Disclosure of a mental health problem carries both risks and benefits. It can be seen as a measure of perceptions of the social environment in which people with mental health problems live, work and study. A nationally representative Australian survey conducted in 2014 showed that, in many settings, non-disclosure was more common than disclosure. This study aimed to investigate whether disclosure in a broad range of settings has changed since the 2014 national survey.

Large nationally representative surveys of Australian adults were conducted in 2014 and 2024. For each, those who reported a mental health problem or were experiencing high psychological distress (n = 1381 in 2014, n = 2613 in 2024) were asked about disclosure in multiple settings. Regression analyses were used to explore whether changes between survey years were significant at p < 0.01, adjusting for sociodemographic variables of age, gender, education level, language spoken at home, country of birth and type of mental health problem. Secondary analyses assessed the sociodemographic and mental health problem characteristics associated with changes.

In 2024, participants were less likely than in 2014 to have disclosed to friends, partners, family members and some people in the neighbourhood, with relative risk ratios (RRRs) ranging from 0.33 (99% confidence interval [CI]: 0.23, 0.48; p < 0.001) for all family members to 0.64 (99% CI: 0.46, 0.88; p < 0.001) for some people in the neighbourhood. Workplace disclosure did not change significantly. For health professionals not involved in mental health treatment, the RRRs of disclosure were higher in 2024 than in 2014 (RRR = 1.56 [99% CI: 1.16, 2.10; p < 0.001] for disclosure to some and RRR = 2.31 [99% CI: 1.61, 3.32; p < 0.001] for disclosure to all).

Except for disclosure to health professionals not involved in mental health treatment, there have been decreases or no changes in disclosure of a mental health problem in most settings over the last 10 years. This likely reflects both perceptions of, and actual, reductions in supportive social environments. Urgent action is needed to ensure that, for people who do disclose a mental health problem, the benefits strongly outweigh the risks.

The COVID-19 pandemic is often portrayed as a universal mental health crisis, especially in studies lacking pre-pandemic data. Research including pre-pandemic assessments nonetheless yields mixed results, making the pandemic’s impact unclear, particularly when considering differences between general and clinical populations (defined as individuals with prior mental disorder diagnoses). This study examined depression and anxiety trajectories from pre-pandemic to pandemic phases in general and clinical populations. It also explored how symptom trajectories varied by sociodemographic and pandemic-related factors.

In the current study, we drew on three general-population cohorts from Germany and France (n = 1,813) that had previously been harmonized within the Co-RESPOND project. We additionally harmonized and integrated three clinical cohorts from the Netherlands (n = 1,069) into this pooled dataset. Cohorts were included in the present study if they provided pre-pandemic baseline data and at least two assessments during the pandemic. Anxiety and depressive symptoms were measured using validated instruments and transformed into z-scores to enable cross-cohort comparability. Symptom trajectories were identified separately for general-population and clinical cohorts using latent growth mixture modelling, and logistic regressions were used to examine factors associated with trajectory membership.

Participants in the general-population sample had a median age of 39.8 years, while those in the clinical sample had a median age of 57.4 years. Women accounted for 64.6% of the general-population group and 67% of the clinical group. In the general population, approximately 80% showed decreasing symptoms, including those with higher initial severity, while 20% maintained low levels. Divorce/separation and having children were related to more favourable anxiety and depression trajectories, while older age and childcare burden were associated with less favourable trajectories of depressive symptoms. In the clinical population, approximately half improved from moderate symptom levels, with the remainder exhibiting consistently high or low symptoms. Being in a relationship, older age and being a man were linked to more favourable anxiety trajectories.

This study provides substantial evidence that the COVID-19 pandemic did not lead to a uniform deterioration in mental health, as most adults across both general and clinical populations experienced stable or improving symptoms. Our findings underscore the need for mental health surveillance and differentiated, proportionate responses that reflect diverse symptom patterns and risk profiles.

Migrant domestic workers (MDWs) are separated from family and at-home support networks while working abroad. This may affect their mental health due to stressors, social isolation and loneliness. Evidence shows mixed results on whether social capital and social support enhance MDWs’ mental health, warranting further investigation. This study assessed how positive and negative dimensions of social network capital are associated with mental health, loneliness and self-rated health among MDWs in Macao SAR, China.

Using respondent-driven sampling, 1,681 MDWs (Filipino n = 1329; Indonesian n = 352) were enrolled. Egocentric name-generating questions captured network size, emotional closeness, social support helpfulness, reciprocity burden and financial support access. Multivariable linear regression examined associations stratified by nationality, and subgroup analysis by network type were examined. To address multiple comparisons across five network capital measures and five outcomes, p-values were adjusted using the Benjamini–Hochberg (BH) false discovery rate procedure.

Network capital characteristics differed across network types. The mean (standard deviation) overall network size was 6.00 (3.77) for Filipino MDWs and 3.69 (2.52) for Indonesian MDWs. Following BH adjustment, among Filipino MDWs, greater social support helpfulness was associated with lower loneliness (Standardized β [Stdβ] = −0.15, Standard error [SE] = 0.02, p < 0.001) and better self-rated health [Stdβ = 0.15, SE = 0.01, p < 0.001]), while higher reciprocity burden was consistently associated with poorer outcomes (e.g., post-traumatic stress disorder [PTSD]: Stdβ = 0.21, SE = 0.63, p < 0.001). Network size was associated with higher mental health symptom scores (Depression: Stdβ = 0.08, SE = 0.04, p = 0.004; Anxiety: Stdβ = 0.08, SE = 0.04, p = 0.003; PTSD: Stdβ = 0.08, SE = 0.11, p = 0.003), but less loneliness (Stdβ = –0.07, SE = 0.01, p = 0.007). Among Indonesian MDWs, reciprocity burden and financial support access showed associations primarily with depression (reciprocity burden: Stdβ = 0.44, SE = 0.60, p < 0.001; financial support: Stdβ = 0.22, SE = 0.97, p = 0.007) and anxiety (reciprocity burden: Stdβ = 0.32, SE = 0.60, p < 0.001; financial support: Stdβ = 0.23, SE = 0.97, p = 0.008) within roommate networks. Most standardized effect sizes were modest (Stdβ < 0.25).

Network capital is associated with mental health, loneliness and self-rated health among MDWs, but patterns differ by nationality and network type. Culturally responsive and context-specific strategies that strengthen supportive ties and reduce network-related burdens may improve MDWs’ health.

Refugees bear the highest burden of mental health issues; however, they often underuse available mental health services. Interventions aimed at those with diagnosed conditions frequently do little to prevent the onset of disorders. Problem Management Plus for Immigrants (PMP-I) is a prevention intervention adapted from the World Health Organization’s Problem Management Plus (PMP). PMP-I includes psychoeducation, problem-solving, behavioural activation, social support and networking, and mind-body exercises. This pilot randomized controlled trial (RCT) aimed to evaluate the impact of PMP-I on mental, social and emotional well-being outcomes among Bhutanese refugees resettled in Massachusetts.

Bhutanese individuals aged 18 or older who had resettled in Massachusetts and scored ≤14 on the Patient Health Questionnaire-9 (PHQ-9) were randomly assigned to two groups: PMP-I (n = 58 families) and a talk programme with a community support services pamphlet (n = 58 families). Trained community interventionists delivered five sessions of PMP-I to intervention participants in their family settings. Primary outcomes included scores on measures of stress (Cohen Perceived Stress Scale-10), and anxiety and depression (Hopkins Symptoms Checklist-25), assessed at baseline, 6-week and 3-month post-intervention. Secondary outcomes included hair cortisol, coping, coping self-efficacy, social support, social network, family conflict resolution and family satisfaction. Linear mixed-effects models were used to analyse differences in changes in outcomes between the intervention and control groups, adjusting for baseline scores on the primary outcomes, as well as age, duration of residence, marital status and history of chronic diseases.

All 232 participants recruited (116 families) were retained throughout the project. The intervention group evidenced a significantly greater decrease than the control group at both 6-week and 3-month post-intervention assessments on the primary outcomes of stress, anxiety, and depressive symptom scores. Similarly, the intervention group demonstrated significantly higher scores at both the 6-week and 3-month periods after the intervention compared to the control group on measures of coping, family conflict resolution, self-efficacy, family satisfaction and social networking with large effect sizes (Cohen’s d > 0.8, p < .01). Hair cortisol concentrations did not differ significantly between the intervention and control groups at either baseline or 3-month post-intervention.

The PMP-I improved the mental, social and emotional well-being of Bhutanese adults (PHQ-9 score ≤ 14) resettled in Massachusetts. Peer-delivered, family-centred PMP-I offers a significant public health benefit; however, a large-scale, RCT involving diverse refugee groups is necessary to replicate its success nationwide and beyond.

Social inclusion is increasingly recognised as a key determinant of health and well-being, encompassing participation in social, economic, political and cultural life through access to resources, opportunities and relationships. Individuals with mental disorders are at increased risk of social exclusion, yet existing evidence often relies on broad population-level indicators that fail to capture the multidimensional nature of inclusion. This systematic review aimed to compare levels of social inclusion between these groups using validated psychometric instruments and to identify the dimensions in which disparities are most pronounced.

The review followed PRISMA guidelines. A two-step search strategy was conducted across PubMed, Embase, PsycINFO, Scopus, CINAHL and Web of Science. First, validated measures of social inclusion and related constructs were identified. Second, studies applying these instruments in individuals with and without mental disorders were retrieved. Eligible studies included adults with clinician-established or self-reported diagnosis of mental disorders and comparison groups from the general population. A random-effects meta-analysis was conducted to estimate standardised mean differences (SMDs) with 95% confidence intervals (CIs) between the two groups, while a thematic narrative synthesis explored domain-specific inequalities.

Ten studies met inclusion criteria, and six were included in the meta-analysis, comprising 844 individuals with mental disorders and 1086 controls. Individuals with mental disorders reported significantly lower levels of social inclusion than the general population (SMD = −0.91; 95% CI: −1.25 to −0.56). The narrative synthesis identified inequalities across several interconnected domains. Individuals with mental disorders experienced weaker social relationships, lower perceived support, reduced community participation and fewer opportunities for meaningful engagement. Marked disadvantages were also observed in employment, income, education and housing, including financial hardship, insecure living conditions and neighbourhood dissatisfaction. Several studies highlighted discrepancies between objective indicators of participation and subjective experiences of inclusion, indicating that participation alone may not reflect a sense of belonging or access to valued social roles. Socioeconomic position, gender and ethnicity appeared to intensify exclusion across domains.

Individuals with mental disorders experience substantial inequalities in social inclusion across interconnected relational, community and socioeconomic domains. These disparities are shaped by broader structural conditions and compounded by intersecting forms of disadvantage, including socioeconomic position, gender and ethnicity. The findings highlight the need for multidimensional, intersectional and person-centred approaches that recognise both the cumulative nature of exclusion and individuals’ subjective experiences of inclusion. Policies and interventions should address the social determinants that constrain opportunities for meaningful inclusion.

OSF: https://doi.org/10.17605/OSF.IO/USXWG.

Individuals with severe mental illnesses (SMIs) experience anxiety that impairs functioning and quality of life. This cluster randomized trial evaluated exposure-based cognitive behavioral therapy (ebCBT) integrated into assertive community treatment (ACT) teams to reduce anxiety.

Fifteen ACT teams were allocated to ebCBT + ACT (k = 8, n = 50) or ACT-only (k = 7, n = 43). The intervention followed four steps: situation identification, four-component analysis (behavior, cognition, emotion, physical symptoms), psychoeducation, and graded exposure. Staff received 50 h training and bimonthly supervision over 12 months. Co-primary outcomes were trait and social anxiety; secondary outcomes were psychiatric symptoms, functioning, quality of life, and recovery.

The ebCBT + ACT group showed significant improvements in State–Trait Anxiety Inventory–Trait scores at 12 months (AMD = −5.30, 95% CI = −8.71 to −1.90, p = 0.002, d = −0.64) and 18 months (AMD = −7.22, 95% CI = −12.1 to −2.34, p = 0.004, d = −0.60). Brief Fear of Negative Evaluation scores showed near-significant improvement at 18 months (AMD = −3.70, 95% CI = −7.44 to 0.04, p = 0.052, d = −0.40). Secondary outcomes, including global functioning, recovery, and quality of life, also improved. Cost-effectiveness analyses indicated favorable cost-effectiveness for anxiety outcomes.

Embedding ebCBT within ACT services may reduce anxiety-related fear and avoidance and enhance recovery-related outcomes in individuals with SMI. These findings support the feasibility and clinical value of integrating structured psychological interventions into intensive community-based outreach services.

Loneliness is a global public health concern that has been widely associated with a variety of mental health impairments. Two dimensions of loneliness have been differentiated, that is, social loneliness (the perceived absence or inadequacy of a broader social network) and emotional loneliness (the perceived absence of a close, intimate relationship or emotional support from a significant person). The present study aimed to test the hypothesis that both dimensions of loneliness are differentially associated with mental health outcomes.

Altogether, 3275 individuals (aged 45.2 ± 15.7 years, 47.9% men), enrolled from the general population, were assessed at two waves spanning 6 to 7 months. Social and emotional loneliness were quantified using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was assessed with the six-item Lubben Social Network Scale, depressive symptoms with the Patient Health Questionnaire-9, generalised anxiety with the Generalised Anxiety Disorder-7, social anxiety with the Social Interaction Anxiety Scale, and paranoid ideation with the Revised Green et al. Paranoid Thoughts Scale. The data were analysed using a cross-lagged panel network model. Covariates included age, gender, education, employment status, place of residence, monthly income, the history of psychiatric treatment and substance use.

Both dimensions of loneliness were bidirectionally associated and were found to have the highest overall weight of outcoming network connections. Emotional loneliness was bidirectionally and positively associated with all measures of mental health. In turn, social loneliness predicted higher levels of social anxiety but was not associated with other mental health outcomes. It was bidirectionally associated with social isolation.

The findings imply the relevance of differentiating social and emotional dimensions of loneliness in the assessment of its underlying mechanisms and consequences for mental health. Emotional loneliness might show a greater importance in the development of psychopathological symptoms compared to its social dimension.

More people than ever are receiving support for mental health issues, and instances of suicide continue to grow. Although mental health funding has increased, UK government figures evidence that the National Health Service (NHS) does not have the resources required to respond to such growth in demand. The experiences of staff working in mental health services can offer insight into the efficacy of current provision and assist in service evaluation; however, research examining this issue outside of the COVID-19 pandemic, and in the context of community mental health, is lacking.

We aimed to explore the perspectives of staff working in a variety of mental health services in North-West England, to elucidate the current standard of care provided and highlight areas for improvement.

One-to-one interviews were conducted with 26 staff members as part of a qualitative grounded theory analysis.

Findings portrayed a community in crisis, consisting of the following themes: stabilisation not recovery, inefficient pathways and barriers to collaboration.

NHS services are struggling to meet the mental health needs of the population, resulting in lengthy waiting times for therapy, a lack of intervention-focused care and an over-reliance on the third sector. While crisis cafés are provided at low cost and result in satisfaction, policy-makers must ensure that these receive adequate funding and do not become overburdened. Staff reported that collaboration between clinical and non-clinical services would improve care pathways and reduce strain on the NHS, but judgemental attitudes and inflexible service development must be challenged to achieve this.

HOPE (National Institute for Health and Care Research Global Health Research Group on Homelessness and Mental Health in Africa) aims to develop and evaluate interventions that address the unmet needs of people who are homeless and have severe mental illness (SMI) living in three African countries in ways that are rights-based, contextually grounded, scalable and sustainable.

We will work in the capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and the capital city (Nairobi) and a rural county (Makueni) in Kenya to understand different approaches to intervention needed across varied settings.

We will be guided by the MRC/NIHR framework on complex interventions and implementation frameworks and emphasise co-production. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercise) on interventions and approaches to homelessness and SMI. We will map contexts; conduct focused ethnography to understand lived experiences of homelessness and SMI; carry out a cross-sectional survey of people who are homeless (n = 750 Ghana/Ethiopia; n = 350 Kenya) to estimate prevalence of SMI and identify prioritised needs; and conduct in-depth interviews and focus group discussions with key stakeholders to understand experiences, challenges and opportunities for intervention. This global and local evidence will feed into Theory of Change (ToC) workshops with stakeholders to establish agreement about valued primary outcomes, map pathways to impact and inform selection and implementation of interventions. Intervention packages to address prioritised needs will be co-produced, piloted and optimised for feasibility and acceptability using participatory action research. We will use rights-based approaches and focus on community-based care to ensure sustainability. Realist approaches will be employed to analyse how contextual variation affects mechanisms and outcomes to inform methods for a subsequent evaluation of larger scale implementation. Extensive capacity-strengthening activities will focus on equipping early career researchers and peer researchers. People with lived experience of SMI and policymakers are an integral part of the research team. Community engagement is supported by working closely with multisectoral Community Advisory Groups.

HOPE will develop evidence to support action to respond to the needs and preferences of people experiencing homelessness and SMI in diverse settings in Africa. We are creating a new partnership of researchers, policymakers, community members and people with lived experience of SMI and homelessness to enable African-led solutions. Key outputs will include contextually relevant practice and policy guidance that supports achievement of inclusive development.

The high level of psychological distress in young people is a growing concern. However, there are few national surveys that describe the trajectories of mental health and wellbeing through adolescence into early adulthood. Further, existing research has largely focused exclusively on mental ill-health, with little focus on positive mental health. This study provides the first national profile of the mental health and wellbeing of Australians aged 12–25 years.

Participants completed the National Youth Mental Health survey in 2018 (n1 = 3832), 2020 (n2 = 974) or 2022 (n3 = 961). We applied Keyes’ Complete Mental Health (CMH) framework to derive categories of mental health and wellbeing, and examine rates of CMH over time, by age and gender.

While approximately half of those surveyed reported flourishing (high wellbeing without mental illness), rates of flourishing declined between 2018 and 2022. Rates of flourishing generally decreased with age, and flourishing was more prevalent amongst males than females.

The findings provide a unique contrast of youth mental health pre-, during and post- the COVID-19 pandemic. While rates of psychological distress are consistently high, the proportion of youth reporting flourishing highlights the need to consider all aspects of psychological functioning to accurately understand and respond to the mental health needs of young people.