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This article traces the historical development of transcultural psychiatry in Sweden from the post-Second World War period to the early 21st century. It argues that the field emerged at the intersection of welfare universalism, humanitarian internationalism, and clinical encounters with migration-related distress. Shaped by labor migration and later refugee reception, Swedish transcultural psychiatry became strongly oriented toward trauma, particularly in relation to war and displacement. While this focus helped institutionalize specialized services and legitimize migrant suffering within psychiatric care, it also individualized structurally produced distress. The article further examines how Swedish exceptionalist self-understandings - especially notions of colorblindness and moral humanitarianism - both enabled and constrained the field, contributing to the relative neglect of racism and the mental health of national minorities.
Following the near-total destruction of mental health services during the Khmer Rouge regime (1975-1979), psychiatry in Cambodia underwent a gradual and resource-constrained revival from the early 1990s onward. This article traces the history of psychiatry in Cambodia from its early institutional foundations in the colonial period, through its collapse during the Khmer Rouge genocide, to its re-establishment and progressive institutionalization in the post-conflict era. Drawing on historical archives, policy documents, and published literature, the paper describes three main phases of development: initial reconstruction and training (1992-2000), expansion of services and education (2001-2015), and recent efforts toward institutionalization and specialization (2015-present). Particular attention is given to the interaction between western psychiatric models and Cambodian cultural frameworks of distress rooted in Buddhism, animism, and community-based healing practices. The article highlights the central role of international collaboration, nongovernmental organizations, and emerging local leadership in shaping psychiatric services, while also documenting persistent challenges including workforce shortages, uneven geographic distribution of care, limited inpatient capacity, and enduring stigma. By situating psychiatry within Cambodia's broader sociocultural and historical context, this review contributes to a transcultural understanding of mental health system reconstruction in post-conflict settings. It also underscores the importance of culturally responsive, community-oriented approaches for sustainable development.
The centenary of Frantz Fanon’s birth in 2025 sparked renewed attention to his work. In recent years, his reception has shifted noticeably: from Fanon as a political activist to Fanon as a psychiatrist. To offer a concise exploration of the historical significance and contemporary relevance of Fanon’s psychiatric writings, and to help make this body of work more accessible to a Dutch-speaking readership. A reflective discussion based on a literature review of both the primary and recent secondary literature, including a recent narrative literature review on Fanon via PubMed. The renewed engagement with Fanon’s psychiatric writing provides a more accurate understanding of his role in the decolonization of psychiatry and sheds light on his radically innovative clinical practice as a psychiatrist. Although formal decolonization largely lies behind us, Fanon remains a vital point of reference for social and transcultural psychiatry. His work continues to issue a postcolonial challenge to the broader psychiatric field: it calls for culturally sensitive care and reminds psychiatry of its societal responsibility to confront institutional racism.
This paper explores the ways in which cultural psychiatry can contribute to the understanding of the larger culture of medicine, through critical engagements with dualisms that structure medicine's curative imaginary-a social imaginary that positions disability as a deviation, a tragedy, and a problem to be solved. Developed as an experimental form of image/text analysis from a sensory ethnographic study of solid organ transplantation and drawing on ethnographic interviews, art workshops, and visual fieldnotes, our analysis tracks the bifurcated logic of cure through vignettes and fragments, building a larger visual and text-based narrative that engages crip technoscience as a means of reconsidering emotional distress and psychosocial challenges of transplantation. Transplantation offers a space to critically engage with the persistence of dualisms in medicine and psychiatry, complicating divisions and boundaries between sickness/health, before/after, mind/body, self/other. We see the enforcement and reinforcement of binary logics, and at the same time these are undone within the tempo and textures of the field when we attend to it through sensory and affective modes of study. Artistic practices and stories told as fragments and gestures rather than linear narratives can build upon one another, scaffolded to offer a different way of viewing dominant motifs in the culture of medicine, which offer different possible futures for thriving in/with disability.
Fan cultures emerge from communities of shared interests, such as those related to television series, novels, video games, and other hobbies. The internet has expanded the popularity and accessibility of fan cultures, with implications for mental health that remain underexplored within clinical practice and research. This narrative review and viewpoint article ponders how the recognition of fan cultures in cultural psychiatry may contribute to improving mental health care for members of fan communities. First, we provide an overview of the role of fan cultures in mental health, with a particular focus on furry culture, a well-studied but often stigmatized community. Drawing from media psychology and fan studies, we review the psychological and social affordances of fan cultures, and we take the furry culture as an example to further discuss how identity, technology, stigma, and community interface with fan culture and mental health. Then, we consider how the Cultural Formulation Interview, a conventional method of cultural psychiatry, could allow the mental health ramifications of fan cultures to be recognized in clinical practice.
To mark the 10th Anniversary of BJPsych Open, we explore the contributions of papers published in BJPsych Open to advance cultural psychiatry practice and policy. In our overview of papers published in BJPsych Open, we found examples of good practice where authors detailed the translation methods and interpretation models in the research. The task facing clinicians and public health practitioners is to evolve applied, locally relevant, culturally competent interventions in which specific adaptations are shaped by the potential beneficiaries, alongside theoretical and practical issues of cultural adaptation. Researchers and clinicians will need to provide evidence of acceptability and effectiveness of adapted interventions, alongside considering financial and implementation realities.
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The theme of the 21st International Congress of the European Society for Child and Adolescent Psychiatry, "Beyond Nature and Nurture," focused on issues surrounding the future of child and adolescent psychiatry. In particular, it focused on how the role of family involvement is evolving in child and adolescent psychiatry. Many mental health disorders affecting young people require a focus on the context and environment of the youth. The "Maisons des Adolescents" take into account the complexity of disorders that emerge during adolescence and their multifactorial causes. Psychological suffering can lead to major health risks, and these disorders often require family involvement. In our symposium, we described different forms of care involving parents in a research and a clinical setting. We looked at the management of suicidal crises in a day-hospital setting and the therapeutic education program for bulimia and binge eating disorder.
Diversity, equity, and inclusion (DEI) are foundational values for cultural psychiatry. The current assault on DEI in the United States and other countries represents a direct challenge to the scientific, ethical, and clinical commitments that have guided progress in mental health over recent decades. This paper examines the history, rationale, and successes of DEI frameworks in health care and psychiatry, discusses legitimate critiques, documents the scope and consequences of the current anti-DEI movement in the United States and other jurisdictions, and draws comparisons with Canadian and United Kingdom contexts. We revisit each component of DEI-diversity, equity, and inclusion-to clarify its scientific grounding and moral significance for mental health. We argue that, rather than dismantling DEI, cultural psychiatry and allied disciplines must respond with renewed commitment to the values of DEI as well as those of dignity, empathy, and integrity, as ways to advance social justice and pluralistic civil society.
Over the past three decades, psychological trauma has become a central framework in Indigenous mental-health research, shaping how silence, disclosure, and healing are interpreted. Within this framework, Inuit silence has been framed as a collective pathology-a "culture of silence"-and a risk factor contributing to suicide in the Arctic. In this article, I draw on pandemic-era public communication and professional narratives collected at a large health event in Greenland to critically reflect on cultures of silence and confession. The article demonstrates how crises such as the pandemic bring to the surface tacit or neglected dynamics, and highlights how hegemonic knowledge frameworks, which prioritize disclosure-centred models of care, shape contemporary mental health governance in Greenland. The case study identifies three recurring patterns: (a) disclosure is framed as both a cure and a civic duty; (b) local practices of quiet that sustain dignity and relational safety are overlooked; and (c) institutional logic of disclosure redirects blame and responsibility from structural conditions to individual and collective failures. Drawing on conceptual metaphor theory, anthropological and historical scholarship on silence and violence, and decolonial approaches to knowledge production, the article highlights the risks of disclosure-centred frameworks. It argues that such models may misrecognize culturally grounded practices of quiet as absence or pathology, rather than as meaningful relational forms of coping and care. It suggests the need for approaches that attend to multiple forms of communication and care, and avoid equating well-being with verbal disclosure and silence with deficiency. By reframing silence as a relational and culturally situated practice, the article contributes to ongoing debates in transcultural psychiatry about the limits of universalizing therapeutic models. It also contributes to scholarship on structural violence, Indigenous mental health, and the potential mistranslation of illness and wellness.
Background: Early identification of posttraumatic symptoms in children and adolescents is essential for timely intervention. The Child and Adolescent Trauma Screen-2 (CATS-2) is a brief, freely accessible instrument that simultaneously assesses DSM-5 PTSD, ICD-11 PTSD, and ICD-11 complex PTSD (CPTSD) symptoms across child and caregiver report forms. Cross-cultural validation of the CATS-2 in underrepresented settings remains limited. This study examined the psychometric properties of the Turkish CATS-2 in a clinical sample.Method: Participants were 196 children and adolescents referred to a child and adolescent psychiatry outpatient clinic. ICD-11 PTSD and CPTSD diagnoses were established through clinician-administered assessments. Internal consistency, test-retest reliability, convergent and discriminant validity, child-caregiver agreement, confirmatory factor analysis (CFA), known-groups validity, and diagnostic accuracy were examined.Results: The CATS-2C showed good to excellent internal consistency (α=.81-.94) and test-retest reliability (ICC = .86-.90). CFA supported a two-factor correlated model of ICD-11 PTSD and disturbances in self-organization (DSO), and the DSM-5 four-factor model, for both forms. The CATS-2C showed strong convergent validity (r = .79-.89) and negligible associations with externalizing symptoms (r = .08-.12, ns). Known-groups validity was excellent for the CATS-2C (η² = .48-.58) but limited for the CATS-2P (η² = .076-.119). Diagnostic accuracy was good to excellent for the CATS-2C (AUC = .868-.947) and poor to acceptable for the CATS-2P (AUC = .606-.735), all subscales significant. Optimal CATS-2C cut-offs against clinician ICD-11 diagnoses were ≥7 for ICD-11 PTSD (sensitivity = 84%, specificity = 78%), ≥17 for ICD-11 CPTSD (93%, 85%), and ≥30 for DSM-5 PTSD (85%, 89%). Child-caregiver agreement was poor (ICC = .259-.344).Conclusions: The Turkish CATS-2C demonstrated sound psychometric properties, supporting its use as a reliable screening tool in child and adolescent mental health settings. The CATS-2P showed acceptable structural validity and internal consistency but more limited diagnostic discrimination, underscoring the importance of directly assessing symptoms from the child. These findings contribute preliminary evidence regarding ICD-11 PTSD and CPTSD constructs in an underrepresented, middle-income clinical setting.Trial registration: ClinicalTrials.gov identifier: NCT06975852. CATS-2 child report showed strong psychometrics across ICD-11 and DSM-5.CATS-2 caregiver report showed valid structure, weaker discrimination.ICD-11 PTSD/CPTSD cut-offs were derived against clinician diagnosis.Findings support ICD-11 PTSD/CPTSD use in a middle-income setting.
Editorials and commentaries have a central role in shaping debate, priorities and values within psychiatry. Reflecting on the first decade of BJPsych Open, we consider how topical writing both responds to and helps define emerging scientific, social, ethical and political challenges. Looking ahead, we suggest that global instability, technological change and pressures on academic freedom will increasingly shape psychiatric discourse, underscoring the importance of editorial independence, methodological rigour and openness to the airing of contested ideas in guiding the journal's next decade.
Indian mental health providers have suggested that the Hindu scripture the Bhagavad Gita ("Gita") could be a source for psychotherapeutic interventions. This raises questions about how mental health practitioners have interpreted relationships between the Gita and psychotherapy, how these interpretations construct selfhood, and how these interpretations of selfhood relate to commentaries from Hindu religious scholars. This paper answers these questions through a critical narrative review of studies on the Gita and psychotherapy, along with textual analyses of authoritative Gita commentaries, analyzed through the pattern theory of the self framework. An April 2025 search for studies that explored psychotherapy and selfhood in the Gita in five databases along with forward citation and backward bibliographic analyses uncovered 17 studies, all suggesting that principles of the Gita could be used within psychotherapy, with eight studies naming cognitive behavioral therapy. Thirteen drew on Hindu concepts of ātman, dharma, and karma to postulate an ideal self to help patients reflect on thoughts, emotions, and behaviors. Authoritative commentaries from Ādi Śaṃkarācārya, Swami Vivekananda, and Swami Chinmayananda show that ātman as the eternal soul, dharma as morally prescribed behaviors, and karma as actions without expectations of results have religious connotations without equivalents in Euro-American forms of psychology. A post-colonial approach to psychiatry can read the Gita alongside its commentators-ancient and modern, religious and non-religious-to uncover ways of conceptualizing selfhood before assuming that religious concepts have direct correspondences with psychotherapy.
To translate, adapt, and validate into Spanish the "How I Feel About My School" scale, a 7‑item subjective well‑being questionnaire developed in the United Kingdom to assess how children aged 4 to 11 feel about different aspects of school. The study consisted of two phases: a first phase involving the transcultural adaptation of the scale, and a second phase focusing on the psychometric validation of the scale. Phase I pursued to obtain a Spanish version that was conceptually equivalent to the original. It was conducted with 48 children and 10 teachers and was carried out in accordance with the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcome Measures, including cognitive debriefings. A content analysis followed over the data from the cognitive debriefing, which resulted in accepting the translated version. In Phase II, the number of participants involved in the study was 471 boys and girls. An exploratory factor analysis was performed, the number of factors being determined through parallel analysis. The reliability of the questionnaire was assessed to explore internal consistency using Cronbach's alpha coefficient. In Phase I, participants found the questions in the scale easy to understand, including the younger children aged 4 and 5 years, who demonstrated good comprehension of the items. Analyses for Phase II indicated that one single factor was identified. Most correlations were significant, and the remaining items showed adequate loadings. The total sample demonstrated moderate internal consistency (Cronbach's alpha = 0.64; ordinal alpha = 0.77; McDonald's omega = 0.66; average inter-item correlation = 0.20). The HIFAMS scale adapted to the Spanish context can be applied in early preschool/school settings. This adapted instrument could support understanding young children's feelings in educational environments within Spanish populations, which can enable the prevention and management of potential risk situations.
In an increasingly diverse world, it is important for mental health professionals to be familiar with symptom presentations from a variety of cultures, including cultural concepts of distress. This study aimed to evaluate how U.S. clinicians diagnosed two cultural concepts of distress-hwa-byung and ataque de nervios-and whether the clinicians' cultural values or competence influenced their diagnosis. A sample of 84 mental health professionals viewed three case vignettes in random order depicting hwa-byung, ataque de nervios, and Generalized Anxiety Disorder. The clinicians provided an unprompted free-response diagnosis and a forced-choice diagnosis from a predetermined list for each vignette. Clinicians provided a wide range of diagnoses for the hwa-byung and ataque de nervios vignettes, with only a minority of participants correctly labeling the cultural concepts of distress. Prompting diagnoses by providing a list of options improved the likelihood of selecting a cultural syndrome. The most common mental health diagnoses selected did not adequately capture the symptom profiles of the cultural concepts of distress. Clinicians appeared to be more familiar with Latinx cultural presentations than East Asian. U.S. clinicians could likely benefit from additional training and exposure to varying cultural presentations of psychopathology. Labeling a cultural syndrome with a psychiatric diagnosis may lead to decreased rapport and insufficient or ineffective treatment options.
Asylum-seeking mothers are often cast as powerless and lacking agency as they resettle in a host country. With unprecedented numbers of families facing forced displacement, understanding womens' lived experiences of adaptation is critical to better serve their resettlement and health trajectories. This study aims to capture asylum-seeking mothers' sense of agency as they navigate resettlement in Montreal, Canada. We conducted 13 in-depth interviews asylum-seeking mothers and analyzed them using thematic analysis. We found that mothers experienced deprivation, discrimination, and precariousness in Canada that constrained their capabilities. Nonetheless, mothers continued to express agency in the form of i) resistance to the narrative of dependency ii) intentionality in their motherhood project, and iii) endurance through meaning-making. In highlighting asylum-seeking mothers' agency, this study may challenge the dominant discourse that characterizes these women as passive and helpless, instead supporting recognition of their capacities and drive for self-determination that can in turn guide research, policy and preventative and clinical interventions.
Adolescence is a crucial developmental stage characterized by rapid biological, psychological, and social changes, that increase vulnerability to mental health issues. Nearly half of all mental health conditions have their onset during this period and are influenced by individual, family, and environmental factors. Schools play a key role in promoting mental well-being among adolescents due to their accessibility and reach. While school-based mental health prevention interventions have shown positive outcomes in high-income countries, evidence from low- and middle-income countries (LMICs) is limited. This study aimed to assess the feasibility and acceptability of Health Action in Schools for a Thriving Adolescent Generation (HASHTAG), a comprehensive school-based intervention for adolescents aged 13-16 years in Nepal. A feasibility cluster-randomized controlled trial was conducted in four secondary schools in Morang district, Nepal. Adolescents completed surveys at baseline and at a 3-month follow-up to evaluate mental well-being, emotional and behavioral outcomes, social support, school climate, and functioning. The intervention comprised two components: Thriving Environment in Schools (TES), implemented over three months and Thriving Together (TT), delivered through six weekly sessions. Quantitative data were collected electronically and analyzed descriptively. Qualitative data were gathered through focus group discussions and in-depth interviews with adolescents, teachers, and facilitators to explore implementation experiences and were analyzed thematically. Both the TES and TT components were well received, with TT sessions achieving an average attendance rate exceeding 70%, and being delivered as planned by trained facilitators, indicating good acceptability and feasibility. Explanatory analysis suggested a positive trend in anxiety outcomes in the intervention group while, social support showed a modest increase. Other outcomes showed small, non-significant changes. Qualitative findings highlighted perceived benefits such as improvements in school cleanliness, staff-student relationships, bullying and discrimination reduction, and positive social and behavioral changes. Participants found breathing exercises, games, the workbook, and the 'feeling box' particularly helpful. Implementation challenges included limited space, logistical constraints, COVID-19 related disruptions, and session length. HASHTAG demonstrated feasibility and accessibility as a school-based intervention for adolescents in Nepal, with preliminary indications of potential benefits. Addressing identified implementation challenges will be important for optimizing delivery in future studies. A fully powered randomized controlled trial is warranted to evaluate effectiveness.
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Risk and protective factors for suicide mortality in youths remain poorly synthesized, as prior reviews have focused on all ages or nonfatal outcomes. To systematically assess factors associated with risk of suicide mortality in youths. MEDLINE, PsycINFO, Embase, and CINAHL from inception to March 7, 2025. Case-control and cohort studies of youths (aged ≤24 years) examining risk and/or protective factors associated with suicide mortality vs living general-population controls were included. Two independent reviewers screened 9497 records. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 reviewers independently screened reports; 1 extracted data, verified by a second. Evidence was synthesized using vote counting and random-effects meta-analysis in April 2026. The primary outcome was suicide mortality at age 24 years or younger. Ninety reports from 68 studies, mostly from high-income countries, identified distinct risk and/or protective factors; 54 reports contributed to 30 meta-analyses. The factors associated with the highest odds of suicide risk included schizophrenia (odds ratio [OR], 22.23; 95% CI, 12.05-41.03; I2 = 85.4%; 7 reports), mood disorders (OR, 11.32; 95% CI, 6.11-20.97; I2 = 64.6%; 7 reports), and self-harm (OR, 14.06; 95% CI, 5.58-35.39; I2 = 90.1%; 10 reports). Clinical indicators of health care use were also associated with higher risk, including mental health services use in preceding year (OR, 7.39; 95% CI, 6.45-8.47; I2 = 0.0%; 5 reports) and psychiatric admission (OR, 31.96; 95% CI, 13.83-73.86; I2 = 94.8%; 6 reports). At the socioecological level, several indicators were associated with higher risk, including maltreatment (OR, 4.03; 95% CI, 1.41-11.50; I2 = 67.1%; 5 reports), out-of-home placement (OR, 4.47; 95% CI, 2.15-9.28; I2 = 42.1%; 5 reports), youth justice system involvement (OR, 2.70; 95% CI, 1.94-3.75; I2 = 64.2%; 7 reports), and low educational attainment (OR, 2.95; 95% CI, 1.66-5.24; I2 = 76.0%; 5 reports). In contrast, indicators of family stability were associated with lower risk, including living with both parents (OR, 0.55; 95% CI, 0.48-0.62; I2 = 12.1%; 11 reports). Heterogeneity was substantial across analyses, while Newcastle-Ottawa ratings indicated moderate-to-high study quality. In this systematic review and meta-analysis, suicide mortality in youths was associated with mental disorders, health care contact, and adversity, supporting both clinical care and population-level prevention, with future research needed in underrepresented populations.
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