The decision-making process regarding antipsychotic continuation or discontinuation following remission from first-episode psychosis (FEP) remains complex and underresearched. While discontinuation increases the risk of relapse, concerns over long-term side-effects such as metabolic disturbances and extrapyramidal symptoms also exist. Current guidelines recommend maintaining antipsychotics for 1–5 years, emphasising shared decision-making (SDM) between clinicians and patients.

This study aimed to explore the decision-making process and describe the factors influencing the decision to discontinue or continue antipsychotic treatment following remission from FEP, from the patients’ perspective.

A descriptive qualitative study was conducted with 12 individuals in remission from FEP who received care at early intervention services in Quebec, Canada. Data were collected through online semi-structured interviews and analysed thematically to identify key factors influencing treatment decisions.

The decision-making process was activated by treatment reflection triggers and shaped by various perceptions (of illness, treatment and stigma) and relationships (with friends, family and the clinical team), ultimately leading to decisions to either discontinue, continue (at standard or reduced dose) or remain ambivalent. This dynamic process was guided by participants’ motivators, such as well-being and societal contribution. Most participants felt that discontinuation discussions were not initiated by the clinical team.

The decision-making process is driven by motivators that were found to be linked to the concept of personal recovery. This study highlights the need for proactive, personalised discussions between clinicians and patients. Future research should focus on decision aids tailored to the FEP population to support SDM and improve treatment outcomes.

Mental illnesses constitute a large and escalating portion of the global burden of disease, particularly in low- and middle-income countries like Uganda. Understanding community perceptions towards mental illness is crucial for developing effective interventions.

To explore beliefs about the perceived causes and treatment of common mental illnesses (depression, anxiety, alcohol use disorder) and suicidality in rural eastern Uganda.

Qualitative study using 31 in-depth interviews and 4 focus group discussions with healthcare workers, community health workers, community leaders and general community members in Buyende District, Uganda. Vignettes were used to depict mental illnesses to elicit perceptions, and data were analysed using the framework method.

Two main themes emerged: perceived causes and treatment of mental illness. Participants identified three primary perceived causes: psychosocial (predominantly financial stress), biological and supernatural. Community support was most frequently endorsed as a perceived effective treatment, followed by biomedical interventions and alternative therapies.

This study identifies common beliefs regarding the causes and perceptions of mental illness in rural Uganda. The predominant focus on financial stressors as a cause of mental illness, coupled with strong emphasis and belief in the effectiveness of community-based support as treatment, highlights the need for context-specific mental health interventions.

Understanding gender identity in transgender and gender-diverse (TGD) individuals is crucial for effective care. The Gender Preoccupation and Stability Questionnaire (GPSQ) measures the preoccupation and stability of gender identity, but no Italian validation is available.

This study aimed to translate, culturally adapt and validate the Italian version of the GPSQ in a clinical sample of TGD adults.

The GPSQ was translated with a forward–backward method and completed by 151 TGD adults at a gender clinic. Participants also filled out the Symptom Checklist-58 and Body Uneasiness Test. We assessed structural validity (EFA), internal consistency, test–retest reliability, and examined known-groups and predictive validity.

The EFA supported a four-factor structure – Gender Identity Instability, Cognitive-Affective Salience, Preoccupation, and Distress/Intervention-Oriented Reflection – with good fit (root mean square error of approximation 0.06; Comparative Fit Index 0.95; Tucker–Lewis Index 0.93; standard root mean square residual 0.04). The GPSQ showed solid internal consistency (α = 0.78; ω = 0.73) and excellent test–retest reliability (r = 0.98; intraclass correlation coefficient 0.98). Higher scores correlated with psychological distress (r = 0.55, p < 0.001) and body image concerns (r = 0.48, p < 0.001). Preoccupation was most linked to obsessive–compulsive symptoms, and Cognitive-Affective Salience to body image concerns. Participants not on hormones scored higher (p = 0.010, Cohen’s d = 0.36).

The Italian GPSQ is a reliable and valid tool to assess gender-related preoccupation and identity instability in TGD individuals. Its multidimensional structure makes it useful in both clinical practice and research in the Italian context.

Suicidal ideation and behaviours are common among adolescents, posing significant challenges. Parents have a protective role in mitigating this risk, yet they often feel ill-equipped to support their adolescents, and their specific support needs are not well understood.

To explore the lived experiences of parents with suicidal adolescents and identify their support needs in the context of a therapist-assisted online parenting programme.

Semi-structured interviews were conducted with three stakeholder groups based in Australia: nine parents with lived experience caring for a suicidal adolescent, five young people who experienced suicidality during adolescence and five clinical/research experts in youth mental health/suicide prevention. Inductive thematic analysis was used to analyse and interpret findings.

Three key themes highlight the experience of parenting a suicidal adolescent: the traumatising emotional experience, uncertainty and parent empowerment. Six themes described parents’ support needs: validation and support, practical and tailored strategies, rebuilding the parent–adolescent relationship, parental self-care, flexible and accessible modes of delivery, and understanding non-suicidal self-injury.

Findings highlight key themes of parenting a suicidal adolescent and parental support needs. An online parenting programme could offer parents flexible access to evidence-based parenting strategies. Yet, a purely digital approach may not address the complexities of the parent-adolescent dynamic and provide adequate tailoring. As such, a hybrid approach incorporating therapist support can provide parents with both the compassionate support and practical guidance they seek.

Asylum seekers have difficulty gaining access to mental healthcare. Lack of understanding of asylum seekers’ mental illness explanatory models appears to be an important barrier. Gaining a better understanding of these explanatory models is crucial for ensuring the inclusion of asylum seekers in healthcare services. The Cultural Formulation Interview (CFI) might help to explore asylum seekers’ explanatory models of mental illness.

To analyse asylum seekers’ explanatory models as elicited by the CFI.

The CFI and its first supplementary module were carried out with asylum seekers with mental health problems. Transcriptions of the interviews underwent reflexive thematic analysis within a social constructivist framework.

In the analysis of 25 illness narratives, three major themes characterising asylum seekers’ explanatory models were identified: a burden of the past, a disenabling current reality, and a personal position and individual experience.

The interplay among pre-, peri- and post-migration experiences, having a continuous impact on asylum seekers’ mental health, was highlighted by the themes ‘a burden of the past’, and ‘a disenabling current reality’. The theme ‘a personal position and individual experience’ revealed how the CFI enables self-determination in clinical encounters by embracing uncertainty and questioning the medicalisation of distress. The analysis characterises asylum seekers’ symptoms as a personal idiom of distress within socio-relational contexts. The CFI provides a clinically useful framework for exploring asylum seekers’ explanatory models and fostering dynamic understanding.

Hypochondriacal disorder involves persistent anxiety about suffering from an undetected serious medical condition, despite medical reassurance. Hypochondriacal disorder significantly affects social relationships, occupational functioning and personal well-being. In university settings, where mental health concerns are prevalent, insights into prevalence of hypochondriacal disorder and associations with depression and other health challenges are essential.

This study examines the prevalence and correlates of hypochondriacal disorder among Norwegian university students, focusing on its associations with depression, mental distress and somatic symptom burden.

The 2022 Students’ Health and Wellbeing Study, a national survey of Norwegian higher education students, included 59 536 participants aged 18–35. Participants were categorised based on a pre-defined diagnostic list of mental and somatic concerns, and participants were grouped as follows: hypochondriacal disorder only, depression only, comorbid hypochondriacal disorder and depression and controls. Validated instruments included the Somatic Symptom Scale-8, the Hopkins Symptoms Checklist, the Satisfaction With Life Scale, an abbreviated version of the University of California, Los Angeles, Three-Item Loneliness Scale and four items on suicidal ideation.

Hypochondriacal disorder was reported by 0.86% (n = 457) of participants, with 52% also reporting depression. Those with hypochondriacal disorder had significantly worse mental and somatic health outcomes, especially when comorbid with depression, including elevated distress, suicidality, insomnia and poor quality of life.

Although uncommon, hypochondriacal disorder is linked to severe mental and somatic health burdens, particularly when co-occurring with depression. These findings highlight the need for integrated mental health strategies in academic settings to address hypochondriacal disorder and its frequent comorbidities.

Although diagnosis acceptance is frequently discussed in psychiatric practice and research, both components – psychiatric diagnoses and the act of accepting them – are inherently unclear.

The present study aimed to evaluate how well existing theoretical concepts of diagnosis acceptance align with patient experiences and to explore themes related to diagnosis acceptance.

An iterative thematic analysis was conducted on 30 illness narratives from (former) psychiatric patients. The analysis proceeded through three phases: (a) review of transcripts for overall narratives and attitudes toward diagnoses, (b) extraction of detailed data using a narrative summary template and (c) refining and comparison of themes across narratives.

Existing acceptance theories insufficiently captured the lived experiences reflected in the narratives. Attitudes toward diagnoses were multidimensional, fluctuated over time and were often described using terms other than ‘acceptance‘. Participants emphasised the importance of sharing their stories without being defined by a diagnosis and conflated DSM-5 classifications with broader diagnostic terms, highlighting challenges in communication of psychiatric constructs. Disagreement with diagnoses did not necessarily hinder therapeutic relationships, emphasising the importance of collaboration over consensus.

Given the limited practical application of existing acceptance theories and our findings on contextual factors relevant to psychiatric diagnosis attitudes, the necessity of diagnosis acceptance as a stand-alone goal for positive outcomes should be questioned. Rather than imposing classifications, creating co-constructed narratives may be more effective. Researchers and clinicians are encouraged to adopt narrative approaches to better understand and support patients, thereby fostering reciprocal, patient-centred mental healthcare.

CD33 has been implicated in the pathogenesis of Alzheimer’s disease primarily through its role in inhibiting the clearance of beta-amyloid (Aβ). However, genetic studies yield mixed results and it is unclear whether the impact of CD33 is specific to Alzheimer’s disease or related to broader neurodegenerative processes. Interestingly, CD33 has also been shown to interact with the hepatitis B (HBV) and C viruses (HCV).

This study aims to investigate the effects of CD33 single-nucleotide polymorphisms (SNPs) on cognitive functions across diverse populations, including healthy controls, individuals with chronic HBV or HCV and those diagnosed with Parkinson’s disease.

We genotyped CD33 SNPs in 563 participants using the Affymetrix platform. Participants’ cognitive functions were cross-sectionally assessed using a neuropsychological test battery spanning six domains.

Our analysis revealed that CD33 SNP variations had no significant cognitive impact on healthy individuals or Parkinson’s disease patients. However, chronic HBV and HCV patients exhibited significant cognitive differences, particularly in memory, related to CD33 SNP genotypes. Moderation analysis indicated a heightened influence of CD33 SNPs on cognitive functions in chronic HBV and HCV individuals. Our data also suggest that inflammation severity may modulate the cognitive effects in hepatitis patients with specific CD33 SNPs.

This study highlights the importance of CD33 SNPs in cognitive outcomes, emphasising their role in the context of chronic viral hepatitis. It contributes to understanding the cognitive profiles influenced by CD33 SNPs and posits CD33’s potential contribution to neurodegenerative disease progression, potentially intensified by HBV/HCV-induced inflammation.

Prolonged grief disorder (PGD) is a chronic, impairing state of intense grief that is responsive to specialised intervention. Online journalling has the potential to reduce PGD symptoms.

To assess whether reminiscence via online journalling facilitates bereavement adjustment – specifically, to identify key themes in online grief journals and examine associations between types of reminiscence and changes in PGD symptom severity.

A cohort of 96 bereaved adults completed 7 days of online journalling on the Living Memory Home (LMH) bereavement website. Participants were recruited from clinics, bereavement support groups and a National Institutes of Health-funded, web-based platform. The Prolonged Grief Disorder-Revised scale (PG-13-R) was administered at baseline and at 1-week and 1-month follow-up.

Descriptive analysis revealed a reduction in PG-13-R scores from baseline to 1-week follow-up (mean difference −3.7, 95% CI: −4.9, −2.5, P < 0.001) and 1-month follow-up (mean difference −5.0, 95% CI: −6.4, −3.7. P < 0.001). Mixed-methods analysis revealed significant negative associations between reflection on negative traits of the deceased and PG-13-R score at all three time points, and between reflection on past experiences with the deceased and PG-13-R score at baseline. Expression of regret and guilt was significantly associated with reduction in PG-13-R scores from 1-week to 1-month follow-up.

Engagement in the LMH website demonstrated significant declines in PGD symptom severity after 1 week of online journalling and at 1-month follow-up. Guided reflection on memories of the deceased, and even on negative or emotionally challenging memories, shows potential for reducing symptoms of PGD.

Inequality can increase the risk of poor mental health. Objective measures explain the effects of socioeconomic disparities, but individuals may perceive inequality differently.

We aimed to investigate the association between the perception of economic inequality and depressive symptoms and suicide ideation.

We used data from the Survey of Korean Youths’ Lives, a nationally representative cross-sectional study of 14 918 young adults aged 19−34 years in South Korea. Multivariate logistic regression analysis was conducted to assess the association between perceived economic inequalities (i.e. income inequality and inequality of intergenerational mobility) and depressive symptoms/suicide ideation. Additionally, subgroup analyses were performed based on objective and subjective income levels.

Young adults with a high perception of economic inequality were more likely to experience depressive symptoms and suicide ideation. For example, those with a high perception of intergenerational mobility inequality had higher odds of depressive symptoms (odds ratio 1.82, 95% CI 1.49, 2.23) and suicide ideation (odds ratio 1.87, 95% CI 1.35, 2.60). Statistical evidence showed no interaction between the perception of inequalities and income, suggesting that a high perception of inequalities is associated with depressive symptoms and suicidal ideation, regardless of income. Nevertheless, the strongest association with poor mental health was observed in those with high perceived inequality and low income.

This study shows that the way young adults perceive economic inequality could affect their depressive symptoms and suicidal ideation. The findings highlight the importance of reducing these perceptions and addressing economic inequalities to improve mental health.

Attitudes of mental health professionals toward coercion are a potential tool in reducing the use of coercive measures in psychiatry.

This study, part of the nationwide Attitudes toward Coercion (AttCo) project, aimed to assess staff attitudes on a nationwide and multiprofessional scale across adult, child and adolescent, and forensic psychiatric departments.

During 9 weeks in 2023, 1702 psychiatric staff members across Germany filled out a survey including gender, age, profession, work experience and setting, and the validated Staff Attitude to Coercion Scale (SACS). Analyses of variance and multivariate regression analysis for SACS mean overall score were computed to assess group differences.

Participants largely supported that coercion could be reduced with more time and personal contact (mean 4.20, range 1–5), and that coercion can harm the therapeutic relationship (mean 4.08); however, they acknowledged that coercion sometimes needs to be used for security reasons (mean 4.10). Regarding group differences, specialisation (P < 0.001) and professional affiliation (P = 0.008) remained significantly associated with SACS mean score (with a higher score in forensic psychiatric staff compared with staff in adult and child and adolescent psychiatry), when controlling for gender, age and work experience.

Differences in attitudes are predominantly linked to professional training and structural surroundings. Professionals in adult psychiatry and child and adolescent psychiatry are more critical than staff in forensic settings, with an emphasis on patients’ rights and individuals’ integrity. Further studies are needed on how mental health professionals view coercion, and how actual use of coercion is influenced by staff attitudes.

Forming ‘if-then’ plans has been shown to reduce self-harm among people admitted to hospital following an episode of self-harm.

To explore whether the same intervention, delivered online, could prevent future self-harm among a large community sample who had previously self-harmed.

UK adults were recruited to a randomised controlled trial and received either an intervention to reduce self-harm or one to reduce sedentariness (control group). Randomisation was stratified to ensure both groups were representative of the UK population. There were three primary outcomes: non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts, assessed at baseline and 6 months post-intervention.

Participants (1040) were randomised to the intervention (n = 520) or control (n = 520) group. The vast majority of people formed implementation intentions in both the experimental (n = 459 (88.3%)) and control (n = 520 (100%)) condition. Overall, the intervention did not significantly reduce the frequency of NSSI, suicidal ideation or suicide attempts. Among people who had self-harmed in the past week at follow-up, mixed analysis of covariance revealed a significant interaction between time and condition for reflective motivation, F(1,102) = 7.08, P < 0.01, pn2 = 0.07, such that significantly lower levels of reflective motivation were reported at follow-up in the control condition, t(57) = 2.42, P = 0.02.

This web-based intervention has limited utility for reducing self-reported self-harm or suicidal ideation in adults with a history of self-harm. Further work is needed to improve the effectiveness of brief interventions for self-harm aimed at adults living in the community and to understand the conditions under which the intervention may or may not be effective.

Withania somnifera (WS) is considered an adaptogen agent with reported antistress, cognition facilitating and anti-inflammatory properties, which may be beneficial in the treatment of mental disorders.

This systematic review investigated the efficacy and tolerability of Withania somnifera for mental health symptoms in individuals with mental disorders.

The protocol of this review was registered with PROSPERO (CRD42023467959). PubMed, Scopus, PsycINFO, CINAHL, Embase and CENTRAL were searched for randomised controlled trials comparing Withania somnifera to any comparator, in people of any age, with any mental disorder. The meta-analyses were based on standardised mean differences (SMDs) and odds ratios with 95% confidence intervals, estimated through frequentist and Bayesian-hierarchical models with random-effects.

Fourteen studies, corresponding to 360 people treated with Withania somnifera and 353 controls were included. Anxiety disorders were the predominant diagnostic category. Thirteen trials administered Withania somnifera orally (median dose 600 mg/day), one with Shirodhara therapy. The median follow-up time was 8 weeks. Although limited by the small number of studies, substantial between-study heterogeneity, and outlier effects, our investigation showed Withania somnifera effectiveness in improving anxiety (outlier-corrected SMD: −1.13 (95% CI: −1.65; −0.60), pooled SMD: −1.962 (95% CI: −2.66; −0.57)), depression (SMD: −1.28 (95% CI: −2.40; −0.16) and stress (SMD: −0.95 (95% CI: −1.46; −0.43) symptoms and sleep quality (SMD: −1.35 (95% CI: −1.79; −0.91). The effect size was confirmed using the Bayesian for anxiety but not for depression. No significant difference between Withania somnifera and the comparators was found for safety and tolerability.

We found evidence supporting the effectiveness of Withania somnifera in treating anxiety symptoms. Future trials should replicate this finding in larger samples and further clarify a possible Withania somnifera role in depression and insomnia treatment.

Extreme events (e.g. floods and disease outbreaks) can overwhelm healthcare workers (HCWs) and healthcare systems. During the COVID-19 pandemic, high levels of distress and mental ill health were reported by HCWs.

To examine and synthesise research findings reported in the qualitative literature regarding the stressors, and their psychosocial impacts, faced by HCWs in the UK during the COVID-19 pandemic, and to provide lessons for future support.

Qualitative articles were identified in EMBASE and OVID (preregistered on PROSPERO: CRD42022304235). Studies were required to have been published between January 2021 and January 2022 and to have examined the impact of COVID-19 on UK HCWs. We included 27 articles that represented the experiences of 2640 HCWs, assessed their quality using National Institute for Health and Care Excellence criteria and integrated their findings using thematic synthesis.

Several secondary stressors were identified, including lack of personal protective equipment, ineffective leadership and communication, high workloads and problems stemming from uncertainty and a lack of knowledge. Stressors were related to adverse psychosocial outcomes including worry, fatigue, lack of confidence in oneself and senior managers, impacts on teamwork and feeling unappreciated or that one’s needs are not recognised.

Our thematic synthesis moves beyond simply mapping stressors faced by HCWs by considering their antecedents, origins and psychosocial impacts. Utilising a theoretical framework that points towards systemic deficiencies, we argue that secondary stressors can be modified to remove their negative effects. Consequently, workforce planning should shift from focusing on individual change towards amending psychosocial environments in which HCWs work.

Some individuals experience abnormally persistent and intense symptoms of grief that significantly interfere with daily functioning. This condition has been described using terms such as complicated or prolonged grief and prolonged grief disorder (PGD).

To identify the availability of evidence addressing a range of policy relevant issues related to grief, bereavement and PGD. In this paper we focus on the availability of evidence from systematic reviews.

We searched 12 databases and the websites of 18 grief- or bereavement-related organisations. Using key characteristics extracted from included reviews, we produced a high-level overview of the available evidence that enabled potential research gaps to be identified.

We identified 212 reviews – 103 focused on people’s experiences of grief/bereavement including service use; 22 reported on PGD prevalence, 42 on PGD risk factors, 37 on factors that influence grief more broadly and 80 on the effectiveness of grief-related interventions. Fifty-five reviews focused on multiple issues of interest. Half of reviews focused on a specific cause/type of death (n = 108). Of these reviews, most focused on three main causes/types of death: a specific health condition or terminal illness (n = 36), perinatal loss (n = 34) and suicide (n = 20).

We identified a large number of reviews, but key evidence gaps exist, particularly in relation to intervention cost-effectiveness and social, organisational or structural-level interventions that are needed for addressing inequities and other modifiable factors that can impair grieving and potentially increase the risk of PGD.