The physical environment of psychiatric in-patient facilities plays a significant role in patient well-being, treatment satisfaction and recovery. Despite growing evidence that architectural design influences clinical outcomes, systematic data on patient preferences regarding hospital structure remain scarce.

To identify structural and architectural requirements for psychiatric hospital design, from the patient perspective.

A cross-sectional, hybrid questionnaire survey incorporating closed- and open-ended questions was administered to former psychiatric in-patients from all wards of a tertiary care centre (University Psychiatric Clinics Basel, Switzerland) who had been treated before September 2023. The survey assessed patient-reported disturbances related to room conditions, preferences for structural and environmental design elements, importance ratings of specific architectural features (measured using Likert scales) and preferred treatment settings.

A total of 604 participants completed the survey (response rate 19.1%). Room-related disturbances were reported by 49% of respondents (n = 282), with key concerns including insufficient privacy, limited withdrawal opportunities and impaired sleep quality. Single-occupancy rooms were rated as very important (10/10) by 64% of respondents. Access to a surrounding park environment (74%) and direct outdoor access (75%) were among the most highly valued features. In-patient treatment was the preferred modality for 54.1% of respondents, followed by out-patient care (17.8%) and day clinics (15.9%).

Psychiatric patients strongly prioritise in-patient settings offering single-occupancy rooms, privacy and access to green spaces and outdoor areas. These findings underscore the importance of systematically incorporating patient perspectives into the architectural and structural planning of psychiatric facilities.

A considerable proportion of individuals who die by suicide have no recorded psychiatric diagnosis, yet their psychosocial and clinical profiles remain poorly understood.

To examine whether conventional demographic, physical health, psychosocial and mental health characteristics distinguish suicide decedents with, versus without, psychiatric diagnoses in a population-based cohort.

This retrospective case–control study used UK Biobank baseline data linked with national mortality records. Suicide decedents were classified as having a recorded psychiatric diagnosis prior to death (PtD) or no recorded diagnosis (NPD). Group comparisons and logistic regression analyses examined associations between psychosocial variables and diagnostic status, including domain-specific multivariable models adjusted for age and gender.

Among suicide decedents, 44% had no recorded psychiatric diagnosis. There were no significant differences between groups in smoking-related variables, diabetes, hyperlipidaemia, body mass index, social support or social connectedness. Hypertension, as well as the use of immunosuppressants and anti-inflammatory agents, were more prevalent in the PtD group. PtD individuals exhibited higher levels of anxiety-related traits, neuroticism and healthcare utilisation. In multivariable analyses, several unadjusted comparisons were attenuated. Neuroticism, ‘suffering from nerves’, healthcare utilisation and lower risk-taking remained significantly associated with PtD status whereas mood-related variables, including depressed mood and anhedonia, were no longer statistically significant following adjustment.

Nearly half of suicide decedents had no recorded psychiatric diagnosis, and conventional psychosocial markers demonstrated limited discriminative value under current measurement conditions. These findings support a detection-gap framework and highlight the need for suicide prevention strategies extending beyond diagnosis-based approaches towards broader, population-level detection.

National policy frameworks, including the UK Government’s Suicide Prevention Strategy (2023–2028), emphasise person-centred, relational approaches that prioritise therapeutic engagement, collaborative safety planning and a flexible understanding of psychosocial risk. Peer support and lived experience initiatives are increasingly recognised as vital components of suicide prevention and recovery support. Community-based suicide crisis (CBSC) support, which emphasises rapid access, person-centred care and lived experience integration, was established to provide immediate support without clinical criteria, barriers to access or waiting lists.

To examine outcomes of a CBSC intervention supporting individuals in suicidal crisis, with particular attention to differences in outcomes across National Health Service (NHS) and non-NHS/self-referral pathways.

A mixed-methods explanatory sequential design was adopted to provide a comprehensive assessment of service impact and client outcomes among individuals (n = 9801) referred through the NHS (n = 2929, 30%) or non-NHS/self-referrals (n = 6872, 70%) between 2019 and 2025.

A subanalysis of 1387 (14%) client interventions showed significant improvements across all mental health recovery domains (p < 0.05), particularly among older clients (aged ≥65 years). Fifty interviews with clients, carers, staff and referrers generated three themes around accessibility, rapid response, continuity of care and the value of lived experience in building trust, reducing stigma and helping with long-term recovery.

CBSC services would benefit from the expansion of NHS partnerships to extend regional reach, standardised monitoring and follow-up, and the strategic use of outcome data to strengthen advocacy and secure sustainable funding. Embedding this community-based model firmly within wider health systems has the potential to enhance its impact, ensure equitable access and inform broader systemic developments in suicide prevention.

There have been limited studies investigating psychiatric outcomes of childhood trauma in individuals with intellectual disability or borderline intellectual functioning.

To investigate the associations of (a) intellectual disability or borderline intellectual functioning with childhood trauma up to age 11 years; and (b) childhood trauma with psychiatric diagnostic, prescribing and behavioural outcomes in adolescence and early adulthood among individuals with intellectual disability or borderline intellectual functioning.

This was a prospective cohort study using data from the Avon Longitudinal Study of Parents and Children birth cohort with linked primary care data.

Of 8661 participants, 310 had intellectual disability or borderline intellectual functioning and 107 had intellectual disability. We found increased odds of bullying (odds ratio = 1.84, 95% CI: 1.39–2.43) and sexual abuse (odds ratio = 2.11, 95% CI: 1.09–4.11) among individuals with intellectual disability or borderline intellectual functioning compared with those without. In the group with intellectual disability, the odds of bullying were attenuated (odds ratio = 1.66, 95% CI: 0.97–2.86), and estimates for sexual abuse were imprecise (odds ratio = 0.69, 95% CI: 0.09–5.09). Among those with intellectual disability or borderline intellectual functioning, we found increased odds of challenging behaviour (odds ratio = 2.62, 95% CI: 1.05–6.57), psychotropic prescribing (odds ratio = 2.73, 95% CI: 1.55–4.81), and suicidal and self-harm behaviours (odds ratio = 3.42, 95% CI: 1.15–10.20) in individuals who had experienced bullying, and increased odds of challenging behaviour (odds ratio = 3.31, 95% CI: 1.28–8.53) in individuals who had experienced emotional abuse compared with those who had experienced no trauma.

We provide evidence of increased odds of childhood bullying and sexual abuse among those with intellectual disability or borderline intellectual functioning. In this group, bullying is associated with increased odds of challenging behaviour, psychotropic prescribing, and suicidal and self-harm behaviours.

Over 1.6 million refugees and asylum seekers from Myanmar reside in neighbouring countries. These populations face substantial mental health challenges, yet existing evidence remains fragmented, making a comprehensive review essential.

To synthesise evidence on common mental disorders among Myanmar refugees, examine associated factors and explore challenges across host countries and refugee subgroups.

A systematic search of PubMed, PsycINFO, Web of Science, Embase, Scopus and grey literature was conducted through July 2025. Eligible studies reported on common mental disorders among Myanmar refugees of any age in regional host countries. Two reviewers independently screened studies and extracted data dually, assessed risk of bias with Joanna Briggs Institute checklists and synthesised findings narratively.

Of 1614 records, 14 studies met inclusion criteria, covering >10 800 refugees in Bangladesh (n = 9), Thailand (n = 3) and Malaysia (n = 2). Reported prevalence was high for depression (30.0–89.0%), anxiety (39.3–41.8%) and post-traumatic stress disorder (3.7–61.2%). Risk factors associated with poorer mental health included potentially traumatic events, female gender, older age, family dependency, post-migration difficulties, lack of social support, food insecurity and pre-existing health conditions. Employment and income were identified as protective factors. Mental health challenges varied by country. Barriers to care included limited service access, lack of culturally appropriate interventions and stigma.

Myanmar refugees experience a high burden of mental disorders shaped by both potentially traumatic events and post-migration stressors. Effective interventions should be context-specific, focusing on person-centred care tailored to the refugee experience, improved living conditions, strengthened social support and enhanced economic opportunities.

Non-suicidal self-injury (NSSI) is a prevalent behavioural health concern during adolescence and has been consistently linked to emotionally invalidating interpersonal environments.

This study tested whether distress tolerance and negative urgency prospectively explained the link between invalidating environments and adolescent NSSI.

The study used a 2-wave longitudinal design with a 6-month interval; 300 Iranian adolescents (70% female, aged 13–17 years) participated.

Cross-lagged panel modelling showed that invalidating environments at wave 1 predicted higher NSSI at wave 2, when we controlled for baseline NSSI, and were associated with increases in negative urgency. Although both negative urgency and distress tolerance were related to later NSSI, only negative urgency significantly mediated this relationship; distress tolerance and the hypothesised serial pathway did not show significant associations. Sensitivity analyses indicated developmental differences across age groups.

The findings highlight impulsive response under distress as a central mechanism linking environmental invalidation to adolescent NSSI and identify negative urgency as a key intervention target.

Clozapine is the only antipsychotic with demonstrated efficacy in treatment-resistant schizophrenia, but remains underutilised worldwide, with limited data from the Middle East and North Africa.

We examined clozapine initiation, delays and outcomes in a large United Arab Emirates (UAE) cohort.

We conducted a retrospective cohort study of patients prescribed antipsychotics at a tertiary psychiatric hospital in the UAE (2018–2025). Treatment resistance was defined as two or more distinct sequential adequate antipsychotic trials, each for at least 6 weeks and at a drug-specific therapeutic dose (defined daily dose method). Outcomes were clozapine initiation, time to initiation, guideline concordance (within 3 months) and hospital admissions.

Of 6256 patients with schizophrenia spectrum diagnoses prescribed antipsychotics, 1738 (27.8%) met treatment-resistance criteria. Clozapine was initiated in 129 (7.4%; 95% CI 6.3–8.8%), comparably between expatriates and nationals (7.7 v. 7.1%; p = 0.72). Among 76 delayed initiators, median delay was 13.2 months (interquartile range 2.2–32.5) and 26.3% were guideline-concordant. The number of adequate trials most strongly predicted initiation (adjusted odds ratio 1.98, 95% CI 1.70–2.30; p < 0.001). Delayed initiation was associated with higher hospital admission rates (adjusted incidence rate ratios 2.5–2.6 for delays up to 24 months; p < 0.05), although an exploratory propensity-weighted analysis was underpowered (β = −2.57; p = 0.12).

Clozapine remains underutilised in this setting, with fewer than 1 in 12 treatment-resistant patients receiving it and only a quarter of delayed initiators achieving guideline-concordant timing. These findings highlight an evidence-to-practice gap and support strategies for earlier clozapine access.

Antipsychotic agents play a paradoxical role in obsessive–compulsive phenomena, augmenting selective serotonin reuptake inhibitors in treatment-resistant obsessive–compulsive disorder yet also inducing or worsening obsessive–compulsive symptoms, mainly in psychotic but also in mood disorders. How strongly individual agents are implicated has not been compared.

To map the distribution and density of evidence on antipsychotic-associated obsessive–compulsive symptoms across all agents, including those without induction evidence, and to synthesise causality indicators and management strategies.

A scoping review following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. PubMed/MEDLINE and Scopus were searched from inception to December 2025, supplemented by two regulatory pharmacovigilance databases (United States FDA Adverse Event Reporting System and World Health Organization VigiBase). Prespecified operational definitions, a four-dimension triangulation framework and a standardised dose metric were applied. Registered on the Open Science Framework (DOI: 10.17605/OSF.IO/R8ZFA).

Eighty-eight primary studies were included. Clozapine carried the densest, most consistent evidence (de novo prevalence 5.9–44.3%; total up to 77.9%); in the one controlled cohort with a drug-free comparator, the number needed to harm for clozapine (at least 6 months) was approximately 4 (95% CI: 2–8). Olanzapine and risperidone were intermediate, and predominantly antidopaminergic agents showed minimal literature. Pharmacovigilance placed aripiprazole, not clozapine, highest, discordant with its sparse clinical literature, indicating that the gradient partly reflects research concentration. Genetic associations supported a serotonergic–glutamatergic framework.

Evidence for inducing obsessive–compulsive symptoms varies across antipsychotics, being most consistent for clozapine and least for predominantly dopamine-blocking agents. Brief routine screening and a pragmatic response pathway may be considered in clozapine services, with vigilance for other agents as evidence accrues.

Survivors of the 1988 Halabja chemical attack have experienced severe, chronic trauma, yet limited research has examined the long-term psychological and biological consequences of chemical warfare exposure more than three decades later.

To examine long-term post-traumatic stress disorder (PTSD) symptoms, depression/anxiety symptoms, somatic symptoms and perceived stress among survivors of the Halabja chemical attack, and to investigate the associations of trauma exposure, sociodemographic factors and hair cortisol concentrations (HCCs) with psychological symptom severity and symptom profiles.

A total of 209 survivors of the Halabja chemical attack participated in structured interviews using culturally adapted and field-tested instruments, including the Post-Traumatic Stress Disorder Checklist for DSM-5, Hopkins Symptom Checklist-25, the Patient Health Questionnaire-13, the Perceived Stress Scale-14 and an adapted War and Adversity Exposure Checklist-26. Hair cortisol and cortisone concentrations were assessed as biomarkers of chronic stress. Data were analysed using correlations, independent-samples t-tests, multiple linear regression analyses, multinomial logistic regression and latent profile analysis (LPA).

Survivors demonstrated a substantial long-term psychological symptom burden. Overall, 87.6% of participants exceeded the cut-off for probable PTSD symptoms, and 75.1% exceeded the cut-off for elevated depression/anxiety symptoms. Most participants (81.8%) reported exposure to 11 or more lifetime traumatic events. Men reported significantly greater cumulative trauma exposure, whereas women reported significantly greater somatic symptom severity. Higher educational attainment and employment were consistently associated with lower psychological symptom severity across multiple outcomes. HCCs were not significantly associated with PTSD symptoms or latent symptom-profile membership after adjustment for trauma exposure and psychosocial variables. The LPA identified four symptom-severity classes characterised by differing levels of PTSD and depression/anxiety symptoms. Greater cumulative trauma exposure and lower social support were associated with membership in more severe symptom classes.

Survivors of the Halabja chemical attack continue to experience substantial psychological distress more than three decades after exposure. Long-term symptom severity appears to be more strongly associated with cumulative trauma exposure and psychosocial adversity than with HCCs. The findings highlight substantial heterogeneity in symptom presentation and support the need for long-term, culturally sensitive and trauma-informed mental health interventions for survivors of chemical warfare and mass violence.

Perinatal mental health problems are increasingly recognised, and specialist services are more widely available for support and treatment. However, little is known about how women use these services. This study examined the use of health and support services associated with perinatal anxiety, and possible inequities.

To determine the health service use and healthcare experiences of women with perinatal anxiety, and to examine regional differences and inequalities.

A prospective longitudinal follow-up of women recruited from 17 hospital trusts. Participants (N = 722) completed anxiety measures 6 weeks postpartum, and health service use and experience measures 6 months postpartum.

Anxiety 6 weeks postpartum was associated with more GP (incidence risk ratio (IRR) 1.02, 95% CI 1.01–1.03) and health visitor (IRR 1.01, 95% CI 1.01–1.02) visits for the mother but not for the infant. Effects were moderated by ethnicity for GP visits (IRR 1.03, 95% CI 1.00–1.06) and by level of education for health visitor visits (IRR 1.02, 95% CI 1.01–1.03). Anxiety was associated with lower satisfaction with GP care for the baby, health visitor care and poorer overall healthcare experiences. Women with anxiety were more likely to attend specialist mental health (odds ratio 1.09, 95% CI 1.06–1.12) or other support services (odds ratio 1.04, 95% CI 1.01–1.06). However, 29.2% of those referred to mental health services and 30.8% referred to other support services did not attend.

Perinatal anxiety increases health service use for mothers but not for infants. Anxiety also negatively impacts satisfaction with healthcare. Findings can inform strategies to improve access and experience of care.

Weight gain is a common, distressing side-effect of antipsychotic medication prescribed for people with severe mental illness. National guidance for antipsychotic-induced weight gain (AIWG) encourages early intervention and physical health monitoring; healthcare professionals (HCPs) often struggle to implement these recommendations in routine care.

To explore how HCPs understand and respond to AIWG for patients.

This realist evaluation, part of the RESOLVE project, builds on a realist synthesis. Thirty HCPs participated in realist interviews. A programme theory with nine context–mechanism–outcome configurations (CMOCs) was generated, explaining how HCPs perceive non-pharmacological care provision for patients with AIWG. Clinical and lived experience stakeholders reviewed and refined the theory and CMOCs.

The nine CMOCs spanned three areas: (a) systemic and professional challenges; (b) strategies to enhance individualised and meaningful support; and (c) the role and limitations of non-professional support. HCPs described how lack of training, siloed services and system-level constraints limited their ability to offer integrated care. They highlighted the importance of relational continuity, early and tailored conversations, and alignment with patients’ values and motivations. Peer and family support were valued, but structural barriers undermined their consistent implementation.

AIWG was experienced as compromising professional values for HCPs working in mental health settings. Person-centred care was often undermined by fragmented systems, role ambiguity and insufficient training. These issues require investment in professional development, structural integration, and relationship-based approaches that support timely, collaborative action.

Problematic teacher–pupil relationships (TPR) affect children’s educational outcomes and mental health, particularly for children with psychiatric disorders and neurodevelopmental conditions, yet few population-based studies have explored this association.

To estimate the association between problematic TPRs and psychiatric disorder classifications including neurodevelopmental conditions and poor mental health, and whether this varied by informant.

A cross-sectional analysis of the Mental Health in Children and Young People 2017 survey (n = 6634) was performed. Mental health was assessed using the Strengths and Difficulties Questionnaire, whereas classification of psychiatric disorders, including neurodevelopmental conditions, was assessed using the Development and Well-Being Assessment. TPR quality was evaluated through reports from parents and children (aged >11 years). Bivariable and multivariable regression analyses were stratified by age (5–10 years, n = 3509; 11–16 years, n = 3010), controlling for covariates. Multiple imputation was used to address missing data.

Data-set information: NatCen Social Research (2024), Mental Health in Children and Young People 2017, UK Data Service, SN 8467.

Problematic TPRs were associated with increased odds of any psychiatric disorder in children aged 5–10 years (adjusted odds ratio = 4.80, 95% CI: 2.74–8.40) and 11–16 years (adjusted odds ratio = 4.07, 95% CI: 2.76–6.01). Strengths and Difficulties Questionnaire total difficulties scores were higher by 4.26 points (95% CI: 3.09–5.42) and 3.93 points (95% CI: 3.04–4.83) for children aged 5–10 and 11–16 years, respectively. Problematic TPRs were also associated with attention-deficit hyperactivity disorder, with no significant differences between informant types. Teacher recognition of poor mental health did not moderate these associations.

These findings support the importance of TPRs in school policy and of supporting teachers to foster positive relationships in schools.

Test anxiety affects up to 40% of university students and is associated with academic failure, depression and suicidal ideation, yet clinical screening and high-frequency research designs remain hampered by the burden of 20-item instruments such as the Test Anxiety Inventory (TAI). Although brief measures exist (e.g. the ten-item Westside Test Anxiety Scale and the five-item TAI), a validated, gender-invariant hierarchy of ultra-short forms tailored to contemporary undergraduates is lacking.

To develop and validate a hierarchy of brief TAI versions (ten-item Short Form, five-item Ultra-Short Form and three-item Micro Form) suitable for systematic screening and ecological monitoring in student mental health contexts.

A large sample of Israeli undergraduates (N = 1803) completed the Hebrew TAI. Items were selected based on exploratory factor analysis loadings. Structural validity and gender measurement invariance were confirmed via confirmatory factor analysis.

The five-item Ultra-Short Form showed excellent fit (comparative fit index (CFI) = 0.995, root mean square error of approximation (RMSEA) = 0.05) and the three-item Micro Form exhibited strong standardised factor loadings (≥0.79). Strict scalar invariance was established across genders for all versions. All versions maintained high internal consistency (α ≥ 0.85) and strong correlations with the full scale (r ≥ 0.88). Selected items prioritised somatic over cognitive distress, suggesting contemporary students experience test anxiety as a visceral, physiological ‘survival threat’ rather than cognitive rumination.

These validated brief measures offer a promising toolkit for ‘agile assessment’ in student mental health settings, enabling early identification of at-risk students, pending external criterion validation and independent replication.

Improving access to community-based crisis care and reducing in-patient admissions are key policy objectives in England, yet evidence on who uses crisis-related services remains limited.

To examine sociodemographic patterns in the use of six crisis-related services in England: crisis phonelines; crisis cafés; Crisis Resolution and Home Treatment teams (CRHTs); voluntary in-patient admissions; compulsory in-patient admissions under the Mental Health Act 1983 (MHA); and conveyance to a Place of Safety (PoS) by police under section 136 of the MHA.

This retrospective observational study used the Mental Health Services Data Set (2021/2022−2023/2024). Adults (18+ years) using any of the six services were included. A multinomial logit regression model estimated average marginal effects for age, gender, ethnicity and area-level deprivation, with robust patient-level standard errors and year fixed effects.

Among crisis-related patients, adjusted analysis showed that several ethnic minority groups were more likely than White individuals to be compulsorily detained or brought to a PoS, and less likely to use CRHTs, with the largest disparities in compulsory admissions for Black (+15.0 percentage points) and Asian (+7.3 percentage points) groups. Compulsory admissions were more common among older adults and men (+1.5 percentage points). Crisis phonelines were used less by older adults, men (−4.8 percentage points), Black (−15.6 percentage points) and Asian (−4.7 percentage points) groups. Although adjusted differences by deprivation were small (<1.0 percentage points), over half of users lived in the 2 most deprived quintiles.

Groups at greater risk of coercive care were less likely to access community crisis services. Addressing these disparities could reduce inequalities.

The psychological consequences of hospital admission for COVID-19, such as post-traumatic stress disorder (PTSD), are under-researched.

To describe the prevalence of, and risk factors for, psychological trauma symptoms in COVID-19 patients discharged from hospital.

We used data from the Post-Hospitalisation COVID-19 (PHOSP-COVID) study of adults discharged from UK hospitals after COVID-19. Psychological trauma was assessed using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) 5 and 12 months after discharge. We used log binomial regression to identify risk factors for probable PTSD.

We describe 1565 study participants discharged from hospital between February 2020 and March 2021 following an admission for COVID-19. Most were male (61.3%), White (77.4%) and from more deprived areas (62%). Of these, 15% had probable PTSD (PCL-5 ≥34) at 5 months which was associated with being 18 to 50 years old (risk ratio: 3.0 (2.1– 4.3), p < 0.001), lower income (e.g. <£19,001, risk ratio 2.1, 95% CI: 1.5 – 2.8, p < 0.001), longer admission and a history of depression or anxiety. Out of 236, 136 (57.6%) with probable PTSD at 5 months still had probable PTSD at 12 months. Persistence was associated with intensive care unit (ICU) admission (risk ratio 1.3, 95% CI 1.1–1.6, p < 0.001) and higher anxiety and PCL-5 scores at 5 months.

Probable PTSD was common 5 months after admission for COVID-19 and was associated with lower socioeconomic status, longer admission and previous depression or anxiety. Over half remained symptomatic at 12 months, associated with ICU admission and higher 5-month PCL-5 scores.

Behavioural and psychological symptoms of dementia (BPSD), particularly agitation, are common among people living with dementia, negatively affecting their psychological well-being and quality of life. Non-pharmacological interventions such as therapeutic gardens may offer a holistic approach to managing these symptoms.

This study aimed to investigate whether participation in a multimodal, dementia-specific therapeutic garden intervention could reduce BPSD, with a particular focus on agitation, and improve psychological well-being among people with dementia.

A naturalistic observational study was conducted with 24 residents of a dementia-friendly garden. Participants engaged in tailored, nature-based therapy over 6 months. The intervention was adapted to individual cognitive and physical abilities and included motor, sensory and social activities within the participants’ familiar living environment. Standardised assessments of BPSD and psychological well-being were administered, including evaluations reported by relatives.

The intervention was associated with a significant reduction in agitation, as measured by the non-cognitive subscales of the Alzheimer’s Disease Assessment Scale (p < 0.05). Furthermore, reduced agitation was linked to improved psychological well-being among participants.

The findings suggest that multimodal therapeutic gardens can serve as an effective non-pharmacological intervention in reducing agitation and supporting psychological well-being in people with dementia. This study adds to the growing evidence that therapeutic gardens could contribute to the functional and emotional health of individuals living with dementia.

Access to depression care can be improved by overcoming a combination of supply-side barriers and demand-side factors.

To describe the systematic development of a community-based intervention to improve uptake of, and adherence to, a psychosocial treatment for depression delivered by trained primary healthcare staff in Goa, India.

This mixed-methods study included five steps: Step 1, Synthesis of existing evidence by conducting relevant systematic reviews and a review of public health programmes in India; Step 2, In-depth interviews with community stakeholders (n = 35); Step 3, Consultation workshops with community stakeholders (n = 19) and primary healthcare staff (n = 34); Step 4, Triangulation of findings from the preceding steps; and Step 5, Content development for the intervention (e-course for training and the community intervention toolkit for delivery).

Overall, 20 strategies to enhance help-seeking and 5 strategies to improve adherence were identified to constitute the intervention. The community-based intervention is organised into four domains (Learn, Inform, Engage and Follow-up), with self-care integrated throughout the intervention. This intervention is designed to be delivered by a community volunteer who is motivated to cater to the communities’ needs. The community volunteer is trained to deliver the intervention via a blended approach, an e-course and in-person one-on-one learning support by a coach, who later acts as a facilitator during the intervention delivery phase.

The systematic method enabled the development of a comprehensive intervention with contextually appropriate delivery strategies. The effectiveness of the intervention is presently being tested as part of a Hybrid Type II Implementation-Effectiveness randomised controlled trial. If found effective, the intervention has the potential to be a low-cost and sustainable opportunity to improve demand and adherence to depression treatment while also providing essential social, emotional and logistical support during the recovery process.

Attitudes of mental health professionals towards coercive measures are crucial with respect to both the application of these methods and efforts to reduce coercion in psychiatric care. Existing instruments primarily assess cognitive aspects, often neglecting emotional and contextual dimensions. The Cologne Questionnaire on Attitudes towards Coercive Measures (KEZ) addresses these gaps but has so far only been available in German and in a relatively long format.

To revise the KEZ for international use and develop and validate a short version suitable for both research and clinical practice. The revised version was intended to ensure a balanced representation of different coercive measures.

A revised long version (KEZ-R) was developed and administered via an anonymous online survey to 611 mental health professionals from Germany and German-speaking Switzerland. Psychometric properties of the German version were analysed using factor and reliability analyses. A short form (KEZ-S) was derived on the basis of theoretical and content-related criteria.

The 40-item KEZ-R replicated the original three-factor structure of the KEZ and showed good reliability (Cronbach’s α = 0.87). The 15-item KEZ-S demonstrated strong correlation with the long version and acceptable overall reliability (α = 0.67). Both versions captured cognitive, emotional and interactional aspects of attitudes towards coercive measures.

The KEZ-R and KEZ-S are reliable instruments for assessment of attitudes towards coercive measures in psychiatric settings. Although validation was conducted in German, the availability of an English translation supports international use and future validation studies.