Peer-reviewed journals

Co-creating mental health promotion and prevention interventions with groups in vulnerable situations in Europe: a mixed-methods study protocol for co-creation implementation and participatory evaluation

Published: 01 July 2025

Authors: Raquel Teixeira,  Cláudia de Freitas,  Liuska Sanna,  Eleonora Prina,  Giulia Turrini,  Amber S. Brizar,  Cătălin Gherdan,  Evaldas Kazlauskas,  Austėja Dumarkaitė,  Henrik Wasmus,  Leonie Fleck,  Ulrich Reininghaus,  Melanie Mack,  Chiara Scarampi,  Maritta Välimäki,  Maija Satamo &  Wietse A. Tol

Abstract: Co-creation has emerged as a crucial strategy for addressing complex public health challenges, including promotion and prevention of mental health concerns. While the evidence base for effective interventions continues to grow, significant gaps remain in their implementation and integration into real-world settings. Co-creation offers a valuable tool for strengthening mental health promotion strategies, ensuring that interventions are evidence-based, contextually relevant, culturally sensitive, sustainable and acceptable to those directly affected. However, there is a paucity of studies examining the evaluation of co-creation research, particularly regarding how participatory methods foster adaptation and influence outcomes and long-term sustainability. This protocol outlines a study designed to implement, evaluate and strengthen co-creation methodologies through a participatory and formative evaluation approach.

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Enhancing Mental Health and Cognitive Function in Older Adults: A Swiss Perspective on Public Health Interventions and Stigma Mitigation Strategies Informed by a Desk Review

Published: 29 January 2025

Authors: Melanie Mack, Chiara Scarampi, Emilie Joly-Burra, Sascha Zuber, Cláudia de Freitas, Raquel Teixeira, & Matthias Kliegel

Abstract: This desk review evaluates the current state of interventions for mental health and cognitive functioning among older adults in Switzerland focusing on the features of these interventions as well as on Swiss-specific contextual factors that contribute to vulnerability and stigma. The goal is to guide the development of effective, evidence-based interventions and policies to ensure that older adults in Switzerland not only live longer but also enjoy better mental health and cognitive functioning. We searched PubMed, PsycINFO, and Scopus for eligible studies from January 2018 until October 2024. We included studies investigating interventions targeting mental health and/or cognitive functioning in older adults living in Switzerland. In addition, we searched for gray literature reporting on cognitive and mental health interventions, as well as mental health, cognitive functioning, stigmatization, and stigma mitigation strategies in the Swiss context. Core features of the interventions (intervention type, efficacy, delivery modes, recruitment, stigma-related aspects) and target populations (groups at risk of vulnerability, stigma sources) were extracted, descriptively summarized, and discussed. A comprehensive search resulted in 1200 records, with 26 peer-reviewed articles and five gray literature reports meeting the inclusion criteria. The findings suggest that individualized multidomain interventions, including behavioral change techniques and multifaceted stigma-mitigating strategies, might be required to sustainably improve mental health in older adults.

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Addressing youths’ climate change-related distress: a qualitative study on the experience of burden, triggering and protective factors

Published: 2 October 2025

Authors: Henrik Wasmus, Leonie Fleck, Tim Schmidt, Stefan Scheydt, Frederike Schirmbeck, Evaldas Kazlauskas, Wietse Tol, Ulrich Reininghaus

Abstract: In recent years, growing scientific and public awareness has highlighted the negative impacts of climate change on mental health, particularly among young people, who are disproportionately affected. These findings underscore the need for effective and scalable interventions to support individuals experiencing climate change-related distress (CCD). At the initial stage, it is crucial to understand how this distress manifests and what the momentary risk and protective factors are that exacerbate and modulate its dynamic occurrence in everyday life.  In this context of need, nine qualitative, semistructured interviews with young individuals, aged between 14 and 25 and living in Germany, with CCD were conducted. Interviews centred on individuals’ burdens, putative triggers eliciting the experience, as well as putative protective factors. We analysed the data and developed themes via Braun and Clarke’s reflexive thematic analysis and electively structured the analysis according to the coding paradigm adopted from Strauss and Corbin. Participants reported experiencing a wide range of negative emotions as well as mental health difficulties associated with climate change, including sleep disturbances, reduced well-being and difficulties concentrating. The experience emerges from the understanding and awareness of the complexity of climate change and its associated consequences for the environment. Protective factors were reported, including positive emotions (eg, hope, finding meaning and purpose), self-efficacy, conceptual knowledge about climate change-related emotions and external factors (ie, social support). Participants employed various strategies to regulate their emotions, ranging from avoidance and distraction to strategies like acceptance, cognitive reappraisal and active engagement in pro-environmental behaviour or activism. Overall, this study enhances our understanding of young individuals’ emergence and daily life experience of CCD. The findings suggest that a prolonged or overly extensive occurrence may result in mental health difficulties. Moreover, the results highlight the importance of strengthening factors associated with resilience at a young age, enabling individuals to cope with CCD. The findings have implications for the development of potential intervention components and suggest imparting conceptual knowledge and adaptive regulatory strategies, supporting habit formation and providing networking opportunities with others affected by CCD.

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Digital Training for Mental Health Promotion in Young People With Climate Change-Related Distress: Protocol for a Feasibility Randomized Controlled Trial

Published: 5 December 2025

Authors: Leonie Fleck; Henrik Wasmus; Frederike Schirmbeck; Claudia de Freitas; Raquel Teixeira; Liuska Sanna; Anne Marijn de Graaff; Manuela De Allegri; Hoa Thi Nguyen; Jan R. Boehnke; Evaldas Kazlauskas; Wietse Tol; Ulrich Reininghaus

Abstract: Climate change–related distress is increasingly recognised as a major mental health concern among young people, highlighting the need for accessible mental health promotion and prevention interventions. This study examines the feasibility and initial signals of efficacy of the Climate Mind and Act (CliMACT) training, a novel hybrid ecological momentary intervention (EMI) designed for youth aged 14–25 years experiencing climate change–related distress. A two-arm, parallel-group, assessor- and analyst-blinded feasibility randomised controlled trial will recruit 50 participants, randomly allocated to either CliMACT plus care as usual (CAU) or CAU only. The intervention combines three sessions with a mental health professional and six weeks of smartphone-based EMI support aimed at strengthening adaptive emotion regulation and engagement in meaningful action through compassion-focused and acceptance and commitment therapy approaches. EMI delivery includes enhancing, consolidating, and adaptive components that provide support in real-world settings, including moments of heightened negative affect. Feasibility outcomes include recruitment, retention, participant satisfaction, adherence, and fidelity to the intervention protocol, while exploratory analyses will assess candidate mental health outcomes, mechanisms of change, indicators of health inequities, and measures relevant to a future economic evaluation. Assessments are conducted at baseline, post training, and four-week follow-up using self-report measures and ecological momentary assessment. Participant enrolment began in December 2024, data collection concluded in August 2025, and findings are expected in 2026. This study is among the first to evaluate an EMI specifically targeting climate change–related distress in youth and will inform a future fully powered efficacy-effectiveness trial.

Conferences and symposiums

de Freitas, C., Teixeira, R., Tol, W., & Sanna, L. (2024, August 30). Co-creation in mental health promotion research: Anticipating risks and tensions, nurturing trust and cultivating transformative change [Conference presentation]. ESA International Conference.

Wasmus, H. (2024, September 8–13). Co-development of an intervention scenario for young people experiencing climate change-related distress [Conference presentation]. Gesundheit gemeinsam.

Gherdan, C., & Brizar, A. (2024, October 3). Mental health programs [Conference presentation]. Amsterdam Leadership Lab - Annual Symposium.

de Freitas, C. (2024, October 9). Keynote: Co-creation in mental health research: Challenges and affordances. 16th Symposium on Mental Health Research. Sant Joan Déu Research Institute.

de Freitas, C., Teixeira, R., Tol, W., & Sanna, L. (2024, November 12–15). Mental health promotion research in co-creation: Lessons from a multisite study in six countries [Conference presentation]. EUPHA International Conference. EUPHA International Conference abstract

Teixeira, R., Tol, W. A., Sanna, L., Prina, E., Thomsen, C., Castaner, M. M., & de Freitas, C. (2024, November 12–15). Co-creating stigma-prevention strategies for mental health interventions with migrant populations [Conference presentation]. EUPHA International Conference. EUPHA International Conference abstract

Brizar, A., Gherdan, C., van Vugt, M., Feenstra, S., Witteveen, A., & Sijbrandij, M. (2024, November 29). Identifying and addressing groups of employees vulnerable to work-related mental health problems: Co-creation in intervention research [Conference presentation]. WAOP Conference.

Wasmus, H. (2024, November 30). Navigating climate change distress: Insights into momentary experiences and intervention needs [Conference presentation]. DGPPN International Conference.

Satamo, M., & Välimäki, M. (2025, May 17). Digital competencies and continuing education for health care professionals supporting psychosocial self-help interventions in Finland [Conference presentation]. NHEPT Conference.

Brizar, A., Gherdan, C., van Vugt, M., Feenstra, S., Witteveen, A., Sijbrandij, M., & Malik, A. (2025, May 24). Empowering managers to address mental health at work: Pilot of WHO’s manager training in the Netherlands [Conference presentation]. EAWOP Conference.

Edelhoff, H., Fleck, L., Reininghaus, U., Wasmus, H., Schirmbeck, F., de Freitas, C., Teixeira, R., Sanna, L., Carswell, K., Kazlauskas, E., & Tol, W. (2025, May 28). CliMACT: A hybrid digital intervention for mental health promotion in young people with climate change-related distress [Conference presentation]. SAA Conference.

Žiemienė, L., Carswell, K., Dumarkaitė, A., de Graaff, A. M., Gražinis, A., Serapinė, R., Tol, W., & Kazlauskas, E. (2025, June 12–15). Chatbot CBT intervention to reduce psychological distress for youth. ESTSS 2025 Conference: Exploring New Approaches for Healing and Recovery in Times of Global Uncertainty and Extreme Stress.

Kairyte, A., de Freitas, C. S. S., Reininghaus, U., Sanna, L., Tol, W., Zelviene, P., & Kazlauskas, E. (2025, June 12). Youth mental health in Lithuania: How we should move forward. The 18th biennial conference of the European Society for Traumatic Stress Studies, Tbilisi, Georgia.

Kazlauskas, E., Dumarkaite, A., de Graff, A., Ziemiene, L., Tol, W., & Carswell, K. (2025, June 12–15). Adapting a chatbot stress management intervention for youth: A Lithuanian perspective. The 18th biennial conference of the European Society for Traumatic Stress Studies, Tbilisi, Georgia.

De Allegri, M., Nguyen, H., Tol, W. A., Reininghaus, U., Barbui, C., & Kliegel, M. (2025, July 23). Economic evaluation to address mental health vulnerabilities from adolescence to older age: Experiences from implementation research in Europe [Conference presentation]. International Health Economics Association Conference.

Fleck, L., Wasmus, H., Reininghaus, U., Schirmbeck, F., de Freitas, C., Teixeira, R., Sanna, L., Carswell, K., Kazlauskas, E., & Tol, W. (2025, September 10). Feasibility and initial signals of efficacy of a digital training for mental health promotion in young people with climate change-related distress [Symposium presentation]. 15th IEPA Conference.

Schirmbeck, F., Fleck, L., Reininghaus, U., Wasmus, H., Kazlauskas, E., Carswell, K., & Tol, W. (2025, September 10). ADVANCE CliMACT intervention: Intervention rationale and components [Poster presentation]. 15th IEPA Conference.

Wasmus, H., Fleck, L., Reininghaus, U., Schmidt, T., Schirmbeck, F., Kazlauskas, E., & Tol, W. (2025, September 10). Addressing youths’ climate change-related distress: A qualitative study on burden, protective factors and intervention needs [Poster presentation]. 15th IEPA Conference.

Dumarkaite, A., Ziemiene, L., Kazlauskas, E., Kairyte, A., Carswell, K., de Graaff, A.-M., Tol, W. A., & Reininghaus, U. (2025, September 10). Chatbot stress management intervention STARS for youth in Lithuania: Cultural adaptation and first results from a pilot randomized controlled trial [Conference presentation]. 15th IEPA Conference.

Prina, E., Purgato, M., & Barbui, C. (2025, September 12). Scaling up mental health prevention through task-sharing in global contexts: Evidence from low- and high-income settings [Conference presentation]. 19th IFPE International Congress.

Barbui, C. (2025, September 12). Mental health in migrant populations: From intervention efficacy to implementation [Conference presentation]. 19th IFPE International Congress.

Välimäki, M. (2025, September 24). Scaling-up interventions in international context: Challenges and opportunities [Keynote address]. 12th Xiangya International Nursing Conference & 2nd Intelligent-Integrated Nursing – Emerging Scientists Forum, Central South University, China.

Välimäki, M. (2025, September 26). Evidence-based health technology innovations in healthcare: Some critical thoughts [Keynote address]. 6th West China International Nursing Conference, Sichuan University, China.

Carswell, K. (2025, October 1). Digital mental health innovation and implementation: An overview of WHO interventions and resources [Conference presentation]. 6th Global Ministerial Summit, Doha, Qatar.

Žiemienė, L., Carswell, K., Dumarkaitė, A., de Graaff, A. M., Gražinis, A., Serapinė, R., Tol, W., Reininghaus, U., & Kazlauskas, E. (2025, October 3–5). Overview and content of a chatbot-based CBT intervention for youth adapted for use in Lithuania. 8th European Society for Research on Internet Interventions (ESRII) Conference: Resilience Through Innovation, Vilnius, Lithuania.

Gherdan, C., Brizar, A., Sijbrandij, M., Feenstra, S., Witteveen, A., & van Vugt, M. (2025, October 5). Adapting WHO’s Doing What Matters in Times of Stress for employees in Dutch small-to-medium enterprises: Feasibility considerations ahead of cluster RCT [Conference presentation]. 8th European Society for Research on Internet Interventions (ESRII).

Dumarkaite, A., Ziemiene, L., Kazlauskas, E., Carswell, K., de Graaff, A. M., Grazinis, A., Serapine, R., Tol, W. A., & Reininghaus, U. (2025, October 5). Chatbot-based intervention for distressed youth in Lithuania: Results of a pilot randomized controlled trial [Conference presentation]. 8th European Society for Research on Internet Interventions (ESRII). 8th European Society for Research on Internet Interventions (ESRII)

de Freitas, C., Teixeira, R., Sanna, L., & Tol, W. A. (2025, November 6). Evaluating the co-creation of mental health promotion and prevention research: Preliminary findings from a participatory study in seven European countries [Conference presentation]. Iberoamerican Congress of Qualitative Health Research.

Carswell, K. (2025, November 20). From open-access tools to nationwide scale-up: New insights from WHO's digital mental health work [Conference presentation]. eMHIC International Congress, Toronto, Canada.

Fleck, L., Wasmus, H., Reininghaus, U., Schirmbeck, F., Soares de Freitas, C. S., Teixeira, R. M., Sanna, L., De Graaf, A.-M., Kazlauskas, E., & Tol, W. (2025, November 27). Prevention and health promotion among young people with climate change related distress: Feasibility and initial signs of efficacy of a digital training [Conference presentation]. DGPPN 2025.

Raquel, & Soares de Freitas, C. S. (2025). Co-creating stigma-reduction strategies in mental health promotion: Participatory foresight insights from six European countries [Conference presentation]. World Congress of Public Health.

Purgato (2026). ADVANCE Project: The Experience of Verona. Research Projects of the Department of Psychiatry: Current Status and Future Prospects.

Prina (2026). ADVANCE Project: Recruitment strategies and implementation challenges of WP4. Research Projects of the Department of Psychiatry: Current Status and Future Prospects.