Incivility in online commenting sections can create a hostile environment and result in the silencing of vulnerable voices. Accordingly, content websites and social media platforms have an ethical responsibility—one that aligns with their strategic interests—to minimize users' exposure to uncivil content. To this end, platforms invest great effort and budget in automatic and manual filtering mechanisms. Yet, these efforts create a competing ethical quandary, as they often come at the expense of free expression, particularly in cases where comments do not explicitly infringe on stated guidelines but might nevertheless be interpreted as offensive. In this paper, we examine an alternative moderation approach, based on comment reordering as opposed to deletion of uncivil comments. Specifically, we show that exposure to uncivil (vs. civil) comments located in the head or at the bottom of a list of comments increases subsequent commenters' likelihood of posting uncivil comments themselves. Exposure to uncivil comments in the middle of a list, however, does not significantly enhance commenters' likelihood of commenting uncivilly. These results offer new theoretical insight into how incivility is transferred between users in online environments. Our results also suggest a straightforward technological solution for mitigating online incivility, which is more ethical and practical than current industry standards. This involves placing civil comments at the beginning and end of the comment thread, with uncivil comments located in the middle. With the rise of social media, user comments and other forms of user-generated content (UGC) have begun to occupy an increasingly prominent role on content websites . Our findings indeed reveal an effect of comment positioning on the extent to which incivility is contagious. Comments that are located at the head or tail of the comment list are significantly more likely to trigger subsequent incivility compared with uncivil comments that are placed in the middle of the list. Notably, comments located at the tail of the comment list are particularly contagious. Our findings suggest a practical solution for reducing online incivility in content website comment sections: placing civil comments at the beginning and the end of the comment thread and positioning uncivil comments in the middle. By adjusting the layout of user-generated comments we may constitute a means of mitigating incivility without significantly limiting freedom of speech and with minimal manual intervention.Incivility is a challenging term to define objectively Rossini, . What isUntil relatively recently, it was not uncommon for online platforms to avoid intervening in uncivil interactions among their users. One motivation to refrain from intervening may be the belief that incivility can increase platform popularity. Indeed, some studies of online platforms have found that incivility can raise user engagement  incivility may be contagious, such that exposure to an uncivil comment can trigger subsequent uncivil comments; and (ii) the extent to which an uncivil comment is contagious depends on the positioning of the comment in a list of comments. We provide our theoretical rationale for these ideas in the following subsections.The term "contagion" is widely used in the domain of biological sciences to refer to the spread of disease through close contact among individuals. Yet, ideas and behaviors can also spread among individuals in a contagion-like fashion —namely, the comment’s serial position in a list of comments.In proposing that an uncivil comment’s serial position may affect the behavior of users exposed to that comment, we build on the literature on the serial position effect .The website’s reach on weekends was 5% of the population of the country. Of note, comments posted on the website were all presented at once, in a single list, meaning the user could view all comments by scrolling, and no comments were “hidden” behind a link. Comments were numbered according to the order in which they were posted and appeared in reverse chronological order, with the exception of comments that were posted as replies to existing comments; each reply appeared as part of a thread beneath the original comment. Such reply threads were very rare, however . Accordingly, in our analysis, we focused only on the first level of comments. To be included in our analysis, an article had to have a minimum of 30 comments (an indication of interest in the topic/article). At the end of the data collection period, our sample included 100 articles and their corresponding comments (n = 600) of the sample comments in random order. Each reviewer was asked to classify each assigned comment as either civil (1) or uncivil (0) using a civility scheme based on the literature  method  comments. In general, we assigned each comment an index according to its position in its corresponding list . We then defined a comment’s serial position  as follows. A comment was defined as being “first” if it was the first comment posted in its list. The identity of the “last” comment in the list, however, was dependent on the index of the focal commenter observing the list. For example, for the fourth commenter, running comment number 3 was last. For the fifth commenter, comment number 4 was last. Similarly, a “middle” comment was defined as any comment that, from the focal commenter’s perspective, was not first or last in its list. A contingency table revealed that a civil comment was followed by another civil comment with a probability of 0.83, and by an uncivil comment with the complementary probability of 0.17. An uncivil comment, on the other hand, was followed by a civil comment with a probability of 0.73, and by an uncivil comment with a probability of 0.27 , such that the coefficient on Pi captures the primacy effect. The primacy effect was found to be significant (p = 0.04), with an uncivil first comment increasing the odds of incivility by 42% .Next, we examined the primacy effect—the effect of the first comment in each article on the prevalence of uncivil comments in that article. To this end, we used a Random-effects model. Random-effects models are often employed when there are repeated observations on the same subject or when the data are clustered . The effect was found to be insignificant (p = 0.14) and smaller , thus refuting the alternative explanation. These findings suggest that a user’s likelihood of posting an uncivil (as opposed to civil) comment is greater when the first comment in the list is uncivil rather than civil. The results are summarized in Table To rule out the alternative explanation that the effect observed was driven by unobservable characteristics of the articles, regardless of the civility rating of the first comment, we repeated the random-effects analysis, this time evaluating the effect of a nt p = 0.4 and smalast comment he or she observes is uncivil (vs. civil)—we conducted an autocorrelation test. This test examined the correlation between the civility rating (civil vs. uncivil) of each focal comment (m) and the civility rating of the last comment published before that comment (m-1). We also examined the correlation between comment m's civility rating and the civility rating of each comment preceding m with lag l: ρ. Together, these comparisons reveal how a focal commenter’s likelihood of posting uncivil content is affected by incivility posted by each of the last l commenters. The analysis revealed a significant decreasing autocorrelation of incivility: 10% (p < 0.001) in lag 1 , 5% (p < 0.001) in lag 2, 4% (p < 0.001) in lag 3, and no autocorrelation thereafter. This result implies that a user’s likelihood of posting an uncivil (as opposed to civil) comment is greater when the last (up to three) comment(s) in the list are uncivil rather than civil, yet is not significantly affected by older comments . This result, together with the primacy effect discussed above, implies that the comments positioned at the edges of a list have the highest impact on the following commenter’s tone. Thus, a website that seeks to prevent commenters from posting uncivil content may benefit from “hiding” uncivil comments in the middle of a comment list, while “padding” the thread with civil comments at the top and bottom.To examine the recency effect—the extent to which a person is likely to post an uncivil (vs. civil) comment when the It is worth noting that although the comments were numbered based on their time stamps, they were actually sorted in reverse chronological order. Therefore, some users may have perceived the first comment posted as the last one in the thread, and vice versa. In such a scenario, the analyses presented in this section would be reversed, such that the effect of primacy would become the effect of recency, and vice versa. However, it is important to emphasize that both effects are significant and in the same direction, regardless of the interpretation. Our controlled studies further address this possible confound, as elaborated next.To shed further light on the phenomena revealed in our observational study, we conducted two randomized controlled studies. Before initiating these studies, we carried out a pre-test to examine factors that are unrelated to the order of a comment thread that might contribute to online incivility, such as age, gender  from the United States, recruited from Prolific in exchange for monetary compensation . We selected this article from a set of several real articles that we had previously identified as controversial, based on the fact that they had generated hundreds or even thousands of responses (both civil and uncivil) on social networks see “ to ensurWe chose four civil comments and two uncivil comments, which participants viewed in the following configurations, corresponding to their experimental conditions: (1) ‘civil’ condition (control-filtering): four civil comments; this configuration represents a filtering process in which all uncivil content is removed following the common practice  on participants’ general tendency to post comments. To this end, we asked participants to report whether they would comment if they were to read the post on social media (Yes/No).We subsequently assessed the effect of experimental condition on readers’ attention and comment recognition. Specifically, we randomly presented participants with four uncivil comments (in random order): two of the uncivil comments were taken from the comments that were posted in response to the article, and two additional uncivil comments did not appear in the article’s comment section.Then, we presented each participant with the original six comments (two uncivil and four civil) one by one in random order and asked them to indicate whether they liked or disliked each comment (Yes/No). Finally, participants completed demographic measures referring to their age, gender, education level, marital status, and employment status.2(6) = 2.75, p = 0.839; age: F = 0.558, p = 0.643; education level: χ2(18) = 16.65, p = 0.547; marital status: χ2(12) = 13.71, p = 0.320, and employment status: χ2(18) = 13.64, p = 0.752), thus verifying our random assignment.We identified no differences across conditions in terms of demographics . These results suggest that the serial positioning of civil versus uncivil comments does not affect users’ general tendency to post comments themselves.7We conducted a Chi-square test to analyze the total impact of the serial position of uncivil comments on participants’ intentions to post comments on social media; the results indicated that this impact was not significant (p = 0.474). This result suggests that any serial positioning effects are unlikely to be driven merely by differences in the level of attention paid to uncivil comments in certain positions.To examine whether participants’ experimental conditions affected comment recognition, we calculated the proportion of correctly recognized original uncivil comments  for each condition in which participants had been exposed to uncivil comments. A Chi-square test indicated that the effect of experimental condition on this measure was insignificant .To examine whether the civility of a comment affected its likelihood of being liked, we calculated the averaged “likes” rate for uncivil and civil comments. A Z-proportion test indicated that uncivil comments received significantly more “likes” (46.4%) than civil comments did  did not enable us to condition our measurement of comments’ civility on participants’ decisions to comment in the first place. However, given the finding of the pilot study that comments’ serial positions do not influence users’ general likelihood of commenting, we assume that the conditional probability of commenting uncivilly, given that the user has chosen to comment, is equal to the unconditional probability of commenting uncivilly when comments are mandatory.age = 32.8, 50.2% female)Our main experiment involved 1,000 participants . Like the article used in the pilot study, each of these articles referred to a topic that we had previously identified as controversial .As in our pilot study, for each article, we chose four civil comments and two uncivil comments that had originally been posted on social media in response to the article (see Appendix D). Likewise, the configuration of comments that each participant viewed corresponded to his or her condition, as follows: (1) 'civil' condition (control-filtering): four civil comments; (2) 'uncivil primacy' condition: two uncivil comments at the top of the thread followed by four civil comments; (3) 'uncivil recency' condition: four civil comments followed by two uncivil comments; and (4) 'uncivil middle' condition: two civil comments followed by two uncivil comments and two civil comments. Participants were instructed to read the article and the comments as they typically would and post their own comments on the article. We told the participants that former participants had written the comments, and that their comments might be visible to future participants. Lastly, participants stated their age and gender.After data collection was complete, participants’ comments were labeled by independent content coders as either civil or uncivil, according to the content analysis procedure described below. Figure In accordance with the Intercoder Reliability (ICR) method . Thus, after the individual scoring, we carried out an intercoder reliability process in which differences in the civility/incivility classifications between reviewers were discussed. First, each expert presented their justification and interpretation of the civility scheme. Next, coders revised the coding of comments and converged to a single agreed-upon classification. There were five comments for which the coders could not reach an agreement regarding the classification. Therefore, these comments were excluded from the analysis  = 6.77, p = 0.526; age: F = 0.038, p = 0.99), thus verifying our random assignment.We identified no differences across conditions in terms of demographics , as were participants in the 'uncivil recency' condition . Participants in the 'uncivil middle' condition were not significantly more likely than participants in the 'civil' condition to post uncivil comments , suggesting that when uncivil comments are placed in the middle of the comment thread (as opposed to the beginning or the end), incivility is less likely to be contagious.We conducted a Chi-square test to analyze the total impact of experimental condition on the civility ratings of participants’ comments; the results indicated that this impact was significant . However, there was no significant difference between the 'uncivil middle' and the 'uncivil primacy' conditions in terms of the likelihood of posting uncivil comments .Towards further elucidating these apparent recency and primacy effects, we compared participants in the 'uncivil middle' condition with those in the 'uncivil recency' condition and found that the latter were more likely to post uncivil comments . The results, presented in Table p = 0.038; primacy: β = -0.666, p = 0.005), and the non-effect of placing uncivil comments in the middle of the comments thread (p = 0.379).To further analyze how participants’ likelihood of commenting uncivilly was influenced by the positioning of uncivil comments in the list, we conducted a logistic regression. Specifically, as in our observational study, we used a random-effects model on the probability of commenting uncivilly as a function of the position, with a random effect on the article displayed. Equation 3 describes the model we fitted, with This research sought to address the ethical tension that arises between a website owner’s responsibility to ensure a civil environment for users and the wish to uphold the value of freedom of expression online. To this end, we explored a novel alternative to traditional comment moderation practices—an approach in which uncivil comments are not eliminated but instead are repositioned strategically within the list of comments, thereby reducing their capacity to cause harm by triggering further incivility. Our results lend support to the idea that online incivility can be—but is not always—contagious  makes users more likely to post an uncivil (rather than civil) comment themselves. Our main lab experiment enabled us to further establish these primacy and recency effects, while controlling the user’s overall experience and manipulating the order of comments to which he or she was exposed. The validity of this experiment was supported by a pilot study, which enabled us to verify that adjustment of the serial positioning of uncivil comments can indeed be considered as an ethical and practical alternative to manual comment moderation. First, that study showed that the serial position of uncivil comments does not affect users’ general likelihood of posting a comment. Accordingly, it seems that the use of a rearrangement process has a minimal risk of creating a chilling effect in which users avoid participating  had the strongest influence on further incivility. The latter result diverges somewhat from findings of studies in other online contexts , which suggest that primacy and recency effects are comparable in magnitude . This setup provides the website designer with control over the comments to which the user is exposed, as well as their order. As noted in the introduction, some social media platforms  use a similar approach to comment presentation, albeit not necessarily for the purpose of mitigating incivility. Another option might be to make sure that a 'civil' comment is visible adjacent to wherever the user writes their own contribution, to make certain that the last comment a user observes does not contain any incivility.It is also important to consider whether—as in the case of any moderation procedure—the comment rearrangement we propose might negatively affect the quality of the website and its level of interest to users. Past research has found mixed results regarding the impact of incivility on users’ engagement. Specifically, several studies reported a positive association between willingness to engage and exposure to uncivil commentary . In social media feeds, featured content is individualized, and news stories are curated by the platform’s algorithms. Such algorithms may rely on multiple criteria to choose what content to promote—and incivility can be one such criterion.Moreover, inside a given discussion thread in response to a particular social media post/tweet, the discussion itself is usually not provided in full; rather, it is common that certain "featured" comments receive the most exposure, whereas other comments are more difficult to access. Though the focus of this practice is not necessarily to mitigate exposure to incivility , it provides a useful mechanism for platforms that might wish to adopt our proposal to hide in the middle  comments identified as uncivil.While our research was based on standard practical methods, it is important to acknowledge their limitations on our methodological choices. In particular, we included configurations in our studies that reflected different sequences of uncivil comments, as well as a configuration that reflected a prevalent filtering process involving the deletion of such comments. Although this filtering process is a primary method used by many online platforms (e.g., Chen et al., Furthermore, comments that appeared in a list were assumed to be independent of one another. This is true for some forms of UGC, for instance, online reviews or testimonials that do not inherently contain a conversational element. On some websites, however, comments may be part of a conversation and, as such, relate to other past comments, in a manner that requires some chronological ordering and indication of clear hierarchies—e.g., through the use of sub-sections or sub-threads. We note that in this case, our findings might be applied to determining the order of first-level threads, as well as of the comments in each sub-thread. Indeed, the contagious nature of incivility may suggest that replies to uncivil comments are likely to be uncivil themselves—highlighting the need to control first the serial positioning of the main threads, such that threads that begin with uncivil comments are located between other threads that begin with civil comments.Relatedly, in this paper, we demonstrated that positioning uncivil comments in the middle of a comment list makes subsequent users less likely to post an uncivil comment themselves. However, we did not examine additional outcomes of such an intervention, including effects on attitudes and feelings of platform users. For example, uncivil comments on a particular issue may lead to perceptions of a greater risk associated with that issue, especially among those who a priori hold attitudes against the issue (Anderson et al.,


We propose to characterise uncertainty owing to model discrepancy with an ensemble of parameter sets, each of which results from training to data from a different protocol. The variability in predictions from this ensemble provides an empirical estimate of predictive uncertainty owing to model discrepancy, even for unseen protocols. We use the example of electrophysiology experiments that investigate the properties of hERG potassium channels. Here, ‘information-rich’ protocols allow mathematical models to be trained using numerous short experiments performed on the same cell. In this case, we simulate data with one model and fit it with a different (discrepant) one. For any individual experimental protocol, parameter estimates vary little under repeated samples from the assumed additive independent Gaussian noise model. Yet parameter sets arising from the same model applied to different experiments conflict—highlighting model discrepancy. Our methods will help select more suitable ion channel models for future studies, and will be widely applicable to a range of biological modelling problems.When using mathematical models to make quantitative predictions for clinical or industrial use, it is important that predictions come with a reliable estimate of their accuracy (uncertainty quantification). Because models of complex biological systems are always large simplifications, model discrepancy arises—models fail to perfectly recapitulate the true data generating process. This presents a particular challenge for making accurate predictions, and especially for accurately quantifying uncertainty in these predictions. Experimentalists and modellers must choose which experimental procedures ( Perhaps more importantly, these models must allow a reliable quantification of confidence in their predictions. The field of ns Smith . Exact mdesign space and denote it protocols, and each corresponds to some scenario that our model can be used to make predictions for. Namely, in Sect. Often, models are trained using experimental data from a particular experimental design, and then used to make predictions under  different scenarios. We call the set of experimental designs under consideration the In this section, we construct a simple example where we train a discrepant model with data generated from a DGP using multiple experimental designs. This example demonstrates that it is important to consider the protocol-dependence of parameter estimates and predictions when using discrepant models.First, we construct a DGP formed of the sum of two exponential terms,Next, we attempt to fit a model which takes the form of single exponential decay,T is a set of observation times.To train our model, we choose a set of odel Eq.  and eachThen, we consider multiple experimental protocols which we may use to fit this model (Eq. ). In parentclass1pt{minimaa. From how closely the discrepant model  is minuscule compared to the difference between parameter estimates obtained from different protocols.The Bayesian posteriors illustrated in Fig. electrophysiology modelling, Lei et al. Discrepancy has proven to be a difficult problem to address in modelling electrically-excitable cells (Kr), carried by the channel encoded primarily by hERG, plays an important role in the recovery of heart cells in from electrical stimulation. It allows the cell membrane to return to its ‘resting potential’ ahead of the next heartbeat. This current can be blocked by pharmaceutical drugs, disrupting this process and causing dangerous changes to heart rhythm. Mathematical models are now routinely used in drug safety assessment to test whether the expected dynamics of IKr under drug block are expected to cause such problems   is used to describe the deterministic time-evolution of some finite number of states. Although, the method would generalise to other types of models straightforwardly. This behaviour may be dependent on the protocol, In this paper, we restrict attention to deterministic models of biological phenomena, in which a system of observation function of the form,This ODE system is related to our noise-free observables via some stem Eq. , \documeparameter space.For concision, we may stack For each protocol, Given some parameter set maximum likelihood estimator because the natural logarithm of the likelihood can be written as,Similarly, we may train our models to data, tity Eq. . In thisHaving obtained such a parameter estimate, we may validate our model, by computing predictions for some other protocol, By computing d, we can obtain arbitrarily accurate parameter estimates by increasing the number of observations, Ideally, we would have a model that is correctly specified, in the sense that the data arise from the model being fitted. In other words, our observations However, when training discrepant models, we may find that our parameter estimates are heavily dependent on the training protocol, as demonstrated in Sect. In Sect. t}h Eqs.  and 25 aIn Sect. ensemble of parameter estimates,As outlined in Sect. This interval Eq. , cannot For the purposes of a point estimate, we use the midpoint of each interval,We now turn our attention to an applied problem in which dynamical systems are used to model cellular electrophysiology. We apply our methods to two special cases of model discrepancy using synthetically generated data.Markov models , the derivative function can be expressed in terms of a matrix, transition rate from state Here, we use Markov models to describe the dynamics of Iholding potential, Before and after each protocol, cells are left to equilibrate with the voltage Kr . In other words, at any fixed voltage  changes in the model parameters. Subsequently, when training the model to data generated from this protocol, many different parameter sets give similar fits that are almost equally plausible. This problem is loosely termed Kr model and protocol in Fig. For both the Beattie and Wang models, numerical unidentifiability is a problem for design The remaining designs, entclass1pt{minimaNumerical solution of ODEsAny time we calculate Synthetic data generationNumPy’s . Specifically, we take the true DGP to be the Beattie model, as shown in Fig. profile likelihoods under the assumption of additive IID Gaussian errors  is centred around their true values, and the resultant predictions are all accurate . In contrast, when the maximal conductance, The spread in predictions for the validation protocol, Moreover, the inaccuracy in our parameter estimates and our predictions varies depending on the design used to train the model. This effect does not appear to be symmetrical, with Further results are provided in Sect. entclass1pt{minimaNext, we apply these methods to an example where we have misspecified the dynamics of the model , must transition through the conducting, open state (O) in order to reach low-voltage closed states , causing a spike of current to be observed. Instead, channels in the Beattie model may transition through the inactive-and-closed state (IC) on their way between O and C, resulting in reduced current during steps from high voltage to low voltage.However, when the discrepant model was used, there was significant protocol dependence in our parameter estimates, and our predictions were much less accurate overall, but perhaps accurate for many applications. Moreover, it seems that for the majority of cols Eq.  was smala and Fig. Nevertheless, our methods provide a useful indication of this model discrepancy. Figure 7Further results regarding Case II are provided in Sect. Kr in electrically excitable cells. Here, we saw that under synthetically constructed examples of model discrepancy, there was great variability between the parameter estimates obtained using different experimental designs. This variability is a consequence of the different compromises that a discrepant model has to make to fit different regimes of a true DGP’s behaviour. Consequently, these parameter estimates produced a wide range of behaviour during validation, despite each individual parameter estimate having little variability under repeated samples of the DGP.We have introduced an uncertainty quantification (UQ) approach to highlight when discrepancy is affecting model predictions. We demonstrated the use of this technique by providing insight into the effects of model discrepancy on a model of IThe variability in the model predictions stemming from this ensemble of parameter estimates is, therefore, an empirical way of characterising the predictive uncertainty due to model discrepancy. Usefully, our spread-of-prediction intervals Eq.  correctlAt first, Case I may seem like an artificial example—in practice, the maximal conductance is taken to be a model parameter and fitted along with the rest of the model. But Case I and Case II are similar: any two Markov models may be regarded as two special cases of a more general model with some transition rates pinned to This means there is a setting in which Case II (misspecified governing equations) is an example of the type of discrepancy explored in Case I, where a “true” parameter value exists in the more general model, but is excluded in the parameter space being optimised over when training the model. This may prove a valuable perspective for modelling ion channel kinetics, where there are many candidate models (Mangold et al. Whilst the spread of predictions under some unseen protocol may provide some feasible range of predictions, we can see from Fig. Using more training protocols in the training set may increase the coverage of the DGP by our interval. Whilst the number of protocols that can be performed on a single biological cell is limited by time constraints (Beattie et al. Besides the types of discrepancies considered in Sect. We were able to quantify model discrepancy by considering the predictive error of our models across a range of training and validation protocols. This provides a way of quantifying model discrepancy that can be compared across models, and could be used to select the most suitable model from a group of candidate models. For a given context of use, we suggest that the spread of predictions can be used to gauge the trustworthiness of a model’s predictions. Even in a model which produces a plausible fit to each individual training protocol, a wide spread of predictions may indicate that a model is ill-suited to a particular predictive task, and should prompt careful reconsideration of the model and the experiments used for its training. In this way, the disagreement between model predictions of Our approach may provide insight into improved experimental design criteria (Lei et al. In this paper, we have applied our methodology to mathematical models of electrophysiology. In both the cases we considered, we saw that model discrepancy could lead to inaccurate predictive models, and due to the use of information-rich training protocols, the variability of our parameter estimates, under repeated samples of the DGP, was negligible. We propose that our methodology could be applied to similar problems, where there is high-frequency time-series data is available as well as mathematical model which are relatively accurate. There are many such biochemical reaction networks for which model selection remains a challenge, and there are numerous approaches to finding suitable mathematical models Klimovskaia et al. . We propIn these examples, we saw little variability due to noise in our parameter inference, and therefore in our ensemble prediction’s spread-of-prediction intervals and/or midpoint predictions, as shown in Sect. The spread of predictions of our ensembles, based on training to data from multiple experimental designs, provides a good indication of possible predictive error due to model discrepancy. Ultimately, whilst our ensemble approach is no substitute for a correctly specified model, it is a useful tool for quantifying model discrepancy, predicting the size and direction of its effects, and may guide further experimental design and model selection approaches.


ESSENCE was created to coin a set of clinical symptoms in early childhood , before the age of 5 to 6 years, that may be present in several specifically undefined disorders and that may be associated with the development of more specific psychiatric disorders in adolescence and adulthood, such as Autism Spectrum Disorder, Schizophrenia or Bipolar Disorder.Those symptoms may include deficits in development, communication, language, social skills, motor coordination, attention, behavior, mood and sleep.The concept of To evaluate the association between Neurodevelopmental Disorders, which manifest by uncharacteristic and diffuse symptoms in early childhood, and AutismSpectrum Disorder, Schizophrenia and Bipolar Disorder.“ESSENCE”; “Schizophrenia”; and “Bipolar Disorder”.We performed a non-systematic review of the existent literature with the keywords: “Attention Deficit”; “Hyperactivity Disorder”; “Autism Spectrum Disorder”; ESSENCE is not a diagnostic term, some symptoms regarding ESSENCE are shared with early symptoms of different Major Psychiatric Disorders, namely speech and language delay, impulsivity, inattention, feeding difficulties, hypo/hyperactivity or other behavior problems.Although There is a growing acceptance that the co-existence of disorders and the sharing of symptoms  is a questionable concept, since we are usually not dealing with completely separate disorders.Neurodevelopmental disorders present with frequent comorbidities and the overlap between the disordersstill needs to be better studied, as in autism spectrum disorder and attention deficithyperactivity, through a greater understanding of shared genetic and environmental factors and that reflect how early symptomatic syndromes can coexist in childhood, and later in adolescence and adulthood .The concept of ESSENCE emphasis the difficulty when making adiagnosis, specifically in Neurodevelopmental Disorders due to the fact that a variety osymptoms overlap. It is known that some disorders that will manifest in adulthood sharesymptoms with ESSENCE. Therefore, it is of great need to associate the current clinical findings with the present and future technologies, e.g. genetic markers, in order to dentify a common core with ESSENCE and Major Psychiatric Disorders.None Declared


Compassion satisfaction (CS) is a phenomenon that has been studied among the helping professions, such as nursing and social work and has been linked to stress, burnout, compassion fatigue, and vicarious trauma. Social work educators may also experience these same issues, yet more research is needed on how they might counter the negative impacts associated with this type of work by utilizing their experiences of CS.A phenomenological study was carried out to explore and describe how social work educators in higher education experiences CS.Eleven in-depth interviews with social work educators were conducted, and constructivist grounded theory techniques were utilized to analyze the data.Social work educators experienced CS within the education and personal realms, which encompassed four different elements: achievement, support, balance, and empathy.The four elements of CS were utilized by social work educators in this study as coping strategies to enhance their experience of CS, thus encountering threats to CS, such as institutional barriers, interaction with administrators and colleagues, and work overload.Interventions fostering compassion satisfaction and reducing compassion fatigue, burnout, and stress should be considered, including interventions that increase the sense of accomplishment, promote holistic self-care, encourage administrative and collegial support, and improve work-life balance. The work demands associated with being an educator in higher education institutions could produce adverse negative outcomes on this population’s professional quality of life. For instance, high levels of time pressure from needing to develop curricula and course materials, teaching, training, and mentoring students, conducting and publishing research, attending conferences, and participating in committee, departmental, and faculty meetings with a lack of administrative and collegial support have been linked to an increased the likelihood of stress and burnout among this population . The strThe literature has also shown that educators in higher education invest a great amount of their time and effort in caring about their students, particularly distressed ones  Identifying and describing the psychological essence of compassion satisfaction among social work educators working in higher education. (2) Investigating how social work educators engage in compassion satisfaction. (3) Understanding threats to compassion satisfaction among this population.The researchers used the method of phenomenology to explore, describe, understand, and interpret the lived experiences of social work educators. The subjective understanding of phenomena experienced by individuals becomes an integral and central part of the study findings . Thus, pN = 11). 100% of the individuals who agreed to participate in the study met the inclusion criteria and completed the study. The participants were not compensated for their participation. The study included only those who were actively teaching social work courses in higher education when the interviews were conducted. Participants’ employment status ranged from teaching one class to full-time. Sampling continued until data saturation was reached. For example, the research team discontinued recruitment when there was enough information to replicate the study, there was no ability to obtain new information, and further coding was no longer feasible  Version 5 measurement instrument  held a master’s degree level of education, whereas 40% were PhDs. Five served as tenure track faculty, three in term positions, and three as adjunct faculty. The number of years participants worked as social work educators in higher education ranged from one to 30, with a mean time of 11 years. In addition, 64% of participants were not practicing social workers. The number of years that participants had practiced social work also varied, with a range of one to 60. The mean time participants had worked in social work practice social was 18 years See .All participants who completed the Professional Quality of Life (ProQOL) Version 5 measurement instrument  scored hWhile the phenomenon of CS has mainly been studied among practitioners working with clients, the participants in this study were able to apply it to the educational realm and described how they experience CS. Two themes emerged: the impact on students and the students’ impact on clients. For example, Theresa described how she experienced CS by recognizing her ability to have an impact on students,So as an educator, I think compassion satisfaction would be knowing you can help your students, motivate your students, and help your students get through some of the issues that might lead to compassion fatigue, to help them, to create awareness for them, and maybe some building blocks or tools to help themselves.Additionally, Samantha explicated how she experienced CS thru recognizing the size of the students’ impact on clients, “I think of the thousands and thousands of clients they are going to interact with and how much of a difference I’m making through that and that’s huge.”Threats to CS identified by social work educators included bureaucracy, work overload, online teaching, and organizational culture. Participants named bureaucracy as the most frequent threat interfering with their experiences of CS. For example, Mariah explained the negative impact of institutional barriers on her experience as a social work educator, “Well, I have moments when I’m really ticked off and I’ve struggled with resentment over institutional barriers more than anything. It’s not the student.” Moreover, Mary explicated how the interaction with administrators and colleagues interfered with her experience of CS, “It’s interacting with administration and colleagues that gives me fatigue. It’s the system.” Participants also noted that the type of work done, as well as being overloaded posed threats to their experiences of CS. For example, Chris noted, “The work as a social work educator, I swear, you could just do nothing but work all the time, you really could, around the clock, um, there’s always something to do.” However, Cal addressed the difficulty in sustaining compassion satisfaction while teaching online courses, “Those are much harder for me to maintain that compassion satisfaction, because it’s really hard to develop relationships online. I struggle with that.” Finally, Leigh talked about the potentially negative impact the organizational culture of research-based institutions of higher learning might have on their educators when she voiced, “They’re really living and dying by that publish or perish, then I think it takes the educator sometimes away from what that primary purpose of being an educator is, and I think when you get pulled away from the primary purpose, whether you realize it or not, there is a, uh, a frustration, there’s a friction.”The strategies participants most frequently mentioned related to experiencing CS concerned the element of achievement. These took place in both the educational realm and the personal realm. Within the personal realm, participants noted the strategies of perceiving student success and participating in energizing engagement. Student success was an important part of CS for many participants. For example, Mariah shared how an experience of CS was facilitated for her by recognizing the achievement of her students, as practitioners,“I’ve just seen people that I’ve taught become outstanding clinicians, so that’s just wonderful. I did not cause that, but I had something to do with that, and that feels good.Other participants saw achievements such as high-quality classroom engagement, which energized their work roles and lead to maintaining CS. Leigh noted, “I experience it when we get in a classroom discussion that just goes off the chain, and its, you know, phenomenally more than you could have hoped for…. there’s just something so satisfying and energizing when you come out of that experience.”Within the personal realm, achievement was focused on self-awareness, such as realizing that one did the best job they possibly could have done. For example, Mary noted,You cannot be dependent on some outside factor or some person constantly giving you, ‘Good job,’ ‘Thank you,’ all the time, because it’s not going to come. It needs to come from inside yourself, and that’s why it makes sense. You’re the compassion satisfaction or the … meaning you get from being able to help somebody else.Likewise, Mariah echoed these sentiments when she said, “I do the best I can. I work on that; I try to work on integrity. I try to be who I am when nobody’s looking.” Self-awareness and self-reflection were related to a lack of support. Participants reported needing to develop these attributes within the personal realm if they were not receiving support from others in the work environment.Many participants put forth narratives about collegial support as a strategy for experiencing CS within the educational realm. For instance, when she first began working in higher education, Theresa recalled a professor who, “…took me under their wing and really helped me, so I was glad that that person was there.” Likewise, Cal expanded on Theresa’s insights when she said, she had a full-time faculty lead that acted as “…kind of my liaison. She’s been very positive, you know, very full of compliments when I’m doing something well.” Participants also detailed that support also arose out of the personal realm and involved family and friends. For example, Mariah noted, “I have a strong network of friends and family and colleagues. All those things help.”Most participants noted to achieve balance, setting boundaries was an important aspect of bolstering experiences with CS. The boundaries were described by participants as keeping appropriate lines between themselves as faculty and the students. This definition encompassed ideas of their roles as helpers, classroom work, and internal boundaries. Emily discussed the importance of having clear boundaries when she stated, “I will mentor them, talk to them kind of thing but if they full on need therapy, I will refer them out.” And, related to Emily’s sentiments on the topic, Theresa offered, “… my job is to help coach them, teach them, and have them learn. I see myself as being responsible to identify the barriers to their learning and get them the resources to help them with that.”The participants also discussed balance as it related to feedback, grading, and fairness. Cal explained, “I get that students get frustrated, but I’m always very careful to phrase my feedback in a way that lets students own their behaviors and their mistakes.” Adding to that, Bradford put forth “…when helping a student, I try to regulate my ability to answer that and make sure I can do that for everybody. So, I make sure there is fairness and equity.”Participants also noted that keeping good boundaries also meant internal boundaries. For example, Samantha explained that she does not take students’ challenging behavior personally when she elaborated, “I do not look at their performance that I’m responsible for, because there are too many other things going on in their life that I cannot intervene with.” Adding to that, Michael detailed: “One of the saddest days for me in social work, way long time ago, was learning that I could do the best job I could possibly do, and have a bad outcome, because I’m not in charge of the outcome.” Within the personal realm, self-care was a strategy that participants utilized to maintain balance and experience CS. Emily noted, “So, I guess if I take care of myself then I will be in a better mindset of things, and so, it’d be easier to deal with something that comes up.” Similarly, Michael noted, “We need to take more responsibility for our own outcomes, our own satisfaction index. I think we should pay more attention to how we are doing mentally, physically.”Speaking to keeping boundaries as a form of self-care, Chris noted a strategy of being ‘done” when ‘the keys go in the basket” This shows a personal boundary between work and home. Adding to that, Chris vocalized: “It took me a while to, you know, work through, this profession…does not define you. And, once I worked my way through that, man, my compassion satisfaction rose… I just really engage in, you know, good self-care habits.”Empathy came up when speaking about students, as well as empathy for themselves. Within the educational realm, the participants noted having extra compassion for students because of their personal challenges outside of the classroom. Mariah voiced.It’s hard and grueling when you are a student. And I think part of compassion is understanding there is this whole range of what people bring to the room, and you often do not know what that is.Empathy for self was noted in the personal realm. This appeared to not only allow a route to self-care, but also allow an honesty from students. As Bradford one day in her class she said to her students, “we are going to end class early, and we’ll pick it up next week, I only got three hours of sleep, I know I’ll be in a better place, and I’ll be able to convey these things to you in a much better way than I am right now, so I’m honest with them about my own life struggles, so they kind of know it’s okay to be honest about theirs.”Current research in the field of traumatology identified CS as an essential protective factor against work-related stressors, such as burnout, compassion fatigue, and secondary traumatic disorder, emphasizing how CS leads to experiencing positive outcomes from work like improving work performance, increasing the level of engagement with clients, and enhancing competency . While sA substantial number of participants were able to apply CS to the educational realm, indicating it can be experienced thru recognizing their abilities to have a positive impact on students and realizing the great size of the influence that students will have on clients in the future. This finding is consistent with how A number of the participants in this study identified bureaucracy, overload, online teaching, and organizational culture as threats to CS. This is clearly seen in the challenges and struggles they experienced from institutional barriers, interaction with administrators and colleagues, work overload, online teaching, and involvement with the organizational culture of research-based institutions of higher learning, which interfered with their experiences of CS. These threats to CS demonstrate how work demands with a lack of administrative and collegial support in higher education institutions could produce adverse negative outcomes on this population’s professional quality of life and increase the likelihood of stress and burnout among this population .Many of our participants focused on achievement, support, balance, and empathy as elements within the educational and personal realms encompassed their lived experience of compassion satisfaction. These four elements were used by participants in this study as practical tools for everyday life to cope with stressors that come from working as social work educators and to facilitate the experience of CS. Participants in this study spoke of a sense of achievement from perceiving students’ success, participating in energizing engagement, being a part of a high-quality classroom, and realizing that they did the best job they possibly could have done, which they used as an important coping strategy to deal with stress and experience CS. Numerous studies point to the significance of a sense of achievement as a protective factor against stress and compassion fatigue, which negatively influence the experience of CS .Participants in this study called upon support as a strategy for dealing with work stressors and experiencing CS. This is clearly seen in the collegial support they experienced within the educational realm and the family and friend support experienced within the personal realm, which contributed positively to their experience of CS as educators. As The importance of achieving balance for the social work educators in higher education in this study was a significant tool to alleviate stress and experience CS. Setting and keeping good boundaries, balance as it related to feedback and personal boundary between work and home were some of the examples that participants in this study discussed as an important strategy for bolstering their experiences with CS. This finding reinforces Our participants in this study also point to empathy as an important strategy to maintain CS, which is in line with the research showing that higher levels of empathy are associated with lower levels of burnout and secondary stress trauma . HoweverMost of the participants in the study sample had taught for over 10 years, and this provided less data on those who were newer to the profession. Therefore, the results may not be as representative as those who are new educators. There were also more females (81%) than males (18%) represented in the participant sample. These percentages differed from the national average of 72.5% for females and 27% for males, as reported in the Council on Social Work Education’s (CSWE) 2017 annual report . Thus, tThis study provided a platform for participants to voice their lived experiences of CS within the educator domain. Based on the study’s findings, further research would be beneficial to further investigate each strategy found and the barriers within education to engaging in the strategy. Further, it would be interesting to investigate how CS differs for those teaching full-time versus those still practicing while working in higher education. Additional research could also focus on comparing CS within higher education across different disciplines to see if there are challenges or strategies unique to the social work education realm. Overall, the lived experiences of CS are a topic ripe for investigation in this field and essential for the well-being of educators. The experience of higher education professionals in social work education is an essential function of personal and educational professional well-being for both those in academia and the future social workers they shape.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving humans were approved by the Institutional Review Board (IRB) at the University of Louisville. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.SS performed the qualitative analysis, participated in the design, and edited both the first and final drafts of the manuscript. BM helped with the data’s design and analysis. JZ carried out the qualitative analysis and contributed to the study’s design. All authors contributed to the article, read, edited, and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Nowadays, the rates of antidepressant prescription are high and increasing. In this context, the issue of whether these medications are addictive has been increasingly discussed.The aim of this review was to explore the debate about the addictive property of antidepressants.We conducted a literature review in the Pubmed database, using the search terms “antidepressants”, “SSRI”, “tricyclic”, “addiction”, “dependence” in various combinations, and narrowing the search to the last 10 years, to identify articles about the addiction to antidepressants.All the articles included in our study highlighted the fact that antidepressants were associated with withdrawal symptoms. These symptoms are heterogeneous, and long-lasting in some cases, and Paroxetine was shown to have particularly high rates of withdrawal symptoms.Some articles reported a psychological and physical dependence on antidepressants. However, the most recent studies agreed that, using established classification systems and concepts and after integrating neurobiological and behavioral criteria, antidepressants are shown to have no addictive property.Antidepressants are proven to be associated with withdrawal symptoms. Whether or not these symptoms are enough to constitute an “addiction” remains controversial, as recent studies agree that antidepressants should not be classified as addictive substances.None Declared


The mental health of school students has been severely impacted by the aftermath of the COVID-19 pandemic. The present study used a mixed methods approach to assess students’ mental health and examine their wishes for support to improve their psychological well-being. We further investigated gender and age group differences in the amount of clinically relevant mental health problems and the roles that mental health and gender had on desired support. Between April and May 2022, a total of 616 Austrian students aged between 14 and 20 participated in a cross-sectional online survey  assessing wishes for support regarding mental well-being and mental health indicators . A wish for support was expressed by 46.6% of the students. Qualitative content analysis revealed that the two most important categories of desired support types were “professional help” and “someone to talk to”. The group of students with a wish for support in general significantly more often showed clinically relevant depression, anxiety, insomnia, eating disorders, or high stress symptoms. Students that wished for professional help significantly more often exceeded the cut-off for clinically relevant depression, anxiety, and high stress. Those who wished for someone to talk to significantly more often exceeded the cut-off for clinically relevant eating disorders. The results indicate a great need for support for young people’s mental health problems and that this need is even more urgent for students. Since the outbreak of the COVID-19 pandemic in 2019, there have been repeated major changes in the daily lives of school students. Not only did they have to deal with several school closures and switches to distance learning, the measures to contain the spread of the virus also entailed an increase in stress and a decrease in critical protective factors for young people’s mental well-being  ,4,5. TheIn addition to the measures that have affected all Austrians during the lockdowns since the COVID-19 pandemic began in March 2020 , students have also faced several complete and partial school closures  and distance learning [However, even more than two years after the outbreak of the COVID-19 virus, and after an above-described easing of the containment measures, impairments in Austrian adolescents’ mental health were still apparent in spring 2022. In April and May, clinically relevant symptoms of depression , anxiety , sleeping problems , moderate stress , and frequent suicidal ideation  were prevalent in adolescents between the ages of 14 and 20. Compared to February 2021, an increase in girls’ clinically relevant depression, anxiety, insomnia, and suicidal ideation symptomatic was observed [Furthermore, qualitative research revealed that in 2021 only 3.3% of Austrian students  and 2.6%Despite the continuing high levels of psychological distress and the many barriers to seeking professional help, to date little is known, not only in Austria but in general, about what help young people themselves would like to receive to deal with their burdens. The present study, as part of a research project on the effects COVID-19 had on young people’s mental health , therefoThe online survey had a cross-sectional design which aimed to determine the mental health status and the wish for support of Austrian school students between the ages of 14 and 20. The study was conducted as an exploratory sequential mixed methods design. Results of the qualitative analysis informed the quantitative analysis by providing the support wish categories . Data coThe data collection period was from the 26 April to the 24 May 2022. During this period the COVID-measures allowed students to participate in regular face-to-face classes at school and there were no restrictions to socialize in place. The study acquired approval from the data protection officer as well as from the Ethics Committee of the University for Continuing Education Krems, Austria (protocol code EK GZ 41/2018–2021) and the procedure followed the Declaration of Helsinki.Participant recruitment was carried out online. The invitation including the online survey link to participate in the study was forwarded to the school representatives. To be eligible for the study, participants had to be between 14 and 20 years old, attend school in Austria, and give electronic informed consent. Their participation was voluntary without incentives.Wish for support was assessed with a dichotomous answer (yes/no) to the question “Would you like to receive support to improve your mental well-being?”.If they answered the above-mentioned wish-for-support-question with “yes”, a more detailed question about the type of support they wanted followed. This open-ended question was not only analyzed qualitatively using qualitative content analysis but the categories that emerged from the qualitative analysis were additionally used in subsequent quantitative and mixed-method analyses. Qualitative categories that were suitable in size for statistical analyses were used to examine differences in the students’ desired types of support regarding their mental health measures and gender.German-validated versions of the following six standardized validated mental health measures were used:The Patient Health Questionnaire-9 (PHQ-9) assesses the participants’ depressive symptoms . The ninGeneral Anxiety Disorder-7 (GAD-7) measures general anxiety  and is vThe Insomnia Severity Index (ISI) asks about sleep-related problems. The questionnaire is validated in German  and consTo assess the perceived stress level of the students, the Perceived Stress Scale (PSS-10) was used. The PSS-10 contains ten items on a five-point Likert scale. The items range from 0 (never) to 4 . Higher perceived stress is indicated by higher sum scores. The German version is validated for adolescents above the age of 14 . High leThe SCOFF screening questionnaire was used to detect eating disorders and consists of five questions addressing the core features of bulimia nervosa and anorexia nervosa. The questions can be answered with “no” (0) or “yes” (1) and disordered eating is defined by a total score ≥2 . The queThe validated screening tool CAGE  assessesParticipants were asked to state their age (in years). They also had to indicate their gender by clicking “female”, “male”, or “diverse”. Diverse indicated that those students did not perceive their gender to fit the binary gender norms. Furthermore, the students provided information about the federal state they live in  as well as about the type of school they attend .As a first step, responses to the open-ended question about the type of support school students wish for to improve their psychological well-being were analyzed using qualitative content analysis. A total of 245 students answered this question about the type of support they wanted with varying levels of detail. While some students only used single keywords to express their support wish, others addressed it in complete sentences.n = 60) of the responses. He used the category system and the definitions of the categories which were already in place. The Percentage Agreement (PA), functioning as a measure for the inter-coder agreement, was PA = 0.92, which indicated that the coders’ allocations were matching in 92% of the cases. Inconsistencies in the coding were dealt with by adding new categories to the system or clarifying coding rules.One coder (M.W.) read through all answers to familiarize herself with the material and to get a feeling of the different types of responses. Afterward, an initial category system was created, which included main categories and thematically related subcategories. Responses were initially but not yet finally coded using the software ATLAS.ti version 22.2.5 . Stateme2) or Fisher Exact Tests were used to examine:differences in the amount of clinically relevant mental health problems  between female, male, and diverse participants, as well as between the age groups of 14 to 17 and 18 to 20 years.differences between the students with a wish for support and students without a wish for support in gender, age group, and clinically relevant mental health problems .differences between the students with a wish for professional help and students without a wish for professional help in gender, age group, and clinically relevant mental health problems .differences between the students with a wish to talk to someone and students without a wish to talk to someone in gender, age group, and clinically relevant mental health problems .Chi-squared tests . The significance level for all tests was set at 5%. All tests were performed two-tailed.Analysis (1.) represents an extended examination  of gender differences  in students’ mental health to Kaltschik et al.’s  matched n = 477) identified as female, 19.8% (n = 122) as male, and 2.8% (n = 17) as diverse.From a total of 932 participants clicking the survey link, 44 were excluded due to missing informed consent, 221 due to missing data, 21 due to being under the age of 14 or over the age of 20 years, 7 due to not attending school, and 23 since they failed the attention check question. The final sample consisted of 616 adolescents and young adults, whose ages ranged from 14 to 20 years . With regards to gender, 77.4% (n = 287) of all 616 respondents declared a need to receive support, 42 of whom did not elaborate on what type of support. A total of 245 participants answered the open-ended question in more detail. Qualitative data analysis resulted in 12 categories, which are depicted in At the end of the online questionnaire, participants were asked if they would like to receive support to improve their psychological well-being. A total of 46.6%  of all 616 participants and 43% of those who requested support. This category referred to psychological, psychotherapeutic, and psychiatric support, as well as to medication. In this category, we subsumed the students’ expressed desire to consult or talk to an expert, statements about hospitals or other facilities and institutions they could get in touch with as well as statements about receiving treatment or therapy. Respondent 63′s statement is an example of how students expressed their wish for professional help: “It would be very helpful if there was a psychologist or a social worker in my school to just talk to someone where you can be sure that they will listen to you”. Students also suggested an annual mandatory consultation: “Just as it is obligatory to see a school doctor every year, every student should see a school psychologist at least once a year. The offer is unfortunately limited at many schools and many would not go on their own accord” explained Respondent 144. Moreover, some participants expressed a wish for facilitated communication between their school and professional help provider.Participants mentioned that access to professional help should be easier, non-committal, of lower threshold, and more convenient. Waiting times should be shorter and services should be more affordable, free of charge, or paid for by health insurance. Furthermore, respondents expressed a desire for school psychologists whom they could consult more frequently or who provided appointments during breaks or class-free periods. Respondent 269, for example, expressed: n = 64) referred to outside third parties without special expertise, people who were important to the respondents, like friends or family, as well as teachers or other types of people whom they could contact in school or in general. Often, they also explicitly wished for a person they did not know, who did not fall into their circle of family or friends . More explicitly they expressed a desire for someone who is understanding, has a neutral perspective, whom they can trust, who does not judge them, and whom they can talk to about sensitive topics. By having such a person in their lives, they hoped to feel less pressured, receive help relaxing, reach their goals, find solutions, receive advice, or simply share their thoughts . Moreover, students expressed the desire to obtain motivation from talking to someone or that they simply wished to know that there was another person whom they can talk to if needed. Respondent 665 furthermore stated that it would help if parents would not be informed about them talking to someone.The second most appeared category “someone to talk to” . This category subsumes wishes for receiving tips or advice. Participants expressed their wish for a low-threshold demand-oriented service. Furthermore, it was mentioned that a framework should be provided to reflect on one’s life situations and that understanding and support on the part of the counselor were desired. The areas in which counseling was desired varied greatly. Students hoped that their fears about the future would be alleviated, that they would be supported in making decisions about their school careers, and that counseling would generally bring clarity into their lives. Moreover, stress-relief, relief of negative thoughts, and support during difficult situations were mentioned as reasons. There was also a desire for counseling to address mental health, whether through education about symptoms indicating poor mental health, advice about mental illness, or general tips on how to feel better.Furthermore, the qualitative content analysis revealed that some students desired “counseling”  includes statements about getting educated, for example, about mental health, stress, and a healthy diet in form of workshops, courses, or information sheets. Respondent 314, for example, mentioned “Perhaps information sheets, with information on how to get some distraction from these stressful school days”. Another student (Respondent 771) asked for “Better mental health education in school (including concerns about eating behaviors)”.The category “information”  wished for “help with eating disorder or weight”. In this category, wishes for help with an eating disorder or abnormal eating behavior, as well as body dysmorphia, were subsumed. Some students named the desire to eat less, have an exercise partner, or someone who created a diet plan for them, so they would stop gaining weight. However, the category also referred to the wish for education on healthy eating behavior and body positivity. Participants expressed that they wanted to “learn more about healthy nutrition. What diet suits me and my body” (Respondent 278) or “overcome my eating disorder, no matter what” (Respondent 184). Some students asked for professional help in dealing with their eating disorders. Such cases were coded as both “professional help” and “help with eating disorder or weight”.Some participants  also emerged as an important support desire for some students. This category referred to statements that the school system and the requirements in school were stressful and students wished for less demand at school. They expressed their desire for having more free time and time for recreational activities, fewer exams, a different grading system, and a decreased school-related workload. Furthermore, criticism was voiced about the school system and the curriculum being outdated and that these should be adjusted to the current situation, which can, for example, be gathered from Respondent 10′s statement: “The curriculum needs to be adapted to today’s generation—it is partly very outdated. The Corona measures have influenced our lives and many things are no longer the way they used to be. Young people must be supported because the only thing we are currently experiencing is psychological damage”.“Less pressure to perform and/or demand at school”  voiced that they would like to receive “support from an educational institution”. This wish for support from an educational institution contained statements about wishes for support from the school in general or their teachers more specifically. Respondents wanted teachers and other school representatives to take the mental health of their students more seriously, for example, by employing more school psychologists and educating teachers on mental health issues . Teachers should also be able to take actions in calls for help and receive the necessary training. Furthermore, students wished for more guidance teachers and on a regular and voluntarily basis offers to talk to health experts at school. In addition, there was a desire to be better informed about mental health and to destigmatize mental illness, especially in school settings. Besides, wishes were expressed for possibilities to relax in school and preventive measures against bullying. As with all categories, the possibility of double coding also exists within this category. For example, mentions of school psychologists were coded as both “support from an educational institution” and “professional help”.A few students  was also a support wish that some school students mentioned. Thereby they expressed their wish for family members and/or friends to support them in different aspects of their lives. For example, they had a desire to talk to them about their problems or concerns and explicitly wished for them to listen. Some students expressed the wish not to be excluded .“Family and/or friend support”  emerged from the content analysis. Statements in this category referred to the students’ wishes for more consideration and being treated with understanding and empathy by the people in their lives . They wished for openness, acceptance, and not being judged both in the school context and in everyday life. They, for example, expressed “More empathy on the part of the schools” (Respondent 77), “More understanding for “bad” days and a lack of drive” (Respondent 405), or “More consideration from teachers” (Respondent 6).Furthermore, the category “consideration and/or understanding of others” . Statements that were subsumed under this category referred to the destigmatization of mental illnesses. They asked for mental disorders and help-seeking to be normalized in society, to no longer be taboo topics, and that people accept these to be nothing to be ashamed of. In general, they mentioned that people should be able to talk more openly about mental illnesses and receiving professional help as well as going to therapy or receiving similar support should not harm one’s career.“Destigmatization” also was a topic of importance for some participants  did not elaborate on the type of support they wished for, but rather on the areas in which they desired help. These statements were categorized under “other support” and appeared in different areas like private problems, financial difficulties, trouble sleeping, schoolwork, or motivation for studying.Some participants  indicated that they wished for support, but either did not know what kind of support would help them or were unable to articulate their support wish and therefore said “I don’t know”. Another 42 participants indicated that they wanted to receive support but did not answer the open-ended question about the type of support they wished for.2 tests, depicted in Students who identified as female or diverse were more likely to show clinically relevant symptoms in five out of six mental health indicators  than those who identified as male. The calculated Chi2 tests also showed that students aged 14 to 17 were significantly more likely to show clinically relevant symptoms of anxiety and insomnia than students aged 18 to 20 years, while there was no significant age group-related difference in regard to depression, high stress, disordered eating, and alcohol abuse (see The Chibuse see .p < 0.001) and between male and diverse students .Furthermore, significant gender differences arose in students’ wish for support to improve their psychological well-being see . Their wFurthermore, seventy percent of the 14–17-year-olds indicated a wish for support, while thirty percent of the 18–20-years-olds did so. Additionally, significant differences were found in the students’ wish for support in five out of six mental health indicators. As depicted in By adding the qualitative categories to the statistical analysis using a mixed methods approach, significant differences in age group and clinically relevant depression, anxiety, and stress were present between those with a wish for professional help and those with no such wish. Students with a wish for professional help were significantly more often of younger age (14–17 years) and significantly more often showed clinically relevant depression, anxiety, and high stress. As indicated in 2Chi test, a significant difference in age and clinically relevant eating disorder was found between the group of students who expressed a wish for someone to talk to and those who did not. Students who wished for someone to talk to significantly more often belonged to the age group of 14–17-year-olds and significantly more often showed clinically relevant disordered eating than those with no such wish. As can be seen in Furthermore, using a n = 124; 20.1% of the total sample), expressed their desire for professional help, which is similar to the professional support wish of school students in 2021 in Austria (47%) [n = 64; 10.4% of the total sample) had a wish for someone to talk to. Disordered eating was significantly more prevalent in students who wished to talk to someone than those with no such wish.The present study aimed to better understand the wishes for support of Austrian school students in the light of their mental health, gender, and age. Worse mental health, specifically depression, anxiety, insomnia, eating disorders, and high stress, was significantly more prominent in adolescents with a desire for support. Of those with a wish for support, 43.2% (ia (47%) . ClinicaThis great desire for psychological and social support among students is not surprising considering the current mental health state of children and adolescents and the psychosocial care situation in Austria. Even though for years attempts have been made to expand psychosocial services in Austria , deficitPsychotherapeutic treatment can only be provided to 0.8% of the Austrian population . There aThis study also showed that the prevalence of clinically relevant symptoms in all mental health measures , except for alcohol abuse, was lower in male than in female students or students who identified as diverse. The evidence of better mental health in male students was in line with other studies on gender differences in adolescents during the COVID-19 pandemic ,66,67,68Compared to female and diverse students, male students were less likely to express a wish for support. On the one hand, one could argue that this was due to their better mental health. On the other hand, men’s lower rate of seeking help has been reported in numerous studies ,70,71,72In the group of students with no wish for professional help and those with a wish for professional help, no significant difference between clinically relevant eating disorder was found, but the group of students without a wish for someone to talk to showed significantly lower numbers of clinically relevant eating disorder compared to those with a wish for someone to talk to. This seems to be in line with what is already known about help-seeking behaviors in individuals with eating disorders. Research shows that people with disordered eating often have problems with acknowledging their illnesses’ severity and show poor mental health literacy ,89,90, wThis study again highlights the need to improve care for adolescents with mental illness. We propose that especially in the field of education, the school as a living environment makes it possible to easily reach many students with psychosocial support. Therefore, we argue that it is important to push the implementation of multi-professional health teams in educational contexts. Starting from kindergarten until students leave the educational system, children, and adolescents should be provided with preventive measures as well as acute care services according to their individual in-the-moment needs . EspeciaThe students’ desire for having “someone to talk to” could be potentially met by teachers whom they could confide in. They could provide space for students to talk about their problems in an everyday school setting  . Furthern = 447; male: 19.8%, n = 122; diverse: 2.8%, n = 17), which means that the types of support wishes cannot be considered gender representative. Moreover, the reasons for certain support wishes as well as why some students did not wish to be supported at all remain unclear. Qualitative interviews would be suited to further examine the reasons behind why students do or do not wish to receive support. The most serious shortcoming is the convenience sample, which not only resulted in a higher percentage of girls participating but which could also have led to a self-selection bias towards students with higher mental health problems. A representative sample would have more strengths but was not possible. This has to be considered when interpreting the results. Additionally, the low internal consistencies of the CAGE (Cronbach’s α = 0.55) and the SCOFF (Cronbach’s α = 0.56) must be addressed as limitations as these raise concerns about the measures’ reliabilities.Some limitations of this study need to be addressed. First, the collection of the data took place within an online survey framework, which especially impacted the qualitative data because students answered the open-ended questions in varying degrees of detail. Differences in the length and precision of responses became apparent during the qualitative analysis. Second, although the qualitative analysis of the types of support wishes gave an overview of how the students wished to be supported, it could not be ruled out that some support wishes were missing or underrepresented due to potentially not being on the students’ minds while filling in the online questionnaire. Nevertheless, it can be assumed that the present overview contains the most important types of support wishes. Furthermore, we have to acknowledge that in this study female students were overrepresented (female: 77.4%, Almost half of the surveyed students explicitly expressed a wish for receiving support to improve their psychological well-being. Significantly more of those who desired support also showed poorer mental health in terms of depression, anxiety, eating disorders, insomnia, and high stress than without a support wish. Most students expressed their wish for support by asking for professional help. Considering young people’s mental health and their explicit wish for help, we propose facilitated access and financial support for psychosocial services, especially for young people, and educative measures to improve adolescents and young adults’ mental health literacy.