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.

Grave concerns have been raised in recent years regarding the graduate student mental health crisis in academia; however, similar attention has not been focused on the subsequent and more challenging career stage in science, that of the postdoctoral researchers. We conducted a pilot survey among postdoctoral associates (N =160) at Weill Cornell Medicine, Cornell Universitys medical school in New York City, to understand the unique challenges faced by the postdoctoral community. Our survey found that respondents mental health and wellness were primarily affected by challenges intrinsic to the demands of academic life, with additional factors related to living in a major metropolitan city. Additionally, the survey identified unique challenges of postdoctoral researchers based on their gender, ethnicity, or citizenship/immigration status. Finally, our analyses also found that respondents had a negative outlook on career progression and ability to transition into an independent position within academia. These results are in line with similar surveys conducted in the past among students and postdoctoral researchers, and highlight the fact that, despite critical evidence, the situation has not changed overtime. Further studies should be conducted across various institutions and cities to gather more comprehensive data on the mental health and wellbeing of early-stage academic researchers. The findings from this study can be utilized by institutional Postdoctoral Offices or Associations to provide updated policies and resources aimed at alleviating some of the professional stresses faced by postdoctoral researchers.

Background and objectivesPerceived uncertainty about future employment and work transitions during economic crises can negatively affect mental health of workers. This study examined the association between work expectations and psychological distress among "Baby Boomers" (born 1948-1965) in the United States and South Korea and explored how employment transitions moderated this association before, during, and after the Great Recession. Research Design and MethodsData came from 2006-2018 waves of the Health and Retirement Study (n=2,647) and Korean Longitudinal Study of Aging (n=1,454). Perceived expectations of working in the next five years were reported on a probability scale (0-100%). Psychological distress was assessed by the Center for Epidemiologic Studies Depression Scale. Six mutually-exclusive employment transitions during the Recession were constructed: entrance to full-time employment, precarious employment, stable full-time employment, self-employment, exit from the labor force, and consistently out of the labor force. Multivariate mixed-effects logistic regression models were used to assess the association between work expectations, employment transitions, and psychological distress. ResultsHigher work expectations were associated with lower odds of psychological distress; this association was most robustly observed during the recession (ORUS=0.93 [0.89, 0.98], ORKorea=0.92 [0.84, 1.01]) and recovery (ORUS=0.95 [0.92, 0.98], ORKorea=0.84 [0.80, 0.89]). The relationship between expectations and distress was pronounced among respondents who were self-employed or transitioning into self-employment. Findings were broadly similar comparing two countries. Discussion and ImplicationsExpectations regarding, and transitions in, employment impact psychological distress. Findings emphasize the need to support the mental health of older adults nearing retirement during periods of economic crisis.

BackgroundMental health problems are not distributed equally in society. Our understanding of when social inequalities in mental health emerge is limited. We sought to examine inequalities in trajectories of mental distress in diverse, representative cohorts of adolescents in inner-London. MethodsWe analysed longitudinal data from our cohort study of adolescent mental health, REACH (n=4663; 51% girls, 29% free school meals [FSM], 85% minoritised ethnic groups). We used latent growth curve models to estimate trajectories of mental distress (total, internalising, and externalising scores from the self-report Strengths and Difficulties Questionnaire) from age 11-16 years, overall and by gender, FSM, ethnic group, and their intersections. ResultsWe found strong evidence of differences in trajectories of mental distress by gender and FSM. Higher mean internalising scores in girls (vs. boys) were evident at age 11-12 and this inequality widened year-on-year (difference in mean intercepts: 0.74 [95% CI 0.52, 0.96]; slopes: 0.50 [0.39, 0.61]). Higher mean levels of distress among those receiving FSM (vs. not) were evident at age 11-12 years (e.g., difference in intercepts, general distress: 0.79 [0.19, 1.39]), and this difference, though modest, persisted through adolescence. By ethnic group and intersecting identities, the picture was more complex and mixed. Broadly, Black African youth generally reported better mental health trajectories vs. their peers; Black Caribbean and Mixed Black-and-White youth shared similar trajectories, differing somewhat from Black African; and by age 16, internalising distress was highest among lower-income White British girls. ConclusionsIn diverse inner-cities, adolescence is an important period in the emergence and persistence of some of the inequalities in mental health reported in adults; others are more nuanced.

ObjectiveTo examine the differences in the prevalence of Non-suicidal Self-Injury (NSSI) over the past year between Students with Disabilities (SWD) and their peers. Participants128,310 students aged 18-35 years from universities throughout the United States. MethodsSecondary data analysis obtained from the Healthy Minds survey (2020-2021) was analyzed using multiple logistic regression to estimate the odds of reporting NSSI among SWD and their peers. Covariates included: demographics, stressful life experiences (SLE), physical and mental health, substance use, and institutional characteristics. ResultsNSSI was significantly associated with disability; unadjusted odds ratio = 1.95 (1.8, 2.1) and adjusted odds ratio = 1.26 (1.2, 1.4). Being 2SLGBTQIA+, a history of physical abuse, loneliness, depression, and suicidal ideation increased the odds of NSSI 50% or more. ConclusionsSWD were more likely to report NSSI in the past year compared to their peers. The results emphasize the need for holistic, targeted support for SWD.

ObjectivesGrowth Mindset and Grit have been proposed as key psychological resources for resilience and adaptation, yet their manifestation and social distribution in later life remain underexplored. This study examines the structure, distribution, and correlates of Growth Mindset and Grit in older adulthood using proxy indicators in the English Longitudinal Study of Ageing (ELSA). MethodsProxy indicators reflecting learning behaviour, personality traits, affect, and beliefs were used to derive three components of Growth Mindset (education-, personality-, and belief-based) and two components of Grit (affective- and personality-based). Multinomial logistic regression models examined associations with age, socioeconomic position, health, and cognitive functioning. ResultsDistinct distributional patterns emerged across components. Education-based Growth Mindset was concentrated in lower categories, whereas personality-, belief-, and affect-based components showed greater variability. Older age was associated with lower Growth Mindset, particularly in education- and belief-based domains, while associations with Grit were more nuanced, including a lower likelihood of low affect-based Grit among older adults. Higher educational attainment, employment, wealth, and better memory performance were associated with more favourable profiles across selected domains. Living alone and limiting longstanding illness were consistently associated with less favourable profiles. ConclusionsGrowth Mindset and Grit appear to function as multidimensional and socially patterned psychological resources in later life. Belief-, personality-, and affect-based components capture meaningful variation even when formal learning declines, underscoring the importance of distinguishing opportunity-constrained indicators from dispositional domains in ageing research.

BackgroundThe evidence on the association between adverse childhood experiences (ACEs) and psychological distress in adulthood tends to rely on cross-sectional studies. In this 50-year long longitudinal study, we examined the association between both prospectively and retrospectively reported ACEs and adulthood trajectories of psychological distress between age 23 and 50. We also studied potential effect modifiers of these associations, spanning social and developmental domains of child development. MethodsThe sample comprised 8,055 participants of the 1958 National Child Development Study. Psychological distress was measured by the Malaise Inventory at ages 23-50. We used growth curve analysis and multinomial regression. ResultsAfter accounting for covariates, those with more ACEs experienced persistently higher psychological distress between age 23 and 50, with a graded relationship observed. The associations were relatively consistent across prospectively and retrospectively reported ACEs. Those with prospective or retrospective ACE score of 1 compared with 0, had on average between 0.27 and 0.39 higher distress throughout adulthood. In relative terms, the prospective ACE score of 2+ (vs 0) was associated with 3.31 and the retrospective ACE score of 4+ (vs 0) with 5.76 (95% CI 4.24 to 7.82) times higher risk of being in the "high symptoms", compared with the "low symptoms" trajectory of distress. None of the potential effect modifiers altered the association between ACEs and trajectories of distress. ConclusionIf the associations between ACEs and trajectories of distress are causal, this emphasises the need to act early to prevent psychopathology across the adult life course.

BackgroundThe COVID-19 pandemic has disproportionately impacted womens mental health, although most evidence has focused on mental illbeing outcomes. Previous research suggests that gendered differences in time-use may explain this disparity, as women generally spend more time doing psychologically taxing activities than men. We investigated gender differences in the long-term trajectories of life satisfaction, how these were impacted during the pandemic, and the role of time-use differences in explaining gender inequalities. MethodsWe used data from 6766 (56.2% women) members of the 1970 British Cohort Study (BCS70), a nationally representative birth cohort of people born in Great Britain in 1970, who were alive and residing in the UK between May 2020 and March 2021. Life satisfaction was prospectively assessed between the ages of 26 (1996) and 51 (2021) using a single question with responses ranging from 0 (lowest) to 10 (highest). We analysed life satisfaction trajectories using piecewise latent growth curve models and investigated whether gender differences in the change in the life satisfaction trajectories with the pandemic were explained by self-reported time spent doing different paid and unpaid activities. FindingsWomen had consistently higher life satisfaction than men prior to the pandemic ({Delta}intercept,unadjusted=0.213 [95% CI: 0.087, 0.340], p=.001) and experienced a more accelerated decline with the pandemic onset ({Delta}quad2,unadjusted=-0.018 [-0.026, -0.011], p<.001). Time-use differences did not account for the more accelerated decrease in womens life satisfaction levels with the pandemic ({Delta}quad2,adjusted=-0.016 [-0.031, -0.001], p=.035). InterpretationOur study shows pronounced gender inequalities in the impact of the pandemic on the long-term life satisfaction trajectories of adults in their 50s, with women losing their historical advantage over men. Self-reported time-use differences did not account for these inequalities, suggesting that they could be linked to other factors including the mental load (invisible, unrecognised labour disproportionately undertook by women) or the menopausal transition.

ObjectivesOver the past 50 years, womens roles have changed significantly, from primarily domestic roles to active labor force participation. Women from the "Baby Boom" cohort (born 1948-1965) have experienced unprecedented access to educational and employment opportunities, which has implications for work and mental health later in life. This study examined gender differences in the association between work expectations and psychological distress among Baby Boomers in the United States and South Korea. MethodsData came from the 2006-2018 waves of the Health and Retirement Study (n=14,005) and Korean Longitudinal Study of Aging (n=2,362). Perceived expectations of working in the next five years were reported on a probability scale (0-100%). Psychological distress was assessed by the Center for Epidemiologic Studies Depression Scale. Multivariate mixed-effects logistic regression models were used to examine the longitudinal association between work expectations and psychological distress for men and women. ResultsIn both countries, women had higher CES-D scores and lower expectations of working in the next 5 years than men. Higher work expectations were robustly associated with lower odds of psychological distress among both men and women in Korea; however, this inverse association was more modest in the US. Moreover, the association between work expectations and distress was stronger among Korean men (ORmen=0.82 [0.78, 0.87]) compared to women (ORwomen=0.88 [0.83, 0.93]), but there were no gender differences among US respondents (ORmen=0.99 [0.96, 1.01]; ORwomen=0.96 [0.95, 0.98]). DiscussionFindings highlight the complex interplay between biology sex and social contexts in shaping expectations regarding work in later life.

BackgroundSocial isolation and loneliness are global public health concerns, adversely impacting mental and physical health. There is an urgent need to expand the evidence base with studies focused on at-risk populations in low-resource contexts. This study aimed to examine the longitudinal association of social isolation and loneliness and health outcomes (probable depression and post-traumatic stress disorder (PTSD), and general health), and to identify individual and social determinants of social isolation and loneliness among refugees in a low-resource context. MethodA longitudinal study involving 1,235 culturally and linguistically diverse refugees was conducted over a two-year period across four time points. Social isolation and loneliness, probable depression and PTSD, and general health were measured using self-report instruments across four time points over two years (six-month intervals). Generalised Linear Mixed Models were used to examine the association between social disconnection and health outcomes over time. Linear regression was used to identify individual, social, and contextual factors associated with social isolation and loneliness. ResultsSocial isolation and loneliness were associated with increased risk of probable depression, PTSD, and poor health over two years. Younger age, higher education, family separation, traumatic experiences, longer time in the protracted displacement setting, and post-displacement stressors significantly predicted higher social isolation and loneliness at baseline. ConclusionThe present findings indicate a dose-response relationship between social isolation and loneliness and mental health outcomes among refugees in a low-resource setting. Multilevel interventions addressing individual, social, and contextual factors are needed to tackle social disconnection and improve health among refugees.

The coronavirus disease 2019 (COVID-19) pandemic has caused a surge in mental health problems across the United States, and some reports suggest a more severe impact for racial and ethnic minorities. The present study was conducted to gain a preliminary understanding of the mental health consequences of the COVID-19 pandemic specifically for dreamers, i.e., undocumented immigrants who entered the U.S. as minors. A population of about 150 dreamers currently enrolled at a public university in Delaware were invited to participate in an online survey. The survey contained questions about demographics, mental health, academics, immigration, COVID-19 infection, and unemployment, in addition to mental health screens for anxiety (GAD-7), depression (PHQ-9), and stress (PSS-10). In total, 109 dreamers completed the survey. We observed remarkably high clinical levels of anxiety and depression: 47% of the dreamers met the clinical cutoff for anxiety, 63% met the cutoff for depression, and 67% (2 in 3) met the cutoff for anxiety and/or depression. Rates of anxiety and depression in our sample were significantly higher than those recently reported for college students overall, suggesting that dreamers may be experiencing a more severe mental health impact of the COVID-19 pandemic. We also found that pandemic-induced concerns about finances, COVID-19 infection, immigration, and unemployment (among other factors) were associated with greater anxiety, stress, and depression among the dreamers in our sample. The present findings are consistent with recent predictions by social scientists that the COVID-19 pandemic would have a disproportionately negative impact on the mental health of undocumented immigrants. HighlightsO_LINearly half the dreamers (47%) met the clinical cutoff for anxiety, and 62% met the clinical cutoff for depression. C_LIO_LI2 in 3 dreamers met the clinical cutoff for anxiety and/or depression. C_LIO_LIThe percentage of dreamers meeting the cutoff for anxiety (47%) and depression (63%) were significantly higher than observed for college students overall during the pandemic (31% and 41%, respectively). C_LIO_LIThe percentage of dreamers meeting the cutoff for anxiety was also significantly higher than previously observed for undocumented college students in a 2015 survey (35%). C_LIO_LI60% of dreamers said the pandemic had a serious negative impact on their mental health, while 90% said the pandemic made them more anxious about finances. C_LIO_LI90% of dreamers said the pandemic made it harder for them to concentrate on coursework, and 2 in 3 said pandemic-related anxiety hurt their academic performance. C_LIO_LIAbout 1 in 3 dreamers are "extremely worried" that the pandemic will prevent them from achieving their academic and professional goals. C_LIO_LI76% of dreamers said the pandemic increased their fears of DACA termination. C_LIO_LI10% of dreamers said they or an immediate family member suspected COVID-19 infection at some point but did not get tested for fear of detainment or deportation. C_LIO_LIAbout 1 in 5 dreamers said they would be "extremely worried" to seek treatment or have a family member seek treatment for COVID-19 due to fears of detainment or deportation. C_LIO_LIDreamers who reported one or both parents lost their job due to the pandemic had significantly greater anxiety and depression scores and were more likely to meet clinical cutoffs for anxiety and depression. C_LI

BackgroundThe closure of the Oru refugee camp in 2012 by the Nigerian government, following the withdrawal of legal and humanitarian support by the United Nations High Commission for Refugees, exposed Liberian and Sierra Leonean stateless refugee children to multiple and chronic traumatic experiences, resulting in forced relocation to an uninhabitable host community. To date, no study has examined their mental health outcomes. This study investigates how different trauma types affect complex PTSD (CPTSD), PTSD, and functional impairment, and examines whether Nigerian and parental language proficiency moderate these associations within a social ecological framework. MethodsA cross-sectional study was conducted with 320 stateless refugee children aged 6-17 years (137 males, 183 females) in Nigeria. Trauma exposure and PTSD symptoms were assessed using DSM-5-based measures (CATS; CPSS-SR-5), while ICD-11 PTSD and CPTSD diagnoses were derived using the ITQ-CA. Functional impairment and school-based support were measured with standardized instruments. Data were analyzed using SPSS v22 and SmartPLS for moderation analyses. ResultsBased on ICD-11 criteria, 50.0% of participants met PTSD and 24.1% met CPTSD criteria. DSM-5 analyses indicated that 31.3% met full PTSD criteria, with many exhibiting subthreshold symptoms. Witnessed and physical trauma were strongly associated with PTSD severity and functional impairment, whereas emotional and sexual trauma were associated with disturbances in self-organization (DSO), indicative of CPTSD. Teacher support was associated with lower DSO symptoms; however, this effect was moderated by Nigerian language proficiency ({beta} = -0.230, 95% CI [-0.338, -0.121]), such that support was protective only for children with higher Nigerian language proficiency. ConclusionsTrauma-related psychopathology among stateless refugee children is highly prevalent and shaped by ecological and institutional conditions. School-based teacher support can protect against DSO symptoms, but its effectiveness depends on childrens linguistic access. These findings highlight the need to integrate ICD-11 CPTSD and DSM-5 PTSD frameworks and underscore the importance of linguistically inclusive, trauma-informed educational and mental health interventions in humanitarian settings.

ObjectivesTo investigate how ethnicity and other sociodemographic, work, and physical health factors are related to mental health in UK healthcare and ancillary workers (HCWs), and how structural inequities in these factors may contribute to differences in mental health by ethnicity. DesignCross-sectional analysis of baseline data from the UK-REACH national cohort study SettingHCWs across UK healthcare settings. Participants11,695 HCWs working between December 2020-March 2021. Main outcome measuresAnxiety or depression symptoms (4-item Patient Health Questionnaire, cut-off >3), and Post-Traumatic Stress Disorder (PTSD) symptoms (3-item civilian PTSD Checklist, cut-off >5). ResultsAsian, Black, Mixed/multiple and Other ethnic groups had greater odds of PTSD than the White ethnic group. Differences in anxiety/depression were less pronounced. Younger, female HCWs, and those who were not doctors had increased odds of symptoms of both PTSD and anxiety/depression. Ethnic minority HCWs were more likely to experience the following work factors that were also associated with mental ill-health: workplace discrimination, feeling insecure in raising workplace concerns, seeing more patients with COVID-19, reporting lack of access to personal protective equipment (PPE), and working longer hours and night shifts. Ethnic minority HCWs were also more likely to live in a deprived area and have experienced bereavement due to COVID-19. After adjusting for sociodemographic and work factors, ethnic differences in PTSD were less pronounced and ethnic minority HCWs had lower odds of anxiety/depression compared to White HCWs. ConclusionsEthnic minority HCWs were more likely to experience PTSD and disproportionately experienced work and sociodemographic factors associated with PTSD, anxiety and depression. These findings could help inform future work to develop workplace strategies to safeguard HCWs mental health. This will only be possible with adequate investment in staff recruitment and retention, alongside concerted efforts to address inequities due to structural discrimination. Summary boxO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIThe pandemic is placing healthcare workers under immense pressure, and there is currently a mental health crisis amongst NHS staff C_LIO_LIEthnic inequities in health outcomes are driven by structural discrimination, which occurs inside and outside the workplace C_LIO_LIInvestigating ethnic inequities in the mental health of healthcare workers requires large diverse studies, of which few exist C_LI What this study addsO_LIIn UK-REACH (N=11,695), ethnic minority staff had higher odds of Post-Traumatic Stress Disorder symptoms; we report many other factors associated with mental-ill health, including those experienced disproportionately by ethnic minority staff, such as workplace discrimination, contact with more patients with COVID-19, and bereavement due to COVID-19 C_LIO_LIThese findings underline the moral and practical need to care for staff mental health and wellbeing, which includes tackling structural inequities in the workplace; improving staff mental health may also reduce workforce understaffing due to absence and attrition C_LI

ABSTRACT Background Liberian and Sierra Leonean children born during and after the 2012 UNHCR cessation clause, and the subsequent closure of the Oru refugee camp in Nigeria, have grown up in conditions of protracted displacement and de facto statelessness. Many of these children have been exposed to multiple forms of trauma, including witnessing violence as well as physical, emotional, and sexual adversities within a complex and resource-constrained environment. Many also experience cultural-linguistic disruptions, including heritage-language attrition and increased reliance on host-country languages, which may be associated with challenges in identity formation and social integration. However, little is known about how trauma exposure interacts with language-related factors to influence PTSD and complex PTSD (CPTSD)-related functional impairment among stateless refugee children. Methods Using a cross-sectional design, 320 children aged 6-17 years (180 Liberian, 140 Sierra Leonean) were assessed. Trauma exposure was measured using the Child and Adolescent Trauma Screen (CATS), and PTSD/CPTSD functional impairment using the International Trauma Questionnaire-Child and Adolescent Version (ITQ-CA). Heritage- and host-language proficiency were assessed using a structured sociolinguistic questionnaire. Multivariate covariance analyses were conducted using SPSS to examine main and interaction effects. Results Multivariate analyses revealed that poorer host-language communication was associated with higher PTSD-related functional impairment (F(3, 311) = 2.85, p = .038, partial eta-squared = .027), whereas CPTSD impairment was largely unaffected. Native-language proficiency also predicted PTSD impairment (F(3, 290) = 3.44, p = .017, partial eta-squared = .034), and children with low heritage-language skills, limited parental/home-language exposure, and no Nigerian-language use showed the highest CPTSD impairment. Emotional connection to the native language provided a modest protective effect. The combined heritage- and host-language exposure was linked to lower trauma-related functional impairment, particularly for children at higher risk of CPTSD. Witnessed trauma emerged as the strongest predictor of functional impairment among refugee children, with CPTSD outcomes showing greater sensitivity (partial eta-squared = .153) than PTSD (partial eta-squared = .076). Conclusions Heritage-language competence and bilingual proficiency were associated with reduced PTSD-related functional impairment, whereas CPTSD was more strongly shaped by cumulative relational trauma. These findings highlight the potential value of interventions that support bilingual development and heritage-language preservation as pathways to resilience among stateless refugee children. Keywords: Language attrition; bilingual competence; trauma exposure; refugee children; CPTSD; PTSD; functional impairment

BackgroundIn economically transitioning China, rising objective SES has coincided with increased depression prevalence. This study examines whether material accumulation is linked to greater psychological strain and how subjective status perception is associated with lower depression risk. MethodsWe analyzed a Chinese national sample (N = 19,049, PBICR2022). ObjectiveSES was constructed via PCA (income, education, employment, housing); subjective SES was measured on a 7-point scale. Depression was assessed using the PHQ-9 (cutoff [&ge;] 10). Bootstrapped mediation and Response Surface Analysis (RSA) mapped the topography of depression risk. ResultsObjective SES showed a positive total association with depression (c = 0.154, P < .001), but subjective status perception suppressed this association: higher objective SES predicted higher subjective status, which in turn predicted lower depression (indirect effect = -0.1086, 95% CI: [-0.127, -0.091]). RSA showed that depression risk was driven primarily by subjective rank rather than objective resources, with diminishing returns at higher levels. The indirect pathway was 2.75-fold stronger among never-married than married individuals and more pronounced among men, yet robust across geographic regions despite cross-provincial migration. LimitationsCross-sectional design precludes causal inference; subjective SES used a single-item measure, and common method variance cannot be fully excluded. ConclusionsMental well-being depends less on absolute resources and more on internalized social position. The inverse association of subjective status with depression is stable across regions but contingent on social anchors like marriage. Public health policy must address status anxiety among vulnerable groups, particularly unmarried men.

Aim Anxiety disorders in older adults are commonly underdiagnosed and undertreated, especially among minority ethnic groups. This UK multicultural qualitative study aimed to explore and compare beliefs about anxiety among self-reporting White British, South Asian, African and Caribbean older adults, using Leventhal's Common-Sense Model. Methods Individual interviews were conducted with 52 older adults who self-reported anxiety (current or past). Data were managed and analysed using the Framework Method. Professional interpreters facilitated interviews with non-English speakers. Findings The study incorporated the perspectives of 27 older adults with distressing anxiety and 25 with non-distressing anxiety. Participants' beliefs mapped onto the illness-related dimensions in Leventhal's Common-Sense Model. Beliefs about anxiety differed across and within cultural groups, with notable distinctions between participants with distressing and non-distressing anxiety. Those with distressing anxiety neither normalised anxiety nor considered it as an illness trajectory. Overall, participants had a fragmented understanding of anxiety disorders. Specific aspects of older adults' beliefs were influenced by their salient identities rather than their cultural background. Two new dimensions were identified: aggravating factors, believed to trigger or exacerbate anxiety symptoms; protective factors, believed to alleviate or prevent mental health problems. Conclusions Applying Leventhal's Common-Sense Model to anxiety has yielded new insights with significant implications for understanding potential causes of low mental health services use among older adults. Grouping people into broad categories of cultural groups disregards the diversity among individuals within the same group. Cross-cultural research should embrace this diversity and employ nuanced approaches to provide meaningful, person-centred insights into people's perceptions of illness.

Women filmed for pornography report extensive abuse and serious health consequences, yet pathways into pornography remain under-examined. Using an embedded qualitative mixed-methods approach, we explored factors shaping these pathways in Sweden. Twenty-five adults (23 women) who had been filmed for pornography completed questionnaires and participated in teller-focused interviews. Informed by a socio-ecological framework, our reflexive thematic analysis generated the global theme Primed for exploitation, comprising three themes: Imprints of early violence, No one has my back: Relational and institutional betrayals, and Compounding structural vulnerabilities. Our findings reveal how childhood abuse and violence, relational and institutional betrayals, material precarity, and a pornified cultural landscape converge to shape pathways into pornography. To prevent and disrupt these pathways, early identification of sexual abuse, timely access to trauma-informed care that avoids individualizing and pathologizing the consequences of violence, and practical support that addresses material precarity are critical. From a socio-ecological perspective, framing entry into pornography as a simple matter of "choice" is fundamentally flawed: it individualizes deeply social processes and obscures the profound impact of cumulative violence, repeated relational and institutional betrayals, and intersecting structural constraints.

BackgroundGrowth curve modelling such as trajectory analysis is useful for examining the longitudinal nature of depressive symptoms, their antecedents and later consequences. However, issues in interpretation associated with this methodology could hinder the translation from results to policy changes and interventions. The aim of this article is to provide a "model interpretation framework" for highlighting growth curve results in a more interpretable manner. Here we demonstrate the association between childhood trauma and trajectories of depressive symptoms. Childhood trauma has been shown to a be strong predictor for later depression, but less is known how childhood trauma has an effect throughout adolescence and young adulthood. Identifying when childhood trauma (and its severity) is likely to have its greatest impact on depression is important for determining the timing of interventions for depression. MethodsWe used data on over 6,500 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC) to estimate trajectories of depressive symptoms between the ages of 11 and 24. Depressive symptoms were measured using the short mood and feelings questionnaire (SMFQ) across 9 occasions. Childhood trauma was assessed between the ages of 5 and 10 years old, and we estimated population averaged multilevel growth curves of depressive symptoms for exposure to trauma (yes vs no) and then in a separate model, the number of trauma types reported such as inter-personal violence or neglect (coded as 0, 1, 2, 3+). We then calculated what the depressive symptoms scores would be ages 12, 14, 16, 18, 20, 22, 24, between these varying trajectories. ResultsReported exposure to childhood trauma was associated with less favourable trajectories of depressive symptoms across adolescence, mainly characterised by exposed individuals having worse depressive symptoms at age 16. There was an exposure-response relationship between the number of childhood traumas and trajectories of depressive symptoms. Individuals exposed to 3 or more types of trauma had substantially steeper and less favourable trajectories of depressive symptoms: becoming worse at a more rapid rate until the age of 18. By age 18, individuals that reported the greatest exposure to trauma (3+ types of trauma) had 14% more depressive symptoms compared to non-exposed participants. LimitationsThis study was subject to attrition, particularly towards the latter ages of the SMFQ. ConclusionChildhood trauma is strongly associated with less favourable trajectories of depressive symptoms across adolescence. Individuals exposed to multiple types of inter-personal violence or neglect are at the greatest risk of worsening depressive symptoms throughout adolescence and young adulthood. Individuals exposed to traumatic experiences in childhood should be identified as at high risk of depression and other adverse outcomes as early trauma may disrupt social development and have lasting consequences on mental health outcomes. The model interpretation framework presented here may be more interpretable for researchers, clinicians and policy makers as it allows comparisons of depression across multiple stages of development to highlight when the effects of depression are greatest.