BACKGROUND: While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. METHODS: We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. RESULTS: SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. CONCLUSIONS: The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.

3rd School of Medicine Charles University Prague Czech Republic

Affective Disorders Unit Department of Psychiatry Ege University Medicine Faculty Izmir Turkey

Center for Treatment of Drug Addiction University Psychiatric Clinic Ljubljana Slovenia

Clinic for Psychiatry University of Kragujevac Kragujevac Serbia

Clinica Universitária de Psiquiatria e Psicologia Médica Faculdade de Medicina Universidade de Lisboa Lisbon Portugal

Clinical Department National Institute of Mental Health Klecany Czechia

Collaborative Antwerp Psychiatric Research Institute Antwerp Belgium

Community Mental Health Center Health Center Prijedor Prijedor Bosnia and Herzegovina

Council of National Psychiatric Associations EPA Strasbourg France

Department of Adult Psychiatry Mater Misericordiae University Hospital Dublin Ireland

Department of Child and Adolescent Psychiatry Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón School of Medicine IiSGM CIBERSAM Complutense University of Madrid Madrid Spain

Department of Developmental and Clinical Child Psychology Institute of Psychology Eötvös Loránd University Budapest Hungary

Department of Emergency Psychiatry and Post Acute Care Hôpital Lapeyronie CHU Montpellier Montpellier France

Department of Mental Health Medical Psychology and Psychotherapy Medical Psychology State Medical and Pharmaceutical University Nicolae Testemitanu from Republic of Moldova Kishinev Moldova

Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy

Department of Psychiatry 2 Ulm University Ulm Germany

Department of Psychiatry and Medical Psychology Belarusian State Medical University Minsk Belarus

Department of Psychiatry and Narcology Riga Centre of Psychiatry and Narcology Riga Stradiņš University Riga Latvia

Department of Psychiatry and Psychological Medicine University Hospital Centre Zagreb and School of Medicine University of Zagreb Zagreb Croatia

Department of Psychiatry and Psychotherapy Ludwig Maximilian University Munich Munich Germany

Department of Psychiatry Faculty of Medicine Comenius University in Bratislava Bratislava Slovakia

Department of Psychiatry Helsinki University Central Hospital Helsinki Finland

Department of Psychiatry Tbilisi State Medical University Tbilisi Georgia

Department of Psychiatry University Hospital Mostar Mostar Bosnia and Herzegovina

Department of Psychiatry University of Campania L Vanvitelli Naples Italy

Department of Psychology Oslo New University College Oslo Norway

Division of Social Psychiatry Medical University of Vienna Vienna Austria

ED 450 Université de Paris Paris France

EPA Sections Strasbourg France

GHU Paris Psychiatry and Neuroscience Clinic of Mental Illnesses and Brain Disorders 75014 Paris France

Health and Community Participation Division Faculty of Nursing and Health Sciences Nord University Namsos Norway

Institute of Mental Health School of Health Sciences University of Nottingham Nottingham United Kingdom

Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

MentAge Basel and Medical Faculty University of Basel Basel Switzerland

Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders Innlandet Hospital Trust Hamar Norway

Norwich Medical School University of East Anglia Norwich United Kingdom

Pomeranian Medical University in Szczecin Szczecin Poland

Psychiatric Clinic Lithuanian Health Sciences University Kaunas Hospital Lithuanian Health Sciences University Kaunas Lithuania

Psychiatric Neuromodulation Unit Department of Clinical Sciences Lund Faculty of Medicine Lund University Lund Sweden

Psychosis Research Unit Aarhus University Hospital Aarhus Denmark

Psychosocial Recovery Center Yerevan State Medical University after Mkhitar Heraci Yerevan Armenia

Research Unit Dr Mirko Grmek Psychiatric Clinic Sveti Ivan Zagreb Croatia

School of Medicine University of Mostar Mostar Bosnia and Herzegovina

State Institution Institute of Neurology Psychiatry and Narcology of the NAMS of Ukraine Kharkiv Ukraine

University of Cagliari and Psychiatry Unit Section of Psychiatry Department of Medical Sciences and Public Health University Hospital Cagliari Italy

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