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Abstract Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma—including from mental health providers—predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.

Emancipative values – advocating for personal freedoms, equality, and autonomy – are theorized to enhance life satisfaction by fostering empowerment and opportunities. The current study tested whether their impact is context-dependent, influenced by societal norms and institutional frameworks. We used data from wave seven of the World Values Survey (WVS) and the Varieties of Democracy (V-Dem) dataset, covering diverse countries and time periods. We examined the interaction between emancipative values and a country’s level of liberal democracy on life satisfaction using a random effects model accounting for country-level variations (random intercept and slope). The model was adjusted for individual-level variables, such as settlement size, income, and educational attainment, as well as country-level factors like lagged income per capita and regional affiliation. This approach allowed us to investigate the direct effect of emancipative values across different democratic contexts. Our final dataset included N = 76,702 participants across 58 countries. Countries with the highest levels of liberal democracy were also the most economically prosperous. Individuals in democratic nations were older, resided predominantly in larger settlements, demonstrated the highest levels of educational attainment, reported the highest incomes, and expressed the strongest adherence to emancipative values. Our random effect model revealed a negative main effect of emancipative values on life satisfaction. A significant positive interaction between democracy and emancipative values was also identified. Less democratic countries demonstrated a negative effect of emancipative values while no significant effect was observed in more democratic contexts. Overall, our study challenges the notion that emancipative values universally enhance life satisfaction, highlighting the significance of cultural and institutional congruence in assessing how personal values affect well-being. These findings emphasize the importance of considering contextual factors when examining the relationship between individual values and life satisfaction across diverse political and cultural landscapes.

While Republican states have been criticized for their limited efforts to contain the spread of COVID-19, it is important to consider that political orientation can modify human behaviour via complex effects that are still poorly understood. During the first period of the pandemic, we found that the association of Republican partisanship with US citizens' mobility varied depending on the nature of the exposure being considered. First, Republican partisanship was associated with increased mobility when the stringency of anti-COVID measures increased. Second, Republican partisanship was associated with decreased mobility when COVID-related deaths increased. Third, Republican partisanship was associated with increased mobility over time, i.e. as time went by, citizens living in Republican states were more mobile than those in Democratic states. These findings raise caution on any over-interpretation of the impact of polarization in US politics on COVID-related behaviour. They prompt consideration of persuasive tools that emphasize risk perception to promote social distancing in Republican states, rather than relying heavily on stringent anti-COVID interventions.

The international outbreak of coronavirus disease (COVID-19) has led many countries to enforce drastic containment measures. It has been suggested that this abrupt lockdown of populations will foster addiction-related habits such as caloric/salty food intake, screen use, and substance use. Our aim was to assess the global changes and factors of increase in addiction-related habits during the early COVID-19 containment phase in France. A web-based survey was provided from day 8 to day 13 of the containment and was completed by 11,391 participants. The questions explored sociodemographic features, psychiatric/addiction history, material conditions of lockdown, general stress, mental well-being, and reported changes in several addiction-related behaviors. Global changes were described and factors of increase were explored using population-weighted and adjusted logistic regression models, providing adjusted odds ratios (aORs) and their 95% confidence intervals. Overall, the respondents reported more increases in addiction-related habits than decreases, specifically 28.4% (caloric/salty food intake), 64.6% (screen use), 35.6% (tobacco use), 24.8% (alcohol use), and 31.2% (cannabis use). Reduced well-being scores and increased stress scores were general factors of increase in addiction-related habits (P<.001 for all habits). Factors of increase in caloric/salty food intake (n=10,771) were female gender (aOR 1.62, 95% CI 1.48-1.77), age less than 29 years (P<.001), having a partner (aOR 1.19, 95% CI 1.06-1.35), being locked down in a more confined space (per 1 square meter/person decrease: aOR 1.02, 95% CI 1.01-1.03), being locked down alone (aOR 1.29, 95% CI 1.11-1.49), and reporting current (aOR 1.94, 95% CI 1.62-2.31) or past (aOR 1.27, 95% CI 1.09-1.47) psychiatric treatment. Factors of increase in screen use (n=11,267) were female gender (aOR 1.31, 95% CI 1.21-1.43), age less than 29 years (P<.001), having no partner (aOR 1.18, 95% CI 1.06-1.32), being employed (P<.001), intermediate/high education level (P<.001), being locked down with no access to an outdoor space (aOR 1.16, 95% CI 1.05-1.29), being locked down alone (aOR 1.15, 95% CI 1.01-1.32), living in an urban environment (P<.01), and not working (P<.001). Factors of increase in tobacco use (n=2787) were female gender (aOR 1.31, 95% CI 1.11-1.55), having no partner (aOR 1.30, 95% CI 1.06-1.59), intermediate/low education level (P<.01), and still working in the workplace (aOR 1.47, 95% CI 1.17-1.86). Factors of increase in alcohol use (n=7108) were age 30-49 years (P<.05), a high level of education (P<.001), and current psychiatric treatment (aOR 1.44, 95% CI 1.10-1.88). The only significant factor of increase in cannabis use (n=620) was intermediate/low level of education (P<.001). The early phase of COVID-19 containment in France led to widespread increases in addiction-related habits in the general population. Reduced well-being and increased stress were universal factors of increase. More specific factors were associated with increases in each of the explored habits.

ObjectivesRecent studies have demonstrated worsened mental health in relatively highly developed countries impacted by social inequalities and unemployment. Here, we investigate (1) whether mental health issues are differently or similarly affected by these social factors and (2) whether their effects on mental health are related or unrelated to each other.SettingAnalysis at the country level among Organization for Economic Cooperation and Development (OECD) countries (n=36). Data on social indicators were collected from OECD and the United Nations Development Programme databases. Data on the prevalence of mental issues were obtained from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study 2017.ParticipantsNo involvement of participants.Primary and secondary outcome measuresUsing linear regression models, we investigated the relative contribution played by human development (as measured by the Human Development Index (HDI)), social inequalities (Gini index) and unemployment (unemployment rate) on the prevalence of 10 mental health issues. We then measured the relationship between the socioeconomic factors’ effects on mental issues using 2×2 Pearson’s correlation test and principal component analysis.ResultsFirst, the overall effect of each socioeconomic factor on a combination of mental health disorders was large (r range: 0.51 to 0.76; p<0.002). However, the influence of social factors on mental health was relative to each mental issue (r range: −0.34 to 0.74). Second, the socioeconomic factors’ effects on mental health showed strong interdependence (rHDI-Gini=0.93, rHDI-unemploy=0.81, runemploy-Gini=0.84; p<0.001. Principal component analysis demonstrated that the first principal component of the three variables (rHDI, rGini, runemploy) explained 91.5% of the variance.ConclusionThese results implore a reanalysis of the socioeconomic determinants of mental health where (1) the heterogeneity of mental health issues would be taken into account and (2) each socioeconomic indicator’s effect would be analysed and interpreted in conjunction with the others.

Mental health and well-being were seriously impacted by the COVID-19 lockdown especially among young people and people with psychiatric disorders. This study aimed to identify factors associated with well-being in young people with psychiatric disorders, during early phase of COVID-19 lockdown in France. A national cross-sectional online study started on the 8.sup.th day of COVID-19 lockdown in France (during March 25-30, 2020). We included young people aged from 16 to 29 who responded to the questionnaire, living and being confined in France, with past or current psychiatric treatment. The questionnaire was accessible online and explored demographics and clinical factors, well-being, stress, situation during lockdown. Well-being was measured by the Warwick-Edinburg Mental Well-Being Scale (WEMWBS). Simple and multiple linear regression analyses were carried out. 439 individuals were included with 262 (59.7%) previously treated and 177 (40.3%) currently treated. WEMWBS total score were 42.48 (9.05). Feeling of useful was the most affected dimension. Well-being was positively correlated with: currently working on site, physical activity, abilities to cope with difficulties, family and social supports (p<0.05). It was negatively correlated with: elevated stress level, anxious ruminations, dissatisfaction with information, difficulties to sleep or reorganize daily life, feeling supported by medicines (p<0.05). No individual factor was correlated with well-being. The stepwise linear multivariate model had simple R.sup.2 coefficient of determination of 0.535. In the specific population of young people with psychiatric disorders, factors associated with well-being at early stage of lockdown were mainly psychosocial and related to brutal disorganisation of daily life.

Since drought is the leading environmental factor limiting crop productivity, and plants have a significant impact in defining the assembly of plant-specific microbial communities associated with roots, we aimed to determine the effect of thoroughly selected water deficit tolerant and susceptible Solanum lycopersicum cultivars on their rhizosphere microbiome and compared their response with plant-free soil microbial communities. We identified a total of 4,248 bacterial and 276 fungal different operational taxonomic units (OTUs) in soils by massive sequencing. We observed that tomato cultivars significantly affected the alpha and beta diversity of their bacterial rhizosphere communities but not their fungal communities compared with bulk soils (BSs), showing a plant effect exclusively on the bacterial soil community. Also, an increase in alpha diversity in response to water deficit of both bacteria and fungi was observed in the susceptible rhizosphere (SRz) but not in the tolerant rhizosphere (TRz) cultivar, implying a buffering effect of the tolerant cultivar on its rhizosphere microbial communities. Even though water deficit did not affect the microbial diversity of the tolerant cultivar, the interaction network analysis revealed that the TRz microbiota displayed the smallest and least complex soil network in response to water deficit with the least number of connected components, nodes, and edges. This reduction of the TRz network also correlated with a more efficient community, reflected in increased cooperation within kingdoms. Furthermore, we identified some specific bacteria and fungi in the TRz in response to water deficit, which, given that they belong to taxa with known beneficial characteristics for plants, could be contributing to the tolerant phenotype, highlighting the metabolic bidirectionality of the holobiont system. Future assays involving characterization of root exudates and exchange of rhizospheres between drought-tolerant and susceptible cultivars could determine the effect of specific metabolites on the microbiome community and may elucidate their functional contribution to the tolerance of plants to water deficit.

Patients with schizophrenia often experience substantial impairments in social functioning and activities of daily living (ADLs). Previous studies have highlighted links between sociodemographic and clinical factors and daily life functioning. However, routinely collected, non-scale-based clinical and sociodemographic characteristics have rarely been systematically evaluated as a standalone predictive framework. Understanding whether such variables alone can inform functional outcomes in schizophrenia may have important implications for public health. Using the French multicentric psychosocial rehabilitation database REHABase, we predicted five dimensions of the Social Autonomy Scale (a validated, clinician-administered questionnaire widely used in France): personal care, basic ADLs, financial autonomy, complex ADLs, and social and affective relationships. We used a SuperLearner ensemble machine learning method with a large set of routinely collected socio-demographic and basic clinical predictors descriptive of schizophrenia patients. Our sample comprised 948 participants. Averaged R2 on hold-out testing sets were higher for basic ADLs (mean R2: 0.35) than for social and affective relationships (0.16), financial autonomy (0.14), complex ADLs (0.13), and personal care (0.01). Factors associated with improved functioning included: being in a relationship, higher education, lower Clinical Global Impression scores, higher Global Assessment of Functioning scores, living in personal housing, being employed, mid-range illness duration, a history of suicide attempts and psychiatric comorbidities. Our findings indicate an association between socio-demographic and standard clinical variables routinely assessed in practice and outcomes in social functioning and ADLs. However, these variables account for only a limited proportion of the observed variance. This underscores the need for more specialized and precise assessments, e.g., based on cognitive abilities, to better understand and address patient functioning. We recommend targeted interventions focused on improving clinical symptoms, housing conditions, and supporting employment. Finally, clinicians should not assume that patients with seemingly protective factors, such as shorter illness duration, or absence of comorbidities, do not require further support.

IntroductionCare pathways are crucial for patients with mental health disorders and should be designed to support integrated rehabilitation while reducing the burden of these disorders. The contemporary shift toward an outpatient follow-up model of care presents an opportunity to improve mental health care beyond the stagnation in advancements in pharmacological treatments. Various pharmacist-led interventions exist and can serve as levers to address ongoing challenges in mental health care pathways: they could help manage difficult transitions, ensure continuity between inpatient and outpatient care, and reduce high rehospitalisation rates. However, the contexts in which these solutions benefit patients and improve care outcomes remain unclear. Thus, the primary objective of this study will be to identify how pharmaceutical solutions contribute to improving mental health care pathways, what works, for whom and in what context. The secondary objective will be to identify the key outcomes currently used to evaluate the impact of pharmaceutical solutions on care pathways.Methods and analysisA systematic realist review will be conducted, following 5 iterative steps to synthesise heterogeneous evidence: (1) Scope definition with a general review of the literature and experts’ discussions, (2) Initial programme theory development based on the preliminary searches, (3) Systematic review for evidence, to refine and test initial programme theory across PubMed, Embase and Web Of Science, (4) Data extraction, including context-mechanism-outcome configurations, and evidence appraisal and (5) Data analysis, synthesis and refined programme theory construction with the realist logic. This process will involve consensus among expert researchers, incorporating insights from individuals with lived experience.The final programme theory modelling will result in a new framework for pharmaceutical solutions applied in diverse mental health contexts. The findings of this systematic realist review could serve as a guide for implementing pharmaceutical solutions across healthcare settings, ensuring that interventions are evidence-based, contextually relevant and grounded in real-world needs.Ethics and disseminationAs this realist review will collect previously published data and will not involve human or animal participants, no ethical approval is required. Since this manuscript is a review protocol, no datasets were generated or analysed. All data extraction forms will be made available as part of the publication of the realist review.PROSPERO registration numberSystematic review registration PROSPERO 2025 CRD420251011954.Dates of the study: September 2025 to September 2026.