Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder.

To inform the understanding of the relationship between sleep and both depression and bipolar disorder.

We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people.

Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders.

Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.

Trait dissociation has not been examined from a structural human brain mapping perspective in healthy adults or children. Non-pathological dissociation shares some features with daydreaming and mind-wandering, but also involves subtle disruptions in affect and autobiographical memory.

To identify neurostructural biomarkers of trait dissociation in healthy children.

Typically developing 9- to 15-year-olds (n = 180) without psychological or behavioural disorders were enrolled in the Developmental Chronnecto-Genomics (DevCoG) study of healthy brain development and completed psychological assessments of trauma exposure and dissociation, along with a structural T1-weighted magnetic resonance imaging. We conducted univariate ANCOVA generalised linear models for each region of the default mode network examining the effects of trait dissociation, including scanner site, age, gender and trauma as covariates and correcting for multiple comparison.

We found that the precuneus was significantly larger in children with higher levels of trait dissociation but this was not related to trauma exposure. The inferior parietal volume was smaller in children with higher levels of trauma but was not related to dissociation. No other regions of interest, including frontal and limbic structures, were significantly related to trait dissociation even before multiple comparison correction.

Trait dissociation reflects subtle cognitive disruptions worthy of study in healthy people and warrants study as a potential risk factor for psychopathology. This neurostructural study of trait dissociation in healthy children identified the precuneus as an essential brain region to consider in future dissociation research.

Many people who have self-harmed prefer informal sources of support or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed or about the risks of peer support interventions in non-clinical settings.

The aims of this review were to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated.

We searched bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary-sector organisations providing one-to-one or group support, or via moderated online peer support forums.

Eight of the ten papers included focused on peer support that was delivered through online media. No study compared peer support with other treatments or a control group, so limited conclusions could be made about its effectiveness. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a sense of community, empowerment, and access to information and support. The most commonly perceived risk associated with peer support was the potential for triggering self-harm.

Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. Mitigations for potential risks include organisations using professional facilitators for groups, trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people while maintaining their own emotional health.

Childhood adversity may lead to mental and somatic complications throughout life. General practitioners are equipped to identify and manage adverse events in households. The relationship between adversities and psychiatric symptoms has not been studied in primary care.

We investigated the relationship of common adversities in families with respect to subsequent development of psychosocial and psychiatric problems in young children.

We analysed data from seven general practices, including participants between 0 and 9 years of age. Adversity was defined as having a household member who was diagnosed with cancer, psychiatric disease or social problems. We compared these patients with controls matched for gender, age and general practice. The primary outcome was any new episode defined with a psychological and psychiatric label. Secondarily, the encounter rates at the general practices after adversity were analysed.

Participants in both groups were followed for an average of 12 years, whereby patients with an adversity were more likely to develop psychiatric morbidities compared with matched references (odds ratio 1.38, 95% CI 1.12–1.68, P = 0.002), also revealing higher encounter rates at general practices. We found no statistically significant association between adversities in the family and increased psychosocial symptoms.

The short- and long-term consequences of exposure to negative events in childhood are of great public health importance. Our data suggest screening more proactively for consequences of commonly occurring adversities in families, as they are a risk factor for subsequent psychiatric symptoms. Enhanced consultation frequency at general practitioners following adversities should be differentiated in more detail.

Within the United Kingdom, there has been differential attainment in academic performance and career progression between International Medical graduates (IMG) and UK medical school graduates. Reasons reported for these differences include; poor relationships with trainers, cultural differences, and inadequate support. To close this differential attainment, effective interventions to support IMGs are indicated. This need for diversity led to the creation of the Association of Black Psychiatrists-UK Tutorial group (The-Tutors). The Tutors is a free online CASC preparatory group that started about 2-years ago and is tailored to meet the specific needs of black doctors sitting the Royal College of Psychiatrists examination. over 100-black Doctors have benefited from the group. This study was conducted to evaluate the experience of these doctors.

The sampling frame was the population of doctors who attended The-Tutors before sitting the CASC examination. Data were collected on socio-demographic characteristics, past psychiatry training experiences, and participants' experience toward preparation and passing CASC.

An online questionnaire was completed and this was distributed through social media (closed WhatsApp groups).

Responses were anonymous.

Total participants were 33, out of which 20 (60.6%) had passed the CASC examination while 13 (39.4%) are still awaiting results.

The majority (51.5%) of the participants had only international training in Psychiatry, 27.3% had their training in the UK, and 12.1% had both, while 9.1% had no formal-psychiatric training.

Most 21(63.6%) participants indicated that the group was ‘extremely useful’ for CASC preparation.

In terms of comparing experience in this group with other CASC preparatory groups, all the respondents found The Tutors group more helpful; 16(48.5%) indicated that the group was ‘extremely helpful’, 14(42.4%) ‘very helpful’ and 9.1% “moderately helpful”.

Most of the participants (75.8%) indicated that they were “extremely likely” to recommend the group to others.

The majority (>65%) of respondents reported that The-Tutors helped in improving their knowledge, communication skills, confidence approaching the examination, and motivation to study.

Close to half (48.5%) of participants who had passed the CASC examination indicated that The-Tutor was “extremely helpful” toward their success.

This study has shown positive experiences of IMG especially of Black ethnic group attending an all- Black-led CASC preparatory group. This could be an indication that support groups specifically targeted toward the needs of IMG could help lead to an increase in success rates in UK examinations.

Although a recent study reported that survivors of critical illness have an increased risk of suicide, the suicide rate and factors associated with suicide in patients with sepsis have not yet been investigated.

We aimed to examine the prevalence and risk factors of suicide among patients with sepsis in South Korea.

All adult patients who were admitted to all hospitals in South Korea with a main diagnosis of sepsis, from 1 January 2010 to 31 December 2018, were included in the study. The primary outcome was suicide within 1 year after sepsis diagnosis.

A total of 251 837 adult patients with sepsis were included, of which 132 691 patients (52.7%) died within 1 year after the diagnosis of sepsis, and death by suicide was the cause in 3903 patients (1.5%). Older age, male gender, living in a rural area, higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores, invasive treatment (continuous renal replacement therapy and mechanical ventilator support) and admission to a hospital with low annual case volumes were associated with a higher risk of suicide. In addition, concurrent substance misuse, post-traumatic stress disorder, bipolar disorder, dementia and previous attempt of suicide or self-harm were associated with a higher risk of suicide.

During the 1-year follow-up period, 1.5% of patients died by suicide after the diagnosis of sepsis in South Korea. Knowledge of the factors associated with suicide might allow for earlier intervention to potentially reduce the number of suicide attempts in patients with sepsis.

Conventional pharmacological approaches have limited effectiveness for schizophrenia. There is interest in the application of oxytocin, which is involved in social cognition. Clinical trials have yielded mixed results, with a gap in understanding neural mechanisms.

To evaluate the behavioural impact of oxytocin administration on a social learning task in individuals with schizophrenia, and elucidate any differential neural activity produced.

We recruited 20 clinically stable right-handed men diagnosed with schizophrenia or schizoaffective disorder. In a double-blind cross-over randomised controlled study, 40 IU of oxytocin or placebo were administered before functional magnetic resonance imaging of participants playing a multi-round economic exchange game of trust. Participants had the role of investors (investment trials) receiving repayment on their investments (repayment trials), playing one session against a computer and a second against a player believed to be human.

During investment trials, oxytocin increased neural signalling in the right lateral parietal cortex for both human and computer player trials, and attenuated signalling in the right insula for human player trials. For repayment trials, oxytocin elicited signal increases in left insula and left ventral caudate, and a signal decrease in right amygdala during the human player trials; conversely it resulted in right dorsal caudate activation during the computer player trials. We did not find a significant change in behavioural performance associated with oxytocin administration, or any associations with symptoms.

During a social learning task oxytocin modulates cortical and limbic substrates of the reward-processing network. These perturbations can be putatively linked to the pathoaetiology of schizophrenia.

The COVID-19 pandemic may disproportionately affect the mental health of healthcare professionals (HCPs), especially patient-facing HCPs.

To longitudinally examine mental health in HCPs versus non-HCPs, and patient-facing HCPs versus non-patient-facing HCPs.

Online surveys were distributed to a cohort at three phases (baseline, July to September 2020; phase 2, 6 weeks post-baseline; phase 3, 4 months post-baseline). Each survey contained validated assessments for depression, anxiety, insomnia, burnout and well-being. For each outcome, we conducted mixed-effects logistic regression models (adjusted for a priori confounders) comparing the risk in different groups at each phase.

A total of 1574 HCPs and 147 non-HCPs completed the baseline survey. Although there were generally higher rates of various probable mental health issues among HCPs versus non-HCPs at each phase, there was no significant difference, except that HCPs had 2.5-fold increased risk of burnout at phase 2 (emotional exhaustion: odds ratio 2.50, 95% CI 1.15–5.46, P = 0.021), which increased at phase 3 (emotional exhaustion: odds ratio 3.32, 95% CI 1.40–7.87, P = 0.006; depersonalisation: odds ratio 3.29, 95% CI 1.12–9.71, P = 0.031). At baseline, patient-facing HCPs (versus non-patient-facing HCPs) had a five-fold increased risk of depersonalisation (odds ratio 5.02, 95% CI 1.65–15.26, P = 0.004), with no significant difference in the risk for other outcomes. The difference in depersonalisation reduced over time, but patient-facing HCPs still had a 2.7-fold increased risk of emotional exhaustion (odds ratio 2.74, 95% CI 1.28–5.85, P = 0.009) by phase 3.

The COVID-19 pandemic had a huge impact on the mental health and well-being of both HCPs and non-HCPs, but there is disproportionately higher burnout among HCPs, particularly patient-facing HCPs.

For every suicide on the British railway network, at least six potential attempts are interrupted by front-line staff or rail commuters. However, the factors that maximise or hinder the likelihood and effectiveness of such interventions are poorly understood.

The aim of the current study was to shed light on the experience of intervening to prevent a suicide at a railway location, including how and why people intervene, and their feelings and reflections in the aftermath.

In-depth interviews were carried out with rail commuters (n = 11) and front-line railway staff (n = 10) who had intervened to stop a suicide by train. Data were analysed thematically.

Participants had intervened to prevent suicide in several ways, both from afar (e.g. by calling a member of staff) and more directly (verbally or non-verbally), in some cases with no prior training or experience in suicide prevention, and often as a ‘quick, gut reaction’ given the limited time to intervene. In more ‘reasoned’ interventions, poor confidence and concerns around safety were the greatest barriers to action. Although often privy to their final outcome, most participants reflected positively on their intervention/s, stressing the importance of training and teamwork, as well as small talk and non-judgemental listening.

Suicides in railway environments can present bystanders with little time to intervene. Potential interveners should therefore be resourced as best as possible through clear infrastructure help/emergency points, visibility of station staff and training for gatekeepers.

Social functioning is crucial for daily living and is an essential indicator of dementia in patients with Parkinson's disease. The pattern of social functioning in patients with Parkinson's disease without dementia (i.e. those who are cognitively intact or have mild cognitive impairment (PD-MCI)) and its determinants are unclear.

In exploring the heterogeneity of social functioning among patients with Parkinson's disease-associated dementia, we determined the optimal cut-off score of the Parkinson's Disease Social Functioning Scale (PDSFS) for patients with PD-MCI, and the variables influencing patients’ social functioning.

A total of 302 participants underwent the Mini-Mental State Examination (MMSE) and PDSFS; 120 patients with Parkinson's disease completed the measurements (MMSE, Activities of Daily Living Scale and Neuropsychiatric Inventory). Group comparisons, receiver operating characteristic curves, Spearman correlation and multiple and hierarchical regression analyses were conducted.

The PD-MCI group scored the lowest on the PDSFS (F = 10.10, P < 0.001). The PDSFS cut-off score was 53 (area under the curve 0.700, sensitivity 0.800, specificity 0.534). The MMSE (β = 0.293, P = 0.002), Activities of Daily Living Scale (β = 0.189, P = 0.028) and Neuropsychiatric Inventory (β = −0.216, P = 0.005) scores predicted the PDSFS score. Further, there was an interaction effect between the Activities of Daily Living Scale and Neuropsychiatric Inventory scores on the PDSFS score (β = 0.305, P < 0.001).

We determined a PDSFS cut-off score for detecting PD-MCI and found that patients with PD-MCI have social dysfunction. Future research should focus on the effects of neuropsychiatry symptoms and activities of daily living on social functioning, and tailor the intervention programme for patients with Parkinson's disease.

Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors.

We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery?

Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed.

Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth.

We recommend that people who respond to survivors’ psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.

Throughout the development of the NHS Lothian Perinatal Mental Health Service, their goals alongside maternity and neonatal teams, family nurse and health visiting services have been to strengthen interdisciplinary working and improve the quality of perinatal mental health care delivered to birthing people. The aims of developing a programme of multidisciplinary education sessions were to develop the knowledge and confidence of non-mental health professionals in caring for birthing people experiencing mental health difficulties, and aid understanding of available services and referral pathways to facilitate appropriate care.

The programme has been delivered by a Perinatal Psychiatrist and Clinical Midwifery Educators in bimonthly sessions lasting two hours. Sessions have included scenario-based learning, education regarding illnesses and disorders, and promotion of infant mental health and trauma-informed care.

Participants have attended virtually via Microsoft Teams or in person. Sessions have been recorded and accessed following teaching. Confidentiality is upheld throughout. A standard operating procedure utilising multi-modal methods has been designed to maximise staff engagement with sessions. Feedback accessed via a QR code has been collated via a Microsoft Forms questionnaire comprising of Likert scale and free-text answer questions. Feedback has guided programme development and topic selection.

Initially, sessions were open to inpatient maternity services, but now outpatient maternity services, neonatology, and health visiting and family nursing colleagues are invited to maximise the reach of the staff delivering sessions.

Sessions have been well accessed by a variety of professionals, with increasing attendance at each session. Feedback has been obtained from 43% of those attending. Results have been very positive: 100% of respondents strongly agreed or agreed that the format of the session worked well with 92% of respondents strongly agreeing or agreeing that the session content was pitched at the appropriate level. 100% of respondents felt that the content covered was useful in their clinical role which supports the emphasis of the sessions on linking knowledge to clinical application to build confidence. 100% of respondents would recommend these education sessions to a colleague.

Feedback to date has shown that participants have found the sessions to be accessible and the content appropriately pitched and clinically valuable. Despite launching the programme amidst the challenges of COVID-19, participants have found the delivery of the sessions to be supportive and collaborative.

The next phase in the development of the programme will be to understand in more detail what participants are learning and the impact on their practice.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has high morbidity and mortality in older adults and people with dementia. Infection control and prevention measures potentially reduce transmission within hospitals.

We aimed to replicate our earlier study of London mental health in-patients to examine changes in clinical guidance and practice and associated COVID-19 prevalence and outcomes between COVID-19 waves 1 and 2 (1 March to 30 April 2020 and 14 December 2020 to 15 February 2021).

We collected the 2 month period prevalence of wave 2 of COVID-19 in older (≥65 years) in-patients and those with dementia, as well as patients’ characteristics, management and outcomes, including vaccinations. We compared these results with those of our wave 1 study.

Sites reported that routine testing and personal protective equipment were available, and routine patient isolation on admission occurred throughout wave 2. COVID-19 infection occurred in 91/358 (25%; 95% CI 21–30%) v. 131/344, (38%; 95% CI 33–43%) P < 0.001 in wave 1. Hospitals identified more asymptomatic carriers (26/91; 29% v. 16/130; 12%) and fewer deaths (12/91; 13% v. 19/131; 15%; odds ratio = 0.92; 0.37–1.81) compared with wave 1. The patient vaccination uptake rate was 49/58 (85%).

Patients in psychiatric in-patient settings, mostly admitted without known SARS-CoV-2 infection, had a high risk of infection compared with people in the community but lower than that during wave 1. Availability of infection control measures in line with a policy of parity of esteem between mental and physical health appears to have lowered within-hospital COVID-19 infections and deaths. Cautious management of vulnerable patient groups including mental health patients may reduce the future impact of COVID-19.

Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed.

The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma.

We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis.

We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive–compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor.

Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions.

Psychotherapy is a mandatory component of the Royal College of Psychiatrists training curriculum. The long-term benefits of psychotherapeutically-informed practice to both patients and doctors are well recognised. In the face of regular service configurations, there was a wish to gather evidence to ensure continued provision of this training experience to a high quality. The purpose of this survey was to obtain feedback from trainees regarding their experience of the psychodynamic psychotherapy long case to evidence the relevance and value of this component of the training programme.

The anonymous survey, including questions, numerical rating scales and free text boxes, was sent to 294 trainees on a combined mailing list. This number may be slightly inaccurate due to incorrect email addresses and duplicates. A reminder email was sent one week later to encourage a higher fill rate.

There were 35 responses: a fill rate of approximately 12%. The largest group of respondents were Core Trainees (3rd year) of whom just over half had completed the long case.

92% of respondents found the long case to be at least ‘slightly useful’, of whom almost a third found it ‘extremely useful’. 94% of trainees found the experience to be at least ‘slightly helpful’ in understanding psychodynamic concepts and 75% found supervision ‘very’ or ‘extremely useful’.

Qualitative responses described it as a unique experience not offered elsewhere in the curriculum that provided important transferable skills.

Difficulties mentioned were similar to those found by previous studies, including practical concerns relating to patient and service factors. There were suggestions for more in-depth training and suggested reading to increase trainees’ confidence. An email was sent signposting trainees to further support in response to some specific concerns.

Overall, the responses suggest that the majority of trainees find the long case a valuable training opportunity. These data are useful to evaluate and improve trainees’ experience within the trust, and could be helpful for other training programmes nationally.

Due to the nature of psychotherapy, there is inevitable variation in trainee experiences but attempts to clarify and/or standardise some elements may result in greater trainee satisfaction. Trainees suggested improvements including addressing practical issues, patient factors, supervision content, and educational resources. A future survey following implementation of some suggested improvements would be helpful; the impact of the COVID-19 pandemic and the switch to remote working is another area that may be useful to explore.

It is essential to conduct randomised controlled trials of psychological interventions on acute psychiatric wards to build a robust evidence base for clinical practice.

This paper aims to share strategies from three different in-patient trials that successfully recruited and retained participants, to disseminate good practice for the conduct of future trials in this challenging and complex clinical setting.

We present strategies from three in-patient trials of psychological interventions: TULIPS (Talk, Understand, Listen for Inpatient Settings), amBITION (Brief Talking Therapies on Wards) and INSITE (Inpatient Suicide Intervention and Therapy Evaluation). All studies recruited participants from acute in-patient wards, initiated therapy within the in-patient setting and followed up on participants post-discharge.

We summarise our recommendations for good practice in the form of ten top tips for success, based on our collective experience of conducting trials on psychiatric wards. Key themes relate to the importance of relationships between the research team and clinical staff; good stakeholder involvement and getting early buy-in from the team; and adapting to the particular demands of the clinical setting.

Sharing good practice recommendations can help reduce research waste arising from poor recruitment and/or retention in future in-patient clinical trials.

Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU).

The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959.

A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder.

This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning.

A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.

Caregivers of children with autism spectrum disorder (ASD) are sensitive to the internalisation of the stigma, known as affiliate stigma, resulting in reduced self-esteem, isolation and poor psychological well-being.

This study aims to validate the Greek version of the Affiliate Stigma Scale (ASS) among mothers of children with ASD.

The translated version of ASS in Greek was administered to 53 mothers of children newly diagnosed with ASD in two time periods: 1–6 months from diagnosis (time point 1) and 12 months from the initial assessment (time point 2). The control group consisted of 62 mothers of typically developing children.

The ASS total mean score revealed a moderate level of stigma to the ASD group in both assessments. The reliability measures by item showed a satisfactory composite reliability (affective 0.828, cognitive 0.833, behaviour 0.857). Cronbach's alpha revealed that the estimated internal consistency was excellent (α = 0.888), and it found a high positive item-total correlation. Receiver operating characteristic analysis results indicated a statistically significant positive discrimination (area under the curve 0.849, P = 0.000) between the groups. The cut-off point was 31.00, with a sensitivity of 0.849 and a 1 – sensitivity of 0.258.

The proposed version of the ASS has good psychometric properties and is valid and reliable for measuring affiliate stigma among caregivers of children with ASD in Greece. Health professionals can use it to assess and understand the stigma experienced by caregivers of children with ASD, and design appropriate interventions to reduce their affiliate stigma.