Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear.

To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes.

Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP.

Ten RCTs (N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [−0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [−0.115, 0.504], p = 0.219), diastolic blood pressure (SMD = −0.21, 95% CI [−0.854, 0.434], p = 0.522), HDL (SMD = 0.157, 95% CI [−0.36, 0.674], p = 0.551), triglycerides (SMD = −0.041, 95% CI [−0.461, 0.38], p = 0.849), or glucose (SMD = −0.071, 95% CI [−0.213, 0.071], p = 0.326). Heterogeneity was moderate to high.

Exercise interventions did not significantly improve metabolic syndrome components in SMI. Future trials must prioritize tailored regimens, adjunctive therapies, and rigorous control of medication effects.

Early diagnosis and intervention are essential for managing and improving long-term outcomes of severe mental illness, highlighting the need for reliable early biomarkers. This longitudinal study explores whether there are sex differences in the development of the brain during childhood and adolescence differs between offspring of parents with and without a diagnosis in the mood-psychosis spectrum.

We obtained 286 T1-weighted and diffusion weighted MRI scans of 184 offspring (aged 8–18 years at baseline) of at least one parent diagnosed with bipolar disorder (n=78) or schizophrenia (n=52) and offspring of parents without severe mental illness (n=54); 102 offspring underwent a follow-up scan (on average 3.9 years between scans). Global brain measures, regional cortical thickness and surface area, gyrification and sulcul morphology were computed. Anatomical brain networks were reconstructed into structural connectivity matrices. Network analysis was performed to investigate anatomical brain connectivity. Group comparisons and the interaction with age were analysed with (non)linear mixed-effects models. Explorative analyses will be done on the interaction with sex. To correct for multiple comparisons, we applied a Benjamini-Hochberg false discovery rate (FDR) correction (q=0.05).

A significant effect of age was found on most of the included brain features, with suggestive evidence for subtle deviations in trajectories in the cortical thickness and network metrics, but not in the gyrification index and sulcul morpholoy in offspring of parents with schizophrenia. Sex effects will be discussed during the meeting.

Our findings suggest the brain development in familial high-risk youngsters is associated with being at familial risk for schizophrenia.

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Sex differences in psychiatric disorders are well-documented, yet clinical diagnoses remain primarily symptom-based, overlooking underlying neurobiological distinctions. Despite evidence of sex-specific symptomatology leading to similar diagnostic labels, treatment paradigms often follow a one-size-fits-all approach, contributing to misdiagnosis, suboptimal treatment, and delayed functional recovery. Women, in particular, are disproportionately affected, as psychiatric research has historically prioritized male cohorts to control for hormonal fluctuations and reproductive events (e.g., menarche, pregnancy, menopause), resulting in a gap in sex-specific interventions.

With the advancement of precision psychiatry, integrating sex-informed, multimodal approaches into clinical decision-making is imperative. Machine learning (ML) provides a promising avenue for improving diagnostic accuracy and individualized risk prediction, moving beyond conventional categorical diagnoses.

Here I will highlight findings from two studies leveraging ML to analyze sex-related neuroanatomical patterns:

• Neuroanatomical Sex Differences in Early-Phase Psychiatric Disorders – Investigating grey matter volume alterations in individuals at clinical high risk for psychosis (CHR), recent-onset psychosis (ROP), and recent-onset depression (ROD) using a Support Vector Machine (SVM) model.

• Sex Differences and Neuroanatomical Classification in Transgender Individuals – Exploring whether ML classifiers trained on cisgender populations accurately reflect neurobiological patterns in transgender individuals, considering sex assigned at birth, gender identity, and hormone therapy.

This research does not seek to exclude individuals with Differences in Sex Development (DSD) but rather aims to establish biological sex as a critical, yet underutilized, variable in psychiatric research. Recognizing sex-specific neurobiological mechanisms is a necessary step toward developing targeted risk calculators (e.g., for postpartum depression, suicide risk) and advancing personalized mental health interventions. By refining ML-based models and integrating sex-informed frameworks, this work contributes to the broader goal of precision psychiatry—tailoring psychiatric care to the diverse biological and psychological realities of individuals.

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This study aimed to cross-compare European countries’ responsiveness to their populations’ mental health (MH) needs.

For the EU-27 countries and the United Kingdom, the 2023 Headway Initiative collected data on 15 key performance indicators (KPIs) in responsiveness in healthcare, including workforce, facilities, quality of care, and MH expenditure, and 14 KPIs in responsiveness in workplaces, schools, and society. Bivariate correlations between Headway-transformed KPI scores, which were standardised in a 1–10 Likert Scale (1: worst performance; 10: best performance), tested for putative associations.

Responsiveness in healthcare: Sweden (10), Denmark (8.8), and Finland (8.3) showed the best performance, while Romania (1.0), Slovakia (1.1), and Latvia and Bulgaria (1.2) had the poorest performance. Responsiveness in workplaces: schools, and society, Germany (10.0), France (9.1), and Denmark (9.1) were the most responsive countries, while Greece and Slovakia (1.0) had the poorest responsiveness. MH status total scores negatively correlated with global scores on responsiveness in healthcare (r = −0.34, p = .075), workplaces (r = −0.46, p = .014), schools (r = −0.59, p = .003), and society (r = −0.53, p = .003) – poorer MH status, greater responsiveness.

European countries significantly differed in their responsiveness to the populations’ MH needs, although the real effectiveness of their MH policies remains to be elucidated. Whether more responsive countries, which achieved poorer MH outcomes, successfully met greater preexisting MH needs, they failed to do so, or the relationship is driven by other third variables (e.g., quality of MH assessment) requires future investigation.

Despite the crucial need for objective diagnostic procedures in psychiatry, the research of the quantitative neural bases of mental disorders is in its infancy, and currently there are no well-validated markers that could be translated into clinical practice. Candidate brain markers for neurodevelopmental, psychotic, and mood disorders have been proposed, but confounding factors and low statistical power leave most of these markers at the very early stage of development. Increasing evidence suggests a crucial role of biological, especially including sex, and environmental factors in shaping behavioral development and psychopathological risk. Moreover, such risk seems associated with greater susceptibility to cardiovascular problems, possibly mediated by alterations in the brain-heart axis. In this context, the study of brain maturation trajectories and brain-heart interactions in relation to sex and environment can provide key insights on the etiology of complex mental illnesses.

This lecture will provide an overview of our recent research on the interactions among biological factors, in particular sex, environmental risk, brain morphology and function, and cardiac autonomic regulation in affective and psychotic disorders using multivariate analysis approaches. Evidence obtained from juvenile cohorts, including samples of twins, will be presented to provide useful information on the genetic and environmental determinants of behavioral developmental trajectories, and on sex differences in these trajectories. The complex relationships among sex, environmental risk, autonomic regulation, brain morphology and connectivity, and mental and physical health will be explored in transdiagnostic samples of young adults and elders. Special focus will be given to sex-shared and sex-specific brain and autonomic mechanisms affected by social stressors, including discrimination, bullyism, and chronic stress, and their possible role in determining the heterogeneous clinical dimensions of psychotic and affective disorders.

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This study aimed to provide an up-to-date cross-national comparison of the European population mental health (MH) status and its determinants.

For the European Union (EU) 27 countries and the UK 6 Key Performance Indicators (KPIs) in MH status (e.g., prevalence of mental disorders) and 19 KPIs in individual (e.g., smoking), environmental (e.g., air pollution) and socioeconomic (e.g., poor housing conditions) determinants of MH were measured. KPIs scores were standardised in a 1–10 Likert Scale (1: worst performance; 10: best performance), thus allowing between-country comparisons of the relative performance. Exploratory unadjusted bivariate correlations between KPIs-transformed scores were run.

Based on the KPIs-transformed scores, Slovakia (8.3), Cyprus (7.8), and Greece (7.1) had the best MH status, while Sweden (3.1), UK (2.6), and The Netherlands (2.1) had the poorest MH status. Regarding determinants of MH Finland (8.0), Sweden, and Estonia (7.5) had the lowest MH risk, while France (3.1) and Romania (2.8) had the highest risk.

Smoking (r = −0.43, p = .021), alcohol use (r = 0.57, p = .002), daylight hours (r = 0.74, p < .001), ecoanxiety (r = −0.51, p = .005), air pollution (r = −0.46, p = .015), commuting time (r = 0.42, p = .026), and Fragile State Index (r = −0.44, p = .018) correlated with overall MH status.

Population-level MH status and its determinants varied across European countries, including “low-risk, poor MH status” and “high-risk, good MH status” countries. Further non-tested determinants of MH and/or between-country differences in responsiveness to MH needs may explain this discrepancy. These results should guide future evidence-based public MH policymaking and universal preventive strategies in Europe.

Recently, there have been wide-ranging debates about gender affirming treatment for young people with gender incongruence. The ethical principle of self-determination of young people must be reconciled with a careful assessment and weighing up of the risks and benefits of medical treatment steps. The focus is on psychosocial support for young people struggling with gender incongruence in adolescence. The evidence for the effectiveness of medical interventions in adolescence is still limited. Nevertheless, there is a great need among affected adolescents. In a literature review and based on international debates, guidelines and treatment recommendations, a cautious and balanced approach to the question of the right support for adolescents with gender dysphoria is recommended.

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Considering the high likelihood of chronicity, it is imperative to understand the risk factors and outcomes associated with severe anorexia nervosa (AN), for which Danish registers provide a unique opportunity. We developed a measure of AN severity adapted from clinical literature for use in register-based research.

The study population included all Danish individuals born between 1963 and 2007 who were diagnosed with AN from 1969 to 2013. Using register data, we constructed the anorexia nervosa register-based severity index (AN-RSI), incorporating early or late illness onset, number of inpatient admissions and outpatient treatments, cumulative treatment length, and illness duration, each weighted based on clinical importance. Associations between AN-RSI scores, evaluated 5 years after first AN diagnosis, and mortality were estimated using survival analysis.

Among 9167 individuals diagnosed with AN, 132 died during follow-up: 17 from AN, 30 from suicide, and 85 from other causes. Higher AN-RSI scores were associated with increased rates of mortality from AN, somatic anorexia diagnosis, suicide, alcohol-related causes, and any cause. AN cases who scored in the top 20% of AN-RSI had especially high mortality rates. Furthermore, severe AN cases were also more likely to be in treatment in the next 5 years after severity was established.

AN-RSI effectively captures mortality and long-term treatment in the absence of detailed patient records and is associated with later mortality in AN patients. AN-RSI could serve as a tool to examine epidemiological and genetic risk factors associated with AN course and outcomes.

The use of artificial intelligence (AI) in psychiatry holds promise for diagnosis, therapy, and the categorization of mental disorders. At the same time, it raises significant theoretical and ethical concerns. The debate appears polarized, with proponents and critics seemingly irreconcilably opposed. On the one hand, AI is heralded as a transformative force poised to revolutionize psychiatric research and practice. On the other hand, it is depicted as a harbinger of dehumanization. To better understand this dichotomy, it is essential to identify and critically examine the underlying arguments. To what extent does the use of AI challenge the theoretical assumptions of psychiatric diagnostics? What implications does it have for patient care, and how does it influence the professional self-concept of psychiatrists?

To explore these questions, we conducted 15 semi-structured interviews with experts from psychiatry, computer science, and philosophy. The findings were analyzed using a structuring qualitative content analysis.

The analysis focuses on the significance of AI for psychiatric diagnosis and care, as well as on its implications for the identity of psychiatry. We identified different lines of argument suggesting that expert views on AI in psychiatry hinge on the types of data considered relevant and on whether core human capacities in diagnosis and treatment are viewed as replicable by AI.

The results provide a mapping of diverse perspectives, offering a basis for more detailed analysis of theoretical and ethical issues of AI in psychiatry, as well as for the adaptation of psychiatric education.

For decades, the standards of gender-related healthcare provided to trans and gender-diverse people have been prepared by international professional associations. These standards are often expected to rely on research evidence, but when the research evidence is not conclusive, an expert consensus is sought. In addition to the standards and guidelines updated with intervals, such as the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, and the Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline of the Endocrine Society, there are several national guidelines developed by the professionals in some European countries. There are significant similarities among these care principles concerning practical recommendations. However, the practice may vary depending on the differences in healthcare delivery systems and, more importantly, legal regulations. In general, international guidelines provide room for flexibility in practical applications. Yet, in recent years, there has been a significant change in many European countries with respect to the public appreciation of gender diversity and gender-related healthcare, mainly resulting from a politicized debate triggered by more conservative arguments rather than evidence. This backlash, which has also had a profound impact on the medical professional sphere, is a cause for concern. In this climate, it is becoming more challenging to develop and implement the standards of care for trans and gender-diverse individuals in many countries. Similarities of challenges in the implementation of standards also exist in the means of handling these challenges.

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Cognitive impairment represents a central component of major depressive disorder (MDD), affecting a large proportion of people living with MDD and showing a consistent negative impact on social, interpersonal, and occupational functioning and subjective quality of life. Cognitive remediation (CR) is a training-based psychosocial intervention targeting cognitive performance and psychosocial functioning that has shown consistent evidence of effectiveness in individuals with schizophrenia and that could provide significant benefits also in people with MDD: this study aimed to assess the effects of a computerized CR intervention in adults living with MDD.

Participants recruited in this single blind multicentric randomized controlled trial were allocated to receive a computerized CR intervention delivered by an active and trained therapist or to an active control condition (computer games – CG). Outcomes were measured with validated instruments by blind assessors and included cognitive performance, depressive symptoms, and psychosocial functioning. Outcomes were assessed using mixed models for repeated measures, considering baseline and end-of-treatment scores.

Hundred and one participants (CR=52 and CG=49) were included and 81 (CR=45 and CG=36) completed the study. CR produced superior results in clinician-rated depressive symptoms (p=0.023, d=042), global clinical severity (p=0.025, d=0.39), subjective depressive symptoms (p=0.005, d=0.45), working memory performance (p=0.004, d=0.34), executive functions/cognitive flexibility (p=0.020, d=0.43), and subjective cognitive impairment (p=0.006, d=0.48).

CR represents an effective intervention in MDD, improving clinical outcomes and cognitive performance in a clinician-rated and in a subjective manner, which should be more consistently implemented in clinical practice and included in MDD treatment recommendations.

Multidisciplinary cooperation is an imperative prerequisite for good clinical practice in general, and for healthcare of gender-variant people in particular. Although self-determination of one’s gender identity is regarded a human right and self-medication in the trans community widespread, gender-affirmative treatment (GAT) with its far-reaching consequences (including reimbursement by social insurances) still is based upon diagnostics – and more importantly – by indication of mental health professionals (MHP). Empathy and affirmative encounter cannot detract from the fact that medical interventions in general cannot be carried out without a diagnosis. It is the assignment and duty of MHPs to make a diagnosis of gender incongruence or gender dysphoria prior to GAT carried out by somatically oriented doctors. This mutual dependency is a constituent of transgender healthcare, not only at the beginning of a transition trajectory but life spanning. Mental and somatic health care are interdependent. Gender affirmative hormonal treatment and its potential side-effects as well as surgical intervention and its potential complications may have large impact on mental health, and vice versa mental health disorders impact medical conditions. MHPs and somatically oriented doctors are socialized and trained in different ways, sometimes complicating understanding. This presentation deals with the needs, peculiarities and obstacles of joint mentoring gender-variant patients from a medical perspective, not only at the beginning of transition but also in times of crisis or in the course of getting older.

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This presentation will provide an overview of our original studies focusing on the mental health impact of the ongoing war in Ukraine on adolescents. Our studies address critical areas such as posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and the prevalence of psychiatric conditions, alongside resilience factors among war-affected youth. By synthesizing findings from the studies , the presentation will hilight the substantial psychological burden of the conflict on Ukrainian adolescents and emphasizes the pressing need for targeted mental health interventions. These studies contribute essential insights into the long-term implications of trauma, resilience, and mental health outcomes in conflict-affected populations, informing both research and clinical practice.

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We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations – the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects – while assessing clinicians’ adherence to guidelines.

A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A–F). Additionally, a review of multiple guidelines/guidance papers was performed.

The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.

These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians’ unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.

Shared decision-making (SDM) is a collaborative process between clinicians and service users to select treatment, guided by evidence and service user preferences. SDM has clinical, economic, and ethical benefits compared to clinician-led decision-making; yet, implementation remains challenging. An important knowledge gap is the influence of culture on implementation. Cultural impacts on service user decision-making preferences have been documented, but little is known about how culture impacts clinician preferences. This study examined associations between country-level cultural characteristics and decision-making preferences of psychiatrists in routine care settings across Europe.

We analysed data from 751 psychiatrists and trainees in 38 European countries, who completed the Clinical Decision-Making Style–Staff (CDMS-S) scale. Country-level Hofstede cultural dimensions were linked to CDMS-S scores using univariate and multivariate regression models. Mixed-effects models were used to account for country-level clustering and controlling for professional and economic variables.

In univariate analyses, all six dimensions were associated with SDM preferences. However, only three remained significant in mixed-effects models. Higher levels of Indulgence and Individualism were associated with stronger preferences for SDM, while higher Power Distance was associated with more clinician-led decision-making. These associations did not remain significant in fully adjusted multivariate models, suggesting professional and systematic factors mediate cultural influences.

Indulgence, Individualism, and Power Distance are associated with psychiatrists’ decision-making preferences across Europe. Culturally sensitive SDM interventions should address not only clinician attitudes but also healthcare structures and patient expectations. Findings offer an empirical foundation for tailoring SDM training and policy to diverse cultural contexts within European psychiatry.

It is important to support the Ukrainian mental health research and practice in time of war and after the war has ended. Norwegian universities engage in this by collaboration in psychiatric research and mental health initiatives.

With a grant from the University of Oslo and in collaboration with the Taras Shevchenko National University Kyiv, the Ukrainian Psychiatric Association, and the Norwegian Psychiatric Association, we launched a research school for young psychiatry and psychology researchers who are based in the Ukraine and who can travel outside the country. The research school and training class was held in Warsaw 2023, Krakow 2023 and in Oslo 2024. It offered scientific lectures, interaction with international researchers, and clinical site visits. The young Ukrainian researchers present their projects from early to completed phase to be openly discussed. Networking and scientific exchange is encouraged. The Oslo university library has opened their doctoral educational programs for Ukrainian doctoral students and the University of Oslo sponsors participation in international conferences.

We now aim for a renewed strategy to help meet the needs of mental health and clinical research in the Ukraine also after the end of the war.

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Antenatal depression symptom is a global health concern, but the trajectories of antenatal depression symptom vary across different studies. Additionally, the influencing factors and adverse pregnancy outcomes of antenatal depression symptom may differ across heterogeneous subtypes, which requires further exploration.

A prospective cohort study was conducted in Hubei province, China, from July 2022 to September 2023. Pregnant women (<14 weeks) were enrolled and followed up at 16, 21, 28, and 37 gestational weeks, with depressive symptom measured using the Edinburgh Postnatal Depression Scale (EPDS). Latent class growth modeling and logistic regression were used for data analysis.

Of 1034 women enrolled, 725 completed all follow-ups. Four depressive symptom trajectories were identified: no depression group (32.13%), persistent subclinical depression group (42.48%), persistent moderate depression group (19.17%), and persistent high depression group (6.21%). Risk factors of depressive symptom trajectories included low social capital, unplanned pregnancy, primiparity, mental illness history, high perceived stress, and low resilience (p < 0.05). Compared to the no depression group, gestational diabetes mellitus (GDM) risk was 1.90 times higher in the persistent moderate group and 2.59 times higher in the persistent high group; small for gestational age (SGA) risk was 2.42 times higher in the persistent moderate group and 3.98 times higher in the persistent high group.

This study identified four antenatal depressive symptom trajectories. Persistent moderate and high depression groups were linked to GDM and SGA, highlighting the importance of mental health assessments and intervention for pregnant women, especially those with higher depression severity, to prevent adverse outcomes.

The study aims to analyze the mental health conditions of Ukrainian university students during and after the war and to examine the impact of these conditions on their academic productivity.

The research combines methods of cross-sectional surveys and regression analysis. The survey includes a demographic section, a mental health screening, and the “Work Productivity and Activity Impairment: Specific Health Problem” (WPAI: SHP) section, adapted for the study’s purposes. The sample consists of 1,398 respondents.

Among all respondents, 85.8% exhibited symptoms of depression, 66.1% of anxiety disorder, 56.9% of sleep disorders, and 48.1% of post-traumatic stress disorder (PTSD). Econometric modeling results confirm the devastating impact of mental health issues on students’ academic productivity during the war: moderate to severe symptoms of mental disorders, such as depression, anxiety disorder, and sleep disorders, are associated with a decline in students’ productivity by 17.4%, 12.2%, and 11.0%, respectively.

The prevalence of mental health issues among university students during and after the war highlights an urgent need for interventions to support their well-being and academic performance. These efforts are critical for fostering a resilient and capable generation essential for Ukraine’s postwar recovery and future development.

Mental health, mental conditions, war, academic productivity, students.

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Growing evidence suggests that inflammation plays a critical role in the early stages of psychosis, potentially contributing to disease onset and progression. Several studies have identified elevated levels of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), in individuals at clinical high risk (CHR) for psychosis and in those with first-episode psychosis (FEP). However, inconsistencies across studies highlight the need for further research to clarify the relationship between immune dysregulation and psychosis onset.

This talk reviews the current literature on inflammatory markers in early psychosis and their potential implications for pathophysiology, early detection, and treatment strategies. Notably, inflammation may serve as a promising biomarker for identifying individuals at risk and monitoring disease progression. Additionally, anti-inflammatory interventions are being explored as potential adjunctive treatments for psychosis.

Beyond the review of existing evidence, we will present original data from the PREGAP study conducted at the Early Intervention \Service (EIS) of Basurto University Hospital. This dataset includes inflammatory marker assessments in CHR and FEP individuals, providing novel insights into immune alterations in early psychosis.

Understanding the role of inflammation in psychosis could open new avenues for personalized medicine, early intervention, and improved treatment outcomes. Future research should focus on large-scale longitudinal studies to confirm the clinical utility of inflammatory markers and identify potential therapeutic targets.

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Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents.

A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors.

After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045].

While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.