International Journal of Social Psychiatry

Background Subclinical Hikikomori and depression are common among college students, yet gender differences in their prevalence and interrelationships are under-explored. This study evaluated gender differences in prevalence and symptom networks of these disturbances. Methods A large-scale, multi-center study was conducted across Xinjiang, Qinghai, and Guangdong provinces, China between September and December 2023. Subclinical Hikikomori and depression were assessed with the 1-month 25-item Hikikomori Questionnaire (HQ-25M) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Gender differences in prevalence were tested with univariate analyses, while network analyses assessed symptom structures within each gender. Expected Influence (EI) identified the most central symptoms, with higher EI indicating greater impact. Bridge EI identified specific symptoms that linked Hikikomori and depression symptom communities. Results Among 6,222 college students, no significant gender differences were found in the prevalence of subclinical Hikikomori (males: 11.4% and females: 13.3%) or depression (males: 19.1% and females: 18.3%). Network analysis revealed ‘I avoid talking with other people’ (HQ18) as the most central symptom for both males (EI = 1.60) and females (EI = 1.73), followed by ‘It is hard for me to join in groups’ (HQ13, EI = 1.442) and ‘I have little contact with other people’ (HQ19, EI = 1.437) in males, and followed by ‘Loss of energy’ (PHQ4, EI = 1.17) and ‘I have little contact with other people’ (HQ19, EI = 1.09) in females. The key bridge symptoms were identified as ‘Guilt feelings’ (PHQ6) for males (Bridge EI = 0.14) and ‘Suicidal ideation’ (PHQ9) for females (Bridge EI = 0.13). Significant overall gender differences in networks were observed ( M = 0.12, p = .01). Conclusion Depression and subclinical Hikikomori are common among Chinese college students although we observed no significant gender differences in its prevalence. The most influential central and bridge symptoms from network models are viable targets for intervention for both genders.

Background The health of African migrants in Australia is a largely under-researched topic despite the steadily increasing size of the population and its uniqueness. In particular, few studies have explored the mental health of African migrants in Australia or their utilization of mental health services. Aims This study explored the barriers to mental health help-seeking among first-generation African migrants in Australia. Methods In this qualitative study conducted using the hermeneutical phenomenological research approach, the purposive sampling method was used to recruit participants. In-depth interviews with participants were undertaken online via Zoom, Teams, and WhatsApp calls. Interviews were recorded and transcribed verbatim, utilizing a thematic analysis as the primary data analysis method. Results African migrants were more inclined to seek support for mental health conditions from religious figures such as priests instead of seeking professional help. Religion and poor knowledge about mental illness were highlighted as barriers to mental health help-seeking. Participants also considered cultural beliefs, fear of stigma as well as the high cost of healthcare in Australia as significant barriers to mental health help-seeking among African migrants. Conclusions Findings reinforce the critical need for culturally competent mental health services tailored to the beliefs, values, religion, and experiences of African and other migrant communities in Australia. Given the strong attachment of many African migrants in Australia to their cultural and religious beliefs, such services are essential for practical support and intervention.

Background Adolescents living in war-affected areas are more likely to suffer from depression than adolescents living outside war-affected areas. However, there is limited evidence from Northern Ethiopia that was affected by armed conflicts. This study was conducted to assess the magnitude of depression and to identify inter-related factors with depression and academic performance in armed conflict-affected areas of North Wollo Zone, Ethiopia. Methods A school-based cross-sectional study was conducted among high school students in North Wollo Zone, Ethiopia. A multistage sampling method was used, and the study participants were selected using simple random sampling. The Structural Equation Model was used to verify the hypothesized relationship between various internal and external or mediating factors. The effect size was provided using standardized beta coefficients, 95% CI, and statistical significance defined as a p -value <.05. Results Out of 3,400 study participants, 48.1% (95% CI [46.5%, 49.8%]) endorsed depressive symptoms. Being female (β = .05, 95% CI [0.011, 0.087]), far from family because of education (β = .10, 95% CI [0.060, 0.134]), anxiety (β = .95, 95% CI [0.893, 1.011]), and alcohol use (β = .14, 95% CI [0.108, 0.180]) had a significant and positive association with a total direct effect on depression. Conversely, academic performance (β = −.04, 95% CI [−0.061, −0.011]) had a significant and negative association with a total direct effect on depression. Conclusion This study found a much higher magnitude of depression among students in conflict-affected areas compared to non-affected areas. High school students, particularly girls in conflict-affected areas, need social support and special protection. Additional efforts are needed to ensure safety and security in high schools and establish student support systems such as student counseling and guidance services.

Background Outcome measurement is increasingly recognised as a vital element of high-quality service provision, but practice remains variable in the field of intellectual disabilities. The Health of the National Outcome Scales for people with Learning Disabilities (HoNOS-LD) is a widely used Clinician Reported Outcome Measure in the UK and beyond. Over its 20-year lifespan, its psychometric properties have been frequently investigated. Multiple dimensionality reduction analyses have been published, each proposing a different latent structure. Aim To analyse a set of HoNOS-LD ratings to test its internal consistency, to identify the optimal number of latent variables, and to propose the items that group together in each domain. Methods A Principal Component Analysis of 169 HoNOS-LD ratings was performed to produce an initial model. The component loadings for each HoNOS-LD item were then examined, allowing the model to be adjusted to ensure the optimal balance of statistical robustness and clinical face-validity. Results HoNOS-LD’s internal consistency (18 items) was ‘acceptable’ (Cronbach’s alpha = 0.797). On excluding three items that had no bivariate correlations with the other 15 items internal consistency rose to ‘good’ (Cronbach’s alpha = 0.828). The final, four-component solution, using the 15 items possessed good internal reliability. Conclusion HONOS-LD statistical properties compared favourably to the other published latent structures and adheres to the tool’s rating guidance. The four-component solution offers an acceptable balance of statistical robustness and clinical face validity. It provides advantages over other models in terms of internal consistency and/or viability for use at a national level in the UK.

Background The experience of flourishing (i.e. high wellbeing) is informing our understanding of psychological health beyond psychopathology. Aims This study examines whether community members define their sense of flourishing in terms of the presence of wellbeing and/or the absence of psychopathology. Methods Participants ( n = 1,094) were stratified by sex and age (18–39 years, 40–59 years and 60 years+), resided in Australia, the United Kingdom, Singapore, South Africa and Malaysia. Participants were presented with 12 items from the European Social Survey Wellbeing Module and 9 symptoms from the Diagnostic Statistical Manual for Major Depressive Disorder and Generalized Anxiety Disorder; mental health items were rephrased to reflect an absence of psychopathology. Respondents selected and ranked the five statements that best reflected their sense of flourishing. Results Wellbeing statements were the most frequently endorsed items for example, ‘Feeling calm and peaceful’, ‘Life is valuable and worthwhile’, ‘Having people who care’ and ‘Feeling positive about oneself’, but they were only endorsed by approximately 35% to 38% of respondents. Three pathology items were amongst the top 10 items endorsed. Conclusions That not one indicator was endorsed by the majority of respondents suggests that flourishing definitions of positive mental health need to be defined by both the presence of wellbeing and absence of psychopathology. Notably, there were few between-nation differences in items endorsed, and those differences reported were not of a large magnitude suggesting consistency in the endorsement of indicators between nations.

Background The 11th International Classification of Diseases introduces the diagnosis of Complex PTSD (CPTSD); characterized by traditional PTSD symptomology plus Disturbances in Self Organisation. Part of this construct involves feeling socially disconnected from others, suggesting that aspects of group and individual identity may be associated with this disorder. Aims The current study seeks to contribute to better understanding the association of individual social and personal identity in development of this disorder in post-conflict contexts. Methodology This study analysed survey data collected as part a case-control investigation of psychological risk and resilience in a trauma-exposed sample in Colombia ( N = 541). Identity orientations, that is, the level of importance ascribed to one’s social and personal identity, was assessed using the Social and Personal Identities Scale (SIPI) and was assessed as predictor of probable CPTSD diagnosis using multinomial logistic regression. Results Analyses indicated that trauma experiences were associated with both diagnostic categories, however Social and Personal identity orientation were significant predictors of probable CPTSD diagnosis, but not probable PTSD diagnosis. Greater Personal identity orientation, that is, viewing oneself as individualistic, was associated with increased likelihood of CPTSD. In contrast, greater Social Identity orientation, that is, stronger group membership identification, was associated with reduced odds of CPTSD diagnosis. Identifying as a victim of the conflict was not significantly associated with risk for PTSD or CPTSD outcomes. Conclusion Greater sense of Social Identity and cohesion is suggested to be protective against CPTSD development, whereas greater personal identity orientation is a risk factor. Theoretical perspectives considering the role of social and personal identity may be valuable in understanding individual risk for CPTSD in post-conflict societies.

Background 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’. Aims To explore relevant interdisciplinary literature for academic research, scholarship and commentary containing voices of experience speaking about the geo. Methods 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. Results 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. Conclusions This study signals what a geopsychiatry from below might entail, providing important foundations for future transdisciplinary work on ‘the geo’ and mental (ill-)health.

Background 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. Aims This study aimed to examine how TNGE BIPOC community members perceive the etiological foundation of suicidal ideation. Method Short-answer responses were collected from 110 participants in a national cross-sectional survey within the United States. Data were analyzed utilizing a directed content analysis approach to thematically categorize etiological factors. Result 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. Conclusions 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.

Background Prison correctional personnel often experience increased workplace violence (WPV) and higher risk of suicide, but the link between the two is not yet clear. This study aims to explore the specific mediating variables and mediating paths between WPV and suicide. Methods This is a cross-sectional study of 472 Chinese correctional personnel conducted through an online survey. We used the Workplace Violence Scale (WVS), the Athens Insomnia Scale (AIS), the Chinese version of the Depression Anxiety Stress Scale (DASS), and the revised Beck Suicidal Ideation scale (BSI) to quantify the WPV experienced by subjects and their mental health status. Data analysis, including mediation and network analysis, was performed using SPSS and R software. Results Presence of insomnia and/or depression mediated the relationship between WPV and suicide risk, which accounted for 36.62% of the total effect. Insomnia alone accounted for 9.87%, depression alone accounted for 12.73%, whereas both put together accounted for 14.03%. Male personnel experienced more WPV than their female counterparts, and WPV in men had a stronger association with suicide risk. Network analysis indicated that daytime dysfunction and downheartedness were important nodes in mediating pathways. Conclusions Experiencing WPV may lead to an increased risk of suicide among correctional personnel, particularly men, with insomnia and depression mediating the experienced risk. Correctional institutions should take measures to reduce the occurrence of WPV experienced by correctional personnel mitigate the impact of this occupational hazard, and prioritise the mental health of correctional personnel, particularly those already experiencing worrying symptoms.

Aim This research examines the ambiguity of the migration process experienced by earthquake victims who had to migrate following the Kahramanmaraş-centered earthquake disaster in 2023 and their adaptation to their new lives. Background The post-earthquake migration process can leave people with uncertainty and the problems that come with it. The uncertainty experienced by these individuals has not been addressed in the literature, and these experiences are important. Methods In this study, which was conducted using the phenomenological research design, the snowball sampling method, one of the purposeful sampling methods, was used. The data was collected face-to-face with 19 earthquake victims through 30 to 40-min in-depth interviews. Colaizzi’s phenomenological analysis method was used to analyze the data obtained. Results According to the analysis results, there are three main categories (From the Earthquake Shock to a New Life: The Journey of Migration and Adaptation, Identity Transformation Caused by Migration: The Adventure of Adapting to a New Life, Dreams and Goals for the Future: A New Beginning in the Pursuit of Hope) and five themes (Getting Lost in the Dark Labyrinths of Migration, The Difficult Journey of Adaptation After Migration, Loss of Identity and Cultural Storms, Broken Ropes and Longing Times, Future Plans and Optimism) that have emerged. Discussion The research shows that migrating earthquake victims are in an environment of uncertainty where they do not know what to do, experience identity crises and cultural conflict after migration, long for the past, and have difficulty adapting. It is also noteworthy that immigrants remain generally optimistic and maintain their hopes for their future despite their problems. Practitioners serving immigrant populations are recommended to integrate grief and loss support into the spiritual care process through psychoeducation, assessments, and therapy.

Background: 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. Aims: 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. Method: 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. Result: 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. Conclusions: 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.

Background 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. Aims 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. Methods 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. Results 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. Conclusions 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.

Background 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. Aims 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. Methods 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. Results 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. Conclusion 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.

Background Currently, paradoxical findings exist regarding the level of functioning in individuals with Hikikomori (prolonged social withdrawal). Aims This systematic review aimed to clarify the functioning, disability, and health of individuals with Hikikomori and their families in comparison to those without Hikikomori. Method Relevant studies were searched from April 22 to 25, 2022, using MEDLINE, PsycINFO, Scopus, and two Japanese databases. Functions were categorized into ‘body functions”; “structure”; and “activity and participation’, which were further classified into subcategories. Results Of the 8,181 studies screened, 24 studies with 1,769 individuals with Hikikomori were included. Twelve, three, and four indicators from six studies on depression and anxiety, three on addiction, and two on thought problem symptoms, respectively, were higher in the Hikikomori group than in the comparison group, with at least moderate effect sizes. Three indicators from three studies on interpersonal relationships were worse in the Hikikomori group, with at least moderate effect sizes. The meta-analyses showed that internalizing symptoms, externalizing symptoms, and thought disorders were significantly higher in the Hikikomori group than those in the comparison group with moderate-to-high effect sizes. Contrastingly, communication/interpersonal interactions were significantly lower in the Hikikomori group than those in the comparison group. No significant differences were observed in daily life/social life and the families’ communication/interpersonal interactions and relationship. Conclusions The study limitations include a high risk of bias and heterogeneity. Overall, individuals with Hikikomori often have impaired mental and interpersonal interaction functions; thus, comorbidities of this condition should be carefully assessed. PROSPERO: CRD42022320592.

Professor Dinesh Bhugra, whose illustrious career in psychiatry spans nearly 5 decades, continues to collaborate with healthcare professionals, policymakers, patients, and caregiver groups worldwide, assuming multifaceted roles with unparalleled dedication. As a distinguished educator, researcher, writer, and mentor, he bridges diverse disciplines with a profound impact. His academic credentials, earned from globally renowned institutions, stand as a testament to his intellectual eminence.

Background The COVID-19 pandemic was associated with increased psychological distress and psychiatric service usage in Australia. Previous research into the first few months of the pandemic found severe inequality in telehealth psychiatry but no change in inequality for psychiatry service usage overall. However, it is unknown how inequality evolved over the remainder of the pandemic, as extended lockdowns continued in major Australian cities. Aims To understand how socioeconomic inequality in psychiatric consultations changed during the COVID-19 pandemic, using new data from 2020 to 2022. Methods We analysed routinely collected national Medicare data, provided to us as service counts per Statistical Area 3 (SA3) region by financial year from 2015 to 2016 to 2021 to 2022. We calculated daily rates of psychiatry attendances per 100,000 working age adults within each SA3 region, and we evaluated inequality in the distribution of consults using concentration indices and curves based on the Index of Relative Socio-economic Disadvantage (IRSD). Results We analysed 7 years of Medicare data from 321 SA3 regions. The national consultation rate increased in 2020 to 2021 from 45.16 to 50.17, and then decreased slightly in 2021 to 22 to 48.65. Inequality as measured by concentration indices rose from 0.169 in 2020 to 2021 to 0.177 in 2021 to 2022. Consultation rates in the most disadvantaged IRSD quintile decreased by 15.9% in 2021 to 2022 compared to smaller decreases of between 1% and 4% in the top 4 quintiles. Conclusion Our study shows that inequality in mental health service provision increased in the second year of the COVID-19 pandemic to the highest level seen in the 7 years of data we analysed. Individuals within the most disadvantaged IRSD quintile experienced a significant and disproportionate decline in service rates. Close monitoring and more granular data are needed to understand the drivers behind this inequity and its current status, and to inform interventions to improve it.

Background 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. Aims 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. Method 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. Results 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. Conclusions 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.

Background 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). Aims 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. Method 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. Results 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. Conclusion 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.

Background Excessive use of smartphones and the Internet can lead to addiction and may increase the risk of developing mental disorders, particularly in the context of the COVID-19 outbreak. Objective This systematic review and meta-analysis synthesized the existing literature reporting the impact of smartphone and Internet addiction on mental health during the COVID-19 pandemic. Methods A systematic search was performed on two databases, PubMed and EMBASE, following the PRISMA guidelines to identify articles conducted from December 2019 when the COVID-19 pandemic began to emerge. Studies were selected based on pre-defined criteria and assessed for quality before inclusion in the meta-analysis. The main effect estimate gathered from eligible studies was the odds ratio, which was computed using the random-effects model. Results Our findings demonstrated significant associations between Internet addiction and depression (OR = 4.09, 95% CI [3.28, 5.09]), Internet addiction and anxiety (OR = 3.08, 95% CI [2.08, 4.57]), smartphone addiction and depression (OR = 3.82, 95% CI [3.31, 4.40]), and smartphone addiction and anxiety (OR = 4.81, 95% CI [3.81, 6.07]) during the COVID-19 pandemic. Conclusion This meta-analysis underscores that Internet and smartphone addiction increases the likelihood of developing mental disorders in the context of the COVID-19 pandemic. During the outbreak of infectious diseases, it is imperative for nations to not only address economic and educational challenges but also prioritize the mental well-being of their citizens.

Background 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. Aim 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. Methods 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. Results 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. Conclusion 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.

Background 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. Aims 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. Methods 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. Results 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. Conclusions 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.

Background 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. Aim we aim to explore suicidal thoughts and attempts rates and their influencing risk factors. Methods 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. Results 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). Conclusions 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.