The Alternative Model for Personality Disorders (AMPD) proposes a dimensional framework with two core criteria: Criterion A (personality functioning) and Criterion B (maladaptive traits). Debate remains regarding their incremental validity, with prior studies producing mixed results. This study employed a Delphi method with 17 experts in personality disorders (PDs) to evaluate the conceptual, discriminative, clinical, and informative value of both criteria. Consensus indicated that Criterion B captures individualized trait expressions, while Criterion A was seen as global or individualized, depending on use of total or subscale scores. Both criteria were viewed as having stable and dynamic aspects. Experts noted Criterion A's overlap with general psychopathology, while Criterion B was seen to include both PD-specific and broader traits. Criterion A was mainly associated with informing treatment intensity, and Criterion B with guiding therapeutic style. Both criteria were seen as informative for several mental health outcomes. Despite overlap, most experts opposed merging the criteria.

Borderline personality disorder (BPD) is associated with poor quality of life (QoL), but little is known about which QoL dimensions are affected or what might predict QoL outcomes. Baseline data were collected from 208 participants (aged 15-25 years, with three or more DSM-5 BPD features) in one of three randomized controlled trials conducted at youth mental health services in Melbourne, Australia. Hierarchical regression analyses revealed that BPD severity, avoidant personality disorder diagnosis (AVPD), and psychotic disorder each independently predicted poorer overall QoL. Both BPD severity and AVPD independently predicted all psychosocial subscale dimensions of QoL. For the physical dimensions, AVPD independently predicted pain and senses, whereas BPD severity and psychotic disorder independently predicted independent living. Co-occurring mood or antisocial personality disorder predicted neither overall QoL nor any dimension of QoL. These findings provide additional weight to the argument that young people with BPD should be a high-priority group for early intervention.

The current study aimed to determine cutoff scores of the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) in clinical and nonclinical samples and thereby test its ability to discriminate between those samples. A total of 814 individuals participated, including a sine morbo (SM; Latin for "without any disease"; here specifically "without any mental disorder") subsample (n = 509), a clinical subsample without personality disorder (non-PD; n = 240), and a clinical subsample with personality disorder (PD; n = 65). Significant differences were found among the subsamples on all LPFS-BF 2.0 scores, with the PD subsample showing the most severe impairments, followed by the non-PD and SM subsamples. To determine cutoff scores, ROC curve analyses were conducted on 70% of the data (training set, randomly selected) and validated on the remaining set of the data (test set), controlling for age, sex, and level of education. The accuracy of the LPFS-BF 2.0 in discriminating between all three subsamples was demonstrated.

People with cancer often experience anxiety and depression following a diagnosis and can face barriers to accessing treatment for their mental health. An increasing number of patients are considering alternative approaches to managing their mental health symptoms, such as the psychedelic, psilocybin. A growing number of clinical trials show significant and enduring improvements in mood and quality of life following psilocybin-assisted therapy (PAT) in this patient group. While the lived experiences of patients undergoing PAT in clinical trials and medical contexts have been explored, the broad decision-making processes, perceptions of societal and self-acceptance of psilocybin, and the impact or otherwise of the legality of psilocybin outside of these settings have not. In this study, qualitative, semi-structured interviews were conducted to explore the attitudes and perceptions of using psilocybin by seven females in the United Kingdom with a current or previous diagnosis of cancer (four who had used psilocybin and three who had considered taking the drug). Data were analysed using Interpretative Phenomenological Analysis (IPA). Three group experiential themes were created: (i) somatic healing needs; (ii) outlawing nature: illegality as both a burden and boundary; and (iii) reconnecting self, nature, and mortality. Participants considered psilocybin a much-needed alternative to traditional treatments for the depression and anxiety they experienced in relation to their cancer diagnosis but felt its legal status was a significant barrier to access. As such, a compassionate access scheme here in the United Kingdom could transform the mental health of people with cancer.

Third-wave Cognitive Behavioral Therapy (CBT) interventions, which integrate mindfulness and acceptance-based strategies, have demonstrated efficacy in reducing anxiety and depression. However, barriers such as cost and limited access to in-person therapy restrict widespread usage. Digital delivery of third-wave CBT provides a promising, cost-effective alternative. This meta-analysis aims to synthesize the evidence for the effectiveness of digital telehealth third-wave CBT interventions in reducing symptoms of depression and anxiety through a comprehensive search of randomized controlled trials. Secondary objectives include subgroup analyses of additional psychosocial outcomes. A total of 13 studies were included with n = 2123 total participants. Results indicated a small-to-moderate reduction in anxiety symptoms (g = -0.38, 95% CI [-0.68, -0.09], df = 9, p = 0.01) with substantial heterogeneity. Depression outcome analysis showed consistent reduction in depressive symptoms (g = -0.41, 95% CI [-0.55, -0.27]), with low heterogeneity. Digital third-wave CBT interventions have the potential to reduce symptoms of depression and anxiety and offer accessibility while being comparable to traditional therapy formats. These findings highlight the potential of digital mental health interventions to address global disparities in mental health care as well as the need for improved trial design and methodologies.We have registered this study with the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42024541721.

Crisis resolution teams (CRTs), which aim to reduce acute admissions to mental health inpatient units, have been the subject of studies on practice, effects and service user experiences. However, such studies involve a limited proportion of the CRTs. National surveys are necessary to understand the large-scale implementation of CRTs. The aims of this survey were to describe the organisation and practices of Norwegian CRTs as reported by team managers. An online questionnaire was sent to team managers of all 56 CRTs in mental health services for adults in Norway in 2013. The response rate was 100%. Findings were compared to national recommendations for CRTs in Norway and to findings from a similar survey in England. CRTs were available for 90% of the Norwegian adult population. Significant variations in team composition and practices indicated differences in CRT services provided across teams, and CRTs were not assigned the role of gatekeeping acute inpatient admissions. Unlike in England, Norwegian CRTs served a broader range of service users than just those who would otherwise require admission to an acute mental health inpatient unit. CRTs showed partial adherence to national recommendations and even less compared to English CRTs and the CRT model in international literature. High adherence to the CRT model would require more specific national recommendations, adequate staffing and training, and for CRTs to be given the resources and authority to act as gatekeepers for acute inpatient admissions.

Asylum seekers face significant mental health difficulties. An assessment of cultural and contextual factors is necessary for a thorough evaluation of their mental illness. The Cultural Formulation Interview (CFI) can be a useful tool for this purpose, though further research is needed in diverse clinical settings and with varied populations to evaluate it as a cross-cultural assessment tool. Therefore, this study aims to map out asylum seekers' experience of the CFI in a real-life clinical context, applying a mixed-method design. The CFI Debriefing Instrument for Patients (n = 63) data were quantitatively analysed. Semi-structured debriefing interviews (n = 61) underwent thematic framework analysis. The study demonstrates how asylum seekers rated the CFI moderately acceptable (6.74; SD: 3.24). Feasibility obtained a modest score (0.44; SD: 0.85). Clinical utility seemed to be perceived slightly higher (1.04; SD: 0.51). Thematic framework analysis identified facilitators such as the CFI's ability to ask relevant and understandable questions, stimulating in-depth conversations, new insights, and the patient-clinician relationship. However, barriers included the number and difficulty of the questions, the unclear benefit of the CFI, painful confrontation with the past and their suffering, and emotional distress. This study underscores asylum seekers' nuanced experience of the CFI. Aspects proper to working with asylum seekers (e.g., impact of trauma, loss) must be considered when implementing the CFI. We formulate attention points to promote the use of the CFI as a tailored instrument to address asylum seekers' mental health needs safely.

Randomized controlled trials (RCTs) often include subgroup analyses to assess whether treatment effects vary across prespecified patient populations. However, these analyses frequently suffer from small sample sizes, which limit the power to detect heterogeneous effects. Power can be improved by leveraging predictors of the outcome-that is, through covariate adjustment-as well as by borrowing external data from similar RCTs or observational studies. The benefits of covariate adjustment may be limited when the trial sample is small. Borrowing external data can increase the effective sample size and improve power, but it introduces two key challenges: (i) integrating data across sources can lead to model misspecification, and (ii) practical violations of the positivity assumption-where the probability of receiving the target treatment is near zero for some covariate profiles in the external data-can lead to extreme inverse-probability weights and unstable inferences, ultimately negating potential power gains. To account for these shortcomings, we present an approach to improving power in preplanned subgroup analyses of small RCTs that leverages both baseline predictors and external data. We propose de-biased estimators that accommodate parametric, machine learning (ML), and nonparametric Bayesian methods. To address practical positivity violations (PPVs), we introduce three estimators: A covariate-balancing approach, an automated de-biased machine learning (DML) estimator, and a calibrated-DML estimator. We show improved power in various simulations and offer practical recommendations for the application of the proposed methods. Finally, we apply them to evaluate the effectiveness of citalopram for negative symptoms in first-episode schizophrenia (FES) patients across subgroups defined by duration of untreated psychosis (DUP), using data from two small RCTs.

This study investigates the intersectional challenges confronting Gazan widows during the Israeli-led genocide and military blockade, using in-depth interviews with thirty internally displaced widows in Rafah. Using thematic content analysis informed by an intersectional framework, it shows how bereavement, displacement, institutional collapse, economic hardship, and patriarchal control undermine health and call for justice-centered interventions that uphold widows' human dignity. The analysis identifies six interrelated themes, including the compounded effects of widowhood and forced displacement, war-related physical and psychological injury, economic precarity, inadequate shelter, barriers to accessing essential services, and faith-based religious coping in the absence of institutional protection.

This study examines the design and marketing of maternal wellness tourism. We adopted a mixed-methods design integrating large-scale user-generated content (≈128,000 entries modeled with Latent Dirichlet Allocation) and 47 semi-structured interviews with expectant mothers; grounded theory guided coding, triangulation, and theory building. We develop a conceptual framework identifying five core dimensions: prenatal safety, psychological restoration, physical comfort, sustainable environment, and informed decision-making. The findings reveal that maternal travel is not purely for leisure but involves complex, risk-averse, and socially influenced decisions. The resulting model integrates the affective, physical, and digital aspects of the travel experience for pregnant women. Practically, it offers marketing insights for destinations, such as building trust through medical partnerships and designing trimester-specific services. The study concludes by advocating for more inclusive and care-oriented tourism planning that aligns with maternal health priorities and sustainable development goals.