To examine health professionals’ views and practices relating to the specific barriers to communication that arise at the time of mental health diagnosis, and the strategies used to support individuals throughout this process.

An online survey of the beliefs and practices of 131 mental health clinicians working in different clinical settings across Australia was conducted.

Exploratory factor analysis of the items relating to barriers to communication resulted in three latent factors (‘stigma, diagnosis and risk’; ‘service structure’; and ‘individual circumstances’ such as the person receiving the diagnosis being young, having a culturally and linguistically diverse background or being unwell at the time of conversation). Using linear regression it was found that variance in ‘stigma, diagnosis and risk’ was significantly explained by whether participating clinicians had medical training, their experience working with serious mental health problems, their confidence handling distress and attitude towards diagnosis. Variance in ‘individual circumstances’ was significantly explained by participating clinicians’ confidence handling distress. The most frequently used strategies to support diagnostic discussions centred on the health professionals’ communication skills, gauging the individual's perception of their circumstances, responding with empathy, following-up after discussion, addressing stigma concerns, using collaborative practice and setting up for the conversation.

Three main areas for health professionals to reflect on, plan for and ultimately address when discussing news with the individual concerned emerged (‘stigma, diagnosis and risk’; ‘service structure’; and ‘individual circumstances’). Variations in practice indicate that practitioners should be cognisant of their own beliefs and background and how this impacts their communication practice.

Socio-cultural integration of refugees has received scant attention in the academic literature. Türkiye hosts the largest number of refugees, including Afghans, as the second largest asylum-seeking group in Türkiye. There is a dearth of research into the mental health and integration of Afghan refugees in Türkiye. The aim of the present study was to investigate socio-cultural integration outcomes among Afghan refugees in Türkiye by considering the role of traumatic events and post-displacement stressors. The role of mental health in integration outcomes was further examined.

A cross-sectional, web-based survey study with 785 Afghan refugees in Türkiye was conducted between April and June 2021. Data were collected on socio-demographic characteristics, potentially traumatic events (PTEs) (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), mental health symptoms (Hopkins Symptoms Checklist-25), social integration- social bonds (contact with co-ethnic group members) and social bridges (contact with the host community)- and cultural integration (Vancouver Index of Acculturation). Structural equation modelling was conducted to test the hypothesized relationship between conflict and displacement-related stressors, mental health and socio-cultural integration.

Findings showed that conflict-related traumatic events and post-displacement stressors significantly predicted higher mental health symptoms. Experiencing traumatic events significantly predicted higher levels of social bridges, adopting destination culture and lower level of maintaining heritage culture. Mental health problems predicted the relationship between stressors related to forced displacement and integration outcomes-social bridges and adopting destination culture. These findings highlight the role of mental health as an indispensable resource for socio-cultural integration. Further, conflict and displacement-related stressors are important determinants of socio-cultural integration among Afghan refugees in Türkiye.

Exposure to PTEs and post-displacement stressors were significant risk factors for the mental health and socio-cultural integration of Afghan refugees in Türkiye. These stressful experiences deteriorate refugees’ mental health, which hinders their integration into the host society.

We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France.

In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results.

Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, −0.22; 95% confidence interval, [−0.33 to −0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, −€4,286 [−4,711 to −4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003–0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040–0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources.

PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.

Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a ‘friendship recession’. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a ‘dark side’ and can potentially promote negative outcomes. To better capture friendship’s potential heterogeneous effects, we took an outcome-wide analytic approach.

We analysed data from 12,998 participants in the Health and Retirement Study (HRS) – a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between t0; 2006/2008 and t1; 2010/2012) were associated with better health/well-being across 35 outcomes (in t2; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite ‘friendship score’ that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.

Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).

Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.

Sono descritte, con la stessa metodologia impiegata in altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi dell'Unità Operativa di Psichiatria di Legnano. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (530/100000 residenti adulti) e un giorno (226/100000 residenti adulti) hanno valori inferiori ai RCP europei. I tassi di incidenza (152/100000 residenti adulti) sono diminuiti nel corso dei 4 anni considerati, mostrando la difficoltà dei servizi ad accogliere nuovi utenti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è, mediamente, di 3,8 a 1. II tasso dei lungoassistiti è di 195/100000 residenti adulti, con un accumulo di quelli che vivono nel territorio, ma non di quelli che sono in Comunita. II costo dei servizi psichiatrici di Legnano è diminuito nella componente ospedaliera e semiresidenziale, mentre è aumentato in quella territoriale.

servizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.

The principles, structure. Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Legnano are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the mean year prevalence (530/100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (152/100000 adult inhabitants) have diminished, showing a difficulty of the psychiatric services in accepting new patients. The ratio between non-hospidalized and hospidalized users is 3.8 to 1. The rate of long-term patients is 195/100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the community is increasing over the years, whereas the similar rate of patients living in the scheltered apartments is stable. The costs of the hospital-based and the semiresidential agencies decreased, while the cost of the community agencies increased.