Questions have been raised whether the patient organisations assessments of coercion – often critical – captures the breadth of patient experiences of coercion. Existing systematic reviews have not captured the full scope of reported experiences, necessitating a more comprehensive approach.

To identify the existing body of qualitative studies reporting patients’ experiences of coercion; map study distribution over time, regions, and type of coercion; and synthesise broad categories of reported experiences.

The review protocol was preregistered (PROSPERO identifier CRD42021248744). We searched 12 databases (MEDLINE, Embase, APA PsycINFO, CINAHL, Web of Science, Sociological Abstracts, Scopus, ASSIA, Norart, SveMed+, OpenGrey.eu and Google Scholar) for qualitative studies published from 1 January 1991 to 3 June 2025. Peer-reviewed studies and approved doctoral theses were included. We used EPPI-Reviewer for screening, data extraction and coding. Study quality was assessed with a modified Critical Appraisal Skills Programme tool.

We included 291 studies, 18 of them from low-and middle-income countries. The most studied coercive practices were involuntary admissions, coercive measures and community treatment orders. Quality concerns included limited author reflexivity and lack of involvement of experts by experience. At least one negative experience was reported in 279 of the studies, while mixed and positive experiences appeared in 166 and 167, respectively.

A large body of qualitative research reporting patient experiences of coercion exists, with a near-universal presence of negative experiences. Improved patient involvement in research, and more studies from low-and middle-income countries and on involuntary medication are needed.

Individuals with schizophrenia have shown distinct cancer incidence patterns.

We aimed to assess whether their cancer-related mortality differs from the general population overall, by gender and by specific cancer types.

We systematically searched Scopus, Web of Science, PsycINFO, PubMed and Embase, up to December 2025. Each record was independently screened by two reviewers, and data were independently extracted by two investigators. Two authors assessed the quality of the included articles with the Newcastle–Ottawa Scale. Analyses were conducted using Stata version 16; between-study heterogeneity was evaluated with Cochran’s Q-statistic and the I2-statistic, and potential sources of heterogeneity were further examined through exploratory meta-regression.

Meta-analysis of cohort studies showed that individuals with schizophrenia had a 55% higher risk of cancer-related death than the general population (standardised mortality ratio (SMR) 1.55; 95% CI 1.16–2.07). In gender-stratified analyses, SMRs for all cancers combined were 1.37 (95% CI 1.01–1.87) in men and 1.43 (95% CI 1.15–1.79) in women. Site-specific SMRs were 1.77 (95% CI 1.17–2.68) for breast, 2.40 (95% CI 2.35–2.45) for respiratory, 1.54 (95% CI 1.35–1.76) for gastrointestinal, 2.32 (95% CI 0.72–7.45) for haematologic, 4.43 (95% CI 0.71–27.62) for skin and soft tissue, 3.03 (95% CI 1.96–4.69) for urogenital and 1.01 (95% CI: 0.36–2.83) for other cancers, although precision varied considerably across cancer sites.

Schizophrenia was associated with substantially elevated cancer-related mortality compared with the general population. These findings underscore the need for earlier cancer detection and guideline-concordant, integrated physical and mental healthcare for this high-risk group.

Post-migration stressors can exacerbate post-traumatic stress disorder (PTSD) and reduce treatment effectiveness among refugees. Evidence for integrated care models in high-income settings remains limited.

To compare treatment as usual (TAU) with an add-on integrated care intervention for unemployed refugees with PTSD.

We conducted a two-arm, parallel-group superiority trial with 1:1 randomisation to TAU or TAU with an add-on integrated care intervention, delivered at a specialised out-patient clinic in Denmark (ClinicalTrials.gov NCT04244864). TAU included sessions with a psychologist and physician over 8–12 months. The integrated care intervention also included structured collaboration with employment services. The primary outcome was functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS) interview. Secondary outcomes included symptoms, quality of life and post-migration stressors. Analyses followed the intention-to-treat principle, using analysis of covariance and linear regression with multiple imputations.

The study included 195 patients in treatment from 2020 to 2025. No difference was observed in WHODAS score between groups pre- to post-treatment (mean difference 0.30, 95% CI −2.40 to 3.00; P = 0.825). Similarly, no differences were found for secondary or exploratory outcomes, and overall change was limited. However, the integrated care group had a lower rate of early dropout (P = 0.042) and higher level of treatment satisfaction (P = 0.035).

Integrated care was feasible but not superior to TAU in improving outcomes for refugees with longstanding symptoms and unemployment. Future research should examine how the timing and intensity of integrated care interventions influence outcomes, including earlier implementation and adequate support for refugees with longstanding and complex needs.

The integrated motivational–volitional (IMV) model of suicidal behaviour has received growing empirical support, yet few studies have tested its core pathways (defeat → entrapment → suicidal ideation → suicide attempts) in clinical psychiatric adolescent populations. Evidence on volitional moderators influencing the transition from ideation to action remains limited.

This study aimed to (a) test the core pathways of the IMV model and (b) examine whether volitional moderators differentiate between adolescents with suicidal ideation and those who have attempted suicide.

In this cross-sectional study, 203 Danish adolescents aged 13–19 years were recruited from an out-patient child and adolescent psychiatry department, including patients in treatment or referred for initial assessment. Participants completed validated measures assessing IMV constructs. Path analysis tested the core pathways and multinomial logistic regression examined associations between volitional moderators and group membership (no suicidal behaviour, suicidal ideation only and suicide attempt), with Wald tests comparing effects across outcomes.

Findings supported the core IMV pathway, with the entrapment–ideation pathway being weakest. Volitional moderators were more strongly associated with suicide attempts than suicidal ideation, with significant differences confirmed by Wald tests. A dose–response pattern showed increasing likelihood of suicide attempts with greater exposure to volitional moderators; effect sizes differed significantly between ideation (odds ratio 2.21) and attempts (odds ratio 3.94).

Results support the IMV model and highlight the role of volitional moderators in differentiating between suicidal ideation and attempts. These findings support a shift towards theory-informed psychosocial assessment in clinical adolescent populations.

Discriminatory practices and barriers to care are increasingly recognised as a significant challenge for mental healthcare institutions. Yet, little research has considered what measures people with experience of using mental health services and mental healthcare service providers recommend to implement anti-discrimination within mental healthcare.

This study aims to explore the perspectives and recommendations of marginalised people with experience of using mental health services, mental healthcare service providers and psychosocial counsellors, to inform more equitable mental healthcare.

Between May 2022 and June 2023, we conducted 17 semi-structured qualitative interviews and 2 focus groups with psychosocial counsellors, people with experience of using mental health services and mental healthcare service providers. Data analysis followed structuring qualitative content analysis, combined with participatory methods.

Study participants recommended interpersonal, organisational and structural measures to address mental healthcare inequities. On an interpersonal level, they emphasised providers’ behaviour and attitudes toward discrimination. Organisationally, they called for a comprehensive intersectional care framework, fostering inclusive therapy environments, increasing staff diversity and implementing continuous anti-discrimination training. Structurally, they advocated for discrimination-critical therapy materials, revised curricula and removing barriers to medical education and healthcare.

The study yielded suggestions for anti-discriminatory, critical consciousness-based and inclusive practices on the interpersonal, organisational and structural levels of mental healthcare. It offers important insights for research devoted to implementing and evaluating such measures.

Task-sharing with non-specialist providers offers a promising solution to the mental health workforce shortage in low-resource settings. Supervision is essential to ensure treatment quality, but is often constrained by limited specialist availability.

This study evaluated the costs of developing PEERS, a smartphone app that can facilitate registering and scheduling supervision sessions, collecting patient outcomes, rating therapy quality and assessing supervision quality among community-based non-specialist providers delivering behavioural activation for depression.

The PEERS digital application was developed between June 2021 and September 2022 for use in Madhya Pradesh and Goa, India. Development involved contributions from researchers, clinicians, technology experts and end users. Activity-based costing was used to systematically document the inputs and expenditures involved in developing the PEERS app and its accompanying training materials from a health systems perspective. Key cost components included human resources, leadership, IT support and infrastructure.

Total development costs were US＄130 027, with the costs of information technology accounting for the largest share (81%; US＄105 110). Human resource contributions accounted for 17% (US＄22 523), which included oversight and contributions from international research collaborators. Additional costs included overhead and infrastructure (US＄2393).

Digital tools are increasingly being used to expand access to and support the delivery of mental health interventions in low-resource settings, yet few studies report on the development costs. By estimating the costs and resources required for developing a digital app for peer supervision, this study can inform efforts to facilitate broader implementation and adaptation of the app for use in other settings.

Afghan refugees experience high levels of cumulative trauma and psychosocial adversity, yet attachment-related trauma has rarely been examined at the narrative level. Narrative attachment assessments may capture culturally embedded expressions of distress beyond post-traumatic stress disorder (PTSD)-focused symptom models.

This study examined narrative attachment-related trauma markers in Afghan refugees receiving out-patient psychological treatment. It investigated whether trauma marker frequency differed between resolved and unresolved attachment representations and whether it was associated with psychological symptom severity.

In an exploratory cross-sectional study, 40 Afghan refugees (mean age = 25.4 years; 75% male) receiving out-patient psychological treatment completed the Adult Attachment Projective Picture System, a narrative-based attachment interview. Trauma markers were identified and quantified within the narratives. Associations with attachment representations (resolved versus unresolved) and psychological symptom severity were examined in a subsample with available self-report data (n = 27).

Participants with unresolved attachment representations showed higher trauma marker frequencies than those with resolved representations. Trauma marker frequency was positively associated with depressive symptoms and overall psychological distress (Spearman’s effect size estimate (r) = 0.40–0.51; 95% bias-corrected and accelerated (BCa) confidence intervals excluding zero) but not with PTSD symptom severity.

Trauma markers captured clinically relevant distress in Afghan refugees beyond PTSD-specific symptomatology, particularly depressive symptoms and general psychological burden. Narrative, attachment-based approaches may be especially valuable in clinical encounters in which distress is conveyed implicitly, relationally, or in culturally contextualised ways rather than through explicit symptom reporting. Culturally sensitive applications of such methods, supported by well-trained interpreters, are essential for clinical understanding and meaningful clinical engagement.

Clozapine reduces overall mortality and suicide risk in schizophrenia, but the specific causes and clinical contexts of death among clozapine-treated patients remain less well characterised.

We aimed to characterise causes of death in clozapine-treated patients within a defined UK catchment area over 17 years (2009–2025); compare features across predefined mortality clusters (suicide, expected, unexpected); compare unexpected death cases with a clozapine-treated comparison cohort alive in 2019 and examine temporal mortality patterns.

We conducted a retrospective, descriptive cohort study of all deaths among clozapine-treated patients within a UK mental health National Health Service Trust between 1 January 2009 and 31 December 2025. Deaths were classified into suicide, expected and non-intentional unexpected, using a previously established framework. Variables were compared across clusters and between unexpected death cases and a clozapine-treated comparison cohort alive in 2019.

Of 87 deaths, 11 (12.6%) were suicides, 29 (33.3%) were expected and 47 (54.0%) were non-intentional unexpected. Malignancy was the most common cause (21/87, 24.1%), followed by cardiovascular (13/87, 14.9%) and respiratory or infective causes (9/87, 10.3%). Age differed across clusters (p = 0.005), with suicides at younger ages. Compared with the 2019 cohort, patients who died unexpectedly were older (55.0 v. 48.6 years, p = 0.006) and more likely to smoke (75.0 v. 34.6%, p < 0.001). Annual mortality peaked in 2021 and was not fully explained by direct COVID-19 deaths.

Mortality in clozapine-treated patients arises across diverse clinical contexts, with more than half classified as non-intentional unexpected. Findings support sustained physical health monitoring, closer attention to smoking and other modifiable risks, and continuity of care.

Cannabis use is common in people with psychosis and is associated with poor outcomes.

To assess insight into cannabis use disorder, perceptions about how cannabis use influences mental health and the desire to change cannabis use among people with psychotic disorders.

Adults with a psychotic disorder and comorbid cannabis use disorder were asked about the impact of cannabis use on their illness and their desire to change cannabis use. Cannabis use disorder was determined using DSM-5 criteria. Participants completed the Substance Use Awareness and Insight Scale.

Sixty-two participants (mean age: 42 years; 95% male; 65% Black ethnicity; 85% severe DSM-5 cannabis use disorder) completed the study. The mean total Substance Use Awareness and Insight Scale score was 4.8 (s.d.: 2.1), with subdomain scores of 3.7 (s.d.: 2.8) for general illness awareness, 6.2 (s.d.: 2.8) for symptom attribution, 3.5 (s.d.: 2.9) for awareness of need for treatment and 5.6 (s.d.: 3.8) for awareness of negative consequences. Fifty-eight per cent said that cannabis use made their mental health ‘better’, whereas only 15% said it made it ‘worse’; 27% reported that cannabis made their psychotic symptoms ‘better’, and 21% said it made them ‘worse’. Nevertheless, more than half the sample (53%) said they wanted to reduce or stop using cannabis.

Many people with psychotic disorders have impaired insight into cannabis use disorder or believe that cannabis improves their mental health; these factors may contribute to persistent use in this population. Interventions that improve insight may help to address ambivalence and support those already wishing to reduce use.

Peritraumatic dissociation and distress are among the most frequently studied early correlates of post-traumatic stress disorder (PTSD), yet their temporal role following large-scale disasters remains insufficiently understood.

This study examined the temporal relationship between peritraumatic dissociation, peritraumatic distress and PTSD symptoms across 3 waves spanning 2 years following the February 2023 Turkey earthquakes.

Data were collected approximately 2 months (Time 1; N = 261), 1 year (Time 2; n = 182) and 2 years post-earthquake (Time 3; n = 131). PTSD symptoms, peritraumatic dissociation and peritraumatic distress were assessed using validated self-report instruments. Pearson correlation analyses and parallel-process latent growth curve models (LGMs) were used to examine temporal changes and longitudinal associations.

Higher initial levels of peritraumatic dissociation (β = 0.40, p < 0.001) and distress (β = 0.46, p < 0.001) significantly predicted greater initial PTSD severity. However, neither peritraumatic dissociation nor distress predicted the slope of PTSD symptoms over time, and slope covariances were non-significant. All three variables declined substantially across waves (ηp2 = 0.75 to 0.79).

Peritraumatic reactions appear to function primarily as indicators of early PTSD severity rather than determinants of long-term symptom trajectories. These findings support multi-stage screening approaches that extend beyond early peritraumatic assessments to incorporate post-traumatic cognitive, social and environmental factors.

Clozapine is the most effective treatment for individuals with treatment-resistant schizophrenia, but concerns about adverse effects continue to limit its use. In contrast to haematological monitoring, which is governed by established protocols, there is no standardised framework for detection of clozapine-associated myocarditis. Clozapine-induced myocarditis is rare but potentially fatal and typically occurs within the first 4 weeks of treatment. As early symptoms such as fever and tachycardia overlap with common side-effects of clozapine, diagnosis is often delayed, and clozapine may be unnecessarily discontinued. Evidence suggests that routine monitoring of troponin and C-reactive protein (CRP), alongside assessment of vital signs and electrocardiography (ECG), can support earlier detection and safer treatment.

To evaluate cardiac monitoring practice in patients initiating clozapine treatment.

We undertook a retrospective review of all patients registered to start clozapine at Kent and Medway Mental Health National Health Service (NHS) Trust between January 2021 and March 2024. Data were collected on baseline ECG completion, weekly troponin and CRP testing during the first 4 weeks, and documented cardiac symptoms.

Of 219 patients, 180 had complete data. Baseline ECG was completed in 80% of cases. No routine troponin monitoring was identified, and CRP testing was infrequent. Tachycardia occurred in more than 40% of patients. Fifteen patients were referred to cardiology before initiation, as well as six in the first 4 weeks and five thereafter. Twelve patients (7%) discontinued clozapine early, mainly owing to tachycardia.

The findings indicate an absence of systematic myocarditis monitoring. Incorporating weekly troponin and CRP testing into existing mandatory blood testing could improve safety, guide appropriate cardiology referrals and reduce unnecessary discontinuation.

Social isolation and loneliness are recognised as important risk factors for various health outcomes. However, their impact on functional bowel disorders (FBDs) remains underexplored.

To explore the associations of social isolation and loneliness with the risk of FBDs in a large prospective cohort.

We included 396 009 participants from UK Biobank who were free of cancer and FBDs at baseline. Social isolation and loneliness were assessed using validated self-reported questionnaires. Incident FBDs were ascertained during follow-up. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs. Mediation, subgroup and sensitivity analyses were conducted.

Over a mean follow-up of 15.2 years, 31 877 incident FBDs cases were recorded. Compared with the least isolated, the most isolated had a higher risk of FBDs (hazard ratio 1.15, 95% CI 1.11–1.20). Loneliness was also associated with higher risk (hazard ratio 1.28, 95% CI 1.21–1.35). The highest risk was observed among participants who were most isolated and lonely (hazard ratio 1.46, 95% CI 1.33–1.60). Depression, anxiety and low physical activity partially mediated the associations between social isolation/loneliness and FBDs. The association between social isolation and FBDs risk appeared stronger among male, overweight and unemployed individuals, whereas middle-aged adults were more susceptible to loneliness-related risk.

Social isolation and loneliness were associated with a higher risk of FBDs, particularly when co-occurring. These findings underscore the potential relevance of social disconnection to FBDs and suggest that it may represent a target for future preventive strategies.

People experiencing homelessness (PEH) attend emergency departments, often presenting with complex needs. The relationship between housing status and access to mental healthcare is not well established.

To compare characteristics, clinical severity and admission rates by housing status, and to examine whether homelessness is associated with admission after adjusting for severity.

We conducted a retrospective cohort study of patients referred to psychiatry at an inner-city emergency department between 1 January and 31 December 2020. Housing status was recorded at presentation. Severity was rated using the Threshold Assessment Grid (TAG, range 0–24). The primary outcome was hospital admission. Group differences were examined using t-tests and χ2 tests. Multivariable logistic regression models assessed variables associated with admission, adjusting for TAG total, age and gender, and then for individual TAG domains.

Of 771 referrals, 282 (36.6%) were PEH. PEH had higher severity (mean TAG 12.3 v. 8.1, p < 0.001) but lower admission rates (10.6 v. 18.0%, p = 0.006). All TAG domains were elevated among PEH, with the largest differences in survival, risk from others and social functioning. Each one-point TAG increase was associated with higher odds of admission (adjusted odds ratio (aOR) 1.34, p < 0.001), as was older age (aOR 1.04 per year, p < 0.001). PEH had lower odds of admission (aOR 0.16, p < 0.001), which persisted following domain-level adjustment (aOR 0.45, p = 0.039).

Despite greater severity, admission rates among PEH were lower following emergency psychiatric assessment. These findings highlight the need for better understanding of how emergency mental health services respond to the complex needs of this population.

Despite growing recognition as a public health concern, the burden of autism spectrum disorder (ASD) in Ethiopia remains poorly characterised owing to limited diagnostic capacity and epidemiological data, hampering evidence-based policy and intervention planning.

This study aimed to quantify the longitudinal burden of ASD in the Ethiopian paediatric population from 1990 to 2023 and project future trends to 2050 to inform national health strategies.

Using Global Burden of Disease (GBD) 2023 data, we estimated ASD prevalence, incidence and disability-adjusted life-years (DALYs) among Ethiopian children and adolescents. Trends were analysed using joinpoint regression and future burden was forecast to 2050 using autoregressive integrated moving average (ARIMA) modelling.

Between 1990 and 2023, ASD prevalence increased by 155%, from 271 805 to 693 644 cases. Correspondingly, the age-standardised prevalence rate increased from 950 to 1185 cases per 100 000 population. Although annual incident cases nearly doubled (from 24 576 to 47 274), the age-standardised incidence rate declined slightly from 86 to 81 cases per 100 000. DALYs increased by 162% to 134 386 in 2023, while the age-standardised DALY rate increased from 179 to 230 per 100 000. Projections to 2050 suggest that the overall ASD burden will persist, with a stable incidence rate but an increasing DALY rate.

Nearly 700 000 Ethiopian children and adolescents were living with ASD in 2023. The significant increases in prevalence and DALYs over three decades underscore the urgent need for a comprehensive national strategy, including enhanced diagnostic infrastructure and early intervention programmes.

Functional neurological disorder (FND) is a common neurological presentation and can be associated with high disability, high healthcare costs and difficulty accessing treatment. Effective treatments are still being established. A feasibility study evaluating eye movement desensitisation and reprocessing (EMDR) therapy as a treatment for FND (MODIFI) demonstrated positive outcomes. The experiences of EMDR for people with FND have not been previously reported.

We aimed to explore the experiences of participants who had completed EMDR therapy in the MODIFI trial.

Participants who completed EMDR therapy in MODIFI were invited to take part in semi-structured interviews on completion of the trial. Eleven participants consented to take part and were interviewed. Interviews were analysed with reflexive thematic analysis.

Analysis was organised into four main domains: (a) expectations before the trial; (b) preparedness for EMDR; (c) mysterious but unique journey and (d) it was hard, but worth it – ‘a rewarding challenge’. Within these domains, we identified ten themes.

Participants reported limited understanding of why or how EMDR might be helpful, but were still motivated to take part. Participants expressed that they had felt anxious about focusing on memories of past experiences. However, they described feeling safe and in control in the therapy, despite it being difficult at times. Overall, participants reported positive effects, and that perceived costs were worthwhile. These results add further support that a full-scale trial evaluating FND-focused EMDR is justified.

Healthcare professional (HCP) students are at high risk of mental health problems, but stigma and fear of career repercussions often deter them from seeking help. Mental Health First Aid (MHFA) is a globally disseminated course teaching the public to identify and respond to people experiencing mental health problems. MHFA training may address some of the challenges faced by HCP students, by improving mental health knowledge and by enhancing well-being and peer support.

To systematically review the available literature regarding the impact of MHFA training on HCP students’ mental health literacy, confidence and intentions to provide help, stigma, peer support and self-care.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews ID: CRD42024589509), five databases were searched. Primary studies evaluating the above outcome measures in HCP students were included. Two authors independently screened references and extracted data. Quality was assessed using the Modified Medical Education Research Study Quality Instrument and Cochrane Risk of Bias tools. A narrative synthesis was performed.

Of 2367 records screened, 26 met inclusion criteria. Confidence in supporting others and mental health literacy showed the most consistent improvements following MHFA training, whereas evidence for changes in stigma was mixed. Peer support, self-care and student well-being were infrequently examined, although qualitative data suggested that MHFA had improved openness to help-seeking.

MHFA shows promise in enhancing mental health literacy, confidence and intentions, and in reducing stigma, particularly when supplemented with experiential learning. HCP students may benefit from tailoring of such courses to their specific needs, fostering a culture of peer support, enhancing well-being and introducing basic concepts in mental health.

Post-traumatic stress disorder (PTSD) symptoms can fluctuate substantially over short periods, yet routine screening typically relies on infrequent self-report. Wearable sensors provide continuous behavioural and physiological signals that may help identify periods of elevated risk.

This study aimed to evaluate whether combining wearable sensor features with daily self-report data could identify short-term PTSD symptom increases among recently discharged veterans.

Seventy-four veterans wore commercial activity trackers and completed brief daily questionnaires over 87 days. For each participant, we defined an individual baseline by using the first 14 days of PTSD scores. Wearable variables were transformed into baseline-referenced deviation features to capture departures from personal norms. Missing data were addressed with multiple imputation by chained equations. Candidate predictors were prioritised with least absolute shrinkage and selection operator regression, and a set of machine-learning classifiers was evaluated. Primary performance was assessed by using the area under the precision–recall curve (PR AUC).

Across feature set sizes (k = 1–25), performance peaked at k = 17. At this iteration, LightGBM achieved the strongest discrimination (PR AUC 0.86 (s.d. 0.07); area under the receiver-operating characteristic curve 0.89 (s.d. 0.04)) with a precision of 0.67 (s.d. 0.08), recall of 0.64 (s.d. 0.08) and F1 of 0.65 (s.d. 0.07). Key predictors reflected a multimodal profile, combining self-reported affect and perceived stress with wearable indicators of sleep continuity, activity variability and autonomic regulation.

Baseline-referenced wearable features combined with daily self-report may help identify near-term PTSD symptom increases among recently discharged veterans with elevated PTSD symptoms and problematic cannabis use. Future work should validate performance in broader PTSD populations, including samples without problematic cannabis use.

Women with first-episode psychosis (FEP) may experience distinct clinical, reproductive and social challenges, yet their experiences of psychosis care remain underexplored. Greater understanding of women’s perspectives is needed to inform gender-responsive service provision.

To explore how women make sense of their experience of psychosis care, to identify areas where gender-specific needs were unmet and to highlight priorities for improving care for women experiencing FEP.

This qualitative study employed semi-structured interviews with women who had experienced FEP and received care through early intervention in psychosis and adult community mental health services (N = 15). Data were analysed using reflexive thematic analysis.

Four overarching themes were identified: (a) violations of personhood and bodily integrity; (b) invisible menstrual and reproductive health in mental healthcare; (c) women-specific barriers to accessing and sustaining care; and (d) moving towards better care for women with FEP. Women described feeling unsafe in mixed-gender in-patient settings, experiencing unmet reproductive and menstrual health needs and navigating caregiving responsibilities that complicated engagement with care. Findings informed a framework of recommendations for improving gender-responsive psychosis care.

This study provides one of the first in-depth qualitative examinations of women’s experiences of FEP care. Women described how their experiences were shaped by issues of safety, autonomy, reproductive health and gendered expectations that remain insufficiently recognised within current service models. These findings highlight persistent gaps in sex- and gender-responsive psychosis care, and support the development of services that more effectively address women’s safety, reproductive health and caregiving needs.