Link workers' and clients' perspectives on how social prescribing offers a social cure for loneliness.

Social prescribing is a healthcare model designed to reduce loneliness and improve individuals' health by addressing unmet social needs. The present study adopted the Social Cure framework to provide an understanding of the psychosocial processes involved in helping participants to engage with social activities, from both the link workers' and clients' perspectives. Semi-structured interviews were conducted with 15 link workers (Mage = 40.12; 87% female) and 15 clients (Mage = 55.33; 73% female, 7% non-binary) of social prescribing programmes across Australia and the transcripts were analysed using reflexive thematic analysis. Three overarching themes were identified: (1) Breaking Down Barriers, (2) Finding Fit with Others, and (3) Rebuilding a Sense of Self. These findings communicate how social prescribing addressed the psychosocial barriers of clients, and how joining groups that fostered positive shared social identities resulted in meaningful improvements to clients' well-being.

Effectiveness of physical activity interventions on undergraduate students' mental health: systematic review and meta-analysis.

This systematic review and meta-analysis assessed the effectiveness of physical activity interventions on undergraduate students' mental health. Seven databases were searched and a total of 59 studies were included. Studies with a comparable control group were meta-analysed, and remaining studies were narratively synthesized. The included studies scored very low GRADE and had a high risk of bias. Meta-analyses indicated physical activity interventions are effective in reducing symptoms of anxiety (n = 20, standardized mean difference (SMD) = -0.88, 95% CI [-1.23, -0.52]), depression (n = 14, SMD = -0.73, 95% CI [-1.00, -0.47]) and stress (n = 10, SMD = -0.61, 95% CI [-0.94, -0.28]); however, there was considerable heterogeneity (anxiety, I2 = 90.29%; depression I2 = 49.66%; stress I2 = 86.97%). The narrative synthesis had mixed findings. Only five studies reported being informed by a behavioural change theory and only 30 reported intervention fidelity. Our review provides evidence supporting the potential of physical activity interventions in enhancing the mental health of undergraduate students. More robust intervention design and implementation are required to better understand the effectiveness of PA interventions on mental health outcomes.

A controlled evaluation of social prescribing on loneliness for adults in Queensland: 8-week outcomes.

Introduction: There have been few controlled evaluations of Social Prescribing (SP), in which link workers support lonely individuals to engage with community-based social activities. This study reports early outcomes of a trial comparing General Practitioner treatment-as-usual (TAU) with TAU combined with Social Prescribing (SP) in adults experiencing loneliness in Queensland. Methods: Participants were 114 individuals who were non-randomly assigned to one of two conditions (SP, n = 63; TAU, n = 51) and assessed at baseline and 8 weeks, on primary outcomes (loneliness, well-being, health service use in past 2 months) and secondary outcomes (social anxiety, psychological distress, social trust). Results: Retention was high (79.4%) in the SP condition. Time × condition interaction effects were found for loneliness and social trust, with improvement observed only in SP participants over the 8-week period. SP participants reported significant improvement on all other outcomes with small-to-moderate effect sizes (ULS-8 loneliness, wellbeing, psychological distress, social anxiety). However, interaction effects did not reach significance. Discussion: Social prescribing effects were small to moderate at the 8-week follow up. Group-based activities are available in communities across Australia, however, further research using well-matched control samples and longer-term follow ups are required to provide robust evidence to support a wider roll out.

Data from four consecutive cohorts of students in Australia (2019-2022) show the impact of the COVID-19 pandemic on domestic and international university students' mental health.

INTRODUCTION: COVID-19 and related travel and social restrictions caused significant stress for university students in Australia and globally. Learning quickly moved online and many students (particularly international students) were separated from social and economic support. This study examined the impact of the pandemic from pre-pandemic (2019) to the COVID-19 Omicron wave (2022) on domestic and international students' mental health. METHODS: Participants were 1540 students (72% females, 28% international) in four first-year cohorts (2019, 2020, 2021, 2022). We screened for mental health concerns (% positive) and symptom scores for depression, anxiety and somatic distress using the PsyCheck, and general wellbeing using the Warwick-Edinburgh Mental Well-being scale. RESULTS: From pre-COVID (2019) to the first wave of COVID-19 (2020), the proportion of students screening positive for mental health problems rose in both domestic students (66-76%) and international students (46-67%). Depression symptoms and wellbeing were worse in 2020 than in 2019, 2021 and 2022. Anxiety symptoms increased from 2019 to 2020 and continued to rise in 2021 and 2022. Somatic symptoms did not show an effect of cohort. Contrary to expectations, domestic students reported higher distress and lower wellbeing than international students across cohorts. CONCLUSION: The pandemic was associated with a marked increase in psychological distress in first-year university students, not all of which settled with the easing of restrictions. Post-pandemic recovery in the Australian university sector must include university-wide access to mental health information and support for incoming students.

Expanding the social cure: a mixed-methods approach exploring the role of online group dance as support for young people (aged 16-24) living with anxiety.

There is an increased interest in whether online arts interventions support mental health and social connections. This study explored eight weeks of online group dance as support for young people (aged 16-24) living with anxiety. The applicability of the 'social cure' theoretical framework to the novel context of an online dance class was sought. The study utilised an embedded QUAL+quan design, incorporating participatory focus group discussions (n = 3 groups; n = 11 participants) and one-on-one interviews (n = 2 participants), creative reflections (n = 16 participants) and ethnographic fieldnotes, and a repeated measures design with surveys at three timepoints (week 1, n = 27; week 4, n = 18; week 8, n = 14). Thematic analysis identified two overarching themes demonstrating how the dance classes (i) provided the opportunity to co-construct a meaningful shared identity and (ii) supported holistic wellbeing. The quantitative findings supported this, suggesting lower anxiety, depression, and loneliness and higher wellbeing, self-esteem, self-efficacy, and group closeness. This study expands the social cure to its application to an online dance context for the first time.

Efficacy of the Tuned In music emotion regulation program in international university students.

OBJECTIVE: Moving overseas to study can be exciting, however many international students find this transition stressful. Therefore, empirically supported strategies to assist with managing stress and supporting well-being are needed. Motivated music listening is an effective stress management strategy, and is linked with international student well-being. Tuned In is a group program designed to increase emotion awareness and regulation using motivated music listening. METHODS AND MEASURES: We evaluated a 4-session online version of Tuned In for motivated music use, emotion regulation, and well-being in international students. The study used a 2 (Treatment; Waitlist) x 3 (timepoints: pre = T1; +4 weeks = T2; +8 weeks = T3) randomised controlled cross-over design. Treatment participants (n = 23) completed Tuned In between T1 and T2, Waitlist participants (n = 27) completed Tuned In between T2 and T3. RESULTS: Between T1 and T2, motivated music use increased in Treatment participants but not for the Waitlist. Treatment participants were also more confident in maintaining happiness and in having healthy ways of managing emotions at T2. All participants enjoyed Tuned In. CONCLUSIONS: Tuned In, a group-based music listening program, even when delivered online, provides benefits for international students. With student well-being at risk as they begin university, enjoyable programs that help develop skills for students' academic journey should be a priority.

Misery loves company: Predictors of treatment response to a loneliness intervention.

OBJECTIVE: The last 10 years have seen a surge of interest in loneliness and interventions to reduce it. However, there is little evidence regarding differential treatment effectiveness and predictors of treatment outcome. This paper aimed to investigate possible predictors of treatment response. METHODS: We analysed data from two clinical trials of an evidence-based loneliness intervention: Groups 4 Health (G4H). Study 1 had 163 observations across two timepoints, n = 94; Study 2 had 297 observations across four timepoints; n = 84. Theorised predictors-symptom severity at baseline, program engagement, and demographic characteristics-were assessed for their effect on the primary outcome: loneliness. RESULTS: Across both trials, participants with more severe baseline loneliness or social anxiety, or who attended more sessions, experienced greater improvement in loneliness. In Study 2, those with diagnosed mental illness or more severe baseline depression also tended to have better outcomes. There was no evidence that age, gender, or ethnicity predicted program efficacy. CONCLUSION: Overall, those with greater need-reflected in either severity of loneliness or psychological distress-tended to show greater improvement over time. This was due, in part, to greater engagement with the program among those who were lonelier. We discuss how loneliness interventions can be deployed most effectively to combat this profound public health challenge.

Testing a psychosocial model of sexual communication and sexual risk-taking: A cross-sectional, online survey study of Australian University students.

OBJECTIVE: Sexually transmitted infection rates are higher among young people relative to other age groups. Despite much investigation, there is not enough research about in-the-moment factors associated with risky sexual behaviour, such as relational and situational variables. The present study sought to test a comprehensive psychosocial model of sexual risk-taking that included a range of factors: individual (emotion dysregulation, impulsivity), relational (attachment, communication), societal (norms, gender), and situational (dating application use, alcohol use). METHODS: 1244 young people aged 18 to 25 years (82.9 % women; 59.2 % single, 36.0 % in a monogamous relationship) participated in an online survey. The cross-sectional model was tested using Structural Equation Modelling. RESULTS: Sexual communication mediated the relationship between attachment anxiety and sexual risk. However, contrary to predictions, greater sexual communication was related to higher risk. Post-hoc analysis showed that this unexpected relationship may be due to the way sexual risk was measured, as an alternative model specifying casual unprotected sex as the outcome showed no positive relationship between sexual communication and risk. CONCLUSION: Findings indicate that young people with anxious attachment are less confident communicating about sexual health. Measures of sexual risk focusing on specific risk activities in context yield different findings to those assessing general sexual behaviours. Findings support interventions focusing on addressing perceived sexual risk norms and the dating application context to reduce risk.

Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use.

This cohort-controlled trial examined whether the 12-session Grit Wellbeing and Self-regulation Program enhanced the treatment outcomes of young people accessing residential alcohol and other drug (AOD) treatment. Grit focuses on increasing wellbeing and reducing substance use and mental health problems by building self-regulation skills, strengths, social connections, and health behaviours. Participants were 194 (66% male, Mage 27.40) young people (aged 18-35 years) accessing a six-week residential treatment program for substance use. Participants received standard treatment, or standard treatment plus Grit (two sessions/week for six weeks). The primary outcome was substance use, measured as: (i) global substance use and (ii) alcohol, methamphetamine, and cannabis use involvement. Secondary outcomes included wellbeing, depression, anxiety, and vocational engagement. Participants were assessed at baseline, and 6-weeks (secondary outcomes only), 3-months, 6-months, and 12-months post-program enrolment. Results revealed that both groups showed a significant improvement in all outcomes at three months, and improvements were maintained at 6- and 12-month follow-ups. The Grit group had a larger reduction in methamphetamine and cannabis use involvement compared to the control group. This study presents promising evidence that a six-week residential program can achieve improvements in AOD use, depression, anxiety, wellbeing and vocational engagement. Further, targeting self-regulation may enhance such programs.

Social prescribing link workers-A qualitative Australian perspective.

Social prescribing (or community referral) is a model of healthcare designed to address social needs that contribute to poor health. At the heart of social prescribing programs is the link worker, who liaises between clients, health professionals and community organisations. Social prescribing is newly emerging in Australia but there are already calls for a large-scale roll out. This research, therefore, aimed to understand Australian link workers' role and skills required, to determine where such a workforce could be drawn from in Australia, and to identify what training and resources are needed to support this potential new workforce. To explore these questions, interviews were conducted with 15 link workers in Queensland, New South Wales and Victoria, and the transcripts were analysed using thematic analysis. Participants were predominantly female (87%); and primarily had qualifications in social work (47%) or nursing (27%). Three overarching themes were identified: (1) skills of successful social prescribing, identifying that link work requires multifaceted social and emotional skills; (2) workforce issues, presenting that link workers experienced challenges such as a lack of available support and training, lack of public awareness of social prescribing and a lack of sustained funding; and (3) job fulfilment, related to link workers' sense of reward and accomplishment from the job. We suggest that fostering job fulfilment in conjunction with the provision of increased support, training and security will reduce feelings of overwork and burnout among link workers and likely lead to longevity in the role. Social prescribing has the potential to be hugely beneficial to clients and the community and fulfilling for link workers, provided that sufficient advocacy and resources are put in place.

Exploring links between social identity, emotion regulation, and loneliness in those with and without a history of mental illness.

OBJECTIVE: Emotion regulation and social identity theorizing provide two influential perspectives on loneliness. From an emotion regulation perspective, loneliness is understood as a negative emotional state that can be managed using emotion regulation strategies. A social identity perspective views loneliness as resulting from a loss or lack of important social groups and related identities. This study aimed to explore the relationships between key constructs drawn from both perspectives, with a view to understanding loneliness in adults with and without a history of mental illness. DESIGN AND METHODS: Participants (N = 875) with a mental illness history (MH Hx, n = 217; Mage = 45 years, 59% female) and without a mental illness history (No MH Hx, n = 658; Mage = 47 years, 48% female) completed a survey comprising measures of group membership and connectedness, emotion regulation strategies, and loneliness. RESULTS: The MH Hx group reported higher internal affect worsening strategy use and loneliness than those No MH Hx. Hierarchical regressions indicated that the unique contributions of emotion regulation strategies and social identity factors to loneliness were equivalent between the groups. Together, social identity and emotion regulation explained 37% of the variance in loneliness in the No MH Hx subsample and 35% in the MH Hx subsample. CONCLUSION: These findings suggest that both emotion regulation and social identity had significant unique contributions to the reported loneliness of people when controlling for demographics and each other in those with and without a history of mental illness. Integration of the two frameworks may provide novel avenues for the prevention and management of loneliness. PRACTITIONER POINTS: Individuals with a history of mental illness report more use of internal emotion worsening regulation strategies and greater loneliness than those with no such history, but there were no differences in social identity factors. Internal emotion worsening strategies and social support received from others explained the variance in reported loneliness for both those with and without a history of mental illness. Internal emotion improving strategies were significant for those with a history of mental illness, while social support given was significant for those without a history of mental illness. Screening clients for emotion regulation difficulties, social disconnectedness, and loneliness may provide clinicians with an indication of risk for developing psychological distress/disorders.

Verbalisation of attention regulation strategies and background music enhance extinction learning and retention.

Relapse and return of fear are common following exposure-based treatments which aim to decrease anxiety by reducing danger expectancies and negative stimulus evaluations. Using Pavlovian conditioning and extinction procedures, recent studies found that verbalising catchphrases to prompt attention to, and memory of, stimulus contingencies during extinction prevented US expectancy generalisation to safe stimuli and reduced anxiety ratings. Verbalizations did not improve negative evaluations of conditional stimuli. Given that negative evaluations predict return of fear, the current study examined whether verbalisation strategies combined with listening to liked, non-lyrical background music enhanced expectancy learning and positively changed stimulus evaluations. A differential Pavlovian conditioning procedure was used involving fear acquisition, extinction, and extinction retest phases. Participants were assigned to a verbalisation condition (N = 21), a verbalisation plus liked, non-lyrical music condition (N = 21) or a control condition (N = 21) during extinction. The verbalisation strategies, with and without music, prevented the generalisation of US expectancies to safe stimuli at retest. Verbalisation strategies plus music increased positive evaluations of conditional stimuli during extinction and retest. Further research on the role of verbalising attention regulation strategies and liked, non-lyrical background music during extinction is warranted with clinical samples.

Experiences of Reproductive Coercion in Queensland Women.

Reproductive coercion is any interference with a person's reproductive autonomy that seeks to control if and when they become pregnant, and whether the pregnancy is maintained or terminated. It includes sabotage of contraceptive methods and intervention in a woman's access to health care. Our study sought to explore the prevalence and associations with reproductive coercion within Queensland, Australia, where legislation addressing domestic violence and abortion are largely state based and undergoing a period of law reform. The study was a retrospective analysis of 3,117 Queensland women who contacted a telephone counseling and information service regarding an unplanned pregnancy. All data were collected by experienced counselors regarding circumstances within a current pregnancy between January 2015 and July 2017. Overall, experience of current domestic violence was significantly more likely to co-occur with reproductive coercion (21.1%) compared with reproductive coercion identified in the absence of other domestic violence (3.1%). Furthermore, significantly more mental health issues were reported by 36.6% of women affected by reproductive coercion, compared with 14.1% of women with no reproductive coercion present. Disclosure for reproductive coercion, violence, and mental health issues was much higher among women who made a repeat contact to the counselors about their pregnancy (17.8%) compared with those who disclosed at first contact (5.9%). These findings demonstrate the importance for health services to ensure that appropriate screening (and re-screening) for reproductive coercion is completed as a distinct part of screening for violence during a health care relationship.

FullFix: a randomised controlled trial of a telephone delivered transdiagnostic intervention for comorbid substance and mental health problems in young people.

INTRODUCTION: Transdiagnostic cognitive-behavioural therapy (CBT) targets common psychological factors that underlie multiple disorders. While transdiagnostic interventions are a promising new approach, limited research has evaluated these treatments within the alcohol and other drug (AOD) sector for young people with comorbid mental health symptoms. This project will examine the feasibility and preliminary efficacy of FullFix-a new risk-targeted transdiagnostic CBT telehealth programme for comorbid AOD and depression/anxiety disorders in young people. Secondary aims are to identify moderators and mediators of treatment outcomes, to determine how and why treatment is effective and who is most likely to benefit. METHODS/DESIGN: Participants will be 130 young people (aged 16-35) accessing AOD services in Queensland, Australia, with comorbid mental health symptoms. They will be randomised to receive either the FullFix intervention plus standard AOD care or standard AOD care alone. Primary outcomes on AOD use and mental health symptoms will be reassessed at 6 weeks, 3 months, 6 months and 12 months, along with secondary outcomes of emotion regulation, social connectedness, perceived self-efficacy, coping skills and quality of life. The trial commenced on October 2018 and expected completion date is September 2021. ETHICS AND DISSEMINATION: Ethical approval for this trial was provided by the University of Queensland (#2018001185). The results of the trial will be disseminated through publication in a peer-reviewed scientific journal, scientific presentations at conferences and distributed via a report and presentations to the partner organisation. TRIAL REGISTRATION NUMBER: ACTRN12618001563257.

How Do Music Activities Affect Health and Well-Being? A Scoping Review of Studies Examining Psychosocial Mechanisms.

Background: This scoping review analyzed research about how music activities may affect participants' health and well-being. Primary outcomes were measures of health (including symptoms and health behaviors) and well-being. Secondary measures included a range of psychosocial processes such as arousal, mood, social connection, physical activation or relaxation, cognitive functions, and identity. Diverse music activities were considered: receptive and intentional music listening; sharing music; instrument playing; group singing; lyrics and rapping; movement and dance; and songwriting, composition, and improvisation. Methods: Nine databases were searched with terms related to the eight music activities and the psychosocial variables of interest. Sixty-three papers met selection criteria, representing 6,975 participants of all ages, nationalities, and contexts. Results: Receptive and intentional music listening were found to reduce pain through changes in physiological arousal in some studies but not others. Shared music listening (e.g., concerts or radio programs) enhanced social connections and mood in older adults and in hospital patients. Music listening and carer singing decreased agitation and improved posture, movement, and well-being of people with dementia. Group singing supported cognitive health and well-being of older adults and those with mental health problems, lung disease, stroke, and dementia through its effects on cognitive functions, mood, and social connections. Playing a musical instrument was associated with improved cognitive health and well-being in school students, older adults, and people with mild brain injuries via effects on motor, cognitive and social processes. Dance and movement with music programs were associated with improved health and well-being in people with dementia, women with postnatal depression, and sedentary women with obesity through various cognitive, physical, and social processes. Rapping, songwriting, and composition helped the well-being of marginalized people through effects on social and cultural inclusion and connection, self-esteem and empowerment. Discussion: Music activities offer a rich and underutilized resource for health and well-being to participants of diverse ages, backgrounds, and settings. The review provides preliminary evidence that particular music activities may be recommended for specific psychosocial purposes and for specific health conditions.

Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes.

OBJECTIVE: To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). METHODS: A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. RESULTS: A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. CONCLUSIONS: Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.

"It's Not the Same": A Comparison of the Psychological Needs Satisfied by Musical Group Activities in Face to Face and Virtual Modes.

According to the social identity approach to health, group memberships influence people's mental health to the extent that they identify with their group. Emerging evidence suggests that music groups, such as choirs, enhance mental health via group identification and the satisfaction of various psychological needs; however, more research is required to understand these processes in other types of music groups. Furthermore, the coronavirus disease 2019 (COVID-19) social distancing restrictions in 2020 prevented music groups from meeting face to face (F2F). Some music groups adapted virtually, but the rate of adaptation of various music activities is unknown, as is the impact of such adaptations on participants' group identification, psychological need satisfaction, and mental health. We explored these questions using a cross-sectional survey with 257 participants (M age = 46 years, 78% female) of singing (n = 172), instrumental (n = 48), and dance groups (n = 37). Participants rated group identification and psychological needs satisfaction retrospectively for their music group in F2F mode and then for the group in adapted mode, along with mental health 12-item short form health survey (SF-12). Results showed that instrumental groups (60%) were less commonly adapted to virtual mode than singing (83%) and dance (86%) groups. Group identification and average psychological needs satisfaction (M = 4.04 and 3.50 out of 5) scores were significantly lower for groups in virtual mode than in F2F mode (M = 4.53 and 4.14, respectively). Psychological needs satisfaction did not mediate the relationship between group identification and SF-12 mental health. Despite this, values on group identification and psychological need satisfaction remained high, which suggests that virtual music groups may be beneficial during the COVID-19 pandemic and in contexts where F2F groups are less accessible.

Music Listening as a Strategy for Managing COVID-19 Stress in First-Year University Students.

The COVID-19 pandemic brought rapid changes to travel, learning environments, work conditions, and social support, which caused stress for many University students. Research with young people has revealed music listening to be among their most effective strategies for coping with stress. As such, this survey of 402 first-year Australian University students (73.9% female, M age = 19.6; 75% domestic and 25% international) examined the effectiveness of music listening during COVID-19 compared with other stress management strategies, whether music listening for stress management was related to well-being, and whether differences emerged between domestic and international students. We also asked participants to nominate a song that helped them to cope with COVID-19 stress and analyzed its features. Music listening was among the most effective stress coping strategies, and was as effective as exercise, sleep, and changing location. Effectiveness of music listening as a coping strategy was related to better well-being but not to level of COVID-19 related stress. Although international students experienced higher levels of COVID-19 stress than domestic students, well-being was comparable in the two cohorts. Nominated songs tended to be negative in valence and moderate in energy. No correlations were found between any self-report measure and the valence and energy of nominated coping songs. These findings suggest that although domestic and international students experienced different levels of stress resulting from COVID-19, music listening remained an effective strategy for both cohorts, regardless of the type of music they used for coping.

Long-term antidepressant use in general practice: a qualitative study of GPs' views on discontinuation.

BACKGROUND: There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term use, rather than new prescriptions. Most antidepressant prescriptions are generated in general practice, and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful. AIM: To explore GPs' insights about long-term antidepressant prescribing and discontinuation. DESIGN AND SETTING: A qualitative interview study with Australian GPs. METHOD: Semi-structured interviews explored GPs' discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis. RESULTS: Three overarching themes were identified from interviews with 22 GPs. The first, 'not a simple deprescribing decision', spoke to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, 'a journey taken together', captured a set of steps GPs take together with their patients to initiate and set-up adequate support before, during, and after discontinuation. The third, 'supporting change in GPs' prescribing practices', described what GPs would like to see change to better support them and their patients to discontinue antidepressants. CONCLUSION: GPs see discontinuation of long-term antidepressant use as more than a simple deprescribing decision. It begins with considering a patient's social and relational context, and is a journey involving careful preparation, tailored care, and regular review. These insights suggest interventions to redress long-term use will need to take these considerations into account and be placed in a wider discussion about the use of antidepressants.