International Journal of Social Psychiatry最新文献

Background: Despite an increase in mental health problems, there is low implementation of mental health services, high catastrophic health spending, and a high incidence of coercive mental health practices. This could hinder recovery after a suicide attempt.

Aims: To analyze catastrophic spending and coercive practices, and their relationship with variables associated with recovery (depression and well-being) and with the functioning of health services (continuity of care), in people who attempted suicide during 2024 and 2025 in Caldas, Colombia.

Method: A cross-sectional and population-based was conducted with stratified random sampling in Colombia. Validated instruments were applied to determine subjective well-being, depressive symptoms and continuity of care in health services. To determine the perception of coercive practices in the care of suicidal behaviors in health services, an instrument was used that divided coercive practices into formal (physical abuse, isolation, forced hospitalization) and informal (involuntary medication, lack of participation in treatment planning).

Results: A multiple linear regression was calculated for formal and informal coercion. The model for formal coercion explained 21% of the variance, and the model for informal coercion explained 63.2%, both with high coefficients for catastrophic health expenditures. Compared to those who did not report coercion, those who did reported it presented with more depressive symptoms, worse continuity of care, catastrophic health expenditures, and a lower socioeconomic status.

Conclusions: There is a relationship between the coercive practices perceived and catastrophic spending on mental health services for psychosocial recovery. Those subjected to any coercive practice may have worse outcomes in terms of catastrophic mental health spending and depressive symptoms. Catastrophic spending is proposed as a form of structural coercion that could hinder psychosocial recovery.

Background: Since the 2022 full-scale invasion of Ukraine, civilians have experienced substantial war-related trauma, yet little is known about the prevalence and risk factors of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) among internally displaced persons (IDPs) actively seeking medical or psychological care.

Aims: To examine the prevalence of PTSD and CPTSD in a clinical sample of Ukrainian IDPs, compare diagnostic rates between psychological and medical treatment-seekers, and identify sociodemographic and war-related predictors of diagnostic outcomes.

Methods: A total of 224 adult IDPs attending an outpatient clinic in Chernivtsi oblast completed the International Trauma Questionnaire. Descriptive statistics, bivariate analyses, and multinomial logistic regression models were used to assess prevalence and identify predictors of PTSD and CPTSD.

Results: In the full sample, 24.5% met criteria for ICD-11 PTSD and 7.6% for CPTSD. Among psychological treatment-seekers, prevalence was higher (PTSD: 28.3%; CPTSD: 9.0%) compared to those seeking exclusively medical care (PTSD: 13.8%; CPTSD: 3.4%). Losing someone close due to the war significantly predicted both PTSD and CPTSD in the final multivariable model, while male gender independently predicted CPTSD.

Conclusions: PTSD rates in this sample were broadly comparable to global estimates for conflict-affected populations, whereas CPTSD prevalence appeared lower than that reported in other Ukrainian samples. Relocation to safer areas within one's own country-without the additional stressors associated with forced international migration-together with the relatively older age of the sample, may have contributed to a reduced CPTSD risk. Sociocultural expectations surrounding masculine roles during wartime might also play a role in male vulnerability to CPTSD, though further evidence is needed. Individuals bereaved by the war may represent a subgroup at heightened risk, highlighting the potential value of targeted psychosocial support. Longitudinal, multi-site studies with diverse samples are needed to clarify symptom trajectories and contextual risk factors in displaced civilians.

Background: Previous studies have shown that depression has a significant impact on all-cause mortality, particularly in men. However, the link between depression and mortality across different age and gender groups is inconsistent. This study aims to explore the relationship between depression and all-cause mortality in various age and gender categories within a Spanish national cohort, while also accounting for other influencing factors over an 11-year follow-up period.

Methods: A nationally representative sample of the Spanish adult population (n = 4,582) was followed up for 11 years. Kaplan-Meier estimates, unadjusted and adjusted Cox proportional hazard regression models were conducted to test whether baseline depression and sociodemographic characteristics (educational level, low income, marital status, feelings of loneliness, alcohol and tobacco use, and having chronic conditions) were associated with all-cause mortality for different gender and age-specific groups, separately.

Results: Unadjusted analysis by age and gender indicated that depression had a significant relationship with all-cause mortality in young-and-middle-aged women (HR = 1.75; p < .01) and men (18-64 years old; HR = 2.96; p < .001) and old men (+65; HR = 1.92; p < .001). Adjusted analysis by age and gender revealed that depression was only a significant factor for all-cause mortality in men aged 65+ (HR = 1.60; p = .025).

Limitations: Cause-specific mortality was not examined. Young adults and middle-aged participants were not analyzed separately.

Conclusions: The depression and all-cause mortality relationship was found only in +65 men. These differences may be driven by gender-specific factors such as delayed help-seeking, higher levels of social isolation, and the accumulation of chronic comorbidities. Therefore, preventive interventions must prioritize age- and gender-specific strategies to address these risk patterns.

Objective: This study examined whether the national availability and composition of mental health professionals, primarily non-psychiatrist providers, are associated with the population prevalence of depression, controlling for economic and demographic factors.

Methods: A cross-sectional ecological analysis used data from 131 countries, sourcing workforce statistics from the WHO Mental Health Atlas 2020 and depression prevalence from GBD 2019. Ordinary Least Squares (OLS) regression models, adjusted for log Gross Domestic Product (GDP) per capita and urbanisation, assessed total workforce density, disaggregated provider densities (psychiatrists vs. psychologists) and the psychiatrist share of the workforce. Heteroskedasticity-consistent standard errors were applied.

Results: Adjusted analysis showed a significant inverse association between overall workforce density and prevalence (β = -.031, p < .001) suggesting that higher workforce density correlates with lower depression prevalence. Psychologist density showed a stronger inverse association (β = -.038, p = .001) than psychiatrist density (β = -.024, p = .048) suggesting that greater availability of psychologists is more strongly correlated with lower depression prevalence. Critically, a higher proportion of psychiatrists was independently associated with increased depression prevalence (β = 1.89 percentage points, p = .032). Analysis of regional variation indicated that the inverse association between psychologist availability and depression prevalence was globally observed, with the steepest marginal effects noted in lower-income settings.

Conclusion: Mental health workforce expansion is correlated with reduced depression, notably when systems include non-psychiatrist providers. These findings indicate that broadening service delivery capacity beyond psychiatric care could potentially improve the effectiveness of national mental health systems, pending further investigation.

Background: Adolescents with major depressive disorder (MDD) often internalize stigma, undermining functioning and help-seeking. Parents may likewise internalize stigma about their child's condition, shaping family dynamics and care engagement.

Aim: To examine internalized stigma in adolescents with MDD and their parents, and its associations with adolescent depressive severity, perceived social support, beliefs about mental illness, help-seeking attitudes, and adolescents' global functioning.

Method: Cross-sectional tertiary-clinic study (July-October 2023) of 55 adolescents (12-18 years) with DSM-5 MDD and one parent each (n = 55); 81.8% of adolescents were female. Adolescents completed BDI, SSDS, ISMI-CA, BTMI, MSPSS, and ATSPPH-SF; clinicians rated GAF. Parents completed BDI, P-ISMI, BTMI, and ATSPPH-SF. Group comparisons, correlations, and multivariable linear regression were used.

Results: Parents of adolescents with a suicide attempt or non-suicidal self-injury (NSSI) reported higher P-ISMI (higher alienation and stereotype endorsement; for NSSI also higher perceived discrimination and social withdrawal). Greater adolescent depressive severity correlated with higher self-stigma across SSDS subscales, which related to poorer GAF and lower MSPSS. Higher parental depressive symptoms correlated with higher P-ISMI. Adolescents' social-inadequacy self-stigma was associated with parental social withdrawal. Help-seeking attitudes were more positive with increasing adolescent age and education. Longer psychiatric follow-up related to higher parental stereotype endorsement and social withdrawal, whereas higher parental education related to lower perceived discrimination. In multivariable models, adolescent depressive symptoms predicted poorer functioning, and parental depressive symptoms explained substantial variance in parental internalized stigma, whereas other predictors showed more limited independent effects.

Conclusion: Internalized stigma in adolescents with MDD and their parents is strongly associated with clinical burden and functioning in this clinical, predominantly female sample. Findings underscore internalized stigma as a family-embedded, interconnected process and suggest that integrating family-inclusive, stigma-informed care that strengthens social support may improve youth depression management and treatment engagement.

Background: Depression and social capital (SC) have been increasingly studied in diverse cultural settings, yet little is known about their relationship in high-altitude regions such as Ladakh, India.

Aims: This study examines the association between social capital and depressive tendencies among Ladakhi residents.

Method: We conducted a cross-sectional survey of 140 residents of Domkhar village, Ladakh, during community medical camps in 2018 to 2019. Depressive tendencies were assessed using the PHQ-9 (cutoff ⩾5, selected to capture mild depressive states based on Asian literature). Social capital was measured with structural and cognitive SC indices, along with the Multidimensional Scale of Perceived Social Support (MSPSS) and the Religious Commitment Inventory (RCI-10). Personality traits were assessed using the Ten-Item Personality Inventory (TIPI).

Results: Depressive tendencies were identified in 12 participants (8.6%). Univariate logistic regression revealed that age ⩾60 years and living alone were significant risk factors, while being married, good subjective well-being, good health, good economic satisfaction, and engagement in structural SC were protective. Cognitive SC showed a protective trend. Extraversion scores were significantly lower among those with depressive tendencies. MSPSS and RCI-10 demonstrated a strong positive correlation. In multivariate analysis including all predictors simultaneously, only subjective well-being remained statistically significant (OR = 0.89, 95% CI [0.80, 0.98]).

Conclusions: Our findings suggest that both social capital and personality traits, particularly extraversion, play protective roles against depressive tendencies in Ladakh. Practical implications include leveraging community and religious structures, such as monasteries and local leaders, to enhance resilience in high-altitude populations.

Background: 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.

Aims: 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.

Methods: 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 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.

Results: 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 = 2.62, SD = 5.07 and 6.56 for Wysa; M = 2.59, SD = 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.

Conclusions: 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.

Background: People living with schizophrenia often experience high levels of stigma and are consistently at risk of internalizing it. Internalized stigma has a negative impact on several clinical and recovery outcomes in people with schizophrenia, but the effect of internalized stigma on important patient reported outcomes that are gaining increasing scientific and clinical relevance, such as life engagement, has not yet been extensively investigated.

Aims: This study aims to investigate the relationship between several different socio-demographic, clinical, functional and medication-related variables and life engagement, with the hypothesis that internalized stigma, alongside other factors, could represent an individual predictor of reduced life engagement.

Methods: Ninety-four participants diagnosed with schizophrenia were included in this cross-sectional study and were investigated with validated instruments assessing life engagement, schizophrenia symptoms severity, global clinical severity, internalized stigma, psychosocial functioning, antipsychotic-related side effects, attitude toward medications, and subjective well-being. Predictors of life engagement were assessed using a stepwise multivariate linear regression analysis.

Results: Greater global clinical severity (β = .685, p < .001), fewer years of education (β = -.240, p < .001), and greater stigma endorsement (β = .180, p = .005) emerged as individual predictors of reduced patient life engagement, explaining a large proportion of the observed variance (Adjusted R² = .649, p = .001).

Conclusions: Internalized stigma, among other well-recognized variables, appears to represent an individual predictor of worse patient life engagement in people living with schizophrenia. This finding should strengthen the notion that stigma, and internalized stigma in particular, represent important dimensions and treatment targets in the clinical management of schizophrenia, also in the perspective of improving patient-reported outcomes.