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OBJECTIVE: Limited understanding exists regarding the cumulative impact of childhood household dysfunction (CHD) on adolescent depressive symptoms in developing countries, as well as the role of lifestyles in this association. This study aims to explore the associations of individual and cumulative CHD indicators with depressive symptoms among Chinese adolescents. Additionally, we investigate potential interactions and joint associations of CHD and lifestyles on depressive symptoms. METHODS: In the second phase of the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research, data on depressive symptoms, CHD indicators, lifestyle factors, and other covariates were collected from 3106 students (mean [SD] age, 15.16 [1.52] years). Linear and logistic mixed-effects models were employed, with both stratified and joint analyses conducted. RESULTS: Except for parental death, each CHD indicator was associated with an increased risk of depressive symptoms. The accumulation of CHD indicators exhibited a positive, graded association with depressive symptoms scores (ß = 3.22, 95% CI: 2.48 to 3.97 for one CHD indicator; ß = 5.45, 95% CI: 4.41 to 6.49 for two or more CHD indicators, all P < 0.01). A significant interaction was found between the number of CHD indicators and the healthy lifestyle score (interaction ß = -0.40, 95% CI: -0.78 to -0.03, P < 0.05), indicating that healthy lifestyles may mitigate the risk of depressive symptoms in individuals experiencing CHD. For example, the OR for having depressive symptoms among adolescents with favourable lifestyles compared with those with unfavourable lifestyles was 0.21 (95% CI: 0.10 to 0.45, P < 0.01) among those experiencing CHD. Moreover, adolescents with two or more CHD indicators and unfavourable lifestyles faced the highest risk of having depressive symptoms (OR = 8.03, 95% CI: 4.83 to 13.34, P < 0.01) compared with those with no CHD indicator and favourable lifestyles. CONCLUSIONS: These findings underscore the importance of promoting comprehensive healthy lifestyles and reducing CHD exposure for the prevention of depressive symptoms in adolescents.

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BACKGROUND: Rates of suicidality are high among young adults and minoritized groups are disproportionately affected. Despite evidence that adverse childhood experiences (ACEs) may increase suicide-related risk, the underlying mechanisms through which ACEs may impact suicidal ideation (SI) remain poorly understood, especially among marginalized young adults with serious mental illnesses (SMI) such as schizophrenia-spectrum, major depressive, and bipolar disorders. This study examines associations between ACEs and SI, and whether perceived stress, dispositional hope, and mental health hope may mediate the relationship. METHODS: The sample consisted of 114 young adults of color with SMI who participated in a larger randomized trial. Data were analyzed using a structural equation modeling (SEM) approach. RESULTS: Young adults with more ACEs reported higher perceived stress, which in turn, was associated with more SI. Higher perceived stress was associated with lower dispositional and mental health hope. Although dispositional hope was negatively associated with SI on a bivariate level, neither dispositional nor mental health hope was significantly associated with SI in the multivariate SEM. This suggests that over and above perceived stress, hope does not appear to be associated with SI. LIMITATIONS: Key limitations include a cross-sectional design, a modest sample size, and an assessment of select ACEs. CONCLUSION: Addressing stress-related processes may be one promising target for suicide prevention efforts in the context of ACEs. Policy interventions focused on the allocation of resources and changing environments that are stress and trauma-inducing are needed to reduce the occurrence of ACEs and their negative sequelae.

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Background: Mental disorders significantly impact individuals and societies globally. Addressing societal stigma is crucial, as it affects help-seeking behaviors and the effectiveness of treatment for mental disorders. Objective: This study aims to explore the knowledge and perceptions of the Spanish population toward mental disorders and their treatment, assess changes in mental health stigma over time, and examine variations across sociodemographic variables by comparing current results with previous studies. Methods: A panel of three psychiatrists designed a questionnaire to collect public opinions about various aspects of mental illness in Spain, covering topics such as social perception, diagnostic reliability, causes, symptoms, treatment, suicide, and media influence. The survey, conducted from October to December 2022, involved 1,002 Spanish individuals aged 18-70. Results: Our results indicated an improved general knowledge of mental health, reduced stigma, and greater acceptance of those affected by these disorders, compared to past research. Almost 80% of the participants have accurate knowledge regarding the complex and multifactorial nature of mental illnesses. Around 90% of the participants share the belief that stigma affects those affected by mental disorders. Psychological and pharmacological treatment are considered to be effective and helpful by more than 70% of the sample. More than 60% of the participants highlighted that suicide needs to be addressed appropriately in the media. Conclusion: These findings suggest a significant shift in how Spanish society views mental disorders, marking progress over decades of discrimination. Reducing the stigma associated with mental health can encourage individuals to seek assistance without the fear of judgment or discrimination, thereby increasing the likelihood of early intervention and treatment. Open conversations about mental health within families, communities, and workplaces can create a supportive environment that enhances recovery. However, continued efforts and awareness campaigns targeted to broader audiences remain necessary. Responsible media portrayals of mental health, avoiding stigmatizing language or sensationalism, are also essential.

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Introduction: Occupational therapy (OT), a vital part of psychiatric rehabilitation, encourages participation in social activities, which is critical for the recovery of people with severe mental illnesses (SMI). However, the effects of OT on the subsequent social activities of patients with SMI have not been fully clarified. We aimed to identify the factors that encourage post-discharge social activity participation among patients with SMI who received OT. Method: Patients who underwent OT at the Kyorin University Hospital between April 2016 and March 2020 were retrospectively examined for baseline data during hospitalization and social activity status 1 year after discharge. Occupational support, group adaptation, artistic activities, and exercise programs were considered. Activities requiring social interaction were defined as social activities, including employment, schooling, sheltered work, and volunteer work. Multiple logistic regression analyses using demographic and medical data, prehospitalization social activity status, and OT participation rates as independent variables were used to examine the factors encouraging social activity participation after discharge. Decision tree analysis was conducted to identify patients who specifically needed to increase OT participation. Results: Of 524 eligible patients, 247 were included in the study. The number of patients who were socially active at admission and after discharge was 116 and 188, respectively. Multiple logistic regression analyses revealed that the following factors were likely to encourage social activity participation after discharge: higher rates of OT participation to facilitate group adaptation (OR = 1.015, 95% CI 1.003-1.027), being socially active at admission (OR = 4.557, 95% CI 2.155-9.637), and no marital history (OR = 0.293, 95% CI 0.130-0.661). Decision tree analysis showed that for patients who were socially inactive at admission and had a history of marriage, increasing OT participation to 52.6% or higher may ensure social activity participation after discharge. Conclusions: This study identified patients whose social participation after discharge could be boosted by OT that facilitates group adaptation. Our findings would facilitate the development of individualized add-on rehabilitation based on the effects of real-world OT practices.

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Intersectionality has become a central analytical framework in the study of exclusion and empowerment experiences among women from marginalized communities. However, the relevance of intersectionality to informal caregiving in mental healthcare has hardly been explored to date. The purpose of the current study is to examine the exclusion experiences and coping resources of immigrant women caring for a family member with a severe mental illness (SMI) through the lens of intersectionality theory. Semi-structured in-depth interviews were conducted with 26 informal female immigrant caregivers from the former Soviet Union residing in Israel. The interviews were analyzed using a qualitative content approach. The findings revealed that the participants experienced stigma and exclusion in several intersecting categories: economic marginalization of immigrant single mothers, ethnic and gender-based stigma of Russian-speaking women, gender-based domestic violence, and mental health stigma by professionals. The participants' coping resources included spirituality and religious faith, support groups, and social activism. The study provides insights into the burdens and rewards experienced by female immigrant caregivers of family members with SMI through the lens of intersectionality theory. Implications for adapting services to the contextual characteristics of female immigrant caregivers and minimizing intersectional stigma and inequities in informal healthcare are discussed.

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Most research on mass murderers to date has focused on perpetrators of male sex, while research on perpetrators of female sex has been relegated to case reports and series. We aimed to more fully examine the phenomenon of female-perpetrated mass murder. We analyzed 1715 worldwide incidents of personal-cause mass murder from 1900 to 2019, identifying 105 (6%) events perpetrated by females. We defined mass murder as any event involving at least three fatalities, not including the perpetrator, using any method. We identified cases of mass murder from English-language databases of mass murder or murder in print or online. There were no significant differences in age and race between female and male perpetrators. Relative to males, female perpetrators were significantly less likely to employ firearms in their mass murders, using them in less than half of cases, compared to over 70% for males. The prevalence of psychotic signs and symptoms among female mass murderers was more than double that among males (25.7% vs. 12.5%, p < 0.01), while the rate of nonpsychotic psychiatric or neurological conditions was also much greater among female perpetrators (29.5% vs. 17.1%, p < 0.01). Over half of female perpetrators took or attempted to take their own lives. More than three-quarters of mass murders by females involved at least one family member as a victim. This study underscores sex-specific differences in the perpetration of mass murder and the need for further research to understand how insights about such dynamics might lead to the development of more effective and informed intervention policies.

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Refugees encounter multiple psychosocial stressors post-resettlement which increases their risk of developing a mental illness. Loneliness and social isolation are commonly reported in the refugee population and have been demonstrated to be associated with multiple physical and mental health comorbidities in the general population. However, no study to date has systematically reviewed how loneliness and social isolation may affect refugees who have resettled in high-income countries. This systematic review aims to study the prevalence, risk factors, consequences, and interventions for loneliness and social isolation among refugees who have resettled in high-income countries. Systematic searches on five electronic databases yielded 2950 papers, of which 69 were deemed eligible following a double-blinded review by title and abstract then later by full text. From the included studies, it was found that the reported range of prevalence rates of loneliness (15.9-47.7%) and social isolation (9.8-61.2%) were higher than population norms. Risk factors associated with loneliness and social isolation included family separation, acculturative stress, being female or a parent and a current diagnosis of a mental illness. Loneliness and social isolation were found to be associated with depression, post-traumatic stress disorder (PTSD), psychological distress as well as physical health problems. Only three interventions addressing loneliness and social isolation were identified which demonstrates the importance of integrating social support in refugee psycho-social support programs. In summary, loneliness and social isolation were reported by a large proportion of refugees who have resettled in high-income countries. Whilst certain risk factors were pre-migratory and static, most were post-migratory in nature and were found to adversely affect mental and physical health. Thus, interventions focused on reducing loneliness and social isolation that are guided by the needs of refugee communities are urgently required.

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This conceptual article examines the organisational crisis in England's National Health Service in light of the recently launched model of policing called Right Care Right Person introduced to reduce police hours spent dealing with mental health crisis calls. It is a move that has come with concerns for health services because these newly created gaps alongside the existing ones pose challenges around funding and timescales in implementing the new model. It is a curious case of organisational paradox that diverting mentally ill persons into health services and 'decriminalising' those whose health conditions bring them to the attention of the justice system, has raised concerns in the health sector about access to adequate mental health services unless an arm of the justice system is involved. Given the similarities in health and legal systems in the Anglo-Western world, this English model has international implications about organisational paradoxes in health systems.

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British-born Dr Edward Waldegrave Wardley (MRCSL, 1842) is an unacknowledged pioneer in the history of mental health care in Australia. Between 1857 and 1872, he assisted in the development of a policy of non-restraint across lunatic asylums in New South Wales (NSW). He then went on to extend this approach to the treatment of NSW's criminally insane patients. In addition, he trialled experiments to intellectually engage educated psychiatric patients across the colony. A prolific writer, and sufferer of chronic depression, Dr Wardley serves as a unique example of a nineteenth-century alienist with lived experience of mental illness.

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Community mental health centers (CMHCs) offer invaluable, publicly-funded treatment for serious mental illness (SMI). Unfortunately, evidence-based psychological treatments are often not delivered at CMHCs, in part due to implementation barriers, such as limited time, high caseloads, and complex clinical presentations. Transdiagnostic treatments may help address these barriers, because they allow providers to treat symptoms across multiple disorders concurrently. However, little research has investigated CMHC providers' experiences of delivering transdiagnostic treatments "on the ground," particularly for adults with SMI. Thus, the aim of the present study was to assess CMHC providers' perspectives on delivering a transdiagnostic treatment - the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) - to adults diagnosed with SMI. In the context of a larger parent trial, providers were randomized to deliver a standard version of TranS-C (Standard TranS-C) or a version adapted to the CMHC context (Adapted TranS-C). Twenty-five providers from the parent trial participated in a semi-structured interview (n = 10 Standard TranS-C; n = 15 from Adapted TranS-C). Responses were deductively and inductively coded to identify themes related to Proctor's taxonomy of implementation outcomes. Four novel "transdiagnostic take homes" were identified: (1) transdiagnostic targets, such as sleep, can be perceived as motivating and appropriate when treating SMI, (2) strategies to bolster client motivation/adherence and address a wider range of symptom severity may improve transdiagnostic treatments, (3) balancing feasibility with offering in-depth resources is an important challenge for transdiagnostic treatment development, and (4) adapting transdiagnostic treatments to the CMHC context may improve provider perceptions of implementation outcomes.

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Objective: Serious mental illness (SMI) remains a leading cause of disability worldwide. However, there is limited Australian evidence of community-based programs to enhance the psychosocial wellbeing of adults experiencing SMI. Foundations is a long-term community-based psychosocial outreach support program delivered in Tasmania, Australia. A longitudinal non-randomised controlled trial was conducted to examine the effectiveness of the Foundations program on adults' psychosocial functioning, clinical symptomology, and hospital readmissions, in comparison to standard care only. Method: Participants were adults aged 18-64 years experiencing SMI. Control participants received standard clinical care only. Intervention participants were engaged in the Foundations program in addition to standard care. Data were collected at program commencement, midpoint, closure, and six-months post-closure. Linear mixed modelling was used to examine differences between groups. Results: Intervention participants achieved better psychosocial functioning in comparison to the control group by program closure and at six-month follow-up. No significant differences were observed for clinical mental health symptomology or hospital readmission rates. Length of readmission stay was significantly shorter for intervention participants. Conclusions: The findings highlight the additional value of community-based, recovery-oriented, psychosocial outreach support alongside clinical mental health care to enhance the psychosocial wellbeing of adults experiencing SMI.

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Background: Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI). Objective: To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment. Methods: Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision. Results: In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings. Conclusions: Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.

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BACKGROUND: Informal caregiving involves increased responsibilities, with financial and emotional challenges, thereby affecting the well-being of the caregiver. We aimed to investigate the effect of spousal mental illness on hospital visits and medical spending among patients with gastrointestinal (GI) cancer. METHODS: Patients who underwent GI cancer surgery between 2013 and 2020 were identified from the IBM Marketscan database. Multivariable regression analysis was used to examine the association between spousal mental illness and healthcare utilization. RESULTS: A total of 6,035 patients underwent GI surgery for a malignant indication. Median age was 54 years (IQR: 49-59), most patients were male (n = 3592, 59.5%), and had a CCI score of ≤ 2 (n = 5512, 91.3%). Of note, in the 1 year follow-up period, 19.4% (anxiety: n = 509, 8.4%; depression: n = 301, 5.0%; both anxiety and depression: n = 273, 4.5%; severe mental illness: n = 86, 1.4%) of spouses developed a mental illness. On multivariable analysis, after controlling for competing factors, spousal mental illness remained independently associated with increased odds of emergency department visits (OR 1.20, 95% CI 1.05-1.38) and becoming a super healthcare utilizer (OR 1.37, 95% CI 1.04-1.79), as well as 12.1% (95% CI 10.6-15.3) higher medical spending. CONCLUSION: Among patients with GI cancer spousal mental illness is associated with higher rates of outpatient visits, emergency department visits, and expenditures during the 1-year postoperative period. These findings underscore the importance of caregiving resources and counseling in alleviating caregiver burden, thereby reducing the overall burden on the healthcare system.

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OBJECTIVES: The mental health of dentists, like all health professionals, is a growing concern. The objectives of this study were to identify the mental health challenges experienced by Canadian dentists and to describe the support needs and promising practices to better support them. METHODS: This study used a mixed-methods case study design to gather data from semistructured qualitative interviews and a survey for triangulation. RESULTS: Thirty-six dentists and 17 stakeholders participated in the interviews, and 397 dentists participated in the survey. The interview and survey data revealed that dentists have experienced several challenges personally, professionally, and socially. Around 44% of participating dentists experienced a wide range of mental health issues, including depression, anxiety, and posttraumatic stress disorder. Sex/gender shaped the mental health experiences of female dentists, who reported more stress related to caring responsibilities. They had a higher percentage of mental health issues (50%) than men (37%). Caretaking emerged as the main challenge in the social and personal domain, particularly for female dentists in both survey and interview findings. The dentists' role in practice was one of the most frequently reported professional challenges. While practice owners reported challenges with staff and practice management, associate dentists experienced difficulties with the lack of autonomy and conflicts with office managers and owners. Other challenges reported by participating dentists included patient care responsibilities, loneliness, and isolation. To address these challenges and their impact, dentists and stakeholders identified several support needs and promising practices, including increasing awareness about mental health issues, expanding existing mental health resources, incorporating mental health content in dental education, and encouraging engagement in organized dentistry, particularly for women. CONCLUSIONS: The impact of mental health challenges on dentists' career trajectory and productivity is an ongoing concern in Canada. Gender-specific strategies to support the mental health of dentists should be developed. KNOWLEDGE TRANSLATION STATEMENT: This study identified the mental health challenges of dentists in Canada to inform the development of interventions and strategies to promote the health and well-being of dentists and dental students. It also highlighted the need for clinicians, students, and individuals in leadership positions in institutions and professional organizations to recognize and consider the working conditions of dentists in various positions to avoid negative consequences on their mental health, reduce the attrition from the professional, and improve patient care outcomes.

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The stepped care model (SCM) is a patient-centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword-based search using terms like "stepped care model," "mental health," and "primary care"; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross-sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost-effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally.

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Background: Self-employment is a significant component of South Korea's labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. Objective: This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. Methods: This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20-59 y) who maintained the same insurance type (self-employed or employee insurance) for ≥3 years (at least 2008-2010) were recruited for this study and monitored until death or December 2021-whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. Results: A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44%); all-cause mortality occurred in 1.27% (99,542/7,851,282) of employees and 3.29% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1% for employees and 2.8% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95% CI 1.42-1.45; female: adjusted HR 1.89, 95% CI 1.84-1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95% CI 0.74-0.79; female: RERI 1.13, 95% CI 1.05-1.21). Conclusions: This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association.

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BACKGROUND: Sleep and mental health share a bidirectional relationship whereby problems in one exacerbate the other. Accordingly, sleep problems are frequent and severe in serious mental illness (SMI) populations, exacerbating SMI symptoms. This study examined the documentation and treatment of sleep problems within anonymised clinical records of SMI patients, and their association with attendance rates and number of appointments scheduled. METHODS: Patient records between 01.09.2021 and 31.08.2022 were identified and relevant records (n = 229) extracted from an NHS Trust database. Content analysis was used to assess documentation and treatment of sleep problems and Chi-square tests were used to assess demographic differences. Mann-Whitney U tests were used to compare attendance rates and number of appointments scheduled between patients with/without sleep problems. RESULTS: Most (n = 170; 84 %) patients with sleep problems had no or minimal assessment of the sleep problem within their records. Patients were primarily offered no (n = 115; 57 %) or non-recommended (n = 69; 34 %) sleep treatment. More outpatients were offered no sleep treatment (n = 89; 64 %) than inpatients (n = 26; 41 %) (p = .002) whilst more inpatients were offered non-recommended sleep treatments (n = 33; 52 %) than outpatients (n = 36; 26 %) (p < .001). No significant associations were found between sleep and attendance or appointments scheduled. CONCLUSIONS: There is a lack of routine clinical attention to sleep assessment and treatment in SMI groups. Where sleep is addressed, treatment often conflicts with guidelines. Improved sleep assessment and treatment could significantly enhance current SMI patient care.

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OBJECTIVES: Approximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MEASUREMENTS: Themes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. RESULTS: The authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. CONCLUSIONS: The study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

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Severe mental illness is usually marked by periods of remission, when symptoms are absent or well controlled, and of exacerbation, when symptoms return or worsen. Relapse of these severe illnesses costs a lot for patients and their families and imposes a financial burden on hospital and community services. Costs for relapse cases were four times higher than that of non-relapse cases. There is a dearth of evidence in on relapse rate on these vulnerable population in Sub-Saharan Africa, therefore this study assessed relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia. Prospective follow up study design was employed among 315 people with severe mental illnesses who were selected by systematic random sampling technique. Epi.data version 4.2 was used for data entry and exported to STATA 14 for analysis. The Kaplan-Meier curve was used to estimate the median duration of occurrence and the Log rank test was used to compare survival curves between different categories of explanatory variables. A survival analysis was used to estimate the cumulative rate of relapse, Cox proportional hazards models was used to examine independent factors associated with time to develop relapse. To estimate the association between predictors and relapse, hazard ratio with 95% confidence intervals was used. Variables score p value < 0.25 with in the Bivariable analysis was entered in to the multivariable analysis model. The statistical significance was accepted at p-value < 0.05. Around 119 (37.78%) had develop relapse, and the remaining 196 (62.22%) were censored. The overall incidence rate of relapse was 3.66 per 100 person-month (95% CI:3.06-4.38) with a total of 3250 patient-month observations. Variables such as: age (18-36 years) [(AHR) = 3.42:95% (CI) :1.67,6.97)], marital status (single and widowed) 1.87 [AHR: 1.87; 95% CI: (1.06 ,3.27)] and 2.14 [AHR: 2.14; 95% CI: (1.03 ,4.44)], duration of delay in getting treatment ( > = 1 year) [(AHR = 2.55:CI:1.20, 5.38)], types of diagnosis (Major Depressive Disorder) (AHR = 2.38, CI:1.37 ,4.14), medication adherence (low adherence) (AHR = 5.252.45, 11.21) were statistically significant (P value < 0.05). Nearly two-fifth of people diagnosis with severe mental illnesses had develop relapse and the median survival time to develop relapse was nine months. It is advised that early detection of severe mental illness and early initiation of treatments are very crucial to prevent relapse. Psycho education, counseling that alleviates poor treatment adherence are highly recommended.

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This paper explores the intricate interplay between living with mental illness and the processes of identifying mental illness in Abeokuta, Nigeria. With a particular focus on the contextual understanding of personhood, this study reveals how sociocultural backgrounds modulate the understanding of mental illness and its treatments within the Yoruba context. Through nine months of ethnographic fieldwork and discursive narrative analysis, the research revealed that becoming a mentally ill person is deeply intertwined with the everyday social life in the study site. The analysis highlights the multifaceted nature of personhood, encompassing various aspects such as parenthood, friendship, employment, and financial freedom. These facets of personhood are shaped by specific social practices and embedded within complex webs of social relations, often becoming more pronounced when these relationships are disrupted, leading to certain behaviours being categorised as mental illness. This paper underscores the significance of recognising and acknowledging the contextual notion and understanding of mental illness to ensure the provision of acceptable and effective care and recovery strategies.