Children and adolescents with psychosis are more likely to have a poor prognosis and to experience treatment resistance, than adults. This is associated with a reduced quality of life, as well as increased care needs and economic cost. Clozapine is recommended for treatment-resistant psychosis because of greater efficacy than other antipsychotics, however this can be insufficient. Clozapine can be augmented with a range of different treatments, however there is relatively little data available for this in children and adolescents.

A systematic search was carried out of four databases (Embase, Medline, PsycInfo, CINAHL) from inception to February 2026, to identify studies of pharmacological and non-pharmacological clozapine augmentation strategies in children and adolescents, including psychotherapeutic or psychosocial interventions, neuromodulation, and nutritional or dietary supplements. To be eligible for inclusion, patients in the study needed to be prescribed clozapine prior to initiation of the adjunctive treatment, and to have outcome measures recorded before and after augmentation. The study was registered on PROSPERO (CRD42024564242).

Nine studies were found that reported on children or adolescents (n=59) receiving medications, ECT or other neuromodulation techniques to augment clozapine. The majority (6/9) were case reports or case series, retrospective chart reviews and one pilot RCT. Some clinical improvement was reported for a majority of patients in the included studies, however this was mostly short-term. No reports were found on adjunctive psychotherapeutic or psychosocial intervention, nor nutritional or dietary supplementation.

Some clozapine augmentation strategies may be effective in children and adolescents, but available evidence is limited and very weak. Of note, the search identified a number of studies which could not be included due to lack of outcome measures. This highlights the potential importance of routinely collected outcome data, in building an evidence base for rare presentations. Research into psychotherapeutic or psychosocial treatments was also lacking. Further high-quality, prospective research is needed to address this gap.

A proportion of patients with anorexia nervosa require compulsory admission due to treatment refusal in the context of high medical or psychiatric risk.

The clinical characteristics and treatment outcomes of patients with anorexia nervosa compulsorily admitted for in-patient care (current and previous) were compared with those of patients admitted voluntarily. The characteristics of their caregivers were also evaluated.

This is a secondary analysis of the Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise trial. We included 274 patient–caregiver dyads: 62 on compulsory admission (‘current compulsory’), 48 on voluntary admission with a history of compulsory treatment (‘previous compulsory’) and 164 on voluntary admission without a history of compulsory treatment (‘voluntary’). Baseline demographic and clinical characteristics, and longitudinal clinical outcomes at 3–6 and 9–12 months, were compared across groups.

Patients in the current compulsory group had an earlier age of onset, a higher proportion of obsessive–compulsive disorder comorbidity and less motivation and confidence to change compared with the voluntary group. The previous compulsory group showed a longer illness duration, older age and lower body mass index (BMI) compared with the other groups. All groups showed improvement, with similar outcomes at the end of the study except for depression symptoms and BMI. Caregivers had varying levels of distress and caregiving skills at baseline, which had improved by the end of the study.

People receiving current or previous compulsory treatment presented with diverse clinical presentations. Further studies are needed to determine whether more individualised approaches improve outcomes in these subgroups.

Trial registration number and data-set information: ISRCTN14644379.

Social anxiety is a common and impairing condition that often emerges in adolescence.

This study aimed to examine the prevalence and severity of social anxiety among Chinese youths in the post-COVID-19 era, and to develop a predictive model identifying key factors associated with social anxiety severity.

A total of 555 youths aged 15–25 years completed an online survey via WeChat on social anxiety (Social Phobia Inventory), depressive symptoms (Patient Health Questionnaire), sleep problems (Pittsburgh Sleep Quality Index), social support (Multidimensional Scale of Perceived Social Support) and internalised stigma (Internalized Stigma of Mental Illness Scale). Social anxiety severity and rates were described, and comparisons were made across sociodemographic groups. Hierarchical multiple regression was used to predict social anxiety severity from depression, sleep, social support and stigma. An additional regression examined which components of social anxiety (fear, avoidance, physical symptoms) predict internalised stigma.

In total, 69.55% of participants reported at least mild social anxiety, with 20% reaching severe or very severe levels. Female, younger participants and those with fewer close friends reported significantly higher anxiety. Depressive symptoms (β = 0.31, P < 0.05) and internalised stigma (β = 0.40, P < 0.05) were strong predictors of anxiety severity, while sleep problems and social support were not significant after controlling for these factors. Among social anxiety dimensions, only avoidance significantly predicted higher stigma (β = 0.17, P < 0.01).

The high post-pandemic prevalence of social anxiety among youths highlights the need for early identification, stigma reduction and interventions targeting depression and avoidance to prevent long-term impairments.

Research on gender-based violence has shown the influence of Dark Tetrad personality traits (i.e. Machiavellianism, narcissism, psychopathy and sadism) on the development and perpetuation of sexist attitudes and cognitions that justify or condone harmful behaviours.

This study explored the potential mediating role of empathy in the relationship between the Dark Tetrad personality traits and support for vindictive rape, as a form of revenge for the perceived violation of traditional sexual norms.

A sample of 1548 adult individuals from the general community (67.3% female, age range 18–83 years) completed the Dark Triad Dirty Dozen, the Short Sadistic Impulse Scale, the Basic Empathy Scale and the Vindictive Rape Attitude Questionnaire.

The results showed that empathy partially mediated the relationship between sadism and attitudes supportive of vindictive rape, while a full mediation of empathy was found in the association between Machiavellianism, psychopathy and attitudes supportive of vindictive rape. Conversely, no significant association between empathy or vindictive rape and narcissism was observed.

Empathy plays an important role in mitigating the effects of Dark Tetrad personality traits on support for vindictive rape. Given the global prevalence of violence against women, these findings are discussed in the context of a social climate that may reinforce the perpetuation of gender inequalities and sex-based stereotypes that are at the root of the acceptance of violence.

Glucocorticoids are widely prescribed for autoimmune and inflammatory conditions, but their long-term use carries serious risks. Patients with psychiatric disorders have a high burden of medical comorbidities, which may be associated with higher odds of receiving sustained glucocorticoid therapy.

We examined whether psychiatric patients were more likely to receive sustained oral glucocorticoid therapy compared with controls, and assessed variation across psychiatric subgroups.

This retrospective, nationwide cohort study used South Korea’s National Health Insurance Service database. Adults diagnosed with a major psychiatric disorder in 2021 (n = 331 020) were compared with a sample without psychiatric disorders (n = 668 980). Propensity score matching generated 283 942 participants per group. The outcome was sustained oral glucocorticoid use in 2022, defined as ≥90 cumulative days with continuous therapy ≥90 days and prescription gaps ≤30 days.

Before propensity score matching, glucocorticoid use in 2022 was more frequent in psychiatric patients (13.8%) than controls (10.8%; odds ratio 1.32, 95% CI 1.31–1.34; P < 0.001). After matching, the difference persisted (14.7 v. 12.5%; odds ratio 1.18, 95% CI 1.16–1.19; P < 0.001). Multivariable analyses confirmed higher odds of glucocorticoid use (odds ratio 1.05, 95% CI 1.03–1.06; P < 0.001). Increased risk was observed for anxiety disorders (odds ratio 1.06) and obsessive–compulsive disorder (odds ratio 1.07), whereas major depressive disorder showed no significant association.

Psychiatric patients are more likely to receive sustained glucocorticoid therapy, underscoring the need for cautious prescribing and monitoring in this vulnerable population.

Dissociative identity disorder (DID) manifests with distinct trauma-avoidant and trauma-related identity states. Overtly conscious trauma-related knowledge processing is identity state-dependent. Previous research on covertly subconscious knowledge processing in DID lacks subject-specific trauma-related stimuli.

Our controlled functional magnetic resonance imaging (fMRI) study explored neural and behavioural differences of overt and covert knowledge processing of individualised self-relevant words in DID.

Behavioural data were gathered while 56 participants underwent task-based fMRI: 14 with DID, 14 DID simulators and a paired control group of 14 healthy controls and 14 participants with post-traumatic stress disorder. Individuals with DID and simulators participated in a trauma-avoidant and a trauma-related identity state. Reaction times and brain activation following overtly and covertly presented individualised words were statistically analysed.

Behavioural analyses showed a main effect of consciousness (P < 0.001). Post hoc between-group pairwise comparisons revealed slower reaction times for individuals with DID compared with simulating (P < 0.05) and paired controls (P < 0.05). Neural data analyses showed increased brain activation in frontal and parietal regions within the diagnosed DID group, especially during overt processing. Between-group comparisons mostly showed less pronounced activation in frontal, occipital and temporal areas.

The present study showed increased cognitive control during overt self-relevant knowledge processing in the trauma-avoidant identity state of DID, in line with previous research. The slower reaction times and increased frontoparietal activation shown in individuals with diagnosed DID, as compared with both control groups, support the notion of cognitive avoidance of trauma-related information in DID and further reinforce the authenticity of DID experiences.

This audit evaluated the Sheffield Health Partnership University NHS Foundation Trust’s (SHPU) adherence to standards for patients receiving Electroconvulsive Therapy (ECT) as outlined by the Electroconvulsive Therapy Accreditation Service (ECTAS) guidelines. The primary objective was to assess the documentation of consent, capacity, target symptoms, and cognitive side effects throughout the treatment course and follow-up phases. Secondary objectives were to identify any improvement in compliance compared with previous audits, and assess whether high quality ECT was being delivered, as determined by statistical analysis of changes in measures of target symptoms and cognitive side effects.

A retrospective audit was conducted on all patients who underwent ECT between December 2022 and December 2024 (N=16). Data were extracted from electronic records to measure compliance with standards for documentation of consent and capacity, and completion of validated scales including the Montgomery–Åsberg Depression Rating Scale (MADRS), Mini-Addenbrooke’s Cognitive Examination (mini-ACE), Clinical Global Impression (CGI), and Item 17 of the Comprehensive Psychopathological Rating Scale (CPRS). Bonferroni corrected paired t-tests were performed on mean assessment scores pre- and post-ECT.

Demographics were comparable to previous datasets. Documentation of legal framework and consent prior to each treatment met SHPU/ECTAS standards. Baseline monitoring achieved 100% compliance for all measures but declined during the treatment phase, falling below 75% by course completion. One-month follow-up showed minor improvement in adherence, followed by successive reductions in months two and three. Analysis of missing data found patients receiving inpatient ECT had more missing data per person on average (11.5 vs. 8.2 for outpatient treatment). Our findings suggest similar compliance to monitoring compared with previous local and national audits. Locally delivered ECT remains efficacious: mean MADRS scores reduced from 42.1 to 21.3 (p<0.01), and mean CGI scores improved from 5.5 to 2.5 (p<0.01). Objective cognitive scores (mini-ACE) significantly increased from a mean of 19.7 to 23.9 (p<0.01), and subjective memory measures (CPRS) showed no statistically significant change.

Findings show that while the service delivers clinically effective treatment with robust initial safeguarding, longitudinal monitoring remains inconsistent. Proposed interventions include the ECT team assuming responsibility for post-treatment monitoring to minimise variability driven by inpatient pressures/discharges to community teams during follow up, updates to local ECT documentation processes to minimise missing data, and establishing ‘ECT Champions’ within referring teams to improve communication and follow-up adherence.

Little is known about self-harm in children involved in family justice proceedings, particularly in private family courts in England and Wales.

To examine records of self-harm in children involved in private and public law proceedings using population-level linked data.

A retrospective e-cohort study of children aged under 18 years, using linked health and family justice (Cafcass Cymru) data (2011–2018). Family court involvement was recorded from age 0 to 17 years. Incidence of self-harm was recorded from age 10 to 17 years to fit with the standard definition of self-harm. Annual incidence of self-harm over time across general practitioner (GP), emergency department and hospital admissions for individual children in private and public law proceedings were compared with a non-court cohort using Poisson regression. Self-harm following court proceedings was compared with an age- and gender-matched non-court cohort using Cox regression.

Adjusted self-harm rates were higher in court-involved children than the non-court cohort (incident rate ratios (IRRs) (95% CI), private: GP 1.8 (1.6–2.1); emergency department 1.4 (1.2–1.7); admissions 1.8 (1.5–2.1); public: GP 4.6 (4.1–5.3); emergency department 5.0 (4.3–5.8); admissions 5.0 (4.3–5.8)). Compared with matched comparison children, risk of self-harm was higher following private (adjusted hazard ratios 2.0 (1.7–2.2)) and public court proceedings (hazard ratio 2.3 (2.7–3.8)). Hazard ratios were greater for those from less deprived areas and those with no history of self-harm.

The elevated risk of self-harm in children involved in public law proceedings is well recognised. Our study highlights risk in children in private family justice proceedings. Elevated risk among those from less deprived areas and those with no history of self-harm may reflect circumstances associated with family justice involvement, resulting in rates comparable to children with other pre-existing vulnerabilities. Contact with family justice is an opportunity to offer preventative support.

Little is known about health-related quality of life (HRQoL) in familial intellectual disability. Economic evaluations of interventions for familial intellectual disability require HRQoL measured through utility data.

We aimed to estimate HRQoL in individuals with familial intellectual disability and their carers and spouses, and identify factors associated with HRQoL.

Families with at least one member with familial intellectual disability were recruited and completed a tailored questionnaire. HRQoL was measured with the Assessment of Quality-of-Life 8D for carers and spouses, and the Health Utilities Index 2 (HUI2) and 3 (HUI3) for individuals with intellectual disability.

A total of 108 carers and 35 spouses, caring for 171 individuals with intellectual disability, completed the survey. Health utility values for carers (0.58) and spouses (0.63) were significantly lower than age- and gender-adjusted population norms (0.8) (p < 0.05). Utility values for individuals with intellectual disability were 0.51 (HUI2) and 0.31 (HUI3), also significantly below age-adjusted norms (p < 0.05). In carers, approximately half reported a mental health condition, and multivariate regression showed that having a mental health disorder, financial stress and caring for someone with aggressive behaviour were associated with lower HRQoL. In individuals with intellectual disability, greater disability severity and need for full-time supervision were associated with lower HRQoL, whereas living with their carer was associated with higher HRQoL.

Familial intellectual disability is associated with significantly lower quality of life of individuals with intellectual disability, their carers and their spouses. HRQoL across the family may help guide planning of health and social support, and demonstrate to policy makers the additional support needs for these families.

Diabetes distress, whereby people with diabetes experience distressing psychological symptoms associated with living with their condition, is an emerging problem in India. Diabetes distress leads to self-care deficits, suboptimal glycaemic control (which can lead to increasing risks of complications) and impaired quality of life.

To determine the burden of diabetes distress and its associated factors in an Indian tertiary care centre in Trichy, Tamil Nadu, India, covering a population of 1.25 million.

This prospective observational study involved a structured questionnaire covering demographic and clinical details, which was given to patients. The Diabetes Distress Scale 17 (DDS-17) was used to assess diabetes distress levels. The DDS-17 also measures four subdomains: emotional burden, physician-related distress, regimen-related distress and diabetes-related interpersonal distress. Patients were divided into two groups based on their DDS-17 score: no diabetes distress (DDS-17 score <2) versus diabetes distress (DDS-17 score ≥2) and compared. Correlation analysis, chi-squared tests and t-tests were used, with P < 0.05 considered statistically significant.

Of 1019 respondents (mean age 56 years; 59.6% male, 40.4% female), diabetes distress was reported in 24.4% (n = 249). Factors significantly associated with higher DDS-17 scores were younger age (<45 years) (P < 0.0001), long-standing diabetes (>10 years) (P < 0.0001), and smoking and alcohol (P < 0.05). Significant protective factors for diabetes distress included working, daily exercise, no comorbidities and medical insurance cover (P < 0.05). Significant positive correlation between DDS-17 score and all four subdomains was observed (P < 0.0001).

Our findings highlight the need for routine psychological screening and holistic management strategies in diabetes care, to improve patient outcomes and quality of life.

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.

Despite the high prevalence of mental health difficulties in young refugees and asylum seekers, evidence suggests that they underutilise mental health services. It is important that we understand their use of, and access to, mental health services.

To examine quantitative evidence on mental health service utilisation and access among young refugees and asylum seekers.

We searched MEDLINE, PsycINFO, Embase, Global Health and The International Bibliography of the Social Sciences. Searches were supplemented by reference list screening and forward-and-backward citation tracking of included studies. Results were synthesised narratively. Our review was pre-registered on PROSPERO (no. CRD42024540885) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Twenty-two studies were included. We found an overall pattern of underutilisation of services by young refugees in comparison with majority population peers, particularly for out-patient services and psychotropic medication. In contrast, there was evidence of increased emergency service use. Service use was particularly decreased for those from low- and middle-income countries, and increased in unaccompanied minors. Service use for trauma-related disorders and schizophrenia was most common, and less likely for neurodevelopmental disorders. Only one study contained data on access-related factors, which identified language as a potential barrier.

There is a disparity between the mental health needs and service use of young refugees, suggesting a need for greater efforts to increase access and use in this population. Future research should explore barriers and facilitators, and build on primary research examining service use in asylum seekers and unaccompanied minors, because both remain underrepresented within the literature.

The APOE-ε4 allele is the most significant genetic risk factor for developing late-onset Alzheimer’s disease (AD), with an estimated lifetime risk of 30% in ε4 heterozygotes. Previous guidelines have recommended against APOE genotyping based on its limited clinical utility in routine practice. This has changed with the advent of amyloid-targeting immunotherapies, multimodal interventions for reducing AD risk and commercially available APOE genotyping services. Given this changing landscape, there is a need to formulate APOE-ε4 genetic counselling tailored to the UK context. We set out to study the attitudes of UK adults to genetic testing and counselling for the APOE-ε4 gene.

We carried out a digital survey on the online POrtal for Patient and Public Engagement in Research (POPPED, https://popped.org.uk). This was advertised via research register mailing lists and is still ongoing. The survey queried respondent demographics, motivations and concerns regarding APOE-ε4 testing, content and format of genetic counselling, and willingness to undertake preventative interventions. Responses were collected with a combination of 5-point Likert scales, ranking and multiple choice questions. Ethical approval was obtained from a university ethics committee and all respondents consented to have their responses stored anonymously on a secure server.

794 responses were received from 7 January – 4 February 2026. Most respondents were aged 65–74 years (38.7%) or 75–84 years (23%), 66.9% were female, and 61.8% had a family member with dementia. 82.7% of respondents were ‘likely’ or ‘some what likely’ to get tested for the APOE-ε4 gene. The main motivations were to contribute to research (85.4%), to adjust life plans accordingly (71.9%) or to understand their dementia risk (70.9%). The main concerns were that no cure for dementia exists (50.4%), inaccurate risk estimation (50.4%), and emotional upset (44.1%). The preferred format of genetic counselling was a face-to-face appointment (86.1% rated this as ‘very appropriate’), and 73.4% of respondents would be likely to accept subsequent preventative lifestyle interventions.

A high proportion of our respondents would be likely to seek out APOE-ε4 testing and counselling, and to subsequently accept lifestyle interventions and be involved in research. While our sample may not be completely representative of the general population, these initial results suggest that there is a need to develop guidelines for face-to-face genetic counselling for UK adults who choose to undergo APOE-ε4 testing.

The COVID-19 pandemic disrupted daily social interactions, potentially affecting mental health. Understanding the risk of depressive and anxiety symptoms is essential for guiding mental health strategies during future crises.

To explore how social networks influenced mental health outcomes during the pandemic and how these relationships changed over time.

Data from the Omtanke2020 study, a prospective cohort study of Swedish adults, were analysed using structural equation modelling (N = 10 918). Surveys at baseline and follow-up at 6 and 12 months assessed social networks, including structural components (e.g. relationship status, frequency of social contact) and perceived components (e.g. emotional support from family, feeling safe at home). Cross-lagged panel modelling was used to observe changes over time in the associations between social network indicators and depressive and anxiety symptoms.

Stronger perceived social support – specifically closeness to family, perceived warmth or love from others and increased societal cohesion – were negatively correlated with depressive and anxiety symptoms across all time points (β coefficients = −0.14 to −0.23, all P < 0.001). Social network variables consistently predicted mental health outcomes, with effect sizes remaining relatively stable over time (β coefficient = −0.17 at baseline, β coefficient = −0.21 at 1-year follow-up).

This study highlights the protective role of the social network – namely perceived social support – in combatting depressive and anxiety symptoms during the COVID-19 pandemic. Interventions that strengthen close interpersonal ties and community cohesion may help mitigate mental health impacts during future public health crises.

Adolescent mental health is a growing public health concern due to the high prevalence of mental disorders, many of which remain unrecognised and untreated. School staff are strategically positioned to promote mental health, recognise mental health problems and support pathways into care, but often lack sufficient mental health literacy (MHL) and confidence to act.

This study evaluated the effects of the WhySchool project, a school-based programme to promote MHL among teachers and school health professionals (SHPs).

We implemented WhySchool in 72 public middle and high schools across Portugal through a cascade training approach. With a pre–post design, we assessed 788 teachers and 201 SHPs on mental health knowledge (MHK), personal depression stigma, openness to seeking help and confidence in identifying/referring students. Paired-sample t-tests with Cohen’s d estimated changes, and generalised linear mixed models (GLMMs) accounted for confounders and within-subject variability.

The programme was associated with significant improvements in all outcomes across both professional groups, with moderate-to-large effect sizes (MHK d = 1.12 (95% CI 1.04 to 1.20); stigma d = −1.05 (95% CI −1.12 to −0.97); openness d = 0.44 (95% CI 0.37 to 0.51); confidence d = 0.87 (95%CI 0.79 to 0.94)). GLMMs confirmed these results. Gains varied across professional groups and demographic characteristics, with those having lower baseline scores generally benefiting most.

The WhySchool resulted in observable improvements in teachers’ and SHPs’ MHL, including increased knowledge, reduced stigma, improved help-seeking attitudes and strengthened confidence to support students. The cascade model provides a viable and sustainable strategy for large-scale implementation, empowering educational communities to better support student mental health.