Ramona Hiltensperger

Recovery Colleges are expanding internationally (264 identified in 31 countries across six continents), yet key tools for defining and assessing them were developed in high-income Anglophone contexts. We conducted a two-round international Delphi study using a cross-cultural de-centring approach to examine the cross-cultural applicability of the RECOLLECT Change Model and RECOLLECT Fidelity Measure, and to develop versions that were more applicable across the participating settings and interoperable versions of these tools. In Round 1, 54 panellists from 20 countries rated item importance and cultural difficulty and provided free-text feedback, analysed using corpus-informed linguistic methods. Core principles were broadly endorsed, but ‘co-production’, ‘recovery’, ‘professionals’ and ‘shifting the balance of power’ were interpreted inconsistently, revealing embedded assumptions about equality, autonomy and open-ended participation. Round 1 findings informed wording refinements tested in Round 2 with 41 panellists from 15 countries. All 11 revised items reached consensus for understandability and cultural appropriateness, strengthening the tools while preserving core Recovery College values. By identifying and revising culturally embedded assumptions while preserving interoperability with the original tools, this study demonstrates a transferable approach to the cross-cultural adaptation of mental health tools.

Aims: While there is growing evidence for the effectiveness of peer support (PS) in improving psychosocial outcomes among individuals with severe mental health conditions, the mechanisms through which these effects occur remain insufficiently understood. This study examines whether social inclusion, hope and empowerment mediate the relationship between PS, personal recovery and health and social functioning. Methods: Data were collected from 565 adults with severe mental health conditions who participated in the multicentre UPSIDES randomised controlled trial across six sites in Germany, Uganda, Tanzania, India and Israel. Participants in the intervention group received structured PS from trained peer workers over a 6- to 8-month period. Standardised, self-report measures of social inclusion, hope, empowerment and personal recovery, as well as clinician-rated health and social functioning, were administered at baseline, 4 months, end of intervention (8 months) and 12-month follow-up. Cross-lagged panel modelling was used to explore longitudinal associations and mediating pathways. Results: The cross-lagged models showed strong autoregressive effects across all variables, indicating high temporal stability. There were no significant direct effects of PS on recovery or health and social functioning. However, mediation analysis identified significant indirect effects of PS on personal recovery via social inclusion ( β = 0.114, 95% confidence interval [CI] [0.049, 0.194], P < 0.05) and hope ( β = 0.037, 95% CI [0.001, 0.086], P < 0.05). Similar indirect effects were observed for health and social functioning (via social inclusion: β = −0.035, 95% CI [−0.064, −0.013]; via hope: β = −0.026, 95% CI [−0.052, −0.006]; both P < 0.05). Conclusions: Findings suggest that PS affects recovery-related outcomes primarily through intermediate mechanisms of enhanced hope and social inclusion. These results support theoretical models positing indirect pathways of change in PS interventions and highlight the value of targeting social and psychological domains when designing and implementing PS in mental health services. Individuals with lower baseline levels of hope and social inclusion may particularly benefit from PS. Trial Registration Number: ISRCTN26008944

Recovery Colleges are expanding internationally (264 identified in 31 countries across six continents), yet key tools for defining and assessing them were developed in high-income Anglophone contexts. We conducted a two-round international Delphi study using a cross-cultural de-centring approach to examine the cross-cultural applicability of the RECOLLECT Change Model and RECOLLECT Fidelity Measure, and to develop globally applicable and interoperable versions of these tools. In Round 1, 54 panellists from 20 countries rated item importance and cultural difficulty and provided free-text feedback, analysed using corpus-informed linguistic methods. Core principles were broadly endorsed, but “coproduction”, “recovery”, “professionals” and “shifting the balance of power” were interpreted inconsistently, revealing embedded assumptions about equality, autonomy and open-ended participation. Round 1 findings informed wording refinements tested in Round 2 with 41 panellists from 15 countries. All 11 revised items reached consensus for understandability and cultural appropriateness, strengthening the tools while preserving core Recovery College values.

Background: Some trials have evaluated peer support for people with mental ill health in high-income, mainly English-speaking countries, but the quality of the evidence is weak. Aims: To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries. Method: This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support. Results: Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score ( β = 0.18, P = 0.031, 95% CI: 0.02–0.34). Conclusions: Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.

Background/Objectives: The connection between nutrition and mental health has become a point of growing interest. In response, nutritional psychiatry research has emerged as a field dedicated to understanding these interactions. A bibliometric analysis was conducted to map the growth and trends in this area, providing insights into its evolving scope and key research contributions. Methods: A literature search was conducted within the Web of Science Core Collection. Data analysis was performed using the result analysis and citation report options of Web of Science as well as the visualization software VOSviewer (Version 1.6.20). Results: A total of 31,556 articles on nutrition and mental health were published from 2000 to 2024 across various WoS categories, mainly in “Psychiatry”, “Public, Environmental & Occupational Health”, and “Nutrition & Dietetics”. The most prolific research groups are based in North America. Recent publications mainly cover seven clusters: (1) public health and social factors, (2) interventions and biological mechanisms, (3) the health of the elderly, (4) nutrition-related illnesses, (5) lifestyle behavior, (6) observational studies, and (7) pregnancy and the postpartum period. Conclusions: In view of the increasing research activities and growing allocation of resources in nutritional psychiatry research, it is important to define research priorities in close collaboration with service users and stakeholders. Research should be approached in a holistic manner through multidisciplinary research consortia to ensure comprehensive and impactful outcomes.

People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.