INTRODUCTION: Youth mental health is a growing concern, with reports of psychiatric diagnoses becoming increasingly prevalent. Among other factors, psychiatrization may inflate the observed prevalence by interpreting experiences previously understood as adversities inherent to human life as symptoms of psychopathology. The current study explores the pathologization of behaviors typical of adolescence by asking contemporary psychiatrists to diagnose and treat a character from a novel who is considered a prototypical teenager of the 19th century: Tom Sawyer. METHODS: A one-page vignette was distributed either in sealed envelopes or via email to 57 psychiatrists who had obtained their license for independent practice between 2021 and 2023 in the Czech Republic. In total, 47 psychiatrists took part, yielding an overall response rate of 82%. The number and frequency of diagnostic conclusions, prescribed medications, and recommended interventions are reported. RESULTS: Most respondents diagnosed the boy described in the vignette with a psychiatric disorder (94%; CI = 81-98%) and recommended an intervention within the healthcare system (89%; CI =76-96%). Two thirds (62%, CI = 46-75%) recommended pharmacotherapy: antidepressants (27%), antipsychotics (22%), stimulants (13%), and anxiolytics (2%); 68% (53-80%) recommended psychotherapy. Nonmedical interventions (e.g., counseling, social services) were recommended by 49%. CONCLUSIONS: The experiences of an adolescent boy, once interpreted as normative "adventures" in the 19th century, were recognized by newly certified psychiatrists as psychiatric disorder. These findings illustrate the extent of psychiatrization over time and suggest that expert diagnoses may substantially contribute to the overinterpretation of problems of living as psychiatric disorders.

• Klíčová slova
• adolescent, cross-cultural comparison, diagnostic inflation, mental disorders, psychiatrization of society,
• Publikační typ
• časopisecké články MeSH

AIMS: The mental health of sexual minority (SM) individuals remains overlooked and understudied in Czechia. We aimed to estimate (1) the prevalence rate and (2) the relative risk of common mental disorders and (3) the mental distress severity among the Czech SM people compared with the heterosexual population. In addition, we aimed to investigate help-seeking for mental disorders in SM people. METHODS: We used data from a cross-sectional, nationally representative survey of Czech community-dwelling adults, consisting of 3063 respondents (response rate = 58.62%). We used the Mini-International Neuropsychiatric Interview to assess the presence of mental disorders. In individuals scoring positively, we established help-seeking in the past 12 months. We assessed symptom severity using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. We computed the prevalence of mental disorders and the treatment gap with 95% confidence intervals. To assess the risk of having a mental disorder, we used binary logistic regression. RESULTS: We demonstrated that the prevalence of current mental disorders was 18.85% (17.43-20.28), 52.27% (36.91-67.63), 33.33% (19.5-47.17) and 25.93% (13.85-38) in heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. Suicidal thoughts and behaviours were present in 5.73% (4.88-6.57), 25.00% (11.68-38.32), 22.92% (10.58-35.25) and 11.11% (2.45-19.77) of heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. After confounder adjustment, gay or lesbian individuals were more likely to have at least one current mental disorder compared with heterosexual counterparts (odds ratio = 3.51; 1.83-6.76). For bisexual and sexually more diverse individuals, the results were consistent with a null effect (1.85; 0.96-3.45 and 0.89; 0.42-1.73). The mean depression symptom severity was 2.96 (2.81-3.11) in heterosexual people and 4.68 (2.95-6.42), 7.12 (5.07-9.18) and 5.17 (3.38-6.95) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. The mean anxiety symptom severity was 1.97 (1.85-2.08) in heterosexual people and 3.5 (1.98-5.02), 4.63 (3.05-6.2) and 3.7 (2.29-5.11) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. We demonstrated broadly consistent levels of treatment gap in heterosexual and SM individuals scoring positively for at least one current mental disorder (82.91%; 79.5-85.96 vs. 81.13%; 68.03-90.56). CONCLUSIONS: We provide evidence that SM people in Czechia have substantially worse mental health outcomes than their heterosexual counterparts. Systemic changes are imperative to provide not only better and more sensitive care to SM individuals but also to address structural stigma contributing to these health disparities.

• Klíčová slova
• mental disorders, population survey, prevalence rate, probability sample, sexual minority, sexual orientation, suicidality, treatment gap,
• MeSH
• dospělí MeSH
• duševní zdraví MeSH
• homosexualita ženská * MeSH
• lidé MeSH
• průřezové studie MeSH
• sexuální a genderové menšiny * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH