International Journal of Social Psychiatry

This contribution advances claims about ‘geopsychiatry from below’, attending to how ‘voices’ with lived experience of mental ill-health speak about ‘the geo’ or, more specifically, ‘place and space’.

To explore relevant interdisciplinary literature for academic research, scholarship and commentary containing voices of experience speaking about the geo.

An ‘indicative’ and ‘facilitative’ review of relevant transdisciplinary literature in arts and humanities and social science, alongside an exploratory workshop where materials are analysed and relationships detected and, provisionally, mapped.

The literature review discloses no coherent body of studies into the geo from below, but rather a fragmented amalgam of materials—field observations, primary quotes and occasional elaborations—that are rarely the direct focus of inquiry (except in some contributions by academic geographers). Combining the literature review and the workshop analysis, an outline series of prompts are developed for relating ‘Kinds of Places’, their associated ‘Affective Qualities’ and actual spaces and places on the ground.

This study signals what a geopsychiatry from below might entail, providing important foundations for future transdisciplinary work on ‘the geo’ and mental (ill-)health.

Gender disparity in mental health treatment has been a longstanding concern in healthcare. Women, who are disproportionately diagnosed with anxiety and depression, often receive more psychotropic medication than men.

This study investigates gender disparity in the treatment of anxiety and depression, aiming to uncover the intersection of medical and social factors and their influence on psychiatric care.

A systematic review methodology following PRISMA guidelines was performed. Literature searches were conducted on PubMed and Web of Science, including observational studies and excluding qualitative studies, which resulted in the screening of eight studies for an in-depth analysis which included meta-analysis. The GRADE approach was considered to address risk of bias.

The findings of this review reveal a clear gender disparity in the treatment of anxiety and depression, with women consistently experiencing over-treatment when compared to men, even after adjusting for mental health status and diagnosis frequency, with statistically significant results for the meta-analysis (PR = 1.45, 95% CI [1.12, 1.78]), concluding that women are 54% more likely than men of receiving psychotropic treatment for anxiety and depression. The reduced number of studies included is acknowledged as a limitation of the study.

Addressing these issues requires a comprehensive understanding of biopsychosocial factors, integrating gender-inclusive politics into medical education and clinical practices. Recognizing and mitigating these underlying causes is paramount to reduce gender-based disparities in mental health and promoting better practices to achieve equitable health outcomes.

In tandem with the rise in numbers of older adults in the general population, more people with schizophrenia (PwS) are also living longer. This vulnerable population has several trajectories of ageing driven by a number of social determinants of health, including the experience of loneliness and they may be more at risk of experiencing loneliness.

This study aimed to examine demographic, psychosocial and clinical variables and their relative contribution to the loneliness of older PwS (OPwS) in a large New Zealand community sample.

New Zealanders 65 years and older who completed their first interRAI assessment during the study period were included. Data from 1,883 OPwS participants was analysed [mean age, 75.1 + 7.7 years; 1,132 (60.3%) females]. The majority were of European ethnicity (64.8%; Māori 15.7%, Pacifica 5.7%) and only a minority were married (20.6%). Chi-square analysis was used to examine relationships between loneliness and demographic and psychosocial variables. Logistic regression was used to measure the relative contribution of these variables to loneliness.

Being lonely was reported for 25.9% of OPwS, a significantly higher rate than that reported in the general population of people over 65 years-of-age. A relationship with loneliness was found for marital status, depression and living arrangements but not gender, ethnicity or social engagement. Co-morbid depression and not being in a marital-type partnership were identified as significant predictors of being lonely. Conversely, living with someone predicted being not lonely.

Older community dwelling PwS experience higher rates of loneliness than older adults in a general population. Addressing loneliness, as well as its correlates, co-morbid depressive symptoms and living arrangements, is crucial to supporting the wellbeing of OPwS.

Substance Use Disorders are often associated with significant levels of domestic and external violence registered among abusers. This investigation aimed to evaluate the Domestic Violence Involvement (DVI) and related gender differences among Crack Cocaine Users in Brazil.

For this purpose, a secondary data analysis of a multicenter cross-sectional study involving 780 Crack Cocaine Users from 6 Brazilian capitals was performed.

The prevalence of DVI among abusers was not different between males and females. Crack-cocaine users with DVI versus without DVI experienced significantly more aggressions and beatings as victims throughout their life (54.7% vs. 40.5%), showed greater difficulty in controlling the impulse to assault or hurt someone throughout their life (65% vs. 36.4%), higher number of physical aggressions (25.9% vs. 11.6%), car theft (27.3% vs. 16.9%), violent crimes (12.9% vs. 6.2%). Men also reported a higher prevalence of detentions/arrests (61%) than women, while women were more frequently charged over their parental powers than men.

Our findings suggested that DVI in Crack-Cocaine users may be a potential predictor of social violence in general with no significant differences between males and females. Legal punishments remain related to the cultural role assigned to each gender with men being more likely to be detained in their lives and women being reported more for parental neglect.

Emotional dysregulation (ED) – the difficulty to control emotional responses to stressors – is a potential driver of intimate partner violence (IPV) perpetration among young men in HIV endemic resource-limited settings. This two-armed pilot cluster randomised controlled trial investigated the effectiveness of Stepping Stones and Creating Futures Plus (SSCF+), a participatory gender transformative and livelihood strengthening intervention, on the emotional dysregulation (ED) among young men in South Africa (SA).

A total of 163 young men ages 18 to 30 years were recruited in 30 clusters (friendship groups) in urban informal settlements and rural areas in KwaZulu-Natal, SA. Clusters were randomly allocated (1:1) to either the experimental SSCF+ or control arm, stratified urban/rural and participants were followed-up at 5 months. Intention-to-treat analysis based on generalised estimating equations (GEE) were fitted to quantify the impact of SSCF+ on the men’s ED using the culturally tested short version of the Difficulties in Emotion Regulation Scale with 16 items (DERS-16).

At 5 months SSCF+ did not significantly reduce ED in the overall sample. However, SSCF+ had a significant impact on ED among the men at risk of depression at baseline (adjusted odds ratio = 0.12, 95% CI [0.03, 0.46], p = .002).

SSCF+, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges, reduced ED among youth with depression challenges in KwaZulu-Natal Province, South Africa.

The World Health Organization advocates Community-Based Rehabilitation (CBR) for resource-constrained settings. There is a need for evidence-based models of employment for persons with severe mental illness (referred to as “patients”) from such settings.

To facilitate and study the employment outcome of patients aged 18 to 50 y, availing a rural CBR project in South India.

Of 98 consented patients, only three men chose wage employment, and eighty-nine chose self-employment. Patients seeking wage employment were offered training and job placement in the nearest metropolitan city. Ten patients were offered loans for self-employment as revolving funds without collateral through the family federation of persons with mental illness. The patients and families were followed up for 10 months after recruitment into intervention. The AIMS-SEEP tool assessed the impact on families that availed of loans.

All three men who chose wage employment in the city discontinued it. Two of ten families did not use it for the intended purpose, and one loan was written off. Seven families chose sheep rearing, and one bought a tailoring machine. Self-employment was a secondary source of income for families and was used for food, clothes, school expenses, health-related costs, household items, and debt repayment. The attendance at monthly meetings of the family federation has more than tripled since loans were issued. Families reported no adverse effects due to the intervention. Only three out of eight families had repaid the loan completely at the end of 10 months. Reasons cited for delay in loan repayment were hospital expenses for a sick family member and children’s school expenses.

In impoverished rural areas, patients and their families prefer self-employment locally over shifting to the city for wage employment. Suggestions for implementing livelihood interventions in other resource-constrained settings are discussed. Families must own the initiative to ensure its sustainability.

Clinical situations marked by severe social withdrawal in youths are increasingly recognized as an important public health issue in European countries, while the relation with the hikikomori syndrome initially described in Japan remains poorly investigated.

This study aims to describe the sociodemographic features of adolescents and young adults with social withdrawal in French and to validate a French version of the Hikikomori Questiuonnaire-25 (HQ-25).

An online questionnaire was completed by 450 participants aged 13 to 25 years. In addition to socio-demographic features, participants were questioned about several aspects of social withdrawal behaviors and a version of the HQ-25 previously adapted in French by a group of patients and clinician experts.

A minority of participants was found ‘at-risk HKM’ (3.6%). They were approximately younger, and lived more frequently with their parents, with balanced sex ratio and no differences regarding the educational level. The level of distress and concern about physical/mental health did not discriminate between the two groups. Regarding psychometric properties of the HQ-25, Cronbach’s alpha of the total was .93, the ICC was .74, and the indices of fit found in the confirmatory factorial analysis of the original three-factor solution were robust.

Considering the social invisibility and the barriers to care access of adolescents and young adults with hikikomori, the development of a self-assessment instrument with good psychometric properties is regarded as an important first step.

Suicide is one of the leading causes of death worldwide especially in low- middle-income areas as Mosul City. It exposed to wars and various stressors for decades that directly affecting populations’ stability, psych and daily life.

we aim to explore suicidal thoughts and attempts rates and their influencing risk factors.

A cross-sectional study was performed among 652 individuals in Mosul along ten months period since March 2023. The questionnaire was distributed among them by using convenient sampling technique. According to PHQ-9 and ASQ, the sample was divided into three groups: normal people (396), suicidal thoughts (166), and suicidal attempts (90). Chi-square, Fishers’ exact, and independent t-tests were used for significant association between variables.

One quarter (25.46%) of population had suicidal thoughts and 13.8% attempted suicide. Among the risk factors were female sex, low education, low social class, big family size, sedative drug use, introverted personality, poor family and personal relationships, bullying, severe depression, and chronic diseases (p-values 0.031 – <0.001).

Suicidal thoughts and attempts were present in high levels in Mosul City compared with other regions in the world. This should be addressed carefully while implanting national preventive and social welfare services.

The border areas of Jammu and Kashmir have long been affected by conflict, potentially impacting the mental health of youth. Understanding the relationships between social health factors and mental health outcomes in these regions is crucial for developing effective interventions.

This study aims to investigate the correlations between social health factors (social support, resilience, and well-being) and mental health outcomes (stress, anxiety, and depression) among youth living in the border areas of Jammu and Kashmir.

A sample of 300 individuals aged 18 to 25 years was recruited, with 150 participants from the Line of Control (LoC) border in Rajouri district and 150 from the International Border (IB) in Jammu district. Participants completed six standardized measures: the Resilience Scale, the Multidimensional Scale of Perceived Social Support (MSPSS), the Patient Health Questionnaire-9 (PHQ-9), the WHO-5 Well-Being Index, the Perceived Stress Scale (PSS), and the Generalized Anxiety Disorder-7 (GAD-7). Pearson Correlation was computed with statistical significance at p < .05.

Significant positive correlations were found between social support, resilience, and well-being in both IB and LoC groups. Depression was positively correlated with anxiety in both groups. However, stress was positively correlated with depression and anxiety only in the LoC group.

These findings highlight the importance of social health factors in maintaining mental well-being among youth in conflict-affected regions. The study suggests that interventions targeting social support, resilience, and well-being may effectively promote mental health in these areas. Additionally, the results underscore the need for context-specific approaches in addressing mental health challenges in different conflict-affected environments.

Over the last decades the study of schizophrenia-spectrum disorders has been focused on early and comprehensive intervention during the first episode of psychosis (FEP), but studies in rural settings are only rare. In Greece mental healthcare in rural areas is mostly delivered by the locally-based Mobile Mental Health Units (MMHUs).

The aim of the present study was to address treatment of FEP patients by the MMHUs in rural areas in Greece, focusing on patients with a first episode of schizophrenia.

This is a multicenter, retrospective observational study with the participation of nine MMHUs across several areas in rural mainland and some islands of Greece. Patients of the age range of 15 to 55 years with a diagnosis of non-affective psychosis were included in the study.

The study sample consisted of 216 patients, while analysis was performed for patients with a diagnosis of schizophrenia (n = 153, 70.8% of the sample). Most patients were males (n = 93, 60.8%), with a mean age at first presentation 34.9 years (Md = 34.5, SD = 11.94). The mean duration of untreated psychosis (DUP) was 7.85 months (Md = 3, IQR = 10.00) and was shorter in younger (15–25 years) patients. More than 60% of patients had been successfully engaged to treatment with the MMHUs, with a mean follow-up duration of 5.17 years (Md = 5.00, IQR = 5.00). Younger patients (26–35 years) tend to disengage from treatment, while those aged 36 to 45 years were more likely to continue follow-up. A reduction of 47.22% in hospital admissions among patients with schizophrenia was observed over follow-up of patients by the MMHUS.

The most noteworthy findings of the study are the low percentage of patients seeking help from the MMHUs, compared to the expected cases and the high attendance rate of those that are examined in this context. Further research on psychosis/schizophrenia in the rural context is warranted.

Patients with serious mental illness (SMI) often engage in religious and superstitious activities. The implications of such engagements remain unclear, with no established guidelines for mental health professionals.

This study aimed to survey perspectives and gather suggestions from various disciplines within mental healthcare regarding the engagement in religious/superstitious activities of SMI patients: schizophrenia spectrum disorders, bipolar disorder, major depressive disorder.

This cross-sectional study was conducted between November and December 2023 among Thai mental health professionals. Participants used 10-point Likert scales to rate their agreement levels for engaging each activity. Additional suggestions were obtained through textual responses, which were subsequently summarised and synthesised.

Of the 403 professionals participated, the majority were female (73.2%), Buddhist (87.6%) and psychiatrists (42.2%), with a median age of 34.0 years. Among patients with active symptoms, patients with major depressive disorder tended to receive the highest mean agreement scores for engagement, while patients with schizophrenia consistently scored the lowest across most activities. Similar trends were observed among patients in remission. From textual responses, two key themes were synthesised: (1) environmental factors and (2) impacts on natural courses.

Patients with active schizophrenia received the lowest levels of agreement while patients with major depressive disorder tended to receive the highest mean agreement scores on engaging religious/superstitious activities.

Although positive childhood experiences (PCEs) have been reported to be crucial for healthy development and better mental and physical health outcomes, their epidemiology and relationship with adverse childhood experiences (ACE) exposure in low and middle-income countries, including India remain underexplored.

The present study aimed to ascertain the prevalence and predictors of PCE exposure and understand the relationship between PCE and ACE exposure among young adults in Delhi-NCR, India.

The present cross-sectional study involved a total of 1,573 young adults (18–25 years) of both sexes (69.7% females) recruited from two Universities in Delhi-NCR, India. PCEs and ACEs were measured using the Benevolent Childhood Experiences scale and ACE-International Questionnaire.

Of the total participants, 42.6% reported experiencing all 10 PCEs, while 50.2% had experienced 6 to 9, and 7.2% had experienced 0 to 5 PCEs. Further, the mean PCE score of the sample was 8.64. Certain sociodemographic groups, for instance, participants from immigrant families, sexual minority groups and those who were obese during childhood than their respective counterparts were at lower odds of high PCE exposure. Also, the study found a significant inverse correlation between ACE and PCE exposure levels; however, the effect size was moderate.

The study indicates the need for targeted PCE promotion interventions for disadvantaged sociodemographic groups. The intervention should simultaneously aim at reducing ACEs, as PCE promotion alone may not always lead to ACE reduction.

The COVID-19 pandemic necessitated substantial modifications in the delivery of patient care on a global scale. Telemedicine-based care services were implemented worldwide to maximize access to healthcare systems.

This study aimed to investigate the use of and satisfaction with telepsychiatry services implemented during the COVID-19 pandemic by psychiatrists across low, middle, and high income countries, and to assess levels of burnout among psychiatrists providing telepsychiatry services in different settings and countries. We hypothesized that use of telepsychiatry will have increased during the pandemic and is associated with increased risk of burnout.

A cross-sectional survey was conducted from October 2020 to June 2021 on psychiatrists practicing in Egypt, United Kingdom, Croatia, Belgium, Indonesia, Italy, and El Salvador. Participants were asked to provide sociodemographic data and to complete a questionnaire developed ad-hoc by the authors on telepsychiatry use, the Modified Arizona Telemedicine Program Satisfaction (MATPS) survey and the Oldenburg Burnout Inventory questionnaire.

A total of 347 participants completed the survey. Sixty three percent indicated that they had not utilized teleservices for clinical consultation or academic purposes prior to the COVID-19 pandemic. A substantial shift was observed during the pandemic, with this percentage increasing to 98%. Over two-thirds of psychiatrists expressed satisfaction with the visual (76%) and audio (77%) aspects of teleconsultation. No significant correlation was found between burnout and satisfaction. While older age was negatively correlated with burnout levels, years of experience showed a positive correlation with levels of burnout.

While there was an increased acceptance and satisfaction with teleconsultation, a persistent preference for in-person consultations remained. The study did not find a correlation between satisfaction in telepsychiatry and levels of burnout. Moreover, increasing age was correlated with lower burn out rate, whereas a correlation between years of experience and heightened levels of burnout was evident.

Among individuals with serious mental illness (SMI), victimisation has been found to increase the risk of engaging in other- and self-directed violence. However, rates of victimisation within this population have been found to vary by ethnic group and primary diagnosis.

This study primarily aimed to examine the relationship between victimisation and other- and self-directed violence among a sample of inpatients with SMI during the first 3 months of admission. The role of ethnicity and primary diagnosis were also explored.

This cross-sectional study utilised data from South London and Maudsley’s (SLaM) anonymised database. Participants (n = 7,265) were aged over 18 upon admission, of White British, Black African, Black Caribbean or Asian ethnicity and had a primary diagnosis of major mood disorder, mania or psychosis.

Among a sample of inpatients with SMI, victimisation increased the risk of other-directed violence but not self-directed violence. While Black African ethnicity was associated with an increased risk of other-directed violence, all minority ethnic groups had a decreased risk of self-directed violence compared to White British ethnicity. Those with a primary diagnosis of mania or psychosis were observed to be at increased risk of other-directed violence and decreased risk of self-directed violence compared to those with a major mood disorder.

Inpatients with SMI who have experienced victimisation are at an increased risk of engaging in other-directed violence during the first 3 months of admission.

The Recovery Model for mental illness explores a broad range of domains for individuals with severe mental illness (SMI) which is not merely the absence from illness but attaining self-sufficiency. The individualized occupational therapy intervention which is part of the recovery model approach includes any or a combination of trainings like Social Skills training, Vocational training, Assertiveness training, Anger Management training, Life Skills training, Stress Management, Study Skills training, Cognitive retraining and Anxiety management.

The objective of the current study was to evaluate the effectiveness in terms of functioning of individuals with (SMI) who had undergone individualized OT intervention.

Patients who had undergone individualized OT intervention were evaluated at designated time points i.e. at discharge, at 3 months and further at 6 months. The outcome measure of functional capacity was scored using the Global Assessment of Functioning instrument.

A total of 31 patients were sampled. The diagnosis of Schizophrenia was seen in 77.4% (n-24) of the sample, Bipolar Affective Disorder in 12.9% (n-4) and Schizoaffective Disorder 9.7% (n-3). The mean GAF for the sample showed improvement and the increment in GAF was maintained on follow up.

In services with limited skilled human resources and where community-based services are not established, culturally adapted interventions with individualized OT interventions can ensure positive gains in terms of socio-occupational functioning.

Transgender, nonbinary, gender-expansive (TNGE) Black, Indigenous, and Other People of Color (BIPOC) have one of the highest rates of suicidal ideation and suicide attempts. As recommended by the cultural framework of suicide, examining culturally relevant lay beliefs and attitudes, such as community perspectives on where suicidal ideation originates, is integral for suicide prevention. Doing so may aide in identifying avenues of support for TNGE BIPOC with chronic suicidal ideation.

This study aimed to examine how TNGE BIPOC community members perceive the etiological foundation of suicidal ideation.

Short-answer responses were collected from 110 participants in a national cross-sectional survey within the United States. Data were analyzed utilizing a conventional content analysis approach to thematically categorize etiological factors.

Participants described four major areas regarding perceived etiology of suicidal thoughts including: (1) chronic trauma and stress; (2) societal and cultural expectations; (3) biological factors; and (4) structural oppression. The most salient etiological factor was structural oppression which was endorsed by 60% of the sample.

Results suggest that experiences of structural oppression should be incorporated in assessing TNGE BIPOC clients’ beliefs about suicide and suicide prevention, given its relative saliency within this sample. Further research is needed to adequately understand how cumulative stress and social-cultural expectations impact the development of suicidal ideation among TNGE BIPOC.