Social Psychiatry and Psychiatric Epidemiology

Background: Sexual minority ([SM] or LGB+) adolescents experience mental health (MH) inequities and disproportionately high rates of bullying and victimisation. Less is known about the cumulative effects of bullying and victimisation across adolescence on MH in early adulthood, or the moderating role of loneliness and social support in this relationship. Objective: To investigate cumulative effects of bullying and victimisation in adolescence on MH in early adulthood, including the role of loneliness/social support. Methods: Drawing on a UK-wide nationally representative sample of individuals (N=12,872/LGB+ 22%) with self-reported bullying and victimisation assessed at ages 11/14/17/23, and MH (psychological distress/self-harm/attempted suicide) at age 23. Logistic models assessed separate associations between cumulative bullying or victimisation (0, 1, [≥]2times) and MH, and differences by sexual identity (using appropriate interactions), with adjustment for loneliness and social support. Findings: Across adolescence, SM individuals experienced higher prevalence of cumulative victimisation (3 times; gay/lesbian:22%, bisexual:22% vs heterosexual:9%) and bullying (2 times; gay/lesbian:35% and bisexual:27% vs heterosexual:18%). Models revealed substantial inequalities with higher proportions of SM individuals reporting self-harm compared to heterosexual peers with the same levels of experienced victimisation. Among those reporting victimisation 1 and [≥]2 times, 15% (95% CI 13-16%) and 23% (21-25%) of heterosexual individuals reported self-harm, increasing to 41% (33-50%) and 53% (47-59%) for bisexual, and 24% (10-39%) and 49% (40-59%) for gay/lesbian individuals, and 24% (11-38%) and 53% (39-67%) for other SM identities, respectively. Similarly, for heterosexual individuals experiencing victimisation 1 and [≥]2 times, 6% (5-8%) and 13% (11-14%) reported attempted suicide respectively. This increased to 21% (13-29%) and 38% (33-44%) for bisexual, and 17% (6-29%) and 34% (24-44%) for gay/lesbian individuals experiencing victimisation 1 and [≥]2 times, respectively. A key finding was that adjustment for loneliness and lack of peer/family support reduced the proportions reporting adverse mental health by 15-45% among SM but not heterosexual individuals. Similar patterns by sexual identity were found for bullying and all indicators of MH. Conclusions: SM individuals experience higher levels of cumulative bullying and victimisation across adolescence, which is associated with substantially higher rates of mental ill-health in early adulthood. Experiences of loneliness explain MH inequalities to greater extent in SM youth compared to heterosexual peers.

Research on adverse childhood experiences (ACEs) has largely relied on retrospective and predominantly adult-focused models that conceptualize mental health difficulties as outcomes of past adversities operating through linear causal pathways. Less is known about how adolescents themselves understand the mechanisms linking adversity and mental health. This study explored young peoples lived experiences of these mechanisms using participatory arts-based methods. Sixty-two young people aged 10-24 years from diverse and often underrepresented backgrounds across England participated in trauma-informed creative workshops. Workshops incorporated multiple artistic modalities, including visual arts, animation, drama, dance, music, film, and creative writing, generating experiential and conversational data. Data were analysed using Framework Analysis within a critical realist approach. Young people did not primarily describe their mental health through narratives linking past adverse events to current outcomes. Instead, they emphasized present-day relational, environmental, and institutional conditions as the most salient influences on wellbeing. Two interconnected pathways were identified: system failures and seeking restoration. System failures referred to ongoing experiences of invalidation, bullying, sensory overwhelm, masking of identity, and unresponsive educational or mental health systems that generated feelings of unsafety. Seeking restoration encompassed actively pursued experiences of belonging, community, validation, sensory regulation, nature connection, creative expression, trust, and authenticity that supported wellbeing. Across pathways, felt (un)safety emerged as the central organizing mechanism through which experiences affected mental health. Findings suggest that adolescents explain their mental health less in terms of historical adversity and more through current experiences of safety, recognition, and belonging. Trauma-informed research and practice may therefore benefit from complementing questions about past adversity with greater attention to what is happening in young peoples lives now and the conditions that support recovery and flourishing.

Objectives To identify research priorities for improving the mental health of neurodivergent higher education (HE) students by exploring the perspectives of individuals with lived experience. Design Qualitative study using an online survey. Data was analysed using a deductive-inductive, hybrid semantic thematic analysis. Setting UK higher education institutions. Participants 104 current and former neurodivergent HE students with diverse neurodivergent profiles and intersecting identities. Main outcome measures Participant recommendations regarding priorities for future research on neurodivergent student mental health. Results Six themes were identified and were grouped into (1) general recommendations for research and (2) recommendations specific to neurodivergence within a HE context. Participants prioritised a shift away from medical model approaches towards research informed by social and strengths-based perspectives. Key priorities included improving understanding of diagnostic barriers and misdiagnosis, reducing stigma, investigating institutional barriers within HE, evaluating the effectiveness of support and accommodations and examining the experiences of underrepresented and intersectional groups. Participants emphasised the need for research on more flexible teaching practices, sensory-friendly learning environments, integrated mental health and educational support and alternatives to diagnosis-dependent access to services. Conclusions Future research should move beyond descriptive accounts towards evaluating interventions and current support provision to understand if they improve the mental health of neurodivergent students. Adopting intersectional approaches, moving beyond binary deficit- or strengths-based frameworks and focusing on inclusive, needs-based support rather than diagnosis-led systems are likely to produce more equitable and effective outcomes for neurodivergent students in higher education.

Background: Girls are more likely than boys to experience psychological distress during adolescence. Drivers of this gender gap remain under-studied, despite its large impact on later life and outcomes, especially for women. Explanatory factors can be gendered in their prevalence (differential exposure) and/or in their impact (differential susceptibility). We developed a multi-domain framework of explanatory factors for distress and applied it in four low- and middle-income countries. Methods: We first proposed a framework of explanatory factors for psychological distress grouped into seven domains (biological, cognitive, psychological, behavioural, social, environmental and broader societal). We applied this framework to identify explanatory variables assessed in childhood and adolescence in the Young Lives longitudinal cohort studies in Ethiopia (N=908), India (N=952), Peru (N=634) and Vietnam (N=887). Distress symptoms at 18-19 years were measured with the Strengths and Difficulties Questionnaire Emotional Symptoms scale. Gendered prevalence of each explanatory factor was tested with Mann-Whitney tests, and gendered impact with country-specific linear regressions including a gender-by-factor interaction term. Exploratory boosted-tree machine-learning models, interpreted with SHAP values and permutation feature importance, examined the contribution of these factors to the gender gap in each country. Results: Distress was higher in girls than boys in every country, the gap ranging from 0.62 points in Ethiopia and Vietnam to 1.76 in India and 2.45 in Peru. Some explanatory factors were consistently gendered in prevalence (e.g. girls experienced greater role overload in each country), while others were gendered only in some countries (e.g. study amount was higher for girls in Peru and Vietnam, but not Ethiopia or India). Gendered impacts on distress displayed more variability across countries. For example, higher self-esteem was more protective for boys than girls in India, Peru and Vietnam, but more protective for girls in Ethiopia. The machine-learning models identified important predictors across all framework domains, though their salience varied by country. Conclusions: Our findings underscore the importance of considering multi-domain explanations for mental-health outcomes and observed inequalities in mental health. Large cross-country differences in the gender gap and in the prevalence and influence of explanatory factors caution against generalising drivers of mental-health outcomes and inequalities across contexts.

Child maltreatment (CM) is a global phenomenon, yet its prevalence, acceptability, and psychosocial consequences vary across cultures. This study examined self-reported CM, its perceived acceptability, and associations with psychosocial outcomes among 1,617 adults (Mage = 25.21, SD = 6.74) across 13 countries and regions. Participants completed an online survey assessing physical neglect, physical abuse, emotional maltreatment, sexual abuse, and witnessing domestic violence, alongside perceived acceptability, post-traumatic growth, resilience, perceived social support, post-traumatic symptoms, and psychological distress. Country/region differences were tested via mixed-effects; whether CM-outcome associations varied by country/region was tested via fixed-effects interaction models. Significant cross-country/region variability emerged for most CM subtypes, especially for emotional maltreatment. Witnessing domestic violence rates did not differ significantly, though its acceptability still varied significantly, as did all other types. Greater CM exposure was linked to poorer mental health for several subtypes and to greater acceptability of maltreatment, raising concerns about intergenerational normalisation. CM-outcome associations were largely consistent across countries/regions, with only isolated, exploratory exceptions. Findings show that while CM's adverse psychosocial impact shows little cross-national variation, its prevalence and normative framing are culturally shaped, underscoring the need for culturally sensitive assessment and intervention.

South Asian Americans are often aggregated within broader Asian American research on mental health help-seeking, potentially obscuring culturally specific family and community processes. This study examined how family systems, sociocultural expectations, and family roles shape recognition of emotional distress and pathways to mental health care among South Asian American young adults. Five semi-structured virtual focus groups were conducted with 23 South Asian American young adults (ages 18-30) residing in Texas. Discussions explored mental health stigma, family influences, help-seeking, barriers to care, and strategies for improving mental health support. Transcripts were analyzed using MAXQDA, with analytic memos and reflexive practices informing theme development. Nine interconnected themes emerged. Participants described community stigma becoming internalized through expectations of self-reliance, perfectionism, and family responsibility, shaping whether distress was recognized as warranting professional support. Families functioned as both barriers and facilitators of help-seeking, while intergenerational differences and mental health literacy influenced recognition and treatment acceptance. Older siblings described greater caregiving responsibilities and serving as early mental health advocates, while younger siblings described benefiting from increased family openness established by older siblings. Participants also emphasized privacy, culturally responsive care with cultural humility, and peer support through shared lived experiences. These findings extend broader Asian American help-seeking literature by identifying how community stigma may become internalized through family and sociocultural expectations and highlighting sibling roles in shaping mental health attitudes within South Asian American families. Findings highlight culturally responsive care, family-centered mental health education, mental health literacy, and professionally facilitated peer support as potential pathways to care.

Background. Population-representative evidence on social inequalities in youth mental health from an intersectional perspective is limited. We investigated inequalities across multiple mental health outcomes among young adults and examined whether measures operated equivalently across social and intersectional groups. Methods. Cross-sectional analyses were conducted with 9,675 participants aged 23 years from the nationally representative UK Millennium Cohort Study (born 2000-2002). Self-reported outcomes included psychological distress (Kessler-6), probable serious psychological distress/'caseness' (Kessler-6 score [≥]13), psychological wellbeing (Short Warwick-Edinburgh Mental Well-Being Scale; SWEMWBS), past-year self-harm, and lifetime suicide attempts. Measurement invariance analyses assessed comparability of the Kessler-6 and SWEMWBS across groups. Intersectional MAIHDA examined inequalities by sex assigned at birth, ethnic identity/background, sexual identity, and childhood poverty. Young people with lived experience of mental ill-health and/or social discrimination contributed to study design, interpretation, and reporting. Findings. Large inequalities were observed across all outcomes, with the largest disparities by sexual identity, followed by sex assigned at birth, childhood poverty history, and ethnic identity/background. Across intersectional strata, predicted psychological distress ranged from -0.27 to 1.32 SDs, and psychological wellbeing from -0.54 to 0.11 SDs. Predicted prevalence varied 6.99-fold (9.81% to 68.55%) for psychological distress 'caseness', 6.84-fold (8.60% to 58.79%) for self-harm, and 22.10-fold (1.96% to 43.32%) for suicide attempts. Young people at the intersection of sexual minority status, female birth sex, childhood poverty, and some ethnic minority identities/backgrounds experienced particularly poor outcomes. Most inequalities showed cumulative patterns consistent with additive expectations, although some intersectional groups experienced better or worse outcomes than expected. Accounting for measurement differences revealed inequalities that were otherwise undetected. Interpretation. Findings highlight the large extent of mental health inequalities when multiple dimensions of social (dis)advantage are considered, and the need to address both the social conditions generating these inequalities and the methodological assumptions shaping how they are measured and understood.

Frequent comparisons with idealized portrayals of others on social media may be linked to poorer mental health. To test this hypothesis, we systematically searched PsycInfo, MEDLINE, and Web of Science for studies published through April 28, 2026. A total of 149 observational studies (N = 76,262) and 77 experimental studies (N = 15,404) were included in meta-analytic syntheses. Upward social comparison tendency correlated cross-sectionally with mental health outcomes, including psychopathology (r = .32) and body dissatisfaction (r = .54). Worse comparative self-evaluations were associated with poorer mental health and vice versa, with moderate-to-large effect sizes. Across experimental studies, upward social comparisons adversely affected mental health. Results were robust in sub-group analyses (e.g., female or young samples). Across study designs, there was no evidence that downward comparisons were linked to mental health. These findings identify upward social comparisons as a robust correlate and potential risk factor for poor mental health.

Background: Post-displacement stressors affect mental health among refugees and asylum-seekers, yet the behavioral mechanisms underpinning this relationship remain understudied. Objective: To examine the role of physical activity in the relationship between post-displacement stressors and mental health outcomes among Farsi/Dari speaking refugees and asylum-seekers in Australia. Methods: Data were drawn from a longitudinal community-based cohort study of 343 Farsi and Dari speaking refugees and asylum-seekers (80 female, 23.3%) in Australia conducted between 2017 and 2019. Data from post-displacement stressors measured at the baseline, physical activity at one-year follow-up, and mental health outcomes (symptoms of posttraumatic stress disorder (PTSD) and depression and personal mastery) at two-year follow-up were included in the study. Longitudinal path analyses were conducted to test the mediating role of moderate-to-vigorous physical activity and sedentary behaviour in the associations between post-displacement stressors and mental health outcomes. Results: After controlling for baseline levels of depression and PTSD, traumatic events, and key demographic characteristics, post-displacement stressors significantly predicted less moderate-to-vigorous physical activity (MVPA) ({beta} = -0.18, 95% CI [-0.292, -0.056]) and more sedentary behavior ({beta} = 0.13, 95% CI [0.011, 0.243]) at one-year follow-up. Less MVPA, in turn, significantly predicted greater symptoms of depression ({beta} = -0.21, 95% CI [-0.353, -0.060]) and lower level of personal mastery ({beta} = 0.19, 95% CI [0.033, 0.327]) while greater time spent in sedentary behavior predicted greater symptoms of depression ({beta} = 0.21, 95% CI [0.060, 0.359]), PTSD ({beta} = 0.24, 95% CI [0.096, 0.386], and lower personal mastery (({beta} = -0.18, 95% CI [-0.336, -0.011]). Significant indirect associations were observed between post-displacement stressors and depressive symptoms and personal mastery through MVPA, and between post-displacement stressors and depressive and PTSD symptoms through sedentary behaviour. Conclusion: These findings provide the first longitudinal evidence that moderate-to-vigorous physical activity and sedentary behavior partially explain the relationship between post-displacement stressors and subsequent mental health outcomes among refugees and asylum-seekers. Addressing these modifiable behaviors may represent targets for future intervention research to promote mental health during resettlement. Keywords: refugees; physical activity; post-displacement stressors; mental health

Background: Previous trauma research includes many limitations, such as the scarcity of pretraumatic health measurements and assessment of traumatic experiences with a broad scope across the lifespan. To respond to these gaps, we aimed to develop a new, prospective, population-based trauma dataset from childhood to middle age. Methods: We used the Young Finns Study that is a population-based, multi-generational, prospective study (n = 3596 for the main generation). It has started in 1980 (baseline assessment) and includes follow-ups in 1983, 1986, 1989, 1992, 1997, 2001, 2007, 2011/2012, and 2018-2020. From the 38-year follow-up and ten measurement points of the YFS, we collected all relevant trauma variables, including both free-format and structured questions that both the participants and their parents responded to. By a data-driven case-to-case analysis, we developed a scale to numerically capture variation in the quality of the experiences. Results: Our final dataset captured a total of 7769 traumatic experiences. We also developed the Traumatic Experience Severity Scale (TESS), including six subscales such as shamefulness, rarity, danger to life or health, effects on everyday life, human-made physical threat, and whether the target person was within or outside one's household. We also preprocessed the dataset to be later easily interleaved with other psychological, cardiovascular, and epigenetic variables of the YFS. Conclusions: We believe this new trauma dataset with thousands of experiences across the lifespan provides new opportunities to multidisciplinary, lifelong trauma research.

Importance: Not in Education Employment or Training (NEET) in youth is associated with poorer mental health and is increasing. Prior work has treated NEET as a single status, obscuring whether repeated disengagement carries cumulative later mental health risk. Objective: Estimate associations between the number of NEET occasions between ages 16 and 33 years and depression, anxiety, wellbeing and a recent suicide attempt at age 33. Secondary analysis explored associations between age of first NEET and type of NEET with outcomes. Design, Setting and Participants: 3,792 individuals from a longitudinal population-based birth cohort (Avon Longitudinal Study of Parents and Children), followed from birth to age 33. Exposure: Number of NEET occasions, modelled as a count and as categories (0, 1, 2, 3+), the age of first NEET occasion and the type of NEET (single, sustained or recurrent occasions). Main Outcomes and Measures: Depression (SMFQ), anxiety (GAD-7), lower life satisfaction (SWLS), recent suicide attempt. Results: Each additional NEET occasion was associated with higher odds of depression (OR: 1.29 [95%CI: 1.18, 1.40], PFDR=3.04x10-08), anxiety (1.21 [1.11, 1.32], PFDR=7.54x10-05), lower life satisfaction (1.53 [1.40, 1.68], PFDR=2.26x10-19) and a recent suicide attempt (1.51 [1.28, 1.77], PFDR=1.17x10-06). Relative to never being NEET, odds of depression were higher at three or more NEET occasions (2.68 [1.74, 4.11], PFDR=1.76x10-05), while lower life satisfaction (5.97 [3.93, 9.05], PFDR=4.94x10-16) and a recent suicide attempt (7.40 [3.08, 17.80], PFDR=1.18x10-05) increased stepwise from one to three or more occasions. Associations were strongest for first NEET at ages 25 to 33, though first NEET between ages 16 to 20 was also associated with a recent suicide attempt (4.49 [2.20, 9.17], PFDR=6.51x10-05). Among those ever NEET, sustained and recurrent NEET showed little association beyond a single occasion, except for lower life satisfaction (2.60 [1.68, 4.02], PFDR=0.0001) and a recent suicide attempt (3.16 [1.23, 8.08], PFDR=0.042). Conclusions and Relevance: Repeated NEET status across adolescence and early adulthood was associated with poorer mental health at age 33, with dose-dependent associations for depression, life satisfaction and a recent suicide attempt. Our findings suggest that preventing repeated NEET and identifying mental health need at the point of first NEET entry, may be important targets for intervention and/or prevention of later poorer mental health.

Background: The decline of mental health among adolescents in the UK over the past two decades has occurred amidst many societal and technological changes making it difficult to identify drivers of these trends. We aimed to identify which aspect of life showed the most rapid deterioration in satisfaction in the UK since 2009 and which aspects have become increasingly correlated with mental health. Methods: Between 2009 and 2024, 15,829 adolescents aged 10-15 rated their satisfaction with life as well as five aspects of life (family, friends, school, schoolwork, appearance), via the UK Household Longitudinal Study. Population-weighted regressions were used to estimate annual summary statistics on these items (means, proportions) and the relative associations between satisfaction items and socioemotional difficulties, as measured by the Strengths and Difficulties Questionnaire (SDQ). Meta-regressions estimated linear changes over time, with interactions testing for heterogeneity across sexes, age-groups, and household income. Results: Mean satisfaction with life dropped over the 16 years of study (B=-0.028, 95% CI=-0.034, -0.022), as did satisfaction with all five aspects of life. Satisfaction with school declined most rapidly (B=-0.027, 95% CI=-0.034,-0.020), becoming accelerated in the most recent 5-year window (2020-24; B=-0.139, 95% CI=-0.178,-0.099). The proportion of dissatisfied individuals rose most rapidly for schoolwork, particularly for females. Satisfaction with appearance became increasingly associated with general life satisfaction (B=0.009, 95% CI=0.005, 0.013, p<.001) and socioemotional difficulties (B=-0.051, 95% CI=-0.073,-0.029, p<.001) over time. Conclusions: Our findings add to international evidence for academic pressure and school environments as plausible drivers of recent declines in life satisfaction, particularly among female adolescents. Future studies should aim to identify the specific aspects of school life that are influencing adolescent mental health and the impact of existing educational policies on student wellbeing should be evaluated.

Background: Although barriers to mental health help-seeking among Asian American populations are well documented, less is known about how favorable individual attitudes toward mental health treatment coexist with family and community influences among South Asian American young adults or which intervention strategies members of this population themselves prioritize. Methods: A cross-sectional mixed-methods survey was completed by 191 South Asian American young adults aged 18-30 years residing in Texas between May and June 2026 using convenience sampling. Participants completed 5-point Likert-scale measures assessing mental health attitudes, stigma, help-seeking, and barriers to care. 144 participants also provided responses to optional open-ended questions exploring barriers to mental health care and recommendations for improving access to mental health support. Quantitative data were analyzed using IBM SPSS Statistics, and qualitative responses underwent thematic analysis in MAXQDA. Results: Participants reported generally positive attitudes toward mental health care and high perceived importance of mental health despite family- and community-level barriers. Greater family pressure was strongly associated with increased mental health stigma (r = 0.711, p < 0.001) and perceived barriers to care (r = 0.654, p < 0.001), while greater perceived barriers were associated with less favorable help-seeking attitudes (r = -0.158, p = 0.036). Qualitative responses contextualized these findings, identifying anticipated community judgment, family expectations, privacy concerns, and limited mental health literacy among older generations as barriers to care. Participants emphasized culturally responsive care and recommended mental health education involving parents, elders, faith leaders, and trusted community institutions. Conclusions: South Asian American young adults may hold favorable attitudes toward professional mental health care while navigating family, community, and cultural contexts that constrain help-seeking. Participant-generated recommendations prioritized culturally responsive care and community-level mental health education involving parents, elders, faith leaders, and trusted institutions, suggesting that interventions targeting individual attitudes alone may be insufficient.

Background Anxiety and depression often co-occur and typically arise early in the life course. Despite the high prevalence of these conditions in low- and middle-income countries, evidence of early-life factors associated with their developmental patterns remains limited in these settings. Understanding these factors could shape prevention efforts. Methods Using the Brazil-based Pelotas 2004 Birth Cohort (n=3,815), we examined associations between socioeconomic, maternal, and child factors and previously-derived co-developmental trajectories of anxiety and depression across childhood and adolescence. The likelihood of anxiety and depression diagnoses was assessed using the Development and Wellbeing Assessment bands at ages 6, 11 and 15. Early-life factors were measured from birth to age 6. Results Previous analyses identified four anxiety and depression co-development trajectories across childhood and adolescence, characterised by stable-low (53.9%), increasing (28.1%), decreasing (15.1%) and persistent-high (2.9%) likelihood of diagnoses. Using the stable-low class as the reference, maternal depression (child aged 1) and childhood emotional/behavioural problems (age 4) were associated with all three other classes (odds ratio (OR) range for maternal depression: 2.52-5.49; for emotional/behavioural problems: 1.06-1.10). Childhood trauma was associated with decreasing (OR: 3.62, 95% CI: 2.44, 5.37) and persistent-high (OR: 3.21, 95% CI: 1.51, 6.85) classes. Low maternal education (OR: 2.90, 95% CI: 1.28, 6.54) and low support from the father of the child during pregnancy (OR: 2.77, 95% CI: 1.20, 6.42) were associated with the persistent-high class. Maternal cohabitation with a partner at birth was associated with lower odds of children being in the increasing class (OR: 0.65, 95% CI: 0.44, 0.96). Conclusion The co-development of anxiety and depression showed associations with a range of early-life factors. Some factors were associated with anxiety and depression regardless of age at onset (e.g., maternal depression), whilst others were more strongly associated with adolescent-onset (e.g., maternal cohabitation) or persistence across both developmental periods (e.g., maternal education).

Those leaving military service frequently present with complex psychosocial problems, but military veterans are often reluctant to engage with statutory healthcare provision. Specialist mental health services have recently been established in the UK to specifically support military veterans with their psychological and social wellbeing. We explored the treatment and support provided by the London branch of a military veterans mental health and wellbeing service (Op COURAGE) from the perspectives of the multidisciplinary service team and their partner organisations and collaborators. We conducted semi-structured interviews with multidisciplinary service staff and members of their partner organisations and external agencies. Qualitative data were analysed using framework analysis.?A total of 16 professionals participated in this study, comprising five service staff, eight collaborators and three partner agency participants. Five themes with subthemes were identified, including (1) blended networks, (2) staff inclusivity and sensitivity, (3) spectrum of psychosocial interventions and holistic support, (4) referral mechanisms, and (5) (in)visibility of the service and advertising. Our evaluation highlighted the advantages of a multidisciplinary team and collaborative partnerships to meet the psychosocial needs of veteran and their significant others. We have proposed that service improvement could include increasing advertisement about this specialist service, deepening knowledge about veterans among staff and further involving veterans and key stakeholders in service decisions.

Background Adolescent mental health after the COVID-19 pandemic has been a major public health concern. Studies covering the post-pandemic period remain scarce and rarely include gender-diverse youth. We examined trends in mental health among cisgender, transgender, and nonbinary youth during the pandemic and through 2025. Methods Participants (N=636,201) were adolescents in grades 8-11 from the Finnish School Health Promotion study between 2019 and 2025, a repeated cross-sectional classroom survey. Validated questionnaires were used to assess clinical levels of depressive, generalized anxiety and social anxiety symptoms, as well as mental well-being. Results In 2025 there were 81,145 (48.6%) cisgender girls, 1137 (0.7%) transgender boys, 78,898 (47.2%) cisgender boys, 449 (0.3%) transgender girls, and 4658 (2.8%) nonbinary youth. Clinically significant depressive and generalized anxiety symptoms remained more prevalent in 2025 (reference) compared with pre-pandemic levels across all groups (ORs for 2019, 0.48-0.86; p<0.01). Compared with other groups, symptoms were most prevalent among transgender boys and nonbinary youth. Among cisgender youth, generalized anxiety symptoms increased across the post-pandemic period (ORs for 2021 and 2023, 0.81-0.95; p<0.0001). Nonbinary youth were the only group to show a recovery pattern in depressive, generalized anxiety, and social anxiety symptoms (ORs for 2021, 1.36-1.52; p<00001) and demonstrated improved mental well-being after the pandemic (beta for 2021, -0.68; p<0.0001). Conclusions The results indicate that the elevated levels of mental health problems among adolescents associated with the COVID-19 pandemic have not subsided. They also reveal persistent disparities by gender identity and call for targeted policy action.

One-to-one peer support is widely used in mental health services, but the components associated with better outcomes remain unclear. We systematically reviewed randomised controlled trials and conducted additive component network meta-analyses to identify which components of one-to-one peer support worker interventions were associated with outcomes for adults using mental health services. CINAHL Ultimate, Embase, MEDLINE, PsycINFO, CENTRAL, ClinicalTrials.gov and ISRCTN were searched, supplemented by citation tracking, previous reviews and expert consultation. Interventions were coded for seven components: Training and development, Maintaining peer support worker wellbeing, Relationship-building, Social support, Emotional support, Practical support and Cultural adaptation. The review followed PRISMA-NMA reporting guidance and was registered with PROSPERO (CRD42022355291). Thirty-six trials randomised 6,645 participants across nine countries. Only quality of life and recovery yielded estimable component effects at one or more follow-up points. For quality of life, Practical support had a positive incremental estimate at 3 months (standardised mean difference 0.52, 95% confidence interval 0.17 to 0.87); no component showed clear evidence of benefit at 6 months; and at 12 months Social support had a positive estimate (1.57, 0.12 to 3.01), whereas Maintaining peer support worker wellbeing had a negative estimate (-1.66, -3.05 to -0.28). These estimates were not consistent across follow-up points. For recovery, Relationship-building had positive estimates at 6 months (0.90, 0.03 to 1.78) and 12 months (0.50, 0.29 to 0.72). Networks were sparse and often disconnected, and additivity could not be tested in disconnected networks. Current trials do not permit definitive prioritisation of peer-support components. Relationship-building was the most consistent candidate component, but all findings remain provisional. Future trials should prospectively specify, manipulate and measure component delivery.

Background Suicide and violence are major contributors to youth mortality. Effective prevention strategies require understanding of their psychological underpinnings. We therefore aimed to determine the interconnections among victimisation, physical violence, depression and suicidal ideation and attempts, among young adults in a North India city. Methods We used data from a survey of young adults aged 18-22 years, recruited across six colleges by random sampling. Our theory-based structural equation model specified suicidal ideation and attempts as an outcome of victimisation, indicated by dating violence, campus bullying and cyberbullying. We coded "suicidal ideation and attempts" as a single ordinal variable, with five levels from "did not consider suicide" to "had a suicide attempt requiring medical treatment". We used the probit link function and theta parameterisation for categorical endogenous variables. We computed standardised path coefficients, p-values and global fit measures. Results Among 752 survey respondents (median age 19 years, 64.4% women), 16.6% had been involved in a physical fight, 24.2% had had depressive symptoms and 4.5% had seriously considered suicide in the past 12 months. We found indirect associations between victimisation and suicidal ideation and attempts, mediated by physical violence and depressive symptoms. Direct effects of victimisation on suicidal ideation and attempts were negligible. Global model fit was acceptable. Discussion Our findings suggest that youth victimisation predisposes to suicidal behaviour, by increasing physical aggression and depression. Prevention of suicide among youth requires multi-level action, including measures to stop bullying and violence, life skills education, and treatment of underlying depression.

Objective We characterized social determinants of health (SDOH) in U.S. children who ever and never had Long COVID. Methods We used cross-sectional data from the 2022-2023 National Health Interview Survey (N=14,993 children 0-17 years). Parents reported child- and household-level information. Long COVID was defined as ever experiencing symptoms lasting [&ge;]3 months that were not present prior to having COVID-19. We produced weighted prevalence estimates by Long COVID status for 3 SDOH domains (Social and Community Context, Healthcare Access and Quality, and Economic Stability) and used Rao-Scott chi-squared tests to examine differences. Results In Social and Community Context, children who ever had Long COVID more often resided in single parent households (33.2% vs. 20.3%; p<0.0001), with someone with severe depression or mental illness (18.5% vs. 8.3%; p<0.0001) or substance abuse (16.7% vs. 8.1%; p<0.0001) or had a lifetime of being disparaged by adults in the home (9.2% vs. 3.9%; p=0.0009). In Healthcare Access and Quality, children who ever had Long COVID more often had public insurance (e.g., Medicaid) (51.3% vs. 41.6%; p=0.02), higher healthcare use, and difficulty paying medical bills (23.2% vs. 12.2%; p<0.0001). In Economic Stability, children who ever had Long COVID had lower parental education, lower food security, and higher participation in social safety net programs (p<0.01 for all comparisons). Conclusion Children who ever had Long COVID more frequently experienced adverse SDOH compared to their peers who never had Long COVID. These findings may help identify children who may benefit from additional resources related to their Long COVID care.

Childhood peer victimization is increasingly recognized as an adverse childhood experience (ACE) with long-term consequences for population health. Most existing research treats bullying as a binary exposure, obscuring the dose-response mechanisms through which cumulative victimization generates escalating health risks. This methodological gap is particularly consequential for prevention, and evidence from the Gulf Cooperation Council (GCC) region remains systematically sparse. This study conducts a national dose-response analysis of childhood bullying and adult health outcomes in Saudi Arabia using the WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ), administered to a nationally representative sample of 10,156 adults by the King Abdullah International Medical Research Center (KAIMRC) and the National Family Safety Program (NFSP), Ministry of National Guard Health Affairs (2013). We conducted a cross-sectional secondary analysis examining associations between bullying frequency and five adult health outcomes: physician-diagnosed anxiety disorder, suicidal ideation, sleep disturbance, tobacco smoking, and substance use. The analytical sample comprised 4,632 adults reporting any childhood peer victimization. Binary logistic regression models adjusted for socioeconomic status, gender, age cohort, parental supervision, and family structure were estimated separately for each outcome. Three pre-specified hypotheses were tested: (H1) any bullying exposure is associated with higher odds of adverse adult health outcomes; (H2) increasing frequency follows a dose-response gradient; and (H3) associations are amplified among socioeconomically disadvantaged respondents and attenuated among those reporting higher parental attention. A consistent dose-response gradient was observed. Frequent victims showed substantially higher adjusted odds of tobacco smoking (OR = 6.55, 95% CI 5.81-7.32) and substance use (OR = 2.71, 95% CI 2.26-3.31) compared to those never bullied. Internalizing outcomes showed significant gradients for anxiety disorder (OR = 0.37, 95% CI 0.16-0.86) and sleep disturbance (OR = 0.39, 95% CI 0.20-0.76). Religion-targeted verbal victimization was the strongest independent predictor of suicidal ideation (OR = 3.01, 95% CI 1.83-4.97) and substance use (OR = 3.24, 95% CI 1.92-5.46), independent of bullying frequency. Bullying-health associations were significantly amplified among socioeconomically disadvantaged respondents, consistent with fundamental cause theory. Parental supervision was protective against substance use (OR = 0.45, 95% CI 0.30-0.67) but showed a paradoxical positive association with suicidal ideation, interpreted as a reactive parenting effect in the cross-sectional design. These findings establish childhood bullying as a cumulative, graded public health risk whose consequences are amplified by structural disadvantage. Prevention strategies must extend beyond school-level programs to address structural inequalities and integrate family-based and community-level protective factors. This study contributes population-level ACE evidence from the underrepresented GCC region and provides a foundation for integrating bullying prevention into Saudi Arabia's Vision 2030 national health agenda.