Afghanistan has experienced decades of war, political instability, displacement, poverty and structural upheaval, all of which are likely to have contributed to the population's deteriorating mental health. Individual studies and reports describe depression, anxiety, trauma-related distress and a severe lack of access to care, especially among women. However, the evidence remains fragmented. There has been no recent synthesis of evidence on mental health conditions, determinants, coping strategies, services and interventions among people living in Afghanistan. This protocol describes a systematic review of the literature on the mental health of this population.

This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. The review will be conducted and reported in accordance with PRISMA 2020. MEDLINE, Embase, APA PsycINFO, Web of Science and WHO Global Index Medicus will be searched using subject headings and keywords related to Afghanistan and mental health, with searches updated before final analysis. Relevant grey literature will also be included. Eligible study designs include quantitative, qualitative and mixed-methods studies reporting mental health outcomes, determinants, coping strategies, access to mental healthcare or mental health interventions among people living in Afghanistan. No language restrictions will be applied. Title and abstract screening and full-text review will be conducted independently by two reviewers, with disagreements resolved through discussion or, if necessary, adjudicated by a third reviewer. Data will be extracted using a piloted structured template. Given the expected heterogeneity in study designs and outcome measures, quantitative findings will be reported as frequencies and qualitative data will be analysed using thematic approaches to support the synthesis. Where appropriate, findings will be grouped by population subgroup and study setting. Study quality will be appraised using the Mixed Methods Appraisal Tool.

Ethical approval is not required for this study as it will involve the analysis of previously published literature and publicly available reports. The findings will be disseminated through peer-reviewed publication and conference presentations and may inform clinicians, researchers, humanitarian agencies and policymakers.

CRD420261403755.

Social and structural determinants of health (SDoH), including youths' lived experiences, shape exposure to stressors and access to resources associated with youth mental health and suicide risk. Although county-level indicators are commonly used to guide prevention efforts, it remains unclear how well they capture lived experiences of adversity or differentiate mental health risk.

Data are from Project Lift Up, a national survey of adolescents and young adults aged 13-22 years (N=4,800 with residential ZIP code data) collected between 2022 and 2023. County-level SDoH indicators from the 2023 County Health Rankings were used to identify latent profiles representing distinct structural contexts. Self-reported SDoH included financial instability, food insecurity, poor home conditions, community disorder, barriers to mental health care, discrimination, and adversity. Multivariate regression models examined associations with depression/anxiety symptoms, lifetime suicidal ideation, suicide attempt, and perceived likelihood of living to age 35. Analyses were conducted in 2026.

Seven county-level SDoH profiles characterized distinct structural contexts and showed modest associations with self-reported SDoH and mental health. Self-reported SDoH were more strongly associated with outcomes than county-level context. Inclusion of self-reported SDoH improved model fit for depression/anxiety symptoms (adjusted R²: 0.16 to 0.42). Food insecurity, discrimination, adversity, and community disorder were consistently associated with higher depression/anxiety symptoms and greater odds of suicide attempt. Mental health care barriers were strongly associated with depression/anxiety and suicidal ideation but not suicide attempt. County-level profiles showed modest associations that were further attenuated after accounting for self-reported SDoH.

County-level SDoH identify geographic patterns of risk, but youths' lived experiences more strongly differentiate individual vulnerability. Prevention strategies relying solely on county-level structural indicators may miss high-risk youth, even in relatively advantaged areas. Integrating geographic targeting with screening for social adversity may improve identification of youth at risk and inform multilevel mental health prevention planning.

Mental disorders in children and adolescents have increased substantially, placing growing pressure on healthcare systems. Home treatment has emerged as an alternative to conventional inpatient treatment as usual (I-TAU), potentially offering clinical and cost benefits. This study aimed to evaluate the cost-effectiveness of an intensive home treatment programme (AT_HOME) compared to I-TAU in Switzerland.

Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs.

The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds.

In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources.

DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).

Mentalization, emotion regulation (ER) and identity integration are important transdiagnostic concepts contributing to mental health. Yet, their interconnections are relatively poorly understood. Adolescence is a critical period for developing these skills, as well as for risk of developing mental health problems. In this study, we used network analysis among adolescents with and without mental health problems to examine how mentalization, ER, and identity integration overlap and interplay with each other, and which aspects of them are the most central in mental health problems. A non-clinical (N = 360) and a clinical sample (N = 110) of Finnish adolescents filled out the Mentalization Questionnaire (MZQ), the short version of the Difficulties in Emotion Regulation Scale (DERS) and the Development and Identity Diffusion in Adolescence (AIDA) questionnaire. Network analyses were conducted on the two data sets. With non-clinical data, measures clustered more expectedly around themselves, whereas with clinical data, different measures overlapped and connected more with each other. Limited access to effective ER strategies (DERS) and Consistent self (AIDA) were more central subconstructs in the clinical sample than in the non-clinical sample, implying that they could have the most central impact on maintaining difficulties in mentalization, ER, and identity development in adolescents with psychiatric disorders. Differences between the networks might imply complexity and individuality of factors contributing to problems with them. This would highlight the importance of individual case formulation about factors contributing to and maintaining problems when considering treatment targets, as well as the need for more research on individual dynamics of psychological problems.

This study provides a real-world evaluation of the multicomponent Emilia-Romagna First Episode Psychosis Program (RER-FEP) (2013-2019). It assesses how timeliness, treatment specificity, and socio-demographic factors related to fairness (including citizenship) are associated with clinical outcomes.

A naturalistic cohort of 1085 FEP patients (aged 18-35) was analyzed. Outcomes included recovery (Δ HoNOS) and remission (HoNOS score ≤ 8). Predictors included duration of untreated psychosis (DUP) as a measure of timeliness and the frequency of FEP-specific interventions (CBT/psychoeducation) as an indicator of treatment specificity.

The 1085 participants (mean age 23.8 years; mean follow-up 2.5 years) showed significant improvements in HoNOS scores (p < 0.001), with the largest reduction observed in the first six months. Longer duration of untreated psychosis was associated with poorer recovery outcomes. Treatment specificity was associated with improved outcomes: exposure to more than 36 FEP-specific interventions was linked to higher odds of remission (OR = 1.74). Regarding fairness, single status and lower educational level were associated with lower likelihood of remission, while foreign citizenship was associated with higher baseline and follow-up severity. Substance use was associated with improvement in behavioral symptoms.

This real-world study suggests that multicomponent early intervention programs are associated with continuous clinical improvement. Outcomes appear to be influenced by timeliness of access, delivery of specific interventions, and socio-demographic factors. These findings highlight the importance of integrating effectiveness and equity considerations within early psychosis services.

The risk of psychiatric readmission and death is high in the year after discharge. Existing posthospitalization interventions show modest and sometimes inconsistent average effects, suggesting that optimizing routine follow-up care may require identifying clinically meaningful heterogeneity in routine care practice. This study aims to identify latent subgroups of follow-up care patterns during the 12 months after psychiatric discharge and examine their associations with patient characteristics, rehospitalization, and all-cause mortality.

Using provincial linkable health administrative databases, we investigated a cohort of 3467 patients discharged after psychiatric hospitalization. Latent class analysis was used to identify subgroup memberships of follow-up care. Multivariable analyses estimated subgroups' associations with patient social and clinical correlates, and survival analyses estimated subgroups' associations with rehospitalization and all-cause mortality.

Five distinct subgroups of follow-up care patterns were identified, including low to high quality of care, diversified care and high access to primary care, with two subgroups having frequent emergency (ED) use. Serious mental disorders and prior hospitalizations were concentrated in the high follow-up care subgroups, where rehospitalization hazards were significantly elevated and approached one-third. Mortality did not differ across subgroups.

Follow-up care after psychiatric discharge is heterogeneous, reflecting patients' clinical risk profiles and outpatient contexts. Rehospitalization was driven primarily by clinical severity, while frequent ED use signalled unmet follow-up care needs, demonstrating two distinct post-discharge dynamics with different implications for quality monitoring and service improvement. These findings support subgroup-informed post-discharge optimization and may help explain the average modest effects of transitional interventions observed in prior research. Both carry direct relevance for policy and practice.

Young people increasingly experience mental health challenges and often turn to the internet for support. Self-guided digital mental health promotion services have become widely used resources for youth seeking help and guidance. These platforms offer accessible, anonymous support, yet little is known about the concerns young people articulate when engaging with them.

This study aims to examine inquiries submitted to the digital letter box of Mindhelper.dk, Denmark's most widely used digital mental health promotion service. Using qualitative analysis, the study aims to identify recurring themes in young people's mental health concerns, explore gender differences in engagement, and generate insights to inform the development of more relevant and targeted digital self-help interventions.

Using an inductive thematic approach informed by a constructivist-grounded theory coding framework, this study analyzes 2523 inquiries submitted to the Mindhelper digital letter box between March 2016 and August 2023. The dataset provides unsolicited first-person accounts from young people in moments of emotional vulnerability, offering insights into how mental health concerns are articulated in naturalistic settings.

The analysis identifies 17 recurring themes reflecting the mental health challenges young people seek help for. These were grouped into 3 overarching analytical categories: Social Relationships and Social Contexts, Emotional Life, and Body and Illness, with the first 2 dominating the material. Prominent themes included Sociality, Love Life, Unease, Self-doubt and Insecurity, and Seeking Support. Across genders, inquiries frequently focused on social relationships, particularly Sociality and Love Life. However, girls were markedly overrepresented among users, while only minor gender differences were observed in the distribution of themes.

The findings suggest that young people's mental health concerns are closely tied to everyday developmental and relational challenges rather than severe psychopathology alone. Digital letter box services may capture early expressions of distress that might not otherwise reach formal support systems. This highlights the preventive potential of such services and the value of using self-initiated digital data to inform the development of relevant digital mental health support and better understand how young people articulate and act on emerging mental health concerns.

High suicide risk is observed after discharge among patients hospitalized with suicidal thoughts and behaviors. Suicidal ideation (SI) is a well-known precursor to suicide attempts (SAs) and suicide, and it is a central indicator of subjective distress.

This study aimed to examine patient characteristics and predischarge symptoms that might (1) distinguish between participants with and without postdischarge SI, (2) predict peak SI frequency, and (3) predict the intensity and longitudinal trajectory of SI.

Before discharge, patients hospitalized due to high suicide risk were screened for diagnosis (MINI 7.0.2 [Mini International Neuropsychiatric Interview] and SCID-5-PD [Structured Clinical Interview for DSM-5 Personality Disorders]), general symptom severity (Outcome Questionnaire-45 [OQ-45]), depression (Patient Health Questionnaire-9 [PHQ-9]), SI (Suicide Status Form-IV [SSF-IV] and Beck Scale for Suicide Ideation), and suicidal behaviors (Suicide Attempt Self-Injury Count). Twenty male and 16 female adult participants installed a mobile app on their smartphones and reported their level of SI on a 5-point Likert scale (1=not at all to 5=very much) 5 times per day for 10 days after discharge. Associations between baseline characteristics and postdischarge SI were analyzed using logistic regression, median regression, and mixed-effects linear regression.

SI was present in 49.2% (528/1073) of all completed surveys. Women reported SI more frequently than men (χ21=63.39; P=.001). No baseline variables differentiated participants who later did (28/36, 77.8%) and did not (8/36, 22.2%) report momentary SI after discharge. Participants hospitalized due to a high risk of suicide (12/36, 33.3%), compared with those hospitalized following an SA (24/36, 66.7%), reported SI more often (χ21=22.64; P=.001) and had a higher frequency of peak SI scores (β=17.74, 95% CI 8.56-26.91; P=.001). Moreover, the variation in the temporal trajectory of postdischarge SI was characterized by large differences between participants (intraclass correlation coefficient [ICC]=0.682), while the intensity of SI did not change over the 10-day period at the group level (β=0.03, 95% CI -0.01 to 0.06; P=.09). Predischarge scores on the SSF-IV chronic subscale, including hopelessness, self-hate, and psychological pain, predicted the intensity of SI after discharge (β=0.13, 95% CI 0.05-0.20; P=.002). No baseline variables predicted the trajectory of SI.

SI after discharge was common, varied substantially between participants, and may be more prevalent than previously reported, particularly in groups with high morbidity and prior SAs. The SSF-IV may be a valuable tool for treatment planning and assessment during the inpatient stay.

Aim: To conduct a comprehensive analysis of the legal guarantees for Ukrainian law enforcement officers performing their official duties in areas of military (combat) operations, and their impact on the preservation of mental and physical health. The research also aims to identify the relationship between the level of implementation of these guarantees, psycho-emotional state, occupational stress, and the risks of burnout among this category of personnel.

Materials and Methods: The study was designed as an interdisciplinary empirical legal study combining legal, medico-social, and statistical methods. It included comparative legal analysis, an anonymous survey, and statistical processing of the data. The study involved 48 law enforcement officers with experience of service in combat zones or other high-risk conditions. The main research instrument was an adapted questionnaire assessing psychological competencies and the perception of legal guarantees.

Results: The respondents highly rated the importance of psychological competencies for professional communication, while self-assessment of communicative skills was moderately high. At the same time, indicators of stress prevention, perception of legal guarantees, legal certainty, maladaptive behaviour risks, and mental health remained at an average level. The lowest scores were related to access to psychological assistance and access to rest and rotation. Correlation analysis showed that stronger legal guarantees were associated with lower occupational stress, while greater legal certainty was linked to better self-assessed mental health. Insufficient legal guarantees were significantly associated with emotional burnout.

Conclusions: Legal guarantees for law enforcement personnel in combat conditions should be regarded not only as a formal element of service status, but also as a practical mechanism for preserving mental and physical health. Strengthening legal certainty, improving access to psychological and medical support, and ensuring effective rest and rotation mechanisms are essential for reducing stress and burnout and for enhancing professional resilience.

ObjectiveBlack sexual minority men (SMM) in the United States experience disproportionate HIV burden and lower engagement across the HIV Continuum of Care (HIV-CoC), partly due to intersecting stigmas. Structural interventions addressing these barriers remain limited.MethodsWe developed This is Your Moment (TiYM), a culturally-grounded media campaign designed to mitigate stigma and encourage engagement in care for Black SMM in Atlanta, Georgia. To inform implementation, we conducted focus groups with 63 stakeholders from six clinics and community-based organizations (March-October 2023), guided by the Consolidated Framework for Implementation Research. Transcripts were analyzed thematically.ResultsParticipants described TiYM as highly acceptable, engaging, and relatable. Facilitators included alignment with organization priorities; ease of QR code integration; potential to improve health literacy and reduce stigma. Barriers included concerns about inclusivity and unintended disclosure.ConclusionKey partners perceived TiYM as having strong implementation potential, while identifying barriers for refinement and implementation strategy.