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Aims: The Covid-19 pandemic and related social restrictions have been associated with increased rates of mental health problems, prompting a global surge in interest in mental well-being, which might have had a positive effect on population mental health literacy (MHL). We aimed to compare levels of mental health related stigma among the Czech general adult population before and after the Covid-19 pandemic, as well as recognition of own mental health problems, among those members of the general population who screened positively for mental disorders. Methods: We conducted a comprehensive analysis of multiple almost identically designed cross-sectional surveys carried out on representative samples of the non-institutionalized adult population in Czechia in 2017, 2019, and 2022. Mental health problems were assessed using the Mini International Neuropsychiatric Interview (M.I.N.I.) in 2017 and 2022, while Self-identification of Mental Illness Scale (SELF-I) gauged self-recognition in 2017 and 2022. Mental health-related stigma was evaluated using the Reported and Intended Behaviour Scale (RIBS) and the Community Attitudes towards Mental Illness scale (CAMI) in 2019 and 2022. Results: Attitudes towards individuals with mental health problems exhibited no statistically significant change; however, reported and intended behaviours, i.e. proxies of social distance, changed for the better. Also, self-recognition of mental health problems demonstrated statistically significant improvements among those screening positive for depression, anxiety, and suicide risk, but not among alcohol use disorders. Conclusions: Population MHL remains low and recent positive changes are likely more attributable to the Covid-19 pandemic and related increase in interest in mental health than to deliberate efforts by government or state or other entities. This underscores the complex interplay between societal factors and mental health outcomes, warranting further exploration and reconsideration of public mental health strategies.

BackgroundEvidence suggests reduced survival rates following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in people with preexisting mental disorders, especially psychotic disorders, before the broad introduction of vaccines. It remains unknown whether this elevated mortality risk persisted at later phases of the pandemic and when accounting for the confounding effect of vaccination uptake and clinically recorded physical comorbidities.Methods and findingsWe used data from Czech national health registers to identify first-ever serologically confirmed SARS-CoV-2 infections in 5 epochs related to different phases of the pandemic: 1st March 2020 to 30th September 2020, 1st October 2020 to 26th December 2020, 27th December 2020 to 31st March 2021, 1st April 2021 to 31st October 2021, and 1st November 2021 to 29th February 2022. In these people, we ascertained cases of mental disorders using 2 approaches: (1) per the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes for substance use, psychotic, affective, and anxiety disorders; and (2) per ICD-10 diagnostic codes for the above mental disorders coupled with a prescription for anxiolytics/hypnotics/sedatives, antidepressants, antipsychotics, or stimulants per the Anatomical Therapeutic Chemical (ATC) classification codes. We matched individuals with preexisting mental disorders with counterparts who had no recorded mental disorders on age, sex, month and year of infection, vaccination status, and the Charlson Comorbidity Index (CCI). We assessed deaths with Coronavirus Disease 2019 (COVID-19) and from all-causes in the time period of 28 and 60 days following the infection using stratified Cox proportional hazards models, adjusting for matching variables and additional confounders. The number of individuals in matched-cohorts ranged from 1,328 in epoch 1 to 854,079 in epoch 5. The proportion of females ranged from 34.98% in people diagnosed with substance use disorders in epoch 3 to 71.16% in individuals diagnosed and treated with anxiety disorders in epoch 5. The mean age ranged from 40.97 years (standard deviation [SD] = 15.69 years) in individuals diagnosed with substance use disorders in epoch 5 to 56.04 years (SD = 18.37 years) in people diagnosed with psychotic disorders in epoch 2. People diagnosed with or diagnosed and treated for psychotic disorders had a consistently elevated risk of dying with COVID-19 in epochs 2, 3, 4, and 5, with adjusted hazard ratios (aHRs) ranging from 1.46 [95% confidence intervals (CIs), 1.18, 1.79] to 1.93 [95% CIs, 1.12, 3.32]. This patient group demonstrated also a consistently elevated risk of all-cause mortality in epochs 2, 3, 4, and 5 (aHR from 1.43 [95% CIs, 1.23, 1.66] to 1.99 [95% CIs, 1.25, 3.16]). The models could not be reliably fit for psychotic disorders in epoch 1. People diagnosed with substance use disorders had an increased risk of all-cause mortality 28 days postinfection in epoch 3, 4, and 5 (aHR from 1.30 [95% CIs, 1.14, 1.47] to 1.59 [95% CIs, 1.19, 2.12]) and 60 days postinfection in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.08, 1.38] to 1.52 [95% CIs, 1.16, 1.98]). Cases ascertained based on diagnosis of substance use disorders and treatment had increased risk of all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.03, 1.43] to 1.91 [95% CIs, 1.25, 2.91]). The models could not be reliably fit for substance use disorders in epoch 1. In contrast to these, people diagnosed with anxiety disorders had a decreased risk of death with COVID-19 in epoch 2, 3, and 5 (aHR from 0.78 [95% CIs, 0.69, 0.88] to 0.89 [95% CIs, 0.81, 0.98]) and all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 0.83 [95% CIs, 0.77, 0.90] to 0.88 [95% CIs, 0.83, 0.93]). People diagnosed and treated for affective disorders had a decreased risk of both death with COVID-19 and from all-causes in epoch 3 (aHR from 0.87 [95% CIs, 0.79, 0.96] to 0.90 [95% CIs, 0.83, 0.99]), but demonstrated broadly null effects in other epochs. Given the unavailability of data on a number of potentially influential confounders, particularly body mass index, tobacco smoking status, and socioeconomic status, part of the detected associations might be due to residual confounding.ConclusionsPeople with preexisting psychotic, and, less robustly, substance use disorders demonstrated a persistently elevated risk of death following SARS-CoV-2 infection throughout the pandemic. While it cannot be ruled out that part of the detected associations is due to residual confounding, this excess mortality cannot be fully explained by lower vaccination uptake and more clinically recorded physical comorbidities in these patient groups.

Abstract Universal evidence‐based prevention and promotion programs lack in availability and scalability for child and adolescent mental health in Central and Eastern Europe. This paper describes the process of applying the theory of change to plan, develop, and pilot a mental health literacy intervention in Czech schools. The process of using theory of change to develop a complex intervention for mental health literacy is described across three stages: formative development, piloting, and evaluation. The application of evidence‐based intervention was discussed within 64 diverse stakeholder meetings and tested over 2 years of piloting. The resulting theory of change map is described in the context of consideration for modifications, revisions, and recommendations for successful implementation of the developed intervention. Continued monitoring and evaluation and a formal evaluation of the effectiveness of mental health literacy curriculum within the region will be essential before scale‐up.

Evidence is scarce in terms of tracking the progress of implementation of mental healthcare plans and policies (MHPPs) in Europe, we aimed to map and analyze the content of MHPPs across the WHO European region.

Mental health policies and plans (MHPPs) are important policy instruments and powerful tools to facilitate development of mental health systems and services across the world. We aimed to map and analyse methods and tools used to assess the extent, process and impact of implementing MHPPs. We systematically searched peer-reviewed and grey literature across seven scientific databases. We extracted and analysed the data on a) the characteristics of included studies (e.g., policy areas, region of origin, income setting) and b) the methodology and evaluation tools applied to assess the extent and process of implementation. We included 48 studies in the analyses. Twenty-six of these studies employed only qualitative methods (e.g., semi-structured interviews, focus group discussions, desk review, stakeholder consultations); 12 studies used quantitative methods (e.g., trend analysis, survey) and 10 used mixed-methods approaches. Generally, methods and tools used for assessment were described poorly with less than half of the studies providing partial or full details about them. Only three studies provided assessment of full policies. There is a lack of rigorous research to assess implementation MHPPs. Assessments of the implementation of entire MHPPs are almost non-existent. Strategies to assess the implementation of MHPPs should be an integral part of MHPPs.

With the launch of the Prisms Global Mental Health series, we are taking the opportunity to make explicit our vision for Global Mental Health. We strongly propose a Public Mental Health approach, incorporating culture and context and prioritizing equity and inclusion, particularly of previously marginalized groups. In using a Public Mental Health approach, we are framing Global Mental Health research as population-oriented research that seeks to understand the etiology, prevention, promotion, and treatment of mental and behavioral health problems with a strong emphasis on ‘knowledge generation’ which is relevant, transferable, and generalizable to different populations and settings. The public health approach also incorporates policy and systems research and evaluation, with a particular focus on accessibility and quality of care and human rights. By using the term Global, we are being explicit in acknowledging the role(s) of culture and context in all stages of research, from conceptualization through interpretation and dissemination. In centering equity and inclusion, we are advocating for a focus on populations who have been marginalized and have not been well represented within Global Mental Health research and active participation of voices of the populations that are included in the research. We are also working to promote participation of individuals from diverse and underrepresented communities and diverse experiences, including those with lived experience, in all stages of research pipeline: from conceptualization to publication of findings. Our readers will see these values and ideas operationalized in the choice of article topics and the published manuscripts as well as in the editorial and advisory board membership and selection of reviewers.

Summary: Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.