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.

Unhealthy eating patterns, physical inactivity and alcohol misuse are commonly reported by individuals with severe mental illness (SMI) and significantly contribute to premature mortality. People with SMI could benefit from psychoeducational interventions focused on lifestyle modification.

To evaluate the effectiveness of the LIFESTYLE programme to improve dietary habits and physical activity levels and reduce alcohol use in individuals with SMI versus controls receiving a less structured psychoeducational programme (Italian Ministry of University and Research, trial registration number: 2015C7374S).

This multicentre randomised controlled trial (RCT) was conducted across six Italian universities and included 401 participants diagnosed with SMI, randomly allocated to either the test group or a comparison group.

At 1-year follow-up, generalised estimating equations showed that the trial intervention boosted the likelihood of higher weekly metabolic equivalents of task (METs) expended on total activity (odds ratio 1.43, 95% CI 1.08–1.89; p < 0.01), on walking (odds ratio 1.50, 95% CI 1.18–1.90; p < 0.001) and on moderate activity (odds ratio 1.85, 95% CI 1.24–2.77; p < 0.01). Improvements in dietary habits included increased intake of fish (odds ratio 1.67, 95% CI 1.45–1.97; p < 0.05), fresh fruit (odds ratio 1.36, 95% CI 1.05–1.76; p < 0.05) and vegetables (odds ratio 1.91, 95% CI 1.56–1.96; p < 0.05), along with reduced junk food consumption (OR = 0.81, 95% CI 0.63–0.99; p < 0.05) and daily alcohol use (odds ratio 0.70, 95% CI 0.52–0.95; p < 0.05).

The LIFESTYLE intervention proved effective in promoting healthier lifestyles among individuals with SMI, with sustained benefits at 1 year. This structured programme could be a valuable addition to routine mental healthcare.

Severe mental disorders (SMDs) impose profound suffering on patients and heavy burdens on family caregivers, often resulting in abusive behaviors. This study aimed to examine the association between psychiatric symptom severity and caregiver abuse, and to assess whether caregiver tobacco dependence moderates this relationship.

A cross-sectional study included 763 patient–caregiver dyads in rural Shandong, China. Psychiatric symptom severity was measured using the 18-item Brief Psychiatric Rating Scale. Caregiver tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence. Patients reported caregivers’ verbal/physical abuse in the past year. Ordered logistic regression and interaction terms tested associations and moderation.

Overall, 25.7% of caregivers engaged in verbal abuse and 14.9% in physical abuse. Psychiatric symptom severity was significantly associated with both verbal (OR = 1.018, 95% CI: 1.010–1.026) and physical abuse (OR = 1.015, 95% CI: 1.005–1.025). Caregivers with moderate to severe tobacco dependence were more likely to commit verbal (OR = 1.851, 95% CI: 1.136–3.016) and physical abuse (OR = 2.292, 95% CI: 1.287–4.079) than non-smokers. Moderate to severe tobacco dependence significantly amplified the association between psychiatric symptom severity and verbal abuse (interaction OR = 1.024, 95% CI: 1.002–1.046), but not physical abuse.

In rural China, greater psychiatric symptom severity among patients with SMDs is associated with increased frequency of both verbal and physical abuse by caregivers, particularly verbal abuse among those with moderate to severe tobacco dependence, underscoring the need for caregiver-targeted psychological support and tobacco cessation interventions.

Psychosocial interventions are vital in treating severe mental illness, yet their use remains limited, and patients often lack adequate information about them. Patient-focused versions of clinical guidelines are designed to enhance mental health literacy and inform patients about available treatments, but these resources are underutilized. This study evaluated the impact of implementing a patient-focused psychosocial intervention guideline on empowerment, knowledge, and use of psychosocial interventions among individuals with severe mental illness.

Multicentre, cluster-randomised trial. The study population comprised adult patients with a severe mental disorder. The intervention group received a multimodal, structured, and protocol-led patient-focused guideline implementation, whereas the control group received treatment as usual. Data were analysed using hierarchical linear models. The primary outcome was the change in patients’ empowerment.

There was no significant intervention effect on empowerment (effect size=0.13, p=0.605), which increased slightly in both groups. The number of psychosocial interventions familiar to patients increased significantly more in the intervention group. Exploratory analyses suggest that patient empowerment could have been influenced by COVID-19-related stress, patient age, the severity of functional impairment, and migration background. The improvement in the utilisation of psychosocial interventions did not differ significantly between the intervention group (M=1.1, SD=2.5) and the control group (M=1.3, SD=2.4).

The implementation of a patient-focused psychosocial intervention guideline failed to enhance empowerment among service users. However, our analyses indicate that the intervention led to an improvement in patient knowledge with respect to guideline content. The availability of psychosocial interventions may have been significantly constrained by the COVID-19 pandemic.

Poorer family functioning during childhood is associated with severe mental disorders in adulthood in the general population. However, family functioning is understudied in families with parental schizophrenia or bipolar disorder. We aimed to investigate family functioning in families with 11-year-old children of parents with schizophrenia or bipolar disorder compared with controls. Second, we aimed to examine associations between family functioning and levels of child psychopathology, child global functioning, and parental social functioning.

In this prospective, population-based cohort study, we included 160 families with parental schizophrenia, 95 families with parental bipolar disorder, and 177 control families. Family functioning was measured with the 12-item version of the McMaster Family Assessment Device – General Functional Scale.

Families with parental schizophrenia (Cohen’s d = 0.29; p = .002) and parental bipolar disorder (Cohen’s d = 0.34; p = .004) had significantly poorer family functioning and a significantly higher prevalence of clinically significant family dysfunction (Cohen’s d range = 0.29–0.34; p values = .007) than control families. Across study groups, poorer family functioning was associated with higher levels of child psychopathology and poorer social functioning of the primary caregiver (p values < .001).

Children in families with parental schizophrenia or bipolar disorder are at increased risk of experiencing family dysfunction, and poorer family functioning confers risk for more symptoms of child psychopathology and poorer parental social functioning. Future studies should investigate the potentially predictive value of family dysfunction in relation to later illness onset and other adverse outcomes in these populations.

To determine the prevalence of overweight and obesity in patients with severe mental disorders (SMD) and the factors associated with their socio-demographic and disease characteristics in a cross-sectional population-based study.

This analysis examined the prevalence of overweight and obesity in 14 868 managed SMD patients in an urban area of Shenzhen city based on data from the health information monitoring system in 2021. Multivariate logistic regression were used to identify the factors associated with the prevalence of overweight and obesity in patients with SMD.

China.

14 868 patients with SMD.

The prevalence of overweight and obesity in patients with SMD in this study was 32·6 % and 16·1 %, respectively. In multivariate analysis, married status, Shenzhen household registration, management durations of 5–10 years and >10 years, participation in family physician services, taking clozapine or aripiprazole, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of overweight and obesity. Compared to their respective reference categories, living with parents, spouse and children, taking risperidone, aripiprazole, amisulpride and perphenazine, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of obesity.

We observed a high prevalence of overweight and obesity in patients with SMD in this study. The findings highlight the need for integrated management of overweight and obesity risk factors among patients with SMD.

Severe mental disorders – such as schizophrenia, bipolar disorder, and substance use disorders – exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed.

This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes – including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health – as compared to standard support/support as usual or other control conditions.

In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online “mi.spot” intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions.

The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.

Violence occurs frequently in the life of forensic psychiatric patients, both as active aggression and in the form of victimization. Undoubtedly, these incidents shape personality, behavior, and affect the ability to interact adequately socially. Thus, such experiences may influence criminal recidivism and serve as forensic psychiatric/psychological predictors upon hospital discharge.

Hence, this study aimed at characterizing two distinct female forensic psychiatric patient populations (nonsubstance use mental disorders [n = 110] versus substance use disorder [n = 415]) regarding their active and passive violent experiences as well as contextualizing these with their individual crime recidivism rates. The analysis followed a record-based, retrospective approach.

While both groups experienced aggression throughout childhood and youth equally often, substance use disorder patients were significantly more often exposed to violence during adulthood. On the other hand, severely mentally ill patients tended to react more often with violence during their hospital confinement. However, regarding their violent recidivism rate, no intergroup effects were observed. Finally, within the addicted group, a violent index crime as well as physical aggression during hospital confinement increased the odds for violent reoffending by approximately 2.4-fold (95% confidence interval 1.3–4.5) and 2.5-fold (95% confidence interval 1.1–5.9), respectively.

In summary, these findings underline the importance of active aggression rather than victimization as an influencing factor on resocialization especially in a substance use disorder patient population.

The WHO would increase diagnosis and treatment of viral hepatitis in the world by 2030, based on the high efficacy of direct-acting-antivirals against HCV, extended vaccination programs in HBC, and epidemiological data. Diagnostic of HCV/HBV infection has been simplified by point-of-care (POC) devices (cheap/easy-to-use/interprete/qick-results), detecting anti-HCV-antibodies or HBV-antigen in capillary blood at the patients´site. The current seroprevalence of viral hepatitis B/C in general population in Spain is 0.5%/1% and would be higher (3-17%) in people with severe-mental-disorder due to risk factors and traditionally less access to health care.

To design a screening protocol for HCV eradication and HBV-detection, and risk factors among severe-mental-disorder patients in a CommunityMentalHealthCenter. To guarantee equal access to viral hepatitis screening and therapy among this population.

Outpatients visited along one-year who accepts participate. Using POC-device for qualitative detection of anti-HCV-antibodies (Quickview-of-Lumiquick-Diagnostics®)/HBsAG (Abbott-Rapid-Diagnostics®). Socio-demographic data; mental disorder(ICD-10); HCV/HBV risk-factors; Neurotoxicity-scale (mood/cognition/sleep/gastrointestinal/sickness/motor); SF-12; Patient-satisfaction. Subjects with positive HCV/HBV POC-test will have a on-site venopuncture to assess hemograme/liver tests, and HCV-RNA (Cobas-TaqMan-RocheDiagnostics)/HBsAg-ELISA (Atellica-Siemens). In positive HCV-RNA (active infection) the psychiatric-team will inform the hepatology-team for non-invasive liver fibrosis assessment and DAA prescription. The patient will receive 8-12-weeks on-site treatment, and assessed (Neurotoxicity/SF-12).HCV cure will be confirmed by HCV-RNA in blood. Chronic-cases will be managed at Hepatology-Unit.

We will present the results of the implementation of the programme and their ability to detect viral-hepatitis-positive cases among patients with severe-mental-disorders and to treat them effectively.

Our results may support the generalisation of the programme in among CMHC’s.

No significant relationships.

People with severe psychiatric disorders (SPD) who experience housing vulnerability have to negotiate discontinuous mental health care pathways including poor access to common rights services and an increased risk of incarceration. To reduce morbidity and improve social integration of these people, Médecins du Monde (NGO), in association with the Ministry of Justice and APHM, is piloting the experimentation of an alternative to prison through assertive community treatment (ACT) and independent housing for people with SPS without housing who are referred to the court for immediate appearance.

The main objective is to evaluate the effectiveness of the innovative program (AILSI) compared to usual services by assessing the duration of re-incarceration at 18 months of follow up.

The AILSI project has been certified as a Social Impact Bond, in which private investors support the program, with the guarantee that the French government will reimburse the investments if social impact outcomes are met. To measure the effectiveness and efficiency of the program, a randomized controlled study was designed: 100 patients will be included in the AILSI group (intervention) and 120 in the TAU group (usual services). Four social impact outcomes are identified: inclusion rate, signed leases rate, total length of re-incarceration and total resource use. It is a mixed quali-quanti research, which integrates a matching to administrative health and judicial databases.

Inclusions are ongoing.

The AILSI program and the research methods used are described herein. In addition, detailed information on the limitations and strengths of the SIB system are also discussed.

No significant relationships.

Housing First (HF), a recovery-oriented approach, was proven effective in stabilising housing situations of homeless individuals with severe mental disorders, yet had limited effectiveness on recovery outcomes on a short-term basis compared to standard treatment. The objective was to assess the effects of the HF model among homeless people with high support needs for mental and physical health services on recovery, housing stability, quality of life, health care use, mental symptoms and addiction issues on 4 years of data from the Un Chez Soi d'Abord trial.

A multicentre randomised controlled trial was conducted from August 2011 to April 2018 with intent-to-treat analysis in four French cities: Lille, Marseille, Paris and Toulouse. Participants were homeless or precariously-housed patients with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia. Two groups were compared: the HF group (n = 353) had immediate access to independent housing and support from the assertive community treatment team; the Treatment-As-Usual (TAU) group (n = 350) had access to existing support and services. Main outcomes were personal recovery (Recovery Assessment Scale (RAS) scale), housing stability, quality of life (S-QoL), global physical and mental status (Medical Outcomes Study 36-item Short Form Health Survey (SF-36)), inpatient days, mental symptoms (Modified Colorado Symptom Index (MCSI)) and addictions (Mini International Neuropsychiatric Interview (MINI) and Alcohol Use Disorders Identification Test (AUDIT)). Mixed models using longitudinal and cluster designs were performed and adjusted to first age on the street, gender and mental disorder diagnosis. Models were tested for time × group and site × time interactions.

The 703 participants [123 (18%) female] had a mean age of 39 years (95% CI 38.0–39.5 years). Both groups improved RAS index from baseline to 48 months, with no statistically significant changes found between the HF and TAU groups over time. HF patients exhibited better autonomy (adjusted β = 2.6, 95% CI 1.2–4.1) and sentimental life (2.3, 95% CI 0.5–4.1), higher housing stability (28.6, 95% CI 25.1–32.1), lower inpatient days (−3.14, 95% CI −5.2 to −1.1) and improved SF-36 mental composite score (−0.8, 95% CI −1.6 to −0.1) over the 4-year follow-up. HF participants experienced higher alcohol consumption between baseline and 48 months. No significant differences were observed for self-reported mental symptoms or substance dependence.

Data at 4 years were consistent with 2-year follow-up data: similar improvement in personal recovery outcomes but higher housing stability, autonomy and lower use of hospital services in the HF group compared to the TAU group, with the exception of an ongoing alcohol issue. These sustained benefits support HF as a valuable intervention for the homeless patients with severe mental illness.

ClinicalTrials.gov identifier: NCT01570712

People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes.

This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients’ physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected.

Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31–2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80–28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45–20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention.

The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with its impact on our way of life, is affecting our experiences and mental health. Notably, individuals with mental disorders have been reported to have a higher risk of contracting SARS-CoV-2. Personality traits could represent an important determinant of preventative health behaviour and, therefore, the risk of contracting the virus.

We examined overlapping genetic underpinnings between major psychiatric disorders, personality traits and susceptibility to SARS-CoV-2 infection.

Linkage disequilibrium score regression was used to explore the genetic correlations of coronavirus disease 2019 (COVID-19) susceptibility with psychiatric disorders and personality traits based on data from the largest available respective genome-wide association studies (GWAS). In two cohorts (the PsyCourse (n = 1346) and the HeiDE (n = 3266) study), polygenic risk scores were used to analyse if a genetic association between, psychiatric disorders, personality traits and COVID-19 susceptibility exists in individual-level data.

We observed no significant genetic correlations of COVID-19 susceptibility with psychiatric disorders. For personality traits, there was a significant genetic correlation for COVID-19 susceptibility with extraversion (P = 1.47 × 10−5; genetic correlation 0.284). Yet, this was not reflected in individual-level data from the PsyCourse and HeiDE studies.

We identified no significant correlation between genetic risk factors for severe psychiatric disorders and genetic risk for COVID-19 susceptibility. Among the personality traits, extraversion showed evidence for a positive genetic association with COVID-19 susceptibility, in one but not in another setting. Overall, these findings highlight a complex contribution of genetic and non-genetic components in the interaction between COVID-19 susceptibility and personality traits or mental disorders.

In 2019 national survey - personal examination of persons, living in residential facilities for mentally disabled people - was executed under the instruction of the Government by specialists of V.Serbsky National Medical Research Centre. For 2559 legally incapacitated residents the procedure of rehabilitation of full or diminished capacity was recommended. For 16132 legally capable residents the procedure for recognising their incapacity was recommended (Kekelidze ZI et al., 2020).

To compare the recommendations on legal capacity in two regions with different systems of inpatient social services.

Full-sized noncontrol observational descriptive screening study.

In table 1 the recommendations on legal capacity in two regions are presented.

Differences in quantity of residents, for whom rehabilitation of full or diminished capacity was recommended, depend on characteristics of the systems of institutional care in the regions. In the first region a complex system of rehabilitation and deinstitutionalization has been organised. In the second region such system is just organising. Among legally capable and those, for whom rehabilitation of capacity was recommended, there were residents, able to live independently or under community-based services.

No significant relationships.

Pharmacogenetics (PGx) studies genetic variance and related differences in drug outcomes. PGx guidelines for psychotropic drugs are available (PGx drugs), but PGx testing is used only limitedly in psychiatric clinical practice.

The aim of this study is to pinpoint different aspects of PGx drug use in the population, to support clinical uptake of PGx.

This drug utilization study investigated prescription PGx drug use in 56,065 young individuals with different severe mental disorders (SMD) in the Danish iPSYCH sample (born 1981-2005). We investigated the number of PGx drug users (incidence, prevalence), age (at first PGx drug use), sex, multiple PGx drugs per user (in light of panel-based PGx testing) and concomitant use of PGx drugs (in light of combinatorial PGx testing).

We identified substantial PGx drug use in terms of incidence rates (e.g. 333 per 10,000 person years for the anticonvulsant lamotrigine) and prevalence (e.g. 15,260 users for the antidepressant citalopram) in patients with SMD. The age of first time PGx drug use ranged from 11.6-20 years, depending on SMD and sex. On average, more than one PGx drug was used by a single person (range 1.6-5.6 drugs, depending on SMD) or even used concomitantly (41-69%) affecting mostly two different PGx genes (84-92% of concomitant PGx drug users).

PGx drugs were frequently used in young individuals with SMD, often subsequently and concomitantly, arguing for panel-based/combinatorial PGx testing over single-gene testing. PGx testing could be applied already at a very young age.

We thank the iPSYCH consortium, in specific the iPSYCH PI’s (Merete Nordentoft, Anders Børglum, Preben B. Mortensen, Ole Mors, Thomas Werge and David M. Hougaard). The iPSYCH project is funded by the Lundbeck Foundation Denmark and the universities and un

Mental disorders have been associated with increased levels of inflammatory markers, which can affect disease trajectories. We aimed to assess levels of C-reactive protein (CRP) and white blood cells (WBC) across individuals with schizophrenia, bipolar disorder, and depression, and to investigate associations with subsequent psychiatric admission and mortality.

We identified all adults in the Central Denmark Region during 2000–2012 with a first diagnosis of schizophrenia, bipolar disorder, or depression and a baseline measurement of CRP and/or WBC count. We followed these individuals until outcome of interest (psychiatric admission or death), emigration or December 31, 2012, using Cox regression analysis to estimate hazard ratios (HRs).

Baseline median CRP differed significantly between mental disorders (P = 0.01) being highest in individuals with bipolar disorder (3.5 mg/L) (particularly during manic states, 3.9 mg/L), followed by schizophrenia (3.1 mg/L), and depression (2.8 mg/L), while baseline WBC count did not differ (median 7.1 × 109/L). Elevated CRP levels were associated with increased all-cause mortality by adjusted HRs of 1.56 (95% CI: 1.02–2.38) for levels 3–10 mg/L and 2.07 (95% CI: 1.30–3.29) for levels above 10 mg/L compared to individuals with levels below 3 mg/L. WBC counts were not associated with all-cause mortality. No association was observed between levels of the inflammatory markers and subsequent psychiatric admissions.

People with severe mental disorders had increased inflammatory markers at first diagnosis, and elevated CRP levels were associated with increased mortality. Thorough screening for physical diseases is of utmost importance among individuals who are diagnosed with severe mental disorder.

The treatment gap for serious mental disorders across low-income countries is estimated to be 89%. The model for Mental Health and Development (MHD) offers community-based care for people with mental disorders in 11 low- and middle-income countries.

In Kenya, using a pre-post design, 117 consecutively enrolled participants with schizophrenia-spectrum and bipolar disorders were followed-up at 10 and 20 months. Comparison outcomes were drawn from the literature. Costs were analysed from societal and health system perspectives.

From the societal perspective, MHD cost Int$ 594 per person in the first year and Int$ 876 over 2 years. The cost per healthy day gained was Int$ 7.96 in the first year and Int$ 1.03 over 2 years – less than the agricultural minimum wage. The cost per disability-adjusted life year averted over 2 years was Int$ 13.1 and Int$ 727 from the societal and health system perspectives, respectively, on par with antiretrovirals for HIV.

MHD achieved increasing returns over time. The model appears cost-effective and equitable, especially over 2 years. Its affordability relies on multi-sectoral participation nationally and internationally.

Assortative mating has been demonstrated in mental disorders but the extent of cohabitation between patients with clinically diagnosed psychiatric disease has been poorly explored.

We conducted a register-based study of all Danes between 18 and 70 years of age in a 13-year observational period, linking data on individuals' contacts with psychiatric services with data on individuals' cohabitation status. Two different Poisson regression analyses were performed: the first comparing the rates of commencing cohabitation with a psychiatric patient between individuals, depending on whether the individuals themselves had, or did not have, a psychiatric diagnosis; the second comparing the incidence rates of psychiatric diagnoses for individuals cohabitating with psychiatric patients with the similar rates for individuals living with unaffected cohabitants.

In total, 159 929 (5.0%) out of 3 204 633 individuals were given a psychiatric diagnosis during the study period. Diagnosed individuals had an overall rate ratio (RR) of commencing cohabitation with a psychiatric patient of 1.95 [95% confidence interval (CI) 1.90–2.00] for women and 1.65 (95% CI 1.61–1.69) for men, when compared with unaffected individuals. The overall RR of receiving a psychiatric diagnosis while cohabitating with a psychiatric patient was 2.40 (95% CI 2.31–2.49) for women and 2.91 (95% CI 2.81–3.01) for men, when compared with those cohabitating with unaffected individuals. Individuals with schizophrenia and men with bipolar disorder had the highest RR of commencing cohabitation with a cohabitant with a similar diagnosis.

Cohabitation among individuals with severe psychiatric disorders is increased. This has implications for research and for the clinical management of patients.