There is increasing concern over the mental distress of youth in recent years, which may impact mental healthcare utilisation. Here we aim to examine temporal patterns of mental healthcare expenditures in the Netherlands by age and sex in the period between 2015 and 2021.

Comprehensive data from health insurers in the Netherlands at the 3-number postal code level were used for cluster weighted linear regressions to examine temporal patterns of mental healthcare expenditure by age group (18–34 vs 35–65). The same was done for medical specialist and general practitioner costs. Additionally, we examined interactions with gender, by adding the interaction between age, year and sex to the model.

Mental healthcare costs for younger adults (18–34) were higher than those for older adults (35–65) at all time points (β = 0.22, 95%-CI = 0.19; 0.25). Furthermore there was an increase in the strength of the association between younger age and mental healthcare costs from β = 0.22 (95%-CI = 0.19; 0.25) in 2015 to β = 0.37 (95%-CI = 0.35; 0.40) in 2021 (p < 0.0001) and this was most evident in women (p < 0.0001). Younger age was associated with lower general practitioner costs at all time points, but this association weakened over time. Younger age was also associated with lower medical specialist costs, which did not weaken over time.

Young adults, particularly young women, account for an increasing share of mental healthcare expenditure in the Netherlands. This suggests that mental distress in young people is increasingly met by a response from the medical system. To mitigate this trend a public mental health approach is needed.

The aims of this feasibility trial were to assess the acceptability and feasibility of peer-led recovery groups for people with psychosis in a low-resource South African setting, to assess the feasibility of trial methods, and to determine key parameters in preparation for a definitive trial.

The design was an individually randomised feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone. Ninety-two isiXhosa-speaking people with psychosis and forty-seven linked caregivers were recruited from primary care clinics and randomly allocated to trial arms in a 1:1 allocation ratio. TAU comprised anti-psychotic medication delivered in primary care. The intervention arm comprised six recovery groups including service users and caregivers. Two-hour recovery group sessions were delivered weekly in a 2-month auxiliary social worker (ASW)-led phase, then a 3-month peer-led phase. To explore acceptability and feasibility, a mixed methods process evaluation included 25 in-depth interviews and 2 focus group discussions at 5 months with service users, caregivers and implementers, and quantitative data collection including attendance and facilitator competence. To explore potential effectiveness, quantitative outcome data (functioning, relapse, unmet needs, personal recovery, stigma, health service use, medication adherence and caregiver burden) were collected at baseline, 2 months and 5 months post randomisation. Trial registration: PACTR202202482587686.

Qualitative interviews revealed that recovery groups were broadly acceptable with most participants finding groups to be an enjoyable opportunity for social interaction, and joint problem-solving. Peer facilitation was a positive experience; however a minority of participants did not value expertise by lived experience to the same degree as expertise of professional facilitators. Attendance was moderate in the ASW-led phase (participants attended 59% sessions on average) and decreased in the peer-led phase (41% on average). Participants desired a greater focus on productive activities and financial security. Recovery groups appeared to positively impact on relapse. Relapse occurred in 1 (2.2%) of 46 participants in the recovery group arm compared to 8 (17.4%) of 46 participants in the control arm (risk difference -0.15 [95% CI: −0.26; −0.05]). Recovery groups also impacted on the number of days in the last month totally unable to work (mean 1.4 days recovery groups vs 7.7 days control; adjusted mean difference −6.3 [95%CI: −12.2; −0.3]). There were no effects on other outcomes.

Peer-led recovery groups for people with psychosis in South Africa are potentially acceptable, feasible and effective. A larger trial, incorporating amendments such as increased support for peer facilitators, is needed to demonstrate intervention effectiveness definitively.

This study aims to explore the concept of future orientation, which encompasses individuals’ thoughts about the future, goal-setting, planning, response to challenges and behavioural adjustments in evolving situations. Often viewed as a psychological resource, future orientation is believed to be developed from psychological resilience. The study investigates the curvilinear relationship between childhood maltreatment and future orientation while examining the moderating effects of genotype.

A total of 14,675 Chinese adults self-reported their experiences of childhood maltreatment and their future orientation. The influence of genetic polymorphism was evaluated through genome-wide interaction studies (GWIS; genome-wide association study [GWAS] using gene × environment interaction) and a candidate genes approach.

Both GWAS and candidate genes analyses consistently indicated that rs4498771 and its linked single-nucleotide polymorphisms, located in the intergenic area surrounding CSF3R, significantly interacted with early trauma to influence future orientation. Nonlinear regression analyses identified a quadratic or cubic association between future orientation and childhood maltreatment across some genotypes. Specifically, as levels of childhood maltreatment increased, future orientation declined for all genotypes. However, upon reaching a certain threshold, future orientation exhibited a rebound in individuals with specific genotypes.

The findings suggest that individuals with certain genotypes exhibit greater resilience to childhood maltreatment. Based on these results, we propose a new threshold model of stress-related growth.

Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye.

A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles).

Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, p = 0.045, d = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference −0.17, 95 % CI −0.32, −0.02, p = 0.028, d = 0.27) and anxiety (adjusted mean difference −0.21, 95 % CI −0.37, −0.05, p = 0.009, d = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference −1.98, 95 % CI −3.93, −0.02, p = 0.048, d = 0.26).

In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.

Research evidence has established an association of obsessive-compulsive disorder (OCD) with suicidal thoughts and suicide attempts. However, further investigation is required to determine whether individuals with OCD have higher risk of death by suicide compared with those without OCD.

Of the entire Taiwanese population, between 2003 and 2017, 56,977 individuals with OCD were identified; they were then matched at a 1:4 ratio with 227,908 non-OCD individuals on the basis of their birth year and sex. Suicide mortality was assessed between 2003 and 2017 for both groups. Time-dependent Cox regression models were used to investigate the difference in suicide risk between individuals with versus without OCD.

After adjustment for major psychiatric comorbidities (i.e., schizophrenia, bipolar disorder and major depressive disorder), the OCD group had higher risk of suicide (hazard ratio: 1.97, 95% confidence interval: 1.57–2.48) during the follow-up compared with the comparison group. Furthermore, OCD severity, as indicated by psychiatric hospitalizations due to OCD, was positively correlated with suicide risk.

Regardless of the existence of major psychiatric comorbidities, OCD was found to be an independent risk factor for death by suicide. A suicide prevention program specific to individuals with OCD may be developed in clinical practice in the future.

The concept of recovery is featured in the strategic plans of the World Health Organization as well as in other national mental health plans; however, there have been differing interpretations of what it means. This article aims to achieve a consensus on the key aspects of recovery in mental health from the perspective of movements of users and survivors of psychiatry at an international level. Four specific objectives were proposed in this study: (1) to identify what recovery in mental health means, (2) to identify the indicators that a person is progressing in their recovery, (3) to determine the factors that facilitate the recovery process, and (4) to determine the factors that hinder the recovery process.

A three-round e-Delphi study was conducted with the participation of 101 users and survivors of psychiatry, adhering to the CREDES checklist to ensure methodological rigour.

The results reveal 26 key aspects that define recovery, 31 indicating that a person is progressing in their recovery process, 8 that facilitate recovery and 12 that hinder recovery. The most agreed-upon statements for defining recovery highlight the importance of empowerment, leading a fulfilling life, ensuring safe-living conditions and acknowledging individuals as holders of rights. Similarly, empowerment and agency were highly agreed upon as relevant recovery indicators. Key findings underscore the significance of a supportive and respectful social environment in facilitating recovery, while coercion, discrimination and lack of support from significant others hinder recovery.

Despite cultural differences and recovery’s subjective nature, our results demonstrate that an international consensus on critical recovery aspects is attainable. Highlighting a significant shift, we emphasize the ‘Transition’ process to signify moving away from the biomedical model approach and advocating for collective rights. Our findings advocate for empowerment, users’ rights and the move towards person-centred care that integrates social, political and economic contexts. These consensus statements lay the groundwork for future research across diverse regions and cultures, offering insights into recovery’s meaning and potential for innovative approaches in diagnosis, intervention and evaluation.

The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings.

This retrospective study involved analysis of headspace’s clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors.

A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a ‘high complexity’ group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing ‘distress complexity’ and ‘psychosocial complexity’ (about 20% each). Compared with the ‘distress complexity’ group, young people in the ‘psychosocial complexity’ group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services.

The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.

Restricting access to means by installing physical barriers has been shown to be the most effective intervention in preventing jumping suicides on bridges. However, little is known about the effectiveness of partial restriction with interventions that still allow jumping from the bridge.

This study used a quasi-experimental design. Public sites that met our inclusion criteria were identified using Google search and data on jumping suicides on Bridge A (South Korea), Bridges B and C (the United States) and Bridge D (Canada) were obtained from the relevant datasets. Incidence rate ratios (IRRs) were estimated using Poisson regressions comparing suicide numbers before and after the installation of physical structures at each site.

Fences with sensor wires and spinning handrails installed above existing railings on the Bridge A, and fences at each side of the entrances and the midpoint of main suspension cables on the Bridge D were associated with significant reductions in suicides (IRR 0.37, 95% Confidence Interval (CI) 0.26 − 0.54; 0.26, 95% CI 0.09 − 0.76). Installation of bird spike on the parapet on the Bridge B, and fences at the front of seating alcoves on the Bridge C were not associated with changes in suicides (1.21, 95% CI 0.88 − 1.68; 1.49, 95% CI 0.56 − 3.98).

Partial means restriction (such as fences with sensor wires and spinning bars at the top, and partial fencing at selected points) on bridges appears to be helpful in preventing suicide. Although these interventions are unlikely to be as effective as interventions that fully secure the bridge and completely prevent jumping, they might best be thought of as temporary solutions before more complete or permanent structures are implemented.

Population studies show the stigma of depression to diminish, while the stigma of schizophrenia increases. To find out whether this widening gap is reflected in the media portrayal of both disorders, this study compares the portrayal of depression and schizophrenia in German print media in 2010 vs. 2020.

We conducted a qualitative content analysis using a mixed deductive-inductive approach to establish a category system. In total, we analyzed 854 articles with the summative approach by Mayring.

The study found a widening gap in the portrayal of schizophrenia and depression in German media between 2010 and 2020. Schizophrenia was depicted increasingly negative between 2010 and 2020, covering more negative stereotypes and focusing on its biological causes. Depression received increased attention and more neutral and professional coverage, with a greater emphasis on psychosocial causes and discussion of treatment options.

By showing a widening gap the study highlights how media may shape public views on mental illnesses and reflects public attitudes at the same time. Media analyses from other nations have shown similar trends. This emphasizes the need for responsible reporting to combat stigma and promote understanding worldwide. Therefore, the authors recommend a balanced coverage that includes accurate professional information about all mental illnesses.

Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients’ mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge.

We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019–2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure.

Of 178,369 hospitalizations, 9.2% (n = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point, p < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score, p < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score, p < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score, p < .001, 95% CI: 2.38; 3.28).

Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.

Suicide prevention strategies have shifted in many countries, from a national approach to one that is regionally tailored and responsive to local community needs. Previous Australian studies support this approach. However, most studies have focused on suicide deaths which may not fully capture a complete understanding of prevention needs, and few have focused on the priority population of youth. This was the first nationwide study to examine regional variability of self-harm prevalence and related factors in Australian young people.

A random sample of Australian adolescents (12–17-year-olds) were recruited as part of the Young Minds Matter (YMM) survey. Participants completed self-report questions on self-harm (i.e., non-suicidal self-harm and suicide attempts) in the previous 12 months. Using mixed effects regressions, an area-level model was built with YMM and Census data to produce out-of-sample small area predictions for self-harm prevalence. Spatial unit of analysis was Statistical Area Level 1 (average population 400 people), and all prevalence estimates were updated to 2019.

Across Australia, there was large variability in youth self-harm prevalence estimates. Northern Territory, Western Australia, and South Australia had the highest estimated state prevalence. Psychological distress and depression were factors which best predicted self-harm at an individual level. At an area-level, the strongest predictor was a high percentage of single unemployed parents, while being in an area where ≥30% of parents were born overseas was associated with reduced odds of self-harm.

This study identified characteristics of regions with lower and higher youth self-harm risk. These findings should assist governments and communities with developing and implementing regionally appropriate youth suicide prevention interventions and initiatives.

Previous studies have reported inconsistent findings regarding the association between post-traumatic stress (PTS) and post-traumatic growth (PTG). Three major issues could account for this inconsistency: (1) the lack of information about mental health problems before the disaster, (2) the concept of PTG is still under scrutiny for potentially being an illusionary perception of personal growth and (3) the overlooking of PTS comorbidities as time-dependent confounding factors. To address these issues, we explored the associations of PTS and PTG with trauma-related diseases and examined the association between PTS and PTG using marginal structural models to address time-dependent confounding, considering pre-disaster covariates, among older survivors of the 2011 Japan Earthquake and Tsunami.

Seven months before the disaster, the baseline survey was implemented to ask older adults about their health in a city located 80 km west of the epicentre. After the disaster, we implemented follow-up surveys approximately every 3 years to collect information about PTS and comorbidities (depressive symptoms, smoking and drinking). We asked respondents about their PTG in the 2022 survey (n = 1,489 in the five-wave panel data).

PTG was protectively associated with functional disability (coefficient −0.47, 95% confidence interval (CI) −0.82, −0.12, P < 0.01) and cognitive decline assessed by trained investigators (coefficient −0.07, 95% CI −0.11, −0.03, P < 0.01) and physicians (coefficient −0.06, 95% CI −0.11, −0.02, P < 0.01), while PTS was not significantly associated with them. Severely affected PTS (binary variable) was associated with higher PTG scores, even after adjusting for depressive symptoms, smoking and drinking as time-dependent confounders (coefficient 0.35, 95% CI 0.24, 0.46, P < 0.01). We also found that an ordinal variable of the PTS score had an inverse U-shaped association with PTG.

PTG and PTS were differentially associated with functional and cognitive disabilities. Thus, PTG might not simply be a cognitive bias among survivors with severe PTS. The results also indicated that the number of symptoms in PTS had an inverse U-shaped association with PTG. Our findings provided robust support for the theory of PTG, suggesting that moderate levels of psychological struggles (i.e., PTS) are essential for achieving PTG, whereas intense PTS may hinder the attainment of PTG. From a clinical perspective, interventions that encourage social support could be beneficial in achieving PTG by facilitating deliberate rumination.

Identifying children and/or adolescents who are at highest risk for developing chronic depression is of utmost importance, so that we can develop more effective and targeted interventions to attenuate the risk trajectory of depression. To address this, the objective of this study was to identify young people with persistent depressive symptoms across adolescence and young adulthood and examine the prospective associations between factors and persistent depressive symptoms in young people.

We used data from 6711 participants in the Avon Longitudinal Study of Parents and Children. Depressive symptoms were assessed at 12.5, 13.5, 16, 17.5, 21 and 22 years with the Short Mood and Feelings Questionnaire, and we further examined the influence of multiple biological, psychological and social factors in explaining chronic depressive symptoms.

Using latent class growth analysis, we identified four trajectories of depressive symptoms: persistent high, persistent low, persistent moderate and increasing high. After applying several logistic regression models, we found that loneliness and feeling less connected at school were the most relevant factors for chronic course of depressive symptoms.

Our findings contribute with the identification of those children who are at highest risk for developing chronic depressive symptoms.

Accumulating studies have assessed mortality risk associated with mood-stabilizers, the mainstay treatment for bipolar disorder (BD). However, existing data were mostly restricted to suicide risk, focused on lithium and valproate and rarely adequately adjusted for potential confounders. This study aimed to assess comparative mortality risk with all, natural and unnatural causes between lithium, valproate and three frequently prescribed second-generation antipsychotics (SGA), with adjustment for important confounders.

This population-based cohort study identified 8137 patients with first-diagnosed BD, who had exposed to lithium (n = 1028), valproate (n = 3580), olanzapine (n = 797), quetiapine (n = 1975) or risperidone (n = 757) between 2002 and 2018. Data were retrieved from territory-wide medical-record database of public healthcare services in Hong Kong. Propensity-score (PS)-weighting method was applied to optimize control for potential confounders including pre-existing chronic physical diseases, substance/alcohol use disorders and other psychotropic medications. PS-weighted Cox proportional-hazards regression was conducted to assess risk of all-, natural- and unnatural-cause mortality related to each mood-stabilizer, compared to lithium. Three sets of sensitivity analyses were conducted by restricting to patients with (i) length of cumulative exposure to specified mood-stabilizer ≥90 days and its medication possession ratio (MPR) ≥90%, (ii) MPR of specified mood-stabilizer ≥80% and MPR of other studied mood-stabilizers <20% and (iii) monotherapy.

Incidence rates of all-cause mortality per 1000 person-years were 5.9 (95% confidence interval [CI]: 4.5–7.6), 8.4 (7.4–9.5), 11.1 (8.3–14.9), 7.4 (6.0–9.2) and 12.0 (9.3–15.6) for lithium-, valproate-, olanzapine-, quetiapine- and risperidone-treated groups, respectively. BD patients treated with olanzapine (PS-weighted hazard ratio = 2.07 [95% CI: 1.33–3.22]) and risperidone (1.66 [1.08–2.55]) had significantly higher all-cause mortality rate than lithium-treated group. Olanzapine was associated with increased risk of natural-cause mortality (3.04 [1.54–6.00]) and risperidone was related to elevated risk of unnatural-cause mortality (3.33 [1.62–6.86]), relative to lithium. The association between olanzapine and increased natural-cause mortality rate was consistently affirmed in sensitivity analyses. Relationship between risperidone and elevated unnatural-cause mortality became non-significant in sensitivity analyses restricted to low MPR in other mood-stabilizers and monotherapy. Valproate- and lithium-treated groups did not show significant differences in all-, natural- or unnatural-cause mortality risk.

Our data showed that olanzapine and risperidone were associated with higher mortality risk than lithium, and further supported the clinical guidelines recommending lithium as the first-line mood-stabilizer for BD. Future research is required to further clarify comparative mortality risk associated with individual SGA agents to facilitate risk-benefit evaluation of alternative mood-stabilizers to minimize avoidable premature mortality in BD.

While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.

Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.

A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3–2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83–7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2–10.5%; RR: 1.56, 95% CI: 1.38–1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2–11.3%; RR: 1.60, 95% CI: 1.42–1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.

Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences.

Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed.

Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = −0.62 [95% confidence interval (CI), −1.07 to −0.17] for one type of social participation; β = −0.57 [95% CI, −1.04 to −0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65–0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61–0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress.

The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.