Background:Armed conflict and forced displacement are associated with elevated risks of anxiety, depression, and trauma. The ongoing war in Ukraine has exacerbated the need for mental health care while simultaneously disrupting access, underscoring the need for scalable and accessible interventions. Objective:This study examined user acceptance and changes in acute psychological distress among users of krisenchat Ukrainian (kcUA), a text-based digital counseling service. It explored patterns of distress levels, user satisfaction, and referral outcomes, comparing kcUA users (in Ukraine and in exile) with krisenchat Germany (kcDE) users. Methods:A pre-post observational study with a 4-week follow-up was conducted using feedback from 4436 help-seekers (2877 of kcDE and 1559 of kcUA) between July 2022 and April 2023. Surveys assessed mental health symptoms, user satisfaction, and local referral success at three time points: retrospectively assessed pre-consultation distress ("T0"), post-counseling (T1), and 4-week follow-up (T2). Results:All user groups reported significant reductions in symptoms of depression, anxiety, and stress immediately after counseling. At T2, kcUA users maintained symptom improvements, while kcDE users showed partial symptom rebound. User satisfaction and service acceptance were high across all groups (≥89% at T1). kcUA users more often reported war-related concerns and were more likely to recommend the service to others. Referral success was higher among kcDE users (46.6%) than kcUA users (34.9%). Conclusions:kcUA was associated with sustained reductions in psychological distress and was well accepted by kcUA users. Anonymous, scalable digital services may play a crucial role in supporting mental health during humanitarian crises.

Mental health problems (MHP) are common in adolescents. Help-seeking behavior (HSB) in this age group is low. An online intervention promoting HSB in adolescents with MHP (ProHEAD-Online) was evaluated in a randomized controlled trial. It was hypothesized that adolescents allocated to ProHEAD-Online would show increased real-world HSB after 12 months compared to adolescents in the control group. A multicenter randomized controlled trial was conducted in a school-based community setting in Germany. n = 1470 students (≥12 years, 74.6% female) with MHP and no HSB at baseline were randomized (ProHEAD-Online: n = 739; control: n = 731). Professional HSB of 4.5% (control) and 5.7% (ProHEAD-Online) was reported at the primary endpoint (OR = 1.27, 95% CI = [0.78, 2.10], p = 0.34). Age at baseline moderated the treatment effect (OR = 0.79, 95% CI = [0.64, 0.97], p = 0.03), ProHEAD-Online only improved HSB in younger adolescents. No significant differences by treatment arm on secondary outcomes (i.e., severity of MHP, health-related quality of life, attitudes toward help-seeking, perceived barriers to help-seeking, help-seeking intentions, and treatment satisfaction). Professional HSB in adolescents with MHP is low. An online intervention to increase HSB in adolescents with MHP was not superior to static online content. Improving HSB, particularly among older adolescents, remains challenging.

University students mental health has become a growing concern worldwide with significant disparities among at-risk groups such as students with chronic illnesses, mental health diagnoses, migration histories, diverse gender identities, and parental responsibilities. These at-risk groups face unique challenges and increased psychological distress, highlighting the need for further research to better understand their specific needs and to shed a light on broader societal issues such as discrimination and stigmatization, thereby informing the development of tailored support measures in higher education settings. These disparities can also be interpreted through Andersen's Behavioral Model, which posits that help-seeking behavior is shaped by predisposing, enabling, and need-related factors. The analyses includes data that were collected between April and May 2022 from N = 5474 students from Saxony, Germany. Via an online survey, variables were assessed using standardized questionnaires on depressive symptoms, anxiety, stress and perceived social support. Further, students were asked on their professional and university help seeking-behavior. Across all five pre-defined at-risk groups of university students, individuals belonging to one of the at-risk groups showed worse mental health outcomes than their respective comparison group. Only for parental students, a different pattern was found, with lower psychopathology and higher perceived social support than non- parents. Regarding the use and knowledge of professional and university help offers, the respective subgroups showed different preferences and knowledge. Viewed through Andersen's Behavioral Model, these findings suggest that elevated psychological distress reflects higher need factors, whereas differences in perceived social support represent variations in enabling factors that may shape help-seeking patterns and service utilization. These findings highlight the urgent need for flexible, low-threshold support options such as online interventions, which can effectively complement traditional counseling services in universities. Study registration DRKS00030697.

Introduction Boys and young men face an elevated risk of mental health problems and suicidality, yet they remain less likely than their female peers to seek professional help. Online counselling services such as krisenchat offer low-threshold support and may help reduce gender-specific barriers, but little is known about how young men use these services. Objective This study investigates male krisenchat users in comparison to other users, focusing on demographics, utilization patterns, satisfaction, chat topics, and barriers to help-seeking behavior, in order to generate insights for improving mental health support for young men. Methods Anonymized data were obtained from n = 29,387 krisenchat users between January and December 2023. After data cleaning, the final sample comprised of N = 9,584 participants. Demographic information, utilization behavior, suicidality, and use of professional help services were documented by counsellors, while user satisfaction, recommendation rates, and emotional distress were assessed through voluntary surveys following consultation. Results Young males accounted for 19.9% of krisenchat users, were on average older than female users and were less likely to have been in prior treatment. Male users sent fewer messages, accessed the service during late-night hours more often than females, and tended to find the service via search engines rather than institutional or social media channels. Compared to female users, they were less likely to disclose self-harm, family problems, or sexual violence, but more likely to bring up sexuality and LGBTQIA+ topics. Importantly, no gender difference was found for suicidality. Despite differences in some utilization patterns, acceptability outcomes — including reductions in distress, satisfaction, and likelihood of recommending the service — were comparable across genders, suggesting equivalent counselling benefits once engaged. Conclusions Digital crisis services like krisenchat hold potential for reducing gender disparities in mental health support. However, targeted strategies to improve visibility, adapt communication styles, and strengthen follow-up pathways are essential to increase engagement and sustained help-seeking among young men. Study Registration DRKS00026671

IntroductionSexual minority individuals continue to face prejudice and discrimination within medical care and academic settings. This contributes to elevated stress levels, which increases their vulnerability to mental health issues like anxiety and depression. Studies examining the mental health, financial situation, loneliness, and help-seeking behavior of students who have experienced discrimination based on their sexual orientation remain scarce. Therefore, this study aims to address this research gap by assessing mental health outcomes, loneliness, impairment status, income, and help-seeking behavior in a large cohort of university students in eastern Germany, comparing these variables between participants who experienced discrimination due to sexual orientation and those who did not.MethodsAn online survey was conducted to assess university students' mental health, as well as to identify relevant risk and protective factors. The questionnaire included questions on various forms of discrimination experienced by participants, including discrimination based on sexual orientation. The final sample comprised 2,625 students, of which 2,569 answered the questionnaire for discrimination experiences and were included in this study. Sociodemographic variables, income, mental health outcomes (assessed via PHQ-9, GAD7, EDE-Q8, and AUDIT-C), help-seeking behavior, impairment status, and loneliness (measured with UCLA-3) were used to examine group differences between participants reporting experiences of discrimination based on sexual orientation and those without discrimination based on sexual orientation.ResultsResults indicated that participants reporting discrimination based on sexual orientation had a significantly higher prevalence of diagnosed mental illness, impairment affecting study, and suicidal thoughts, as well as a higher mean PHQ-9 and GAD-7 score compared to the students without experiences of discrimination based on sexual orientation. Students facing discrimination based on sexual orientation reported more frequent impairments affecting their studies. No significant differences between the groups were observed in hazardous alcohol use (AUDIT-C), eating disorder symptoms (EDE-Q8), loneliness (UCLA-3) and monthly income.DiscussionThe findings highlight the association between discrimination based on sexual orientation and poorer mental health among sexual minority university students. Moreover, the results emphasize the need for targeted mental health services and more inclusive support structures for sexual minority students at university.

'krisenchat' (crisis chat) is a free, 24/7 psychosocial counseling service for children, adolescents, and young adults up to the age of 25 who are experiencing acute psychosocial crises. Support is provided anonymously and accessibly via chat by trained volunteer professionals. Counseling is delivered through widely used messaging platforms (e.g., WhatsApp, SMS, and since August 2025 web-based chat) and addresses a range of issues, including psychological distress, suicidal ideation, bullying, experiences of violence, and familial conflicts. This review article synthesizes and contextualizes current empirical findings on the use and impact of krisenchat. The available data indicate high feasibility and broad acceptance of the service among the target population. There is substantial evidence for a pronounced demand for low-threshold, 24/7 messenger-based counseling options for young people in crisis situations within the German-speaking context. The service appears to be effective across diverse age groups, topics, and presenting concerns. User feedback is very positive, with over 85% of users indicating they would recommend the service to others in need. In addition, krisenchat appears to fulfill a crucial gatekeeping function by providing psychoeducational information and facilitating referrals to formal health and support systems. Notably, a significant proportion of users-many of whom report severe psychological symptoms-had not previously accessed professional mental health services. At present, krisenchat represents the only digital counseling service in the German-speaking region that is accessible to young people outside of regular service hours, including evenings and weekends. These findings underscore its essential role in bridging existing gaps in the mental health care system for youth.

Postpartum maternal mental health problems affect the development of mother-child interaction and of children’s attachment security. Focus-based brief parent-infant psychotherapy (PIP-f) was developed to support parents ‘mentalize’ their child’s affective states and promote a healthy parent-child relationship and child development. Efficacy of PIP-f was evaluated against care-as-usual (CAU) in a randomized controlled trial within the SKKIPPI project. N = 120 mothers diagnosed with an ICD-10 psychopathological disorder and their infants under one year were randomly assigned to PIP-f (n = 57) or CAU (n = 63). Primary outcome was maternal sensitivity in mother-child interaction after 6 weeks of intervention. Secondary outcomes include maternal and child psychopathological symptoms, child development, parenting stress, emotional availability, parental reflective functioning and child attachment after 6 weeks and 12 months. PIP-f was not superior to CAU in maternal sensitivity (b = 0.129, 95

Introduction:Children of mentally ill parents have an increased risk of developing a mental illness. From an ethical and health-economic perspective, psychotherapeutic care for this risk group is necessary to counter the risk of transgenerational transmission of mental illness. The psychosocial situation of affected families is complex and requires customized support. Within the Children-of-Mentally-Ill-Parents-Network (CHIMPS-NET), three family-based, needs-tailored new forms of care (NFC) - based on the manualized CHIMPS intervention - are implemented and evaluated at 21 locations in Germany. The online intervention iCHIMPS is described in a separate study protocol. Methods:For each NFC, a prospective, rater-blinded, cluster-randomized, controlled study is conducted. Data is collected from the perspective of both parents, all children aged 8 years and older, external raters and therapists at four measurement points: at baseline (T1) and 6 (T2), 12 (T3) and 18 (T4) months after randomization. Allocation to the respective trials is based on baseline assessments of children's mental health symptoms/diagnoses and family functionality, which is followed by randomization. We hypothesize that children in the intervention groups (IGs) have fewer parent-reported mental health problems at T3 than in the respective control groups (CGs), which receive Treatment-as-Usual (TAU). The biometric effect evaluation is supplemented by health economic evaluations and a qualitative evaluation. Discussion:CHIMPS-NET has both raised awareness for children of mentally ill parents and enabled various stakeholders to network with each other. The network contributes to evidence-based care for this risk group. An update of the CHIMPS manual regarding the customized NFC is in process. Clinical trial registration:https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html; DRKS00020380; https://www.clinicaltrials.gov: NCT04369625.

BackgroundAdolescence is a critical period for the onset of mental health problems, a situation further exacerbated by recent global crises. This underscores the importance of low-threshold, anonymous online counseling services. Krisenchat, founded in Germany in 2020 following the COVID-19 outbreak, provides such support. While prior research has offered cross-sectional insights, little is known about changes in user characteristics and measures of the service's feasibility over time, especially regarding the chat topics addressed and in recognition of all gender identities.ObjectiveThis study examined the long-term feasibility and scalability of krisenchat over three years (2020–2023) and explored changes over time in user characteristics, service feasibility and satisfaction, emotional distress, and counseling topics.MethodsThis cross-sectional study analyzed retrospective, naturalistic, anonymous data on sociodemographic variables, utilization behavior, and user satisfaction from krisenchat users over three selected, consecutive time periods (Oct 2020–Mar 2021, N = 4,029; Oct 2021–Mar 2022, N = 6,647; Oct 2022–Mar 2023, N = 5,218). χ2 tests were used to identify associations between users’ sociodemographic characteristics and chat topics over time. Kruskal–Wallis H tests examined measures such as age, emotional distress, user satisfaction, and perceived helpfulness. This was followed by an exploratory analysis of chat topics across time and genders.ResultsUsers reported significantly reduced emotional distress after chat sessions. Across all periods, the average user was 17 years old and female, while engagement among males and gender-diverse individuals increased over time. krisenchat remained feasible and well-received in all time points. Key chat topics included psychosocial distress, mental health symptoms and emotional distress. Chat topics evolved, towards more psychosocial concerns.ConclusionThis study highlights the robustness of krisenchat from 2020 to 2023, underscoring its sustained relevance in both pandemic and post-pandemic contexts. By integrating gender analyses and exploring chat topics over time, the study reveals novel insights into shifting user needs, such as increased psychosocial distress and relational concerns in post-pandemic periods. Observed trends, such as increased engagement among males and diverse users, emphasize the importance of tailored outreach efforts. These findings enrich the evidence base for digital mental health services and offer insights for future interventions.Study RegistrationDRKS00026671

INTRODUCTION:It is challenging for children and adolescents to report and seek help for child welfare endangerment. Online chat-based counseling services have emerged as viable, low-threshold options, enabling at-risk individuals to seek help digitally. Krisenchat is a confidential, 24/7 chat service designed to assist young people in acute crises. OBJECTIVE:This study aimed to characterize users of krisenchat who were flagged by counselors as potentially cases of child welfare endangerment, and to differentiate them from other users of the service. PARTICIPANTS AND SETTING:Anonymized data were obtained from the n = 29,387 krisenchat users between January and December 2023. METHODS:Demographic information, utilization behavior, suicidality, and use of professional help services were documented by counselors, while user satisfaction, recommendation rates, and emotional distress were assessed through voluntary surveys following consultation. RESULTS:Overall, 10.7% of users were flagged by counselors as suspected cases of child welfare endangerment. These users were more likely to be younger (M = 14 vs. M = 17), female (84.3% vs. 76.7%), and to report sexual violence (15.6% vs. 5.5%) and suicidal behavior (10.9% vs. 4.2%) compared to those not flagged. They also reported higher emotional distress (M = 6.80 pre vs. M = 4.65 post, p < .001) than other users (M = 4.65 pre vs. M = 4.57 post, p = .550) prior to the chat. CONCLUSIONS:The findings highlight the potential of messenger-based platforms as tools for early detection and intervention, while underscoring the importance of trust-building to facilitate full disclosure.

BACKGROUND:Given the high prevalence of mental illnesses in adolescents, there is an urgent need for effective prevention strategies. The aim of this study was to evaluate the school-based internet intervention StresSOS for the universal prevention of mental illnesses in youth. METHODS:A two-arm, randomized controlled trial was conducted. Participants were recruited from schools across five regions of Germany. Young people between the ages of 12 and 25 years without mental health problems were invited to the trial and randomly assigned to StresSOS or to the attention placebo control condition, stratified by sex. Participants in both conditions received eight web-based sessions with information and exercises and weekly e-mail teasers about program content and a monitoring survey. StresSOS comprised content on life skills, particularly stress management and mental health literacy, and the control condition content comprised healthy nutrition. The primary outcome was self-reported mental health status at a 12-month follow-up. Intention-to-treat analyses were calculated. The trial was preregistered with the German Register of Clinical Trials (DRKS00014693, see https://drks.de/search/en/trial/DRKS00014693). RESULTS:A total of 5,268 eligible students were invited to participate, 2,327 (44%) activated their account and were randomized to StresSOS (n = 1,154) or to the control condition (n = 1,173). Due to COVID-19-related school closures, 1,209 were lost to follow-up, and data from 1,118 students were analyzed (535 in StresSOS and 583 in the control group). Participation in StresSOS led to significantly reduced incidences of emerging mental health problems at the 12-month follow-up (controls: n = 162 [28%] 'with problems'; StresSOS: n = 113 [21%] 'with problems'; OR 0.70, 95% CI [0.52, 0.92], p = .01). CONCLUSIONS:StresSOS was effective in universally preventing the onset of mental health problems, with a small effect. Internet interventions have the potential to contribute to a reduction of the disease burden in young people.

OBJECTIVE:Rates of help-seeking and treatment uptake are low in eating disorders. Delayed initiation of treatment has a negative impact on prognosis and treatment outcome and leads to a higher burden on the healthcare system. The aim of this study was to explore factors associated with help-seeking and their interactions in a large sample of adolescents and young adults with current symptoms of an eating disorder. METHODS:Based on the Classification and Regression Trees (CART) algorithm, the data collected within the German school-based project ProHEAD (N = 9796; age: 12-25 years) were used to estimate a decision tree to classify students into help-seekers and non-help-seekers for a mental health issue. RESULTS:Of those screened, 13% reported substantial current eating disorder symptoms (N = 1273). Out of those, 77.3% reported that they did not seek formal help (i.e., from a mental health professional). The absence of suicidal ideation and emotional problems, as well as a low level of education and openness to mental health issues, was characteristic of those who did not seek help for a mental health problem. Emotional problems, suicidality, and depressive symptoms were identified as the most important factors associated with general help-seeking. DISCUSSION:In line with previous research, our findings indicate that individuals with eating disorder symptoms are more likely to seek help when other mental health issues are present. Public health efforts should aim to promote awareness and increase knowledge of eating disorders.

BACKGROUND: Men are at a significantly higher risk of dying by suicide than women. At the same time, they are less likely to seek help compared to women, alongside other risk factors. The aim of this qualitative study is to examine the facilitating and inhibiting aspects that affect help-seeking in men who have attempted suicide in order to inform gender-specific suicide prevention. METHODS: Fourteen qualitative, problem-centered interviews were conducted with men who have had at least one suicide attempt in their life. Facilitating and inhibiting aspects for help-seeking were analyzed using structuring qualitative content analysis. RESULTS: Facilitating aspects for seeking help include access to professional support, social resources, favorable psychological resources, positive experiences with the support system, and symptom burden. Inhibiting aspects include perceived inaccessibility of professional support, psychological aspects that hinder help-seeking, negative experiences with the support system, stigma/guilt and shame, and hegemonic masculinity norms. CONCLUSIONS: The findings regarding inhibiting and facilitating aspects offer various avenues to improve men’s access to psychiatric and psychosocial support systems, as well as to advance gender-specific suicide prevention at the intra-individual level (e.g., strengthening favorable psychological resources), the interpersonal level (e.g., training gatekeepers for men with few social resources), and the societal level (e.g., availability of psychosocial support).

Background:Increasing non-participation in research studies and high dropout rates in research on mental health apps compromise interpretability and generalizability of results. Analyzing underlying reasons holds promise for improving future recruitment methods, study design, and app features. Objective:This study investigated reasons for non-participation and dropout among adult psychiatric outpatients in a study examining an app for self-reflection, daily structuring, relaxation, mindfulness, and psychoeducation in Germany during COVID-19 pandemic, as well as potential differences between dropouts and completers. Methods:Descriptive statistics on reasons for non-participation using an anonymous questionnaire and for dropout based on semi-structured telephone interviews were performed. Differences between dropouts and completers in sociodemographic, clinical, app-related, and daily mood data were analyzed. Results:Of N = 88 persons approached for potential study participation, n = 57 (64.8%) participated in the app study, while n = 31 (35.2%) declined. Of n = 31 non-participants, n = 29 (93.5%) indicated specific reasons. On average, M = 1.72 (SD = 1.03) reasons were provided per non-participant, with no motivation for regular app use (n = 7, 24.1%), no interest in using an app for the presented content (n = 6, 20.7%), and no time for app use (n = 6, 20.7%) being the most common. Of n = 57 study participants, n = 40 (70.2%) were completers and n = 17 (29.8%) were dropouts. On average, M = 2.82 (SD = 1.29) dropout reasons were provided per dropout, with too severe health complaints (n = 6, 35.3%), not individually suitable contents (n = 5, 29.4%), and lack of incentives to use the app (n = 5, 29.4%) being the most frequent. Dropouts and completers did not differ significantly in sociodemographic, clinical, and app-related variables (all p > .05). Dropouts reported their mood significantly less often than completers during the first five and seven days of the intervention period (all p < .001). Conclusions:This study provides exclusive insights into non-participation and dropout in an app study among adults with mental disorders. It identified personal motivation, app-related aspects, no interest in app-based offers, and personal health complaints as common reasons. Suggestions for improving future studies include focusing on incentives, app questionnaires, app installation, user needs analysis, and symptom severity. Early app engagement and adherence measurements (for example number of daily mood reports) may help identify potential dropouts earlier in future studies. Clinical Trial Registration:https://drks.de/search/de/trial/DRKS00027536, identifier DRKS00027536.

Abstract Background Cognitive behavior therapy (CBT) is the gold-standard treatment for obsessive–compulsive disorder (OCD). However, access to CBT and specialized treatments is often limited. This pilot study describes the implementation of a guided Internet-Based CBT program (ICBT) for individuals seeking treatment for OCD in a psychiatric outpatient department in Leipzig, Germany, during the COVID-19 pandemic. The aim of the study was to investigate the acceptability, feasibility, and effectiveness of the ICBT program for OCD. Methods In an open, naturalistic pilot trial, N = 57 patients with OCD received a 10-week ICBT program (called “OCD-NET”). It consisted of 10 different modules covering psychoeducation, cognitive restructuring, exposure with response prevention, and overall therapist support and guidance through the program. The primary outcome was feasibility and acceptance of the OCD-NET program assessed via recruitment and retention rate, adherence and user satisfaction. Secondary outcomes were OCD symptoms at the end of treatment, assessed using the self-report Obsessive Compulsive Inventory – Revised (OCI-R) and self-rated measures of depressive symptoms, quality of life, self-efficacy, and psychological distress. Additionally, treatment credibility, working alliance, and satisfaction were assessed. Results On average, participants completed 6.30 (SD = 3.21) modules, and n = 19 (33.9%) participants completed all 10 modules of the program. Overall, n = 45 (78.9%) were treatment completers (minimum 4 modules completed), n = 11 (19.3%) were non-completers, and n = 1 (1.8%) was a dropout. Satisfaction with the program was high, with a majority of participants indicating that they would recommend it to others (n = 56, 98.2%) and that it provided the support they needed (n = 49, 86.0%).Mixed-effect models showed a significant reduction in OCD symptoms (OCI-R), with large within-group effect sizes in both intention-to-treat (ITT) and completer analyses. In ITT analyses, the OCI-R decreased significantly with a within-group effect size of d = 1.13 (95% CI 0.88 – 1.38). At post-treatment, n = 17 (29.8%) participants showed a treatment response on the OCI-R (≥ 40% reduction). The treatment also resulted in statistically significant improvements in depressive symptoms (d = 0.90 [0.65; 1.15]) and self-efficacy (d = -0.27 [-0.53; -0.00]). No significant differences were observed in quality of life (WHOQOL-BREF) or psychological distress (Mini-SCL GSI) scores between baseline and post-treatment, in either the ITT or completer analyses. Conclusions The OCD-NET program is overall highly acceptable and appears to meet patients’ needs in routine care, even under pandemic constraints. ICBT with therapist guidance significantly reduces OCD and depressive symptoms in real world settings. The results also suggest that this ICBT program could be integrated into routine psychiatric outpatient treatments. However, future research should investigate how upscaling and sustainable implementation could be effectively achieved. Trial registration German Clinical Trials register (DRKS): DRKS00021706, registration date: 15.05.2020.

Public attitudes vary across mental health (MH) problems. However, research on young people and certain MH conditions is limited. This online-experiment examined stigma and potential help-seeking among 554 adolescents and emerging adults aged 14-29 years towards generalized anxiety disorder, depression (DEP), bulimia nervosa (BN), non-suicidal self-injury (NSSI), and problematic alcohol use (ALC). Participants were randomized to a video vignette depicting one of the five MH problems. Attitudes were measured with the Universal Stigma Scale (subscales: "blame/ personal responsibility" and "impairment/ distrust") and the General Help Seeking Questionnaire assessing the likelihoods of seeking professional, informal, and no help for the respective MH problem. Data were analysed using Kruskal-Wallis and Bonferroni-corrected Dunn's tests. Compared to all of the other conditions, ALC was the most stigmatized. Furthermore, ALC was more likely to prompt any help-seeking as compared to DEP, BN, and NSSI, and professional help-seeking in comparison to DEP. BN elicited more blame than DEP, whereas the reverse pattern emerged for distrust. However, this sample generally held positive MH attitudes. The results highlight the importance of addressing disorder-specific stigma and may inform the development of targeted anti-stigma and help-seeking campaigns.Trial registration: This study has been registered at the German Clinical Trials Register (www.drks.de) on September 23rd, 2020 https//drks.de/search/de/trial/DRKS00023110 #DRKS00023110.

IntroductionMedication adherence is a critical component in the treatment of psychiatric conditions such as obsessive-compulsive disorder (OCD). Poor adherence is associated with an increased risk of relapse, subsequent (re)hospitalization, and prolonged remission, which ultimately leads to a worse prognosis. This study aimed to assess medication adherence over time in individuals with OCD, identify predictors, and gather patient-reported strategies to maintain adherence.MethodsThis study surveyed N = 100 patients recruited in the outpatient department of a university medical center in Leipzig, Germany, between January 2019 and January 2020 (Ethics Committee approval number: 332/18-ek; date of approval: 25 September 2018). Medication adherence was assessed using indirect (i.e., Drug Attitude Inventory, Medication Adherence Rating Scale) and direct methods (i.e., therapeutic drug monitoring via serum drug concentration). Additionally, the participants reported strategies they found helpful for maintaining adherence.ResultsThe participants exhibited mild impairments in various aspects of functioning despite relatively functional daily lives. Most were prescribed selective serotonin reuptake inhibitors (SSRIs), with a subset receiving combination therapy for treatment-resistant cases. Medication adherence was classified into three categories: 24.4% of the participants were good adherers, 62.2% were partially adherent, and 13.4% were non-adherent. Therapeutic drug monitoring (TDM) indicated that 84.6% of the participants had drug levels within the therapeutic range. Concerns about side effects and doubts regarding the efficacy of the medication were commonly reported, which might contribute to suboptimal adherence. However, no significant associations were found between adherence and sociodemographic or clinical variables, which suggested the need for a more comprehensive approach considering psychosocial factors. Behavioral strategies for maintaining adherence (e.g., incorporating medication into daily routines) were preferred and rated as helpful, while invasive monitoring methods were largely rejected.DiscussionThis study highlights the importance of a multifaceted approach to improving medication adherence in individuals with OCD. While SSRIs remain the primary pharmacological treatment, a significant portion of patients still struggle with adherence. Although TDM provides valuable insights into drug levels, it may not fully capture adherence behavior due to metabolic and behavioral variability. Addressing patient concerns about side effects and medication efficacy, alongside implementing behavioral strategies that integrate medication into daily routines, may improve adherence and enhance treatment outcomes.

Mental health problems, such as depression, have a high prevalence in young people. However, the majority of youths suffering from depression do not seek professional help. This study aimed to compare help-seeking behavior, intentions and perceived barriers between youthswith different levels of depressive symptoms. This cross-sectional study is part of a large-scale, multi-center project. Participants were n = 9509 youths who were recruited in German schools and completed a baseline screening questionnaire. Based on their depressive symptoms, youths were allocated to the following three subgroups: (a) without depressive symptoms, (b) with subclinical symptoms, (c) with clinical symptoms (measured by PHQ-A). Quantitative analyses compared previous help-seeking behavior, help-seeking intentions and perceived barriers (Barriers questionnaire) between these subgroups. An additional exploratory qualitative content analysis examined text answers on other perceived barriers to help-seeking. Participants were mostly female (n = 5575, 58.6

BackgroundThe COVID-19 pandemic affected university students' mental health worldwide. International students were presenting high levels of stress, anxiety, and depressive symptoms before the pandemic. This study aimed to investigate (i) differences between various timepoints of the COVID-19 pandemic (2020, 2021, and 2022) in mental health outcomes and social and emotional aspects in domestic and international students, separately, (ii) differences between international and domestic students between the three timepoints on mental health outcomes and social and emotional aspects, and (iii) possible moderation effects of timepoints on mental health outcomes and social and emotional aspects of domestic and international students.Material and methodsData from three cross-sectional anonymous online surveys conducted in German universities were analyzed and compared. Data were collected in 2020, 2021, and 2022, respectively, with a total N = 14,498. Depressive symptoms, hazardous alcohol use, social support, self-efficacy, resilience, perceived stress, and loneliness were assessed through standardized self-report instruments. Differences between domestic and international students in mental health outcomes, and social and emotional aspects across three timepoints were assessed with one-way and two-way ANCOVAs.ResultsRegardless of the timepoint, international students presented more depressive symptoms and perceived stress, lower perceived social support and resilience, but higher levels of self-efficacy and less alcohol consumption compared to domestic students. A significant interaction effect between timepoint and student status emerged only for loneliness.ConclusionsInternational students generally presented poorer mental health outcomes than domestic students. Mental health care and prevention such as low-threshold, online counseling should address university students, especially international students.