搜索结果：The International journal of social psychiatry

BACKGROUND: By the end of 2023, it was estimated that over 473 million children were living in areas affected by armed conflict globally. In these settings, adolescents are at heightened risk of experiencing multiple forms of violence. While parenting interventions are a promising strategy that can equip parents with skills and practices to prevent violence against children, little is known about desired content of parenting interventions for caregivers of adolescents in conflict settings. This qualitative study aims to address this gap through participatory methods with adolescents and parents in a setting of co-occurring conflict and displacement. The study is situated in the development phase of the Medical Research Council (MRC) framework for developing and evaluating complex intervention. METHODS: Same-sex participatory workshops were conducted with n = 73 participants: n = 37 parents, n = 16 adolescent boys and n = 20 adolescent girls living in Ituri province of the Democratic Republic of Congo. Workshops explored perception of the burden of violence among adolescents, the experience of parents living in a conflict setting, associated changes in parenting practices, and proposals on content for parenting interventions to reduce violence against adolescents. The study applied reflexive data analysis and grouped themes corresponding to the research question. RESULTS: Parents and adolescents perceive parenting interventions as a strategy that may contribute to reducing different forms of violence experienced by adolescents. Majority of content in existing parenting interventions were nominated by adolescents and by caregivers. Nine components/themes were identified by participants as important for inclusion in a parenting intervention. Three themes related to experiences of violence, three themes related to healthy relationships and three themes related to strategies for parents to manage their conduct, skills, and their mental health. While the parenting content proposed as relevant for participants in a conflict setting mirrors content from non-conflict settings, the findings illustrate the necessity to tailor interventions to strengthen the adolescent-parent relationship and address family violence. CONCLUSION: The findings can inform researchers, policy makers and practitioners working with adolescents and parents in conflict settings on what content to adapt, newly develop or replicate to evaluate and implement evidence-based parenting interventions.

The aim of this study was to analyze whether exposure to esthetic content aligned with beauty standards on social media mediates the relationship between a history of childhood/adolescent sexual abuse and bulimic symptomatology in adolescents, and whether sex moderates these pathways. Participants were 283 secondary school students (52.6% female) from Chimbote, aged 13 to 17&#x2009;years (M&#x2009;=&#x2009;15.2, SD&#x2009;=&#x2009;1.14). The following instruments were administered: the sexual abuse dimension of the CTQ-FC, the bulimia dimension of the EAT-26, and an ad hoc questionnaire assessing exposure to esthetic content on Facebook, Instagram, and TikTok. The results showed a moderate total effect of childhood/adolescent sexual abuse history on bulimic symptoms (&#x3b2;&#x2009;=&#x2009;.38, p&#x2009;<&#x2009;.001). Exposure to esthetic content on social media predicted higher bulimic symptomatology (Facebook [&#x3b2;&#x2009;=&#x2009;.24, p&#x2009;<&#x2009;.01] and TikTok [&#x3b2;&#x2009;=&#x2009;.17, p&#x2009;<&#x2009;.05]), and childhood/adolescent sexual abuse history significantly predicted greater Instagram use (&#x3b2;&#x2009;=&#x2009;.22, p&#x2009;<&#x2009;.01). However, indirect effects through the platforms did not reach statistical significance in the total sample or in sex-stratified analyses (female-male). It was concluded that, although social media use is associated with bulimia and childhood/adolescent sexual abuse history predicts increased symptoms, esthetic content on social media does not function as a significant mediator in this relationship, nor does sex moderate the pathways of the model. Interpretations are discussed within trauma theory and biopsychosocial frameworks, as well as implications for prevention and clinical intervention.

Schizophrenia is a severe mental disorder associated with a significant burden of care. Approximately 30% of patients have treatment-resistant schizophrenia (TRS), characterized by persistent psychotic symptoms, being clozapine the antipsychotic of choice for these individuals. To assess whether caregivers of patients on clozapine experience a higher burden of care compared to caregivers of patients on other antipsychotics. We conducted a post-hoc analysis of a cross-sectional study. Sixty caregiver-patient dyads were included (45 on clozapine; 15 on other antipsychotics). Caregivers were assessed using the Family Burden Interview Schedule - Short Form (FBIS-SF). Patients were evaluated using the Clinical Global Impression - Schizophrenia (CGI-SCH) and the Personal and Social Performance (PSP) scales. Patients on clozapine exhibited more severe positive symptoms (3.96&#x2009;&#xb1;&#x2009;1.22 vs. 2.40&#x2009;&#xb1;&#x2009;1.40; p&#x2009;<&#x2009;.001) and higher total CGI-SCH scores (13.67&#x2009;&#xb1;&#x2009;3.32 vs. 11.33&#x2009;&#xb1;&#x2009;3.52; p&#x2009;=&#x2009;.024). No significant differences were found in total FBIS-SF scores between the groups. In the clozapine group, caregiver burden was associated with female patient gender, lower social functioning (PSP), and receiving social benefits. In the non-clozapine group, an earlier age of onset correlated with increased burden. Despite greater clinical severity in the clozapine group, the overall burden was comparable to the non-clozapine group, suggesting that clozapine treatment may help stabilize the impact on families. Factors such as female gender, low functioning, and receiving social benefits (a proxy for illness severity) are correlated with specific burden domains. Due to the small size of the non-clozapine subgroup, these associations should be interpreted with caution.

The COVID-19 pandemic has exacerbated the mental health challenges globally and adversely affected the marginalised populations, including transgender and non-binary (TNB) individuals. Despite evidence, there is a lacuna of a systematic synthesis explicitly focussing on the prevalence of screen-positive common mental health problems, as prior reviews either examined sexual and gender minority populations as a whole or overlooked the full scope of pandemic-related mental health challenges, which the current review seeks to address through systematic review and meta-analysis. A comprehensive literature search was conducted across PubMed, Scopus, PsycINFO, and Web of Science, applying the PRISMA 2020 guidelines between March and August 2025. Eligible studies reporting the mental health outcomes of TNB individuals during the pandemic were screened, extracted, and critically appraised with the help of the COVIDENCE and JBI checklists for analytical cross-sectional studies. Meta-analyses were performed using a DerSimonian-Laird random effects model with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment to estimate pooled prevalence with 95% confidence intervals. Heterogeneity was quantified with I2 statistics. For depression (n&#x2009;=&#x2009;4,832), the screen-positive pooled prevalence was estimated as 0.59 (95% CI [0.47, 0.70]; I2&#x2009;=&#x2009;98.23%). The pooled prevalence for screen-positive anxiety (n&#x2009;=&#x2009;2,833) and substance (n&#x2009;=&#x2009;1,632) use was 0.50(95% CI [0.37, 0.63]; I2&#x2009;=&#x2009;94.04%) and 0.47 (95% CI [0.16, 0.79]; I2&#x2009;=&#x2009;98.58%), respectively. It is identified that the pandemic reinforced existing healthcare disparities, with disrupted gender-affirming care (e.g. hormone therapy, surgeries) significantly associated with increased psychological distress and gender dysphoria among transgender and gender diverse individuals. Mental health problems among TNB individuals were markedly elevated during the COVID-19 pandemic, highlighting the urgent need for tailored mental health interventions, uninterrupted gender-affirming care, and policies that address systemic social stigma and discrimination. Strengthening telehealth, community-based supports, and inclusive public health strategies are essential to mitigate disparities and promote resilience in this population.

Social Anxiety Disorder (SAD) and hikikomori share characteristics of social withdrawal. While childhood trauma is a known risk factor for both conditions, the specific mechanisms linking early trauma to hikikomori through cognitive pathways remain unclear. This study aimed to compare childhood trauma, cognitive distortions, and hikikomori levels in individuals with and without SAD and to examine the mediating role of cognitive distortions in the relationship between childhood trauma and hikikomori. A total of 171 participants were included in the study: 78 patients with SAD and 93 healthy controls (HCs). All participants completed the Childhood Trauma Questionnaire (CTQ-28), Cognitive Distortions Scale (CDS), and 25-item Hikikomori Questionnaire (HQ-25). Group comparisons were performed using t-tests and chi-square tests. Mediation analysis was conducted using the PROCESS macro (Model 4), controlling for age, sex, marital status, education level, and SAD. The SAD group had significantly higher CTQ-28, CDS, and HQ-25 scores than the HCs group (p&#x2009;<&#x2009;.001). Mediation analysis revealed that childhood trauma was associated with hikikomori levels both directly (B&#x2009;=&#x2009;0.33, p&#x2009;=&#x2009;.007) and indirectly through cognitive distortions (Effect&#x2009;=&#x2009;0.15, 95% bootstrap CI [0.06, 0.26]). The total effect of childhood trauma on hikikomori was also statistically significant (B&#x2009;=&#x2009;0.48, p&#x2009;<&#x2009;.001). The model, which controlled for age, sex, marital status, education, and SAD status, explained 42% of the variance in hikikomori severity (R2&#x2009;=&#x2009;.42). Our findings suggest that childhood trauma is associated with greater hikikomori symptoms, both directly and through the mediating effect of cognitive distortions. Therefore, cognitive distortions may be a potential intervention target for socially withdrawn individuals with a history of childhood trauma.

Anxiety has psychological, behavioural, and emotional effects on individuals' lives. These effects play a role in both internal distress of individuals and deterioration of their interpersonal relationships. The present study examined the serial mediating role of loneliness and life satisfaction in the relationship between anxiety experienced by participants and suicidal risk. The study was conducted as a descriptive and correlational research. The study was conducted with 608 married adolescent girls aged between the ages of 16 and 20 (M age&#x2009;=&#x2009;17.50, SD&#x2009;=&#x2009;1.31). "Adolescent Descriptive Form," "State-Trait Anxiety Inventory for Children (STAIC-Trait Form)," "Short-Form of the UCLA Loneliness Scale (ULS-8)," "Suicide Probability Scale (SPS)," and "The Satisfaction with Life Scale (SWLS)" were used as data collection measures. The data used in the study were analysed by using structural equation modelling. It was found that participants' trait anxiety positively predicted feelings of loneliness (&#x3b2;1&#x2009;=&#x2009;.852; p&#x2009;<&#x2009;.001) and negatively predicted life satisfaction (&#x3b2;1&#x2009;=&#x2009;-.510; p&#x2009;<&#x2009;.001). Loneliness (&#x3b2;1&#x2009;=&#x2009;.424; p&#x2009;<&#x2009;.001) positively predicted suicide risk. Life satisfaction (&#x3b2;1&#x2009;=&#x2009;-.276; p&#x2009;<&#x2009;.001) was found to negatively predict suicide risk. Loneliness, life satisfaction, and trait anxiety scale scores were found to explain 91.2% of the variance in participants' suicide risk scale scores. The results of the study show that loneliness and life satisfaction play a serial mediating role in the relationship between anxiety and suicidal risk. The findings indicate that efforts should be made to reduce feelings of loneliness and increase life satisfaction in order to reduce the impact of anxiety experienced in the home on suicidal risk. Therapies aimed at reducing feelings of loneliness should also focus on increasing perceived social support and coping skills. Increasing individuals' participation in daily life activities and reducing their workload will increase their life satisfaction.

There is a knowledge gap regarding the geographic distribution of suicide risk and its associated socio-demographic factors in the years following the onset of the COVID-19 pandemic. This study aimed to describe the spatial patterns of suicide risk in Argentina from 2015 to 2022 and identify contributing factors. Suicide mortality data were obtained from the Ministry of Health of the Nation. Multivariate Bayesian hierarchical regression models were employed to assess associations between suicide risk and three key variables: population density, socioeconomic status, and an index of social fragmentation. In 2020, high-risk suicide areas in the center-east of the country, which had persisted in previous years, were no longer observed. However, these high-risk areas re-emerged during 2021 to 2022. Except for 2017 and 2019, suicide risk was consistently higher in rural areas. Elevated values of the social fragmentation index were associated with increased suicide risk during 2021 to 2022. The post-2020 period reflects a return to the pre-pandemic geographic pattern of suicide in Argentina, with rural areas remaining persistent high-risk zones. However, in the post-pandemic era, suicide appears to disproportionately affect areas with weaker social ties.

While the relationships between self-stigma, self-esteem, and quality of life have been extensively discussed in populations with mental disorders, there is currently a lack of a meta-analysis to confirm their reliable associations. This study explores the connections between self-stigma, self-esteem, and quality of life in individuals with mental disorders. A systematic search across three databases identified 82 relevant studies. Meta-analytic structural equation modeling was performed on the included data using R software, and the quality of the included studies was assessed. The results of the path analysis indicated a negative correlation between self-stigma and self-esteem (&#x3b2;&#x2009;=&#x2009;-.493, 95% CI [-0.541, -0.447]), as well as a negative correlation between self-stigma and quality of life (&#x3b2;&#x2009;=&#x2009;-.251, 95% CI [-0.327, -0.173]). A positive correlation was found between self-esteem and quality of life (&#x3b2;&#x2009;=&#x2009;.384, 95% CI [0.303, 0.465]). Among patients with mental disorders, self-esteem played a mediating role in the relationship between self-stigma and quality of life (&#x3b2;&#x2009;=&#x2009;-.189, 95% CI [-0.235, -0.148]). Subgroup analysis of national income levels reveals a significant moderating effect. Self-esteem mediates the relationship between self-stigma and quality of life among individuals with mental disorders. Future interventions aimed at improving the quality of life of individuals with mental disorders should consider the impacts of self-stigma and self-esteem.

This study examined associations of social identity and experience variables with specific patterns of disordered eating behaviors among sexual and gender diverse youth, a population at elevated risk of disordered eating behaviors and eating disorders. Using data from a nationwide U.S. survey of sexual and gender diverse youth between the ages of 13 and 18 (n&#x2009;=&#x2009;10,743), we determined profiles of engagement across three disordered eating behaviors: restriction, binge-eating, and purging through Latent Profile Analysis and examined the associations between profile membership and gender, sexual orientation, race/ethnicity, four types of bullying victimization (gender-based, sexual orientation-based, race-based, weight-based), lesbian, gay, bisexual, transgender, and queer (LGBTQ)-specific parental acceptance, and depressive and anxiety symptoms. Three latent profiles emerged: (1) High Restriction & Binge-eating (28.6%), (2) Low Disordered Eating Behaviors (36.9%), (3) High Restriction (34.4%). All bullying victimization was significantly associated with increased odds of belonging to a disordered profile (Restriction and Binge-eating, and High Restriction); weight-based bullying was specifically associated with greater odds of belonging to the High Restriction & Binge-eating profile. Parental acceptance was most strongly associated with not belonging to either disordered profile. The High Restriction & Binge-eating profile was associated with more elevated depressive and anxiety symptoms than the High Restriction profile. Binge-eating distinguished two patterns of disordered eating behaviors among sexual and gender minority youth; the High Restriction & Binge-eating profile associated with slightly worse social experiences and outcomes. Future prevention and intervention efforts may focus on fostering safer environments for sexual and gender diverse youth through reducing bullying and increasing parental acceptance, as these social experience variables were more strongly associated with disordered eating behaviors profile membership than identity variables.

New-type depression, which exhibits characteristics that are different from those of traditional depression, is thought to be associated with hikikomori. However, a causal relationship has yet to be established. Thus, this study examined the causal relationship between the psychological characteristics of new-type depression (interpersonal sensitivity and privileged self) and hikikomori. The analysis included 393 male individuals with hikikomori, with longitudinal data collected from participants by asking them to respond 3 times at 3-month intervals. Participants responded to scales to measure the psychological characteristics of new-type depression and the severity of hikikomori symptoms. We analyzed the data using a random-intercept cross-lagged panel model. Our results showed significant cross-lag effects. In particular, our findings revealed that the extent of hikikomori at Time 1 increased IS and PS at Time 2, whereas IS and PS at Time 2 increased the extent of hikikomori at Time 3. Our data fit the model. These results suggest a self-reinforcing pattern in which hikikomori tendencies intensify with increasing IPS over time. We propose that it is important to address both new types of depression and hikikomori rather than addressing one or the other in the treatment of these two disorders. However, this study focused exclusively on individuals who were hikikomori, men, unemployed, and non-disabled. Future studies should include individuals without hikikomori infections or new types of depression.

Mental health first aid refers to the support provided by lay people to someone developing a mental health problem or experiencing a mental health crisis. Best-practice mental health first aid is defined by expert consensus guidelines describing recommended and non-recommended support actions, which underpin Mental Health First Aid training programmes. While such guidelines aim to improve social responses to mental health problems, little longitudinal evidence exists on their association with outcomes for people receiving this support. This study examined the association between the quality of mental health first aid received from someone close and subsequent psychosocial and help-seeking outcomes. A community sample of 468 adults who reported a mental health problem completed questionnaires at baseline and 6-month follow-up assessing the mental health first aid actions they had received from someone close to them, psychological distress, internalised stigma, quality of life, functioning, relationship quality, perceived change in mental health and professional help-seeking. Regression models were used to examine associations between recommended and non-recommended mental health first aid actions and changes in outcomes at follow-up. Receiving a greater number of recommended mental health first aid actions was associated with improved relationship quality (b&#x2009;=&#x2009;0.06, 95% CI 0.02,&#x2009;0.10), better perceived mental health change (b&#x2009;=&#x2009;0.04, 0.01,&#x2009;0.08), decreased internalised stigma (b&#x2009;=&#x2009;-0.02, -0.03,&#x2009;-0.01), and increased odds of seeking help from a general practitioner (OR&#x2009;=&#x2009;1.15, 1.04,&#x2009;1.28). Receiving non-recommended actions was associated with increased internalised stigma (b&#x2009;=&#x2009;0.05, 0.00,0.10) and psychological distress (b&#x2009;=&#x2009;0.63, 0.05,&#x2009;1.20), but also with improved relationship quality (b&#x2009;=&#x2009;0.18, 0.04,&#x2009;0.10). Effect sizes were small overall. These findings provide evidence that high quality mental health first aid is associated with meaningful changes in psychosocial and help-seeking outcomes for people experiencing mental health problems. Best-practice mental health first aid may contribute to improved social responses to mental illness and reduced stigma within close relationships.

Secure extended care units (SECUs) are low-secure locked inpatient units. They are considered the most restrictive intervention within the continuum of mental health rehabilitation programmes for patients within non-forensic public mental health services. Limited information about psychosocial and forensic aspects of patients referred to such units is available. This study explored the psychosocial and forensic characteristics and predictors of acceptance in an Australian SECU programme over a 5-year period (2019-2023). A retrospective study design investigated 121 consecutive referrals. The 98 first-time patient referrals were included in the main analysis. Descriptive statistics were used with non-parametric comparisons (Chi-square and Fisher exact test where appropriate). Logistic regression was undertaken to assess the influence of covariates. Referral from an inpatient mental health setting was the only predictor that influenced acceptance onto the SECU (OR 3.168, 95% CI: [1.129, 8.913], p&#x2009;=&#x2009;.029). More than four-fifths had a forensic history. Only 14 % had a history of youth offending, but 73% had a past conviction before referral. Sixty percent had a history of Family violence and two-thirds were on Bail. Services prioritised containment and abstinence, whereas patients sought skills development and employment. Patients had least contact with a Psychologist among all allied health disciplines before referral. The study provides evidence that the SECU is receiving patients with high forensic and psychosocial needs, which are unmet within community mental health programmes in the absence of medium and high-secure units. There is a need for a balanced approach between containment, rehabilitation, and community reintegration for this cohort.

The COVID-19 pandemic has had a strong psychological impact on family units. This study investigated the contribution of sociodemographic and clinical factors to psychological distress in parents or caregivers of children with a mental illness at a specialist tertiary hospital in Gauteng, South Africa. A structured sociodemographic and clinical questionnaire measuring psychological distress was self-administered to 150 participants. The Perceived Stress Scale (PSS) was used to measure the severity of stress, the Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depression, and the Generalized Anxiety Disorder-7 (GAD-7) was used to measure the severity of anxiety. Significant predictors of mental health status include loss of home due to COVID-19 (odds ratio [OR: 46.61], 95% confidence interval [CI: 5.81, 1,089.92]), history of psychiatric treatment (OR: 11.98, [3.16, 57.22]), perceived decline in quality of life (OR: 11.88, [1.20, 185.28]), female sex (OR: 3.83, [1.00, 17.7]), and difficulty spending time with extended family (OR: 3.09, [1.10, 9.29]). The mental health status of caregivers of children with mental illness during the COVID-19 pandemic was likely influenced by the loss of a home due to COVID-19, a history of psychiatric treatment, a perceived decline in quality of life, the female gender, and difficulty spending time with extended family. Our study demonstrated the intricate interplay of socioclinical factors with depression, anxiety, and perceived stress.

One of the sections of the International Classification of Diseases 11th Revision (ICD-11), which focuses on the diagnosis of personality disorder (PD), has received great support from the scientific community for dimensionally focusing on its functioning instead of categories of low validity and utility for daily clinical practice. The goal of this paper is to provide a positive framework to complement the personality spectrum, and thus, with a comprehensive approach, strengthen the usefulness of the ICD-11-PD model. This is a narrative review focused on primary literature identified through searches conducted in PubMed and Web of Science in April 2024. The keywords used were "personality disorder," "dimensional models of personality disorders," and "ICD-11 personality disorders." Given the nature of the review, we included studies employing diverse diagnostic criteria for personality disorders, as well as those based on the new ICD-11 definition. Despite the promising benefits of this new model, preliminary evidence has highlighted several shortcomings, including low discriminant validity, weak latent structures, and a lack of clarity in distinguishing between PD and normal personality. From this perspective, complementary positive framework is proposed, which designates happiness and social well-being as determinants of the clinical importance of personality functioning in the new ICD-11-PD model. With this integrative model, such deficiencies could be better addressed by providing a personalized and empowering assessment and intervention approach that can obtain cost-effective results in primary and specialized care.

Neurodevelopmental disorders (NDDs) in children, such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability, are often associated with significant sleep disturbances. These disruptions can adversely affect the child and the psychological well-being of family members. This systematic review aims to synthesize evidence on the impact of sleep disturbances in children with NDDs on the psychological outcomes of their families. A comprehensive search was conducted across PubMed, Web of Science, Embase, and PsycINFO. Eligible studies examined associations between sleep disturbances in children with NDDs and relatives' psychological outcomes, such as caregiver stress, anxiety, depression, and quality of life. The risk of bias was assessed using the STROBE Checklist, and findings were narratively or quantitatively synthesized, where appropriate. A total of 10 studies were included. Evidence indicates that sleep disturbances in children with NDDs are strongly associated with increased caregiver stress and elevated symptoms of anxiety and depression. Reduced sleep quality and duration in children are linked to poorer family functioning and lower quality of life in caregivers. Sleep disturbances in children with NDDs profoundly impact the psychological well-being of their families, highlighting the need for targeted interventions to improve sleep in children and provide mental health support for caregivers. Future research should explore longitudinal outcomes and the effectiveness of family-centered interventions to address this multifaceted challenge.

Experiences associated with war, migration, and loss can result in complex psychological challenges in children and adolescents. The objective of this study was to identify distinct psychological profiles related to symptoms of depression and trauma among youth of Polish, Ukrainian, and displaced backgrounds. The study involved 222 participants aged 7 to 21&#x2009;years, originating from Poland, Ukraine, and a group of displaced children from Ukraine. Hierarchical cluster analysis was conducted using the ITQ-CA questionnaire, while depressive symptoms were assessed with CDI-2. The obtained clusters were compared with psychological and sociodemographic factors. The analysis identified two to three clusters with distinct symptom profiles. Cluster 1 was characterized by higher depressive symptoms and lower PTSD severity, whereas clusters 2 and 3 exhibited an opposite pattern. Factors such as age, exposure to war, loss experience, living arrangements, and interests distinguished cluster membership. Age was positively correlated with the severity of PTSD, although the degree of this relationship varied depending on the cluster. Additionally, associations were found between the frequency of healthcare utilization and the severity of psychopathological symptoms. Children and adolescents with war-related experiences do not constitute a homogeneous group in terms of psychological symptoms. In practice, this means that a one-size-fits-all approach to diagnosis and intervention is insufficient. Instead, profiling individual symptom patterns, considering factors like age, specific trauma exposures, living situations, and even engagement in hobbies, is essential for guiding trauma-informed care. The results have significant clinical implications for designing individualized, culturally sensitive psychological interventions, ensuring that support is specifically matched to the unique needs of each child or adolescent, rather than relying on broad diagnostic categories. For instance, interventions for younger children with higher depression may focus on emotional support, while older adolescents with higher PTSD may require targeted support for complex trauma.

The psychological mechanisms linking war-related nightmares to psychotic experiences remain insufficiently elucidated, especially among the vulnerable displaced population. The present study investigated the mediating effect of anxiety-depression symptoms in the association between war-related nightmares and psychotic experiences within a sample of internally displaced Lebanese citizens during the 2025 southern Lebanon attack. A cross-sectional study was performed on displaced Lebanese citizens between October 2024 and March 2025 and included 249 displaced Lebanese citizens. Three scales were used: The Community Assessment of Psychic Experiences scale-9, the Patient Health Questionnaire-4 and the Nightmares to War scale. The indirect effect analysis taking psychotic experiences as the dependent variable was accommodated for the subsequent covariates: education, age and nightmares to war. Psychological distress (indirect effect: Beta&#x2009;=&#x2009;.07; Boot SE&#x2009;=&#x2009;0.03; Boot CI [0.01, 0.13]) partially mediated the association between nightmares to war and psychotic experiences. Greater levels of nightmares to war were notably linked to higher psychological distress and higher psychological distress was significantly associated with higher psychotic experiences. Moreover, higher nightmares to war were directly associated with more psychotic experiences. The effect size was 0.08 [0.01; 0.15]. The sensitivity analyses showed that anxiety (indirect effect: Beta&#x2009;=&#x2009;.07; Boot SE&#x2009;=&#x2009;0.03; Boot CI [0.02,&#x2009;0.13]; effect size&#x2009;=&#x2009;0.08;&#x2009;95% CI [0.02, 0.15], but not depression (indirect effect: Beta&#x2009;=&#x2009;.03; Boot SE&#x2009;=&#x2009;0.02; Boot CI [-0.01, 0.08]; effect size&#x2009;=&#x2009;0.04;&#x2009;95% CI [-0.01, 0.10], played an indirect role in the association between nightmares to war and psychotic experiences. This study established a significant connection between war-related nightmares and psychotic experiences, with psychological distress partially mediating this relationship and anxiety playing an indirect role in the association. Therefore, our findings highlighted the importance of routine assessment for trauma-related nightmares and affective symptomatology to detect individuals at heightened risk of developing psychotic experiences and thus facilitate timely, evidence-based interventions.

Hikikomori, a globally emerging psychiatric syndrome, is characterised by near-complete withdrawal from social interaction. While various interventions exist, research on the effectiveness of peer support for psychological recovery remains limited. Furthermore, many individuals with hikikomori struggle to access or regularly attend traditional face-to-face support because of fears of going out or social anxiety, creating a critical gap in support provision that digital solutions are uniquely positioned to address. This study clarified the experiences of individuals with hikikomori who received web-based peer support in virtual hangouts, focussing on their satisfaction with the service and the influencing factors. A web-based, self-administered questionnaire survey was conducted from October 2020 to September 2021 in Japan. The sample comprised 80 people with hikikomori. Participants reported sociodemographic and hikikomori-related information, psychological distress (Kessler 6, K6), reasons for hangout participation, service satisfaction level (Client Satisfaction Questionnaire with eight items-Japanese version, CSQ-8J), and hangout participation frequency. CSQ-8J scores were used to group participants as highly or less satisfied. Data were analysed using t-tests and chi-squared tests. Participants in the highly satisfied group were significantly younger and reported an earlier onset of hikikomori or school non-attendance. The most common reason for hangout participation in the highly satisfied group was 'referral from a support organisation or self-help group'. Participants in the less satisfied group tended to have higher mean K6 scores, but no statistically significant difference was found. The findings suggest that virtual hangouts are effective in supporting people with hikikomori, particularly the youth, with high levels of satisfaction reported. This study highlights the significant potential of web-based peer support in overcoming traditional barriers, offering a more accessible and inclusive model for supporting individuals experiencing social withdrawal. To further increase efficacy, virtual hangouts could be combined with individual counselling and visiting support.

The incidence of mental health concerns is growing, and demand for support is exceeding service capacity. Digital tools can provide additional support but risk causing harm if not delivered safely. We aimed to establish real-world evidence of the impact of an artificial intelligence-based mental health conversational agent (Wysa) on depression and anxiety in patients waiting for Talking Therapies treatment. A mixed-methods randomized controlled trial was conducted with patients referred to Talking Therapies in the Central and Northwest London NHS Foundation Trust. The primary outcome was change in depression severity over 12&#x2009;weeks between groups; secondary outcomes included anxiety severity, quality of life, safety, engagement, and app usage. Comparative analyses used linear regression; thematic analysis was conducted on qualitative data. 2,161 patients were screened, 625 were invited, 99 consented, and 76 were randomized (2:1). Thirty patients were lost to follow-up. Descriptive analysis found that mean differences in depression were similar between arms, but with large standard deviations (M&#x2009;=&#x2009;2.62, SD&#x2009;=&#x2009;5.07 and 6.56 for Wysa; M&#x2009;=&#x2009;2.59, SD&#x2009;=&#x2009;4.38 and 3.82 for control). Results were similar for secondary outcomes. Wysa was potentially helpful, easy to use, and appreciated as an accessible source of support, but limitations with the conversational agent negatively affected engagement. Although sample size limited the analysis, participant feedback highlighted its potential to supplement clinical services. Our study findings suggest that the change of depression score is similar in both arms thus indicating that there is no evidence that Wysa treats depression in this study. However, limited sample size could have influenced this. Key lessons to improve the quality of effectiveness studies of digital health technologies were identified.