Understanding lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London: a qualitative study protocol.

INTRODUCTION: It is important to promote resilience in preadolescence; however, there is limited research on children's understandings and experiences of resilience. Quantitative approaches may not capture dynamic and context-specific aspects of resilience. Resilience research has historically focused on white, middle-class Western adults and adolescents, creating an evidence gap regarding diverse experiences of resilience in middle childhood which could inform interventions. East London's Muslim community represents a diverse, growing population. Despite being disproportionately affected by deprivation and racial and cultural discrimination, this population is under-represented in resilience research. Using participatory and arts-based methods, this study aims to explore lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London. METHODS AND ANALYSIS: We propose a qualitative study, grounded in embodied inquiry, consisting of a participatory workshop with 6-12 children and their parents/carers to explore lived experiences and perceptions of resilience. Participants will be identified and recruited from community settings in East London. Eligible participants will be English-speaking Muslims who identify as being black or South Asian, have a child aged 8-12 years and live in East London. The workshop (approx. 3.5 hours) will take place at an Islamic community centre and will include body mapping with children and a focus group discussion with parents/carers to explore resilience perspectives and meanings. Participants will also complete a demographic survey. Workshop audio recordings will be transcribed verbatim and body maps and other paper-based activities will be photographed. Data will be analysed using systematic visuo-textual analysis which affords equal importance to visual and textual data. ETHICS AND DISSEMINATION: The Queen Mary Ethics of Research Committee at Queen Mary University of London has approved this study (approval date: 9 October 2023; ref: QME23.0042). The researchers plan to publish the results in peer-reviewed journals and present findings at academic conferences.

Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis.

Background: Depressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored. Aims: To explore the interactions between depressive symptoms and cognitive function, their developmental trajectories and the associations with all-cause dementia, Alzheimer's disease (AD) and all-cause death in older adults. Methods: Data were from the Health and Retirement Study. Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status, respectively. All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses. All-cause death was determined by interviews. The restricted cubic spline, group-based trajectory modelling and subdistribution hazard regression were used. Results: Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found, especially in women (p for interaction <0.05). Independent trajectory analysis showed that emerging or high (vs no) depressive trajectories and poor or rapidly decreased cognitive trajectories (vs very good) from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia, AD and all-cause death. 15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined, where rapidly decreased cognitive function was more common in those with no depressive symptoms. Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function, those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death, with subdistribution hazard ratios (95% confidence intervals) of 4.47 (2.99 to 6.67) and 1.84 (1.43 to 2.36), especially in women. Conclusions: To effectively mitigate the risk of dementia and death, it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms, particularly in women.

New role of platelets in schizophrenia: predicting drug response.

Background: Elevated platelet count (PLTc) is associated with first-episode schizophrenia and adverse outcomes in individuals with precursory psychosis. However, the impact of antipsychotic medications on PLTc and its association with symptom improvement remain unclear. Aims: We aimed to investigate changes in PLTc levels following antipsychotic treatment and assess whether PLTc can predict antipsychotic responses and metabolic changes after accounting for other related variables. Methods: A total of 2985 patients with schizophrenia were randomised into seven groups. Each group received one of seven antipsychotic treatments and was assessed at 2, 4 and 6 weeks. Clinical symptoms were evaluated using the positive and negative syndrome scale (PANSS). Additionally, we measured blood cell counts and metabolic parameters, such as blood lipids. Repeated measures analysis of variance was used to examine the effect of antipsychotics on PLTc changes, while structural equation modelling was used to assess the predictive value of PLTc on PANSS changes. Results: PLTc significantly increased in patients treated with aripiprazole (F=6.00, p=0.003), ziprasidone (F=7.10, p<0.001) and haloperidol (F=3.59, p=0.029). It exhibited a positive association with white blood cell count and metabolic indicators. Higher baseline PLTc was observed in non-responders, particularly in those defined by the PANSS-negative subscale. In the structural equation model, PLTc, white blood cell count and a latent metabolic variable predicted the rate of change in the PANSS-negative subscale scores. Moreover, higher baseline PLTc was observed in individuals with less metabolic change, although this association was no longer significant after accounting for baseline metabolic values. Conclusions: Platelet parameters, specifically PLTc, are influenced by antipsychotic treatment and could potentially elevate the risk of venous thromboembolism in patients with schizophrenia. Elevated PLTc levels and associated factors may impede symptom improvement by promoting inflammation. Given PLTc's easy measurement and clinical relevance, it warrants increased attention from psychiatrists. Trial registration number: ChiCTR-TRC-10000934.

Can lithium be used in the setting of clozapine commencement in patients with COVID-19 associated neutropenia: A case report.

COVID-19 infection may increase the likelihood of neutropenia in patients already on clozapine. In clozapine treated patients experiencing COVID-19 associated neutropenia, adjunct therapy with lithium can be considered.

Digital psychiatry in low-and-middle-income countries: New developments and the way forward.

Low- and middle-income countries (LMICs) bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap. The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap. Digital psychiatry in LMICs has always lagged behind high-income countries, but there have been encouraging developments in the last decade. There is increasing research on the efficacy of digital psychiatric interventions. However, the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs. A striking development has been the rise in mobile and smartphone ownership in LMICs, which has driven the increasing use of mobile technologies to deliver mental health services. An innovative use of mobile technologies has been to optimize task-shifting, which involves delivering mental healthcare services in community settings using non-specialist health professionals. Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious. Despite these promising developments, many barriers such as service costs, underdeveloped infrastructure, lack of trained professionals, and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs. To overcome these barriers, digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services, ensure collaboration between different stakeholders, and focus on reducing the digital divide.

Navigating the intersection of psychiatry and ophthalmology: A comprehensive review of depression and anxiety management in glaucoma patients.

Glaucoma, a prevalent and debilitating eye disease, has long been associated with vision impairment and blindness. However, recent research has shed light on the often-underestimated psychological dimensions of this condition. Anxiety and depression, two pervasive psychiatric comorbidities, have been increasingly recognized among glaucoma patients. This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology, in the context of managing depression and anxiety in glaucoma patients. By meticulously examining peer-reviewed literature, we synthesize current knowledge on the prevalence, risk factors, and underlying mechanisms of anxiety and depression in glaucoma. The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders. Factors such as progressive vision loss, complex medication regimens, and the fear of further visual deterioration contribute to their vulnerability. Moreover, we delve into the bidirectional relationship between glaucoma and mood disorders, shedding light on the complex interplay between ocular and emotional health. Our review investigates the implications of anxiety and depression on glaucoma management, including their potential impact on treatment adherence, disease progression, and overall quality of life. We also explore the neurobiological pathways linking glaucoma and mood disorders, providing a foundation for future research and potential therapeutic interventions. In conclusion, recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care. This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma. By addressing anxiety and depression in glaucoma care, healthcare providers can enhance the overall quality of life for these patients, ultimately leading to improved outcomes and a brighter future for those affected by this condition. This review offers valuable insight for healthcare practitioners and researchers, providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.

Psychotherapy training in postgraduate psychiatry training in Nigeria - Are we doing enough?

Introduction: Nigeria, with an estimated 40 million people living with mental disorders, faces a critical shortage of psychiatrists to address the significant burden. Despite psychotherapy being integral to psychiatric training, it lacks structure, consistency and adequate supervision. This is alarming, particularly given the substantial demand for specialized psychotherapeutic support among those with mental illness. Methodology: A cross-sectional study utilised an online survey targeting early career psychiatrists recruited from the Early Career Psychiatrists section of the Association of Psychiatrists in Nigeria. Results: The questionnaire was distributed to 252 early career psychiatrists across Nigeria, with a 42.9% response rate, of which 50% were male, with 73.2% trainees and 26.8% early career psychiatrists. While 52.8% had received some psychotherapy training, only 2.8% were qualified psychotherapists. Notably, only 27.6% of those with psychotherapy training had over 100 hours of training. Factors such as receiving psychotherapy training during postgraduate training and having supervised psychotherapy training were found significant for having independent psychotherapy training. Conclusions: There is little emphasis on psychotherapy training in the postgraduate training in Nigeria. Those who had full training in psychotherapy were self-sponsored. Structured, supervised and mandatory psychotherapy within psychiatry training curriculum is recommended.

Brief Coping Scale TCS-9: Optimising the Assessment of Coping Strategies. The case of Health Care Workers.

Background: The COVID-19 pandemic has intensified the focus on mental health, particularly on the coping strategies of healthcare workers who have faced unparalleled stress due to their pivotal role in addressing health disparities and determinants of health. Constantly operating in high-risk environments and managing the surge of critically ill patients, these professionals' psychological resilience has been sternly tested, necessitating robust assessment tools. Aim: This study aims to refine the extensive 54-item Toulouse Coping Scale into a more pragmatic and less time-consuming instrument while preserving its statistical integrity, to support the mental well-being of healthcare workers. Setting: The setting for this study was amongst healthcare workers in Greece, during the COVID-19 pandemic, a period marked by significant psychological demands on medical staff. Methods: We conducted an unbiased exploratory factor analysis on the Toulouse Coping Scale's 54 items, drawing from a sample of 144 healthcare workers, adhering to strict methodological criteria. Results: Data completeness was achieved across the sample, which comprised 40 (28%) males and 104 (72%) females, predominantly aged between 31 and 50 years. The final instrument, encapsulating two domains with a total of nine questions, demonstrated strong internal consistency, with an eigenvalue of 3.438 for the first domain and 1.478 for the second, validated by a scree plot. Conclusion: The streamlined TCS-9 scale facilitates a more rapid assessment of coping strategies while reducing redundancy. The two-domain structure ensures that the revised scale retains the original's thoroughness in a more concise form. Contribution: By enabling quicker and more efficient evaluations, the TCS-9 enhances the practicality of assessing coping mechanisms in healthcare settings, thereby contributing to the sustenance of health systems and the promotion of health equity.

Digital psychiatry in Nigeria: A scoping review.

Background: Mental healthcare workforce shortage in Nigeria poses a major obstacle to mental health services scale-up. Digital psychiatry may provide a veritable platform to bridge treatment gaps. Aim: To provide an overview of quantity and range of peer-reviewed publications on digital psychiatry in Nigeria. Setting: A comprehensive literature search encompassed all original, peer-reviewed research articles on digital psychiatry in Nigeria. PubMed, Google Scholar, and a direct exploration of relevant journal article reference lists were utilised. Inclusion criteria covered peer-reviewed original articles conducted in Nigeria between January 2013 and January 2023, regardless of quality. Exclusions comprised case reports, reviews, dissertations, and abstracts. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were adhered to, while methodological framework of Arksey and O'Malley was used to describe the review. Results: Fourteen studies meeting inclusion criteria exhibited two primary research areas: implementation and intervention. Most studies focused on intervention strategies, showcasing efficacy of digital devices in enhancing outcomes in depression and clinic appointments. Implementation studies indicated favorable acceptance by both clients and healthcare practitioners. Conclusion: Digital technology seems acceptable to Nigerian patients and clinicians. Policies to operationalise provision of digital healthcare services will have positive impact in addressing unmet mental health needs. Finally, the quality of the evidence from majority of studies has to be enhanced, and additional studies are required to uncover gaps in some regions of the country. Contribution: This research demonstrates that, despite some drawbacks, digital methods of providing mental healthcare are practical in Nigeria.

Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study.

INTRODUCTION: Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry. METHODS: The 26-week, open-label feasibility study included participants aged 18-65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of "completers", with adherence defined as >80% injections obtained in the period, weeks 12-26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers. RESULTS: Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m2; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was -11.4 kg [-15.4; -5.9]. The net difference in HbA1C and BMI was -2.0 mmol/mol [-4; -1] and -3.6 kg/m2 [-4.7; -1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline. CONCLUSION: The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.

Adherence to the ultra-processed dietary pattern and risk of depressive outcomes: Findings from the NutriNet Brasil cohort study and an updated systematic review and meta-analysis.

BACKGROUND & AIMS: We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association. METHODS: In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours. RESULTS: In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I2: 71%. CONCLUSION: A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis.

Quantifying Apathy in Late-Life Depression: Unraveling Neurobehavioral Links through Daily Activity Patterns and Brain Connectivity Analysis.

BACKGROUND: Better understanding apathy in late-life depression (LLD) would help predicting poor prognosis of the disease such as dementia. Actimetry provides an objective and ecological measure of apathy from patients' daily motor activity. We aimed to determine if patterns of motor activity were associated with apathy and brain connectivity in networks underlying goal-directed behaviors. METHODS: Resting-state functional MRI and diffusion MRI were collected from 38 non-demented LLD subjects. Apathy was evaluated using the diagnostic criteria for apathy, the apathy evaluation scale (AES) and the apathy motivation index (AMI). Functional principal components (fPC) of motor activity were derived from actimetry recordings of 72 hours. Associations between fPC and apathy were estimated by linear regression. Subnetworks whose connectivity was significantly associated with fPC were identified via the threshold-free network-based statistics. The relationship between apathy and microstructure metrics was estimated along fibers by diffusion tensor imaging and a multicompartment model called neurite orientation dispersion and density imaging via tractometry. RESULTS: We found two fPC associated with apathy: mean diurnal activity, negatively associated with AES, and an early chronotype, negatively associated with AMI. Mean diurnal activity was associated with increased connectivity in the default-mode, the cingulo-opercular and the frontoparietal networks, while chronotype was associated with a more heterogenous connectivity pattern in the same networks. We did not find significant associations between microstructural metrics and fPCs. CONCLUSION: Our findings suggest that mean diurnal activity and chronotype could provide indirect ambulatory measures of apathy in LLD, associated with modified functional connectivity of brain networks underlying goal-directed behaviors.

Experience of violence and attitudes of staff members towards coercion in psychiatric settings: observational study.

BACKGROUND: Among important dimensions related to the use of coercive measures, professionals' attitude towards coercion is of particular interest. Little is known about how experiences of violence in the workplace might influence these attitudes. AIMS: The present study aimed to investigate potential correlates of attitudes towards coercion, especially experiences of violence in the workplace. METHOD: Mental health professionals were contacted through an online survey to assess their attitudes towards coercion using the Staff Attitude to Coercion Scale (SACS). The three subscales of the SACS (critical, pragmatic and positive attitudes) were analysed in a multivariate multiple linear regression, using a set of covariates including experiences of violence in the workplace. We hypothesised that experience of violence in the workplace would correlate with less critical attitudes of staff members towards coercion. RESULTS: A total of 423 professionals were included in the regression analysis. Age, professional category, feeling of insecurity, having witnessed or used coercion, and the emotional burden associated with coercive measures had a joint significant effect on the three SACS subscales. A feeling of insecurity, but not the experience of violence, was associated with a less critical, more positive appraisal of coercive measures. The emotional burden related to the use of coercion was associated with a more critical attitude. CONCLUSIONS: The present results highlight the importance of considering staff members' training and well-being regarding their feelings of insecurity when addressing attitudes towards coercion. The experience of patients should be integrated into staff training and coercion reduction programmes.

Variation in opinions on coercion use among mental healthcare professionals: a questionnaire study.

INTRODUCTION: Even if coercive measures are widely applied in psychiatry and have numerous well-known drawbacks, there is limited known on the agreement among mental healthcare professionals' opinions on their use. In a questionnaire study using standardized scenarios, we investigated variation in staff opinions on coercion. METHODS: In a web-based survey distributed to staff at three psychiatry hospitals, respondents were asked to consider if and what coercion to use by introducing two hypothetical scenarios involving involuntary psychiatric admission and in-hospital coercion. RESULTS: One hundred thirty-two out of 601 invited staff members responded to the survey (Response Rate = 22%). There was large variation in participating staff members' opinions on how to best manage critical situations and what coercive measures were warranted. In the first scenario, 57% of respondents (n = 76) believed that the patient should be involuntarily admitted to hospital while the remaining respondents believed that the situation should be managed otherwise. Regarding the second scenario, 62% of respondents responded that some in-hospital coercion should be used. The majority of respondents believed that colleagues would behave similarly (60%) or with a tendency towards more coercion use (34%). Male gender, being nursing staff and having less coercion experience predicted being less inclined to choose involuntary hospital admission. CONCLUSION: There is a high degree of variation in coercion use. This study suggests that this variation persists despite staff members being confronted with the same standardized situations. There is a need for evidence-based further guidance to minimize coercion in critical mental healthcare situations.

Flourishing and the scope of medicine and public health.

A framework is put forward for the proper scope of considerations concerning flourishing within medicine, psychiatry, clinical counselling, public health and public policy. Each of these disciplines and associated institutional practices have distinctive contributions to make in advancing flourishing within society. In each case, there are also various aspects of flourishing that extend beyond each practice's purview; and yet to restrict attention only to health, narrowly conceived, limits what each of these practices can in fact accomplish. A clearer understanding of what aspects of flourishing do, and do not, lie within the bounds of each discipline and practice has the potential to better enable the pursuit of societal well-being.

Switch to Lisdexamfetamine in the Treatment of Attention-Deficit Disorder at a Psychiatric Outpatient Clinic for School-Aged Children: A Danish Cohort Study.

Objectives: This study aimed to examine switch from first-line methylphenidate (MPH) to lisdexamfetamine (LDX) in school-aged children with attention-deficit/hyperactivity disorder (ADHD). Methods: This is a retrospective observational study based on systematic review of patient records of all children (7-13 years) diagnosed with ADHD and referred to a Danish specialized outpatient clinic. The study included 394 children switching from MPH to LDX as either second-line or third-line treatment (atomoxetine [ATX] as second-line treatment) during the study period from April 1, 2013, to November 5, 2019. Results: One in five children switched from MPH to LDX at some point during the study period. The most frequent reasons for switching to LDX were adverse effects (AEs; 70.0% for MPH, 68.3% for ATX) and lack of efficiency (52.0% for MPH, 72.7% for ATX). Top five AEs of LDX were decreased appetite (62.4%), insomnia (28.7%), irritability/aggression (26.1%), weight decrease (21.1%), and mood swings (13.9%). MPH and LDX had similar AE profiles, yet most AEs were less frequent after switching to LDX. At the end of the study period, the majority were prescribed LDX as second-line rather than third-line treatment (86.1% in 2019). However, the likelihood of LDX as second-line treatment decreased with the number of psychiatric comorbidities, ADHD symptom severity as assessed by parents, and if AEs were a reason for MPH discontinuation. Among children observed for at least 1 year after initiation of LDX, 41.3% continued LDX treatment for a year or longer. LDX continuation was less likely if AEs were a reason for MPH discontinuation. Similarly to MPH and ATX, the most frequent reasons for LDX discontinuation were AEs (74.4%) and lack of efficiency (34.7%). Implications: The findings support LDX as an important option in the personalized treatment of children with ADHD and may support prescribers in the clinical decision-making on switching medication.

Workforce migration and brain drain - A nationwide cross-sectional survey of early career psychiatrists in Nigeria.

Background: Nigeria's shortage of psychiatrists is exacerbated due to health worker migration. Aim: This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria. Methods: We conducted a cross-sectional survey covering Nigeria's six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29. Results: Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had 'ever' considered migration, 69.2% were planning to leave 'now', and 52.9% had taken 'practical migration steps'. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05-4.88) predicted planning to leave 'now', while being in a relationship (OR = 3.46, 95%CI = 1.06-11.30) predicted taking 'practical migration steps'. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested. Conclusions: Systemic changes to address psychiatrists' migration from Nigeria are needed.

[Family guidance for the elderly: a family group care at home]. / La guidance familiale en psychiatrie de la personne âgée : un soin groupal familial à domicile.

The Elderly Psychiatry Family Guidance Centre, set up in 2009 in the French Rhône department, is a hospital-based team working at the request of professionals in the network. It is aimed at families in which a member over the age of 65 is experiencing a loss of autonomy that is beyond the family's resources. Combining psychodynamic and systemic tools, this group treatment focuses on psychological aspects and elements of everyday reality. It encourages family communication in order to restore balance. It activates specific levers: intervention during the crisis, modularity of the framework, work on the environment and the network. It offers six renewable sessions, at home, and summaries with partners. The system has temporal and geographical limitations. This experiment shows that it is possible to offer family care that can be linked to individual care, can be identified in the professional network, and is accessible to families who are not initially interested. This finding opens up the possibility of spreading the scheme.

Using unsupervised clustering approaches to identify common mental health profiles and associated mental healthcare service use patterns in Ontario, Canada.

Mental health is a complex, multidimensional concept that goes beyond clinical diagnoses, including psychological distress, life stress and well-being. This study aims to use unsupervised clustering approaches to identify multidimensional mental health profiles that exist in the population, and their associated service use patterns. The data source for this study is the 2012 Canadian Community Health Survey- Mental Health linked to administrative healthcare data holdings, included were all Ontario adult respondents. We used a Partioning Around Medoids clustering algorithm with Gower's proximity to identify groups with distinct combinations of mental health indicators and described them by their sociodemographic and service use characteristics. We identified four groups with distinct mental health profiles, including one group who met the clinical threshold for a depressive diagnosis, with the remaining three groups expressing differences in positive mental health, life stress and self-rated mental health. The four groups had different age, employment and income profiles and exhibited differential access to mental healthcare services. This study represents the first step in identifying complex profiles of mental health at the population level in Ontario, Canada. Further research is required to better understand the potential causes and consequences of belonging to each of the mental health profiles identified.

Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset.

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.