Cross-national studies provide a valuable framework for examining how assessments of criminal responsibility in forensic psychiatry vary across psychiatric systems and legal contexts. This paper presents a comparative analysis of forensic psychiatric practice in Italy and Switzerland, two neighboring jurisdictions rooted in the Roman legal tradition, yet characterized by distinct trajectories in criminal law and forensic development. Particular attention is devoted to structural differences in psychiatric care, contrasting Italy's community-based model with Switzerland's predominantly hospital-centered system. The analysis further explores divergences in approaches to the assessment of recidivism risk and in expert evaluation methodologies, demonstrating how such variations reflect broader legal, institutional, and epistemological configurations. It also examines disparities in professional training, situating them within their respective cultural and practical contexts. These factors collectively shape the role of the forensic psychiatrist as an independent expert engaged in addressing complex questions concerning criminal behavior, criminal responsibility, and the interplay between psychopathology and free will within judicial proceedings. By identifying both convergences and divergences, this study underscores the value of comparative inquiry in advancing the field and contributes to ongoing efforts toward the development of more standardized international approaches in forensic psychiatry. It concludes by emphasizing the need for further research in this foundational domain, with the aim of enhancing the rigor, coherence, and cross-cultural validity of forensic psychiatric evaluations, particularly in the expertise report and assessment of recidivism risk.
[This corrects the article DOI: 10.3389/fpsyt.2026.1686106.].
No recent study has examined whether method of abortion is associated with psychotropic medication use, an indicator of mild mental health problems. To examine whether medication or procedural abortions were associated with increased risk of psychotropic medication use. This population-based Danish registry cohort study followed the psychotropic medication redemptions of females aged 12 to 38 years having elective, first first-trimester abortions between January 1, 2000, and December 31, 2018, from 1 year before their medication or procedural abortion until their first psychotropic medication prescription claim (redemption), December 31, 2018, emigration from Denmark, or death, whichever came first. Analyses were conducted between June 2023 and June 2025. First abortion method (first medication abortion or first procedural abortion). Any first psychotropic medication prescription redemption, first antidepressant medication redemption, and first antianxiety medication redemption during the study period. Incidence rate ratios (IRRs) were calculated in adjusted regression models. Bonferroni-corrected P values were used to account for multiple tests. Of 67 390 females included in this study (mean [SD] age, 21.8 [4.6] years), 4575 (6.8%) had a prior psychiatric diagnosis; 33 793 had a record of a first medication abortion, 33 597 had a record of a first procedural abortion, and 19 979 (29.6%) had a first psychotropic medication redemption during the study period. In fully adjusted models, using the conventional P value level of .05, compared with the year before a medication or procedural abortion, there were small increased risks of any first psychotropic medication redemption in the first year after medication abortion (IRR, 1.10; 95% CI, 1.02-1.19; P = .01) and procedural abortion (IRR, 1.09; 95% CI, 1.01-1.16; P = .02). There were no statistically significant associations in 1 to 2 years and 2 to 5 years after abortion relative to the year before an abortion for each abortion method. There were decreased risks of any first psychotropic medication redemption more than 5 years after medication abortion (IRR, 0.85; 95% CI, 0.78-0.91; P < .001) and more than 5 years after procedural abortion (IRR, 0.83; 95% CI, 0.78-0.88; P < .001). Using the Bonferroni-corrected P value of .002, the small increased risks of psychotropic medication redemption observed in the first year after an abortion no longer met the criteria for statistical significance, while the lower risks for more than 5 years after abortion continued to meet the criteria for statistical significance. In this Danish population-based cohort study, compared with the year before a medication or procedural abortion, small increased risks of psychotropic medication prescription redemptions were observed during the first year after abortion, and decreases in risk of psychotropic medication prescription redemptions were observed more than 5 years after abortion when using conventional levels of statistical significance. The small increased risks observed in the first year after an abortion no longer met the criteria for statistical significance following Bonferroni adjustment for multiple statistical tests. Additional research may be needed to replicate and understand these results.
Despite often coexisting, the association between mental disorders and malnutrition is not well characterized. This study aimed to describe the prevalence of mental disorders and their association with malnutrition, nutritional interventions, and clinical outcomes. A retrospective cohort study was conducted on 431 patients in a specialized malnutrition clinic. Nutritional status was classified using the Global Leadership Initiative on Malnutrition (GLIM) criteria as well-nourished (GLIM 0) or malnourished (GLIM 1-2). The primary outcome was to determine the prevalence of pre-existing mental disorders, including mood, anxiety, psychotic, substance use-related, and eating disorders. Secondary outcomes included differences in anthropometrics, micronutrient levels, nutritional interventions, follow-up status, and mortality between patients with and without mental disorders. Categorical variables were compared using Pearson's chi-square test and continuous variables using Welch's t-test or Mann-Whitney U test. A total of 363 patients (84.2%) were malnourished (GLIM 1-2), and 272 patients (63.1%) had a pre-existing mental disorder. Mental disorders were more prevalent among malnourished patients compared with well-nourished patients (65.6% vs 50.0%, P = 0.02). Patients with mental disorders were more likely to receive nutritional interventions: oral nutrition supplementation (34.6% vs 22.0%, P = 0.01), enteral nutrition (16.5% vs 9.4%, P = 0.04), and mirtazapine for appetite (28.3% vs 0.6%, P < 0.001). Lastly, patients with mental disorders were more likely lost to follow-up (15.1% vs 12.0%, P = 0.04). Mental disorders, particularly for mood and anxiety, are highly prevalent in this cohort and are associated with increased nutritional interventions and loss to follow-up. These findings emphasize the importance of a multidisciplinary approach to managing patients with malnutrition and mental disorders.
Behavioral variant frontotemporal dementia is characterized by significant changes in personality and behavior with typical age of onset between the fifth and sixth decade of life. The following case study describes a 44-year-old female patient with a significant psychiatric history and distant mild traumatic brain injury who began to behaviorally decompensate in her mid-to-late 30s. She was referred for neuropsychological evaluation due to report of memory problems and progressive neuropsychiatric and neurobehavioral decline. Neuropsychological testing revealed diffuse cognitive impairment mediated by pronounced neurobehavioral executive dysfunction. Laboratory and genetic testing were unremarkable. Neuroimaging revealed statistically significant asymmetric hypometabolism in the bilateral frontotemporal region, more pronounced on the left. Taken together, results were suggestive of a primary underlying frontotemporal lobar degenerative process with secondary exacerbation due to chronic psychiatric distress. This case report highlights the importance of thorough differential diagnosis of a neurodegenerative process in a young adult with an overlay of longstanding psychiatric illness, especially when the etiology in question falls outside the typical age of onset.
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The transition from pediatric to adult medical care is associated with increased symptoms of anxiety, depression, and experiences with disease stigma for adolescents and young adults (AYA) with sickle cell disease (SCD). Community-informed conceptual frameworks suggest that caregiver communication could play an important role in enhancing AYA well-being during this critical period; yet this association has yet to be empirically investigated in this population. This study examined the influence of caregiver-AYA communication on psychosocial outcomes among AYA with SCD. AYA with SCD ages 16-25 were enrolled in a prospective, 3-month study. Participants completed baseline (T1) and follow-up surveys 3 months later (T2). Measures included the Parent-Adolescent Communication Scale, PROMIS Anxiety and Depression short forms, Measure of Sickle Cell Stigma, and Sickle Cell Self-Efficacy Scale. Cross-sectional and prospective bivariate and multivariate associations were investigated. Bivariate correlations showed that open caregiver-AYA communication at T1 was cross-sectionally associated with lower anxiety (r = -.35, p = .016), and prospectively associated with lower anxiety (r = -.31, p = .047), depression (r = -.31, p = .045), total stigma (r = -.36, p = .016) expected discrimination stigma (r = -.30, p = .048), and internalized stigma (r =  .40, p = .008). Communication at T1 remained negatively associated with total stigma (β = -.21, p = -.038), internalized stigma (β = -.24, p = .044) and expected discrimination stigma (β = -.28, p = .030) at T2 when controlling for age, gender, and baseline psychosocial factors. AYA who reported open caregiver communication at baseline reported significantly fewer symptoms of anxiety, depression, and stigma 3 months later. Thus, improving caregiver-AYA communication may improve AYA psychosocial functioning, which could lead to improved SCD-related care and transition.
Skin-picking disorder (SPD) is a psychodermatological condition marked by recurrent, compulsive picking of one's own skin. This study aimed to analyze a large cohort of treatment-seeking SPD patients, focusing on triggers and concomitant diseases through face-to-face evaluations. A cross-sectional, multicenter study was conducted. Patients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SPD completed a 23-item semi-structured questionnaire covering demographics, concomitant diseases, triggers, and clinical features. A total of 236 SPD patients were enrolled, and 189 of whom were female. Additional dermatological diseases were identified in 84 participants, and 93 reported a history of primary psychiatric disorder. Mostly cited motivations for engaging in the behavior included itch relief, out of habit, and tension reduction. Picking commonly involved multiple body sites, especially extremities and trunk, with facial picking more frequent in younger patients and those with concomitant dermatological disorders. Over 25% reported more than 20 picking episodes/day, symptoms peaking between 08:00 PM and midnight, often during inactivity. Sensory symptoms included itching and burning. SPD is a multifactorial disorder with diverse clinical features and triggers. Sensory symptoms, body site involvement, and timing of episodes can guide clinicians in recognizing dermatologic and psychiatric comorbidities. Integrated dermatologic-psychiatric care is key for effective management.
Stigma toward mental health problems is now being understood as a context-dependent, multidimensional concept. Nonetheless, empirical research continues to study stigma as a monolithic aspect, obscuring meaningful within-group variations. Such inquiries often obscure the people-centered patterns of stigma within the population. Recognizing such patterns aids in better understanding how stigma differentially influences help-seeking and resilience in the context of mental health. Accordingly, the present study seeks to identify latent profiles for stigmatizing attitudes and their correlates among Indian adults. The study also explores how these profiles potentially differ in resilience and help-seeking attitudes. The data were collected via a cross-sectional survey with 564 Indian adults. Standardized self-report measures like the Attitudes Toward Mental Health Problems Scale, the Connor-Davidson Resilience Scale - 10-item version, and the Inventory of Attitudes Toward Seeking Mental Health Services were used. Latent Profile Analysis revealed a four-profile model that differed significantly in resilience and help-seeking attitudes. Further, a multinomial logistic regression revealed attitudes toward seeking mental health services, accessibility, reliance on religion, and mental health awareness as correlates of profile membership. The findings indicate the presence of multiple patterns of stigmatizing attitudes among Indian adults. The results of this study could inform practice, policy, and context-sensitive interventions to reduce stigma and promote the use of mental health services.
A timely diagnosis of dementia may provide valuable time for treatment and planning, yet underdiagnosis is common. This study investigated the relationship between presence of dementia pathologies and timeliness of dementia diagnosis by healthcare providers. This was a retrospective study using 5 cohorts at Rush Alzheimer's Disease Center. We included participants who met all of the following criteria: (1) incident dementia based on annual cohort assessments, (2) linkage to Medicare records, and (3) a completed postmortem brain autopsy. Postmortem neuropathologic examinations identified the presence of AD, limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC), vascular pathologies, and neocortical Lewy bodies (LBs). In linked Medicare data, we defined timely diagnosis as the presence of claims with dementia diagnoses within 3 years before or 1 year after the cohort-based dementia onset. We used logistic regressions to quantify associations of neuropathology markers with timely diagnosis vs underdiagnosis. Of the 500 eligible participants (71% female, 95% non-Latino White, mean [SD] age at cohort dementia onset = 88 [7] years, mean [SD] years from onset to death = 4 [3]), only 54% received a timely diagnosis. After controlling for demographics, time to death, and other neuropathologies, a pathologic diagnosis of AD (OR = 1.91, 95% CI 1.21-3.00) and moderate/severe LATE-NC pathologies (OR = 1.83, 95% CI 1.25-2.68) were independently associated with higher odds of timely diagnosis. Moderate/severe vascular pathologies (OR = 0.94, 95% CI 0.55-1.59) and neocortical LB pathologies (OR = 1.00, 95% CI 0.64-1.55) were not significantly associated with receipt of a timely diagnosis. In a separate multivariable logistic regression, we found that participants with 3 or 4 neuropathologies present had an over 2-fold increase in odds of timely diagnosis (OR = 2.24, 95% CI 1.32-3.82), compared with those with 1 or no neuropathology. In deceased older adults with cohort-determined incident dementia, the healthcare system was twice as likely to capture those with pathologic diagnosis of AD, moderate/severe LATE-NC, and more than 3 copathologies in a timely manner. While findings from this predominantly White and highly educated sample warrant replication in broader population, this study is an important initial step toward understanding biological correlates of timely diagnosis of dementia.
For individuals suffering from schizophrenia, hope is a vital part of their treatment process. Hope prevents despair caused by a mental condition, which can lead to relapse or even death. This scoping review aims to synthesize qualitative evidence on the multidimensional strategies that foster and sustain hope among individuals with schizophrenia throughout the recovery process. This study utilized a scoping review method following the PRISMA-ScR framework. Literature searches were conducted on 4 electronic databases, namely Pubmed, Scopus, EBSCOhost, and ScienceDirect, with the publication period limited from January 2014 to December 2024, in English and full text. This study is confined to qualitative research findings. The primary keywords for this article are "Schizophrenia", "Psychotic Disorders", "Strategies", "Enhancing", "Maintaining", "Hope", and "Mental Health Recovery". This scoping review employs theme analysis. Eight qualitative studies met the inclusion criteria. The thematic synthesis identified six interconnected themes that highlight the strategies employed by schizophrenia survivors to cultivate hope in their recovery journey. These themes encompass the crucial role of social support in fostering hope, medication adherence and education as a pathway to stability, the role of environment in building hope, self-management in building hope, enhancement of spirituality, and the significance of setting life goals along with meaningful engagement. A comprehensive mapping of the methods utilized by individuals with schizophrenia can provide a basis for healthcare providers to create suitable support models, thereby fostering and sustaining hope for recovery among schizophrenia survivors.
Levetiracetam (LEV) is widely used in pediatric epilepsy but is often associated with behavioral adverse effects. However, its impact on internalizing symptoms such as anxiety and depression remains insufficiently explored. This study aimed to evaluate longitudinal changes in depressive and anxiety symptoms following LEV initiation using both total scores and item-level analyses. A prospective clinical follow-up study was conducted in 35 pediatric epilepsy patients (mean age: 12.2 ± 3 years). Psychometric assessments were performed at baseline and during the maintenance phase using the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory for Children (STAIC). Pre- and post-treatment scores were compared using non-parametric tests, and item-level analyses were conducted to descriptively examine changes across specific symptom domains. Thirty patients completed the longitudinal evaluation. LEV did not demonstrate a significant change in BDI scores (9.83 ± 9.55 vs. 10.13 ± 9.86; p = 0.68). In contrast, state anxiety significantly decreased (STAIC-1: 40.83 ± 9.04 vs. 36.2 ± 12.36; p = 0.011), while trait anxiety showed a non-significant reduction. Item-level analysis supported the overall stability of depressive and anxiety symptoms. Behavioral activation requiring treatment discontinuation occurred in 8.5% of patients and was observed early after treatment initiation. In this cohort, levetiracetam was not associated with a significant increase in depressive or anxiety symptoms. The observed reduction in state anxiety should be interpreted cautiously and may be influenced by multiple factors beyond treatment effects. Item-level analysis may provide additional clinical insight by distinguishing transient behavioral changes from clinically significant psychiatric deterioration. Given the limited sample size and absence of a control group, findings should be considered descriptive and warrant confirmation in larger, controlled studies.
Dementia imposes a growing public health burden in Korea, with substantial implications for families living with affected members. Although prior Korean studies have suggested an association between dementia-related household context and depressive symptoms, population-based evidence on co-residence with a family member with dementia remains limited. This study examined the association between co-residence with a family member with dementia and depressive symptoms among Korean adults aged 50 years and older. We conducted a cross-sectional analysis using data from the 2024 Korea Community Health Survey. Among 231,728 respondents, 120,029 adults aged ≥ 50 years living in non-single-person households were included. The exposure was co-residence with a family member reported to have dementia, rather than a direct measure of caregiving status, intensity, or duration. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), with a score ≥ 10 indicating clinically significant depressive symptoms. Survey-weighted multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. Overall, 15.8% of individuals reported depressive symptoms. Living with a family member with dementia was highly associated with depressive symptoms (OR = 1.35; 95% CI: 1.29-1.42; p < 0.0001). Among men, significant lower associations showed with good health status (OR = 0.14; 95% CI: 0.13-0.16). Among women, similar patterns were observed, with high income (OR = 0.71; 95% CI: 0.63-0.80) and good health (OR = 0.14; 95% CI: 0.13-0.16) being strongly protective against depression. Co-residence with a family member with dementia was associated with higher odds of depressive symptoms among Korean adults aged 50 years and older. These findings suggest the need to consider mental health screening and support strategies for families living with dementia, while acknowledging the cross-sectional and self-reported nature of the data.
Early onset substance use and social anxiety are associated with adverse psychosocial outcomes, including impaired academic performance. This study aimed to investigate if problematic substance use is associated with poorer school functioning and if social anxiety is associated with this relationship. Participants (n = 711), aged 8-20, were enrolled in the Texas Youth Depression and Suicide Research Network registry study aiming to characterize youth with depression and/or suicidality. Baseline data from CRAFFT 2.1 + N, MINI-KID, SAS-SR, and PHQ-A were used for multivariate analyses using linear regression to examine the relationship between problematic substance use and school functioning, as well as the interaction between problematic substance use and social anxiety and their association with school functioning. Over 20% of participants met criteria for problematic substance use, with alcohol and marijuana being the two most common reported substances used. Youth with problematic substance use were on average two years older and had significantly greater impairment in school functioning compared to youth without problematic substance use. However, youth with problematic substance use and social anxiety had comparable impairments in school functioning compared to those with problematic substance use that did not have social anxiety. In youth without problematic substance use, having social anxiety was associated with similar levels of impairment in school functioning compared to youth with problematic substance use alone. The significant co-occurrence of problematic substance use, social anxiety, and depression suggests the need for early identification and intervention to prevent and/or mitigate impairment in school functioning. Significant levels of comorbid depression and/or suicidality experienced by our participants may have impacted our findings. Future research comparing youth with and without depression will help elucidate this.
This study aimed to examine drawing characteristics in the Synthetic House-Tree-Person (S-HTP) drawing test among children with attention-deficit/hyperactivity disorder (ADHD) and to explore their associations with ADHD symptom severity. A total of 60 children aged 7-11 years (30 with clinically diagnosed ADHD and 30 healthy controls) completed the S-HTP drawing test and the SNAP-IV scale. Drawing characteristics were independently coded by two trained raters using predefined criteria. Group differences were analyzed using chi-square and rank-sum tests. Logistic regression analyses were performed to evaluate associations with ADHD status, and ROC analyses were used to assess discrimination. FDR correction and bootstrap internal validation were additionally applied. Six drawing characteristics differed significantly between groups in the initial analyses, of which five remained significant after FDR correction. Seven drawing characteristics showed exploratory associations with SNAP-IV scores. After adjustment for age, gender, family structure, and Raven's Standard Progressive Matrices scores, three drawing characteristics remained associated with ADHD status: A3 (tracing in shaky lines; OR = 4.31, 95% CI: 1.10-16.94), A4 (lines jagged and not joined; OR = 5.45, 95% CI: 1.45-20.49), and A8 (more than seven different colors; OR = 0.20, 95% CI: 0.05-0.72). Exploratory ROC analyses indicated that combining these characteristics improved discriminatory performance. The combined model achieved an AUC of 0.835. Bootstrap internal validation yielded an optimism-corrected AUC of 0.812, indicating reasonable model stability within the present sample. Certain S-HTP drawing characteristics were associated with ADHD status and symptom severity in this sample. In particular, A3, A4, and A8 were identified as drawing characteristics of potential interest for future research. However, given the exploratory design, relatively small sample size, and lack of external validation, further studies are required before the clinical utility of these findings can be established.
Accurate, consistent and comprehensive metadata are essential for the reuse of functional genomics data deposited in repositories such as the Gene Expression Omnibus (GEO), however, achieving this often requires careful manual curation, which is time-consuming, costly and prone to errors. In this paper, we evaluate the performance of Large Language Models (LLMs), focusing on OpenAI's GPT-4o, as an assistive tool for entity-to-ontology annotation of two commonly encountered descriptors in transcriptomic experiments, mouse strains and cell lines. Using over 9 000 manually curated experiments from the Gemma database and over 5 000 associated journal articles, we assess the model's ability to identify relevant free-text entries and map them to appropriate ontology terms. Using zero-shot prompting and retrieval-augmented generation (RAG) to incorporate domain-specific ontology knowledge, GPT-4o correctly annotated 77% of mouse strain and 59% of cell line experiments, and uncovered manual curation errors in Gemma for over 200 experiments (2% of total). GPT-4o substantially outperformed non-LLM alternatives, and was statistically indistinguishable from the highest-performing 2026 frontier models. Model errors often arose from typographical mistakes or inconsistent naming in the GEO record or publication, and resembled those made by human curators. Along with annotations, our approach requests that the model output supporting context and verbatim quotes from the sources. These were typically accurate and enabled rapid curator verification. We further found that for the difficult cell line task, an ensemble of LLMs can boost precision at the cost of recall. These findings suggest that while LLMs are not ready to fully replace manual curators, they can effectively support them. A human-in-the-loop workflow, in which LLM's annotations are provided to human curators for validation, should improve the efficiency and quality of large-scale biomedical metadata curation.
Canadian population-based data show that sexually diverse youth face greater mental health challenges than their heterosexual peers. However, nuances within sexual diversity-particularly among mostly heterosexual persons-are overlooked, and psychotic-like experiences remain underexplored. We examined the mental health of sexually diverse young adults from Quebec, spanning indicators from well-being to psychotic-like experiences. Data were drawn from 1324 youth from the Quebec Longitudinal Study of Child Development-a representative cohort born in 1997/98 and followed up until age 23. Participants self-reported their sexual orientation and mental health across nine indicators: suicidality, depression, anxiety, binge drinking, cannabis, other drug use, psychotic-like experiences, well-being, and help-seeking. Standardized mean differences (SMD) assessed group differences, stratified by assigned sex at birth and sexual orientation. A total of 324 (24.47%) youth identified as non-heterosexual. These youth reported poorer outcomes across all indicators (SMDs ranged from 0.19 for cannabis use to 0.52 for suicidality) and had higher odds of seeking psychological help (OR = 2.09, 95% CI [1.52-2.89]). Sexually diverse females reported poorer outcomes across all indicators compared to heterosexual females. Sexually diverse males had elevated risks for suicidality, depression, anxiety, and reduced well-being compared to heterosexual males. Mostly heterosexual (N = 156, 48.15%) and bisexual persons (N = 85, 26.23%) reported more symptoms than heterosexuals. Despite Canada's inclusive stance on sexual diversity, sexually diverse youth-especially those identifying as mostly heterosexual and bisexual-continue to face significant mental health disparities. Our findings highlight the need for accessible, tailored mental health services to support this population. RéSUMé: OBJECTIFS: Les données canadiennes issues d’études populationnelles montrent que les jeunes issus de la diversité sexuelle présentent des problèmes de santé mentale plus importants que leurs pairs hétérosexuels. Cependant, les différences au sein de la diversité sexuelle, particulièrement chez les personnes majoritairement hétérosexuelles, demeurent peu étudiés, et les expériences de type psychotique sont négligées. Nous avons examiné la santé mentale de jeunes adultes québécois avec des orientations sexuelles diverses, en nous appuyant sur des indicateurs allant du bien-être aux expériences de type psychotique. MéTHODES: Les données proviennent de 1 324 jeunes issus de l’Étude longitudinale du développement de l’enfant au Québec — une cohorte représentative née en 1997/98 et suivie jusqu’à l’âge de 23 ans. Les participants ont déclaré leur orientation sexuelle et leur santé mentale à l’aide de neuf indicateurs : tendances suicidaires, dépression, anxiété, consommation excessive d’alcool, consommation de cannabis, consommation d’autres drogues, expériences de type psychotique, bien-être et recours à l’aide. Les différences moyennes standardisées (DMS) ont été utilisées pour comparer les groupes, stratifiées selon le sexe attribué à la naissance et l’orientation sexuelle.  RéSULTATS: 324 jeunes (24,47 %) se sont identifiés comme non hétérosexuels. Ces jeunes ont fait état de résultats moins favorables pour l’ensemble des indicateurs (les DMS variaient de 0,19 pour la consommation de cannabis à 0,52 pour les tendances suicidaires) et présentaient un risque plus élevé de rechercher de l’aide psychologique [rapport de cotes (OR) = 2,09 ; IC à 95 % [1,52–2,89]]. Les personnes de sexe féminin à orientation sexuelle diverse ont fait état de résultats moins favorables pour tous les indicateurs par rapport aux personnes de sexe féminin hétérosexuelles. Les personnes de sexe masculin à orientation sexuelle diverse présentaient des risques accrus de tendances suicidaires, de dépression, d’anxiété et démontraient leur bien-être réduit par rapport aux personnes de sexe masculin hétérosexuelles. Les personnes majoritairement hétérosexuelles (N = 156, 48,15 %) et bisexuelles (N = 85, 26,23 %) ont signalé davantage de symptômes que les personnes hétérosexuelles. CONCLUSION: Malgré les politiques canadiennes favorables à la diversité sexuelle, les jeunes issus de la diversité sexuelle — en particulier ceux qui s’identifient majoritairement hétérosexuels ou bisexuels — continuent de faire face à d’importantes inégalités en matière de santé mentale. Nos résultats soulignent la nécessité de mettre en place des services de santé mentale accessibles et adaptés pour soutenir cette population.
Despite the importance of incorporating individuals with lived experience in the collaborative development and delivery of eating disorder (ED) services, a paucity of research has addressed the role of content creators with lived experience within the context of social media in contributing to help-seeking and recovery spaces. This qualitative study documents content creators' experiences of recovery-oriented content creation and informal digital support through social media platforms. It also explores how content creators contribute to recovery-oriented communication, prevention, and co-design of digital interventions. A total of 10 Italian female content creators in stable recovery from eating disorders (i.e., no relapse in the past 5 years) were recruited via the Instagram community #DicciComeAiutarti and they were interviewed. Through a reflexive inductive thematic analysis five overarching themes were identified: (1) Using Lived Experience to Build Recovery-Oriented Narratives and Communities, which highlighted lived experience as a relational resource for fostering recovery and shared meaning online; (2) Social media as a Double-Edged Sword, describing social media as both a supportive and potentially harmful space for ED recovery; (3) Communication Strategies for Effective Engagement, focusing on how participants adapted communication practices to the affordances and limits of different platforms; (4) Social Networking, Prevention, and Health Promotion, which framed online activity as part of a broader prevention and health advocacy effort; and (5) Providing Hope in Digital Peer Support, illustrating how structured peer-support contexts reshaped the sharing of lived experience and hope in recovery. Finally, the findings of the present study suggest that content creators can meaningfully contribute to the prevention and treatment of ED when integrated into supervised, ethically framed digital networks. The co-production of interventions with individuals who have recovered can engender a more humanised form of digital health communication, strengthening therapeutic engagement and supporting recovery-oriented public health strategies.
Growing research confirms the efficacy of transdiagnostic cognitive behavioral psychotherapy, that is treatments applicable across multiple diagnoses within a disorder class or spectrum, by examining group-level changes from pre- to posttreatment. However, less is known about interindividual differences and dynamic changes during therapy. Understanding different symptom trajectories and their associations with treatment outcome would allow early detection of nonresponders and treatment adjustments. Using data from the treatment group of a randomized controlled trial, we aimed to investigate trajectories in transdiagnostic cognitive behavioral therapy (CBT) with the Unified Protocol (UP) in patients with anxiety disorders. Patients reported on demographics, clinical history, coping strategies, treatment motivation, and expectations before starting transdiagnostic CBT. Participants provided symptom ratings across 16 sessions of the UP as well as at posttreatment, 6-, and 12-month follow-up (N = 64, 71.9% female, age: M = 32.67, SD = 11.91). Using latent class growth analysis (LCGA), we identified symptom trajectory classes and tested whether these could be predicted from baseline data. We also examined associations between classes and treatment outcome, using multilevel modeling and reliable change indices (RCIs). LCGA revealed four distinct trajectory classes: low severity-improved (n = 21, 32.81%), high severity-improved (n = 19, 29.69%), high severity-stagnant (n = 12, 18.75%), and low severity-worsened (n = 12, 18.75%). Only the number of comorbidities emerged as a significant predictor of class, with patients in the high severity-stagnant group having more comorbidities. They also showed higher symptom severity at baseline, posttreatment, and follow-ups compared to other classes, despite clear improvement. Latent classes of symptom changes during transdiagnostic CBT can be distinguished and important pretreatment factors identified, informing treatment selection and personalization. Particularly patients with high initial burden and a higher number of comorbidities may require monitoring and adaptive treatment strategies, which should be explored in future studies. Trial Registration: ClinicalTrials.gov identifier: NCT03945617.
Day-care centres provide meaningful engagement to persons with severe mental illness (SMI) and are a key component of community-based psychiatric rehabilitation. 'Manasadhara', a state-funded public-private partnership in Karnataka, offers such day-care services across district centres. To explore staff perspectives on the benefits and challenges of the Manasadhara programme for service users and their caregivers. In-depth interviews were conducted with 12 staff members using a semi-structured interview guide developed through pilot testing and expert review following one focused group meeting. Those with at least 6 months of work experience were included purposively after obtaining informed consent. Interviews were audio recorded, transcribed verbatim and analysed using a combined inductive-deductive content analysis approach. Staff reported multidimensional improvements in persons with SMI: (1) Functional independence-better hygiene, routine adherence. (2) Clinical and behavioural changes-reduced aggression, improved cooperation. (3) Pre-vocational skills-development of work habits, punctuality, and attempts to return to employment or support family businesses. (4) Financial and personal recovery gains. Staff further report that caregivers have reduced supervision burden, improved ability to work and strengthened family relationships. Mechanisms of change included behavioural activation, peer modelling and graded skill exposure. Reported challenges are related to financial, logistics and systemic issues. The Manasadhara programme provides structured engagement to persons with SMI. Staff reported a range of benefits to both persons with SMI and their caregivers, and a few challenges demonstrating its potential as a scalable, public-funded model for community-based psychiatric rehabilitation.