{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T17:12:04Z","timestamp":1788628324932,"version":"build-2803163510"},"reference-count":69,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hartlepool Borough Council\/Local Government Association"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The relationship between substance use and mental health is complex, and both constitute a global public health burden. In the UK, the estimated annual financial costs of alcohol-related harm and illicit drug use are GBP 21.5 billion and GBP 10.7 billion, respectively. This issue is magnified in the North East of England, where treatment access is low and a large proportion of individuals experience socioeconomic deprivation. The present study aimed to explore the experiences of adults and adolescents accessing a substance misuse treatment service in the North East, in order to inform policy makers, commissioners, and providers of substance misuse treatment and prevention. Semi-structured qualitative interviews were conducted with an opportunistic sample of n = 15 adult participants (aged 18 years and over) and n = 10 adolescent participants (aged between 13 and 17 years). Interviews were audio-recorded, transcribed, anonymised, and analysed thematically. Five key themes were identified: (1) initiation of substance use, (2) early life experiences, (3) the bi-directional relationship of mental health and substance use, (4) cessation of substance use, and (5) accessing treatment. Future preventative interventions should focus on providing support to individuals who have been exposed to adverse childhood experiences, with treatment provision for individuals experiencing co-occurring mental health and substance use issues taking a more holistic approach.<\/jats:p>","DOI":"10.3390\/ijerph20115967","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:18:43Z","timestamp":1685204323000},"page":"5967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u2018The Addiction Was Making Things Harder for My Mental Health\u2019: A Qualitative Exploration of the Views of Adults and Adolescents Accessing a Substance Misuse Treatment Service"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6223-6081","authenticated-orcid":false,"given":"Liam","family":"Spencer","sequence":"first","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4674-561X","authenticated-orcid":false,"given":"Hayley","family":"Alderson","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steph","family":"Scott","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Kaner","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2932-4474","authenticated-orcid":false,"given":"Jonathan","family":"Ling","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Spencer, L.P., Addison, M., Alderson, H., McGovern, W., McGovern, R., Kaner, E., and O\u2019donnell, A. (2021). \u2018The Drugs Did for Me What I Couldn\u2019t Do for Myself\u2019: A Qualitative Exploration of the Relationship between Mental Health and Amphetamine-Type Stimulant (ATS) Use. Subst. Abus. Res. Treat., 15.","DOI":"10.1177\/11782218211060852"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.11604\/pamjs.supp.2014.17.1.3328","article-title":"The association between substance use and common mental disorders in young adults: Results from the South African Stress and Health (SASH) Survey","volume":"17","author":"Saban","year":"2014","journal-title":"Pan Afr. Med. J."},{"key":"ref_3","unstructured":"(2023, March 01). The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An Evidence Review, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/733108\/alcohol_public_heheal_burden_evidence_review_update_2018.pdf."},{"key":"ref_4","unstructured":"(2023, March 01). Adult Substance Misuse Treatment Statistics 2019 to 2020, Available online: https:\/\/www.gov.uk\/government\/statistics\/substance-misuse-treatment-for-adults-statistics-2019-to-2020\/adult-substance-misuse-treatment-statistics-2019-to-2020-report."},{"key":"ref_5","unstructured":"McDaid, D., Park, A.-L., Davidson, G., John, A., Knifton, L., McDaid, S., Morton, A., Thorpe, L., and Wilson, N. (2023, March 01). The Economic Case for Investing in the Prevention of Mental Health Conditions in the UK. Available online: https:\/\/www.mentalhealth.org.uk\/explore-mental-health\/publications\/economic-case-investing-prevention-mental-health-conditions-UK."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s00127-018-1526-x","article-title":"Social inequalities in mental disorders and substance misuse in young adults: A Birth Cohort Study in Southern Brazil","volume":"53","author":"Barros","year":"2018","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_7","unstructured":"Bradshaw, J., and Mayhew, E. (2020). Child Poverty in the North East Region, Social Policy Research Unit, University of York. Available online: https:\/\/cpag.org.uk\/sites\/default\/files\/files\/policypost\/Child%20poverty%20in%20the%20NE.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.childyouth.2017.07.015","article-title":"Passports out of poverty: Raising access to higher education for care leavers in Australia","volume":"97","author":"McNamara","year":"2019","journal-title":"Child. Youth Serv. Rev."},{"key":"ref_9","unstructured":"(2023, March 01). Health Profile for England 2021, Available online: https:\/\/www.gov.uk\/government\/publications\/health-profile-for-england-2021."},{"key":"ref_10","unstructured":"(2021). Public Health Profiles: Mortality, Office for Health Improvement and Disparities."},{"key":"ref_11","unstructured":"(2022). Local Alcohol Profiles for England, Public Health England."},{"key":"ref_12","unstructured":"(2022). Health Profile for the North East of England 2021, Public Health England."},{"key":"ref_13","unstructured":"(2021). Adult Substance Misuse Treatment Statistics 2020 to 2021, Public Health England."},{"key":"ref_14","unstructured":"Murphy, C. (2022). Drugs, Identity and Stigma, Palgrave Macmillan."},{"key":"ref_15","first-page":"254","article-title":"The Development and Maintenance of Drug Addiction","volume":"39","author":"Koob","year":"2013","journal-title":"Neuropsychopharmacology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e356","DOI":"10.1016\/S2468-2667(17)30118-4","article-title":"The effect of multiple adverse childhood experiences on health: A Systematic Review and Meta-Analysis","volume":"2","author":"Hughes","year":"2017","journal-title":"Lancet Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1542\/peds.2011-2663","article-title":"The lifelong effects of early childhood adversity and toxic stress","volume":"129","author":"Shonkoff","year":"2012","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1467-8624.1998.tb06128.x","article-title":"The life course as developmental theory","volume":"69","year":"1998","journal-title":"Child Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.chiabu.2015.03.008","article-title":"Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis","volume":"45","author":"Nurius","year":"2015","journal-title":"Child Abus. Negl."},{"key":"ref_20","unstructured":"Hughes, K., Ford, K., Davies, A., Homolova, L., and Bellis, M. (2023, March 01). Sources of Resilience and Their Moderating Relationships with Harms from Adverse Childhood Experiences: Report 1: Mental Illness. Available online: https:\/\/common.bangor.ac.uk\/system\/files\/uploaded_files\/news\/School%20of%20Healthcare%20Sciences\/2018\/01\/ace_resilienre_report_en_pdf_11162.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.addbeh.2004.01.005","article-title":"Adverse childhood events, substance abuse, and measures of affiliation","volume":"29","author":"Zlotnick","year":"2004","journal-title":"Addict. Behav."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"108563","DOI":"10.1016\/j.drugalcdep.2021.108563","article-title":"Adverse childhood experiences (ACEs) and substance use disorder (SUD): A Scoping Review","volume":"221","author":"Leza","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101142","DOI":"10.1016\/j.ssmph.2022.101142","article-title":"Adverse childhood experiences and adolescent drug use in the UK: The moderating role of socioeconomic position and ethnicity","volume":"19","author":"Karamanos","year":"2022","journal-title":"SSM\u2014Popul. Health"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Houtepen, L.C., Heron, J., Suderman, M.J., Fraser, A., Chittleborough, C.R., and Howe, L.D. (2020). Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A Pospective Cohort Study in the UK. PLOS Med., 17.","DOI":"10.1371\/journal.pmed.1003031"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Alderson, H., Spencer, L., Scott, S., Kaner, E., Reeves, A., Robson, S., and Ling, J. (2021). Using Behavioural Insights to Improve the Uptake of Services for Drug and Alcohol Misuse. Int. J. Environ. Res. Public Heal., 18.","DOI":"10.3390\/ijerph18136923"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/add.13931","article-title":"Qualitative research","volume":"113","author":"Maher","year":"2018","journal-title":"Addiction"},{"key":"ref_27","first-page":"664","article-title":"Substitute prescribing in heroin addiction","volume":"12","author":"Doan","year":"2019","journal-title":"InnovAiT Educ. Inspir. Gen. Pr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1360-0443.2011.03650.x","article-title":"Psychosocial therapeutic interventions for volatile substance use: A Systematic Review","volume":"107","author":"MacLean","year":"2012","journal-title":"Addiction"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: Guided by Information Power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"26152","DOI":"10.3402\/qhw.v9.26152","article-title":"What can \u201cthematic analysis\u201d offer health and wellbeing researchers?","volume":"9","author":"Braun","year":"2014","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_32","unstructured":"(2023, March 01). Young People\u2019s Substance Misuse Treatment Statistics 2020 to 2021: Report, Available online: https:\/\/www.gov.uk\/government\/statistics\/substance-misuse-treatment-for-young-people-statistics-2020-to-2021\/young-peoples-substance-misuse-treatment-statistics-2020-to-2021-report."},{"key":"ref_33","unstructured":"(2023, March 01). Regional Ethnic Diversity, Available online: https:\/\/www.ethnicity-facts-figures.service.gov.uk\/uk-population-by-ethnicity\/national-and-regional-populations\/regional-ethnic-diversity\/latest."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.adolescence.2020.06.004","article-title":"Early cannabis initiation: Substance use and mental health profiles of service-seeking youth","volume":"83","author":"Hawke","year":"2020","journal-title":"J. Adolesc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/j.1530-0277.2008.00810.x","article-title":"Longitudinal Associations Between Alcohol Problems and Depressive Symptoms: Early Adolescence through Early Adulthood","volume":"33","author":"Marmorstein","year":"2008","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/j.1360-0443.2012.04001.x","article-title":"Pathways to heroin dependence: Time to Re-Appraise Self-Medication","volume":"108","author":"Darke","year":"2012","journal-title":"Addiction"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/00004583-200207000-00017","article-title":"A developmental analysis of sociodemographic, family, and peer effects on adolescent illicit drug initiation","volume":"41","author":"Guo","year":"2002","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_38","first-page":"63","article-title":"Causes of drug initiation among adolescents","volume":"14","author":"Motyka","year":"2022","journal-title":"Can. J. Fam. Youth"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ivaniushina, V., and Titkova, V. (2021). Peer influence in adolescent drinking behavior: A meta-analysis of stochastic actor-based modeling studies. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250169"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1001\/archpsyc.62.2.182","article-title":"The Structure of Genetic and Environmental Risk Factors for Anxiety Disorders in Men and Women","volume":"62","author":"Hettema","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1038\/nn1583","article-title":"Genetic influences on impulsivity, risk taking, stress responsivity and vulnerability to drug abuse and addiction","volume":"8","author":"Kreek","year":"2005","journal-title":"Nat. Neurosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/add.16127","article-title":"The association between maternal and paternal substance use and child substance use, internalizing and externalizing problems: A systematic review and meta-analysis","volume":"118","author":"McGovern","year":"2023","journal-title":"Addiction"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Muir, C., Adams, E.A., Evans, V., Geijer-Simpson, E., Kaner, E., Phillips, S.M., Salonen, D., Smart, D., Winstone, L., and McGovern, R. (2022). A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances. Trauma Violence Abuse.","DOI":"10.1177\/15248380221134297"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"105825","DOI":"10.1016\/j.childyouth.2020.105825","article-title":"Substance-use disorders among child welfare and juvenile justice adolescents in residential care: The role of childhood adversities and impulsive behavior","volume":"121","author":"Seker","year":"2020","journal-title":"Child. Youth Serv. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1007\/s10488-019-01003-3","article-title":"Determinants of Implementing Evidence-Based Trauma-Focused Interventions for Children and Youth: A Systematic Review","volume":"47","author":"Powell","year":"2019","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1080\/10826084.2016.1197941","article-title":"Adolescent substance use in the context of the family: A qualitative study of young people\u2019s views on parent-child attachments, parenting style and parental substance use","volume":"51","author":"McLaughlin","year":"2016","journal-title":"Subs. Use Misuse"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1001\/archgenpsychiatry.2011.160","article-title":"Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement","volume":"69","author":"Kessler","year":"2012","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_48","first-page":"128","article-title":"The association between cannabis use and depression: A Review of Evidence","volume":"114","author":"Degenhardt","year":"2012","journal-title":"Marijuana Madness"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1080\/21635781.2015.1055866","article-title":"Help-Seeking Stigma and Mental Health Treatment Seeking among Young Adult Veterans","volume":"3","author":"Kulesza","year":"2015","journal-title":"Mil. Behav. Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"108706","DOI":"10.1016\/j.drugalcdep.2021.108706","article-title":"The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature","volume":"223","author":"Meyers","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Hakobyan, S., Vazirian, S., Lee-Cheong, S., Krausz, M., Honer, W.G., and Schutz, C.G. (2020). Concurrent Disorder Management Guidelines. Systematic Review. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082406"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s10488-012-0449-1","article-title":"Dual Diagnosis Capability in Mental Health and Addiction Treatment Services: An Assessment of Programs across Multiple State Systems","volume":"41","author":"McGovern","year":"2012","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_53","unstructured":"(2023, March 01). Better Care for People with Co-Occurring Mental Health and Alcohol\/Drug Use Conditions: A Guide for Commissioners and Service Providers, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/625809\/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf."},{"key":"ref_54","unstructured":"O\u2019Donnell, A. (2022). The ADEPT (Alcohol Use Disorder and Depression Prevention and Treatment) Study\u2014Experiences of Getting Help for Heavy Drinking and Depression, National Institute for Health and Care Research."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jsat.2006.03.014","article-title":"Physical health as a motivator for substance abuse treatment among medically ill adults: Is It Enough To Keep Them in Treatment?","volume":"31","author":"Pollini","year":"2006","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1037\/a0026027","article-title":"Deconstructing the age-prevalence curve of alcohol dependence: Why \u201cmaturing out\u201d is only a small piece of the puzzle","volume":"121","author":"Jackson","year":"2012","journal-title":"J. Abnorm. Psychol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1037\/0002-9432.74.3.365","article-title":"Perceived Reasons for Substance Misuse among Persons with a Psychiatric Disorder","volume":"74","author":"Laudet","year":"2004","journal-title":"Am. J. Orthopsychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1016\/j.jadohealth.2016.06.021","article-title":"Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews","volume":"59","author":"Das","year":"2016","journal-title":"J. Adolesc. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.chc.2010.03.005","article-title":"Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents","volume":"19","author":"Griffin","year":"2010","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3109\/14659890903040060","article-title":"The therapeutic relationship between therapists and substance-using clients: A qualitative exploration","volume":"15","author":"Kothari","year":"2010","journal-title":"J. Subst. Use"},{"key":"ref_61","first-page":"1","article-title":"Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach","volume":"12","author":"Lago","year":"2017","journal-title":"Subst. Abus. Treat. Prev. Policy"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/j.1360-0443.2005.001069.x","article-title":"The impact of comorbid anxiety and depression on alcohol treatment outcomes","volume":"100","author":"Burns","year":"2005","journal-title":"Addiction"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jad.2017.04.058","article-title":"The paradox of public holidays: Hospital-treated self-harm and associated factors","volume":"218","author":"Griffin","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s00038-018-1095-5","article-title":"Do people with intersecting identities report more high-risk alcohol use and lifetime substance use?","volume":"63","author":"Demant","year":"2018","journal-title":"Int. J. Public Health"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1177\/0539018406069584","article-title":"The logic of small samples in interview-based qualitative research","volume":"45","author":"Crouch","year":"2006","journal-title":"Soc. Sci. Inf."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1023\/A:1025659701805","article-title":"Nuance, Complexity, and Context: Qualitative Methods in Genetic Counseling Research","volume":"6","author":"Beeson","year":"1997","journal-title":"J. Genet. Couns."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Vasileiou, K., Barnett, J., Thorpe, S., and Young, T. (2018). Characterising and justifying sample size sufficiency in interview-based studies: Systematic analysis of qualitative health research over a 15-year period. BMC Med. Res. Methodol., 18.","DOI":"10.1186\/s12874-018-0594-7"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/0141076816665270","article-title":"Bringing together physical and mental health within primary care: A new frontier for integrated care","volume":"109","author":"Das","year":"2016","journal-title":"J. R. Soc. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/2159676X.2022.2146164","article-title":"Doing together: Reflections on facilitating the co-production of participatory action research with marginalised populations","volume":"15","author":"Pettican","year":"2022","journal-title":"Qual. Res. Sport Exerc. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/11\/5967\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:43:09Z","timestamp":1760125389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/11\/5967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,26]]},"references-count":69,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["ijerph20115967"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20115967","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,26]]}}}