Pub Date : 2025-12-29DOI: 10.1016/j.ssmmh.2025.100580
Nicole Black, Danusha Jayawardana, David W. Johnston, Trong-Anh Trinh
Rising out-of-pocket costs for psychotherapy in Australia have heightened concerns about financial barriers to mental healthcare, particularly for lower-income households, who disproportionately experience psychological distress. Using nation-wide linked administrative records of income and healthcare use, we estimate the magnitude of income-related inequity in psychotherapy use among 5.4 million individuals diagnosed with a mental health condition, and examine how such inequity has evolved over the decade from 2014 to 2023. Our findings show that income-related inequity is substantial, consistently higher among children than among adults, and has nearly doubled over the decade. By 2023, only 32% of low-income children and 40% of low-income adults accessed psychotherapy within three months of receiving a mental health treatment plan, compared with 55% among both high-income children and adults. We rule out changes in complexity of mental health disorders and the introduction of telehealth services as key drivers. We find no discernible difference by gender or age subgroups. Examination of antidepressant use reveals a growing gap in the opposite direction, with lower-income individuals increasingly reliant on medication without psychotherapy, relative to higher-income individuals. This suggests a shift towards lower-cost treatment pathways among disadvantaged groups. Our findings highlight the need for policies to address the increasing costs and other barriers to accessing psychotherapy, especially for lower-income households.
{"title":"The growing divide: Income inequities in access to mental healthcare in Australia","authors":"Nicole Black, Danusha Jayawardana, David W. Johnston, Trong-Anh Trinh","doi":"10.1016/j.ssmmh.2025.100580","DOIUrl":"10.1016/j.ssmmh.2025.100580","url":null,"abstract":"<div><div>Rising out-of-pocket costs for psychotherapy in Australia have heightened concerns about financial barriers to mental healthcare, particularly for lower-income households, who disproportionately experience psychological distress. Using nation-wide linked administrative records of income and healthcare use, we estimate the magnitude of income-related inequity in psychotherapy use among 5.4 million individuals diagnosed with a mental health condition, and examine how such inequity has evolved over the decade from 2014 to 2023. Our findings show that income-related inequity is substantial, consistently higher among children than among adults, and has nearly doubled over the decade. By 2023, only 32% of low-income children and 40% of low-income adults accessed psychotherapy within three months of receiving a mental health treatment plan, compared with 55% among both high-income children and adults. We rule out changes in complexity of mental health disorders and the introduction of telehealth services as key drivers. We find no discernible difference by gender or age subgroups. Examination of antidepressant use reveals a growing gap in the opposite direction, with lower-income individuals increasingly reliant on medication without psychotherapy, relative to higher-income individuals. This suggests a shift towards lower-cost treatment pathways among disadvantaged groups. Our findings highlight the need for policies to address the increasing costs and other barriers to accessing psychotherapy, especially for lower-income households.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100580"},"PeriodicalIF":2.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.ssmmh.2025.100585
Thea Mink , Madeleine Patrick , Amelia Conrad , Tanvir Ahmed , Srishty Arun , Vinod Ramanarayanan , Niladri Chakraborti , Y. Malini Reddy , Abhilaasha Nagarajan , Tanushree Bhan , Sheela S. Sinharoy , Bethany A. Caruso
Recent research has identified linkages between women's sanitation experiences, like safety and privacy, and their mental health. Our study examined associations between sanitation-related empowerment resources (Bodily Integrity, Safety and Security, Privacy, and Time) and mental health outcomes (well-being, depression, and anxiety). We conducted a secondary analysis of cross-sectional data collected in 2021–2022 from household surveys of women in Bangladesh, India, Senegal, and Uganda (n = 2285). Primary exposures were sanitation-related empowerment resources measured using the Agency, Resources, and Institutional Structures for Sanitation-related Empowerment (ARISE) Scales. Three outcomes were assessed: subjective well-being (World Health Organization Well-being Index, WHO-5), anxiety (General Anxiety Disorder measure, GAD-2), and depression (Patient Health Questionnaire, PHQ-2). Linear regressions of WHO-5 scores and negative binomial regressions of PHQ-2 and GAD-2 scores on the four sanitation-related empowerment resources were conducted.
Mean scores for the outcomes were: well-being = 17.2 (SD = 5.9), depression = 1.1 (SD = 1.4), and anxiety = 1.0 (SD = 1.4). Mean scores for primary exposures were: Bodily Integrity = 3.7 (SD = 0.4), Safety and Security = 3.5 (SD = 0.4), Privacy = 3.8 (SD = 0.5), and Time = 3.1 (SD = 0.5). Higher Privacy was associated with higher well-being scores in both regional samples with higher Time additionally associated with higher well-being scores in Bangladesh and India. In Bangladesh and India, higher Bodily Integrity and Time were associated with lower depression scores, and higher Bodily Integrity, Safety and Security, and Time were associated with lower anxiety scores. In Senegal and Uganda, higher Bodily Integrity, Safety and Security, and Privacy were associated with lower depression scores, and higher Privacy was associated with lower anxiety scores. Our findings provide evidence of associations between women's sanitation-related resources of Bodily Integrity, Safety and Security, Privacy, and Time and mental health. Sanitation initiatives should aim to enhance and evaluate women's experiences of these resources given their potential to benefit women's mental health and well-being.
{"title":"Sanitation-related empowerment resources are associated with women's well-being, anxiety, and depression: findings from Bangladesh, India, Senegal, and Uganda","authors":"Thea Mink , Madeleine Patrick , Amelia Conrad , Tanvir Ahmed , Srishty Arun , Vinod Ramanarayanan , Niladri Chakraborti , Y. Malini Reddy , Abhilaasha Nagarajan , Tanushree Bhan , Sheela S. Sinharoy , Bethany A. Caruso","doi":"10.1016/j.ssmmh.2025.100585","DOIUrl":"10.1016/j.ssmmh.2025.100585","url":null,"abstract":"<div><div>Recent research has identified linkages between women's sanitation experiences, like safety and privacy, and their mental health. Our study examined associations between sanitation-related empowerment resources (Bodily Integrity, Safety and Security, Privacy, and Time) and mental health outcomes (well-being, depression, and anxiety). We conducted a secondary analysis of cross-sectional data collected in 2021–2022 from household surveys of women in Bangladesh, India, Senegal, and Uganda (n = 2285). Primary exposures were sanitation-related empowerment resources measured using the Agency, Resources, and Institutional Structures for Sanitation-related Empowerment (ARISE) Scales. Three outcomes were assessed: subjective well-being (World Health Organization Well-being Index, WHO-5), anxiety (General Anxiety Disorder measure, GAD-2), and depression (Patient Health Questionnaire, PHQ-2). Linear regressions of WHO-5 scores and negative binomial regressions of PHQ-2 and GAD-2 scores on the four sanitation-related empowerment resources were conducted.</div><div>Mean scores for the outcomes were: well-being = 17.2 (SD = 5.9), depression = 1.1 (SD = 1.4), and anxiety = 1.0 (SD = 1.4). Mean scores for primary exposures were: Bodily Integrity = 3.7 (SD = 0.4), Safety and Security = 3.5 (SD = 0.4), Privacy = 3.8 (SD = 0.5), and Time = 3.1 (SD = 0.5). Higher Privacy was associated with higher well-being scores in both regional samples with higher Time additionally associated with higher well-being scores in Bangladesh and India. In Bangladesh and India, higher Bodily Integrity and Time were associated with lower depression scores, and higher Bodily Integrity, Safety and Security, and Time were associated with lower anxiety scores. In Senegal and Uganda, higher Bodily Integrity, Safety and Security, and Privacy were associated with lower depression scores, and higher Privacy was associated with lower anxiety scores. Our findings provide evidence of associations between women's sanitation-related resources of Bodily Integrity, Safety and Security, Privacy, and Time and mental health. Sanitation initiatives should aim to enhance and evaluate women's experiences of these resources given their potential to benefit women's mental health and well-being.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100585"},"PeriodicalIF":2.6,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.ssmmh.2025.100584
Jennifer S. Hirsch , Gloria Fortuna , Jessie V. Ford , Alicia Jen , Jessica L. Weissman , Aarushi H. Shah , Fraidy Reiss
{"title":"Forced marriage, divorce, and the ecology of marital self-determination: findings from research with Orthodox Jews in New York","authors":"Jennifer S. Hirsch , Gloria Fortuna , Jessie V. Ford , Alicia Jen , Jessica L. Weissman , Aarushi H. Shah , Fraidy Reiss","doi":"10.1016/j.ssmmh.2025.100584","DOIUrl":"10.1016/j.ssmmh.2025.100584","url":null,"abstract":"","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100584"},"PeriodicalIF":2.6,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.ssmmh.2025.100579
Carmen H. Logie , Ofir Sivan , Rachel Leggett , Moses Okumu , Miranda Loutet , Frannie MacKenzie , Simon Odong Lukone , Nelson Kisubi , Lesley Gittings , Peter Kyambadde , Caetano Dorea , Manjulaa Narasimhan
Extreme weather events (EWE) contribute to heightened psychosocial stressors through complex pathways, including by worsening resource insecurities. Refugee settlements globally are disproportionately exposed to EWE compared with host national populations, yet refugees' experiences of resource insecurity-related psychosocial stressors in low-income humanitarian settings are understudied. Our study focused on understanding the lived experiences of psychosocial stressors in the context of EWE and resource insecurity among refugee youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved 32 walk-along interviews with a purposive sample of refugee youth aged 16–24 (16 men, 16 women); youth led the interviewer to 1–3 places where they obtained food, water, and/or sanitation resources, discussed the place's meaning and impact on wellbeing, and took photos. We also conducted 12 in-depth interviews with key informants with expertise in refugee youth wellbeing, EWE, and/or resource security. We conducted framework thematic analysis informed by resource scarcity and water insecurity-related distress frameworks. Participant narratives reflected four key themes regarding linkages between EWE, resource insecurities, and psychosocial distress: 1) material deprivation and uncertainty (sub-themes: drought-related food and water insecurity; flooding-related infrastructure and agricultural damage); 2) shame of social failure (sub-themes: sanitation insecurity stressors; unemployment and food insecurity distress and related substance use); 3) interpersonal conflict, including multi-level violence (sub-themes: increased violence; concerns about crime and theft); and 4) coping and asset management strategies (sub-themes: social and economic infrastructure; social capital; household relations). Together findings suggest the need for integrating psychosocial support within social and economic opportunities and poverty reduction with refugee youth.
{"title":"Psychosocial stressors related to extreme weather events and multiple resource insecurities: qualitative insights from refugee youth in an Ugandan humanitarian setting","authors":"Carmen H. Logie , Ofir Sivan , Rachel Leggett , Moses Okumu , Miranda Loutet , Frannie MacKenzie , Simon Odong Lukone , Nelson Kisubi , Lesley Gittings , Peter Kyambadde , Caetano Dorea , Manjulaa Narasimhan","doi":"10.1016/j.ssmmh.2025.100579","DOIUrl":"10.1016/j.ssmmh.2025.100579","url":null,"abstract":"<div><div>Extreme weather events (EWE) contribute to heightened psychosocial stressors through complex pathways, including by worsening resource insecurities. Refugee settlements globally are disproportionately exposed to EWE compared with host national populations, yet refugees' experiences of resource insecurity-related psychosocial stressors in low-income humanitarian settings are understudied. Our study focused on understanding the lived experiences of psychosocial stressors in the context of EWE and resource insecurity among refugee youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved 32 walk-along interviews with a purposive sample of refugee youth aged 16–24 (16 men, 16 women); youth led the interviewer to 1–3 places where they obtained food, water, and/or sanitation resources, discussed the place's meaning and impact on wellbeing, and took photos. We also conducted 12 in-depth interviews with key informants with expertise in refugee youth wellbeing, EWE, and/or resource security. We conducted framework thematic analysis informed by resource scarcity and water insecurity-related distress frameworks. Participant narratives reflected four key themes regarding linkages between EWE, resource insecurities, and psychosocial distress: 1) material deprivation and uncertainty (sub-themes: drought-related food and water insecurity; flooding-related infrastructure and agricultural damage); 2) shame of social failure (sub-themes: sanitation insecurity stressors; unemployment and food insecurity distress and related substance use); 3) interpersonal conflict, including multi-level violence (sub-themes: increased violence; concerns about crime and theft); and 4) coping and asset management strategies (sub-themes: social and economic infrastructure; social capital; household relations). Together findings suggest the need for integrating psychosocial support within social and economic opportunities and poverty reduction with refugee youth.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100579"},"PeriodicalIF":2.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.ssmmh.2025.100582
Xinxin Zhu , Yi Yang , Helen Wright , Lydia Gabriela Speyer , Marie Allitt , Ingrid Obsuth , Patrick Errington , Aja Louise Murray
There has been considerable recent debate surrounding the effects of social media use and adolescents' mental health. A key source of controversy is whether observed associations might be confounded by ‘third variables’ (which influence both social media use and mental health). To address this, we used counterfactual analysis to account for measured confounding. This approach provides estimates of causal effects by comparing observed outcomes with those that would be expected under an alternative exposure condition. We employed it to evaluate the link between social media use (including messaging and visiting social networking websites) at ages 11 and 14 and later mental health issues (including emotional symptoms, self-harm, and/or suicide attempts) at ages 14 and 17. Data was from the UK Millennium Cohort Study (MCS), a nationally representative sample. The study was conducted with the input of a young persons' advisory group, who informed our prioritization of the study research question, helped interpret findings, and identify study limitations. Inverse probability of treatment weighting (IPTW) analyses indicated no significant effects of social media use frequency at age 11 (defined as use on most days) or time spent at age 14 (≥2 h per weekday) on emotional problems or self-harm at age 14 or 17, respectively (analytic n = 3036–4419). The only exception was significant association between higher time spent on social media at age 14 and lifetime suicide attempts at age 17. These findings highlight the importance of considering potential confounders when examining social media use effects. Given that frequency and time-based measures are unlikely to capture the complexity of this association, we recommend future research also apply similar approaches utilizing more nuanced measures.
{"title":"The association between social media use and mental health symptoms in middle adolescence: A counterfactual analysis","authors":"Xinxin Zhu , Yi Yang , Helen Wright , Lydia Gabriela Speyer , Marie Allitt , Ingrid Obsuth , Patrick Errington , Aja Louise Murray","doi":"10.1016/j.ssmmh.2025.100582","DOIUrl":"10.1016/j.ssmmh.2025.100582","url":null,"abstract":"<div><div>There has been considerable recent debate surrounding the effects of social media use and adolescents' mental health. A key source of controversy is whether observed associations might be confounded by ‘third variables’ (which influence both social media use and mental health). To address this, we used counterfactual analysis to account for measured confounding. This approach provides estimates of causal effects by comparing observed outcomes with those that would be expected under an alternative exposure condition. We employed it to evaluate the link between social media use (including messaging and visiting social networking websites) at ages 11 and 14 and later mental health issues (including emotional symptoms, self-harm, and/or suicide attempts) at ages 14 and 17. Data was from the UK Millennium Cohort Study (MCS), a nationally representative sample. The study was conducted with the input of a young persons' advisory group, who informed our prioritization of the study research question, helped interpret findings, and identify study limitations. Inverse probability of treatment weighting (IPTW) analyses indicated no significant effects of social media use frequency at age 11 (defined as use on most days) or time spent at age 14 (≥2 h per weekday) on emotional problems or self-harm at age 14 or 17, respectively (analytic n = 3036–4419). The only exception was significant association between higher time spent on social media at age 14 and lifetime suicide attempts at age 17. These findings highlight the importance of considering potential confounders when examining social media use effects. Given that frequency and time-based measures are unlikely to capture the complexity of this association, we recommend future research also apply similar approaches utilizing more nuanced measures.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100582"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.ssmmh.2025.100583
Mia Akiba , Stephanie J. Lewis , Tsitsi Mawere , Alli Roshni , Karen Muchezana , Wilson Mutsvuke , Walter Mangezi , Conall O'Cleirigh , Sharli Paphitis , Nick Grey , Tarisai Bere , Melanie A. Abas
{"title":"Trauma-related experiences among people living with HIV in Zimbabwe: a qualitative study","authors":"Mia Akiba , Stephanie J. Lewis , Tsitsi Mawere , Alli Roshni , Karen Muchezana , Wilson Mutsvuke , Walter Mangezi , Conall O'Cleirigh , Sharli Paphitis , Nick Grey , Tarisai Bere , Melanie A. Abas","doi":"10.1016/j.ssmmh.2025.100583","DOIUrl":"10.1016/j.ssmmh.2025.100583","url":null,"abstract":"","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100583"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.ssmmh.2025.100581
Ben Mathews , Kausar Parvin , Kerryann Walsh , David Finkelhor , Daryl Higgins , James G. Scott , Sarah Napier , Melanie Burton , Mariesa Nicholas , Jennie Noll , Asher Flynn , Andrea de Silva
Background
Online child sexual victimization (OCSV) is increasingly prevalent, but little evidence exists about associated health outcomes. This study investigates whether two types of OCSV – nonconsensual sharing of sexual images, and sexual solicitation by an adult – are associated with health risk behaviours and mental disorders.
Method
This study analyzed data from the Australian Child Maltreatment Study (ACMS), a nationally representative cross-sectional survey. A sub-sample of 3500 Australians aged 16–24 years provided information about OCSV. Items from the National Adolescent Mental Health Surveys assessed non-suicidal self-injury, suicide attempt, and smoking. The MINI International Psychiatric Interview assessed generalized anxiety disorder (GAD); major depressive disorder (MDD), and alcohol use disorder (AUD). Logistic regression examined associations between online child sexual victimization and health risk behaviours and mental disorders.
Results
Experiencing nonconsensual sharing of sexual images was significantly associated with suicide attempt among all youth (OR = 1.45), self-harm among women (OR = 1.90) and all youth (OR = 1.94), smoking among women (OR = 1.86) and all youth (OR = 1.86), and MDD among men (OR = 1.92) and all youth (OR = 1.43). Online sexual solicitation was not significantly associated with health risk behaviours or mental disorders except for self-harm among all youth (OR = 1.45).
Conclusion
Nonconsensual sharing of sexual images is strongly associated with multiple adverse outcomes, especially health risk behaviours, and particularly among women. Future research could consider other adverse outcomes of online sexual solicitation by adults, such as distress, and behavioural outcomes. Findings can inform educational, health and legal policies and programs promoting safe technology use and addressing related health issues.
{"title":"Online child sexual victimization and associated health risk behaviours and mental disorders: Findings from a national survey in Australia","authors":"Ben Mathews , Kausar Parvin , Kerryann Walsh , David Finkelhor , Daryl Higgins , James G. Scott , Sarah Napier , Melanie Burton , Mariesa Nicholas , Jennie Noll , Asher Flynn , Andrea de Silva","doi":"10.1016/j.ssmmh.2025.100581","DOIUrl":"10.1016/j.ssmmh.2025.100581","url":null,"abstract":"<div><h3>Background</h3><div>Online child sexual victimization (OCSV) is increasingly prevalent, but little evidence exists about associated health outcomes. This study investigates whether two types of OCSV – nonconsensual sharing of sexual images, and sexual solicitation by an adult – are associated with health risk behaviours and mental disorders.</div></div><div><h3>Method</h3><div>This study analyzed data from the Australian Child Maltreatment Study (ACMS), a nationally representative cross-sectional survey. A sub-sample of 3500 Australians aged 16–24 years provided information about OCSV. Items from the National Adolescent Mental Health Surveys assessed non-suicidal self-injury, suicide attempt, and smoking. The MINI International Psychiatric Interview assessed generalized anxiety disorder (GAD); major depressive disorder (MDD), and alcohol use disorder (AUD). Logistic regression examined associations between online child sexual victimization and health risk behaviours and mental disorders.</div></div><div><h3>Results</h3><div>Experiencing nonconsensual sharing of sexual images was significantly associated with suicide attempt among all youth (OR = 1.45), self-harm among women (OR = 1.90) and all youth (OR = 1.94), smoking among women (OR = 1.86) and all youth (OR = 1.86), and MDD among men (OR = 1.92) and all youth (OR = 1.43). Online sexual solicitation was not significantly associated with health risk behaviours or mental disorders except for self-harm among all youth (OR = 1.45).</div></div><div><h3>Conclusion</h3><div>Nonconsensual sharing of sexual images is strongly associated with multiple adverse outcomes, especially health risk behaviours, and particularly among women. Future research could consider other adverse outcomes of online sexual solicitation by adults, such as distress, and behavioural outcomes. Findings can inform educational, health and legal policies and programs promoting safe technology use and addressing related health issues.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100581"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.ssmmh.2025.100574
Theoni Stathopoulou , Konstantinos Bourazas , Korina Hatzinikolaou , Eirini Adamopoulou , Lina Zirganou-Kazolea , Jennifer Cavounidis , Natalia Spyropoulou , Giampaolo Nicolais , Catherine Panter-Brick , Richard F. Mollica
Background: Understanding the mental health challenges of refugee adolescents is critical for informing targeted educational policies and interventions. Yet few studies identify which school-based factors most strongly relate to their resilience and well-being. This study draws on a multi-informant dataset from 170 refugee students attending school in Greece, applying Bayesian variable selection to identify key predictors of mental health outcomes. Methods: We collected student (), teacher () and parent/guardian () data about each student (Strengths and Difficulties Questionnaire, SDQ; Child and Youth Resilience Measure-Revised, CYRM-R); sense of belonging, school attendance. We ran two models, one based on student self-reports, the other based on teacher, parent, and guardian data. Results: The self-reported sense of belonging was the most consistent protective factor of SDQ and CYRM-R outcomes, while bullying, discrimination, and disrupted schooling were associated with greater vulnerability. In triangulated analysis, student self-reports contributed the largest share of predictive information, followed by adult reports Discussion: This study highlights the importance of centering youth perspectives in mental health assessment and intervention and the critical role of inclusive school environments and educational continuity in supporting refugee integration. The Bayesian approach offers a robust framework for guiding evidence-based interventions for supporting the integration of refugee students in host-country educational settings.
{"title":"Belonging, discrimination, and risk in displacement: Bayesian variable selection in predicting mental health and resilience among refugee adolescents in Greece","authors":"Theoni Stathopoulou , Konstantinos Bourazas , Korina Hatzinikolaou , Eirini Adamopoulou , Lina Zirganou-Kazolea , Jennifer Cavounidis , Natalia Spyropoulou , Giampaolo Nicolais , Catherine Panter-Brick , Richard F. Mollica","doi":"10.1016/j.ssmmh.2025.100574","DOIUrl":"10.1016/j.ssmmh.2025.100574","url":null,"abstract":"<div><div>Background: Understanding the mental health challenges of refugee adolescents is critical for informing targeted educational policies and interventions. Yet few studies identify which school-based factors most strongly relate to their resilience and well-being. This study draws on a multi-informant dataset from 170 refugee students attending school in Greece, applying Bayesian variable selection to identify key predictors of mental health outcomes. Methods: We collected student (<span><math><mrow><mi>n</mi><mo>=</mo><mn>170</mn></mrow></math></span>), teacher (<span><math><mrow><mi>n</mi><mo>=</mo><mn>165</mn></mrow></math></span>) and parent/guardian (<span><math><mrow><mi>n</mi><mo>=</mo><mn>124</mn></mrow></math></span>) data about each student (Strengths and Difficulties Questionnaire, SDQ; Child and Youth Resilience Measure-Revised, CYRM-R); sense of belonging, school attendance. We ran two models, one based on student self-reports, the other based on teacher, parent, and guardian data. Results: The self-reported sense of belonging was the most consistent protective factor of SDQ and CYRM-R outcomes, while bullying, discrimination, and disrupted schooling were associated with greater vulnerability. In triangulated analysis, student self-reports contributed the largest share of predictive information, followed by adult reports Discussion: This study highlights the importance of centering youth perspectives in mental health assessment and intervention and the critical role of inclusive school environments and educational continuity in supporting refugee integration. The Bayesian approach offers a robust framework for guiding evidence-based interventions for supporting the integration of refugee students in host-country educational settings.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100574"},"PeriodicalIF":2.6,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persons with persistent and multiple barriers (PPMB), including mental health and substance use (MHSU) and other disabilities, often experience inequitable challenges obtaining and sustaining competitive employment opportunities. Specialized employment services, such as Individual Placement and Support (IPS), embedded within primary healthcare settings is one approach being trialed to address these inequities. Little is known about the medium and longer-term experiences of PPMB enrolled in IPS programs integrated within primary healthcare.
Methods
We conducted a longitudinal qualitative study using semi-structured interviews with program clients. We analyzed interviews (12- and 24-months) sequentially and collectively using a reflexive thematic approach. We developed, defined, and named themes iteratively, using annotations throughout the process to record personal reflections and assumptions.
Results
Thirty-one participants were enrolled in the study, with 31 interviews conducted at 12 months and 20 interviews at 24 months after program enrollment. Four key themes and one subtheme were generated: (1) negative work experiences have lasting and cyclical impacts, (subtheme) positive work experiences help break negative employment cycles, (2) health remains a significant barrier across the employment journey, (3) social connection is a foundation for health and employment, and (4) growth takes time: progress through self-discovery and support.
Conclusion
Continuous access to integrated specialized health and employment services are necessary for PPMB to achieve sustainable progress towards health, recovery, and employment. As such, integrated and multi-sector programs need to receive sustained funding and cross-ministerial support to ensure equitable employment opportunities for those with MHSU, PPMB, and other disabilities.
{"title":"“I've actually surprised myself at what I can do”: Understanding the longer-term experiences of individual placement and support (IPS) embedded within primary healthcare","authors":"Amanda Kwan , Padmini Thakore , Madelyn Whyte , Taite Beggs , Stephany Berinstein , Jonathan Morris , Skye Barbic","doi":"10.1016/j.ssmmh.2025.100578","DOIUrl":"10.1016/j.ssmmh.2025.100578","url":null,"abstract":"<div><h3>Background</h3><div>Persons with persistent and multiple barriers (PPMB), including mental health and substance use (MHSU) and other disabilities, often experience inequitable challenges obtaining and sustaining competitive employment opportunities. Specialized employment services, such as Individual Placement and Support (IPS), embedded within primary healthcare settings is one approach being trialed to address these inequities. Little is known about the medium and longer-term experiences of PPMB enrolled in IPS programs integrated within primary healthcare.</div></div><div><h3>Methods</h3><div>We conducted a longitudinal qualitative study using semi-structured interviews with program clients. We analyzed interviews (12- and 24-months) sequentially and collectively using a reflexive thematic approach. We developed, defined, and named themes iteratively, using annotations throughout the process to record personal reflections and assumptions.</div></div><div><h3>Results</h3><div>Thirty-one participants were enrolled in the study, with 31 interviews conducted at 12 months and 20 interviews at 24 months after program enrollment. Four key themes and one subtheme were generated: (1) negative work experiences have lasting and cyclical impacts, (subtheme) positive work experiences help break negative employment cycles, (2) health remains a significant barrier across the employment journey, (3) social connection is a foundation for health and employment, and (4) growth takes time: progress through self-discovery and support.</div></div><div><h3>Conclusion</h3><div>Continuous access to integrated specialized health and employment services are necessary for PPMB to achieve sustainable progress towards health, recovery, and employment. As such, integrated and multi-sector programs need to receive sustained funding and cross-ministerial support to ensure equitable employment opportunities for those with MHSU, PPMB, and other disabilities.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100578"},"PeriodicalIF":2.6,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.ssmmh.2025.100577
Nakawala Lufumpa , Anne Hilger , Anna Shaw , Gracya Rudiman , Ellen Moscoe , Laure Experton , Brandon A. Kohrt , Odyssia Ng , Syed Shabab Wahid
Background
Despite the growing prevalence of mental health disorders in low- and middle-income countries (LMICs), significant barriers to seeking and accessing mental health services persist. Within lower-income populations, the prevalence of mental health disorders and barriers to addressing them are worsened by poverty. Self-Help Plus (SH+) is a group-based stress management program delivered using a task-sharing model and designed to circumvent barriers to addressing mental health concerns. Cultural adaptations of SH + have been implemented in several LMICs and are considered cost-effective. However, to date, SH + has not been adapted for Senegalese populations. The study detailed in this manuscript aims to assess the feasibility and acceptability of SH+ in lower-income populations in Senegal.
Methods
The RESTORE study is a pilot feasibility cluster-randomized controlled trial of SH+ in four Senegalese communities. Clusters of adults in social protection program beneficiary households will be randomly selected to receive five sessions of SH+. The intervention will be delivered in groups of up to 30 beneficiaries and co-facilitated by two community workers. A combination of quantitative and qualitative research methods will be used to assess the feasibility and acceptability of both the SH + intervention and randomized controlled trial procedures. The main clinical outcome for the study is general psychological well-being measured by the General Health Questionnaire-12 (GHQ-12). The study sample will include adults from social protection program beneficiary households in the treatment and control groups, SH + facilitators, and the intervention supervisor.
Discussion
The findings of this study will be used to inform the potential integration of SH+ and/or similar mental health interventions into the national social protection program in Senegal.
Trial registration
This study is registered through ClinicalTrials.gov: NCT06698471.
{"title":"Relief from stress via social protection in Senegal (RESTORE): Study protocol for a pilot feasibility cluster-randomized controlled trial of self-help plus (SH+) mental health intervention in Senegal","authors":"Nakawala Lufumpa , Anne Hilger , Anna Shaw , Gracya Rudiman , Ellen Moscoe , Laure Experton , Brandon A. Kohrt , Odyssia Ng , Syed Shabab Wahid","doi":"10.1016/j.ssmmh.2025.100577","DOIUrl":"10.1016/j.ssmmh.2025.100577","url":null,"abstract":"<div><h3>Background</h3><div>Despite the growing prevalence of mental health disorders in low- and middle-income countries (LMICs), significant barriers to seeking and accessing mental health services persist. Within lower-income populations, the prevalence of mental health disorders and barriers to addressing them are worsened by poverty. Self-Help Plus (SH+) is a group-based stress management program delivered using a task-sharing model and designed to circumvent barriers to addressing mental health concerns. Cultural adaptations of SH + have been implemented in several LMICs and are considered cost-effective. However, to date, SH + has not been adapted for Senegalese populations. The study detailed in this manuscript aims to assess the feasibility and acceptability of SH+ in lower-income populations in Senegal.</div></div><div><h3>Methods</h3><div>The RESTORE study is a pilot feasibility cluster-randomized controlled trial of SH+ in four Senegalese communities. Clusters of adults in social protection program beneficiary households will be randomly selected to receive five sessions of SH+. The intervention will be delivered in groups of up to 30 beneficiaries and co-facilitated by two community workers. A combination of quantitative and qualitative research methods will be used to assess the feasibility and acceptability of both the SH + intervention and randomized controlled trial procedures. The main clinical outcome for the study is general psychological well-being measured by the General Health Questionnaire-12 (GHQ-12). The study sample will include adults from social protection program beneficiary households in the treatment and control groups, SH + facilitators, and the intervention supervisor.</div></div><div><h3>Discussion</h3><div>The findings of this study will be used to inform the potential integration of SH+ and/or similar mental health interventions into the national social protection program in Senegal.</div></div><div><h3>Trial registration</h3><div>This study is registered through ClinicalTrials.gov: <span><span>NCT06698471</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100577"},"PeriodicalIF":2.6,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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