International Journal of Social Psychiatry最新文献

{"title":"Investigating the component structure of the Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD).","authors":"Jon Painter, Kiran Purandare, Joanne McCabe, Ashok Roy, Rohit Shankar","doi":"10.1177/00207640251323819","DOIUrl":"10.1177/00207640251323819","url":null,"abstract":"<p><strong>Background: </strong>Outcome measurement is increasingly recognised as a vital element of high-quality service provision, but practice remains variable in the field of intellectual disabilities. The Health of the National Outcome Scales for people with Learning Disabilities (HoNOS-LD) is a widely used Clinician Reported Outcome Measure in the UK and beyond. Over its 20-year lifespan, its psychometric properties have been frequently investigated. Multiple dimensionality reduction analyses have been published, each proposing a different latent structure.</p><p><strong>Aim: </strong>To analyse a set of HoNOS-LD ratings to test its internal consistency, to identify the optimal number of latent variables, and to propose the items that group together in each domain.</p><p><strong>Methods: </strong>A Principal Component Analysis of 169 HoNOS-LD ratings was performed to produce an initial model. The component loadings for each HoNOS-LD item were then examined, allowing the model to be adjusted to ensure the optimal balance of statistical robustness and clinical face-validity.</p><p><strong>Results: </strong>HoNOS-LD's internal consistency (18 items) was 'acceptable' (Cronbach's alpha = 0.797). On excluding three items that had no bivariate correlations with the other 15 items internal consistency rose to 'good' (Cronbach's alpha = 0.828). The final, four-component solution, using the 15 items possessed good internal reliability.</p><p><strong>Conclusion: </strong>HONOS-LD statistical properties compared favourably to the other published latent structures and adheres to the tool's rating guidance. The four-component solution offers an acceptable balance of statistical robustness and clinical face validity. It provides advantages over other models in terms of internal consistency and/or viability for use at a national level in the UK.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"1078-1085"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the modified NAVIGATE program for early schizophrenia in Shanghai through the specialized hospital and community integration: A comparative study.","authors":"Lihua Wang, Huijie Lu, Yihua Jiang, Dianming Zhu, Ping Sun, Haiming Sun, Lanlan Wang, Wenhui Jiang, Yanru Wu, Zeping Xiao","doi":"10.1177/00207640241311031","DOIUrl":"10.1177/00207640241311031","url":null,"abstract":"<p><strong>Background: </strong>The modified NAVIGATE program for early schizophrenia, called the Recovery program, was implemented in the Minhang district of Shanghai, China, with a population of approximately 2.7 million, representing 11% of the city's population of about 24 million. The specialized hospital and communities integrated to form multidisciplinary treatment teams to provide multi-component treatment and services, and to receive group training and supervision together. The aim of the study is to evaluate and compare the effects of the Recovery program with conventional care on psychiatric symptoms and social functioning.</p><p><strong>Method: </strong>A total of 128 participants with a diagnosis of schizophrenia, aged 15 to 40 years, and illness duration ⩽5 years were enrolled. Patients living in the Minhang district were assigned to the Recovery program, and those living in other districts of Shanghai received the conventional care. Patients were followed up at baseline and after 2, 4, 6, 8, 10, and 12 months with assessments of symptoms, social functioning, treatment adherence, relapse, community activities, and school/work attendance using the Positive and Negative Symptom Scale (PANSS), the Clinical Global Impression Scale (CGI), and the Personal Social Functioning Scale (PSP).</p><p><strong>Results: </strong>Sixty-three participants receiving the Recovery program care showed greater improvement in psychotic symptoms and social functioning than 65 participants receiving conventional care. Participants in the Recovery program had lower rates of missed psychiatric visits >2 months (3.2% vs. 49.2%), antipsychotic discontinuation (7.9% vs. 36.9%), and relapse (4.8% vs. 26.2%) compared with conventional care.</p><p><strong>Conclusions: </strong>The modified NAVIGATE program can be implemented in the Minhang district of Shanghai, China, through the integration of the specialized hospital and community, and improves clinical outcomes for patients with early schizophrenia compared to conventional care. It has great potential for implementation in other districts in China.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"1127-1140"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of suicide attempt among subjects who were previously exposed to sexual abuse.","authors":"Hurşit Ferahkaya, Melek Türker, Fatma Coşkun, Necati Uzun, Ömer Faruk Akça","doi":"10.1177/00207640251334268","DOIUrl":"10.1177/00207640251334268","url":null,"abstract":"<p><strong>Background and aims: </strong>Child sexual abuse is a condition that can affect the victim's life in every period and is closely related to physical and mental problems. One of the important consequences of child sexual abuse is suicide. The idea that there is a close relationship between child sexual abuse and suicidal ideation and attempts is widely accepted in the literature, but this relationship is quite complex. In this study, we investigated the factors associated with suicide risk in children and adolescents who were victims of sexual abuse.</p><p><strong>Methods: </strong>Two groups were formed: participants who were sexually abused and attempted suicide, and participants who were sexually abused and did not attempt suicide. They were evaluated in terms of anxiety, depression, posttraumatic stress disorder, borderline personality traits, impulsivity, traumatic experiences, and perceived social support using scales.</p><p><strong>Results: </strong>The total scores of anxiety-depression, posttraumatic-stress-disorder, impulsivity, traumatic experiences, and borderline personality traits scales were found to be significantly higher, while the perceived social support scale score was found to be significantly lower in the group who attempted suicide.</p><p><strong>Conclusion: </strong>Our findings revealed factors associated with suicide attempts in child and adolescent who were sexual abuse victims. Taking these factors into account when evaluating victims of sexual abuse will provide early intervention to high risk patients.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"1155-1163"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining depression literacy and related factors among caregivers of psychiatric patients.","authors":"Reyhan Eskiyurt, Birgül Özkan, Ali Çayköylü","doi":"10.1177/00207640251345315","DOIUrl":"10.1177/00207640251345315","url":null,"abstract":"<p><strong>Background: </strong>Mental health literacy is considered crucial for promoting mental health, early diagnosis, referral to mental health services, and ongoing care. The demands and obligations of caregiving can profoundly affect caregivers' health, work, social life, and relationships, often leading to mental health challenges.</p><p><strong>Aim: </strong>This study was conducted to examine the mental health of informal caregivers and to determine its relationship with study variables.</p><p><strong>Methods: </strong>This study was conducted between July 1, 2024 and October 1, 2024, involving informal caregivers of individuals diagnosed with psychiatric conditions. A total of 277 caregivers participated in the study. The research tools were a sociodemographic form, the Depression Literacy Questionnaire (DLS), the Beck Depression Inventory (BDI), and the Self-Actualization Index (SAI). The data were analyzed using descriptive statistics and correlation.</p><p><strong>Results: </strong>The participants' SAI, BDI, and DLS mean scores were 45.26 ± 6.38, 10.00 ± 8.90, and 12.84 ± 2.73, respectively. A significant negative relationship was found between their SAI and BDI scores (<i>p</i> < .05), while a significant positive relationship was identified between their SAI and DLS scores (<i>p</i> < .05). However, no significant relationship was observed between their BDI and DLS scores (<i>p</i> > .05). Depression literacy was significantly higher among women, single individuals, those with higher education levels, individuals with higher incomes, and those who sought help from a mental health professional (<i>p</i> < .05).</p><p><strong>Conclusions: </strong>Increasing levels of depression literacy should be considered an important preventive strategy for addressing mental health issues in the community.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"1030-1039"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What works where and why? A systematic review and meta-analysis of digital interventions addressing suicide-related outcomes in community, education and clinical settings.","authors":"Natasha Josifovski, Sylvia Eugene Dit Rochesson, Quincy Jj Wong, Jin Han, Mark E Larsen, Michelle Torok","doi":"10.1177/00207640251358109","DOIUrl":"https://doi.org/10.1177/00207640251358109","url":null,"abstract":"<p><strong>Background: </strong>Digital suicide prevention interventions have previously been shown to be effective, however the field has rapidly developed.</p><p><strong>Aims: </strong>To undertake a contemporary review of the evidence and understanding where interventions may work best.</p><p><strong>Method: </strong>A meta-analysis following the PRISMA guidelines was conducted. PubMed/Medline, PsycINFO and Cochrane Central were searched for randomised controlled trials up to February 2024. Interventions were categorised according to their delivery setting, and as direct (directly targeting suicidality) or indirect (targeting depression), and effects on suicidal ideation and behaviours (plans, self-harm, attempts and suicide death) were calculated using Hedge's <i>g</i>.</p><p><strong>Results: </strong>Forty-six papers reporting 48 unique trials were included. The majority of studies examined direct interventions (<i>n</i> = 27, 56.3%), and most were delivered in community settings (<i>n</i> = 31, 64.6%). There was a small and significant effect for suicidal ideation in clinical settings (<i>g</i> = -0.35, 95% CI [-0.59, -0.10], <i>p</i> = .006) and community settings (<i>g</i> = -0.10, 95% CI [-0.19, -0.01], <i>p</i> = .037), but not in education settings (<i>g</i> = -0.20, 95% CI [-0.55, 0.16], <i>p</i> = .283). Pairwise comparisons between settings were not significant, nor were there any significant effects for suicidal behaviours.</p><p><strong>Conclusions: </strong>The results show that digital interventions to reduce suicide ideation are effective when delivered in community and clinical settings. Fewer studies have been conducted in, and the evidence does not yet support the effectiveness in, education settings. Furthermore, there does not appear to be any evidence supporting the effectiveness of digital interventions in reducing suicidal behaviours. Design features (such as treatment modality) may account for less variance in effectiveness than previously thought.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"207640251358109"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immigrant, racialised and ethno-culturally diverse communities and community treatment orders: A scoping review.","authors":"Hira Ahmad, Alasdair Forrest, Martin Rotenberg","doi":"10.1177/00207640251353689","DOIUrl":"https://doi.org/10.1177/00207640251353689","url":null,"abstract":"<p><strong>Background: </strong>People with serious mental illness from immigrant, racialised and ethno-culturally diverse communities experience greater coercion in mental health care.</p><p><strong>Aims: </strong>This review aims to scope the literature and synthesise findings relevant on the association between these groups, and the use of Community Treatment Orders (CTOs) and related forms of compulsory community treatment.</p><p><strong>Method: </strong>Five electronic databases were searched to identify relevant studies. Studies were included if they directly examined the association between immigrant, racialised and ethno-culturally diverse communities and community treatment orders and related forms of treatment or presented relevant data as part of a larger study.</p><p><strong>Results: </strong>Of the 43 studies included 9 studies focussed directly on associations between immigrant, racialised and ethno-culturally diverse communities and CTOs, while 34 studies presented relevant data related to immigrant, racialised and ethno-culturally diverse communities and CTOs albeit not the primary focus of the study. Most studies were quantitative, with varied study designs. The majority of studies were from Australia and New Zealand. followed by North America and the UK. Of the nine studies focussing directly on ethnicity and CTOs, results were mixed, and varied based on design, population and jurisdiction.</p><p><strong>Conclusions: </strong>The relationship between ethnicity, immigration status and CTOs is complex, with mixed findings across jurisdictions. Most of the literature comes from Australia and New Zealand, were Indigenous populations were a significant focus. The review highlights the need for more qualitative and quantitative research, especially in underrepresented ethnic groups and jurisdictions outside of Australia and New Zealand.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"207640251353689"},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insurance status and psychological distress during the 2007 to 2009 U.S. recession: A novel integrative data analysis approach.","authors":"Lumi Bakos","doi":"10.1177/00207640251358330","DOIUrl":"https://doi.org/10.1177/00207640251358330","url":null,"abstract":"<p><strong>Background: </strong>The 2007 to 2009 U.S. economic recession was associated with widespread job loss, housing instability, and rising mental health challenges. While previous studies have linked economic downturns to psychological distress, limited research has examined how health insurance status modifies this relationship during and after a recession.</p><p><strong>Aims: </strong>This study investigated changes in psychological distress (PD) among U.S. adults before, during, and after the 2007 to 2009 recession and examined whether insurance status mediated the relationship between economic hardship and PD.</p><p><strong>Methods: </strong>Using Behavioral Risk Factor Surveillance System (BRFSS) data from 2007, 2009, 2012, and 2013, the study applied an integrative data analysis (IDA) framework to construct composite demographic profiles and approximate longitudinal trends. Structural equation modeling (SEM), including exploratory and confirmatory factor analysis, panel modeling, and mediation analysis, was used to examine PD trends and the influence of insurance coverage and income.</p><p><strong>Results: </strong>Exploratory and confirmatory factor analyses confirmed a two-factor structure of PD: depression and anxiety symptoms. From 2007 to 2009, PD remained stable, but levels improved between 2009 and 2012. Higher uninsured rates significantly increased PD, with a 1% increase in the uninsured population resulting in a 17.4% rise in PD. Mediation analysis showed that limited access to mental health treatment partially explained the relationship between being uninsured and increased distress.</p><p><strong>Conclusion: </strong>Health insurance status plays a critical role in moderating psychological distress during economic downturns. Expanding insurance coverage and integrating mental health services into economic recovery efforts may mitigate long-term mental health consequences of financial crises.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"207640251358330"},"PeriodicalIF":2.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Household income and first psychiatric hospital admissions among children and adolescents.","authors":"Veera Nieminen, Kimmo Suokas, Christian Hakulinen, Reija Autio, Sami Pirkola","doi":"10.1177/00207640251353675","DOIUrl":"https://doi.org/10.1177/00207640251353675","url":null,"abstract":"<p><strong>Background: </strong>Parental socioeconomic factors are associated with mental health outcomes already during childhood, but gender differences in these connections have rarely been studied.</p><p><strong>Aims: </strong>We explored the associations between household income and severe mental health disorders requiring psychiatric inpatient hospital care, with particular focus on gender differences.</p><p><strong>Methods: </strong>In this national register-based cohort study, we followed over 1.6 million children and adolescents born in Finland between 1991 and 2020 until first psychiatric hospital admission, moving away from parents, death, emigration from Finland or the end of 2020, whichever time came first. We calculated age- and gender-specific incidence rates (IRs) for first admissions. In order to evaluate gender differences and the magnitude of association between income and psychiatric hospital admission, we fitted multivariable Poisson regression models and calculated incidence rate ratios (IRRs) and 95% confidence intervals.</p><p><strong>Results: </strong>In total, 2.1% of the study population were admitted to psychiatric hospital for the first time within the specified period. Among girls in all income deciles, IRs distinctly peaked during adolescence. Among boys, IRs started to increase earlier, especially in the lowest income deciles, and there was no steep peak during adolescence in any income group. Lower household income was associated with higher risk for psychiatric hospital admission, and this association was steeper for boys (IRR 3.18 [2.87-3.53] than for girls (IRR 2.15 [1.97-2.35]) in the lowest compared to the highest income decile, after adjusting for potential confounders.</p><p><strong>Conclusion: </strong>Our results indicate that low income may play a more prominent role in severe mental disorders among boys, whereas adolescence emerges as a critical period for girls, regardless of their household income levels.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"207640251353675"},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral context, coping strategies, and mental health outcomes among combat veterans.","authors":"James Fm Cornwell, Elizabeth L Wetzler, Michael D Wood, Ryan G Erbe","doi":"10.1177/00207640251360298","DOIUrl":"https://doi.org/10.1177/00207640251360298","url":null,"abstract":"<p><strong>Objective: </strong>Although research has been conducted on the influence of coping strategies on mental health, research has not investigated the relationships among moral context, the adoption of those strategies, and mental health outcomes.</p><p><strong>Design: </strong>Studies were designed to measure the effects of moral context (specifically, moral injury and ethical leadership) on the adoption of adaptive or maladaptive coping strategies and their subsequent mental health consequences.</p><p><strong>Method: </strong>Data was collected on 551 total military personnel, spanning two distinct survey administrations, who reported at least one combat deployment.</p><p><strong>Results: </strong>Findings suggest that ethical leadership is associated with greater adaptive coping strategy adoption, while potentially morally injurious events (particularly self-transgression) are associated with greater maladaptive coping strategy adoption. Mediation analysis demonstrated that a significant portion of the effect of self-transgression on depression (95% CI [0.003, 0.038]) and anxiety (95% CI [0.004, 0.066]) is attributable to its attendant increase in maladaptive coping strategy adoption.</p><p><strong>Conclusions: </strong>This research suggests that moral context can lead to differential adoption of adaptive and maladaptive coping strategies. It also suggests that maladaptive coping strategies can account for a portion of the effect of self-transgression moral injury on depression and anxiety.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"207640251360298"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the early detection of patients with psychotic spectrum disorder or bipolar disorder in rural Grete/Greece: The role of the mobile mental health unit.","authors":"Alexandros N Vgontzas, Eirini M Mitropoulou, Kalliopi Diakaki, Vasiliki Galanopoulou, Avgi Zografaki, Maria Anastasaki, Maria Daskalaki, Vasilis Chatziorphanos, Aikaterini Koutra, Panagiotis G Simos","doi":"10.1177/00207640251358331","DOIUrl":"https://doi.org/10.1177/00207640251358331","url":null,"abstract":"<p><strong>Background: </strong>Early detection and intervention are considered important determinants of long-term outcomes of severe mental disorders. Preliminary evidence has shown that in Crete/Greece in rural areas there is a significant delay in seeking mental health care for patients with psychosis or bipolar disorder.</p><p><strong>Aims/objectives: </strong>The primary aim of this study is to examine: the mean age and percentage of involuntary admissions of patients with psychotic spectrum or bipolar disorder at first admission/visit; and whether these associations were affected over the 10 years of the mobile mental health unit (MMHU) operation (2013-2023). A secondary objective is to analyze demographic and clinical differences between younger and older patients at first admission/visit.</p><p><strong>Methods: </strong>Participants were adults >15 years, diagnosed with psychotic spectrum disorder or bipolar disorder, living within a well-defined catchment-area in Crete/Greece. We compared age of first admission/visit for psychotic or bipolar patients at three time points, specifically years 2013, 2018, and 2023 and differences of patients' demographic and clinical characteristics based on age of first admission/visit.</p><p><strong>Results: </strong>The average age of first admission/visit for patients with psychotic spectrum disorders ranges from 39.7 to 43.1, while the average age range for those with bipolar disorder is approximately 40.7 to 45.97 years. Notably, there was no reduction of the age of first admission/visit over the ten years of the MMHU operation (2013-2023), whereas there was a high percentage of involuntary admissions. Finally, patients who are single, abuse drugs, and have a higher education are more prone to seek psychiatric help earlier.</p><p><strong>Conclusions: </strong>In rural Crete/Greece the average age of seeking mental care for both disorders was and remains markedly high. The lack of consistent and reliable mental health services coupled with the fear of stigma and cultural characteristics of Greek families and small rural towns, discourages individuals seeking mental health care early.</p>","PeriodicalId":14304,"journal":{"name":"International Journal of Social Psychiatry","volume":" ","pages":"207640251358331"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}