Self-harm typically occurs in adolescence and has been conceptualized as a dysfunctional strategy to regulate intense negative emotions. Furthermore, empirical literature outlines that self-harmers are more prone to have an insecure attachment style. Moreover, the link between quality of attachment and capacity to regulate emotions has been theoretically and empirically supported.

To examine the associations between attachment style, self-harm behaviors and emotion dysregulation among a sample of adolescents. The sample consisted of 740 adolescents aged between 13 and 19 years (mean age = 16.70, SD = 0.91).

To explore the nature of different pathways by which insecure attachment leads to self-harm behaviors.

As expected, insecure attachment and emotion dysregulation were positively associated with self-harm behaviors. Moreover, emotion dysregulation mediated the link between attachment styles and self-harm. Specific pathways between types of insecure attachment dimension of emotion dysregulation and self-harm behaviors emerged.

Such results confirm the theorization of self-harm behaviors as a dysfunctional strategy to regulate emotions. Moreover, such emotion dysregulation in self-harmers seem to be connected to insecure attachment. Depending on the subtype of insecure attachment, specific dimensions of emotion dysregulation seem to be involved in self-harm behavior, suggesting interesting clinical implications.

The authors have not supplied their declaration of competing interest.

ADHD is the commonest neurodevelopmental disorder in young people (YP) aged 5–18 years. YP with untreated ADHD are 5 times more likely to develop co-morbid psychiatric disorders.

To carry out a population service evaluation of the assessment process and management of YP with ADHD at Child and Young People's Service (CYPS), Malta age 0–16 years for 2014.

To describe the service input, assessment and treatment of YP attending CYPS and compare to ADHD NICE guidelines 2008.

All patients diagnosed with ADHD at CYPS throughout 2014 were included. The incidence of YP with ADHD on treatment age 3–16 years in Malta was calculated. Information was collected from; (i) retrospective case file review and (ii) methylphenidate and atomoxetine registry and compared with NICE guidelines.

One hundred and thirty-six YP were diagnosed with ADHD. The minimum 12-month incidence of ADHD on treatment (3–16 years) in Malta was 553 per 100,000. Pre-diagnosis assessments were more frequently performed by other YP services (n = 97, 71.3%, P ≤ 0.01). A psychiatrist or paediatrician confirmed the diagnosis in 113 (83.1%). Sixty-two (45.3%) of YP were prescribed medication, 50 (36.8%) were referred for parental skills course and 55 (40.4%) psychotherapy. Mean waiting time for first appointment was 187.6 days (CI ± 26.9, 0–720), and first specialist review was 301.0 days (CI ± 34.4, 0–800) (1–3).

The incidence for YP (3–16 years) with ADHD on treatment was lower than the US. Since most pre-diagnostic assessments were carried out by other services, this raised the question about the reliability and validity. We recommend a diagnostic MDT meeting following the multimodal assessment to diagnose ADHD. Medication prescribing followed NICE overall, standardising non-pharmacological management is required.

The authors have not supplied their declaration of competing interest.

Structured self-reports, such as Beck's Depression Inventory (BDI) are widely used in assessing adolescents’ psychological wellbeing.

To investigate what factors are associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population.

To recognize what factors may contribute to high BDI scores besides depressive symptoms.

The study population consisted of 206 adolescents (13–17 years old) who were hospitalised for the first time in adolescent psychiatry and 203 age and gender matched adolescents recruited from schools in the same region. Study subjects filled self-reports on depression symptoms (BDI-21), substance misuse (AUDIT), psychiatric symptoms (SCL-90), defense styles (DSQ-40) and self-image (OSIQ). Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. Information on background and life events was gathered from study subjects.

We compared subjects who scored in BDI-21 either 0–15 points or 16–63 points firstly among subjects who did not fill diagnostic criteria for current unipolar depression and secondly among those who did fulfill the diagnostic criteria. High BDI-21 scores in subjects without depression diagnosis were associated with female sex, older age, several adverse life events, higher psychiatric co-morbidity, worse self-image and more immature, neurotic and image-distorting defense styles (and less mature defense style). Low BDI-21 scores among subjects with depression diagnosis were associated with male sex, more positive self-image and less immature defense style.

High BDI-21 scores may reflect a broad range of challenges in an adolescent's psychological development even in the absence of depression.

The authors have not supplied their declaration of competing interest.

Acts of indiscipline, incivility and violence are common in the school environment and reflect on physical and mental health of those involved.

To characterize conflict records made by students, teachers/others and parents/guardians in a Brazilian high school institution.

Qualitative research, exploratory documental. Studied 113 records from 2014 to 2016.

“Indiscipline and Incivility”–75 records (66 by teachers/others and 9 by students) of students: improper use of clothes and accessories, cell phone use in class, not bringing material, dating in school, conversations during class, do not respect the timetables, inappropriate jokes, disrupting activities, theft of materials and disrespect toward authority figures. “School violence”–22 records (12 by students, 9 by teachers/others and 1 by parent/guardian) of school violence: physical violence between students, psychological/verbal between students/teachers/others, and a match of sexual abuse. Three records (by teachers/others) of violence against the school: students destroyed teaching and cleaning materials and caused damage to the patrimony. Fifteen records (12 by students, 2 by parents/guardians and 1 by teacher) of school's violence: teachers’ harassment (excessive rigor in regard to school performance, clutter in the ratings, refusal to clarify doubts and inappropriate criticism on student's behavior) and institutional negligence (teachers’ delay, lack of clarification on teaching organization and supervision in practical activities).

Some students’ acts of indiscipline and incivility can be protests against the social control of the school. Assistance in case of conflicts and violence as well as preventive measures must be based on interdisciplinary and inter-sectorial articulation practice.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in pediatric populations with an early onset. Mental health of mother can effect on child mental health and relation between mother and child is very important. The aim of this study was investigation about mental health of mothers with children suffering from attention deficit/hyperactivity disorder.

This cross sectional study was carried out on 100 mothers of children with ADHD diagnosis (Kashan, Iran). The data collection instruments included the Goldberg's General Health Questionnaire, and the questionnaire form includes the personal information and the variables associated to mental health.

The total means score of GHQ in the mothers’ was 26/6 ± 11/78. Fifty-eight percent of the mothers have mental health problem. The highest mean score in the sub scales was related to the anxiety subscale (7.73) and the most common mental health problem in these mothers was anxiety problems (11%). Mental health problem is most common in mothers with low socio-economic status, younger age than 30 years old, education lower than diploma degree, householder mothers, single, having boy child with ADHD, having child more than 9 years old.

According to the results of this study, 58% of the mothers have mental health problem. So with screening and on time diagnosis and treatment, we can prevent disadvantage effects of these problems on social and mental health of their children.

The author has not supplied his/her declaration of competing interest.

Severe depression is greatly impairing during adolescence and involves a high risk for suicidal behaviors.

Identify clinical and demographic factors associated with severity of depression in adolescents diagnosed with a major mood disorder so as to improve clinical treatment and prevent suicidal behaviors.

We analyzed factors associated with depression severity in 145 severely ill adolescents diagnosed with a major affective disorder using the K-SADS (Kiddie-Schedule for Affective Disorders and Schizophrenia) at the Mood Disorder Outpatient Program of Bambino Gesù Children's Hospital (Rome). Depressive and manic symptoms were rated with the CDRS-R (Children's Depression Rating Scale-Revised) and K-SADS-MRS (Mania Rating Scale), respectively. Bivariate comparisons were followed by multivariable linear regression modeling.

Depression severity was greater among females than males (mean CDRS scores: 53.0 vs. 42.8; P < 0.0001) and with major depressive versus bipolar disorder diagnosis (50.4 vs. 45.4; P = 0.001). Manic symptoms, including irritability, mood lability, crowded thoughts, delusions, and insomnia, were more likely with more severe depression; their number and severity correlated with CDRS-R total score (respectively, β = 1.53 and 5.44;both P < 0.0001). Factors independently and significantly associated with CDRS-R depression score in multivariate modeling were:

– presence of suicidal ideation;

– absence of ADHD;

– female sex;

– greater number of manic symptoms.

Severe depression was associated with manic symptoms and with suicidal ideation among adolescents diagnosed with either bipolar or major depressive disorders. This relationship should be considered in treatment planning and suicide prevention, including consideration of mood-stabilizing and antimanic agents in the treatment of severe adolescent depression.

The authors have not supplied their declaration of competing interest.

Pediatric bipolar disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders, with high levels of morbidity and disability and with a great risk of suicide.

While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified.

To assess the prevalence, demographics, clinical correlates and course of these euphoric versus irritable pediatric mania.

Systematic review of the available studies assessing the phenomenology, course and outcome of pediatric mania.

Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age.

Severe irritability is the most common presentation of abnormal mood described in children with bipolar disorder. Longitudinal studies of samples with irritable versus elated mood presentation and chronic versus episodic course may help clarify whether these are factors predicting different long-term course, treatment-response and outcome of pediatric onset bipolar disorder.

The authors have not supplied their declaration of competing interest.

The potential pattern of regional cerebral blood flow (rCBF) in major depressive disorder (MDD) underlies different response to antidepressants medication remain unclear. This study aimed to investigate the differences of rCBF between patients with different treatment response.

Eighty MDD patients [(44 treatment-responsive depression (RD) and 36 non-responding depression (NRD)] and 42 healthy controls (HC) underwent pulsed arterial spin labeling (PASL) scans in magnetic resonance imaging and clinical estimates. The exact rCBF values of each groups were obtained via quantification evaluation.

Compared to NRD, the RD patients showed decreased rCBF values in frontal sensorimotor network (i.e. left paracentral lobule, left medial frontal gyrus, right superior frontal gyrus and right middle frontal gyrus), and further receiver operating curve (ROC) analyses demonstrated that the altered rCBF in these four regions exhibited outstanding performance on distinguishing NRD from RD. The NRD also exhibited reduced rCBF in bilateral cerebellum posterior lobe and right middle occipital gyrus and elevated rCBF in right postcentral gyrus and right middle frontal gyrus as compared to HC.

The decreased rCBF in frontal sensorimotor network appeared to be distinct characteristics for NRD, and might be severed as promising neuroimaging markers to differentiate depressed patients with weak early response to antidepressant medication. These findings expand our understanding of neural substrate underlying the antidepressant efficacy.

The authors have not supplied their declaration of competing interest.

Othello syndrome is a psychotic disorder characterized by delusion of infidelity or jealousy. It predominantly occurs in the context of specific psychiatric or neurological disorders. Othello syndrome is associated with mental changes including excessive aggression, hostility, and irritability. Patients with Othello syndrome misinterpret the behaviour of the spouse or sexual partner to provide evidence for their false perception.

The purpose of this paper is to examine the phenomenon of Othello syndrome as a result of specific neurological diseases.

The study design was a retrospective case series of patients with Othello syndrome. We searched the electronic databases PubMed and Embase for review articles and original research using the search terms ‘Othello syndrome, Morbid Jealousy, Pathological Jealousy, Delusional Jealousy, Delusions and Infidelity, Delusions of Jealousy or Infidelity’.

In the present study of 95 case reports, the relationship between Othello syndrome and a neurological pathology was described. This syndrome was most commonly associated with neurodegenerative diseases (59%), followed by medication induced Othello syndrome (13.7%) and vascular dementia (8.4%). Lesions particularly in the right (dorsolateral) frontal lobes were associated with this syndrome.

This study demonstrates that Othello syndrome occurs most frequently in patients with right frontal lobe dysfunction. It is predominantly related with Lewy Body Disease and Alzheimer's disease. Clinicians should keep an “index of suspicion” regarding dementia when Othello syndrome presents in elderly persons.

The authors have not supplied their declaration of competing interest.

22q11.2 deletion syndrome (22q11DS) is a genetic disorder caused by a microdeletion on chromosome 22q11.2 and associated with an increased risk for psychosis. A dysfunctional motivational reward system is thought to be one of the salient features in psychosis caused by abnormal dopamine functioning. It is unknown whether patients with 22q11DS have a dysfunctional reward system.

This study aims to investigate reward learning in 22q11DS. The study included 10 adults with 22q11DS (age: 33.1 years, 60% female) and 10 age-gender-matched healthy controls (HC, age: 39.7 years, 60% female). A single infusion 18F-fallypride PET scan was acquired during which all subjects performed a version of the learning phase of the Probabilistic Stimulus Selection Task for reward learning (RL), modified to deliver social feedback.

IQ-scores were significantly lower in the 22q11DS group (P < .001) compared to HC. The 22q11DS group both earned significantly less money (P < .05) and performed worse during the RL-task (P < .05) than HC. However, the learning curve for the RL-task was the same for both groups. IQ-scores were a significant positive predictor for earnings (P < .05) and performance (P < .05), but not for the learning curve.

These preliminary results indicate that people with 22q11DS are capable of learning at the same speed as HC, however they are less susceptible for reward than HC because their overall performance during RL is worse than HC. This lower reward sensitivity could be a result of haplo-insufficiency of COMT in 22q11DS and consequently abnormal prefrontal dopamine functioning.

The authors have not supplied their declaration of competing interest.

Alexithymic traits and coping strategies may affect the onset and course of many psychiatric conditions. However, their role in determining hopelessness and suicide risk has been not still elucidated.

The present study analyzed the correlations between alexithymia, coping strategies, and hopelessness.

We aimed to evaluate whether specific coping strategies and alexithymia may predict hopelessness which is widely considered an independent risk factor for suicide.

This is a cross-sectional study conducted on 276 patients (19.9% men, 81.1% women; mean age: 48.1 years, SD: 16.9), of which most with major affective disorders, who were admitted at the Psychiatric Unit of the University of Genoa (Italy). All participants were assessed using the Beck Hopelessness Scale (BHS), Coping Orientations to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20).

Alexythimic subjects significantly differ from non-alexythimic individuals in terms of substance abuse (χ2 = 23.1; P = .027). According to bivariate analyses, we found a significant correlation between hopelessness and suicidal thoughts/wishes (r = .34; P = .01), humor (r = –.24; P = .05), and behavioural disengagement (r = .205; P = .05). Behavioural disengagement is also a positive predictor of hopelessness (OR = 1.25; 95% CI: 1.03–1.52) while humour is a negative predictor of hopelessness (OR = 0.85; 95% CI: 0.73–0.99).

Behavioural disengagement needs to be considered a risk factor while humor is a protective factor for suicide. Surprisingly, we found no significant association between alexithymia and hopelessness. Further additional studies are requested to test these exploratory findings in order to more deeply elucidate the role of both alexithymia and coping strategies in suicidal behaviour.

The authors have not supplied their declaration of competing interest.

In clinical samples, symptomatic ultra-high risk (UHR) criteria and the basic symptom criterion “cognitive disturbances” perform well in predicting psychosis, and best when both approaches are combined.

However, little-to-nothing is known about clinical high risk (CHR) and their constituent symptoms in the community.

We studied the prevalence, clinical relevance, and moderators of CHR criteria and symptoms in the community.

Regression analyses involved 2683 community participants (age 16–40 years; response rate: 63.4%). Semi-structured telephone interviews were performed by well-trained psychologists.

Lifetime and current CHR symptoms were reported by 21.1% and 13.8% of interviewees. Frequency of symptoms was mostly low, only 2.4% met any CHR criterion. A stepwise relationship underlay the association of the two types of CHR symptoms and criteria with the presence of mental disorders and functional deficits, with odds ratios being highest (7.4–31.8) when UHR and basic symptoms occurred together. Report of a family history of mental disorder generally increased risk for CHR symptoms. While younger age increased risk for basic symptoms, lifetime substance misuse and trauma increased risk for UHR symptoms.

Prevalence of CHR criteria was within the to-be-expected range from prevalence rates of psychoses. Clinical relevance of both CHR symptoms and criteria increased in a stepwise manner from basic symptoms via UHR symptoms to their combined presence, reinforcing the clinical utility of their combined use. The risk factors selectively associated with basic and UHR symptoms support developmental models relating basic symptoms to neurobiological and UHR symptoms to psychological factors.

The authors have not supplied their declaration of competing interest.

Recent findings demonstrated significant overlaps among major psychiatric disorders on multiple neurocognitive domains. However, it is not clear which are the cognitive functions that contribute to this phenomenon.

To find the optimal clustering solution using the two-step cluster analysis on a sample of psychiatric patients.

To classify into subgroups a cross-diagnostic sample of psychiatric inpatients on the basis of their neurocognitive profiles.

Seventy-one patients with psychotic, bipolar, depressive and personality disorders hospitalised at Psychiatric Diagnosis and Care Service of Bufalini Hospital of Cesena participated in the study. The symptomatology was assessed using Health of the Nation Outcome Scales-Roma and Brief Psychiatric Rating Scale. Cognitive functions were evaluated using Tower of London, Modified Wisconsin Card Sorting Test, Judgment and Verbal Abstract Tasks test, Raven matrices, Attentional Matrices, Stroop Test and Mini Mental State Examination. Two-step cluster analysis was conducted using the standardized scores of each neurocognitive test.

Two groups were obtained:– group 1, with good cognitive performances;– group 2, with almost all subjects having impaired cognitive performances.

Executive functions and attention are the major determinants of the cluster solution. The clusters did not differ on socio-demographic correlates. Different diagnoses were equally distributed amongst the clusters.

Two-step cluster analysis was useful in identifying subgroups of psychiatric inpatients with different cognitive functioning, overcoming other cluster techniques limitations. According to former literature, these results confirm a continuum of severity in cognitive impairment across different psychiatric disorders.

The authors have not supplied their declaration of competing interest.

One of the WHO's innovations for improving the ICD-11 chapter Mental and Behavioral Disorders was the creation of the Global Clinical Practice Network (GCPN), an international network of more than 12,000 mental health and primary care professionals from 144 countries.

In order to evaluate perceived clinical utility of the ICD-11 guidelines, the case-controlled field studies that involved the application of the proposed diagnostic guidelines to standardized case material were implemented via the Internet in different languages.

Two hundred and seventy-eight Russian mental health care professionals, the GCPN members, have participated in case controlled Internet study for the chapter “Schizophrenia and Other Primary Psychotic Disorders”. Russian participants were represented by psychiatrists mostly (89%) and much less by psychologists (8%) which corresponds with the general situation in the Russian mental health care system.

Russian clinicians have used the proposed ICD-11 diagnostic guidelines successfully to assess delusional disorder as well as schizophrenia. But there were certain categories (schizoaffective disorder, subthreshold delusions) with which the participants seemed to struggle. The critical comments were focused on opposing so called syndrome-based assessment and nosological diagnostics. Most concerns were about elimination of Schizophrenia subtypes.

Russian mental health care professionals proved to be interested in ICD revision process and demonstrated their special diagnostics opinion based on rich clinical traditions and psychopathological approach. In order to use ICD-11 guidelines in clinical practice more efficiently supplementary appropriate training would be needed.

The authors have not supplied their declaration of competing interest.

There has been a rapid influx of 30,000 Syrian refugees in Canada, many are women of childbearing age, and most have young children. The literature reports that refugee women are almost 5 times more likely to develop postpartum depression than Canadian-born women. However, little is known about the experiences that the Syrian refugee women have encountered pre- and post-resettlement and their perceptions of mental health issues in general, and of maternal depression in particular. Thus, there is an urgent need to understand the refugee women's experiences of having a baby in Canada from a mental health perspective.

Participants include Syrian refugee women who migrated to Saskatoon Canada in 2015–16 and who were either pregnant or up to one year postpartum. Qualitative data was collected via a focus group with thematic analysis, while depression with Edinburgh Postnatal Depression Scale (EPDS) and PTSD screening and sociodemographic descriptive data were collected from a structured questionnaire to provide context for the qualitative analysis.

Twelve women participated in the focus group, despite smiling often, 58% of them screened as probable depression (EPDS > 10), 25% screened positive for depression (> 12 on EPDS), and 17% screened positive for PTSD. None of the women indicated intimate partner violence or suicidal thoughts. All participants indicated social support, mostly partner, and 25% had a history of depression. Thematic analysis will be shared.

Perinatal Depression is a serious problem for refugee women that deserve more in-depth study to ensure optimal outcomes and to develop services and programs.

The authors have not supplied their declaration of competing interest.

Emotional facial expression paradigms of adults have been very used in the literature; however, studies with baby's emotional faces are very few.

To study the psychometric validity and reliability of a series of basic emotions faces of babies stimuli.

We used 72 photographs of 12 baby faces (6–12 months), both sex and different ethnic groups, expressing basic emotions (happiness, sadness, fear, anger, surprise and neutral) elicited in the laboratory by pre-task defined. A total of 119 subjects of both sexes (63% women) in different age groups (18–65 years) and ethnicities, were invited to evaluate the facial emotional stimuli presented by the computer program SuperLab. They should choose the emotion represented by the photograph. Furthermore, 31 subjects were randomly selected to perform a test-retest assessment after an interval of 20 days.

It was observed that 35 stimuli presented hit rate exceeding 70% and 11 between 60% and 50%. The facial emotion of happiness was the most easily recognized, while fear was associated with the lower success rates. Only seven stimuli presented a hit rate lower than 20% (fear). All stimuli, except for one, showed a good reliability test/retest (McNemar test > 0.05).

The study offers a series of baby emotional facial stimuli with good validity and reliability for research setting. However, the 30% of stimuli without satisfactory success rate may be problems with stimuli or stimulating task, as it becomes difficult to distinguish the emotion face on the baby.

The authors have not supplied their declaration of competing interest.

The term “Hikikomori” refer to the modern phenomenon–severe (acute, prolonged) social withdrawal (SSW). Recently, there have been increasing reports of Hikikomori around the globe, Ukraine is not an exception.

To describe epidemiological and psychopathological features of Hikikomori from Ukraine.

Hikikomori was defined as a six-month or longer period of spending almost all time at home, avoiding social situations, social relationships, associated with significant distress/impairment. Lifetime history of psychiatric diagnosis was determined by the M.I.N.I. 7.0. Additional measures was Alexithymia Scale (TAS-20), Life experience questionnaire (LEQ), Buss-Durkee Hostility Inventory (BDHI), Chaban quality of life scale (CQLS).

In total, 65.4% of Hikikomori group (HG, n = 26) had at least one psychiatric diagnosis, 34.6% had not. Personality disorders (15.4%), PTSD (11%), MDD (7.7%), SAD (7.7%), OCD (7.7%), bulimia nervosa (3.8%) were the most common. Onset of SSW in 41.7% started before 18 y.o. Healthy individuals formed the control group (CG, n = 25). Individuals with Hikikomori had high level of alexithymia (TAS-20 M = 71, SD = 11.6 vs. M = 60.8 SD = 13.8, P = 0.006). Childhood trauma was reported by 31.8% of CG vs. 52% of HG. Hikikomori had higher trauma index (LEQ M = 3.03, SD = 0.98 vs. 2.31, SD = 1.1, P = 0.019), larger number of lifespan traumatic events (LEQ 95%CI 4.57–7.35 vs. 2.8–5.28, P = 0.039); higher levels of irritability, resentment, suspiciousness, higher aggressiveness (BDHI M = 23, SD = 6.4 vs. M = 16.6, SD = 6, P = 0.001), low quality of life (CQLS M = 12.4, SD = 3.3, Р ≤ 0.001).

Hikikomori exist in Ukraine, SSW quantitatively and qualitatively related to childhood trauma, manifests in adolescence, can be characterized by defined psychopathological features and affects quality of life.

The author has not supplied his/her declaration of competing interest.

Depression is a frequently seen but under-recognized and under-treated syndrome in community. Stigmatization is an important barrier for care-seeking and treatment.

In this study, we aimed to investigate the relationship of sociodemographic factors and attitudes towards depression between young and old age groups in a clinical population.

A total of 133 patients (18–88 years old, n = 37 old-age group, n = 96 young-age group) with a diagnosis of depression were recruited in this study. All the patients were evaluated with a semi-structured clinical interview and using stigmatization scales.

As young and old age groups compared, RHIDO total scores, RHIDO alienation sub-scale scores, social withdrawal subscale scores, and resistance to stigmatization subscale scores were found to be higher in young-age group than old-age group. Except working status, other sociodemographic factors were not found to have any effect on the scores of stigmatization scales.

Regarding the clinical features; number of episodes, comorbid physical disorders and time since first admission had an effect on RHIDO total and subscale scores. Negative attitudes towards depression were seen to be common in all the subjects, but no statistically significant difference was found between young and old age groups.

Stigmatization is very common also for depression, and it is found to be related to different features including age, working status, and time since first admission. In order to help for decreasing the negative attitudes and increasing the help seeking behavior, some interventions should be conducted both in psychiatry clinics and society.

The authors have not supplied their declaration of competing interest.

We present three community case studies for how community development and cultural enhancement affected mental health as an epiphenomenon.

An initiative was undertaken in 3 Northern Canadian aboriginal communities to enhance spiritual and cultural fluency and to provide opportunities to healthy interaction among community members. We began each process with a narrative investigation of the community by eliciting stories about perceived problems in the community. We collected further narratives at the end of the intervention about how it had affected people personally. We reviewed the narratives for commonalities and themes using modified grounded theory and dimensional analysis. We measured numbers of patients presenting to behavioral health services with mental health diagnoses, number of people sent to hospital for mental health treatment, and number of suicide attempts. We collected quality of life data using the My Medical Outcome Profile 2.

Community development and cultural enhancement efforts reduced all of the variables we were tracking. Follow-up interviews revealed common themes of people becoming more present-centered, feeling higher quality in their relationships; feeling more connected to god, creator, nature, or higher power; feeling more peaceful; feeling more accepting of death and change; and having a greater sense of meaning and purpose. As an interesting side effect, people began to eat more traditional diets and to be more active.

Creating opportunities for community interaction and shared community projects and enhancing interactions with spiritual elders resulted in improvement in indices of mental health in three indigenous communities in Northern Canada.

The authors have not supplied their declaration of competing interest.

Global estimates suggest over 130 million girls and women have undergone FGM. While practiced in Africa, Asia and the Middle East, due to immigration trends it is now prominent in Western society. While studies have focused on physical health consequences, post-2000 a small but growing number of studies have reported on the psychological impact of FGM. This paper reports on a project exploring the mental health consequences of FGM, the effectiveness of therapeutic support, and the sustainability of a new service through training peer mentors.

To establish and evaluate 3 drop-in clinics, offering emotional support to women who have experienced FGM. Build capacity through training peer mentors to continue the work of supporting women.

Community-based participatory research (CBPR) was used for this two-part project. In part 1, 30 women participated, data being collected via the Warwick-Edinburgh Mental Well-being Scale (WEMWS) and follow-up interviews. Part 2 involved the training of 12 peer mentors. Data was analysed using descriptive statistics and thematic analysis and evaluation respectively.

Improvement was found in the women's mental well-being, with themes (1) Speaking the unspoken (2) Emancipation of emotion (3) Harnessing hope, being identified. Of the 12 peer mentors successfully completing the course, 9 are now volunteering.

Mental health professionals are best placed to enable women to address FGM traumas and improve their mental well-being. Additionally, they can raise public and professional awareness and, through research, can help develop more appropriate and sensitive services for migrant women from practicing communities.

The authors have not supplied their declaration of competing interest.