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K-12 schools are a major sector for efforts to prevent and treat student mental health problems. In the United States, these efforts have led to the emergence of the MultiTiered System of Supports (MTSS) universal prevention, early intervention, and treatment policy framework. With a major focus on behavioral and mental health, MTSS has been adopted by all fifty state education departments. However, multi-level complexities of addressing student mental health within and across organizational structures complicate MTSS and broader policy development, implementation, and evaluation; disconnects between policy writers and practitioners obstruct progress, limiting positive outcomes. To bridge these policy-to-practice gaps, a multi-component solution is needed. The authors propose integrating the following elements: the Massachusetts School Mental Health Consortium's Five Guiding Principles for Building a Coordinated School Mental Health System, the comprehensive school improvement methodology Evolutionary Systems Improvement (ESI); and the ontological framework of BioPsychoSocioTechnical Systems Theory (BPST). Individual application of these components has already yielded systems-level improvements outperforming compliance-driven procedures. Used together, these components offer a multi-level solution for establishing conceptually-guided, measurement-based loops that transcend the restrictions of uninformed policy, supporting stakeholders as they work to systematically eliminate barriers and improve student mental health. [ABSTRACT FROM AUTHOR]

Background: Mental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany. Methods: Using data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18–79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity. Results: Means of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups. Conclusions: Both versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health. [ABSTRACT FROM AUTHOR]

Abstract Background Mental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany. Methods Using data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18–79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity. Results Means of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups. Conclusions Both versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health.

This study aims to expand the understanding of mental health, its importance, and the promotion of mental health services within barangays in the Philippines. 16 barangay healthcare workers in Bacoor City participated in a questionnaire survey, with five individuals undergoing follow-up interviews. The researcher used a self-made 5-point Likert-scale to measure the level and relationship of accessibility, awareness, and applicability of mental health services. The findings of this study revealed a significant positive correlation among the key factors of applicability, awareness, and accessibility of mental health services. This correlation underscores the potential for substantial enhancements in mental health services through targeted interventions. [ABSTRACT FROM AUTHOR]

Abstract Background Mersey Care NHS Foundation Trust’s Life Rooms initiative is an established and successful model of integrating arts and culture within NHS provision. In the face of COVID-19, the Life Rooms was restructured to provide a full suite of online resources. Following the lifting of restrictions, in-person arts provision returned to the Life Rooms sites. Additional evidence in respect of the impact on mental health and wellbeing of the return to in-person arts and cultural activities provided by the Life Rooms, as well as the relative merits of online and in-person arts and cultural activities, is needed to inform future planning around in-person, online, and/or hybrid provision. Methods Interviews with practitioners delivering cultural and creative courses at the Life Rooms (n = 8) and users of the Life Rooms (n = 5) were conducted to explore the impact of the return to in-person arts provision at the Life Rooms, as well as the merits of online and in-person arts provision. Data were analysed using thematic analysis. Results Three overarching themes were identified: ‘Provision, access, and reach’; ‘Value of arts and creativity’; and ‘Challenges with the Life Rooms model in the new normal’. The findings demonstrate the critical role of arts and cultural provision in providing stigma-free environments to reconnect the vulnerable and isolated. As re-engagement remained slow, there is a need to be responsive to hesitation around re-engaging in-person. The Life Rooms online learning offer remained vital for those who are vulnerable or otherwise unable to access in-person activities. Conclusions As our findings show a demand for maintaining online provision that enables accessibility together with in-person provision that boosts community connectedness, ensuring continued online access alongside in-person delivery should be prioritised. As mental health demands could continue to grow in coming years as the pandemic evolves, in-person arts engagement could have an important role in meeting mental health needs.

AbstractAfter the reform of mental health care system approved in 1978, the structure and organization of Italian mental health care has represented an innovative model of care, shifting from the asylum-based system to the community-based model, with the gradual closure of all mental hospitals. According to the 2023 Mental Health Report, issued every year by the Italian Ministry of Health, more than 700.000 Italian people is suffering from severe mental disorders. The burden on mental health services is highly demanding, with an estimate of more than 9 million of health services provided to patients. With the shift to community-based care, the responsibility for healthcare was moved to regional level. Therefore, a significant heterogeneity and variation in the provision of care has been observed, which is still one of main reasons for concern. In this review we aim to provide an overview on the quality of care in Italy, highlighting the main benefits of the mental healthcare system as well as limitations and pitfalls. [ABSTRACT FROM AUTHOR]

Scientific literature has revealed that there are gender differences in aspects related to mental health. These differences are especially evident in the higher prevalence of emotional disorders (EDs) in women, the greater severity of some clinical variables and symptoms and, also, in the response to psychological treatment. The Unified Protocol (UP) is a transdiagnostic treatment specially designed to address EDs with growing evidence about its cost-effectiveness. The aim of this study is to analyze gender differences in clinical variables and the response to UP treatment applied in a group format. The sample consisted of 277 users (78.3% women) of the Spanish specialized public mental health system, all of them with a diagnosis of EDs. Depressive and anxiety symptomatology, neuroticism, extraversion, interference and quality of life were assessed at baseline, post-treatment, and at 3-, 6- and 12-month follow-ups. We found a statistically significant differences between men and women in severity of depressive and anxious symptomatology, with women presenting the highest scores at the beginning of the treatment. After the intervention, these differences were reduced until no statistically significant differences were found in any of the variables over the 12-month follow-up. The results of this study support the creation of gender-heterogeneous UP groups in the public mental health system for the transdiagnostic treatment of people with EDs. Trial NCT03064477 (March 10, 2017). [ABSTRACT FROM AUTHOR]

Purpose: The Warwick-Edinburgh Mental Well-Being Scale represents an internationally established inventory to assess population mental well-being. Particularly the short form (SWEMWBS) is recommended for use in Mental Health Surveillance. In the present study, we present normative data of the SWEMWBS for the German adult population. Methods: Data from the telephone survey German Health Update (GEDA) in 2022 representative of the German adult population (48.9% women, 18–98 years) was processed to estimate SWEMWBS percentile norm values, T-values, z-values and internationally comparable logit-transformed raw scores for the total sample (N = 5,606) as well as stratified by sex, age group and sex with age group combinations. Results: The average mental well-being was comparable to that of other European countries at M = 27.3 (SD = 4.0; logit-transformed: M = 24.79, SD = 3.73). To provide a benchmark, the cut off for low well-being was set at the 15th percentile (raw score: 23; logit-transformed: 20.73), for high well-being at the 85th percentile (raw score: 32; logit-transformed: 29.31). Conclusion: The present study provides SWEMWBS norm values for the German adult population. The normative data can be used for national and international comparisons on a population level to initiate, plan and evaluate mental well-being promotion and prevention measures. [ABSTRACT FROM AUTHOR]

Recent studies showed that the ICD-11 C-PTSD is associated with considerable individual and social consequences. This study focused on the persistence and psychological predictors of C-PTSD. We analyzed longitudinal survey data from a sample of Hong Kong adults (N = 230) with an interval of approximately six months. Participants completed standardized self-report measures of C-PTSD and various psychological factors (including self-criticism, self-compassion, ruminative response, event centrality, and experiential avoidance) at both timepoints. Over 80% of participants with probable C-PTSD at baseline remained to meet the criteria for PTSD/C-PTSD at follow-up, while over 50% of participants with probable PTSD at baseline remitted at follow-up. Participants with probable C-PTSD were characterized by greater use of mental health services at both timepoints. Additionally, hierarchical multiple regression showed that, among a variety of psychological factors, experiential avoidance was the only significant predictor of PTSD (β = 0.271, p =.001) and disturbances in self-organization (DSO) (β = 0.200, p =.011) symptoms, after controlling for baseline symptom severity and treatment usage. This study shows that C-PTSD persists over time and its symptoms are predicted by experiential avoidance. More efforts are needed to prevent and address C-PTSD in the community. We also offer insights into the management of trauma-related disorders. [ABSTRACT FROM AUTHOR]

Background: Mersey Care NHS Foundation Trust's Life Rooms initiative is an established and successful model of integrating arts and culture within NHS provision. In the face of COVID-19, the Life Rooms was restructured to provide a full suite of online resources. Following the lifting of restrictions, in-person arts provision returned to the Life Rooms sites. Additional evidence in respect of the impact on mental health and wellbeing of the return to in-person arts and cultural activities provided by the Life Rooms, as well as the relative merits of online and in-person arts and cultural activities, is needed to inform future planning around in-person, online, and/or hybrid provision. Methods: Interviews with practitioners delivering cultural and creative courses at the Life Rooms (n = 8) and users of the Life Rooms (n = 5) were conducted to explore the impact of the return to in-person arts provision at the Life Rooms, as well as the merits of online and in-person arts provision. Data were analysed using thematic analysis. Results: Three overarching themes were identified: 'Provision, access, and reach'; 'Value of arts and creativity'; and 'Challenges with the Life Rooms model in the new normal'. The findings demonstrate the critical role of arts and cultural provision in providing stigma-free environments to reconnect the vulnerable and isolated. As re-engagement remained slow, there is a need to be responsive to hesitation around re-engaging in-person. The Life Rooms online learning offer remained vital for those who are vulnerable or otherwise unable to access in-person activities. Conclusions: As our findings show a demand for maintaining online provision that enables accessibility together with in-person provision that boosts community connectedness, ensuring continued online access alongside in-person delivery should be prioritised. As mental health demands could continue to grow in coming years as the pandemic evolves, in-person arts engagement could have an important role in meeting mental health needs. [ABSTRACT FROM AUTHOR]

There is an empirical association between stress and symptoms of food addiction (FA), but it is still not clear which domains of stress are the most relevant when it comes to FA, limiting the ability of researchers and practitioners to address problematic eating‐related health outcomes. In order to address this gap in the literature, we analysed how different domains of chronic stress are related to FA. We used data from a subsample of the LIFE‐Adult‐Study (N = 1172), a German cohort study. We conducted a linear regression analysis with stress domains (Trier Inventory for Chronic Stress, TICS) as predictors of FA (Yale Food Addiction Scale, YFAS). In the second regression analysis we included sociodemographic variables, personality, and smoking as control variables. There was a significant and positive association between Social Overload, Work Discontent, Excessive Demands from Work, and Chronic Worrying and FA. After adding control variables, only Social Overload, Excessive Demands from Work, and Chronic Worrying remained significant predictors. Connections between stress domains and FA can serve as starting points for the development of meaningful interventions that support individuals self‐care strategies (Social Overload), complexity management (Excessive Demands from Work), and coping with negative emotions (Chronic Worrying). [ABSTRACT FROM AUTHOR]

The prevalence of depression related to precarious employment (PE) has become a significant public health concern, given the declining trend of the standard employment relationship. Research has focused on the mental health detrimental effects of employment conditions, whereas there is scarce evidence concerning the burden of depression that could be prevented by targeting precariousness. This paper estimates the impact of PE on the risk of depression and the attributable fraction within the active and working salaried population in Spain. Observational cross-sectional on data drawn from the Spanish portion of European Health Survey 2020. After applying selection criteria and descriptives, binary logistic regression models stratified by sex are used to examine the associations between a 9-categories combination of employment precariousness and occupational social class, and depressive symptoms. There is a higher risk of depression among individuals in PE and among those who are unemployed, with a notable gradient based on occupational social class for women. Adjusting by sex, age and foreign-born origin, we estimate that approximately 15.0% (95% confidence interval [CI]: 1.0%–26.2%) of depression cases among the working population and 33.3% (95% CI: 23.2%-43.2) among the active population can be attributed to PE. These findings highlight the public health impact of PE on mental health, provide evidence to estimate the economic burden linked to employment-related mental health, and underscore the need for policy changes and interventions at the level of labour markets and workplaces to mitigate the detrimental effects of PE. [ABSTRACT FROM AUTHOR]

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health. [ABSTRACT FROM AUTHOR]

Background: The age of onset (AOO), incidence and cumulative incidence of mental disorders are critical epidemiological measures, providing essential insights into the development and course of these disorders across the lifespan. This study aims to provide up‐to‐date estimates of the AOO, age‐specific incidence, and cumulative incidence for a comprehensive range of mental disorders using data from Danish registers. Methods: We conducted a follow‐up study encompassing all Danish residents from January 1, 2004, to December 31, 2021, totaling 91,613,465 person‐years. Data were sourced from the Danish Psychiatric Central Research Register, identifying individuals treated for various mental disorders in psychiatric hospitals, outpatient departments, and accident/emergency departments, that is, treated in secondary care settings. We investigated specific categories of mental disorders, including substance abuse disorders, schizophrenia, mood disorders, anxiety, eating disorders, borderline personality disorders, intellectual disabilities, pervasive developmental disorders, and behavioral and emotional disorders. Age‐sex‐specific incidence rates were estimated using Poisson generalized linear models, and cumulative incidence was calculated using Aalen–Johansen's competing risks model. The study provides estimates of AOO, incidence, and cumulative incidence for various mental disorders, including their age and sex distributions. Results: The cumulative incidence by age 80 years for any mental disorder was 30.72% (95% confidence interval: 30.62%–30.83%) for males and 34.46% (34.35%–34.57%) for females. The most common types of mental disorders were anxiety‐related disorders 16.27% (16.19%–16.36%) for males and 23.39% (23.29%–23.50%) for females, and followed by mood disorder 10.34% (10.27%–10.41%) for males and 16.67% (16.58%–16.77%) for females. For those who develop mental disorder, half will have developed their disorder by approximately age 22 years (median and interquartile range: males 21.37 (11.85–36.00); females 22.55 (16.31–36.08)). Conclusions: Approximately one in three individuals will seek treatment for at least one mental disorder in a secondary care setting by age 80. Given that half of these individuals develop mental disorders before age 22, it is crucial to tailor service planning to meet the specific needs of young individuals. Web‐based interactive data‐visualization tools are provided for clinical utility. [ABSTRACT FROM AUTHOR]

Most Mexicans do not trust the water provided by the public network to be healthy enough to drink. This has made Mexico a key consumer of bottled water worldwide. Besides the inadequate quality of water and health concerns, there are other studied reasons for promoting bottled water usage among Mexicans, such as debilitated regulatory frameworks and the power of multinational corporations. Therefore, an argument arises of how much the Mexicans' distrust of the public water network is based on the actual quality of water. This article contributes to this argument by analyzing national household survey data. The association between the two dominant types of drinking water (containers/bottles and public tap water) and mental health conditions (remembering difficulty, depression, and nervousness) are studied in Chihuahua and Nuevo León states, where the usage rates of the two water types are the closest (to minimize biased results). Our results illustrate different conditions for the states demonstrating that, considering mental health conditions, not trusting the quality of public network water in all Mexican regions may not be appropriate. Nevertheless, there might be rightful health concerns in some regions. The outcomes are helpful for authorities to prioritize policies to address water quality management/education actions. [ABSTRACT FROM AUTHOR]

Recent studies have documented that post-traumatic stress disorder (PTSD) symptoms are robustly associated with depressive symptoms and may mediate the relationship between trauma exposure and depressive symptoms. However, no study has explored the differential mediating effects of four specific PTSD symptom clusters. This study made the first attempt to examine the mediating effects of different PTSD symptom clusters on the linkage between trauma exposure and depressive symptoms. We analyzed data from two large samples of Chinese middle school students (N = 693 and 957) who had experienced the 2013 Ya'an earthquake. Participants completed standardized measures of trauma exposure, PTSD symptoms, and depressive symptoms. The prevalence of probable PTSD was 3.4% and 3.6%, respectively, in the two samples. Mediation analyses revealed that negative alterations in cognitions and mood and alterations in arousal and reactivity were statistically significant mediators in the relationship between trauma exposure during the earthquake and depressive symptoms. The results are very consistent in both samples. The findings suggest that symptom-specific tailored management of these two specific PTSD symptom clusters might have the potential to change the trajectory of developing depressive symptoms among trauma-exposed populations.

Background: The pandemic of coronavirus disease 2019 (COVID-19) is an immense public mental health threat. Asia has a great mix of rural and urban populations which differ in health-care facilities. Its virulence is escalating the psychological impact but its epidemiological dynamics are still needed to be explored. Therefore, we explored the prevalence of COVID-19 and its impact on public mental health in rural versus urban adults aged 18–65 years in the province of Sindh, Pakistan. Materials and Methods: A cross-sectional survey was conducted in Sindh, Pakistan, from April to July 2021. Stratified random sampling was used for 1494 respondents. Seven rural and urban districts were chosen. After informed consent, information on demographics, depression, and anxiety was collected through structured questionnaires. Statistical analyses were performed by SPSS version 26 with mean ± standard deviation for continuous and frequency (percentages) for categorical variables. t-test and Chi-square test were applied at P ≤ 0.05. Results: The prevalence of COVID-19 was found to be 20.9% in Sindh, Pakistan. Among 1494 respondents, the rural–urban distribution was 757 (50.7%) and 737 (49.3%) with females on the slightly higher side (774 [51.9%]). There was a statistically significant difference in age, household members, earning members, gender, marital status, and occupation. Prevalence of depression and anxiety was 42.2% and 85.5%, respectively. Both were statistically significant for rural–urban populations with P < 0.001 for depression and P = 0.003 for anxiety. Conclusion: The study showed a significant difference in the public mental health of the equitable rural versus urban population of Sindh, Pakistan, during the COVID-19 pandemic, which requires strategies by policymakers.

Abstract Background Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. Methodology A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. Results A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. Conclusion High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research.

Introduction: Mind Space is an experiential mental health exhibition in Hong Kong, aiming to raise public awareness and provide education regarding mental health. This prepost study aimed to 1) examine the relationships between visitors' characteristics and their mental health stigma at baseline, and 2) provide a preliminary evaluation of the effectiveness of Mind Space in reducing stigma and promoting help-seeking attitudes toward mental health conditions. Methods: We analyzed data from all consenting visitors who attended Mind Space between September 2019 and December 2021. Visitors' attitudes toward mental health conditions and their willingness to seek professional psychological help were measured through online questionnaires before and after visits. Multiple linear regression was used to identify the demographic predictors of outcome variables at baseline. Changes in outcome variables after attending Mind Space were assessed using paired sample t-tests. Results: A total of 382 visitors completed the baseline questionnaires, among which 146 also completed the post-test. At baseline, higher socioeconomic levels and personal contact with people with mental health conditions predicted more positive attitudes and understanding toward mental disorders. Tentatively, the results also showed that after attending Mind Space, a significant reduction in negative attitudes about mental illness (t=4.36, p=<.001; d=.361) and improvements in the propensity to seek professional help (t=-5.20, p<.001; d=-.430) were observed, along with decreases in negative attitudes toward stereotypes (t=4.71, p=<.001; d=.421) and restrictions (t=2.29, p=.024; d=.205) among healthcare professionals. Discussion: Our findings highlight the need for mental health education for people with lower socioeconomic status and the importance of direct contact in public mental health education initiatives. The present study also suggests that Mind Space may be a useful model for public mental health education, but the exhibition requires further evaluation to ascertain if any reductions in stigma are maintained over time. [ABSTRACT FROM AUTHOR]

In Italy, despite strong community-based mental health services, needs assessment is unsatisfactory. Using the Mental Health Clustering Tool (MHCT) we adopted a multidimensional and non-diagnosis dependent approach to assign mental health services users with similar needs to groups corresponding to resources required for effective care. We tested the MHCT in nine Departments of Mental Health in four Italian regions. After a brief training, 318 professionals assessed 12,938 cases with a diagnosis of schizophrenia, depression, bipolar disorder and personality disorder through the MHCT. 53% of cases were 40–59 years, half were females, 51% had a diagnosis of schizophrenia, 48% of cases were clinically severe. Clusters included different levels of clinical severity and diagnostic groups. The largest cluster was 11 (ongoing recurrent psychosis), with 18.9% of the sample, followed by cluster 3 (non-psychotic disorders of moderate severity). The MHCT could capture a variety of problems of people with mental disorders beyond the traditional psychiatric assessment, therefore depicting service population from a different standpoint. Following a brief training, MHCT assessment proved to be feasible. The automatic allocation of cases made the attribution to clusters easy and acceptable by professionals. To what extent clustering provide a sound base for care planning will be the matter of further research. [ABSTRACT FROM AUTHOR]

Background: Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. Methodology: A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. Results: A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. Conclusion: High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research. [ABSTRACT FROM AUTHOR]

Studies show a connection between anxiety and stress, but with little differentiation between different domains of stress. In this article, we utilize a multi-dimensional approach to better understand the relationship between different chronic stress domains and anxiety. This will allow researchers to identify and address those areas of stress that are most relevant with regard to anxiety. We used data from a sub sample of the LIFE-Adult-Study (n = 1085) to analyze the association between nine different areas of chronic stress (Trier Inventory for Chronic Stress, TICS) and anxiety (General Anxiety Disorder 7, GAD-7), controlling for sociodemographic variables, personality, and social support. There was a significant and positive association between Work Overload, Pressure to Perform, Social Tensions, Social Isolation, Chronic Worrying, and anxiety. After including the control variables, only Work Overload and Chronic Worrying remained significant. By focusing on Work Overload and Chronic Worrying researchers, practitioners, and policy makers can help to mitigate anxiety and related health problems in the population in an efficient way. [ABSTRACT FROM AUTHOR]