BJPsych Open最新文献

{"title":"Impact of social isolation and loneliness on the risk of functional bowel disorders: findings from a large-scale cohort study.","authors":"Yan Ran, Jian Lei, Lianli Wang, Yan Zhuang, Laifu Li, Jiamiao Chen, Zhuoya Sun, Lin Mei, Fei Dai","doi":"10.1192/bjo.2026.12065","DOIUrl":"https://doi.org/10.1192/bjo.2026.12065","url":null,"abstract":"<p><strong>Background: </strong>Social isolation and loneliness are recognised as important risk factors for various health outcomes. However, their impact on functional bowel disorders (FBDs) remains underexplored.</p><p><strong>Aims: </strong>To explore the associations of social isolation and loneliness with the risk of FBDs in a large prospective cohort.</p><p><strong>Method: </strong>We included 396 009 participants from UK Biobank who were free of cancer and FBDs at baseline. Social isolation and loneliness were assessed using validated self-reported questionnaires. Incident FBDs were ascertained during follow-up. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs. Mediation, subgroup and sensitivity analyses were conducted.</p><p><strong>Results: </strong>Over a mean follow-up of 15.2 years, 31 877 incident FBDs cases were recorded. Compared with the least isolated, the most isolated had a higher risk of FBDs (hazard ratio 1.15, 95% CI 1.11-1.20). Loneliness was also associated with higher risk (hazard ratio 1.28, 95% CI 1.21-1.35). The highest risk was observed among participants who were most isolated and lonely (hazard ratio 1.46, 95% CI 1.33-1.60). Depression, anxiety and low physical activity partially mediated the associations between social isolation/loneliness and FBDs. The association between social isolation and FBDs risk appeared stronger among male, overweight and unemployed individuals, whereas middle-aged adults were more susceptible to loneliness-related risk.</p><p><strong>Conclusions: </strong>Social isolation and loneliness were associated with a higher risk of FBDs, particularly when co-occurring. These findings underscore the potential relevance of social disconnection to FBDs and suggest that it may represent a target for future preventive strategies.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e217"},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'A challenging but rewarding journey': qualitative study of participants' experiences of EMDR for functional neurological disorder within the MODIFI trial.","authors":"Sarah R Cope, Billie James, Serena Vanzan, Jared G Smith, Sharif El-Leithy, Mark J Edwards, Patricia Hogwood, Kati J Turner, Dawn Golder, Jo Billings","doi":"10.1192/bjo.2026.12060","DOIUrl":"https://doi.org/10.1192/bjo.2026.12060","url":null,"abstract":"<p><strong>Background: </strong>Functional neurological disorder (FND) is a common neurological presentation and can be associated with high disability, high healthcare costs and difficulty accessing treatment. Effective treatments are still being established. A feasibility study evaluating eye movement desensitisation and reprocessing (EMDR) therapy as a treatment for FND (MODIFI) demonstrated positive outcomes. The experiences of EMDR for people with FND have not been previously reported.</p><p><strong>Aims: </strong>We aimed to explore the experiences of participants who had completed EMDR therapy in the MODIFI trial.</p><p><strong>Method: </strong>Participants who completed EMDR therapy in MODIFI were invited to take part in semi-structured interviews on completion of the trial. Eleven participants consented to take part and were interviewed. Interviews were analysed with reflexive thematic analysis.</p><p><strong>Results: </strong>Analysis was organised into four main domains: (a) expectations before the trial; (b) preparedness for EMDR; (c) mysterious but unique journey and (d) it was hard, but worth it - 'a rewarding challenge'. Within these domains, we identified ten themes.</p><p><strong>Conclusions: </strong>Participants reported limited understanding of why or how EMDR might be helpful, but were still motivated to take part. Participants expressed that they had felt anxious about focusing on memories of past experiences. However, they described feeling safe and in control in the therapy, despite it being difficult at times. Overall, participants reported positive effects, and that perceived costs were worthwhile. These results add further support that a full-scale trial evaluating FND-focused EMDR is justified.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e220"},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of autism spectrum disorder among children and adolescents in Ethiopia (1990-2023) with projections to 2050: insights from the Global Burden of Disease study.","authors":"Molalign Aligaz Adisu, Yabibal Asfaw Derso, Zelalem Abere Gessesse, Abraham Dessie Gessesse, Bogale Molla, Alemu Birara Zemariam, Tesfaye Engdaw Habte","doi":"10.1192/bjo.2026.12076","DOIUrl":"https://doi.org/10.1192/bjo.2026.12076","url":null,"abstract":"<p><strong>Background: </strong>Despite growing recognition as a public health concern, the burden of autism spectrum disorder (ASD) in Ethiopia remains poorly characterised owing to limited diagnostic capacity and epidemiological data, hampering evidence-based policy and intervention planning.</p><p><strong>Aims: </strong>This study aimed to quantify the longitudinal burden of ASD in the Ethiopian paediatric population from 1990 to 2023 and project future trends to 2050 to inform national health strategies.</p><p><strong>Method: </strong>Using Global Burden of Disease (GBD) 2023 data, we estimated ASD prevalence, incidence and disability-adjusted life-years (DALYs) among Ethiopian children and adolescents. Trends were analysed using joinpoint regression and future burden was forecast to 2050 using autoregressive integrated moving average (ARIMA) modelling.</p><p><strong>Results: </strong>Between 1990 and 2023, ASD prevalence increased by 155%, from 271 805 to 693 644 cases. Correspondingly, the age-standardised prevalence rate increased from 950 to 1185 cases per 100 000 population. Although annual incident cases nearly doubled (from 24 576 to 47 274), the age-standardised incidence rate declined slightly from 86 to 81 cases per 100 000. DALYs increased by 162% to 134 386 in 2023, while the age-standardised DALY rate increased from 179 to 230 per 100 000. Projections to 2050 suggest that the overall ASD burden will persist, with a stable incidence rate but an increasing DALY rate.</p><p><strong>Conclusions: </strong>Nearly 700 000 Ethiopian children and adolescents were living with ASD in 2023. The significant increases in prevalence and DALYs over three decades underscore the urgent need for a comprehensive national strategy, including enhanced diagnostic infrastructure and early intervention programmes.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e219"},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insight into cannabis use disorder in people with psychotic disorders.","authors":"Edward Chesney, Millie Lloyd, Sebastien Brodeur, Arsime Demjaha, Lisa Conlan, Ikram Slimani, Ayşe Doğa Lamper, Ananya Sarma, Will Lawn, Dominic Oliver, Tom P Freeman, Robin Murray, Marta Di Forti, Amir Englund, John Strang, Philip McGuire","doi":"10.1192/bjo.2026.12064","DOIUrl":"https://doi.org/10.1192/bjo.2026.12064","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use is common in people with psychosis and is associated with poor outcomes.</p><p><strong>Aims: </strong>To assess insight into cannabis use disorder, perceptions about how cannabis use influences mental health and the desire to change cannabis use among people with psychotic disorders.</p><p><strong>Method: </strong>Adults with a psychotic disorder and comorbid cannabis use disorder were asked about the impact of cannabis use on their illness and their desire to change cannabis use. Cannabis use disorder was determined using DSM-5 criteria. Participants completed the Substance Use Awareness and Insight Scale.</p><p><strong>Results: </strong>Sixty-two participants (mean age: 42 years; 95% male; 65% Black ethnicity; 85% severe DSM-5 cannabis use disorder) completed the study. The mean total Substance Use Awareness and Insight Scale score was 4.8 (s.d.: 2.1), with subdomain scores of 3.7 (s.d.: 2.8) for general illness awareness, 6.2 (s.d.: 2.8) for symptom attribution, 3.5 (s.d.: 2.9) for awareness of need for treatment and 5.6 (s.d.: 3.8) for awareness of negative consequences. Fifty-eight per cent said that cannabis use made their mental health 'better', whereas only 15% said it made it 'worse'; 27% reported that cannabis made their psychotic symptoms 'better', and 21% said it made them 'worse'. Nevertheless, more than half the sample (53%) said they wanted to reduce or stop using cannabis.</p><p><strong>Conclusions: </strong>Many people with psychotic disorders have impaired insight into cannabis use disorder or believe that cannabis improves their mental health; these factors may contribute to persistent use in this population. Interventions that improve insight may help to address ambivalence and support those already wishing to reduce use.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e214"},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocarditis monitoring during clozapine initiation: audit of practice in an NHS trust.","authors":"Madelaine Bridges, Agostina Secchi, Yash Kumar, Von-de Viel Nettey, Jagdip Bahia, Eromona Whiskey, Sukhi S Shergill","doi":"10.1192/bjo.2026.12079","DOIUrl":"https://doi.org/10.1192/bjo.2026.12079","url":null,"abstract":"<p><strong>Background: </strong>Clozapine is the most effective treatment for individuals with treatment-resistant schizophrenia, but concerns about adverse effects continue to limit its use. In contrast to haematological monitoring, which is governed by established protocols, there is no standardised framework for detection of clozapine-associated myocarditis. Clozapine-induced myocarditis is rare but potentially fatal and typically occurs within the first 4 weeks of treatment. As early symptoms such as fever and tachycardia overlap with common side-effects of clozapine, diagnosis is often delayed, and clozapine may be unnecessarily discontinued. Evidence suggests that routine monitoring of troponin and C-reactive protein (CRP), alongside assessment of vital signs and electrocardiography (ECG), can support earlier detection and safer treatment.</p><p><strong>Aims: </strong>To evaluate cardiac monitoring practice in patients initiating clozapine treatment.</p><p><strong>Method: </strong>We undertook a retrospective review of all patients registered to start clozapine at Kent and Medway Mental Health National Health Service (NHS) Trust between January 2021 and March 2024. Data were collected on baseline ECG completion, weekly troponin and CRP testing during the first 4 weeks, and documented cardiac symptoms.</p><p><strong>Results: </strong>Of 219 patients, 180 had complete data. Baseline ECG was completed in 80% of cases. No routine troponin monitoring was identified, and CRP testing was infrequent. Tachycardia occurred in more than 40% of patients. Fifteen patients were referred to cardiology before initiation, as well as six in the first 4 weeks and five thereafter. Twelve patients (7%) discontinued clozapine early, mainly owing to tachycardia.</p><p><strong>Conclusions: </strong>The findings indicate an absence of systematic myocarditis monitoring. Incorporating weekly troponin and CRP testing into existing mandatory blood testing could improve safety, guide appropriate cardiology referrals and reduce unnecessary discontinuation.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e216"},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does time matter? The temporal relationship between peritraumatic reactions and post-traumatic stress disorder: parallel-process latent growth curve model.","authors":"Emre Alpay, Resul Çakır, Feyruz Usluoğlu","doi":"10.1192/bjo.2026.12077","DOIUrl":"https://doi.org/10.1192/bjo.2026.12077","url":null,"abstract":"<p><strong>Background: </strong>Peritraumatic dissociation and distress are among the most frequently studied early correlates of post-traumatic stress disorder (PTSD), yet their temporal role following large-scale disasters remains insufficiently understood.</p><p><strong>Aims: </strong>This study examined the temporal relationship between peritraumatic dissociation, peritraumatic distress and PTSD symptoms across 3 waves spanning 2 years following the February 2023 Turkey earthquakes.</p><p><strong>Method: </strong>Data were collected approximately 2 months (Time 1; <i>N</i> = 261), 1 year (Time 2; <i>n</i> = 182) and 2 years post-earthquake (Time 3; <i>n</i> = 131). PTSD symptoms, peritraumatic dissociation and peritraumatic distress were assessed using validated self-report instruments. Pearson correlation analyses and parallel-process latent growth curve models (LGMs) were used to examine temporal changes and longitudinal associations.</p><p><strong>Results: </strong>Higher initial levels of peritraumatic dissociation (<i>β</i> = 0.40, <i>p</i> < 0.001) and distress (<i>β</i> = 0.46, <i>p</i> < 0.001) significantly predicted greater initial PTSD severity. However, neither peritraumatic dissociation nor distress predicted the slope of PTSD symptoms over time, and slope covariances were non-significant. All three variables declined substantially across waves (ηp² = 0.75 to 0.79).</p><p><strong>Conclusions: </strong>Peritraumatic reactions appear to function primarily as indicators of early PTSD severity rather than determinants of long-term symptom trajectories. These findings support multi-stage screening approaches that extend beyond early peritraumatic assessments to incorporate post-traumatic cognitive, social and environmental factors.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e215"},"PeriodicalIF":4.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measures for intersectional mental healthcare: results from a participatory interview and focus group study with psychosocial counsellors, people with experience of using mental health services and providers.","authors":"Mirjam Faissner, Patiani Batchati, Neneh Rosalía Quadflieg, Alva Träbert, Eike Leidgens, Georg Juckel, Jakov Gather, Amma Yeboah","doi":"10.1192/bjo.2026.12026","DOIUrl":"10.1192/bjo.2026.12026","url":null,"abstract":"<p><strong>Background: </strong>Discriminatory practices and barriers to care are increasingly recognised as a significant challenge for mental healthcare institutions. Yet, little research has considered what measures people with experience of using mental health services and mental healthcare service providers recommend to implement anti-discrimination within mental healthcare.</p><p><strong>Aims: </strong>This study aims to explore the perspectives and recommendations of marginalised people with experience of using mental health services, mental healthcare service providers and psychosocial counsellors, to inform more equitable mental healthcare.</p><p><strong>Method: </strong>Between May 2022 and June 2023, we conducted 17 semi-structured qualitative interviews and 2 focus groups with psychosocial counsellors, people with experience of using mental health services and mental healthcare service providers. Data analysis followed structuring qualitative content analysis, combined with participatory methods.</p><p><strong>Results: </strong>Study participants recommended interpersonal, organisational and structural measures to address mental healthcare inequities. On an interpersonal level, they emphasised providers' behaviour and attitudes toward discrimination. Organisationally, they called for a comprehensive intersectional care framework, fostering inclusive therapy environments, increasing staff diversity and implementing continuous anti-discrimination training. Structurally, they advocated for discrimination-critical therapy materials, revised curricula and removing barriers to medical education and healthcare.</p><p><strong>Conclusions: </strong>The study yielded suggestions for anti-discriminatory, critical consciousness-based and inclusive practices on the interpersonal, organisational and structural levels of mental healthcare. It offers important insights for research devoted to implementing and evaluating such measures.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e210"},"PeriodicalIF":4.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the costs of developing a digital supervision tool for task-shared depression care: findings from a multi-site study in India.","authors":"Shreyas Kamat, Luanna Fernandes, Ankita Shah, Ravindra Agrawal, Anant Bhan, Chunling Lu, Abhijit Nadkarni, Carina Akemi Nakamura, Vikram Patel, Julia R Pozuelo, Daisy Radha Singla, John A Naslund","doi":"10.1192/bjo.2026.12052","DOIUrl":"10.1192/bjo.2026.12052","url":null,"abstract":"<p><strong>Background: </strong>Task-sharing with non-specialist providers offers a promising solution to the mental health workforce shortage in low-resource settings. Supervision is essential to ensure treatment quality, but is often constrained by limited specialist availability.</p><p><strong>Aims: </strong>This study evaluated the costs of developing PEERS, a smartphone app that can facilitate registering and scheduling supervision sessions, collecting patient outcomes, rating therapy quality and assessing supervision quality among community-based non-specialist providers delivering behavioural activation for depression.</p><p><strong>Method: </strong>The PEERS digital application was developed between June 2021 and September 2022 for use in Madhya Pradesh and Goa, India. Development involved contributions from researchers, clinicians, technology experts and end users. Activity-based costing was used to systematically document the inputs and expenditures involved in developing the PEERS app and its accompanying training materials from a health systems perspective. Key cost components included human resources, leadership, IT support and infrastructure.</p><p><strong>Results: </strong>Total development costs were US＄130 027, with the costs of information technology accounting for the largest share (81%; US＄105 110). Human resource contributions accounted for 17% (US＄22 523), which included oversight and contributions from international research collaborators. Additional costs included overhead and infrastructure (US＄2393).</p><p><strong>Conclusions: </strong>Digital tools are increasingly being used to expand access to and support the delivery of mental health interventions in low-resource settings, yet few studies report on the development costs. By estimating the costs and resources required for developing a digital app for peer supervision, this study can inform efforts to facilitate broader implementation and adaptation of the app for use in other settings.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e211"},"PeriodicalIF":4.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing the integrated motivational-volitional model of suicidal behaviour among Danish adolescents in clinical psychiatric care: focus on volitional moderators.","authors":"Erik Christiansen, Agnieszka Konieczna, Katrine Ulrikke Madsen, Christina P Larsen, Sarah Grube Jakobsen, Rory C O'Connor","doi":"10.1192/bjo.2026.12066","DOIUrl":"10.1192/bjo.2026.12066","url":null,"abstract":"<p><strong>Background: </strong>The integrated motivational-volitional (IMV) model of suicidal behaviour has received growing empirical support, yet few studies have tested its core pathways (defeat → entrapment → suicidal ideation → suicide attempts) in clinical psychiatric adolescent populations. Evidence on volitional moderators influencing the transition from ideation to action remains limited.</p><p><strong>Aims: </strong>This study aimed to (a) test the core pathways of the IMV model and (b) examine whether volitional moderators differentiate between adolescents with suicidal ideation and those who have attempted suicide.</p><p><strong>Method: </strong>In this cross-sectional study, 203 Danish adolescents aged 13-19 years were recruited from an out-patient child and adolescent psychiatry department, including patients in treatment or referred for initial assessment. Participants completed validated measures assessing IMV constructs. Path analysis tested the core pathways and multinomial logistic regression examined associations between volitional moderators and group membership (no suicidal behaviour, suicidal ideation only and suicide attempt), with Wald tests comparing effects across outcomes.</p><p><strong>Results: </strong>Findings supported the core IMV pathway, with the entrapment-ideation pathway being weakest. Volitional moderators were more strongly associated with suicide attempts than suicidal ideation, with significant differences confirmed by Wald tests. A dose-response pattern showed increasing likelihood of suicide attempts with greater exposure to volitional moderators; effect sizes differed significantly between ideation (odds ratio 2.21) and attempts (odds ratio 3.94).</p><p><strong>Conclusions: </strong>Results support the IMV model and highlight the role of volitional moderators in differentiating between suicidal ideation and attempts. These findings support a shift towards theory-informed psychosocial assessment in clinical adolescent populations.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e209"},"PeriodicalIF":4.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attachment-related trauma markers and symptom severity in Afghan refugees.","authors":"Thomas Egger, Anna Buchheim, Britta Dumser, Manuela Gander","doi":"10.1192/bjo.2026.12057","DOIUrl":"10.1192/bjo.2026.12057","url":null,"abstract":"<p><strong>Background: </strong>Afghan refugees experience high levels of cumulative trauma and psychosocial adversity, yet attachment-related trauma has rarely been examined at the narrative level. Narrative attachment assessments may capture culturally embedded expressions of distress beyond post-traumatic stress disorder (PTSD)-focused symptom models.</p><p><strong>Aims: </strong>This study examined narrative attachment-related trauma markers in Afghan refugees receiving out-patient psychological treatment. It investigated whether trauma marker frequency differed between resolved and unresolved attachment representations and whether it was associated with psychological symptom severity.</p><p><strong>Method: </strong>In an exploratory cross-sectional study, 40 Afghan refugees (mean age = 25.4 years; 75% male) receiving out-patient psychological treatment completed the Adult Attachment Projective Picture System, a narrative-based attachment interview. Trauma markers were identified and quantified within the narratives. Associations with attachment representations (resolved versus unresolved) and psychological symptom severity were examined in a subsample with available self-report data (<i>n</i> = 27).</p><p><strong>Results: </strong>Participants with unresolved attachment representations showed higher trauma marker frequencies than those with resolved representations. Trauma marker frequency was positively associated with depressive symptoms and overall psychological distress (Spearman's effect size estimate (<i>r</i>) = 0.40-0.51; 95% bias-corrected and accelerated (BCa) confidence intervals excluding zero) but not with PTSD symptom severity.</p><p><strong>Conclusions: </strong>Trauma markers captured clinically relevant distress in Afghan refugees beyond PTSD-specific symptomatology, particularly depressive symptoms and general psychological burden. Narrative, attachment-based approaches may be especially valuable in clinical encounters in which distress is conveyed implicitly, relationally, or in culturally contextualised ways rather than through explicit symptom reporting. Culturally sensitive applications of such methods, supported by well-trained interpreters, are essential for clinical understanding and meaningful clinical engagement.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"12 5","pages":"e212"},"PeriodicalIF":4.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}