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Abstract Background Postpartum mental health care is a public health priority requiring interprofessional and interorganizational collaboration. Primary care physicians (PCPs) have the potential to play an essential role in facilitating access to health care and providing comprehensive and coordinated care for postpartum mental health problems. In Japan, however, there are no previous studies on the extent to which PCPs are involved in postpartum mental health care. Therefore, this study aimed to investigate the practices and experiences of Japanese PCPs in providing such care. Methods This study presents a subset of the findings from a cross‐sectional study using an online questionnaire on postpartum care among Japanese PCPs. We employed descriptive analysis to examine their practices and experiences in providing general and postpartum mental health care. Results We received 339 valid responses from 5811 PCPs. The median proportion of the outpatients with mental health problems that PCPs regularly saw was 15%. Approximately two out of three PCPs (68.7%) reported routinely performing screening for depression and anxiety. Seventy‐six percent of PCPs had the opportunity to provide care for postpartum women. Approximately one in two PCPs (47.8%) had managed cases of postpartum mental health problems and collaborated with various professionals and resources to provide care. Conclusions The majority of Japanese PCP participants in the study provide mental health care and have managed cases of postpartum mental health problems, collaborating with various health professionals.

Abstract Young individuals with post‐traumatic stress disorder (PTSD) display peripheral vascular and autonomic nervous system dysfunction, two factors potentially stemming from a redox imbalance. It is currently unclear if these aforementioned factors, observed at rest, alter peripheral haemodynamic responses to exercise in this population. This study examined haemodynamic responses to handgrip exercise in young individuals with PTSD following acute antioxidant (AO) supplementation. Thirteen young individuals with PTSD (age 23 ± 3 years), and 13 age‐ and sex‐matched controls (CTRL) participated in the study. Exercise‐induced changes to arm blood flow (BF), mean arterial pressure (MAP) and vascular conductance (VC) were evaluated across two workloads of rhythmic handgrip exercise (3 and 6 kg). The PTSD group participated in two visits, consuming either a placebo (PL) or AO prior to their visits. The PTSD group demonstrated significantly lower VC (P = 0.04) across all exercise workloads (vs. CTRL), which was significantly improved following AO supplementation. In the PTSD group, AO supplementation improved VC in participants possessing the lowest VC responses to handgrip exercise, with AO supplementation significantly improving VC responses (3 and 6 kg: P

Abstract Transgender individuals experience elevated mental health issues and a diminished quality of life compared to the general population. While gender‐affirming dermatology treatments hold promise in addressing these challenges, there is a notable dearth of research in this area. Therefore, the objective of this study was to provide a comprehensive summary of the existing literature on the psychosocial effects of gender‐affirming dermatology treatments in transgender populations. A systematic review of original research on gender‐affirming dermatology treatments in transgender populations was conducted from PubMed (including Medline), Cochrane Library and Embase following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 2020 guidelines. The search was limited to studies published after 1 January 2013 and was conducted on 26 June 2023. Relevant reviews were excluded but had their references screened. All studies that met the inclusion criteria also had their references screened. Article screening involved two steps: initial abstract/title screening using Rayyan.ia, followed by full‐text screening for selected articles. Risk of bias was assessed using Joanna Briggs Institute critical appraisal checklists. Thirteen studies were analyzed and most revealed a positive association between gender‐affirming dermatology treatments and favorable psychosocial outcomes. However, there was a large imbalance in the focus on transfeminine versus transmasculine individuals, alongside disparities in gender identification methods. Hair removal followed by nonsurgical injectables were the primary treatments studied. Most studies faced notable limitations, preventing a definitive causal relationship between gender‐affirming dermatology treatments and psychosocial effects. Across studies, there were discrepancies in the type of psychosocial outcome studied and a lack of standardized assessment tools. Despite these limitations, gender‐affirming dermatology treatments appear to have psychosocial benefits for transgender individuals, but further robust studies are needed for a comprehensive understanding of this relationship.

Abstract Aim Numerous recent reports have highlighted the association between mental disorders and electrocardiographic findings. The early repolarization pattern (ERP) on electrocardiogram has been linked with a history of suicide attempts and attention deficit hyperactivity disorder, and associations with impulsivity have also been reported. It is known that suicidal intent is more common at night. Patients who have a mental disorder and ERP may have a higher likelihood of impulsivity, potentially increasing the risk of suicide at night. Methods The subjects were 43 patients with a history of suicide attempts who had undergone electrocardiographic examination at Jikei University School of Medicine Kashiwa Hospital and received intervention from our department. Due to the diurnal variation in electrocardiographic findings, only patients who underwent the examination during the daytime were included. Patients' clinical backgrounds were compared according to the presence or absence of ERP, and the association between nocturnal suicide attempts and ERP was examined using multivariate analysis. Results The frequency of nocturnal suicidal behavior was 76.2% in patients with ERP and 31.8% in those without ERP, but the difference was not significant after Bonferroni correction. In the multivariate analysis, there was a significant association of ERP with nocturnal suicide attempts (p = 0.018). Conclusion The finding of an association between ERP and nocturnal suicide attempts indicates that ERP is a biological indicator that can predict nocturnal suicide attempts.

Abstract Background With the burden of colorectal cancer in Canada, there is a need to address the psycho‐oncologic challenges, including mental health. This study aims to explore the lived mental health experiences in patients with CRC across the phases of the CRC care continuum. Methods We employed a patient‐oriented constructivist grounded theory design and recruited English speaking participants ≥18 years, diagnosed with CRC within the last 10 years, residing in Canada. We collected data through semi‐structured individual interviews using a guide co‐constructed with patient research partners. Data collection and analysis were iterative, employed theoretical sampling, and culminated in a theoretical model. Results Twenty‐eight participants diagnosed with CRC (18 females, 10 males), aged 18–63 years at time of diagnosis were interviewed, with representation across all CRC stages. There were 10 participants (36%) in treatment, 12 participants (43%) in follow‐up, and 6 participants (21%) in the beyond phase. We constructed a patient‐oriented theory illustrating the dynamic nature between one's self‐identity and their mental health experiences across the CRC care continuum. Mental health experiences encompass emotional and cognitive‐behavioral responses, expressed differently across phases. Mental health care experiences are also shaped by barriers, facilitators, and individual contextual factors, all of which influence their access to care. Conclusion Our theory provides insight into the mental health experiences of patients with CRC across phases of the CRC care continuum. Understanding patients' emotional and cognitive‐behavioral responses and care experiences can help identify opportunities to integrate mental health into CRC care.

Abstract Background South‐East Asia is a densely populated region with a considerable, however, under‐prioritized mental health burden. Little is known about the mental health burden and services status in the prisons of the region. Objectives We aimed to investigate the individual country‐wise prison mental health status in South‐East Asian region. Methods We performed a narrative review based on the evidence available in PubMed, Scopus, PsycINFO, Google, and Google Scholar considering the review objectives. We highlighted country perspectives on total population, prison numbers, prisoner numbers, the prevalence of psychiatric disorders and suicide among prisoners, prison mental health services, current challenges, and ways ahead. Results We discussed the prison mental health of five countries (Bangladesh, India, Indonesia, Nepal, and Sri Lanka). We found overcrowding (131.4%–215.6%) in the prisons, a high prevalence of psychiatric disorders in the prisons (40%–100%), negligible prison mental health services, and a lack of data on prison suicide with some variations among the five countries. Among the countries, Bangladesh has the highest prevalence (66.4%–100%) of psychiatric morbidity with an absence of a mental health system. Conclusions Prison mental health in tSouth‐East Asia is a neglected domain and warrants attention regarding ensuring adequate mental health services to the prisoners as there are high unmet mental health needs and an absence of poorly supported mental health needs.

ABSTRACT Background Young adults with type 1 diabetes (T1D) face complex health challenges, including a heightened risk for distress. To counter this distress, there is a need to develop accessible, acceptable comprehensive care solutions that integrate diabetes and mental health care to enhance self‐efficacy and counter mental health challenges in this population. Objective To describe the engagement of individuals with lived experience of T1D and mental health challenges in the development of a recruitment strategy to support the co‐design of an innovative integrated care programme. Results Seven individuals with lived experience formed a Partner Advisory Council (PAC) to recruit young adults (18–29 years old) living with T1D, their friends or family and health researchers and professionals in co‐design interviews (n = 19) and co‐design events (n = 12). The PAC played a key role in developing a comprehensive recruitment strategy, overcoming traditional barriers and stigmas in the design of an integrated model of care. Conclusion Assuming the presence of mental health challenges in young adults living with T1D during recruitment had far‐reaching impacts on the development of a whole‐person and integrated diabetes and mental health care solution. The efficient recruitment of this sample provided invaluable insights into the nuanced challenges experienced by young adults with T1D, the individual skills developed in response to their mental health challenges and the ways that this understanding can shape future programming to support mental health, quality of life and well‐being. The ongoing involvement of the PAC as co‐researchers underscores the enduring impact of patient engagement in developing integrated care solutions. Patient or Public Contribution The co‐design of the TECC‐T1D3 model was enriched by the invaluable contributions of individuals with lived experience. This included the engagement of a diverse PAC in the recruitment of participants in co‐design interviews and co‐design events. PAC members actively participated in research decision‐making with their insights informing a robust recruitment strategy. Beyond recruitment, PAC members continue to serve as co‐researchers, shaping ongoing research and actively contributing to the TECC‐T1D3 project. Six PAC members are co‐authors on this manuscript.

Abstract Background Experiencing gender‐based violence (GBV) is common among refugees. Intersecting systems of oppression can increase the risk of GBV and of suffering detrimental consequences, while concurrently creating barriers to meaningful support. Despite this, refugees with lived experience of GBV are rarely involved in the development, planning and adaptation of services and policies. Methods This article reports on a formative research process that aimed to involve public contributors (refugee victim‐survivors of GBV) and relevant stakeholders in co‐designing a service model aimed at improving psychosocial support in Sweden. Led by a partnership of public contributors and academic researchers, the research process consisted of iterative cycles of co‐design workshops, complemented by scoping of existing literature. Results The co‐design process resulted in a characterisation of the psychosocial service system needs, as perceived by the survivor co‐researchers and stakeholders, and a two‐level empowerment and support service model. The model included (i) a community‐based intervention to promote help‐seeking and (ii) psychosocial group support delivered in specialist clinics. Outcomes of the project included perceived benefits for those involved, service‐led direct changes and acquisition of funding for continued research on the co‐designed model. Conclusion Improving psychosocial support for refugees in Sweden affected by GBV requires safe spaces to connect with peers and familiarise with available services, laws and rights in the society. Further, strengthened collaborations across sectors are necessary to meet the variety of needs. Co‐design workshops were an effective way to initiate changes in the service delivery model for psychosocial support for refugees in Sweden affected by GBV. Patient or Public Contributions This is a participatory reflection on a participatory process. The survivor co‐researchers contributed to designing and carrying out the PPI process and have co‐authored this manuscript.

ABSTRACT Background Mental distress is on the rise for young people, and there are high levels of unmet need for support. Increasingly, young people are engaging with online mechanisms of support to avoid cost and wait times; however, online support does have its limitations. We surveyed young people, 15–30 years of age, in Aotearoa New Zealand to explore their views of digital support for mental health. The aim of this study was to find out from young people what they thought about various types of online support and perceived benefits and drawbacks. Methods A cross‐sectional online survey promoted through social media advertising was used. Participants included anyone aged 15–30 years living in Aotearoa New Zealand. The survey ran for 10 weeks between February and May 2022. It included demographic questions and asked about (i) use of digital support for mental health; (ii) what digital support is best used for; (iii) best ways of publicising mental health supports to young people; and (iv) where they would choose to get information about mental health support. Questions were a mix of forced choice and free text. Participants could opt to take part in a follow‐up interview. Results Surveys were completed by 1471 participants; two respondents participated in an interview. A total of 641 participants had used digital support before (44%). The most used forms of digital support were websites (n = 324) and watching videos (n = 260), although these were not necessarily rated as the most helpful. Alternatives that people most wanted to try were podcasts and phone or video consultations with a counsellor or therapist. Drawbacks of digital support included privacy concerns, technical issues, lack of quality and motivation requirements. Benefits included ease of access, anonymity and a non‐threatening starting point. Conclusions Digital support has a place in mental health care, but strong sentiment was expressed in favour of real‐life support. It may also be worth investing in more innovative types of digital support such as online performing arts and podcasts. Patient or Public Contribution A group of young people were recruited as co‐researchers, had input into survey design, data analysis and interpretation and are co‐authors (list of co‐authors). Survey respondents also included young people with lived experience who are members of the general public.

ABSTRACT Objectives The purpose of this study was to engage key stakeholders in a health research priority‐setting process to identify, prioritize and produce a community‐driven list of research questions addressing intersectional issues on mental health and addictions (MHA) in acquired brain injury (ABI). Methods A multiphasic health research priority‐setting process was co‐designed and executed with community‐based stakeholders, including researchers, health professionals, clinicians, service providers, representatives from brain injury associations, policy makers and people with lived experience of ABI and MHA, including patients and their family members. Stakeholders' ideas led to the generation of research questions, which were prioritized at a 1‐day workshop. Results Fifty‐nine stakeholders participated in the priority‐setting activity during the workshop, which resulted in a rank‐ordered list of the top 10 questions for research addressing the intersections of ABI and MHA. Questions identified touched on several pressing issues (e.g., opioid crisis, homelessness), encompassed multiple subtypes of ABI (e.g., hypoxic‐ischaemic, mild traumatic), and involved different domains (e.g., identification, intervention) of health research. Conclusions This community‐driven health research priority‐setting study identified and prioritized research questions addressing the intersections of ABI and MHA. Researchers and funding agencies should use this list to inform their agendas and address stakeholders' most urgent needs, fostering meaningful improvements to clinical services. Patient or Public Contribution An 11‐person working group comprised of people with lived experience, service providers, researchers, healthcare professionals and other key stakeholders collaboratively developed and informed the scope, design, methodology and interpretation of this study. Over 50 community‐based stakeholders contributed to the research priority‐setting activity. One co‐author is a person with lived experience.

Key Clinical Message The use of online search engines to “google” health‐related information is common in health anxiety, and requires careful consideration within psychological treatment. Its nature in older adult populations is less closely understood. This report demonstrates the reduction in googling frequency using cognitive‐behavioral therapy in an 83‐year‐old female with health anxiety.

Abstract Objectives Emergency department (ED) visits resulting from suicidal thoughts and behaviors have increased at alarming rates among youth in the United States in recent years. Understanding trends among specific racial, ethnic, gender, and/or age subgroups can provide the foundation for tailored solutions for those with the greatest need for support. Methods Using data from the Florida State Emergency Department Database from 2016 to 2021, we calculated annual rates of ED suicide‐related diagnoses per 1000 young people aged 8‒21 years. We explored annual trends by age and intersectional race/ethnicity and sex subgroups. Additionally, we examined subgroup‐specific stratified percent changes from 2016 to 2019 and 2016 to 2021. Results Among 8‒12‐year olds, the highest rates of suicide‐related ED encounters occurred among Black males and females and this trend was steady over time. Among 13‒21‐year‐old patients, Black and White females displayed the highest rates of suicide‐related ED encounters across 2016‒2021, and all subgroups experienced a slight decline in 2020 and 2021. Rates generally increased between 2016 and 2019, with the largest percent increase (10.6%) occurring among Black females aged 18‒21 years, whereas there was a trend of decreased rates among most subgroups between 2019 and 2021. Conclusions Across all years and age groups, Black females showed consistently higher rates of suicide‐related ED encounters than almost any other subgroup, supporting previous research that Black adolescent females may be disproportionately suffering from the mental health crisis faced by young people. Furthermore, preteen Black males need additional mental health support, as do adolescent and young adult White females.

Abstract Introduction Peruvian young transgender women (YTW) ages 16−24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older. Methods Between February and July 2022, a cross‐sectional quantitative study with YTW ages 16−24 years in Peru (N = 211) was conducted consisting of a bio‐behavioural survey accompanied by laboratory‐based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio‐demographic and behavioural characteristics and HIV status. Results HIV prevalence was 41.5% (95% CI: 33.9−49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7−28.4), chlamydia 6.3% (95% CI: 3.1−11.1) and gonorrhoea 12.3% (95% CI: 7.9−18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6‐month STI test. More than two‐thirds (67.8%) had not heard of antiretroviral pre‐exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate‐to‐severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse. Conclusions Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma‐related conditions.

Abstract Background and Aims This study aimed to evaluate the factors associated with addictive behavior and mental health in adolescents aged 11–17 years in Bangladesh. Methods This study analyzed data from the Bangladesh Global School‐based Health Survey (GSHS) conducted in 2014. Adolescents aged 11–17 years studying government schools were considered as respondents for this survey. A two‐phase group sample design was utilized to deliver illustrative information of all understudies in grades (classes) 7–10 in Bangladesh. Bivariate analyses followed by a weight‐adjusted multiple logistic regression was fitted to a sample of size 2989 adolescents. Results One in ten and one in four adolescents had different substance addictions and some forms of mental health conditions, respectively. Sex of participants (adjusted odds ratio [AOR]: 4.49; confidence interval [CI]:2.28–8.84), being bullied (AOR: 3.08; CI:1.46–6.49), use of tobacco among parents (AOR: 5.82; CI:3.16–10.75), parental understanding of adolescents' problems (AOR: 0.45; CI:0.23–0.82), and food affordability (AOR: 1.24; CI:1.09–1.42) were associated with addictive behaviors of adolescents. Bullied males with nonempathetic parents were found to be more vulnerable to addictive behaviors and bullied females showed higher tendencies to mental health issues. Conclusion Considering the elevated prevalence of reported mental health concerns, identifying vulnerable groups and formulating intervention‐oriented policies engaging youths can pave the way towards achieving robust health and well‐being for them in Bangladesh.

Background Black patients meeting indications for implantable cardioverter‐defibrillators (ICDs) have lower rates of implantation compared with White patients. There is little understanding of how mental health impacts the decision‐making process among Black patients considering ICDs. Our objective was to assess the association between depressive symptoms and ICD implantation among Black patients with heart failure. Methods and Results This is a secondary analysis of the VIVID (Videos to Address Racial Disparities in ICD Therapy via Innovative Designs) randomized trial, which enrolled self‐identified Black individuals with chronic systolic heart failure. Depressive symptoms were assessed by the Patient Health Questionnaire‐2 and the Mental Component Summary of the 12‐Item Short‐Form Health Survey. Decisional conflict was measured by an adapted Decisional Conflict Scale (DCS). ANCOVA was used to assess differences in Decisional Conflict Scale scores. Multivariable logistic regression was used to examine the association between depressive symptoms and ICD implantation. Among 306 participants, 60 (19.6%) reported depressed mood, and 142 (46.4%) reported anhedonia. Participants with the lowest Mental Component Summary of the 12‐Item Short‐Form Health Survey scores (poorer mental health and higher likelihood of depression) had greater decisional conflict regarding ICD implantation compared with those with the highest Mental Component Summary of the 12‐Item Short‐Form Health Survey scores (adjusted mean difference in Decisional Conflict Scale score, 3.2 [95% CI, 0.5–5.9]). By 90‐day follow‐up, 202 (66.0%) participants underwent ICD implantation. There was no association between either the Patient Health Questionnaire‐2 score or the Mental Component Summary of the 12‐Item Short‐Form Health Survey score and ICD implantation. Conclusions Depressed mood and anhedonia were prevalent among ambulatory Black patients with chronic systolic heart failure considering ICD implantation. The presence of depressive symptoms did not impact the likelihood of ICD implantation in this population.

Abstract Introduction Adolescent girls and young women (AGYW) who may benefit from HIV pre‐exposure prophylaxis (PrEP) face high levels of common mental disorders (e.g. depression, anxiety). Common mental disorders can reduce PrEP adherence and increase HIV risk, yet mental health interventions have not been well‐integrated into PrEP delivery. Methods We conducted a four‐phase human‐centred design process, from December 2020 to April 2022, to understand mental health challenges among AGYW in Johannesburg, South Africa and barriers to integrated mental health and PrEP services. In the “Discover” phase, we conducted in‐depth interviews with AGYW and key informants (KIs) in Johannesburg. We conducted a rapid qualitative analysis, informed by the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers of integrated mental health and PrEP services and mapped barriers to potential implementation strategies. In the “Design” and “Build” phases, we conducted stakeholder workshops to iteratively adapt an evidence‐based mental health intervention, the Friendship Bench, and refine implementation strategies for South African PrEP delivery settings. In the “Test” phase, we piloted our adapted Friendship Bench package. Results Interviews with 70 Discover phase participants (48 AGYW, 22 KIs) revealed the importance of integrated mental health and PrEP services for South African AGYW. Interviewees described barriers and implementation strategies for mental health and PrEP services around the CFIR domains: intervention characteristics (e.g. challenges with AGYW “opening up”); outer Johannesburg setting (e.g. community stigma); inner clinic setting (e.g. judgemental healthcare providers); characteristics of counsellors (e.g. training gaps); and the implementation process (e.g. need for demand creation). The Design and Build workshops included 13 AGYW and 15 KIs. Implementation barriers related to the quality and accessibility of public‐sector clinic services, lay counsellor training, and community education and demand creation activities were prioritized. This led to 12 key Friendship Bench adaptations and the specification of 10 implementation strategies that were acceptable and feasible in initial pilot testing with three AGYW. Conclusions Using a human‐centred approach, we identified determinants and potential solutions for integrating mental health interventions within PrEP services for South African AGYW. This design process centred stakeholders’ perspectives, enabling rapid development of an adapted Friendship Bench intervention implementation package.

Abstract The contribution of companion animals to human mental wellbeing has received an increasing amount of scientific interest. Research findings concerning the nature of this relationship are however mixed. Variability in behavior and characteristics of the animal might explain this heterogeneity. The main aim of the present study is to investigate the association between companion animals and mental wellbeing in daily life and the role that animal characteristics play in this association, using an ecological momentary assessment approach. The sample will comprise of adult owners of a dog and/or a cat. Participants will start with a baseline assessment including demographic characteristics of the owner and the animal, as well as the C‐BARQ or Fe‐BARQ to assess general behavior of the animal. After the baseline assessment, a signal‐contingent scheme with semi‐random intervals will be used to examine human–animal interaction (HAI) in the natural setting of pet‐owners' daily lives. Participants will complete up to ten short assessments per day over the course of 5 days, reporting on the presence of‐, interaction with‐, and behavior of the companion animal. They also report on stressful activities and events, and on their current positive and negative affect. Multilevel regression analysis will be used to investigate the relationship between HAI, animal characteristics and mental wellbeing. With this study we hope to provide insight into the type of animal, behavior of the animal and specific elements of interaction with an animal, and their potential associations with human wellbeing. The knowledge gathered in this study will add to unraveling mechanisms underlying HAI and help to identify in which contexts and under what conditions HAI can have the greatest impact.

Abstract Background Mentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan. Methods We conducted a cross‐sectional study involving postgraduate year 1 and 2 (PGY‐1 and PGY‐2) residents in Japan who took the General Medicine In‐Training Examination (GM‐ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM‐ITE completion. The primary outcome was the Patient Health Questionaire‐2 (PHQ‐2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ‐2 positive. We examined associations between self‐reported mentorship and PHQ‐2 by multi‐level analysis. Results Of 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ‐2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65–0.86). Mentor characteristic significantly associated with negative PHQ‐2 response was a formal mentor (aOR; 0.68; 95% CI 0.55–0.84). Conclusions A mentor‐based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan.

Abstract Introduction High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence‐based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group‐based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. Methods The intervention comprised four weekly in‐person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April−September 2022), with pre‐post surveys plus 3‐month follow‐up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre‐exposure prophylaxis (PrEP)/HIV treatment use. Results Mean age of the 240 participants was 26 years (range 18−42). Seventy‐seven percent self‐identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre‐post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3‐month follow‐up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever‐PrEP use were the same, 75% of immediate‐group participants reported currently using PrEP at 3 months post‐intervention versus 53% of delayed‐group participants right after the intervention (p

Abstract Introduction Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high‐impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, “grey areas,” or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. Discussion A group of IS experts affiliated with NIMH‐funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH‐related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence‐based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. Conclusions HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high‐impact HIV/MH implementation research.

Abstract Across the fields of psychology, neuroscience, and psychiatry, dance—broadly and heterogeneously defined across cultures and movement styles—has been investigated for a range of potential benefits in healthy and clinical populations. There is a growing body of literature investigating the potential for dance, and in particular social forms of dance, to have a positive impact on mental health and well‐being. Given widespread availability through community providers, social dance and movement could be an accessible, non‐invasive, and affordable approach to the prevention and treatment of mood disorders, including depression. However, the existing literature is heterogenous, and there is a lack of methodological cohesiveness and systematization in the field of dance for mental health research. In this narrative review, we propose a novel classification system for social dance mental health research, which encompasses solo dance, partner dance, group dance, dance movement therapy, and cooperative movement. We review the existing literature examining the effects of social dance and movement in the context of low mood and depression and identify future research directions for building a solid evidence base for the application of social dance and movement in the prevention and treatment of mood disorders.

Abstract Caregivers may play an essential role in buffering and/or exacerbating coronavirus disease 2019 (COVID‐19) fears and behaviors in youth. However, few studies have examined these associations in children from racial or ethnic minority groups, who have been historically marginalized and may be disproportionately susceptible to psychological consequences. Here, we examined the associations among caregivers and children in COVID‐19‐related fears, behaviors, and impact in a majority Black (71.9%) sample of children. Children (N = 64, 24 females, ages 7–10 years) were recruited from three Detroit, Michigan‐area schools during the 2019–2020 school year. Following school shutdowns in March 2020, children and their caregivers were invited to complete remote surveys in May and August 2020. We examined the associations among child and caregiver COVID‐19‐related fears, preventive behaviors, and perceived impact. We also examined whether aspects of the caregiver–child relationship (i.e., closeness, conflicts) moderated these associations. Caregiver–child fears about social distancing, preventive behaviors, and the perceived impact of COVID‐19 were positively correlated. The positive correlation between caregiver–child preventive behaviors strengthened over time and was moderated by caregiver–child closeness. These findings suggest that caregivers may impact fear as well as preventive behaviors and perceived impact of the pandemic in marginalized youth.

Abstract Aim The mental healthcare system in Japan is transitioning from institution‐based to community‐based treatment. To prevent prolonged hospitalization and community integration of psychiatric patients, mental health social workers (MHSWs) are pivotal in coordinating post‐discharge arrangements for psychiatric inpatients. This study aimed to propose a care model to improve clinical outcomes in psychiatric emergency wards in Japan. Methods We conducted a mail‐in questionnaire survey targeting medical facilities with psychiatric emergency wards. We collected data of the psychiatric care system, including facility profiles, staffing conditions and caseloads, and the provided psychiatric services and treatment options. Using multiple regression analyses, we explored associations between these data and clinical outcomes, focusing on the average number of days for hospitalization and the integration of patients into a community. Results Data were collected from 82 facilities (response rate, 45.8%). The average number of days for hospitalization and community integration were 64.7 and 327.9 days, respectively. The caseloads for MHSWs were significantly associated with longer hospitalization (β = 0.31, p = 0.009) and shorter duration of community living (β = −0.28, p = 0.027). Conclusion The clinical performance in psychiatric emergency wards surpassed the Japanese government's targets regarding these outcomes. We found that heavy caseloads on MHSWs were associated with worse clinical outcomes for patients in psychiatric emergency wards. These findings suggest that reducing MHSW caseloads (≤20 cases) may be a potential interventional strategy to prevent prolonged hospitalization and promote successful community integration of patients.

Abstract Aim This study investigated the association between COVID‐19 pandemic‐related work environment changes and suspected post‐traumatic stress disorder (PTSD) in Japanese workers. Methods A web survey of 1104 workers was conducted in Japan between February 24 and March 2, 2021. The Japanese version of the Impact of Event Scale–Revised and questions regarding work environments and COVID‐19 pandemic‐related lifestyle changes were used. Results PTSD was suspected in 19.7% of respondents and was significantly higher in men (22.2%) than in women (17.2%). Being older and having an independent business were associated with decreased suspected PTSD risk. Longer online work hours, decreased sleep duration, and alcoholism were associated with increased suspected PTSD risk. When stratified by sex, long online work hours and fewer years of service were associated with increased suspected PTSD risk in men. An association between alcoholism and suspected PTSD was also observed in men. Younger age and decreased sleep duration were significantly associated with suspected PTSD in women. Conclusion Younger men with shorter work service duration were particularly vulnerable to pandemic‐related PTSD, emphasizing the risks associated with long online work hours and alcoholism in men. Decreased sleep duration was a PTSD predictor in both sexes, suggesting its importance in PTSD prevention strategies for workers.

Abstract This is a protocol for a systematic review and meta‐analysis of research on mental health outcomes of abortion. Does abortion increase the risk of adverse mental health outcomes? That is the central question for this review. Our review aims to inform policy and practice by locating, critically appraising, and synthesizing empirical evidence on associations between abortion and subsequent mental health outcomes. Given the controversies surrounding this topic and the complex social, political, legal, and ideological contexts in which research and reviews on abortion are conducted, it is especially important to conduct this systematic review and meta‐analysis with comprehensive, rigorous, unbiased, and transparent methods. We will include a variety of study designs to enhance understanding of studies' methodological strengths and weaknesses and to identify potential explanations for conflicting results. We will follow open science principles, providing access to our methods, measures, and results, and making data available for re‐analysis.

Abstract Background High‐income countries offer social assistance (welfare) programs to help alleviate poverty for people with little or no income. These programs have become increasingly conditional and stringent in recent decades based on the premise that transitioning people from government support to paid work will improve their circumstances. However, many people end up with low‐paying and precarious jobs that may cause more poverty because they lose benefits such as housing subsidies and health and dental insurance, while incurring job‐related expenses. Conditional assistance programs are also expensive to administer and cause stigma. A guaranteed basic income (GBI) has been proposed as a more effective approach for alleviating poverty, and several experiments have been conducted in high‐income countries to investigate whether GBI leads to improved outcomes compared to existing social programs. Objectives The aim of this review was to conduct a synthesis of quantitative evidence on GBI interventions in high‐income countries, to compare the effectiveness of various types of GBI versus “usual care” (including existing social assistance programs) in improving poverty‐related outcomes. Search Methods Searches of 16 academic databases were conducted in May 2022, using both keywords and database‐specific controlled vocabulary, without limits or restrictions on language or date. Sources of gray literature (conference, governmental, and institutional websites) were searched in September 2022. We also searched reference lists of review articles, citations of included articles, and tables of contents of relevant journals in September 2022. Hand searching for recent publications was conducted until December 2022. Selection Criteria We included all quantitative study designs except cross‐sectional (at one timepoint), with or without control groups. We included studies in high income countries with any population and with interventions meeting our criteria for GBI: unconditional, with regular payments in cash (not in‐kind) that were fixed or predictable in amount. Although two primary outcomes of interest were selected a priori (food insecurity, and poverty level assessed using official, national, or international measures), we did not screen studies on the basis of reported outcomes because it was not possible to define all potentially relevant poverty‐related outcomes in advance. Data Collection and Analysis We followed the Campbell Collaboration conduct and reporting guidelines to ensure a rigorous methodology. The risk of bias was assessed across seven domains: confounding, selection, attrition, motivation, implementation, measurement, and analysis/reporting. We conducted meta‐analyses where results could be combined; otherwise, we presented the results in tables. We reported effect estimates as standard mean differences (SMDs) if the included studies reported them or provided sufficient data for us to calculate them. To compare the effects of different types of interventions, we developed a GBI typology based on the characteristics of experimental interventions as well as theoretical conceptualizations of GBI. Eligible poverty‐related outcomes were classified into categories and sub‐categories, to facilitate the synthesis of the individual findings. Because most of the included studies analyzed experiments conducted by other researchers, it was necessary to divide our analysis according to the “experiment” stage (i.e., design, recruitment, intervention, data collection) and the “study” stage (data analysis and reporting of results). Main Results Our searches yielded 24,476 records from databases and 80 from other sources. After screening by title and abstract, the full texts of 294 potentially eligible articles were retrieved and screened, resulting in 27 included studies on 10 experiments. Eight of the experiments were RCTs, one included both an RCT site and a “saturation” site, and one used a repeated cross‐sectional design. The duration ranged from one to 5 years. The control groups in all 10 experiments received “usual care” (i.e., no GBI intervention). The total number of participants was unknown because some of the studies did not report exact sample sizes. Of the studies that did, the smallest had 138 participants and the largest had 8019. The risk of bias assessments found “some concerns” for at least one domain in all 27 studies and “high risk” for at least one domain in 25 studies. The risk of bias was assessed as high in 21 studies due to attrition and in 22 studies due to analysis and reporting bias. To compare the interventions, we developed a classification framework of five GBI types, four of which were implemented in the experiments, and one that is used in new experiments now underway. The included studies reported 176 poverty‐related outcomes, including one pre‐defined primary outcome: food insecurity. The second primary outcome (poverty level assessed using official, national, or international measures) was not reported in any of the included studies. We classified the reported outcomes into seven categories: food insecurity (as a category), economic/material, physical health, psychological/mental health, social, educational, and individual choice/agency. Food insecurity was reported in two studies, both showing improvements (SMD = −0.57, 95% CI: −0.65 to −0.49, and SMD = −0.41, 95% CI: −0.57 to −0.26) which were not pooled because of different study designs. We conducted meta‐analyses on four secondary outcomes that were reported in more than one study: subjective financial well‐being, self‐rated overall physical health, self‐rated life satisfaction, and self‐rated mental distress. Improvements were reported, except for overall physical health or if the intervention was similar to existing social assistance. The results for the remaining 170 outcomes, each reported in only one study, were summarized in tables by category and subcategory. Adverse effects were reported in some studies, but only for specific subgroups of participants, and not consistently, so these results may have been due to chance. Authors' Conclusions The results of the included studies were difficult to synthesize because of the heterogeneity in the reported outcomes. This was due in part to poverty being multidimensional, so outcomes covered various aspects of life (economic, social, psychological, educational, agency, mental and physical health). Evidence from future studies would be easier to assess if outcomes were measured using more common, validated instruments. Based on our analysis of the included studies, a supplemental type of GBI (provided along with existing programs) may be effective in alleviating poverty‐related outcomes. This approach may also be safer than a wholesale reform of existing social assistance approaches, which could have unintended consequences.

Abstract Introduction Symptoms of cancer‐related fatigue (CRF) can have a significant impact on patients' quality of life and treatment adherence. We aimed to investigate the relationship between CRF and multiple psychosocial and somatic indicators within a large mixed cancer sample. Methods In this cross‐sectional study, N = 1787 outpatients with cancer were assessed for CRF, pain, anxiety, and depression using validated screening instruments. We further obtained clinical parameters (Hb, CRP, creatinine, leukocytes, ASAT, and ALAT), sociodemographic data (age, gender, income, education level, marital status, parenthood, and living area), and lifestyle factors. Multivariate linear regression models were applied to estimate the impact of each indicator on CRF. Results Overall, 90.6% of patients experienced some CRF, with 14.8% experiencing severe CRF. No gender difference was found in the prevalence of CRF. Patients with higher levels of pain, depressive symptoms, and lower Hb levels had significantly higher levels of CRF (ps

Abstract Environmental losses are increasingly evoking ‘‘ecological grief’’ among environmental and conservation professionals. Ecological grief is a natural but difficult psychological experience, and a risk to well‐being. Despite this, there are currently few resources available to support environmental professionals and their organizations to reduce the risks to well‐being and cope effectively with ecological grief. As a result, environmental professionals who experience this risk in the workplace are unlikely to be equipped with the knowledge, skills, or context to support themselves, colleagues, or peers, in experiences of ecological grief. In this paper, we provide information, guidance, and examples of workplace support for ecological grief. Drawing on insights from the field of grief and bereavement, we identify peer support and organizational responses as key supportive factors for those experiencing ecological grief. We also present a new concept, ‘‘ecological grief literacy,’’ to guide effective peer and organizational support. While peers have the potential to provide interpersonal support and connection for ecological grieving, it is essential that the organizations that employ environmental professionals enact policies and practices that provide structures, resources, and contexts to enable environmental professionals to effectively support ourselves and each other.

Abstract Background and Aims Inflammatory bowel disease (IBD) is a chronic inflammatory gastrointestinal tract disease subdivided into Crohn's disease (CD) and ulcerative colitis (UC). There is currently no cure for IBD, and individuals with IBD frequently experience a lower health‐related quality of life (HRQOL) than the general population. Gamification has become an increasingly popular topic in recent years. Adapting game design concepts to nongaming contexts represents a novel and potential approach to changing user engagement. This study will be conducted with the aim of evaluating the effect of a gamified mobile‐based self‐management application on disease activity index, quality of life, and mental health in adults with IBD. Methods A multicenter, parallel, two‐arm, exploratory randomized controlled trial with a 6‐month follow‐up per patient will be designed to compare the impact of the gamified mobile‐based tele‐management system on primary and secondary health outcomes and outpatient visits in 210 patients with all types of IBD which are divided equally into a control group with standard care and an intervention group which will use the developed mobile application named MY IBD BUDDY. All patients will attend study visits at baseline, 12 and 24 weeks, and routine IBD clinic visits or telephone consultations based on randomization group assignment. Disease activity or disease activity index, mental health (anxiety and depression) symptoms, quality of life, self‐efficacy, and IBD‐specific knowledge will be measured at baseline with two follow‐ups at 12 and 24 weeks. Conclusions In sum, the outcomes of our trial will demonstrate the impact of the gamified mobile‐based self‐management system on disease activity, quality of life, and anxiety and depression by means of interactive care and patient empowerment. Trial Registration IRCT: IRCT20200613047757N1. Registered November 16, 2021. Prospectively registered and visible at OSF (https://doi.org/10.17605/OSF.IO/AWFY9).

Abstract Background and Aims This article examines the prevalence of burnout among healthcare providers in the aftermath of the recent earthquakes in Syria and Turkey and explores the associated risk factors. Methods This cross‐sectional study included 270 healthcare providers in three Syrian cities damaged by earthquakes. Participants were asked to fill out a validated questionnaire on the fifth day of emergency response using the Geldard Occupational Burnout questionnaire. Results The mean score for the Geldard Occupational Burnout Questionnaire was 129.79, with 81.4% indicating moderate burnout risk and only 3% indicating high risk. Gender was not significantly associated with burnout, but there was a significant difference in burnout scores between city groups, with Latakia scoring significantly lower than Aleppo. Conclusion This study highlights the prevalence of burnout among healthcare providers in the aftermath of an earthquake in Syria, with the majority having a moderate risk of burnout. Gender was not significantly associated with burnout risk. Further research is needed to develop effective interventions and address study limitations. The study emphasizes the importance of prioritizing healthcare providers' mental health to ensure high‐quality care after natural disasters.

Abstract INTRODUCTION Depression is a risk factor and possible prodromal symptom of Alzheimer's disease (AD), but little is known about subsequent risk of developing depression in persons with AD. METHODS National matched cohort study was conducted of all 129,410 persons diagnosed with AD and 390,088 with all‐cause dementia during 1998–2017 in Sweden, and 3,900,880 age‐ and sex‐matched controls without dementia, who had no prior depression. Cox regression was used to compute hazard ratios (HRs) for major depression through 2018. RESULTS Cumulative incidence of major depression was 13% in persons with AD and 3% in controls. Adjusting for sociodemographic factors and comorbidities, risk of major depression was greater than two‐fold higher in women with AD (HR, 2.21; 95% confidence interval [CI], 2.11–2.32) or men with AD (2.68; 2.52–2.85), compared with controls. Similar results were found for all‐cause dementia. DISCUSSION Persons diagnosed with AD or related dementias need close follow‐up for timely detection and treatment of depression. Highlights In a large cohort, women and men with AD had >2‐fold subsequent risk of depression. Risks were highest in the first year (>3‐fold) but remained elevated ≥3 years later. Risk of depression was highest in persons aged ≥85 years at AD diagnosis. Persons with AD need close follow‐up for detection and treatment of depression.

Abstract Aim The aim of this qualitative study was to explore the barriers and facilitators to accessing and receiving mental health care for paid and unpaid carers of older adults. Methods Unpaid and paid carers for older adults in England were interviewed remotely between May and December 2022. Participants were asked about their experiences of mental health needs and support. Reflexive thematic analysis was used to analyse the data. Results Thirty‐seven carers participated (npaid = 9; nunpaid = 28), with the majority caring for a parent with dementia. Thematic analysis generated four themes: lack of healthcare support, social care system failing to enable time off, personal barriers and unsupportive work culture. Healthcare professionals failed to provide any link to mental health services, including when a dementia diagnosis was received. Structural and organisational barriers were evidenced by carers being unable to take time off from their unpaid caring duties or paid caring role, due to an absence of social care support for their relative. Conclusions This is the first study to have explored the barriers to mental health care and support for paid and unpaid carers for older adults and suggests that structural, organisational and personal barriers cause severe difficulties in accessing required support to care for older relatives, services users and residents. Public Involvement Two unpaid carers aided with the development of topic guides, data analysis, interpretation and dissemination. Both were supported and trained to code anonymised transcripts.

Abstract Background Mental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched. Method This study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty‐one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in‐depth interviews. Results The findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after‐hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers. Conclusion The findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning‐making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis. Patient or Consumer Contribution The first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.

Abstract Background This paper aims to explore the impact of recovery education on recovery knowledge, attitudes and the quality of life of students undertaking recovery education, contributing to the evidence base in relation to the impact of recovery education. It also explores the experiences of all stakeholders involved in the co‐facilitation, delivery and participation in recovery education. Setting and Participants This study evaluates the experiences of stakeholders involved in the co‐facilitation, delivery and participation in recovery education across four recovery colleges in Ireland. Participants included students undertaking recovery education, peer educators, education facilitators, recovery college coordinators and practitioner/service providers. Discussion Findings from the quantitative survey when compared with extant literature suggest that students had a good understanding of recovery education. The social aspect of empowerment for growth and wellbeing was identified through themes relating to co‐production and facilitating student learning. Support for equitable access to recovery education, including co‐production for both the public and staff, was identified as a challenge for the future. Conclusion The findings from both the qualitative and quantitative components of the study show the positive impact of recovery education on stakeholders while acknowledging the need for ongoing support for people working in recovery education and the development of services. In particular, there was a high level of recovery knowledge found in students undertaking recovery education. Patient or Public Contribution This study utilised a co‐created study design. From inception a steering group comprising stakeholders (peer educators, recovery education facilitators including past recovery college students and nonpeer staff involved in the co‐production of recovery education) directed the conduct of the evaluation. This steering group participated in an iterative process of information sharing, suggestions for evaluation process and language.

Abstract Context Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice‐related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. Objective and Population Studied Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. Methods A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. Results Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. Conclusions Our findings highlight important gaps in the collaborative practices surrounding the management of mental health‐related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. Patients of Public Contribution This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population.

Abstract Background There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In‐principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. Objectives We conducted a systematic review of quantitative, qualitative and mixed‐method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. Methods Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. Results Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision‐making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health‐related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). Conclusions On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision‐making in the healthcare they offer. Patient or Public Contribution This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision‐making, for the greater involvement of people with mental ill health in their healthcare.

Abstract Background and Aims Mental health problem is a rising public health concern. People of all ages, specially Bangladeshi university students, are more affected by this burden. Thus, the objective of the study was to use tree‐based machine learning (ML) models to identify major risk factors and predict anxiety, depression, and insomnia in university students. Methods A social media‐based cross‐sectional survey was employed for data collection. We used Generalized Anxiety Disorder (GAD‐7), Patient Health Questionnaire (PHQ‐9) and Insomnia Severity Index (ISI‐7) scale for measuring students' anxiety, depression and insomnia problems. The tree‐based supervised decision tree (DT), random forest (RF) and robust eXtreme Gradient Boosting (XGBoost) ML algorithms were used to build the prediction models and their predictive performance was evaluated using confusion matrix and receiver operating characteristic (ROC) curves. Results Of the 1250 students surveyed, 64.7% were male and 35.3% were female. The students' ages ranged from 18 to 26 years old, with an average age of 22.24 years (SD = 1.30). Majority of the students (72.6%) were from rural areas and social media addicted (56.6%). Almost 83.3% of the students had moderate to severe anxiety, 84.7% had moderate to severe depression and 76.5% had moderate to severe insomnia problems. Students' social media addiction, age, academic performance, smoking status, monthly family income and morningness‐eveningness are the main risk factors of anxiety, depression and insomnia. The highest predictive performance was observed from the XGBoost model for anxiety, depression and insomnia. Conclusion The study findings offer valuable insights for stakeholders, families and policymakers enabling a more profound comprehension of the pressing mental health disorders. This understanding can guide the formulation of improved policy strategies, initiatives for mental health promotion, and the development of effective counseling services within university campus. Additionally, our proposed model might play a critical role in diagnosing and predicting mental health problems among Bangladeshi university students and similar settings.

Abstract Aim With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma‐sensitive interactions. Design and Methods This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma‐sensitive practice in the perinatal period. Results Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re‐enacting dynamics of trauma. To be trauma‐sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment. Implications for the Profession and/or Patient Care This paper fills a gap in the translation of theory to practice for trauma‐sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress. Patient or Public Contribution No patient or public contribution.

Abstract Aim While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID‐19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession. Design Secondary data from a cross‐sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling. Methods Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes. Results Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job. Patient or Public Contribution The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study.

Abstract Background Involving consumers in systematic reviews can make them more valuable and help achieve goals around transparency. Systematic reviews are technically complex and training can be needed to enable consumers to engage with them fully. The Cochrane Common Mental Disorders group sought to engage people with lived experience of mental health problems in the Voice of Experience College, three workshops introducing them to systematic review methods and to opportunities to contribute as Cochrane consumers. We aimed to collectively evaluate the College from the perspective of both facilitators and consumers, to critically reflect on the experience, and to identify how the College could be sustained and spread to other review groups. Methods This study was a longitudinal qualitative and collaborative evaluation, structured around normalisation process theory. Both facilitators and consumers were involved in not only providing their perspectives but also reflecting on these together to identify key learning points. Results The workshops were positively evaluated as being engaging and supportive, largely due to the relational skills of the facilitators, and their willingness to engage in joint or two‐way learning. The College suffered from a lack of clarity over the role of consumers after the College itself, with a need for greater communication to check assumptions and clarify expectations. This was not achieved due to pandemic disruptions, which nevertheless demonstrated that resources for involvement were not prioritised as core business during this period. Conclusions Soft skills around communication and support are crucial to effective consumer engagement. Sustaining involvement requires sustained communication and opportunities to reflect together on opportunities and challenges. This requires committed resources to ensure involvement activity is prioritised. This is critical as negative experiences later in the involvement journey can undermine originally positive experiences if contributors are unclear as to what their involvement can lead to. Open discussions about this are necessary to avoid conflicting assumptions. The spread of the approach to other review groups could be achieved by flexibly adapting to group‐specific resources and settings, but maintaining a core focus on collaborative relationships as the key mechanism of engagement. Patient and Public Contribution Public contributors were collaborators throughout the evaluation process and have co‐authored the paper.

Abstract Background Comorbid distress in adolescents and young adults with physical long‐term conditions (LTCs) is common but can be difficult to identify and manage. Self‐directed self‐management interventions to reduce distress and improve wellbeing may be beneficial. It is unknown, however, which intervention characteristics are successful in supporting young people. This rapid review aimed to identify characteristics of self‐directed self‐management interventions that aimed, in whole or part, to address distress, wellbeing or self‐efficacy in this population. Methods A systematic search was conducted for relevant controlled studies in six databases. Data on study settings, population, intervention characteristics, outcome measures, process measures and summary effects were extracted. The risk of bias was assessed using the Cochrane Risk of Bias tool v1, and the strength of evidence was rated (informed by Grading of Recommendations, Assessment, Development and Evaluations). Patient and public involvement members supported the review process, including interpretation of results. The rapid review was registered with PROSPERO (ID: CRD42021285867). Results Fourteen studies were included, all of which were randomised trials. Heterogeneity was identified in the health conditions targeted; type of intervention; outcome measures; duration of intervention and follow‐up. Three had distress, wellbeing or self‐efficacy as their primary outcome. Four modes of delivery were identified across interventions—websites, smartphone applications, text messages and workbooks; and within these, 38 individual components. Six interventions had a significant benefit in mental health, wellbeing or self‐efficacy; however, intervention characteristics were similar for beneficial and non‐beneficial interventions. Conclusions There is a paucity of interventions directly targeting distress and wellbeing in young people with physical LTCs. In those identified, the heterogeneity of interventions and study design makes it difficult to identify which characteristics result in positive outcomes. We propose the need for high‐quality, evidence‐based self‐management interventions for this population; including (1) more detailed reporting of intervention design, content and delivery; (2) robust process evaluation; (3) a core outcome set for measuring mental health and wellbeing for self‐management interventions and (4) consistency in follow up periods. Public Contribution Seven young people with an LTC were involved throughout the rapid review, from the development of the review protocol where they informed the focus and aims, with a central role in the interpretation of findings.

Abstract Introduction Peer supporters are a valuable asset to mental health and support services, but their own mental health needs are often overlooked in research and practice. This study explored peer supporters' perceived challenges of maintaining their mental health and emotional wellbeing and co‐produced training needs. Methods A qualitative approach was used to explore factors affecting peer supporters' mental health and emotional wellbeing. Semi‐structured interviews and focus groups were conducted online with 11 peer supporters across North East England. Results A thematic analysis identified: ‘Lack of training and support’, ‘Role ambiguity’ and ‘Emotional labour’ as challenges experienced by peer supporters in relation to maintaining their mental health and emotional wellbeing. Peer supporters' own lived experiences had the potential to act as a barrier towards providing support to others. Conflict with peer ‘supportees’ sometimes negatively impacted on the peer supporter experience. Participant responses emphasised a need for person‐centred, co‐produced training. Conclusion This work highlights the need for targeted training for peer supporters, including both role‐specific education and strategies to support their mental health and emotional wellbeing. Patient or Public Contribution Participants were contacted and asked to provide feedback on finalised themes to ensure the analysis was congruent with their experiences, further enabling the future development of an emotional wellbeing training programme for peer supporters.

Abstract Introduction Although youth‐friendly service characteristics have been previously identified, consensus among a representative group of stakeholders about which of these characteristics are truly relevant to the youth‐friendliness of services is currently lacking. In our study, young adults, parents and professionals were consulted on this topic to reveal existing (dis)agreement. In addition, (dis)agreement on feasibility for implementation in clinical practice was also assessed. Methods A mixed‐method Delphi approach was used with three online questionnaire rounds and a physical meeting. Young adults (18–26 years) and parents were part of a public panel and professionals were allocated to the professional panel. In the rounds, participants were asked to rate the importance and feasibility of each item. Subsequently, the percentage agreement (% of participants giving a score of 7 or above on a 9‐point Likert scale) within and across panels was calculated. Consensus was assumed to have been reached when at least 70% agreement was achieved. A thematic analysis of the qualitative data, obtained in the rounds and the physical meeting, was performed to identify overarching themes and characteristics of relevance to the youth‐friendliness of services. Results For 65% of the items included in the Delphi questionnaire, consensus on importance was reached within both panels. Participants showed more insecurity about the feasibility of these items, however. Our thematic analysis revealed reasons for disagreement between and within the panels. Conclusions Our study revealed substantial between‐ and within‐panel agreement on youth‐friendly service characteristics. We recommend that the items for which consensus was reached should be used as a checklist in terms of youth mental health service development, design and delivery. The characteristics for which there was disagreement between and within the panels should inspire an ongoing trialogue between young adults, parents and professionals both on the individual level and the service level. Patient or Public Contribution In this study, (parents of) young adults with lived experience were included as experts, including one of the coauthors. This coauthor contributed to the manuscript by having a final say about the included quotes.

Abstract Background The recovery‐oriented care approach in mental health is recognised as the vision for mental health. People with a diagnosis of mental illness value the support and the individualistic approach emphasised in the recovery‐oriented mental health care approach as they believe it facilitates their recovery. However, as a developing country, Botswana has a long way to go in availing mental health care resources to people with mental illness, let alone adopting new mental health approaches such as recovery. Aim The study aimed to explore the perceptions of nurses working in mental health care facilities of recovery‐oriented mental health care. Methods Four mental health facilities from Botswana consented to participate in the study. A descriptive qualitative approach was utilised to explore nurses' views on how they perceive recovery from mental illness. Thirty nurses participated in the focus group discussions across the four study sites. All participants consented to participate and to be recorded. Tesch's (in Qualitative enquiry and research design: Choosing among five approaches. 3th ed. SAGE, 2013:198) thematic analysis was used for this study. Results Three main themes were identified in participants' perceptions of recovery‐oriented care mental health: Recovery from mental illness is possible, the Meaning of recovery from mental illness and Factors facilitating recovery from mental illness. Public Contribution The study offers a perspective into how nurses perceive recovery‐oriented approaches from a developing country and add to the gap existing in recovery‐oriented mental health care approach from the African context.

Abstract Four decades of research on the health effects of ‘connection to nature’ identifies many wellbeing advantages for young people. Yet this literature has developed largely without reference to biophysical evidence about mass biodiversity loss, the degradation of marine environments and climate change. As these interlocking planetary crises progress, children will be more likely to witness the marine environments they learn about degrade or disappear as they grow up. Improving ocean literacy is important to protect marine environments into the future. However little is known about how learning about ocean degradation affects young people's emotional wellbeing. We undertook qualitative research to investigate how ocean literacy educators in Aotearoa New Zealand view the content they deliver in relation to the emotional wellbeing of young people. Semi‐structured interviews were conducted with 21 key informants from non‐government organisations (NGOs), Ministry of Education funded programmes, university‐community partnerships, youth‐led initiatives and local and national museums and aquariums. Transcripts were analysed using the six steps of Braun and Clarke's (2022) reflexive thematic analysis. Ocean literacy education was described as positively affecting young people's emotional wellbeing through interactive experiences in coastal environments. These provided opportunities for experiencing wonder, curiosity and a shared sense of connection and belonging. Educators reported witnessing distress and overwhelm in young people when some information was delivered. This resulted in educators ‘not focusing on the negative’ and moving straight to solutions young people could take part in. Our findings provide opportunities for re‐imagining ocean literacy education as a space for promoting mental wellbeing, especially when young people have the opportunity to be part of collective experiences that promote joy and wonder. Intergenerational solutions where young people can be supported to take action with adults who work in solidarity with them are also recommended. Further research into how educators can be resourced to acknowledge and facilitate support around young people's negative emotional responses (such as grief, overwhelm and anxiety) is required. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Engaging people with lived experience of mental health system encounters in the design and actualization of continuing professional development initiatives for mental health professionals can have transformative systemic impacts. Yet, despite evidence that involving people with lived experience benefits mental health professional education, far less focus has been placed on how to engage people with lived experience in continuing professional development initiatives. Tensions persist regarding the role of lived experience perspectives in continuing professional development, as well as how to establish people with lived experience as partners, educators and leaders in a thoughtful way. We propose that meaningful and equitable partnerships with people with lived experience can be realized by engaging in critical reflexivity and by systematically challenging assumptions. This paper explores three topics: (1) the current state of engagement with people with lived experience in continuing professional development initiatives; (2) barriers to meaningful engagement and (3) recommendations for using critical reflexivity to support the involvement and leadership of people with lived experience in continuing professional development for mental health professionals. Patient or Public Involvement This viewpoint manuscript was co‐designed and co‐written by people with diverse lived and learned experiences. Each author's professional roles involve meaningfully and equitably partnering with and centring the perspectives of those with lived experience of mental health system encounters. In addition, approximately half of the authorship team identifies as having lived experience of accessing the psychiatric system and/or supporting family members who are navigating challenges related to mental health. These lived and learned experiences informed the conception and writing of this article.

Abstract Background There is growing evidence demonstrating the impact of engaging people with lived experience (PWLE) in health research. However, it remains unclear what evidence is available regarding the impact of engagement specific to mental health and substance use research. Methods A scoping review of three databases and thematic analysis were conducted. Sixty‐one articles that described the impact of engagement in mental health and substance use research on either individual experiences or the research process were included. Results Key topics include (a) the impact of engagement on individual experiences; (b) the impact of engagement on the research process; and (c) facilitators and barriers to impactful engagement. Studies largely focused on the perceived positive impact of engagement on PWLE (e.g., personal and professional growth, empowering and rewarding experience, feeling heard and valued), researchers (e.g., rewarding experience, deeper understanding of research topic, changes to practice), and study participants (e.g., added value, fostered a safe space). Engagement activities were perceived to improve facets of the research process, such as improvements to research quality (e.g., rigour, trustworthiness, relevance to the community), research components (e.g., recruitment), and the research environment (e.g., shifted power dynamics). Facilitators and barriers were mapped onto the lived experience, researcher, team, and institutional levels. Commonly used terminologies for engagement and PWLE were discussed. Conclusion Engaging PWLE—from consultation to co‐creation throughout the research cycle—is perceived as having a positive impact on both the research process and individual experiences. Future research is needed to bring consistency to engagement, leverage the facilitators to engagement, and address the barriers, and in turn generate research findings that have value not only to the scientific community, but also to the people impacted by the science. Patient or Public Contribution PWLE were engaged throughout the scoping review process, including the screening phase, analysis phase, and write‐up phase.

Abstract Introduction Approximately 20% of people with a long‐term condition (LTC) experience depressive symptoms (subthreshold depression [SUBD]). People with SUBD experience depressive symptoms that do not meet the diagnostic criteria for major depressive disorder. However, there is currently no targeted psychological support for people with LTCs also experiencing SUBD. Online peer support is accessible, inexpensive and scalable, and might offer a way of bridging the gap in psychosocial care for LTC patients. This article explores the psychosocial needs of people living with LTCs and investigates their perspectives on online peer support interventions to inform their future design. Methods Through a co‐produced participatory approach, online focus groups were completed with people with lived experience of LTCs. Focus groups were audio recorded and transcribed verbatim. Reflexive thematic analysis (TA) was conducted adopting a critical‐realist approach and an inductive analysis methodology that sought to follow participants' priorities and concerns. Results Ten people with a range of LTCs participated across three online focus groups, lasting an average of 95 (±10.1) min. The mean age was 57 (±11.4) years and 60% of participants identified as female. The three key emerging themes were: (1) relationship between self and outside world; (2) past experiences of peer support; and (3) philosophy and vision of peer support. Adults living with LTCs shared their past experiences of peer support and explored their perspectives on how future online peer support platforms may support their psychosocial needs. Conclusion Despite the negative impact(s) of having a long‐term physical health condition on mental health, physical and mental healthcare are often treated as separate entities. The need for an integrated approach for people with LTCs was clear. Implementation of online peer support to bridge this gap was supported, but there was a clear consensus that these interventions need to be co‐produced and carefully designed to ensure they feel safe and not commercialised or prescriptive. Shared explorations of the potential benefits and concerns of these online spaces can shape the philosophy and vision of future platforms. Patient or Public Contribution This work is set within a wider project which is developing an online peer support platform for those living with LTCs. A participatory, co‐produced approach is integral to this work. The initial vision was steered by the experiences of our Patient and Public Involvement (PPI) groups, who emphasised the therapeutic value of peer‐to‐peer interaction. The focus groups confirmed the importance and potential benefit of this project. This paper represents the perspectives of PPI members who collaborate on research and public engagement at the mental–physical interface. A separate, independent Research Advisory Group (RAG), formed of members also living with LTCs, co‐produced study documents, topic guides, and informed key decision‐making processes. Finally, our co‐investigator with lived experience (E. A.F.) undertook the analysis and write‐up alongside colleagues, further strengthening the interpretation and resonance of our work. She shares first joint authorship, and as a core member of the research team, ensures that the conduct of the study is firmly grounded in the experience of people living with LTCs.