participants with SSD and persistent voices after undergoing the modified therapies. Data were analyzed within a pragmatist-critical realism orientation, with a hybrid deductive-inductive approach to thematic analysis. Reflexive team dialogues supported analytical rigor.Results One overarching theme: A challenging yet transformative therapy, and three subthemes, corresponding to the specific modifications, were generated: Emotional connection with voice, Recognizability builds resistance, and The power of the written word. The modifications were generally perceived to enhance therapeutic experience and effectiveness, albeit participants' perspectives varied and sometimes contrasted.Conclusions Findings suggest that refining VRT for persistent voices may involve improving avatar's facial expressions, tailoring therapy to voice experiences, and using recognizable VR environments with gradual exposure and selective visual tools. While controlled studies are needed to establish efficacy, these insights offer practical guidance for VRT refinement and development.

Objective:Cohabitating partners of people with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis and spondyloarthritis, require information on disease management to support people and navigate their roles. Partner participation in rheumatology consultations could potentially facilitate this, but this remains unexplored. This study investigated both people with arthritis and their partners' perspectives on partner participation in rheumatology consultations. Methods:People with arthritis and their partners were recruited through patient organizations, social media and rheumatology departments. Interview guides were co-developed with five patient research partner couples. Data were collected via focus groups and individual interviews, and analyzed separately for people with arthritis and partners using reflexive thematic analysis. Results:Five focus groups and 15 individual interviews were conducted with 19 people with inflammatory arthritis and 11 partners. People with arthritis themes included: (1) partner participation as a matter of coincidence, (2) longing for more to be addressed, (3) ambivalence about support needs, and (4) need for organizational changes. Partner themes included: (1) being able to provide support is the main goal, (2) being burdened by the lack of support, and (3) creating a space for partners. Conclusion:Partners are not systematically included in consultations, and partner participation is influenced by both people with inflammatory arthritis awareness and needs, and the level of facilitation by health professionals. Beyond knowledge, partners received little support during consultations. Both people with inflammatory arthritis and partners expressed a desire for consultations to enhance partners' ability to participate and for health professionals to address the broader impact of inflammatory arthritis.

To map the evidence on factors influencing access, uptake, retention, and effects of social prescribing for people living with autoimmune diseases. Autoimmune diseases affect mental health and well-being, including loneliness, yet these aspects remain insufficiently addressed in routine care. Social prescribing offers a person-centred approach to care by linking individuals to nonclinical, community-based support; however, evidence on its access, uptake, retention, and effects in autoimmune populations is limited. A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA-ScR. Studies involving adults (≥ 18 years) with autoimmune diseases were included. Eligible interventions involved referral to nonmedical, community-based support. MEDLINE, Embase, CINAHL, PsycInfo, Scopus, and Cochrane Reviews were searched alongside grey literature. Two reviewers independently screened, extracted, and synthesised data. A total of 8670 records were identified; 914 were screened in full text and seven studies were included. Studies were conducted in the United States, United Kingdom, and Ireland using qualitative, quantitative, and evaluation designs. Social prescribing was primarily delivered in primary care and community settings, with few hospital-based initiatives. Facilitators for social prescribing included clinical recognition, structured referral pathways, relational continuity, and tailored support. Barriers included stigma, biomedical focus in care, practical constraints, and limited organisational support. Relational continuity and care integration influenced engagement across all factors. This review found that access, uptake, retention, and effects of social prescribing in autoimmune populations are shaped more by how interventions are organised and delivered than by their specific content. Relational continuity, flexibility, and organisational support were central. Determinants of access and outcomes reflect broader systemic factors, highlighting the need for equitable access and stronger cross-sector coordination.

Many with psychosis spectrum disorders are not in education, employment, or training. The present study aimed to describe the facilitators and barriers surrounding competitive employment or advanced education. Qualitative data were collected through first three interviews with service providers working in SEE (N = 3), followed by two focus groups with experts by experience with schizophrenia spectrum disorders (N = 13). The interviews and focus group discussions were audio taped and transcribed, enabling reflexive thematic analysis. Three themes, each compromising two subthemes, were identified. The participants described the (1) Price and prize of work and study, including (1.1) Breaking points and (1.2) Motivations. In (2) Facilitators: The importance of individualized support, interventions were viewed as either (2.1) Fruitful or (2.2) Futile. The participants described (3) Barriers: Managing the invisible in conjunction with (3.1.) Symptoms and (3.2) Handling stigma. Experts by experience with psychosis spectrum disorders are highly motivated to pursue education or employment. Both benefits and challenges of this were identified. While work or study was seen as meaningful and confidence-building, it could also worsen symptoms or trigger first episode psychosis. Professionals taking a special interest in job-seeking were valued, though factors like lacking social skills and stigma formed barriers. Overall, the findings highlight strong motivation alongside a need for flexible, individualized approaches that balance opportunities with mental health risks.

Frailty is increasingly recognized among older patients with rheumatoid arthritis (RA) and is associated with functional decline and growing dependence on others. As frailty progresses, significant others often assume extensive practical, emotional, and coordinative responsibilities, becoming informal caregivers. Given that RA is commonly managed across healthcare sectors, these responsibilities may also involve navigating and coordinating care across settings. Yet, their experiences and support needs remain underexplored in rheumatology care. This study aimed to explore how frailty in older patients with RA affects their informal caregivers, including the support they provide and their perceived needs, as understood by both older patients and informal caregivers themselves. Individual, semi-structured interviews were conducted with 17 older patients with RA and frailty (11 women, mean age 74) and thirteen informal caregivers (5 women, mean age 69). Older adults were recruited from four rheumatology outpatient clinics affiliated with Copenhagen University Hospital, Denmark. Data were analyzed using reflexive thematic analysis. Three interrelated themes were developed: (1) Gradual consolidation of caregiving in everyday life, (2) Emotional landscape of caregiving, and (3) Persistently navigating the healthcare system. Caregiving was identified as a progressively expanding role that reshaped daily routines, introduced emotional strain, and required navigation of fragmented healthcare services. Both patients and informal caregivers highlighted a need for clearer information about RA symptoms and disease trajectories, as well as care pathways and available support services, alongside improved coordination in the healthcare system and greater recognition of the roles of informal caregivers. The findings suggest that frailty in RA affects not only patients but also those closest to them. Recognizing informal caregivers as key partners in care and strengthening communication between health professionals across healthcare sectors may help mitigate caregiver burden.

Objective: To explore danish adolescents' experiences of Family-Based Treatment (FBT) for anorexia nervosa (AN). Method: Individual semi-structured interviews were conducted with 15 adolescents (13 females, mean age 15.8 years) at the end of treatment and analysed via inductive reflexive thematic analysis. Result: Three overarching themes were generated through analysis: Losing Control - Gaining Freedom captured adolescents' initial distress at relinquishing responsibility for renourishment to parents, later experienced as liberating, as parental oversight countered AN and restored agency. The Difficult Trust reflected how AN itself complicated trust, with adolescents feeling that others did not always believe or trust them. From Conflict to Closeness described evolving parent-child relationships, showing that early conflicts gave way to strengthened bonds, particularly with the parent who assumed primary responsibility, as collaborative engagement fostered improved communication and mutual understanding. Overall, early distress coexisted with long-term gains in autonomy and familial closeness. Conclusion: By the end of treatment, adolescents came to recognize the rationale and value of parental responsibility for renourishment in FBT, reporting that it facilitated recovery while strengthening relationships. The findings emphasize the importance of trust, safe therapeutic spaces, and active involvement from both parents, and highlight a need for targeted adaptations for transitional-age youth.

OBJECTIVES:To explore implementation processes, acceptability among participants who engaged with virtual reality (VR), recruitment feasibility and exploratory within-session effects of recreational VR programmes in a closed psychiatric intensive care unit (PICU). The qualitative component focused on patients' and professionals' experiences of VR use, while quantitative measures examined inclusion rates, exploratory within-session changes in emotional distress and descriptive trends in coercive events, pro re nata (PRN) medication, perceived stress and length of hospitalisation during a year with versus a year without VR. DESIGN:Parallel mixed-methods pilot clinical trial with qualitative priority (QUAL-quan). SETTING:A Danish closed PICU. PARTICIPANTS:All admitted patients who consented to participate during a 2-year period were eligible. Qualitative data included semi-structured individual patient interviews (n=9), a focus group discussion with professionals (n=4) and non-participant observations (8 sessions × 20 min). Quantitative data were collected by ward professionals and via electronic health record extraction. A total of 26 patients were included during the VR year and 9 during the control year, reflecting substantial under-recruitment relative to the planned sample (35/124). INTERVENTIONS:VR programmes for stress reduction, mindfulness, entertainment and distraction, including passive and active activities. RESULTS:Three overarching themes were generated in a qualitative content analysis: (1) Agency in a restrictive environment (categories: Own symptom mastering, A broader clinical toolbox and Connection through a shared third), (2) Escaping and expanding reality (categories: A refuge from distress and A gateway to inaccessible experiences) and (3) Professional readiness and implementation challenges (categories: The know-why gap and The know-how gap). Participants who engaged with VR described experiences of reduced distress, improved mood and greater calmness and perceived VR as a valuable addition to care, supporting autonomy and strengthening therapeutic relationships. However, knowledge and trust gaps, along with insufficient training, limited use. Quantitative measures partly corroborated these findings: an exploratory within-session analysis showed that emotional distress was lower after VR use than before use (95% CI -3.46 to -0.81, p=0.003). However, under-recruitment limited statistical power for between-period comparisons. CONCLUSIONS:Among participants who engaged with VR, the use of VR programmes was generally perceived as acceptable and potentially useful in selected clinical situations. However, recruitment feasibility was not achieved, and the study design does not permit conclusions regarding effects on coercion, PRN medication, perceived stress or length of hospitalisation. Integration into standard care appeared possible under selected clinical circumstances, offering therapeutic value for patients and professionals, but it depended on adequate theoretical understanding and training of professionals. TRIAL REGISTRATION NUMBER:NCT05654740.

The ACTIVATE consensus aimed to develop recommendations for assessing, prescribing and promoting physical activity when healthcare professionals consult patients with non-communicable diseases in clinical practice. We developed the consensus through a comprehensive, multistep approach including 27 experts with professionally diverse backgrounds from 13 different countries, including three patient representatives. Initially, we conducted a survey at the World Congress for Sport Physical Therapy in 2022 to document the need for a consensus, which was followed up by development of a conceptual framework with guiding principles and research questions at a stakeholder meeting. We subsequently conducted three rapid umbrella reviews, covering the existing scientific literature to inform the statements for a Delphi survey. The Delphi survey involved two voting rounds (email survey) and one face-to-face (online) round. Finally, we identified recommendations on how to assess, prescribe and promote physical activity through consensus. We recommend routine physical activity assessments using quick and easy tools, documenting physical activity levels and providing tailored prescriptions for patients not meeting WHO guidelines for physical activity. Furthermore, the ACTIVATE consensus highlights the necessity for regular follow-ups to facilitate patients' integration of physical activity into their daily routines, to enhance overall well-being and quality of life.

Contemporary mental health policies prioritize patient-centred approaches to care, but research has indicated challenges implying a potential disregard for service users' experiential knowledge. This article details a study of Danish mental health service users' experiences of antipsychotic medication prescription and counselling practices. Repeated semi-structured interviews were conducted with 13 participants diagnosed with schizophrenia attending an outpatient clinic specializing in guided tapering of antipsychotic medication. Data were analysed using abductive analysis, which ultimately illuminated four harmful epistemic practices as part of participants' interactions with mental health clinicians: 1) Presenting a bleak narrative, 2) Subjecting the other to alarmism and risk-aversion, 3) Diverting attention away from medication issues, and 4) Excluding the other from decision-making. We argue that these epistemic practices can be interpreted as manifestations of epistemic injustice and fearmongering. The paper highlights ostensibly helpful but paternalistic practices inadvertently leading to a marginalization of service users' knowledge and expertise.

Objective:Research on online communities centred around self-harming and suicidal behaviour often focuses on harmful effects. The concept of peer support, which may help explain why individuals engage with such forums, remains under-explored. This study aimed to examine how peer support is experienced in these communities. Methods:Thirteen in-depth, semi-structured interviews were conducted with current and former participants in online communities focused on self-harming and suicidal behaviour (12 women and one non-binary person, mean age 28). A reflective thematic analysis was used to identify patterns in the data. Results:Four main themes emerged: (1) You are allowed to feel bad and express it on your own terms, (2) Anonymity and intimacy is not a paradox in the online world, (3) It is necessary to have friends in real life as well, and (4) When support, relations, and motivation change over time, one must ask: Should I stay or should I go? The findings not only illustrate the communities as emotionally supportive spaces that foster belonging and intimacy, but also point to challenges in maintaining boundaries and disengaging when support becomes unhelpful. Conclusion:Online communities centred around self-harming and suicidal behaviour provide an alternative to traditional mental health services, often perceived as paternalistic and unsupportive of autonomy. Participants describe online peer support as a way to share emotional burdens and form meaningful relationships. However, the informal nature of support may complicate recovery, especially when individuals become entrenched in the community. These dynamics warrant further research and consideration in mental health practice.

OBJECTIVES:To investigate the prevalence of loneliness among patients with IA with a specific focus on the associations with disease activity and impact. METHODS:We used data from a Danish cross-sectional survey comprising information on socio-demographics, mental health status, and social contacts among 12 713 patients with IA [rheumatoid arthritis (RA)/psoriatic arthritis (PsA)/axial spondylarthritis (axSpA)]. Data were linked to the DANBIO Rheumatology Registry and the National Patient Registry. Loneliness was measured by asking: 'Are you ever alone, although you would prefer to be together with others?'. Association with disease activity and disease impact (Patient Global Assessment, pain, fatigue, physical function) was estimated using multivariable logistic regression [age, sex, cohabitation status, educational level, mental health status (depression, anxiety) and co-morbidity]. RESULTS:: Approximately one-third reported loneliness. Prevalence was lowest for patients with RA [31.6% (95%CI: 30.5; 32.6)] compared with PsA and axSpA [36.0 (34.0; 38.0)] and [36.3 (34.1; 38.4), respectively]. It was highest among axSpA patients reporting high levels of depression [66.2% (60.0; 72.8)]. A positive association was observed between loneliness and disease activity. For disease impact, prevalence estimates were between 40% and 60% when patients experienced high levels of pain, fatigue, low levels of physical function, and high Patient Global Assessment. CONCLUSIONS:Loneliness was highly prevalent in IA and associated with disease activity and impact. Therefore, loneliness is an important target for future mental health interventions in IA.

Objective: To explore parents' experiences of Family-Based Treatment (FBT) for Anorexia Nervosa (AN). Method: Twenty semi-structured interviews with parents of young people (YP) in FBT at end of treatment (EOT), analysed via a combination of thematic and narrative analysis. Results: The analysis identified three distinct themes, starting from a shared point of crisis marked by acute concern for their child's health and urgent need for intervention. Parents then travelled different routes shaped by challenges, support, and meanings they made over time. The Straight Road reflected strong alignment with FBT; parents found the process demanding but ultimately experienced strengthened relationships through shared recovery. The Bumpy Road was defined by initial disagreements with FBT and efforts to negotiate a more collaborative role for the YP, leading to deepened family relations. The Detoured Road was shaped by misalignment with FBT, often involving unmet support needs and relational strain not fully resolved by EOT. Conclusion: Findings suggest that alignment with the principles of FBT plays a central role in shaping parental experiences. However, parents commonly described intense caregiving and strained family ties. Findings highlight the importance of assessing and supporting parental alignment with FBT, as misalignment may exacerbate caregiving strain and disrupt family dynamics.

Introduction: Borderline Personality Disorder (BPD) affects 1-2 % of the population and poses significant health challenges. Individuals with BPD face a reduced life expectancy of 14-27 years, primarily due to suicide and cardiovascular-related issues. This scoping review aimed to provide an overview of the existing literature on physical activity (PA) in BPD management, focusing on research characteristics and exploring underlying rationales. Methods: The PubMed, CINAHL, Embase, PsycINFO, Scopus, PEDro and Cochrane databases were searched for both unpublished and published studies from 1980 to February 2025. The search followed the PRISMA-ScR guidelines and the Population, Concept, and Context framework. Results: Twenty-one studies met the inclusion criteria, including seven RCTs (four ongoing), five non-randomized controlled trials, two non-controlled intervention studies, one single-case experimental study, and six case studies. The studies included 229 participants, primarily female, and covered six PA modalities: structured exercise, yoga, dance movement therapy, outdoor PA's, sports, and body awareness and psychomotor therapies. Analysis identified seven categories of rationales for incorporating PA: improving patient care, fostering emotional regulation, promoting mental health, regulating maladaptive behaviors, enhancing social skills, protecting physical health, and reclaiming embodiment, with fostering emotional regulation as the most prominent. Conclusion: This review highlights the promising but fragmented research on PA interventions for BPD, with a primary emphasis on psychological aspects. Notable gaps include limited attention to somatic comorbidities and the lack of consistent outcome measures. Future research should prioritize the development of multidisciplinary interventions to address both psychological and physical factors.

Objectives Up to one third of people with rheumatoid arthritis (RA) are frail, facing increased vulnerability, comorbidities, and psychological challenges. As people with RA live longer, frailty becomes increasingly relevant to clinical care. This study explores how individuals aged ≥65 years with RA experience frailty and how it affects their daily lives and health management. Methods We conducted an explorative qualitative interview study using purposeful sampling. Participants were recruited from a rheumatology outpatient clinic. Inclusion criteria were age ≥65 years, RA diagnosis, a Multidimensional Health Assessment Questionnaire score >1, and a frailty score, assessed using the Clinical Frailty Scale (CFS), of 4 to 7 (living with very mild frailty to severely frail). We aimed for variation in age, sex, and frailty. The individual semistructured interviews were analysed using reflexive thematic analysis. Results Seventeen participants (10 women, mean age 75 years) were included: 4 living with very mild frailty (CFS score 4), 6 mildly frail (CFS score 5), and 7 moderately frail (CFS score 5). The following 3 themes were developed: (1) ‘When frailty distorts the life, you once knew’, highlighting the emotional toll of facing physical decline, (2) ‘The hard shared burden of frailty’, exploring the relational dynamics of frailty, and (3) ‘Navigating frailty and RA—balancing unmet needs’, emphasising the challenges of balancing autonomy and support. Conclusions The experience of frailty profoundly shapes the experience of ageing with RA, complicating self-management and challenging both identity and relationships. These findings highlight the need for healthcare systems across sectors to address frailty holistically, supporting both physical and psychosocial needs through coordinated care.

Children and adolescents with mental illness are at increased risk of developing overweight and obesity, a relationship that is complex, bidirectional, and often exacerbated by the weight-related side effects of psychotropic medications. This review addressed the research question: How are overweight and obesity addressed in children and adolescents with mental illness? Following JBI and PRISMA-ScR guidelines, a systematic search of PubMed, CINAHL, EMBASE, and PsycINFO was conducted, including studies in English or Scandinavian languages, across all designs, that focused on non-pharmacological approaches for this population aged 0-19 years. The search was completed in May 2025. Nine studies met the inclusion criteria, comprising four qualitative studies, four cohort studies, and one cross-sectional study. Based on inductive content analysis, three overarching themes were developed: approaches to weight and health, showing a predominant focus on individual lifestyle modifications; roles, resources, and prioritization, reflecting how constrained resources influence healthcare professionals' decisions; and critical repercussions and future directions, highlighting the consequences for children, adolescents, and their families. Overall, interventions mainly target behavior change, with limited attention to structural or systemic factors. These findings underscore the need for tailored guidance and clear clinical strategies to support healthcare professionals and families in addressing weight-related issues in child and adolescent mental health care.