SSM. Mental health最新文献

{"title":"Intersectional analysis of suicide risk among transgender and non-binary people","authors":"Heather Santos ,&nbsp;Greta R. Bauer ,&nbsp;Thomas Joiner ,&nbsp;Agus Surachman ,&nbsp;Félice Lê-Scherban ,&nbsp;Ayden I. Scheim","doi":"10.1016/j.ssmmh.2025.100496","DOIUrl":"10.1016/j.ssmmh.2025.100496","url":null,"abstract":"<div><div>Transgender and non-binary (TNB) people experience high rates of suicidal thoughts and behaviors, but less is known about how suicide risk varies within TNB communities. We investigated variation in suicidality among TNB people across intersecting social identities and positions. This study uses data from Trans PULSE Canada, a 2019 community-based survey of TNB people aged 14+ in Canada. Among 2054 participants aged 16+, conditional inference trees (CTREE) were used to identify subgroups with varying levels of past-year suicidal ideation and suicide attempts. Twelve predictor variables were chosen through literature review and community knowledge based on their relevance to suicide risk. Findings show that over the past year, 30.2 % of participants reported suicidal ideation and 4.2 % reported a suicide attempt. Six subgroups with varying levels of past-year suicidal ideation were identified, with a higher prevalence of ideation among those with lower educational attainment (particularly youth aged 16–24; 49.4 %) and among college-educated participants who identified as disabled (38.3 %). The CTREE for past-year suicide attempts identified variation across three subgroups: participants aged 16–19 (11.0 % attempted), and those aged 20+ with or without a history of sex work (8.4 % and 2.5 %, respectively). In conclusion, past-year suicidal ideation and attempts were high compared to general population estimates, although somewhat lower than in previous Canadian TNB studies. Suicide attempts were concentrated among those aged 16–19, and amongst those 20+ with a history of sex work. Suicide prevention research should investigate individual and structural level interventions to reduce disproportionate suicide risk among these groups.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100496"},"PeriodicalIF":4.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of the REAL™, a school-based, virtual reality-integrated social emotional learning intervention to promote mental health for early Malaysian adolescents","authors":"Aimi Nur Athira Putri Baharuddin ,&nbsp;Nik Ruzyanei Nik Jaafar ,&nbsp;Normala Ibrahim ,&nbsp;Abdul Rahman Ahmad Badayai ,&nbsp;Hajar Mohd Salleh Sahimi ,&nbsp;Nurul Ain Mohamad Kamal ,&nbsp;Nur Husna Ismail ,&nbsp;Ely Salwana ,&nbsp;Mohd Pilus Abdullah ,&nbsp;Mohd ‘Ammar Ihsan Ahmad Zamzuri","doi":"10.1016/j.ssmmh.2025.100494","DOIUrl":"10.1016/j.ssmmh.2025.100494","url":null,"abstract":"<div><h3>Background</h3><div>The REAL™ module was developed to impart social and emotional learning (SEL) skills to early Malaysian adolescents using virtual reality (VR) components at school within the local social and cultural dynamics. This study aimed to evaluate the effectiveness of the intervention in improving 1) emotional regulation (ER) skills and 2) depression and anxiety in adolescents attending lower secondary schools in Malaysia.</div></div><div><h3>Methods</h3><div>This randomized controlled trial study was conducted from February 2023 to November 2023. A total of 226 participants aged 13 and 14 years old from lower secondary school students were recruited from four secondary schools selected by multistage cluster sampling in Selangor, Malaysia. Data were collected across four-time points (T0: baseline, T1: immediate post-test, T2: three-month post-test, and T3: six-month post-test) via a locally translated and validated set of questionnaires, including The Difficulties in Emotion Regulation Scale (DERS) for the emotional regulation score, Beck Depression Inventory (BDI) for depression scores and Beck Anxiety Inventory for anxiety scores. A repeated-measures ANCOVA was performed to evaluate the effect of the intervention versus the control group on emotional regulation scores, depression scores, as well as anxiety scores.</div></div><div><h3>Results</h3><div>A significant main effect of the group intervention was observed for emotional regulation (F (1, 223) = 20.05, p &lt; 0.001), depression (F (1, 223) = 51.16, p &lt; 0.001), and anxiety (F (1, 223) = 32.75, p &lt; 0.001). The intervention group showed a sustained reduction for all domains compared to the control group, particularly at time T3. These findings reflect differences in outcomes between the intervention and control groups.</div></div><div><h3>Conclusion</h3><div>This study showed that the REAL™ intervention improved adolescents' emotional regulation skills and reduced their depression and anxiety scores. The program features a feasible school-based delivery using a socioculturally sensitive module integrated with VR components. This could facilitate adolescents’ learning engagement and resonate with their sociocultural context, making the skills relatable and attainable.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100494"},"PeriodicalIF":4.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Solution-focused Intervention for Mental health (SIM): description and feasibility testing of a positive psychology intervention in Swedish adolescents","authors":"Fredrik Söderqvist ,&nbsp;Lena Uvhagen ,&nbsp;Johanna Gustafsson ,&nbsp;Cynthia Franklin","doi":"10.1016/j.ssmmh.2025.100493","DOIUrl":"10.1016/j.ssmmh.2025.100493","url":null,"abstract":"<div><div>A paucity of studies exists that report on the description and testing of school-based interventions set out to promote mental well-being among adolescents, particularly in a Swedish context. The aim of this paper is to describe a new strength-based intervention designed using the core elements of solution-focused brief therapy for coaching within a normative frame of mental well-being. The Solution-focused Intervention for Mental health (SIM) is a nine-week, classroom-based, group intervention that has been developed to be both feasible and effective in addressing the current public health challenge concerning adolescent mental health. The intervention is described in accordance with guidelines for group-based behaviour change interventions. The results of three subsequent studies are presented and they support the intervention's feasibility. These studies demonstrate improvements in student participation, session attendance and ratings, as well as in a mental well-being outcome. The first two studies show small effect sizes and the third shows a medium effect size, thereby further substantiating the efficacy of implementing SIM in upper secondary schools. The program is now ready to be evaluated in a forthcoming randomized controlled trial.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100493"},"PeriodicalIF":4.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training antenatal care providers to deliver brief problem-solving therapy in rural Ethiopia: a developmental evaluation","authors":"Roxanne C Keynejad ,&nbsp;Adiyam Mulushoa ,&nbsp;Tesera Bitew ,&nbsp;Louise M. Howard ,&nbsp;Charlotte Hanlon ,&nbsp;Sharon Markless","doi":"10.1016/j.ssmmh.2025.100492","DOIUrl":"10.1016/j.ssmmh.2025.100492","url":null,"abstract":"<div><h3>Background</h3><div>Task-sharing is the redistribution of tasks usually performed by specialists, to staff with less training and fewer qualifications. Despite the established clinical efficacy of task-shared brief psychological interventions in low and middle-income countries, training and supervision models are infrequently reported and rarely evaluated.</div></div><div><h3>Methods</h3><div>From the interpretive paradigm, we conducted a developmental evaluation of training, supervision, and task-sharing of antenatal care providers (ANCPs) to deliver problem-solving therapy for antenatal depression in rural Ethiopia. We triangulated 18 qualitative interviews with women intervention recipients, ANCPs, mental health specialist trainer/supervisors and research staff, with documentary data. We employed reflexive thematic analysis before ‘peer review’ of our interpretations by a female Ethiopian research assistant.</div></div><div><h3>Findings</h3><div>Four over-arching themes encompassed the developmental journey, impacts, factors influencing success, and improvements. The complex adaptive healthcare system exerted unforeseen effects on the iterative development of training, supervisory and task-sharing plans. High quality communication skills (‘common elements’) training was most valued by ANCPs, while women especially appreciated psychological intervention ‘specific elements.’ An apprenticeship cascade model could balance the need for frequent, in-person specialist supervision against logistical barriers to travel from the capital. Fostering peer ‘communities of practice’ could support ANCPs' well-being and enhance their continued professional development.</div></div><div><h3>Conclusions</h3><div>This study contributes to sparse literature evaluating task-sharing training and supervisory approaches in resource-restricted settings, from an interpretive paradigm. Developmental evaluation proved a flexible methodological approach for exploring perspectives of stakeholders occupying diverse roles. We demonstrate the importance of embedding in-depth pedagogical consideration and qualitative evaluation into trials which depend on high quality clinical education.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100492"},"PeriodicalIF":4.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can sport promote adolescent mental health? A qualitative study from the rural plains of Nepal","authors":"Joanna Morrison ,&nbsp;Damodar Rimal ,&nbsp;Indira Pradhan ,&nbsp;Nagendra P. Luitel ,&nbsp;Kelly Rose-Clarke","doi":"10.1016/j.ssmmh.2025.100491","DOIUrl":"10.1016/j.ssmmh.2025.100491","url":null,"abstract":"<div><div>Sport holds potential to deliver adolescent mental health promotion, which is particularly important in low resource settings where there is high burden but lack of access to specialist services. We conducted a qualitative study in rural plains Nepal to describe adolescent stressors and coping strategies and analyse the mechanisms through which sport may promote or undermine mental health. We collected data from 81 adolescents, caregivers, teachers, coaches, and health workers through interviews, group discussions, and group walks. We used an interpretive descriptive approach to data collection and analysis. We found that adolescents were anxious about financial pressures on households, romantic relationships and relationships within families. Academic pressure and harassment of girls was common. Poor achievement in sport and resultant ridicule and loss of social status was also a source of shame and stress. Conversely, if adolescents participated in sport within a supportive environment, it provided opportunities for increased self-esteem, strong social support networks, development of discipline and stress release. We suggest five main areas of importance to consider when designing and implementing sport for mental health promotion interventions: 1)Involving communities, adolescents and caregivers in design, implementation and evaluation to prevent tensions and create a joint vision for how sport can support adolescents 2)Engaging with the social determinants of health 3) Developing adolescent coping strategies and signposting mental health support 4)Addressing fear of failure and lack of body confidence through creating a supportive, inclusive environment 5)Addressing negative gendered social norms. We show how sport interventions can be developed to support adolescent mental health through acknowledging and responding to complex community contexts.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100491"},"PeriodicalIF":4.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the sense of separation: Investigating the temporal association of continuum beliefs and interconnected explanations with stigma and advocacy for individuals with anxiety disorders and schizophrenia","authors":"Ben C.L. Yu,&nbsp;Shirley X. Peng,&nbsp;Sylvia Xiaohua Chen,&nbsp;Jacky C.K. Ng","doi":"10.1016/j.ssmmh.2025.100490","DOIUrl":"10.1016/j.ssmmh.2025.100490","url":null,"abstract":"<div><h3>Background and aims</h3><div>Social stigma has been adversely affecting various aspects of life for people with mental illness across different cultural contexts, highlighting an urgent need to reduce this stigma. It has been theorized that a sense of separation is a key component of stigmatization, and addressing this component is considered a feasible way to reduce social stigma. This study aimed to investigate the temporal relationship between continuum belief and interconnected explanations—constructs thought to address the sense of separation—and their impact on stigma and collective action for people with anxiety disorders and schizophrenia and their mechanism. Continuum belief views mental illness as existing on a spectrum of severity, rather than as a binary state of normality versus mental disorder. Interconnected explanation refers to the perception that individuals see themselves as contributing factors to the welfare of those with mental illness.</div></div><div><h3>Methods</h3><div>Valid responses were collected from 377 participants who reported that they did not have a history of clinical diagnosis of mental illness (57 % women; mean age = 21.55 years, SD = 5.15) from a public university in Hong Kong at baseline. A total of 308 (82 %) and 305 (81 %) valid responses were collected from the same group of participants at 1-month and 2-month follow-up assessments, respectively.</div></div><div><h3>Results</h3><div>Perceived similarity did not mediate the relationship between continuum belief and stigma or collective action, both concurrently and prospectively, after controlling for interconnected explanation, interconnected accountability, and previous contact experiences. However, interconnected accountability significantly mediated the relationship between interconnected explanation and both the intention to participate in and actual participation in collective action, but not stigma, for people with anxiety disorders and people with schizophrenia, both concurrently and prospectively.</div></div><div><h3>Conclusion</h3><div>This study provides evidence supporting the potential of interconnected explanation in promoting collective action for people with mental illness. It also offers insights into how continuum belief might be utilized for stigma reduction and advocacy promotion.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100490"},"PeriodicalIF":4.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring concept creep: Youth’s portrayal of ADHD on TikTok","authors":"Wietske de Vries,&nbsp;Laura Batstra,&nbsp;Arjen van Assen","doi":"10.1016/j.ssmmh.2025.100489","DOIUrl":"10.1016/j.ssmmh.2025.100489","url":null,"abstract":"<div><div>TikTok has quickly become a popular platform for youth to access and share mental health information. Videos discussing characteristics of diagnoses, such as Attention Deficit Hyperactivity Disorder (ADHD), receive significant engagement. However, concerns have been raised about the spread of misinformation and potential self-diagnosis among viewers of these videos.</div><div>To assess the accuracy of the information shared, we conducted a content analysis of 100 popular TikTok videos. Our findings showed that 55 % of the characteristics that youth attributed to ADHD in their videos did not align with the DSM-5-TR criteria of this diagnosis. Investigation of the top comments further suggests that the majority of the viewers (59,6 %) identified with the depicted behaviors and experiences. Moreover, most of the top-commenters accepted or even validated that these traits were part of ADHD, even though this was often not the case.</div><div>Our findings illustrate how youth broaden the ADHD concept on TikTok. This bottom-up psychiatrization may affect the self-image of other young people who identify with this content, as they come to understand their own behaviors through a pathological lens. It additionally raises concerns about the already high demand for health care, as individuals may seek help after self-diagnosing. This study highlights the need to make health care providers, educators and parents aware of the misinformation circulating online about ADHD. This would enable them to better support youth and help them to be critical of mental health content they encounter on social media.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100489"},"PeriodicalIF":4.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negotiating boundaries: (A qualitative study of) mental health professionals’ demarcation of psychiatric diagnosis in everyday practice","authors":"Jonathan Munch Bach ,&nbsp;Klaus Nielsen ,&nbsp;Henriette Bruun","doi":"10.1016/j.ssmmh.2025.100488","DOIUrl":"10.1016/j.ssmmh.2025.100488","url":null,"abstract":"<div><div>The purpose of this article is to explore how mental health professionals make use of and negotiate the boundaries of psychiatric diagnosis in their everyday practice. The study is based on empirical material from four months of participant observation and interviews conducted in both inpatient and outpatient psychiatric clinics in Denmark.</div><div>In this article, we demonstrate how diagnoses are not only used to describe the condition of a patient, but also to decide questions of agency, to render certain problems practicable, and to demarcate the boundaries of their practice.</div><div>Finally, we show how these negotiations hold consequences for the <em>trajectories of care</em> offered to patients and propose the notions of <em>situated rationality</em> and <em>psychiatry as a multiple institution</em> as important terms to understand the everyday practice and negotiations of mental health professionals.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100488"},"PeriodicalIF":4.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘I am happy because I am pregnant, but becoming a mother is not easy,’ the experience of pregnancy, antenatal depression, and perception of yoga in rural pregnant women in Maharashtra, a qualitative study","authors":"Rahul Shidhaye ,&nbsp;Kalyani Shinde ,&nbsp;Unnati Thete ,&nbsp;Sonali Shelke ,&nbsp;Chitra Thanage ,&nbsp;Shamal Talole ,&nbsp;Swapnali Palande ,&nbsp;Suryabhan Gore","doi":"10.1016/j.ssmmh.2025.100487","DOIUrl":"10.1016/j.ssmmh.2025.100487","url":null,"abstract":"<div><h3>Background</h3><div>Antenatal depression is a significant public health problem. It is critical to understand the ‘experience’ of pregnancy and the overall socio-cultural context of pregnant women to design and implement interventions to address antenatal depression effectively. The evidence base in this field is predominantly in the form of quantitative cross-sectional studies. There are few qualitative studies from low- and middle-income country settings. This study is part of the formative work related to the development of a yoga-based intervention for antenatal depression in rural women in Maharashtra, India.</div></div><div><h3>Methods</h3><div>We contacted pregnant women in the antenatal clinic and community centres in the study area and completed 26 In-Depth Interviews (IDIs). Of the total sample, 16 women had depression (EPDS≥10). All IDIs were conducted in Marathi, audio-recorded, transcribed, and then translated into English. We used NVivo 9 (QSR) to store and code the data, and a thematic content analysis approach to analyse and synthesize the findings.</div></div><div><h3>Results</h3><div>Five main themes emerged from the data: 1) experience of pregnancy (positive as well as negative), 2) coping strategies used by women, 3) support they receive from family members and professional support, 4) gender expectations, and 5) perception of yoga practice during pregnancy.</div></div><div><h3>Discussion</h3><div>We found that most women experienced positive emotions about pregnancy, and this was even true for women who screened positive for probable depression. Women reported several psychological problems and felt that the physical symptoms they experienced and interpersonal problems affected their psychological well-being. Husbands, in-laws, and parents supported women during pregnancy. Interestingly, neither community health workers nor obstetricians discussed or provided psychological support. Rest, spending time on social media, and talking to family members were common coping strategies used by women. Women were aware of yoga as they had practiced it during school but reported challenges in undertaking yoga practice during pregnancy.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100487"},"PeriodicalIF":4.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathways of service user participation in mental health decision-making in Lebanon","authors":"Thurayya Zreik ,&nbsp;Sandy Chaar ,&nbsp;Michelle Lokot ,&nbsp;Rozane El Masri ,&nbsp;Rayane Ali ,&nbsp;Bassel Mekssasi ,&nbsp;Joseph Elias ,&nbsp;Michele Asmar ,&nbsp;Martin McKee ,&nbsp;Felicity L. Brown ,&nbsp;Rabih El Chammay ,&nbsp;Bayard Roberts","doi":"10.1016/j.ssmmh.2025.100486","DOIUrl":"10.1016/j.ssmmh.2025.100486","url":null,"abstract":"<div><div>Inclusive participation of mental health service users is critical for effective decision-making and governance, yet remains underexplored in humanitarian settings. Lebanon, facing protracted crises and hosting over 1.5 million Syrian refugees, provides a unique case to examine pathways of service user participation in mental health decision-making. This qualitative study investigates barriers, facilitators, and power dynamics influencing service user participation at the micro-, meso- (service), and macro- (policy) levels. Semi-structured interviews and focus group discussions were conducted with 33 purposively selected participants, including Syrian and Lebanese service users, NGO staff, and UN representatives. Data were collaboratively analysed using Dedoose software based on codes developed deductively and inductively. Our findings reveal that participation is limited and predominantly consultative, with power imbalances including gender, socioeconomic status, stigma, and displacement status creating significant barriers. Users reported decision-making power at the individual level, particularly in seeking services and treatment planning, but meaningful participation at service or governance levels was rare. Providers highlighted efforts to gather user input but often framed participation as part of routine monitoring and evaluation. Reluctance to engage formal governance structures, due to mistrust and structural and attitudinal barriers, further inhibited participation. Strategies to enhance meaningful participation include increasing awareness, capacity-building, promoting flexibility in service design, and strengthening user-led advocacy. Addressing power imbalances and promoting inclusive, user-centered approaches are essential to advancing inclusion in mental health systems, with valuable implications for humanitarian and crisis-affected settings globally.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100486"},"PeriodicalIF":4.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}