Few studies have examined the experiences of carers of people with psychosis using a representative sample. Aiming to obtain generalisable results concerning carers in the context of increased emphasis on involving carers in Australian mental health service delivery and policy frameworks, this study recruited carers within the second Australian national survey of psychotic disorders (Survey of High Impact Psychosis, SHIP). Given that most SHIP participants had long-term illness and extended relationships with carers, the health and wellbeing of carers as a group were expected to be relatively stable. However, since it is unknown whether carers’ health and wellbeing would change, our main aim was to explore change and stability in carers’ health and wellbeing and the relationship between any changes experienced by individual carers and corresponding SHIP participants’ functioning over time.

Ninety-eight caregivers of SHIP participants were recruited at baseline and completed validated instruments assessing their health and wellbeing. Seventy-eight carers were re-interviewed at 1-year follow-up. Clinical factors were extracted from the SHIP database. Wilcoxon matched-pairs signed-rank test and t-test were used to analyse changes in variables over time. Cross-lagged analyses were conducted to identify possible causative relationships in changes in SHIP participant and carer variables.

A substantial percentage of carers experienced social isolation (28.6%), psychological distress (37.7%) and poorer quality of life than population norms. There were no statistically significant changes between baseline and follow-up scores for almost all carers’ health and wellbeing variables, other than a poorer perception of their quality of life in relation to their physical health after 1 year. Cross-lagged analyses suggested that poorer functioning of people with psychosis influenced carers’ social isolation, grief and psychological distress.

Findings show that carers’ perception of their health and wellbeing did not improve within current mental health service delivery frameworks over time. Carer's persistently poor health and wellbeing suggests a pressing need to enhance services that improve carers’ health and wellbeing especially their physical health and the functioning of people with psychosis whom they support.

This study evaluated the measurement invariance of the strengths and difficulties questionnaire (SDQ) self-report among adolescents from seven different nations.

Data for 2367 adolescents, aged 13–18 years, from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria and Croatia were available for a series of factor analyses.

The five-factor model including original SDQ scales emotional symptoms, conduct problems, hyperactivity–inattention problems, peer problems and prosocial behaviour generated inadequate fit degree in all countries. A bifactor model with three factors (i.e., externalising, internalising and prosocial) and one general problem factor yielded adequate degree of fit in India, Nigeria, Turkey and Croatia. The prosocial behaviour, emotional symptoms and conduct problems factor were found to be common for all nations. However, originally proposed items loaded saliently on other factors besides the proposed ones or only some of them corresponded to proposed factors in all seven countries.

Due to the lack of a common acceptable model across all countries, namely the same numbers of factors (i.e., dimensional invariance), it was not possible to perform the metric and scalar invariance test, what indicates that the SDQ self-report models tested lack appropriate measurement invariance across adolescents from these seven nations and it needs to be revised for cross-country comparisons.

To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics.

Seven databases were searched with a strategy including four categories of terms ('stigma’, ‘mental health’, ‘intervention’ and ‘low- and middle-income countries’). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A ‘best fit’ framework synthesis was used to organise data, followed by a narrative synthesis.

Fifty-six studies were included in this review, of which four were ineffective and analysed separately. A framework was developed which presents a new categorisation of stigma intervention components based on the included studies. Most interventions utilised multiple methods and of the 52 effective studies educational methods were used most frequently (n = 83), and both social contact (n = 8) and therapeutic methods (n = 3) were used infrequently. Most interventions (n = 42) based their intervention on medical knowledge, but a variety of other themes were addressed. All regions with LMICs were represented, but every region was dominated by studies from one country. Components varied between regions for most categories indicating variation between cultures, but only a minority of studies were developed in the local setting or culturally adapted.

Our study suggests effective mental health stigma reduction interventions in LMICs have increased in quantity and quality over the past five years, and a wide variety of components have been utilised successfully – from creative methods to emphasis on recovery and strength of people with mental illness. Yet there is minimal mention of social contact, despite existing strong evidence for it. There is also a lack of robust research designs, a high number of short-term interventions and follow-up, nominal use of local expertise and the research is limited to a small number of LMICs. More research is needed to address these issues. Some congruity exists in components between cultures, but generally they vary widely. The review gives an in-depth overview of mental health stigma reduction core components, providing researchers in varied resource-poor settings additional knowledge to help with planning mental health stigma reduction interventions.

To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain; and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.

Data from a longitudinal adult population-based cohort from the provinces of Madrid and Barcelona were analysed (n = 1103). Structured face-to-face home-based interviews (pre-pandemic) and telephone interviews were performed. Both depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). A variety of validated instruments and sociodemographic variables including age, sex, educational level, occupational status, home quietness, screen time, resilience, loneliness, social support, physical activity, disability, economic situation and COVID-19-related information were also considered. Population prevalence estimates and multivariable logistic regressions were computed.

Overall, prevalence rates of depression and suicidal ideation did not change significantly from before to after the COVID-19 outbreak. However, the rates of depression among individuals aged 50+ years showed a significant decrease compared to before the pandemic (from 8.48 to 6.41%; p = 0.01). Younger individuals (odds ratio (OR) = 0.97 per year older; 95% confidence interval (CI) = 0.95–0.99) and those feeling loneliness (OR = 1.96; 95% CI = 1.42–2.70) during the lockdown were at an increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.46; 95% CI = 0.32–0.66) and suicidal ideation (OR = 0.33; 95% CI = 0.16–0.68), whereas individuals perceiving social support were at a lower risk of developing suicidal thoughts (OR = 0.35; 95% CI = 0.18–0.69).

Continuous reinforcement of mental health preventive and intervening measures during and in the aftermath of the crisis is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.

The aim of this feasibility trial was to evaluate the feasibility and acceptability of the locally adapted Group Problem Management Plus (PM+) intervention for women in the conflict affected settings in Swat, Pakistan.

This mixed-methods study incorporated a quantitative component consisting of a two arm cluster randomised controlled feasibility trial, and qualitative evaluation of the acceptability of the Group PM+ to a range of stakeholder groups. For the quantitative component, on average from each of the 20 Lady Health Workers (LHWs) catchment area (20 clusters), six women were screened and recruited for the trial with score of >2 on the General Health Questionnaire and score of >16 on the WHO Disability Assessment Schedule. These LHW clusters were randomised on a 1 : 1 allocation ratio using a computer-based software through a simple randomisation method to the Group PM+ intervention or Enhanced Usual Care. The Group PM+ intervention consisted of five weekly sessions of 2 h duration delivered by local non-specialist females under supervision. The primary outcome was individual psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale at 7th week after baseline. Secondary outcomes include symptoms of depression, post-traumatic stress disorder (PTSD), general psychological profile, levels of functioning and generalised psychological distress. Intervention acceptability was explored through in-depth interviews.

The results show that lay-helpers with no prior mental health experience can be trained to achieve the desired competency to successfully deliver the intervention in community settings under supervision. There was a good intervention uptake, with Group PM+ considered useful by participants, their families and lay-helpers. The outcome evaluation, which was not based on a large enough study to identify statistically significant results, indicated statistically significant improvements in depression, anxiety, general psychological profile and functioning. The PTSD symptoms and depressive disorder scores showed a trend in favour of the intervention.

This trial showed robust acceptance in the local settings with delivery by non-specialists under supervision by local trained females. The trial paves the way for further adaptation and exploration of the outcomes through larger-scale implementation and definitive randomised controlled trials in the local settings.

The assessment of limitations in social capacities can be done with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). The aim of this study was to assess the reliability and the convergent validity of the Italian version of this scale.

We recruited 120 consecutive patients diagnosed with schizophrenia, major depression, bipolar I disorder and anxiety disorders. Included measures were the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression Scale (CGI-S), the Personal and Social Performance Scale (PSP) and the Social and Occupational Functioning Assessment Scale (SOFAS).

The median CGI-S and BPRS scores were 5 and 16.5. Mean Mini-ICF-APP total score was 18.1. Schizophrenics' Mini-ICF-APP score was higher, while that of anxious patients was lower than in the other diagnoses. Intra-class correlations (ICC) revealed a significant inter-rater agreement for total score (ICC 0.987) and for each item of the Mini-ICF-APP. The test–retest agreement was also highly significant (ICC 0.993). The total score of the Mini-ICF-APP obtained good negative correlations with PSP (rs = −0.767) and with SOFAS scores (rs = −0.790). The distribution items of the Mini-ICF-APP showed some skewness, indicating that self-care (item 12) and mobility (item 13) were amply preserved in most patients. The Mini-ICF-APP total score was significantly correlated with both CGI-S (rs = 0.777) and BPRS (rs = 0.729).

As a short instrument, the Mini-ICF-APP scale seems to be well suited to everyday psychiatric practice as a means of monitoring changes in psychosocial functioning, in particular in schizophrenic patients.

We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations.

Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986–2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression.

We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33–1.62) to 1.05 (95% CI: 1.01–1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05).

Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.

Depression requires the presence of either depressed mood or anhedonia, yet little research attention has been focused on distinguishing these two symptoms. This study aimed to obtain the prevalence rates of these two core depression symptoms and to explore the risk factors for each symptom by race/ethnicity.

2423 White, African American, Hispanic and Asian/Pacific Islander (API) women from the Massachusetts area completed the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2007 to 2008.

Socioeconomic variables (SES) accounted for increased rates in depressed mood and anhedonia among African Americans and Hispanics compared with Whites. API women were still 2.1 times more likely to report anhedonia after controlling for SES. Stressors were associated with depressed mood across groups and associated with anhedonia for Whites and Hispanics. Having a female infant was associated with depressed mood for APIs. Being non-US born was associated with anhedonia for Whites, APIs and African Americans, but not Hispanics.

Prevalence rates for depressed mood and anhedonia differ across race/ethnic groups and risks associated with depressed mood and anhedonia depend on the race/ethnic group, suggesting the importance of distinguishing depressed mood from anhedonia in depression assessment and careful inquiry regarding symptom experiences with a diverse patient population.

Little is understood about of the role of coping strategies in psychological well-being (PWB) and distress for the general population and different physical and psychiatric disease groups. A thorough examination of these relationships may provide evidence for the implementation of public mental health promotion and psychiatric disease prevention strategies aimed at improving the use of positive coping approaches or addressing the causes and maintainers of distress. The present study using a structural equation modelling (SEM) approach and nationally representative data on the Canadian population investigates the relationships among PWB, distress and coping strategies and identifies major factors related to PWB for both the general population and diverse-specific disease groups.

Data examined were from the Canadian Community Health Survey of Mental Health and Well-being (CCHS 1.2), a large national survey (n = 36 984). We applied exploratory factor analysis (EFA), confirmatory factor analysis and SEM to build structural relationships among PWB, distress and coping strategies in the general population.

Both SEM measurement and structure models provided a good fit. Distress was positively related to negative coping and negatively related to positive coping. Positive coping indicated a higher level of PWB, whereas negative coping was associated with a lower level of PWB. PWB was negatively related to distress. These same relationships were also found in the population subgroups. For the population with diseases (both physical and psychiatric diseases, except agoraphobia), distress was the more important factor determining subjective PWB than the person's coping strategies, whereas, negative coping had a major impact on distress in the general population. Strengths and limitations were also discussed.

Our findings have practical implications for public psychiatric disease intervention and mental health promotion. As previously noted positive/adaptive coping increased the level of PWB, whereas negative/maladaptive coping was positively related to distress and negatively related to PWB. Distress decreased the level of PWB. Our findings identified major correlates of PWB in both the general population and population subgroups. Our results provide evidence for the differential use of intervention tactics among different target audiences. In order to improve the mental health of the general population public mental health promotion should focus on strategies that reduce negative coping at a population level, whereas clinicians treating individual clients should make the reduction of distress their primary target to maintain or improve patients’ PWB.

To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials.

Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO ‘Evidence to Decision’ framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677).

The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders.

These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.

To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients.

131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed.

Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = −0.24; p < 0.01) and reason (r = −0.27; p < 0.01) about one's own treatment. Negative symptoms were associated with poorer understanding of treatment (r = −0.23; p < 0.01). Poorer cognitive functioning, as measured by MMSE, negatively affected MacCAT-T understanding in patients affected by SSD, but not in those affected by BD (SSD r = 0.37; p < 0.01; BD r = −0.01; p = 0.9). Poorer MacCAT-T reasoning was associated with more manic symptoms in the BD group of patients but not in the SSD group (BD r = −0.32; p < 0.05; SSD r = 0.03; p = 0.8). Twenty-two per cent (n = 29) of the 131 recruited patients showed high treatment DMC as defined by having scored higher than 75% of understanding, appreciating and reasoning MacCAT-T subscales maximum sores and 2 at expressing a choice. The remaining involuntarily hospitalised patients where considered to have low treatment DMC. Chi-squared disclosed that 32% of BD patients had high treatment DMC compared with 9% of SSD patients (p < 0.001).

Treatment DMC can be routinely assessed in non-consensual psychiatric settings by the MacCAT-T, as is the case of other clinical variables. Such approach can lead to the identification of patients with high treatment DMC, thus drawing attention to possible dichotomy between legal and clinical status.

Functional and mental health impairments that adults with attention-deficit/hyperactivity disorder (ADHD) experience may be exacerbated by regular substance use and co-morbidity with substance use disorders (SUD). This may be especially true during young adulthood, which represents a critical stage of life associated with increased substance use and associated problems. However, previous studies investigating the association between ADHD and substance use and SUD have demonstrated inconsistent results, probably due to methodological limitations (e.g., small and non-representative samples). Thus, the relationship of ADHD with substance use and related disorders remains unclear. The aim of the present study was to examine the association between ADHD and both the use of licit and illicit substances and the presence of SUD in a large, representative sample of young men.

The sample included 5677 Swiss men (mean age 20 ± 1.23 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed using the adult ADHD Self Report Screener (ASRS). The association between ADHD and substance use and SUD was assessed for alcohol, nicotine, cannabis and other illicit drugs, while controlling for socio-demographic variables and co-morbid psychiatric disorders (i.e., major depression (MD) and anti-social personality disorder (ASPD)).

Men with ADHD were more likely to report having used nicotine, cannabis and other illicit drugs at some time in their life, but not alcohol. ADHD was positively associated with early initiation of alcohol, nicotine and cannabis use, the risky use of these substances, and the presence of alcohol use disorders, and nicotine and cannabis dependence. Additionally, our analyses revealed that these patterns are also highly associated with ASPD. After adjusting for this disorder, the association between ADHD and licit and illicit substance use and the presence of SUDs was reduced, but remained significant.

Our findings suggest that adult ADHD is significantly associated with a propensity to experiment with licit and illicit substances, especially at earlier ages, to exhibit risky substance use patterns, and to subsequently develop SUDs. Preventive strategies that include early intervention and addressing co-morbidity with ASPD may be crucial to reducing substance use and the development of pathological substance use patterns in young men affected by ADHD and, thus, helping to prevent further illness burden later in life.

Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects.

Using a 1 : 1 matched case–control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide.

The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233–4.457], living alone (OR = 2.176; 95% CI: 1.113–4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243–3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405–13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764–13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089–5.492) were significantly associated with an elevated suicide risk in older people in rural China.

Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

To assess the association of sleep factors (sleep duration, trouble sleeping, sleep disorder) and combined sleep behaviours with the risk of clinically relevant depression (CRD).

A total of 17 859 participants (8806 males and 9053 females) aged 20–79 years from the National Health and Nutrition Examination Survey (NHANES) 2007–2014 waves were included. Sleep duration, trouble sleeping and sleep disorder were asked in the home by trained interviewers using the Computer-Assisted Personal Interviewing (CAPI) system. The combined sleep behaviours were referred to as ‘sleep patterns (healthy, intermediate and poor)’, with a ‘healthy sleep pattern’ defined as sleeping 7–9 h per night with no self-reported trouble sleeping or sleep disorders. And intermediate and poor sleep patterns indicated 1 and 2–3 sleep problems, respectively. Weighted logistic regression was performed to evaluate the association of sleep factors and sleep patterns with the risk of depressive symptoms.

The total prevalence of CRD was 9.5% among the 17 859 participants analysed, with females having almost twice as frequency than males. Compared to normal sleep duration (7–9 h), both short and long sleep duration were linked with a higher risk of CRD (short sleep: OR: 1.66, 95% CI: 1.39–1.98; long sleep: OR: 2.75, 95% CI: 1.93–3.92). The self-reported sleep complaints, whether trouble sleeping or sleep disorder, were significantly related with CRD (trouble sleeping: OR: 3.04, 95% CI: 2.59–3.56; sleep disorder: OR: 1.83, 95% CI: 1.44–2.34). Furthermore, the correlations appeared to be higher for individuals with poor sleep pattern (OR: 5.98, 95% CI: 4.91–7.29).

In this national representative survey, it was shown that there was a dose-response relationship between sleep patterns and CRD.