We evaluated the association between adverse migration experiences, border community stress, and mental health symptoms in a community-recruited sample of asylum-seeking women. As part of a mixed-methods, community-academic partnership, we analyzed cross-sectional questionnaires conducted with asylum-seeking women at the Tijuana-San Diego border (N = 151) between Feb–July 2024. Symptoms of anxiety (56.6 %), moderate-to-severe depression (45.9 %), and post-traumatic stress (52 %) were common, with 70.1 % experiencing symptoms of at least one of these. Most (82.1 %) faced adverse experiences during migration journey and high levels of current border community stress. When we examined the relationship between each type of adverse migration experience and mental health symptoms, lack of safe shelter during migration was marginally associated with experiencing current generalized anxiety symptoms, whereas other types of adverse experiences had positive, but null, associations. Higher border community stress was associated with experiencing generalized anxiety, depression, and PTSD symptoms. Asylum-seeking women at the Mexico-U.S. border face significant mental health risks during migration and while waiting to enter the U.S. Structural and multilevel interventions to mitigate these are needed, including changes to asylum deterrence policies and scale-up of humanitarian services.
{"title":"Adverse migration experiences, border community stress, and the mental health of asylum-seeking women in transit at the Mexico-U.S. border","authors":"Shira M. Goldenberg , Kayla Saadeh , Kaylee Ramage , Eileen Pitpitan , Steffanie Strathdee , Monica Álvarez Aguilar , Nicole Elizabeth Ramos , Gudelia Rangel , Ietza Bojorquez","doi":"10.1016/j.ssmmh.2025.100567","DOIUrl":"10.1016/j.ssmmh.2025.100567","url":null,"abstract":"<div><div>We evaluated the association between adverse migration experiences, border community stress, and mental health symptoms in a community-recruited sample of asylum-seeking women. As part of a mixed-methods, community-academic partnership, we analyzed cross-sectional questionnaires conducted with asylum-seeking women at the Tijuana-San Diego border (N = 151) between Feb–July 2024. Symptoms of anxiety (56.6 %), moderate-to-severe depression (45.9 %), and post-traumatic stress (52 %) were common, with 70.1 % experiencing symptoms of at least one of these. Most (82.1 %) faced adverse experiences during migration journey and high levels of current border community stress. When we examined the relationship between each type of adverse migration experience and mental health symptoms, lack of safe shelter during migration was marginally associated with experiencing current generalized anxiety symptoms, whereas other types of adverse experiences had positive, but null, associations. Higher border community stress was associated with experiencing generalized anxiety, depression, and PTSD symptoms. Asylum-seeking women at the Mexico-U.S. border face significant mental health risks during migration and while waiting to enter the U.S. Structural and multilevel interventions to mitigate these are needed, including changes to asylum deterrence policies and scale-up of humanitarian services.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100567"},"PeriodicalIF":2.6,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578815","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 : 2025-11-07DOI: 10.1016/j.ssmmh.2025.100564
Tone Jørgensen , Trine Brinkmann , Ann-Karina E. Henriksen , Esben S.B. Olesen
Youths with restrictive eating disorders can be admitted to voluntary and involuntary treatment in acute psychiatric units for children and adolescents when their need for help is urgent or there is an emergency situation related to their vital functions. Providing sufficient nutrition for these patients is a key focus in treatment plans, making meal planning and calorie intake an essential part of the treatment. This article examines mealtime practices in the treatment of restrictive eating disorders at child and adolescent psychiatric acute hospitals in Norway. The analysis shows a complex interplay between treatment and coercion, where coercion underpins and ultimately ensures treatment compliance. The study contributes to the limited literature on coercion in inpatient child and adolescent psychiatry, and findings call for critical reflection to advance new ways of enforcing nutritional intake for patients with eating disorders admitted to involuntary treatment.
The analysis is based on ethnographic fieldwork conducted across three acute units in Norway. Drawing on Goffman's perspectives on frame analysis and his dramaturgical approach to social interaction, we examine how the establishment of frames in eating situations produces different meanings for this treatment activity. In our analysis, we demonstrate how three different frames (a biomedical therapeutic frame, a coercion frame, and a mealtime frame) constitute and regulate interactional behaviour in eating situations, and how participants negotiate these frames. It is argued that treatment and coercion are entangled in the routine treatment activity of meals, which makes coercion omnipresent in the treatment of restrictive eating disorders.
{"title":"Mealtime practices in the treatment of restrictive eating disorders: an ethnographic study of Norwegian youth psychiatric units","authors":"Tone Jørgensen , Trine Brinkmann , Ann-Karina E. Henriksen , Esben S.B. Olesen","doi":"10.1016/j.ssmmh.2025.100564","DOIUrl":"10.1016/j.ssmmh.2025.100564","url":null,"abstract":"<div><div>Youths with restrictive eating disorders can be admitted to voluntary and involuntary treatment in acute psychiatric units for children and adolescents when their need for help is urgent or there is an emergency situation related to their vital functions. Providing sufficient nutrition for these patients is a key focus in treatment plans, making meal planning and calorie intake an essential part of the treatment. This article examines mealtime practices in the treatment of restrictive eating disorders at child and adolescent psychiatric acute hospitals in Norway. The analysis shows a complex interplay between treatment and coercion, where coercion underpins and ultimately ensures treatment compliance. The study contributes to the limited literature on coercion in inpatient child and adolescent psychiatry, and findings call for critical reflection to advance new ways of enforcing nutritional intake for patients with eating disorders admitted to involuntary treatment.</div><div>The analysis is based on ethnographic fieldwork conducted across three acute units in Norway. Drawing on Goffman's perspectives on frame analysis and his dramaturgical approach to social interaction, we examine how the establishment of frames in eating situations produces different meanings for this treatment activity. In our analysis, we demonstrate how three different frames (a biomedical therapeutic frame, a coercion frame, and a mealtime frame) constitute and regulate interactional behaviour in eating situations, and how participants negotiate these frames. It is argued that treatment and coercion are entangled in the routine treatment activity of meals, which makes coercion omnipresent in the treatment of restrictive eating disorders.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100564"},"PeriodicalIF":2.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519436","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 : 2025-11-07DOI: 10.1016/j.ssmmh.2025.100563
Seyed Ahmad Mir Mohamad Tabar , Alexandra Brewis , Mahmod Teimouri , Maryam Sohrabi
This study examines how water-related emotions explain differences in mental health outcomes associated with household water insecurity, based on randomized sampling of 685 households in 2024 in a severely water-stressed region of Iran. This extends current water insecurity research by empirically testing both negative and positive emotional mediators of mental health outcomes. In response to recent calls for better means to capture water-related emotional valences we first develop and validate a novel adaptation of the PANAS scale. Using structural equation modeling, we then are able to confirm that negative water-related emotions (such as anger and shame) mediate the relationship between household water insecurity and mental health, with stronger negative emotional responses linked to heightened depression/anxiety. However, positive water-related emotions (such as gratitude and hope) also independently predict better mental health. This suggests a novel dual-pathway model. Contrary to expectations, gender does not significantly moderate these relationships, likely due to context-specific gender roles through which men and women share household water management responsibilities. Overall, our findings emphasize the need for more nuanced models that link the lived experience of water insecurity with emotion and mental health, including consideration of the potential role of positive emotions.
{"title":"Rethinking water insecurity's relationship to mental health: Evidence from Iran indicates positive emotions also matter","authors":"Seyed Ahmad Mir Mohamad Tabar , Alexandra Brewis , Mahmod Teimouri , Maryam Sohrabi","doi":"10.1016/j.ssmmh.2025.100563","DOIUrl":"10.1016/j.ssmmh.2025.100563","url":null,"abstract":"<div><div>This study examines how water-related emotions explain differences in mental health outcomes associated with household water insecurity, based on randomized sampling of 685 households in 2024 in a severely water-stressed region of Iran. This extends current water insecurity research by empirically testing both negative and positive emotional mediators of mental health outcomes. In response to recent calls for better means to capture water-related emotional valences we first develop and validate a novel adaptation of the PANAS scale. Using structural equation modeling, we then are able to confirm that negative water-related emotions (such as anger and shame) mediate the relationship between household water insecurity and mental health, with stronger negative emotional responses linked to heightened depression/anxiety. However, positive water-related emotions (such as gratitude and hope) also independently predict better mental health. This suggests a novel dual-pathway model. Contrary to expectations, gender does not significantly moderate these relationships, likely due to context-specific gender roles through which men and women share household water management responsibilities. Overall, our findings emphasize the need for more nuanced models that link the lived experience of water insecurity with emotion and mental health, including consideration of the potential role of positive emotions.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100563"},"PeriodicalIF":2.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519435","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}
South Africa faces a significant burden from mental, neurological, and substance-use (MNS) conditions, with a substantial treatment gap that hampers the country's progress toward universal health coverage (UHC). Despite National Health Insurance (NHI) reforms, equity in access, affordability and preparedness remain concerns. The South African Mental Health Investment Case (MHIC) was commissioned to evaluate the costs and benefits of implementing mental health interventions over a 15-year period to inform national planning and budgeting. The analysis incorporated a comprehensive stakeholder consultation process including a Delphi study for expert consensus and uses the WHO Inter-UN OneHealth Tool and Excel-based modelling to estimate health and economic benefits.
The MHIC estimates substantial economic and social returns, particularly for interventions targeting common mental health conditions, with benefit to cost ratios of 4.0 and 3.6 to 1 for adult and childhood depression, 4.7 to 1 for perinatal depression and 1.5 and 0.6 to 1 for adult and childhood anxiety, respectively. The total investment needed represents approximately 11.6 % of the current health budget and aligns with recommended international norms for mental health funding. The cost of inaction is significant, unaddressed MNS conditions could cost South Africa 4 % of its GDP annually. The MHIC highlights the value of early prevention programs, including school-based interventions and targeted psychosocial support, which could avert prevalent cases and enhance productivity. By reallocating resources towards primary and community-based care, the MHIC advocates for an efficient and sustainable approach aligned with South Africa's UHC goals, emphasizing the critical need for intersectoral collaboration.
{"title":"The costs, outcomes and returns on investment of a package of intersectoral interventions for mental, neurological, and substance-use disorders, and intellectual disabilities in South Africa","authors":"Donela Besada , Sumaiyah Docrat , Barbara Barrett , Crick Lund","doi":"10.1016/j.ssmmh.2025.100560","DOIUrl":"10.1016/j.ssmmh.2025.100560","url":null,"abstract":"<div><div>South Africa faces a significant burden from mental, neurological, and substance-use (MNS) conditions, with a substantial treatment gap that hampers the country's progress toward universal health coverage (UHC). Despite National Health Insurance (NHI) reforms, equity in access, affordability and preparedness remain concerns. The South African Mental Health Investment Case (MHIC) was commissioned to evaluate the costs and benefits of implementing mental health interventions over a 15-year period to inform national planning and budgeting. The analysis incorporated a comprehensive stakeholder consultation process including a Delphi study for expert consensus and uses the WHO Inter-UN OneHealth Tool and Excel-based modelling to estimate health and economic benefits.</div><div>The MHIC estimates substantial economic and social returns, particularly for interventions targeting common mental health conditions, with benefit to cost ratios of 4.0 and 3.6 to 1 for adult and childhood depression, 4.7 to 1 for perinatal depression and 1.5 and 0.6 to 1 for adult and childhood anxiety, respectively. The total investment needed represents approximately 11.6 % of the current health budget and aligns with recommended international norms for mental health funding. The cost of inaction is significant, unaddressed MNS conditions could cost South Africa 4 % of its GDP annually. The MHIC highlights the value of early prevention programs, including school-based interventions and targeted psychosocial support, which could avert prevalent cases and enhance productivity. By reallocating resources towards primary and community-based care, the MHIC advocates for an efficient and sustainable approach aligned with South Africa's UHC goals, emphasizing the critical need for intersectoral collaboration.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100560"},"PeriodicalIF":2.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519429","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 : 2025-11-07DOI: 10.1016/j.ssmmh.2025.100558
Josh Nguyen , Timothy J. Cronin , Sophie Marsland , Joel R. Anderson , Christopher A. Pepping
Background
Sexual minority individuals continue to experience significantly higher levels of mental ill health than heterosexual people due to ongoing exposure to sexual minority stressors. Internalized sexual stigma is a key driver of negative mental health outcomes among sexual minority individuals and couples, yet few longitudinal studies have examined how internalized stigma changes over time and its antecedents. This study examined (1) the seven-year trajectory of internalized stigma, and (2) the effect of structural discrimination, friend and family support for relationship, and concealment on changes in internalized stigma at both within-person and between-person levels.
Methods
We used linear mixed effects models in a sample of 660 sexual minority adults (n = 330 same-sex couples; Mage = 39.5 years, SD = 10.8) who were assessed annually over seven years.
Results
Results showed that internalized stigma remained stable over time. There were significant between-person effects of structural stigma, friend support, and concealment on internalized stigma over time, suggesting that those who, on average, report greater structural stigma and concealment, and lower support from friends, tend to report higher internalized stigma over time. There were significant within-person effects of concealment on internalized stigma at the same timepoint, indicating that when individuals conceal their sexual identity more than usual, they are also more likely to report higher internalized stigma. There was no lagged within-person association between concealment and internalized stigma. There were no within-person effects of friend or family support on internalized stigma at the same or following timepoint.
Conclusions
These findings highlight the importance of examining individual, social and structural drivers of internalized stigma over time. This research has important implications for developing effective interventions to reduce minority stress and improve mental health among sexual minority individuals.
{"title":"Within and between person effects of structural stigma, support, and concealment on internalized stigma: A 7-year longitudinal study in a sample of same-sex couples","authors":"Josh Nguyen , Timothy J. Cronin , Sophie Marsland , Joel R. Anderson , Christopher A. Pepping","doi":"10.1016/j.ssmmh.2025.100558","DOIUrl":"10.1016/j.ssmmh.2025.100558","url":null,"abstract":"<div><h3>Background</h3><div>Sexual minority individuals continue to experience significantly higher levels of mental ill health than heterosexual people due to ongoing exposure to sexual minority stressors. Internalized sexual stigma is a key driver of negative mental health outcomes among sexual minority individuals and couples, yet few longitudinal studies have examined how internalized stigma changes over time and its antecedents. This study examined (1) the seven-year trajectory of internalized stigma, and (2) the effect of structural discrimination, friend and family support for relationship, and concealment on changes in internalized stigma at both within-person and between-person levels.</div></div><div><h3>Methods</h3><div>We used linear mixed effects models in a sample of 660 sexual minority adults (<em>n</em> = 330 same-sex couples; <em>M</em><sub>age</sub> = 39.5 years, <em>SD</em> = 10.8) who were assessed annually over seven years.</div></div><div><h3>Results</h3><div>Results showed that internalized stigma remained stable over time. There were significant between-person effects of structural stigma, friend support, and concealment on internalized stigma over time, suggesting that those who, on average, report greater structural stigma and concealment, and lower support from friends, tend to report higher internalized stigma over time. There were significant within-person effects of concealment on internalized stigma at the same timepoint, indicating that when individuals conceal their sexual identity more than usual, they are also more likely to report higher internalized stigma. There was no lagged within-person association between concealment and internalized stigma. There were no within-person effects of friend or family support on internalized stigma at the same or following timepoint.</div></div><div><h3>Conclusions</h3><div>These findings highlight the importance of examining individual, social and structural drivers of internalized stigma over time. This research has important implications for developing effective interventions to reduce minority stress and improve mental health among sexual minority individuals.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100558"},"PeriodicalIF":2.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518971","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 : 2025-11-05DOI: 10.1016/j.ssmmh.2025.100562
M.M.A. Eilander , L. Baams , B.P.C. Kreukels , H.W. Bos , M.A. Bremmer , M. Geerdink , J. Lakeman , J. De Lange , I. Barlag , D.D. Van Bergen
Background
Transgender and gender diverse (TGD) young people are at higher risk of suicidality than their cisgender peers. TGD youth experience a peak in mental health challenges during adolescence and young adulthood, with 93 % of first suicide attempts occurring before age 25. The heightened risk of suicidality can be explained through experienced gender dysphoria, gender minority stress and feelings of thwarted belongingness and perceived burdensomeness.
Aims
This protocol describes the T-ROTS study (TRans yOung people Therapy Suicide prevention): a single-blind randomized controlled trial examining the efficacy of online cognitive behavioral therapy for suicide prevention developed for TGD young people (CBT-SP-TGD) aged 16–28. The experimental group receiving CBT-SP-TGD will be compared to the control group receiving general online cognitive behavioral therapy for suicide prevention, which is the treatment as usual (TAU).
Methods
The primary objective of this study protocol is to describe how we will investigate the efficacy of a CBT-SP-TGD, in reducing suicidal ideation and behavior, and depression, compared to TAU, measured at three months follow-up. The secondary objective is to describe how we will investigate if CBT-SP-TGD helps to decrease participants' minority stress, self-injurious behavior, maladaptive coping strategies and increase participants’ adaptive coping strategies and emotion regulation. We also describe how we will explore intervention effects between different gender identities, and if suicidal ideation is reduced through decreasing thwarted belongingness and perceived burdensomeness.
Conclusion
T-ROTS aims to advance understanding of outcomes, mechanisms, and core components of interventions targeting suicidality disparities between cisgender and TGD individuals. It will provide practical guidance for improving mental health and suicide prevention treatment for TGD populations.
{"title":"The T-ROTS study protocol: A randomized controlled trial of cognitive behavioral therapy - Suicide prevention for transgender and gender diverse young people","authors":"M.M.A. Eilander , L. Baams , B.P.C. Kreukels , H.W. Bos , M.A. Bremmer , M. Geerdink , J. Lakeman , J. De Lange , I. Barlag , D.D. Van Bergen","doi":"10.1016/j.ssmmh.2025.100562","DOIUrl":"10.1016/j.ssmmh.2025.100562","url":null,"abstract":"<div><h3>Background</h3><div>Transgender and gender diverse (TGD) young people are at higher risk of suicidality than their cisgender peers. TGD youth experience a peak in mental health challenges during adolescence and young adulthood, with 93 % of first suicide attempts occurring before age 25. The heightened risk of suicidality can be explained through experienced gender dysphoria, gender minority stress and feelings of thwarted belongingness and perceived burdensomeness.</div></div><div><h3>Aims</h3><div>This protocol describes the T-ROTS study (TRans yOung people Therapy Suicide prevention): a single-blind randomized controlled trial examining the efficacy of online cognitive behavioral therapy for suicide prevention developed for TGD young people (CBT-SP-TGD) aged 16–28. The experimental group receiving CBT-SP-TGD will be compared to the control group receiving general online cognitive behavioral therapy for suicide prevention, which is the treatment as usual (TAU).</div></div><div><h3>Methods</h3><div>The primary objective of this study protocol is to describe how we will investigate the efficacy of a CBT-SP-TGD, in reducing suicidal ideation and behavior, and depression, compared to TAU, measured at three months follow-up. The secondary objective is to describe how we will investigate if CBT-SP-TGD helps to decrease participants' minority stress, self-injurious behavior, maladaptive coping strategies and increase participants’ adaptive coping strategies and emotion regulation. We also describe how we will explore intervention effects between different gender identities, and if suicidal ideation is reduced through decreasing thwarted belongingness and perceived burdensomeness.</div></div><div><h3>Conclusion</h3><div>T-ROTS aims to advance understanding of outcomes, mechanisms, and core components of interventions targeting suicidality disparities between cisgender and TGD individuals. It will provide practical guidance for improving mental health and suicide prevention treatment for TGD populations.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100562"},"PeriodicalIF":2.6,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518972","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 : 2025-11-04DOI: 10.1016/j.ssmmh.2025.100561
Ram P. Sapkota , Vanessa Peynenburg , Blake F. Dear , Nick Titov , Heather D. Hadjistavropoulos
Disorder-specific Internet-delivered cognitive behavioral therapy (ICBT) for Adjustment Disorder (AD) has shown moderate effect sizes but may lack scalability in routine care, where clients present with diverse concerns. Transdiagnostic ICBT, which targets common emotional and behavioral difficulties regardless of diagnosis, may offer a more scalable solution. This study explored the utility of a transdiagnostic ICBT course for individuals with high AD symptoms. Between June 15th, 2022, and June 19th, 2023, 585 participants (72.1 % women; 83.2 % White) who completed a therapist-guided, transdiagnostic ICBT course and met the inclusion criteria for the present study were included in the analysis. AD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up using the Adjustment Disorder–New Module 8 (ADNM-8). At pre-treatment, 356 (60.9 %) of participants scored above the clinical cut-off (>23) on the ADNM-8. Large within-group reductions in AD symptoms were observed from pre-to post-treatment (Cohen's d = 1.31, 95 % CI [1.13, 1.48]) and pre-treatment to follow-up (d = 1.61, 95 % CI [1.41, 1.81]). Approximately 70 % of participants with high AD symptoms scored below the cut-off at post-treatment, increasing to 75 % at follow-up. Treatment engagement and satisfaction were high across groups, with 76.9 % completing four or more lessons and 81.5 % reporting overall satisfaction. Transdiagnostic ICBT appears to be a useful and acceptable treatment for individuals with high AD symptoms. Symptom improvement was comparable to those from disorder-specific interventions. The high number of self-reported AD symptoms highlights the need for early identification and scalable treatment options in routine care.
针对适应障碍（AD）的特定网络认知行为疗法（ICBT）已显示出中等效果，但在常规护理中可能缺乏可扩展性，因为客户存在不同的关注点。跨诊断ICBT针对的是常见的情绪和行为困难，而不考虑诊断，它可能提供一个更可扩展的解决方案。本研究探讨了跨诊断ICBT课程对AD高症状个体的效用。在2022年6月15日至2023年6月19日期间，585名参与者（72.1%为女性，83.2%为白人）完成了治疗师指导的跨诊断ICBT课程，并符合本研究的纳入标准。使用调整障碍-新模块8 （ADNM-8）在治疗前、治疗后和3个月的随访中评估AD症状。在治疗前，356名（60.9%）参与者在ADNM-8上的得分高于临床临界值（>23）。从治疗前到治疗后（Cohen’s d = 1.31, 95% CI[1.13, 1.48]）和治疗前到随访期间（d = 1.61, 95% CI [1.41, 1.81]）， AD症状在组内显著减轻。大约70%的阿尔茨海默病症状高的参与者在治疗后得分低于临界值，在随访中增加到75%。各组的治疗参与度和满意度都很高，76.9%的人完成了四个或更多的课程，81.5%的人报告了总体满意度。跨诊断ICBT似乎是一种有用的和可接受的治疗个体的高AD症状。症状改善与疾病特异性干预相当。大量自我报告的阿尔茨海默病症状突出了在常规护理中早期识别和可扩展治疗方案的必要性。
{"title":"Exploring the utility of transdiagnostic internet-delivered cognitive behavioral therapy for symptoms of adjustment disorder: A longitudinal observational study in a routine online care setting in Western Canada","authors":"Ram P. Sapkota , Vanessa Peynenburg , Blake F. Dear , Nick Titov , Heather D. Hadjistavropoulos","doi":"10.1016/j.ssmmh.2025.100561","DOIUrl":"10.1016/j.ssmmh.2025.100561","url":null,"abstract":"<div><div>Disorder-specific Internet-delivered cognitive behavioral therapy (ICBT) for Adjustment Disorder (AD) has shown moderate effect sizes but may lack scalability in routine care, where clients present with diverse concerns. Transdiagnostic ICBT, which targets common emotional and behavioral difficulties regardless of diagnosis, may offer a more scalable solution. This study explored the utility of a transdiagnostic ICBT course for individuals with high AD symptoms. Between June 15th, 2022, and June 19th, 2023, 585 participants (72.1 % women; 83.2 % White) who completed a therapist-guided, transdiagnostic ICBT course and met the inclusion criteria for the present study were included in the analysis. AD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up using the Adjustment Disorder–New Module 8 (ADNM-8). At pre-treatment, 356 (60.9 %) of participants scored above the clinical cut-off (>23) on the ADNM-8. Large within-group reductions in AD symptoms were observed from pre-to post-treatment (Cohen's <em>d</em> = 1.31, 95 % CI [1.13, 1.48]) and pre-treatment to follow-up (<em>d</em> = 1.61, 95 % CI [1.41, 1.81]). Approximately 70 % of participants with high AD symptoms scored below the cut-off at post-treatment, increasing to 75 % at follow-up. Treatment engagement and satisfaction were high across groups, with 76.9 % completing four or more lessons and 81.5 % reporting overall satisfaction. Transdiagnostic ICBT appears to be a useful and acceptable treatment for individuals with high AD symptoms. Symptom improvement was comparable to those from disorder-specific interventions. The high number of self-reported AD symptoms highlights the need for early identification and scalable treatment options in routine care.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100561"},"PeriodicalIF":2.6,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465637","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 : 2025-10-31DOI: 10.1016/j.ssmmh.2025.100555
Steffi Gebus , Hala Kerbage , Eva Alisic , June Thorvaldsen Forsberg , Jon-Håkon Schultz
Lebanon's multi-layered crisis - marked by regional conflict, economic collapse, the COVID-19 pandemic, and the 2020 Beirut Port Blast - has severely affected the psychosocial well-being of Syrian refugee children in Beirut. In response to the blast, a global psychosocial support intervention, the Better Learning Programme (BLP), was adapted into a targeted, short-term program delivered by five counselors, reaching 1100 Syrian refugee children over 10 months. This study examines the mechanisms driving improvements in psychosocial well-being and the barriers that hindered progress for these children. Data collection was longitudinal in nature and consisted of 30 online interviews, six face-to-face interviews, and one group interview with five psychosocial counselors. The counselors observed significant improvements in children's psychosocial well-being through three primary mechanisms: psychosocial safety, self-regulation, and co-regulation. Psychosocial safety was fostered through the creation of child-centered spaces and the provision of practical tools to support emotional well-being. Self-regulation enabled children to manage emotions and stress through psychoeducation and cognitive restructuring, while co-regulation promoted belonging and resilience through group cohesion and strong counselor-child relationships. These mechanisms reflect the multidimensional nature of well-being and emphasize the importance of relational, cultural, and contextual factors in delivering effective support in crisis settings. However, barriers such as emotional exhaustion of counselors, lack of systemic reinforcement, and external challenges such as economic hardship impeded the intervention's implementation. This study provides insights into how a flexible, counselor-led psychosocial support intervention can strengthen well-being and highlights the critical role of relational, cultural, and contextual dynamics in shaping effective responses in crisis-affected, low- and middle-income settings.
{"title":"Unveiling mechanisms of change: Analyzing a short-term psychosocial support intervention for refugee children in Lebanon","authors":"Steffi Gebus , Hala Kerbage , Eva Alisic , June Thorvaldsen Forsberg , Jon-Håkon Schultz","doi":"10.1016/j.ssmmh.2025.100555","DOIUrl":"10.1016/j.ssmmh.2025.100555","url":null,"abstract":"<div><div>Lebanon's multi-layered crisis - marked by regional conflict, economic collapse, the COVID-19 pandemic, and the 2020 Beirut Port Blast - has severely affected the psychosocial well-being of Syrian refugee children in Beirut. In response to the blast, a global psychosocial support intervention, the Better Learning Programme (BLP), was adapted into a targeted, short-term program delivered by five counselors, reaching 1100 Syrian refugee children over 10 months. This study examines the mechanisms driving improvements in psychosocial well-being and the barriers that hindered progress for these children. Data collection was longitudinal in nature and consisted of 30 online interviews, six face-to-face interviews, and one group interview with five psychosocial counselors. The counselors observed significant improvements in children's psychosocial well-being through three primary mechanisms: psychosocial safety, self-regulation, and co-regulation. Psychosocial safety was fostered through the creation of child-centered spaces and the provision of practical tools to support emotional well-being. Self-regulation enabled children to manage emotions and stress through psychoeducation and cognitive restructuring, while co-regulation promoted belonging and resilience through group cohesion and strong counselor-child relationships. These mechanisms reflect the multidimensional nature of well-being and emphasize the importance of relational, cultural, and contextual factors in delivering effective support in crisis settings. However, barriers such as emotional exhaustion of counselors, lack of systemic reinforcement, and external challenges such as economic hardship impeded the intervention's implementation. This study provides insights into how a flexible, counselor-led psychosocial support intervention can strengthen well-being and highlights the critical role of relational, cultural, and contextual dynamics in shaping effective responses in crisis-affected, low- and middle-income settings.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100555"},"PeriodicalIF":2.6,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465145","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 : 2025-10-31DOI: 10.1016/j.ssmmh.2025.100559
Melissa Uehling
Delivering effective, compassionate psychiatric care that emphasizes meaningful exploration of patient perspectives remains a challenge for modern psychiatry. Despite the development of certain modalities that seek to improve understanding of patients with psychosis, many individuals experiencing psychosis continue to report feeling misunderstood or misrepresented by psychiatrists. Drawing upon the theoretical frames of subjectivity and intersubjectivity, this work seeks to explore how the perspectives of psychiatrists and patients may align or misalign during psychiatric treatment, and if and how diverging perspectives of patients are explored during treatment. This study involved 11 months of ethnographic fieldwork within multiple clinics under a major US healthcare system that offer specialty psychosis care in the southeastern United States. Findings revealed that psychiatrists and patients often markedly differed in their subjective conceptualizations of the meaning of the illness, the goals of the treatment encounter, and the desired relational dynamics within the treatment encounter. In many of the observed psychiatrist-patient dyads, patients felt pressured, often in subtle ways, to conform to the psychiatrist's subjective perspective. Alternatively, in certain relationships, the psychiatrist demonstrated more flexibility and harmonization towards the patient's perspective. Furthermore, numerous structural factors, such as time constraints, insurance restrictions, and the biomedical emphasis of care, led to limitations on the possibilities for exploration of patient perspectives during treatment. The findings indicate important implications for psychiatric care for those experiencing psychosis, and suggest possible paths forward for improved understandings in psychiatric treatment.
{"title":"(Un)shared realities of psychosis treatment: An ethnographic study of (mis)alignment between psychiatrists and patients experiencing psychosis","authors":"Melissa Uehling","doi":"10.1016/j.ssmmh.2025.100559","DOIUrl":"10.1016/j.ssmmh.2025.100559","url":null,"abstract":"<div><div>Delivering effective, compassionate psychiatric care that emphasizes meaningful exploration of patient perspectives remains a challenge for modern psychiatry. Despite the development of certain modalities that seek to improve understanding of patients with psychosis, many individuals experiencing psychosis continue to report feeling misunderstood or misrepresented by psychiatrists. Drawing upon the theoretical frames of subjectivity and intersubjectivity, this work seeks to explore how the perspectives of psychiatrists and patients may align or misalign during psychiatric treatment, and if and how diverging perspectives of patients are explored during treatment. This study involved 11 months of ethnographic fieldwork within multiple clinics under a major US healthcare system that offer specialty psychosis care in the southeastern United States. Findings revealed that psychiatrists and patients often markedly differed in their subjective conceptualizations of the meaning of the illness, the goals of the treatment encounter, and the desired relational dynamics within the treatment encounter. In many of the observed psychiatrist-patient dyads, patients felt pressured, often in subtle ways, to conform to the psychiatrist's subjective perspective. Alternatively, in certain relationships, the psychiatrist demonstrated more flexibility and harmonization towards the patient's perspective. Furthermore, numerous structural factors, such as time constraints, insurance restrictions, and the biomedical emphasis of care, led to limitations on the possibilities for exploration of patient perspectives during treatment. The findings indicate important implications for psychiatric care for those experiencing psychosis, and suggest possible paths forward for improved understandings in psychiatric treatment.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100559"},"PeriodicalIF":2.6,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465144","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 : 2025-10-30DOI: 10.1016/j.ssmmh.2025.100556
Victoria Loblay , Qaisar Khan , Ian B. Hickie , Mahalakshmi Ekambareshwar , Yun J.C. Song , Dilrabo Tosheva , Haley M. LaMonica
Cultural adaptation is essential for effective implementation of digital parenting interventions across diverse settings, including in low- and middle-income countries. Dominant frameworks for cultural adaptation focus on intervention design components at the expense of attending to processes of adaptation that take place during implementation and neglect the significance of cultural context for measurement and evaluation of outcomes. Despite many programs shifting to online platforms and the exponential rise in parenting apps, there is also a lack of theorisation of cultural adaptation for digital interventions. We used a Mixed-Method Grounded Theory approach to draw on learnings from an evaluation of a digital childrearing program and UNICEF Multiple Indicator Cluster Surveys in Uzbekistan. Our analysis centred on areas of ‘cultural friction’ where key intervention targets (e.g. child discipline) are closely tied to cultural values and attitudes toward childrearing. In the context of Uzbekistan, our findings highlight key cultural models that emerged in the implementation of the digital parenting program: the critical roles of grandparents as gatekeepers and protectors of children, as well as the submissive role of young mothers. However, points of cultural friction were navigated and interpreted in a range of ways within different family systems. Grandparents' roles as ‘protectors’, for example, could be harnessed to encourage shifting discipline practices, as long as technology-based scientific knowledge was not presented as a threat to the moral authority of elders. In terms of a generalisable framework for cultural adaptation, this demonstrates the importance of locating opportunities where changes in childrearing practice can align with cultural models, family dynamics and familiar channels of knowledge transmission.
{"title":"Developing a conceptual framework for cultural adaptation of digital parenting interventions: A mixed-method grounded theory study from Uzbekistan","authors":"Victoria Loblay , Qaisar Khan , Ian B. Hickie , Mahalakshmi Ekambareshwar , Yun J.C. Song , Dilrabo Tosheva , Haley M. LaMonica","doi":"10.1016/j.ssmmh.2025.100556","DOIUrl":"10.1016/j.ssmmh.2025.100556","url":null,"abstract":"<div><div>Cultural adaptation is essential for effective implementation of digital parenting interventions across diverse settings, including in low- and middle-income countries. Dominant frameworks for cultural adaptation focus on intervention design components at the expense of attending to processes of adaptation that take place during implementation and neglect the significance of cultural context for measurement and evaluation of outcomes. Despite many programs shifting to online platforms and the exponential rise in parenting apps, there is also a lack of theorisation of cultural adaptation for <em>digital</em> interventions. We used a Mixed-Method Grounded Theory approach to draw on learnings from an evaluation of a digital childrearing program and UNICEF Multiple Indicator Cluster Surveys in Uzbekistan. Our analysis centred on areas of ‘cultural friction’ where key intervention targets (e.g. child discipline) are closely tied to cultural values and attitudes toward childrearing. In the context of Uzbekistan, our findings highlight key cultural models that emerged in the implementation of the digital parenting program: the critical roles of grandparents as gatekeepers and protectors of children, as well as the submissive role of young mothers. However, points of cultural friction were navigated and interpreted in a range of ways within different family systems. Grandparents' roles as ‘protectors’, for example, could be harnessed to encourage shifting discipline practices, as long as technology-based scientific knowledge was not presented as a threat to the moral authority of elders. In terms of a generalisable framework for cultural adaptation, this demonstrates the importance of locating opportunities where changes in childrearing practice can align with cultural models, family dynamics and familiar channels of knowledge transmission.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100556"},"PeriodicalIF":2.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465146","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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