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Lifetime prevalence of psychotic experience, and its associated factors among Senegalese women: a cross-sectional study

BMC Psychiatry volume 25, Article number: 425 (2025) Cite this article

Abstract

Background

Psychotic experiences, which include a range of symptoms such as delusions and hallucinations, is an indication of elevated risk for mental disorders and poor quality of life. These experiences are often underreported and undertreated in low- and middle-income countries, including Senegal. This study aimed to investigate the lifetime prevalence of psychotic experience, its associated factors and adverse outcomes among Senegalese women.

Methods

This study analyzed the 2023 demographic and health survey data of 16,521 Senegalese women. Descriptive analysis, cross-tabulations, chi-square test, and binary logistic regression models were computed in STATA 18. The multivariable logistic regression analysis followed a backward stepwise approach.

Results

Overall, 6,819 women (41.3% [95%CI: 38.4–44.2]) had a lifetime prevalence of psychotic experience. Referential delusions were the most prevalent (24.5%), followed by paranoid ideation (17.1%), auditory hallucinations (14.1%), bizarre delusions (13.3%), possession (12.4%), visual hallucinations (11.5%), and thought insertion/broadcasting (11.4%). The odds of psychotic experience increased consistently with age. Higher educational attainment (AOR = 0.73, 95%CI: 0.61–0.88) and being currently in union were associated with lower odds of psychotic experiences (AOR = 0.90, 95%CI: 0.81–0.99). A higher risk of psychotic experience was found among women who were exposed to media (AOR = 1.08, 95%CI: 1.00-1.17), those in the richest wealth index (AOR = 2.33, 95%CI: 2.06–2.63), and currently employed women (AOR = 1.21, 95%CI: 1.12–1.30). Dietary habits were relevant, as consuming fried and processed food (AOR = 1.25, 95%CI: 1.15–1.37) and soda and energy drinks (AOR = 1.14, 95%CI: 1.03–1.27) were both associated with increased odds of psychotic experiences. Women who reported a lifetime prevalence of psychotic experience were significantly more likely to attempt suicide (AOR = 10.89; 95%CI: 7.10-16.72), anxiety (AOR = 4.64; 95%CI: 3.89–5.52), and depression (AOR = 7.39; 95%CI: 5.14–10.62).

Conclusion

In conclusion, four out of ten women in Senegal had a lifetime prevalence of psychotic experience. These experiences increase the likelihood of anxiety, depression and suicidal attempts. We also conclude that psychotic experiences are associated with sociodemographic and lifestyle factors including age, educational level, employment status, media exposure and dietary habits. Interventions to reduce psychotic experiences should focus on education, media exposure, employment, and dietary habits.

Peer Review reports

Background

Psychotic experience as a concept describes a continuum of hallucinations and delusions that occur at the sub-clinical level to those in the general population [1]. It is a prevalent characteristic in various psychiatric, neuropsychiatric, and neurodevelopmental conditions, as well as a defining trait of schizophrenia spectrum and other psychotic disorders [2]. In the context of this study, psychotic experiences (PEs) include paranoid thoughts, thought insertion/broadcasting, possession delusions, referential delusions, bizarre delusions, auditory hallucinations, and visual hallucinations [3]. In adults, PEs are linked to both concurrent and subsequent mental health conditions [4].

Globally, the lifetime prevalence of psychotic experience in any general population is estimated to be 7.8% [5]. The vast majority of individuals who experience psychotic symptoms do not seek clinical services, nor do they develop a diagnosable psychotic disorder [6]. While these experiences are usually transitory, they are often distressing and associated with impaired social and occupational functioning [7, 8] indicating that PEs may represent a common and under recognized public health threat [9].

In many low- and middle-income countries (LMICs) like Senegal, issues of mental health often remain underestimated and undertreated [10]. The prevalence of mental health disorders is exacerbated by limited access to mental health services, societal stigma, and cultural factors that may hinder the recognition and treatment of these conditions [11,12,13,14]. The healthcare infrastructure in Senegal, while improving, still faces challenges in providing comprehensive mental health care, leading to crucial gaps in the diagnosis and management of psychotic disorders [15, 16].

A study in Senegal found that 34.9% of women reported experiencing mental disorders [17]. Women, in particular, face unique stressors and vulnerabilities that can heighten the prevalence and impact of psychotic experiences [18]. A multi-country study revealed that 18.7% of Senegalese have ever had at least one PE [19]. Factors such as domestic violence, reproductive health concerns, and socioeconomic inequalities which disproportionately affect women exacerbate the risk of PEs [20,21,22,23]. This situation can result in prolonged duration of untreated PEs among women, and thus, increases the likelihood of more severe symptoms, poorer social functioning, and a lower quality of life [24, 25].

While existing literature [17, 22] provides evidence of a high mental health disorder in Senegal, there is a dearth of literature specifically for PEs. Moreover, the existing studies, including systematic reviews, on PEs have paid less attention to low-and-middle-income countries (LMICs) such as Senegal [4, 7]. This disproportionate focus on high-income countries severely limits our understanding of how PEs manifest, persist, and interact with social and health factors in resource-constrained settings. Consequently, the following questions remain unanswered: (a) What is the prevalence of PEs among Senegalese women? (b) What factors are associated with PEs in Senegal? (c) What adverse outcomes are associated with PEs in the context of Senegal? The lack of clarity to these questions indicates a significant knowledge gap. As such, the present study contributes to narrowing the knowledge gap by investigating the lifetime prevalence of psychotic experiences, their associated factors, and adverse outcomes among Senegalese women. Insights from this study have significant implications for prevention and early intervention of PEs in resource-constrained settings like Senegal.

Methods

Data source and design

This study was based on secondary data from the 2023 Senegal demographic and health survey (SDHS). The SDHS was carried out in accordance with the action program of the third National Strategy for the Development of the Statistics (SNDS-III). Following a two-stage sampling method, the survey was designed to be representative of Senegal at the national and regional level [26]. A pretest training was conducted at the National Agency of Statistics and Demography of Senegal headquarters in Dakar, beginning on July 20. It included 12 days of classroom sessions and four days of fieldwork. The training used the integrated approach where the theoretical and CAPI were taught simultaneously. The training included 10 women and 8 men in total [26]. The objective of the pre-test was to detect possible problems in the questionnaires and the program to test the methodology of the survey and to assess the time required to conduct the interviews. Data collection was carried out from January to August 2023 with a break of about two months. A total of 8,782 households was selected from the survey sample, of which 8,591 were occupied. In these occupied households, 8,423 were successfully surveyed, giving a response rate of 98%. In the households interviewed, 17,459 women aged 15–49 years were identified as eligible for the individual interview [26]. Interviews were completed for 16,583 women, resulting in a 95% response rate.

Measures

Outcome variable

Psychotic experience: PEs was one of the outcome variable and also served as an exposure variable to predict adverse outcomes. This variable was a composite index of seven indicators: paranoid, thought insertion/broadcasting, possession, referential delusions, bizarre delusions, auditory hallucination and visual hallucination (see Table 1). These indicators originally had the responses of ‘yes’, ‘no’ and ‘don’t know’. We categorized each indicator by grouping ‘no’ and ‘don’t know’ as no. As such, the individual indicators now had a binary response of yes and no. We then used the ‘egen’ command in STATA to create an index where all those who responded ‘yes’ to any of the seven indicators were coded as having had PE while a response of ‘no’ indicated no experience of psychosis. Using Cronbach alpha test, we checked for the reliability of the seven items as a measure of PEs. The scale reliability coefficient was 0.77. This result suggests acceptable reliability, as a value above 0.7 indicates satisfactory internal consistency [27].

Suicidal attempt

This was derived from the question, “Have you ever attempted suicide in your lifetime?” It had a binary response of ‘yes’ and ‘no’. Responding ‘yes’ meant the individual had ever attempted suicide.

Depression: A single item question was used: “Have you ever been told by a doctor/health care worker you have depression”. Individuals who responded ‘yes’ were classified as being depressed.

Anxiety

We relied on the question, “Have you ever been told by a doctor/health care worker you have anxiety”. Individuals who responded ‘yes’ were classified as being anxious.

Explanatory variables

We selected the explanatory variables based on evidence from previous literature [21,22,23]. A total of ten explanatory variables were selected. This included age (15–49 years), place of residence (rural and urban), educational level (no formal education, primary, secondary and tertiary), marital status (never married, currently in union, previously in union), media exposure (yes and no), wealth index (poorest, poorer, middle, richer and richest), currently employed (yes and no), ever consumes fried and processed food (yes and no), alcohol consumption (yes and no), and consumption of soda energy drinks (yes and no). The SDHS originally measured media exposure using three variables: frequency of reading newspapers or magazines (not at all = 0, less than once a week = 1, at least once a week = 2, almost every day = 3); frequency of listening to the radio (not at all = 0, less than once a week = 1, at least once a week = 2, almost every day = 3); and frequency of watching television (not at all = 0, less than once a week = 1, at least once a week = 2, almost every day = 3). Using the ‘egen’ command in STATA, we created a composite variable where individuals who reported no engagement with any of these media (radio, TV, or newspaper/magazine) were classified as having no media exposure, while those who engaged with any of the media were categorized as having media exposure.

The SDHS constructs wealth index using principal component analysis (PCA) based on data collected on household ownership of selected assets, such as televisions and bicycles; materials used for housing construction; types of water access and sanitation facilities; and other indicators of household wealth. Each asset is assigned a weight (factor score) generated through PCA, and the resulting scores are standardized and summed to produce a continuous index of household wealth. Households are then ranked according to this index and divided into quintiles: poorest, poorer, middle, richer, and richest.

Statistical analysis

All statistical analyses were performed using STATA version 18 (StataCorp, College Station, TX, USA) and Rstudio. As earlier indicated, the 2023 SDHS contained the observations of 16,583 women aged 15–49 years. However, after dropping missing values for PEs (n = 62), we had 16,521 observations remaining. It was this final sample that the data analysis was performed. To account for any sampling bias from under or over-sampling of respondents in the total population, all descriptive estimates were weighted using the individual weight variable (v005) in the dataset. This weight adjusts for both the probability of selection and individual non-response, ensuring that the results are representative of the national population. Specifically, v005 incorporates the household sampling weight and corrects for differences in response rates across regions and demographic groups. For analysis, it is typically normalized by dividing by 1,000,000, as the raw values in the dataset are scaled up to avoid decimals. To consider the complex survey design of the DHS data, the “svyset” command in STATA was employed. We performed bivariable and multivariable logistic regression models to examine the factors associated with PEs. Additionally, a multivariable logistic regression model was computed to examine the association between PEs and adverse effects including suicidal attempt, depression and anxiety. Variables were selected into the multivariable logistic regression by following a backward stepwise approach which iteratively remove statistically non-significant variables. A multicollinearity diagnostic test was conducted using the variance inflation factor (VIF) to rule out the potential existence of collinearity between variables. The Akaike information criterion (AIC) was used to determine the best model. Adjusted odds ratio (AOR) and 95% confidence intervals (CI) were reported. Statistical significance was pegged at p-value (p < 0.05).

Table 1 Framing of PE questions
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Results

Participants’ characteristics

A total of 16,521 women were included in the analysis. Of this number, the majority were aged 15–19 years (23.4%), resided in urban areas (49.0%), had no formal education (43.6%), and were currently in a union (64.3%). Most participants were exposed to media exposure (67.8%), were in the richest wealth index (24.0%), and were currently not working (63.8%). Also, 17.6% of the participants consumed fried and processed food (e.g., instant noodles, chips, etc.) while 10.5% consumed soda and energy drinks. Alcohol consumption is low among the sample (see Table 2).

Table 2 Participants’ characteristics and prevalence of psychotic experience
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Prevalence of psychotic experience

Overall, 6,819 women (41.3% [95%CI: 38.4–44.2]) had psychotic experiences (see Table 2). The prevalence of psychotic experience was high among those aged 40–44 years (44.9%), urban residents (46.8%), those with primary education (44.1%), and those who were previously in a union (47.8%). Participants with media exposure reported a higher prevalence of psychotic experiences (43.9%). A higher prevalence of psychotic experiences was found among women in the richest wealth index (50.0%), those currently employed (46.6%), as well as among women who consumed fried and processed food (51.9%), and those who consumed soda and energy drinks (48.1%).

Women who consumed alcohol reported a higher prevalence of psychotic experiences even though the difference was not statistically significant. Regarding the typology of psychotic experience, we found referential delusions to be the most prevalent (24.5%), followed by paranoid ideation (17.1%), auditory hallucinations (14.1%), bizarre delusions (13.3%), possession (12.4%), visual hallucinations (11.5%), and thought insertion/broadcasting (11.4%) (see Fig. 1).

Fig. 1
figure 1

Typology of psychotic experiences among Senegalese women

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Distribution of psychotic experience typologies across participant characteristics

Table 3 shows the distribution of the types of psychotic experiences across all participants’ characteristics. Women in urban areas, those in the richest wealth index, those currently employed, those who consumed fried and processed food, consumed soda and energy drinks, and those who were exposed to media consistently reported a higher prevalence for all types of psychotic experience. Similarly, being previously in union was associated with a higher prevalence of all types of psychotic experience, except for bizarre delusions which as most prevalent among never married women. Women who consumed alcohol reported a higher prevalence of paranoid ideation, possession, referential delusions, and auditory hallucinations. Interestingly, those who did not consume alcohol reported a higher prevalence of bizarre delusions and visual hallucinations.

Table 3 Distribution of psychotic experience typologies across participant characteristics
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Factors associated with psychotic experiences among Senegalese women

The odds of experiencing psychosis increasing consistently across age groups compared to the younger women (15–19 years), particularly notable in the 40–44 years’ group (AOR = 1.46, 95%CI: 1.26–1.70). Higher educational attainment was associated with a lower likelihood of psychotic experiences (AOR = 0.73, 95%CI: 0.61–0.88) compared to those with no formal education. Women currently in union were less likely to report psychotic experiences compared to those never married (AOR = 0.90, 95%CI: 0.81–0.99). A higher risk of psychotic experience was found among women who were exposed to media (AOR = 1.08, 95%CI: 1.00-1.17), those in the richest wealth index (AOR = 2.33, 95%CI: 2.06–2.63), and currently employed women (AOR = 1.21, 95%CI: 1.12–1.30). Dietary habits were relevant, as consuming fried and processed food (AOR = 1.25, 95%CI: 1.15–1.37) and soda and energy drinks (AOR = 1.14, 95%CI: 1.03–1.27) were both associated with increased odds of psychotic experiences (Table 4).

Table 4 Factors associated with psychotic experiences
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Linear trend test results for age, education, and wealth index in relation to psychotic experiences

The results indicate a statistically significant linear trend for age, education, and wealth index. The p-values for each variable (age: <0.0001, education: 0.0017, wealth index: <0.0001) confirm that there is a significant association with psychotic experiences across ordered categories of these variables (Table 5).

Table 5 Linear trend test results for age, education, and wealth index in relation to psychotic experiences
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Association between psychotic experience and adverse health outcomes

The analysis presented in Table 6 indicates a strong association between experiencing psychotic episodes and adverse health outcomes. Specifically, women who reported having psychotic experiences were significantly more likely to attempt suicide (AOR = 10.89; 95%CI [7.10-16.72], p < 0.001), anxiety (AOR = 4.64; 95%CI [3.89–5.52], p < 0.001), and depression (AOR = 7.39; 95%CI [5.14–10.62], p < 0.001).

Table 6 Association between psychotic experience and adverse health outcomes
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Discussion

Evidence from a West African country [28] has shown that women are at a higher risk of experiencing psychotic-like symptoms than men. Given the limited understanding of the dynamics in Senegal, we investigated the lifetime prevalence of psychotic experience, its associated factors and adverse outcomes among Senegalese women. We found that four out of ten women in Senegal had ever experienced psychotic-like symptoms. Our estimated prevalence of PE is higher compared to other jurisdictions like the United States (27%) [29], Chile (12.9%) [30], Qatar (27.8%) [3], and South Sudan (23.3%) [31]. The estimated lifetime prevalence of psychotic experience in Senegal is also higher than what has been reported in existing systematic reviews including that of Linscott and Van Os (7.2%) [32], and Healy et al. [33] (9.8%). The higher prevalence observed in this study compared to the systematic reviews may stem from the point that these reviews have often not included SSA countries due to the lack evidence from countries in the Africa sub-region. It, therefore, calls for more research in other SSA countries in order to address the knowledge gap and update reviews on psychotic experience.

Another possible explanation for our higher prevalence rate is the timing of our study relative to the COVID-19 pandemic. The previous studies from other jurisdictions [3, 29,30,31] were conducted before the pandemic, whereas our research was carried out in the post-COVID-19 era. This is corroborated by a cohort study conducted in Tokyo, Japan that suggests that the “steady decline in PEs across adolescence was halted and reversed concurrent with the COVID-19 pandemic onset” [34]. The pandemic has been associated with increased stress, social isolation, economic hardship, and disruption of daily life, all of which are factors that can contribute to heightened mental health issues, including psychotic-like experiences [35]. Nevertheless, the findings of this study indicate that age, educational level, employment status, media exposure and dietary habits were significant factors that explained the prevalence of PE in Senegal.

Our study revealed that higher educational attainment was associated with significantly lower odds of PE. Although the observed association is inconsistent with previous literature [30] that have found no association between educational status and PE, it is congruent with Mamah et al. [21] whose study revealed that PE is more prevalent among individuals with lower educational attainment. We argue that higher education may enhance cognitive skills and problem-solving abilities, enabling individuals to better cope with life’s stressors. It also promotes healthier lifestyles and greater social support networks [36], both of which are protective factors against mental health problems including PE.

Marital status was another factor that significantly predicted the likelihood of experiencing psychotic symptoms. Being married served as a protective factor against PE. Similar findings have been observed in the United States [29, 36]. Our result is also corroborated by a multi-country study [37] that found a higher prevalence of PE among non-married individual than among married people. This finding can be explained from the perspective that marriage provides emotional support and companionship, which can alleviate feelings of loneliness and isolation, both of which are risk factors for mental health issues including PE. Additionally, a supportive spouse can offer practical assistance and encouragement in seeking clinical support which can help reduce the persistence of psychotic experiences.

We also found that dietary habits including the consumption of soda drinks and fried/processed foods were associated with higher odds of psychotic experience. The result aligns with a scoping review [38] on diet and psychosis that found high intake of refined carbohydrates to be associated with a higher risk of psychotic symptoms. Available evidence suggests that soda drinks and fried/processed foods are often high in sugar, unhealthy fats, and additives which exacerbate inflammation and oxidative stress in the brain [38]. Furthermore, empirical literature shows that such neuroinflammations and oxidative stress increases the risk of psychotic experiences [39, 40]. Hence, explaining the high odds of PE among those who consumed soda drinks and fried/processed foods.

The study revealed that being employed and higher wealth index were associated with higher odds of PE. These findings are somewhat surprising given the fact that other research [21, 29, 31, 37] shows the contrary with poverty and unemployment being significant risk factors of PE. Nonetheless, the findings resonate with Myaba et al. [41] who reported a higher PE among those who were employed. Further research is required to fully understand the nuances of employment, wealth status, and PE. We, however, posit that high-stress jobs, even if well-paying, may contribute to mental health issues, including PE, due to prolonged exposure to high demands, tight deadlines, and significant responsibilities. These factors can lead to chronic stress, burnout, and mental fatigue, which are known risk factors for psychotic symptoms [42]. Women who reported being exposed to media were more likely to experience psychotic symptoms. This accords with earlier observations [43,44,45] which showed that media exposure and use increases the risk of psychotic experiences. This may have something to do with the kind of content that are exposed to women through the media. However, the SDHS does not provide details of the contents consumed on media platforms.

Regarding the adverse outcomes, we found that ever experiencing PE exacerbated the risk of suicidal attempts, anxiety, and depression. These results corroborate the findings of Healy et al. [33] whose systematic review reported a 3.08 times higher risk of any mental disorder among persons who experienced psychotic symptoms. Similarly, Narita et al. [46] reported 4.33 times higher odds of suicidal attempts among individuals who had ever experienced psychotic symptoms. A systematic review also shows that PE increases the risk of suicidal attempts by 2.68 times [47]. The mechanisms through which this association exists are manifold. One perspective is that hallucinatory psychotic symptoms often command the individual to inflict self-harm, thus encouraging suicide attempts [48]. Additionally, paranoid psychotic symptoms may force individuals to withdraw from social networks, heightening their anxiety and feelings of depression.

Implications for policy and practice

For policymakers, the high prevalence of psychotic experiences among women, particularly referential delusions and paranoid ideation, necessitates the development of targeted mental health strategies and interventions. Policies should prioritize mental health education, early detection, and treatment services, especially for older women, those with lower educational attainment, and those not in unions. The significant association between psychotic experiences and suicide attempts, anxiety, and depression highlight the need for comprehensive screening and holistic treatment plans. Mental health professionals in Senegal should incorporate routine assessments for psychosis in their evaluations, especially for women presenting with anxiety or depression. Clinicians must advise patients on the potential mental health impact of soda, energy drinks, and processed food consumption, and provide support for healthier lifestyle choices. Future research should focus on elucidating the mechanisms underlying the observed associations, particularly the role of media exposure and dietary habits in the development of psychotic experiences. Longitudinal studies could provide insights into causality and the progression of psychotic symptoms over time.

Strengths and limitations

One of the strengths of this study is the two-stage sampling method adopted by the SDHS. This approach enables us to generalize the findings women in Senegal at the national and regional level. Also, the use of backward stepwise approach improved the robustness of our statistical analysis by streamlined model that includes only the most significant variables, which enhances interpretability and reduces multicollinearity. Additionally, given the automated nature of the backward stepwise approach, it helped to reduce the potential for human bias in model selection. Notwithstanding, there were some limitations. The SDHS was based on cross-sectional design, and thus, precludes us from establishing causal inferences. Also, anxiety and depression were self-reported. As such, we may have missed undiagnosed anxiety and depression. The study may not be generalized to women aged 50 years and older, and men. Given the cross-sectional nature of the data, we are unable to determine the temporality of PEs and mental health outcomes. As such, it is possible that this association may be bidirectional. Hence, caution should be exercised when interpreting our findings.

Conclusion

In conclusion, four out of ten women in Senegal experience psychotic symptoms. These experiences increase the likelihood of anxiety, depression and suicidal attempts. We also conclude that psychotic experiences are associated with sociodemographic and lifestyle factors including age, educational level, employment status, media exposure and dietary habits. Interventions to reduce psychotic experiences should focus on education, media exposure, employment, and dietary habits.

Data availability

The datasets generated and/or analysed during the current study are available in the Measure DHS repository: http:www.//dhsprogram.com/data/available-datasets.cfm.

Abbreviations

AIC:

Akaike Information Criterion

AOR:

Adjusted Odds Ratio

CI:

Confidence Interval: PEs: Psychotic Experiences

SDHS:

Senegal Demographic and Health Survey

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Acknowledgements

We acknowledge the Measure DHS for granting us free access to the dataset used in this study.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Population and Health, University of Cape Coast, Cape Coast, Ghana

    Joshua Okyere, Castro Ayebeng & Kwamena Sekyi Dickson

  2. School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK

    Joshua Okyere

  3. Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Hohoe, Ghana

    Samuel Salu

  4. School of Demography, Australian National University, Canberra, Australia

    Castro Ayebeng

  5. Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia

    Qorinah Estiningtyas Sakilah Adnani

Authors
  1. Joshua Okyere
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  2. Samuel Salu
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  3. Castro Ayebeng
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  4. Qorinah Estiningtyas Sakilah Adnani
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  5. Kwamena Sekyi Dickson
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Contributions

JO conceptualized the study. JO and CA designed the analyses. JO curated the data and performed the formal analyses. JO, SS, CA, QESA and KSD drafted the initial manuscript. SS, CA, QESA and KSD reviewed the initial manuscript for its accuracy. All authors reviewed the final manuscript and approved its submission. JO had the final responsibility of submitting the manuscript.

Corresponding author

Correspondence to Joshua Okyere.

Ethics declarations

Ethical approval and consent to participate

We did not need to seek ethical clearance because the DHS dataset we used is publicly available. We obtained the datasets from the DHS Program after completing the necessary registration and getting approval for their use. We followed all the ethical guidelines that pertain to using secondary datasets in research publications. You can find detailed information about how we used the DHS data and the ethical standards we followed at this link: http://goo.gl/ny8T6X.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Okyere, J., Salu, S., Ayebeng, C. et al. Lifetime prevalence of psychotic experience, and its associated factors among Senegalese women: a cross-sectional study. BMC Psychiatry 25, 425 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12888-025-06879-0

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12888-025-06879-0

Keywords

BMC Psychiatry

ISSN: 1471-244X

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