Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health

Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health Felipe Agudelo-Hernández, Ana Belén Giraldo-Álvarez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7948517/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Purpose This community-based, population-level study aimed to validate an instrument for assessing knowledge of human rights and mechanisms for exercising them, and to explore its relationship with subjective well-being and depressive symptoms in Colombia. Methods A total of 622 adults participated in an analytical cross-sectional and population study. Participants completed the Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health, alongside validated scales for subjective well-being, resilience, depressive symptoms, loneliness, psychosocial disability, and continuity of care. Results The FRI instrument demonstrated excellent content validity (IVC = 1), high internal consistency (α = 0.987; ω = 0.922), and a robust factorial structure (KMO = 0.968; Bartlett p < .001), revealing two components: recognition of personal rights and freedoms, and institutional participation. Significant correlations were found between human rights knowledge and lower depressive symptoms (ρ = − 0.167; OR = 0.82; p = .030), as well as higher subjective well-being (ρ = 0.088; p < .05). A linear regression model explained 49.4% of the variance in depression, underscoring the protective role of institutional participation. Conclusion These findings support the validity of the FRI instrument and its relevance for designing rights-based mental health interventions. By strengthening individual agency and promoting dignified, participatory environments, this tool offers a pathway for advancing psychosocial recovery and equity in mental health at the population level. Psychosocial Recovery Suicide Mental Health Rights-Based Approach Introduction Suicide is one of the leading causes of premature mortality worldwide ( 1 ) and disproportionately affecting young populations ( 2 ). The actual magnitude of this phenomenon is likely significantly higher due to limitations in epidemiological surveillance systems, stigma, and misclassification of causes of death ( 3 ). In Latin America, the epidemiological landscape is particularly concerning. Between 2010 and 2016, the region experienced a 6% increase in suicide rates, with high prevalence among adolescents and young adults, and a marked gender disparity ( 4 ). These findings underscore the need for more effective policies and interventions that address structural inequalities to sustainably reduce suicide mortality ( 1 ). Various social determinants have been identified as associated with suicide mortality, including unemployment, job insecurity, low income, lack of social protection, and childhood adversity. Housing conditions, environmental factors, and access to basic services also play a significant role ( 5 ). These social vulnerabilities intersect with the recognition of fundamental rights, as established by the Convention on the Rights of Persons with Disabilities (CRPD) ( 6 ). Negative experiences with healthcare personnel have been found to be common, with staff failing to recognize these negative experiences. Furthermore, there is an underrepresentation of those seeking these services who have negative experiences ( 7 ). The CRPD recognizes individuals with psychosocial disabilities as full rights holders, including autonomy, equality before the law, and protection against coercive practices. However, despite its widespread global adoption, deep challenges remain in its implementation, and stigmatizing attitudes persist, particularly within health services ( 8 ). The WHO QualityRights initiative has been widely adopted as a strategy to implement the principles proposed in the CRPD, through evaluation and training tools aimed at transforming mental health services ( 9 ). Nevertheless, violations of human rights persist, despite being protected by various international legal frameworks—especially regarding the principle of autonomy. Involuntary treatments continue to be administered based on clinical diagnosis rather than the individual’s decision-making capacity, representing a breach of autonomy in favor of beneficence ( 10 ). Likewise, coercive practices such as physical restraint and isolation continue to be widely used, with multiple risk factors linked to vulnerability and adverse outcomes for those subjected to them ( 11 ). These realities highlight the urgent need to strengthen the effective implementation of approaches like QualityRights. In this regard, the implementation of the CRPD presents complex and urgent challenges for existing legislation, particularly in the field of mental health. It demands a thorough review of laws that permit coercive practices in the context of disability, alongside the broader structural changes proposed by the CRPD ( 12 ). This need for normative and structural change is framed within international commitments such as the WHO Comprehensive Mental Health Action Plan 2013–2030 and Target 3.4 of the Sustainable Development Goals, which promote the reduction of suicide mortality and the strengthening of rights in mental health ( 13 ). Aligned with these commitments, mental health systems in Latin America have historically developed under biomedical paradigms focused on control and coercion rather than recovery and respect for human rights. This operational logic has created a critical gap between care needs and the availability of appropriate resources, exacerbated by the persistence of coercive practices and limited implementation of community-based models ( 14 ). On this basis, individuals who survive a suicide attempt face not only the consequences of their individual and psychosocial suffering but also structural barriers, stigmatization, and systematic violations of their fundamental rights. Depressive symptoms following a suicide attempt are central to understanding suffering, as they negatively impact functionality and the recovery process. The persistence of a depressive mood state after an attempt is a critical factor in maintaining overall symptomatology and increasing the risk of recurrent suicidal behavior, especially during the immediate post-event or post-discharge period. Therefore, addressing depressive symptoms as a therapeutic priority is essential in both clinical interventions and public health strategies, given their direct impact on comprehensive recovery and quality of life ( 1 , 14 ). This regional landscape is also reflected in Colombia, where a sustained increase in suicide attempts has been observed since 2018, particularly among young adults. This phenomenon is linked to structural factors within mental health services, such as workforce overload, stigma toward individuals with mental disorders, limited cultural competence, and the use of coercive practices, all of which have been shown to worsen mental health outcomes ( 15 ). The Law 1996 of 2019 introduces a paradigm shift by eliminating judicial interdiction and recognizing that all persons with disabilities, including psychosocial disabilities, have full legal capacity. This promotes support for decision-making rather than its replacement, in line with the Convention on the Rights of Persons with Disabilities ( 16 ). However, this regulation coexists with clinical practices based on guardianship models, where family members or institutions make decisions about treatments, involuntary hospitalization, or informed consent, highlighting a gap between the principles of autonomy and clinical practice. As part of efforts to respond to this issue, the present study was conducted in the Department of Caldas, Colombia, between 2023 and 2025, with the aim of validating an instrument designed to measure knowledge of human rights and the mechanisms for exercising them following a suicide attempt. Complementary objectives included analyzing the relationship between such knowledge, subjective well-being, and depressive symptoms, as well as exploring differences between individuals who recognize their rights and those who do not. The instrument is based on the conceptual framework of the WHO QualityRights program, adapted to the Colombian context. The proposed hypotheses are: ( 1 ) The instrument designed to measure knowledge of human rights and the mechanisms for exercising them among individuals who have attempted suicide demonstrates adequate psychometric properties, including a factorial structure consistent with the WHO QualityRights conceptual framework and high internal consistency; ( 2 ) Knowledge of human rights and the mechanisms for enforcing them positively influences the reduction of depressive symptoms following a suicide attempt; ( 3 ) Individuals with greater knowledge of their human rights and the mechanisms for exercising them exhibit higher subjective well-being and lower depressive symptoms after a suicide attempt, compared to those lacking such knowledge. Methods Study Design and Context and Participants This was a cross-sectional, population-based study focused on the creation and psychometric validation of a new instrument to assess knowledge of human rights in mental health following a suicide attempt. This study employed random sampling stratified by age, sex, and place of origin from the total population with reported suicide attempts in Caldas, Colombia, during 2023–2024 (N = 1,174). The sample size calculated with a 95% confidence level suggested a minimum of 295 participants. However, a total of 622 individuals was achieved in the sample. The study was conducted in the state of Caldas, Colombia—one of the regions with the highest suicide rates nationally—and was applied to individuals who had entered mental health services after a suicide attempt. This context highlights the relevance of developing tools that promote rights-based approaches in community mental health services. Participants were identified through Colombia’s national public health surveillance system (SIVIGILA), which registers suicide attempts as part of mandatory reporting protocols. Data collection took place during the first quarter of 2025. Participants were contacted in person by the research team in collaboration with staff from the Territorial Health Directorate of Caldas, as part of the post-attempt follow-up protocol established in Colombia. Inclusion criteria were having a registered suicide attempt in SIVIGILA and being able to voluntarily participate. Exclusion criteria included refusal to participate, severe comprehension difficulties, or clinical conditions preventing informed understanding of the study. Instruments Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health The instrument used in this study was titled Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health . It was developed based on the rights outlined in the Convention on the Rights of Persons with Disabilities ( 6 ) and knowledge of the institutions responsible for enforcing these rights. It consists of 31 dichotomous items (Yes/No) designed to assess knowledge of human rights in the context of community mental health. To assess content validity, the Delphi technique was applied. Seven experts participated, with backgrounds in community psychiatry, human rights law, community mental health, health services, and lived experience. Experts were also selected based on their experience in research, human rights advocacy, or psychometrics. Each expert evaluated the items using a digital form, considering ten criteria: clarity, objectivity, relevance, organization, sufficiency, adequacy, consistency, coherence, methodology, and significance. Additionally, they assessed whether each item was understandable to the target population. Each item was categorized as unnecessary, useful, or essential. Based on these ratings, the Content Validity Coefficient (Aiken’s V) was calculated using the formula: IVC = {ne - N/2} {N/2} where ne is the number of experts rating the item as essential, and N is the total number of experts. The IVC ranges from − 1 to + 1, with positive scores indicating greater content validity. Items with scores between 0.50 and 0.99 were considered acceptable. Face validity was assessed through a semi-structured cognitive interview using the final version of the instrument. The goal was to identify and address potential sources of error, thereby improving the tool’s quality and effectiveness. The analysis focused on the following areas: comprehension, retrieval, judgment, response option adequacy, and content adequacy. Interviews were conducted in person between April and May 2024 by a physician with a master’s degree and training in the technique. Twenty users of mental health services participated, all adults: 12 with incomplete secondary education, six with completed secondary education, and four professionals; 10 men, nine women, and one transgender person; 10 from urban areas, five from semi-urban areas, and five from rural areas. Content analysis of the interviews was performed by two of the authors. Overall, the items were found to be understandable. Results showed that 95% of participants reported adequate comprehension, retrieval, judgment, and response adequacy for all items. Participants suggested including university legal clinics as institutional resources, noting their accessibility and relevance in the study context (Supplement 1). They also indicated that many rights were familiar but only recognized after being mentioned in the instrument. Three participants noted that presenting these rights in instrument format helped with identification and “keeping each right more present” — Woman, age 30. Additional scales used Caldas Scale: 33 dichotomous items assessing psychosocial disability related to mental disorders across five domains—treatment adherence, personal and emotional disability, family functioning, social disability, and occupational disability. The occupational domain explores household contributions, satisfaction with daily tasks, and ability to work. Cronbach’s alpha = .81 ( 17 ). Developed in the study area and recommended in Colombia’s Community-Based Rehabilitation strategy. UCLA Loneliness Scale (10-item version): Adapted for Colombia, measures perceived loneliness with scores ranging from 10 to 40; scores below 20 indicate severe loneliness, and scores between 20 and 30 indicate moderate loneliness ( 18 ). EBS-8 (Brief Subjective Well-Being Scale): Assesses life satisfaction and affective states; Cronbach’s alpha = .958 ( 19 ). Connor-Davidson Resilience Scale (CD-RISC-10): Evaluates resilience; validated in Colombia with Cronbach’s alpha = .827, retaining original factorial structure (20). PHQ-9 (Patient Health Questionnaire): Used to screen for depressive symptoms; reliability coefficients in Colombian populations range from α = .80 to .86 ( 21 ). Alberta Continuity of Services Scale for Mental Health (ACSS-MH): Assesses perceived continuity of care across relational, informational, and management dimensions; Spanish version validated in Colombia reported total alpha = 0.86, with subscale alphas ranging from .63 to .85 ( 22 ). Ethical considerations The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. All procedures involving human subjects/patients were approved by (Masked for review). After learning the objectives of the study, participants signed the informed consent that authorized the use of the information collected for the current study, with restrictions on its availability. The privacy and confidentiality of the information was guaranteed. Statistical Analysis Data analysis was structured to address the main objectives of the study and was conducted using SPSS software. Data cleaning and quality control procedures were performed, including the identification of outliers and missing values. This included checking for duplicate entries, out-of-range values, and inconsistencies between responses. Missing data were managed using pairwise deletion to preserve the maximum amount of valid information for each analysis. All data were manually verified for accuracy by two independent researchers before statistical processing. To evaluate psychometric properties, an exploratory factor analysis (EFA) was performed using principal components extraction and Varimax rotation. Internal consistency for each subscale was calculated using Cronbach’s alpha. Spearman’s rank-order correlations were computed to explore relationships between variables, as the Kolmogorov-Smirnov test indicated non-normal distributions for most variables. To compare differences between individuals with knowledge of their rights and those without, Mann-Whitney U tests were conducted for each variable. The effect size for the Wilcoxon signed-rank test was calculated using the rank correlation coefficient, r, which is obtained by dividing the Z statistic by the square root of the sample size (Z/√N). Given the normal distribution of total PHQ-9 scores, exploratory multivariate linear regression models were applied to explain variability in depressive symptom scores (PHQ-9). In addition, PHQ-9 total scores were converted into dichotomous variables based on established cut-off points for depression, and binary logistic regression was performed for both mild and moderate depression thresholds. We report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study. This study was not preregistered. Results Descriptive data The sample consisted of 622 adults (≥ 18 years) who had attempted suicide and were receiving mental health care in the department of Caldas, Colombia. The mean age was 26.71 years (SD = 13.89). In terms of education, most had incomplete secondary (39.1%) or completed primary education (34.7%). Clinically, 99% of participants had a prior diagnosis of mental illness. Access to mental health services was high: individual psychotherapy (86%), family psychotherapy (97.9%), support groups (97.6%), occupational therapy (98.7%), psychiatry (87.5%), neuropsychology (92.4%), and medication expenses (78.6%). Coercive practices were reported by 7.2% of participants. The human rights scale had a mean score of 14.21 (SD = 12.18), indicating wide dispersion in levels of rights recognition and appropriation. Mean scores on the applied scales are shown in Table 1 . Table 1 Means of Scales and Other Sociodemographic Data Variable Category N % Marital status Single 77 12.4% Common-law union 32 5.1% Married 440 70.7% Separated 70 11.3% Widowed 3 0.5% Educational level None 11 1.8% Incomplete primary 26 4.2% Completed primary 216 34.7% Incomplete secondary 243 39.1% Completed secondary 31 5.0% Professional 92 14.8% Graduate (specialization/master’s/PhD) 3 0.5% Clinical history Diagnosed mental illness 616 99.0% Depression 463 74.4% Anxiety 424 68.2% Psychoactive substance use 43 6.9% Schizophrenia 7 1.1% Attention Deficit Hyperactivity Disorder (ADHD) 11 1.8% Household spending Medications 489 78.6% Individual psychotherapy 535 86.0% Family psychotherapy 609 97.9% Support groups 607 97.6% Occupational therapy 614 98.7% Neuropsychology 575 92.4% Psychiatric consultations 544 87.5% Use of coercive measures Has received 45 7.2% Knowledge of health-related rights Yes 537 86.3% Partially 57 9.2% No 28 4.5% Mean Standard Deviation Well-being EBS (Total) 33.45 6.55 Resilience CDRISC (Total) 22.34 8.00 Depression PHQ-9 (Total) 9.99 4.28 Loneliness UCLA (Total) 23.08 4.89 Psychosocial disability Caldas (Total) 14.17 12.18 Caldas: Treatment adherence 9.99 0.69 Caldas: Occupational disability 5.23 1.32 Caldas: Personal disability 5.16 1.99 Caldas: Family disability 8.19 0.49 Caldas: Social disability 4.19 1.43 Continuity of care Alberta: Relationship with primary caregiver 1.79 0.41 Alberta: Follow-up 1.86 0.35 Alberta: Sensitive treatment 1.98 0.14 Alberta: Access to health services 1.98 0.15 Alberta: Treatment continuity 1.99 0.11 Days since last emotional crisis 300.03 150.67 Human Rights Scale 14.21 12.18 Insert Table 1 Instrument Development and Validation Apparent validity was assessed through expert judgment by individuals with lived experience in mental health. Although no direct pilot testing was conducted with the target population, individuals with lived experience assessed item clarity and accessibility, allowing inference of relevance and comprehensibility. All items received a Content Validity Coefficient (CVC) of 1. Internal reliability was high: Cronbach’s alpha for the full scale was .987, and McDonald’s omega was .922. An exploratory factor analysis (EFA) was conducted using principal components and Varimax rotation. Sampling adequacy was confirmed (KMO = 0.968; Bartlett’s test of sphericity: χ² (435) = 36,533.86; p < .001). The rotation converged in five iterations. Two components were identified: ( 1 ) Recognition of Personal Rights and Freedoms (α = 0.973; 14 items), and ( 2 ) Institutional Participation and Linkage (α = .974; 17 items). Factor loadings ranged from 0.731 to 0.939 for the first component and from .312 to .843 for the second. The rotated component matrix is shown in Table 2 . Table 2 Psychometric properties of Freedoms, Rights, Institutions (FRI) Item Recognition of Personal Rights and Freedoms Institutional Participation and Linkage Communalities Equality/Non-discrimination 0.791 — 0.814 Access to multiple aspects of society 0.823 — 0.881 Right to life — 0.384 0.329 Equality before the law 0.872 — 0.849 Access to justice 0.861 — 0.736 Right to Liberty 0.849 — 0.909 Not to be subjected to torture, cruel or degrading treatment 0.867 — 0.898 Protection from any form of exploitation 0.864 — 0.912 Respect for integrity 0.868 — 0.934 Freedom of movement 0.837 — 0.910 To live independently and be included in the community 0.843 — 0.939 Freedom of expression and access to information 0.783 — 0.901 Right to privacy 0.786 — 0.947 Right to home and family 0.731 — 0.911 Right to education — 0.312 0.121 Right to health — 0.433 0.281 Right to habilitation and rehabilitation — 0.730 0.881 Right to work and employment — 0.712 0.915 Right to an adequate standard of living and social protection — 0.745 0.938 Right to participate in political and public life — 0.747 0.944 Right to participate in cultural, recreational, sports, and leisure activities — 0.747 0.940 Right to participate in public data and information — 0.780 0.933 Do you know the mechanisms to exercise your rights? — 0.843 0.749 Ombudsman Office — 0.804 0.836 Attorney General’s Office — 0.760 0.943 Municipal Legal Office — 0.788 0.882 Colombian Family Welfare Institute (ICBF) — 0.810 0.850 Office of the United Nations High Commissioner for Human Rights — 0.755 0.952 Inter-American Court of Human Rights — 0.752 0.956 Other institution — 0.697 0.693 Legal aid office — 0.803 0.895 Indicators Total Cronbach’s Alpha .973 .974 .987 McDonald’s Omega .914 .917 .936 Alpha based on standardized items .985 Explained variance (%) 53.375% 30.834% — KMO measure .966 Bartlett’s test of sphericity χ²=35653.172; df = 406; Sig = < .0001 Insert Table 2 A positive correlation was observed between the human rights scale and subjective well-being (ρ = .088; p < .05), and a negative correlation with depressive symptoms (ρ = –.167; p < .01). Statistically significant differences were found between groups based on exposure to coercive practices in total rights scores (U = 9920; p = .007), subjective well-being (U = 10068.5; p = 0.012), and depressive symptoms (U = 10109; p = .012), with small effect sizes (r = .10). A significant difference was also observed in health rights knowledge (U = 3607; p < .001), with a large effect size (r = .54). A multiple linear regression model was estimated with six predictors, explaining 49.4% of the variance in depressive symptoms (PHQ-9) (adjusted R² = .494; F (6.614) = 101.85; p < .001). Significant coefficients included: institutional participation and linkage (B = –.087; β = –.134; p < .001), subjective well-being (B = –.292; β = –.445; p < .001), perceived loneliness (B = .190; β = .216; p < .001), psychosocial disability (Caldas; B = .165; β = .133; p < .001), anxiety diagnosis (B = .843; β = .092; p = .002), and family spending on support groups (B = 1.824; β = .063; p = .028). Collinearity diagnostics showed acceptable tolerance and VIF values (VIF range: 1.01–2.02); residuals were independent (Durbin-Watson = 1.881). Full coefficients are presented in Table 3 . Table 3 Linear Regression Model for Depressive Symptoms (PHQ-9) Variable B SE Beta t p 95% CI Lower 95% CI Upper Tolerance VIF (Constant) 5.286 2.672 — 1.978 0.048 0.038 10.533 — — TOTAL EBS -0.292 0.027 -0.445 -10.971 < .0001 -0.344 -0.239 0.496 2.016 TOTAL UCLA 0.190 0.036 0.216 5.342 < .0001 0.120 0.260 0.497 2.011 Institutional Participation and Linkage -0.087 0.019 -0.134 -4.641 < .0001 -0.123 -0.050 0.983 1.017 Total Caldas 0.165 0.039 0.133 4.247 < .0001 0.089 0.242 0.827 1.210 Anxiety Diagnosis History 0.843 0.267 0.092 3.153 0.002 0.318 1.368 0.963 1.039 Family Spending on Support Groups 1.824 0.828 0.063 2.204 0.028 0.198 3.449 0.990 1.010 Note : B = unstandardized coefficient; SE = standard error; Beta = standardized coefficient; 95% CI = 95% confidence interval for B; VIF = variance inflation factor. Predictors with VIF > 5 should be interpreted with caution due to potential multicollinearity. Dependent variable: Depressive symptoms (PHQ-9). Insert Table 3 Squared semi-partial correlations (sr²) were calculated to estimate the unique contribution of each predictor: subjective well-being (sr² ≈ .16), loneliness (sr² ≈ .04), institutional participation (sr² ≈ .03), and other predictors such as disability, anxiety diagnosis, and support group spending (sr² ≈ .01–.03). Additionally, an exploratory logistic regression model was estimated including total human rights knowledge scores. This predictor was statistically significant (B = –.199; OR = 082; p = .030). Discussion This study aimed to validate an instrument for assessing knowledge of human rights and the mechanisms for exercising them following a suicide attempt. The findings support this objective, demonstrating a coherent factorial structure aligned with the WHO QualityRights framework, strong internal consistency, excellent content validity, and optimal sample adequacy. Secondary analyses examined associations between rights knowledge, subjective well-being, and depressive symptoms, as well as differences between individuals who recognize their rights and those who do not. Knowledge of human rights was significantly associated with lower depressive symptoms and higher subjective well-being, suggesting a potential protective role in emotional recovery. These findings are consistent with recent reports indicating that rights-based agency in mental health may enhance autonomy and reduce emotional distress ( 23 ). These results are contextualized within a regional landscape characterized by structural vulnerabilities, stigma, and limited access to mental health services, which hinder the recognition and exercise of mental health rights ( 8 , 9 ). In Latin America, poverty, social exclusion, structural violence, and lack of social protection have been identified as risk factors for suicidal behavior, particularly among adolescents and young adults ( 1 , 24 ). Multivariate analysis revealed significant associations between depressive symptoms and variables including subjective well-being, loneliness, psychosocial disability, anxiety history, and household spending on support groups. These findings align with prior research identifying childhood adversity, economic hardship, and social exclusion as key risk factors for suicidal behavior ( 2 , 5 ). Significant differences were also observed between individuals who had experienced coercion and those who had not, across all variables analyzed. Effect sizes were small, except for knowledge of health-related rights, which showed a large effect. This supports the instrument’s sensitivity to experiences of rights violations and its potential utility in evaluating institutional practices from the perspective of individuals with lived experience. Studies emphasize that one way to reduce the harm that experiences of abuse often cause is to have effective mechanisms for making them visible ( 7 ). Prior literature has documented systematic rights violations among individuals with mental health conditions, especially in institutional and coercive settings ( 12 , 25 ). Despite growing international interest, measurement of human rights knowledge and exercise in mental health remains limited, particularly from the user perspective. The WHO QualityRights Tool Kit is the most widely recognized instrument, designed to assess compliance with human rights standards in mental health and social care services, in line with the Convention on the Rights of Persons with Disabilities (CRPD) ( 25 , 26 ). However, its institutional focus does not address individual knowledge appropriation or lived experience ( 26 ). Other tools, such as HRXSW and HRESW, have been used in educational contexts, particularly among medical and social work students in Colombia ( 15 ). While useful for evaluating training interventions, their applicability to populations with lived experience is limited, and they do not directly assess mental health rights or institutional mechanisms. The HR-14 provides a broad assessment of perceived human rights status, including the health system ( 27 ) (Wildner et al., 2002), but its general scope limits its utility in identifying specific mental health knowledge. The scale developed by Eiroa-Orosa and Limiñana-Bravo en 2019 ( 28 ) targets mental health professionals and assesses beliefs and attitudes toward the rights of individuals with lived experience. Although informative for care environments, it does not evaluate direct knowledge or the capacity to exercise rights in real-world settings. The instrument developed in this study represents a novel contribution by integrating principles of the CRPD ( 6 ) and constructing its items from the perspective of individuals with lived experience. Its factorial structure revealed two solid components: recognition of personal rights and freedoms, and institutional participation. Unlike previous instruments, this questionnaire seeks to capture the degree of appropriation, understanding, and connection with institutional mechanisms, thereby expanding its applicability in both community and clinical settings. Taken together, these findings affirm that the validated instrument not only meets the required psychometric criteria but also offers a valuable tool for identifying structural gaps in mental health systems and service delivery, guiding human rights–centered interventions, and strengthening the empowerment of individuals in situations of psychosocial vulnerability. In this regard, the findings of the present study not only support the psychometric validity of the instrument but also reinforce the need for clinical and community teams to understand human rights knowledge from the standpoint of lived experience as part of comprehensive training—placing lived experience at the center of professional development. Such understanding requires interpretive, ethical, and contextual competencies to address inseparable clinical, social, and structural challenges, advance sensitive lines of research, and improve care in complex settings. Training professionals with both clinical and humanistic competencies—through a dual-model approach—not only enhances clinical practice but also drives scientific innovation and contributes to closing structural gaps in mental health ( 29 ). These findings are consistent with recent scholarship emphasizing the importance of participatory ethics and rights-based frameworks that prioritize individual agency and accountability in mental health systems ( 9 ) (Patterson, 2024). In this sense, the validated instrument contributes not only to psychometric evaluation but also to the advancement of inclusive, ethical, and transformative approaches in psychosocial care—reinforcing the relevance of rights recognition as a foundation for recovery and empowerment. Limitations This study has limitations that should be considered. Its cross-sectional design precludes causal inferences between human rights knowledge and emotional well-being. Moreover, the focus on individuals with recent suicide attempts limits generalizability to broader populations with psychosocial disabilities. Although the instrument demonstrated robust psychometric properties, its application was restricted to a single department in Colombia, and intercultural validation is needed in other Latin American countries. Furthermore, while the perspective of individuals with lived experience was incorporated, the inclusion of Indigenous, rural, or digitally excluded communities was not controlled for, which may affect representativeness. A significant portion of the sample had not been hospitalized or exposed to coercive practices, limiting the study’s ability to assess the instrument in clinical contexts where such experiences are more common. This lack of balance may restrict the generalization of findings to institutional settings. The study did not examine clinical or institutional factors—such as type of care or treatment setting—that may influence the appropriation of rights. Future research should address these variables and incorporate longitudinal designs to assess the sustained impact of rights knowledge on psychosocial recovery. Additional studies could also evaluate the scale’s applicability across diverse experiences of psychosocial distress in both clinical and community settings. Conclusions This study provides strong evidence of the link between human rights knowledge and emotional well-being following a suicide attempt, highlighting its potential protective role against depressive symptoms during the recovery process. The psychometric validation of the instrument confirms its utility for assessing rights knowledge and exercise from the perspective of lived experience, moving beyond previous institutional approaches. In the Latin American context, marked by inequality, stigma, and exclusion, advancing human rights recognition and education in mental health is essential to strengthen personal agency, reduce psychosocial suffering, and guide more equitable public policies. The instrument developed represents a step toward guaranteeing rights in the field of psychosocial disability, with potential to close structural gaps and promote more dignified and participatory environments. Declarations Acknowledgments To Adiela Hernández-Gutiérrez for the methodological support and insights. To Dr. Gloria Inés Saldarriaga Toro, for allowing peer support to advance in mental health services in Caldas, Colombia, despite the barriers of the health system. Declaration of Interest statement The authors report there are no competing interests to declare. The opinions and concepts expressed in this manuscript are the sole responsibility of the authors. CRediT author statement Felipe Agudelo-Hernández Conceptualization Data curation Formal analysis Investigation Methodology Software Supervision Validation Visualization Writing – original draft Writing – review & editing Ana Belén Giraldo-Álvarez Conceptualization Formal analysis Methodology Validation Visualization Writing – original draft Writing – review & editing Availability of data and materials Analysis data is available for consultation upon request Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Ethics approval and consent to participate The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. All procedures involving human subjects/patients were approved by the Bioethics Committee of the Caldas Territorial Directorate and the University of Manizales (acta CB_04-2025). After learning the objectives of the study, participants signed the informed consent that authorized the use of the information collected for the current study, with restrictions on its availability. The privacy and confidentiality of the information was guaranteed. References Kim S, Woo S, Kim N, Lee H, Park J, Kim T, Yon DK (2025) Global, regional and national trends in suicide mortality rates across 102 countries from 1990 to 2021 with projections up to 2050. Nat Mental Health 1–11. 10.1038/s44220-025-00474-8 Lovero KL, Santos D, Come PF, Wainberg AX, M. L., Oquendo MA (2023) Suicide in Global Mental Health. Curr psychiatry Rep 25(6):255–262. https://doi.org/10.1007/s11920-023-01423-x Peterkin D, Rogers ML, Lawrence OC, Richards J, Zheng S, Astudillo-García CI, Levy YA, Barzilay S, Blum Y, Chistopolskaya K, Çinka E, Dudeck M, Husain MI, Jiménez A, Yilmaz FK, Kuśmirek O, Lee MB, Menon V, Peper-Nascimento J, Sadovnichaya V, Galynker I (2025) Rates and Reasons for Concealing Suicidal Ideation From Clinicians: A Cross-National Examination. Suicide Life-Threat Behav 55(4):e70039. https://doi.org/10.1111/sltb.70039 Pan American Health Organization (2023) Suicide Mortality in the Americas: Regional Report . https://www.paho.org/en/enlace/burden-suicide 5, Gallagher K, Phillips G, Corcoran P, Platt S, McClelland H, O'Driscoll M, Griffin E (2025) The social determinants of suicide: an umbrella review. Epidemiol Rev 47(1):mxaf004. https://doi.org/10.1093/epirev/mxaf004 United Nations (2006) Convention on the Rights of Persons with Disabilities. United Nations, New York. https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf Li ACM, Mak WWS, Chui H (2025) A qualitative study of service user reports of negative experiences regarding therapist practices. J Couns Psychol. Advance online publication https://doi.org/10.1037/cou0000796 Mahdanian AA, Laporta M, Drew Bold N, Funk M, Puras D (2023) Human rights in mental healthcare; A review of current global situation. Int Rev Psychiatry (Abingdon) 35(2):150–162. https://doi.org/10.1080/09540261.2022.2027348 Patterson D (2024) Human Rights-based Approaches and the Right to Health: A Systematic Literature Review. J Hum Rights Pract 16(2):603–623. https://doi.org/10.1093/jhuman/huad063 Szmukler G, Daw R, Callard F (2014) Mental health law and the UN Convention on the rights of Persons with Disabilities. Int J Law Psychiatry 37(3):245–252. https://doi.org/10.1016/j.ijlp.2013.11.024 Beames L, Onwumere J (2022) Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review. J Psychiatr Ment Health Nurs 29(2):220–239. https://doi.org/10.1111/jpm.12757 Bartlett P (2012) The United Nations Convention on the Rights of Persons with Disabilities and Mental Health Law. Mod Law Rev 75(5):752–778. 10.1111/j.1468-2230.2012.00923.x World Health Organization (2021) Comprehensive Mental Health Action Plan 2013–2030 . World Health Organization. https://www.who.int/publications/i/item/9789240031029 World Health Organization (2023) World Mental Health Report: Transforming Mental Health for All. World Health Organization. https://www.who.int/publications/i/item/9789240063600 Agudelo-Hernández F, Cuadrado L, Delgado-Reyes AC (2025) The policies say something else': Psychiatric rehabilitation in Colombia, a necessity amid contradictory public policies. Glob Public Health 20(1):2541233. https://doi.org/10.1080/17441692.2025.2541233 Congreso de la República de Colombia (2019) ). Ley 1996 de 2019. http://www.secretariasenado.gov.co/senado/basedoc/ley_1996_2019.html Agudelo-Hernández F, Andrés Romero E, Quintero-Pulgar Y (2023) Diseño y validez de un instrumento para determinar discapacidad psicosocial asociada a trastornos mentales. Rev Iberoam Diagn Eval Aval Psicol 69(3):161–171. https://dialnet.unirioja.es/servlet/articulo?codigo=9164168 Russell D, Peplau LA, Cutrona CE (1980) The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Personal Soc Psychol 39(3):472–480. https://doi.org/10.1037//0022-3514.39.3.472 Calleja N, Mason TA, Pérez OG (2022) Escala de Bienestar Subjetivo, versión corta (EBS-8): Revalidación, invarianza de medición y teoría de respuesta al ítem. Acta Colombiana de Psicología 25(1):203–217. 10.14718/acp.2022.25.1.13 Vélez-Botero H, Agudelo-Hernández F (2023) Validez y confiabilidad de la Escala Breve de Resiliencia Connor-Davidson para población adulta colombiana. Tesis Psicológica , 18 (1). 10.37511/tesis.v18n1a8 Cassiani-Miranda CA, Cuadros-Cruz AK, Torres-Pinzón H, Scoppetta O, Pinzón-Tarrazona JH, López-Fuentes WY, Paez A, Cabanzo-Arenas DF, Ribero-Marulanda S, Llanes-Amaya ER (2021) Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia. Revista Colombiana de psiquiatria 50(1):11–21. https://doi.org/10.1016/j.rcp.2019.09.001 Agudelo-Hernández F, Vélez-Botero H, Rojas-Andrade R (2023) Alberta en un contexto latinoamericano. Revista Chil de neuro-psiquiatría 61(3):258–269. https://dx.doi.org/10.4067/s0717-92272023000300258 . Traducción y adaptación de la Escala de Continuidad de Servicios de Salud Mental de World Health Organization (2023) World Mental Health Report: Transforming Mental Health for All. World Health Organization. https://www.who.int/publications/i/item/9789240063600 Meda N, Angelozzi L, Poletto M, Patane' A, Zammarrelli J, Slongo I, Sambataro F, De Leo D (2025) How many people die by suicide each year? Not 727,000: a systematic review and meta-analysis of suicide underreporting across 71 countries over 122 years. Front Psychiatry 16:1609580. https://doi.org/10.3389/fpsyt.2025.1609580 World Health Organization (2012) WHO QualityRights Tool Kit: Assessing and Improving Quality and Human Rights in Mental Health and Social Care Facilities. World Health Organization. https://www.who.int/publications/i/item/9789241548410 Funk M, Bold ND (2020) WHO's QualityRights Initiative: Transforming Services and Promoting Rights in Mental Health. Health Hum Rights 22(1):69–75 Wildner M, Fischer R, Brunner A (2002) Development of a questionnaire for quantitative assessment in the field of health and human rights. Soc Sci Med 55(10):1725–1744. https://doi.org/10.1016/s0277-9536(01)00300-8 Eiroa-Orosa FJ, Limiñana-Bravo L (2019) An Instrument to Measure Mental Health Professionals' Beliefs and Attitudes towards Service Users' Rights. Int J Environ Res Public Health 16(2):244. https://doi.org/10.3390/ijerph16020244 Jain V, Zamanian K, Krishnan L (2025) The New Clinician-Scholars-Dual Training in Medicine and Humanities Drives Health Research Innovation. JAMA , 10.1001/jama.2025.15526. Advance online publication. https://doi.org/10.1001/jama.2025.15526 Additional Declarations No competing interests reported. Supplementary Files Supplement1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Jan, 2026 Reviews received at journal 28 Dec, 2025 Reviews received at journal 03 Dec, 2025 Reviewers agreed at journal 19 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers invited by journal 16 Nov, 2025 Editor assigned by journal 11 Nov, 2025 Submission checks completed at journal 31 Oct, 2025 First submitted to journal 25 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7948517","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549029976,"identity":"dc315f1f-5362-4428-a807-b795fddcb8d3","order_by":0,"name":"Felipe Agudelo-Hernández","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYJCCA4wNDAz8IFZCASlaJBtAWgyItQakxeAAiEWMFt327sTDhTts8o3Pr0788MCAQZ5f7AB+LWZnzm44PPNMmuW2G283SwAdZjhzdgIBLTdyNxzmbTtsYHbj7AaQlgSD24S03H8L0vLfwHjG2c0/iNNygxek5YCBAX/vNiJtOQN2WLKBxA3ebRYJBhJE+OX42c2fedvsDPj7z26++aPCRp5fmoAWBJAAq5QgVjkI8B8gRfUoGAWjYBSMJAAApxZKH/VijukAAAAASUVORK5CYII=","orcid":"","institution":"Universidad de Manizales. Manizales","correspondingAuthor":true,"prefix":"","firstName":"Felipe","middleName":"","lastName":"Agudelo-Hernández","suffix":""},{"id":549029977,"identity":"8fb4707b-6872-48b8-8edb-0e307ffe9cee","order_by":1,"name":"Ana Belén Giraldo-Álvarez","email":"","orcid":"","institution":"University of Caldas","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Belén","lastName":"Giraldo-Álvarez","suffix":""}],"badges":[],"createdAt":"2025-10-27 10:58:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7948517/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7948517/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96833334,"identity":"6ef534b3-e5bf-4575-be48-d44f5783d8c3","added_by":"auto","created_at":"2025-11-26 14:18:16","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67042,"visible":true,"origin":"","legend":"","description":"","filename":"FreedomsRightsInstitutionsmain2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/0b7017e724ea00f534ee2242.docx"},{"id":96833333,"identity":"813394d2-8fa5-4eed-90d9-a5059a2e280e","added_by":"auto","created_at":"2025-11-26 14:18:16","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3165,"visible":true,"origin":"","legend":"","description":"","filename":"1215b96f6b5b4392b7e0b21015cd48d8.json","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/a9a09dd940fd92b4111d46e6.json"},{"id":96833336,"identity":"4609c8d5-cc86-4af2-b652-4edee81f5b2f","added_by":"auto","created_at":"2025-11-26 14:18:16","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":138389,"visible":true,"origin":"","legend":"","description":"","filename":"1215b96f6b5b4392b7e0b21015cd48d81enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/6c4dfe773ca27fcf2f96a55e.xml"},{"id":96833337,"identity":"e7d1ddf6-94a5-42d3-bdeb-997f73c43274","added_by":"auto","created_at":"2025-11-26 14:18:16","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135376,"visible":true,"origin":"","legend":"","description":"","filename":"1215b96f6b5b4392b7e0b21015cd48d81structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/6660d6a39b4f54bc06c4b7be.xml"},{"id":96833335,"identity":"31d1c527-e89f-4824-aff7-24aae4e5230b","added_by":"auto","created_at":"2025-11-26 14:18:16","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":144087,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/276baa5ce66b705645be81da.html"},{"id":96917830,"identity":"9b10dc58-94f8-4483-8e15-b547945da95f","added_by":"auto","created_at":"2025-11-27 14:10:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":959919,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/9ffb66d0-52c1-4b9f-9bf9-22dab091f7dc.pdf"},{"id":96833332,"identity":"5d9c03a6-eb27-48d0-8fb4-c553ac331c6a","added_by":"auto","created_at":"2025-11-26 14:18:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19373,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7948517/v1/4e81b17a7c319757673db940.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuicide is one of the leading causes of premature mortality worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and disproportionately affecting young populations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The actual magnitude of this phenomenon is likely significantly higher due to limitations in epidemiological surveillance systems, stigma, and misclassification of causes of death (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Latin America, the epidemiological landscape is particularly concerning. Between 2010 and 2016, the region experienced a 6% increase in suicide rates, with high prevalence among adolescents and young adults, and a marked gender disparity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These findings underscore the need for more effective policies and interventions that address structural inequalities to sustainably reduce suicide mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVarious social determinants have been identified as associated with suicide mortality, including unemployment, job insecurity, low income, lack of social protection, and childhood adversity. Housing conditions, environmental factors, and access to basic services also play a significant role (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These social vulnerabilities intersect with the recognition of fundamental rights, as established by the Convention on the Rights of Persons with Disabilities (CRPD) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNegative experiences with healthcare personnel have been found to be common, with staff failing to recognize these negative experiences. Furthermore, there is an underrepresentation of those seeking these services who have negative experiences (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The CRPD recognizes individuals with psychosocial disabilities as full rights holders, including autonomy, equality before the law, and protection against coercive practices. However, despite its widespread global adoption, deep challenges remain in its implementation, and stigmatizing attitudes persist, particularly within health services (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe WHO QualityRights initiative has been widely adopted as a strategy to implement the principles proposed in the CRPD, through evaluation and training tools aimed at transforming mental health services (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Nevertheless, violations of human rights persist, despite being protected by various international legal frameworks\u0026mdash;especially regarding the principle of autonomy. Involuntary treatments continue to be administered based on clinical diagnosis rather than the individual\u0026rsquo;s decision-making capacity, representing a breach of autonomy in favor of beneficence (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Likewise, coercive practices such as physical restraint and isolation continue to be widely used, with multiple risk factors linked to vulnerability and adverse outcomes for those subjected to them (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These realities highlight the urgent need to strengthen the effective implementation of approaches like QualityRights.\u003c/p\u003e\u003cp\u003eIn this regard, the implementation of the CRPD presents complex and urgent challenges for existing legislation, particularly in the field of mental health. It demands a thorough review of laws that permit coercive practices in the context of disability, alongside the broader structural changes proposed by the CRPD (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This need for normative and structural change is framed within international commitments such as the WHO Comprehensive Mental Health Action Plan 2013\u0026ndash;2030 and Target 3.4 of the Sustainable Development Goals, which promote the reduction of suicide mortality and the strengthening of rights in mental health (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAligned with these commitments, mental health systems in Latin America have historically developed under biomedical paradigms focused on control and coercion rather than recovery and respect for human rights. This operational logic has created a critical gap between care needs and the availability of appropriate resources, exacerbated by the persistence of coercive practices and limited implementation of community-based models (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). On this basis, individuals who survive a suicide attempt face not only the consequences of their individual and psychosocial suffering but also structural barriers, stigmatization, and systematic violations of their fundamental rights.\u003c/p\u003e\u003cp\u003eDepressive symptoms following a suicide attempt are central to understanding suffering, as they negatively impact functionality and the recovery process. The persistence of a depressive mood state after an attempt is a critical factor in maintaining overall symptomatology and increasing the risk of recurrent suicidal behavior, especially during the immediate post-event or post-discharge period. Therefore, addressing depressive symptoms as a therapeutic priority is essential in both clinical interventions and public health strategies, given their direct impact on comprehensive recovery and quality of life (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis regional landscape is also reflected in Colombia, where a sustained increase in suicide attempts has been observed since 2018, particularly among young adults. This phenomenon is linked to structural factors within mental health services, such as workforce overload, stigma toward individuals with mental disorders, limited cultural competence, and the use of coercive practices, all of which have been shown to worsen mental health outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The Law 1996 of 2019 introduces a paradigm shift by eliminating judicial interdiction and recognizing that all persons with disabilities, including psychosocial disabilities, have full legal capacity. This promotes support for decision-making rather than its replacement, in line with the Convention on the Rights of Persons with Disabilities (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, this regulation coexists with clinical practices based on guardianship models, where family members or institutions make decisions about treatments, involuntary hospitalization, or informed consent, highlighting a gap between the principles of autonomy and clinical practice.\u003c/p\u003e\u003cp\u003eAs part of efforts to respond to this issue, the present study was conducted in the Department of Caldas, Colombia, between 2023 and 2025, with the aim of validating an instrument designed to measure knowledge of human rights and the mechanisms for exercising them following a suicide attempt. Complementary objectives included analyzing the relationship between such knowledge, subjective well-being, and depressive symptoms, as well as exploring differences between individuals who recognize their rights and those who do not. The instrument is based on the conceptual framework of the WHO QualityRights program, adapted to the Colombian context.\u003c/p\u003e\u003cp\u003eThe proposed hypotheses are: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The instrument designed to measure knowledge of human rights and the mechanisms for exercising them among individuals who have attempted suicide demonstrates adequate psychometric properties, including a factorial structure consistent with the WHO QualityRights conceptual framework and high internal consistency; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Knowledge of human rights and the mechanisms for enforcing them positively influences the reduction of depressive symptoms following a suicide attempt; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Individuals with greater knowledge of their human rights and the mechanisms for exercising them exhibit higher subjective well-being and lower depressive symptoms after a suicide attempt, compared to those lacking such knowledge.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Context and Participants\u003c/h2\u003e\u003cp\u003eThis was a cross-sectional, population-based study focused on the creation and psychometric validation of a new instrument to assess knowledge of human rights in mental health following a suicide attempt. This study employed random sampling stratified by age, sex, and place of origin from the total population with reported suicide attempts in Caldas, Colombia, during 2023\u0026ndash;2024 (N\u0026thinsp;=\u0026thinsp;1,174). The sample size calculated with a 95% confidence level suggested a minimum of 295 participants. However, a total of 622 individuals was achieved in the sample.\u003c/p\u003e\u003cp\u003eThe study was conducted in the state of Caldas, Colombia\u0026mdash;one of the regions with the highest suicide rates nationally\u0026mdash;and was applied to individuals who had entered mental health services after a suicide attempt. This context highlights the relevance of developing tools that promote rights-based approaches in community mental health services.\u003c/p\u003e\u003cp\u003eParticipants were identified through Colombia\u0026rsquo;s national public health surveillance system (SIVIGILA), which registers suicide attempts as part of mandatory reporting protocols. Data collection took place during the first quarter of 2025. Participants were contacted in person by the research team in collaboration with staff from the Territorial Health Directorate of Caldas, as part of the post-attempt follow-up protocol established in Colombia. Inclusion criteria were having a registered suicide attempt in SIVIGILA and being able to voluntarily participate. Exclusion criteria included refusal to participate, severe comprehension difficulties, or clinical conditions preventing informed understanding of the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eFreedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health\u003c/h2\u003e\u003cp\u003eThe instrument used in this study was titled \u003cem\u003eFreedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health\u003c/em\u003e. It was developed based on the rights outlined in the Convention on the Rights of Persons with Disabilities (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and knowledge of the institutions responsible for enforcing these rights. It consists of 31 dichotomous items (Yes/No) designed to assess knowledge of human rights in the context of community mental health.\u003c/p\u003e\u003cp\u003eTo assess content validity, the Delphi technique was applied. Seven experts participated, with backgrounds in community psychiatry, human rights law, community mental health, health services, and lived experience. Experts were also selected based on their experience in research, human rights advocacy, or psychometrics. Each expert evaluated the items using a digital form, considering ten criteria: clarity, objectivity, relevance, organization, sufficiency, adequacy, consistency, coherence, methodology, and significance. Additionally, they assessed whether each item was understandable to the target population. Each item was categorized as unnecessary, useful, or essential. Based on these ratings, the Content Validity Coefficient (Aiken\u0026rsquo;s V) was calculated using the formula:\u003c/p\u003e\u003cp\u003eIVC = {ne - N/2} {N/2}\u003c/p\u003e\u003cp\u003ewhere \u003cem\u003ene\u003c/em\u003e is the number of experts rating the item as essential, and \u003cem\u003eN\u003c/em\u003e is the total number of experts. The IVC ranges from \u0026minus;\u0026thinsp;1 to +\u0026thinsp;1, with positive scores indicating greater content validity. Items with scores between 0.50 and 0.99 were considered acceptable.\u003c/p\u003e\u003cp\u003eFace validity was assessed through a semi-structured cognitive interview using the final version of the instrument. The goal was to identify and address potential sources of error, thereby improving the tool\u0026rsquo;s quality and effectiveness. The analysis focused on the following areas: comprehension, retrieval, judgment, response option adequacy, and content adequacy. Interviews were conducted in person between April and May 2024 by a physician with a master\u0026rsquo;s degree and training in the technique. Twenty users of mental health services participated, all adults: 12 with incomplete secondary education, six with completed secondary education, and four professionals; 10 men, nine women, and one transgender person; 10 from urban areas, five from semi-urban areas, and five from rural areas.\u003c/p\u003e\u003cp\u003eContent analysis of the interviews was performed by two of the authors. Overall, the items were found to be understandable. Results showed that 95% of participants reported adequate comprehension, retrieval, judgment, and response adequacy for all items. Participants suggested including university legal clinics as institutional resources, noting their accessibility and relevance in the study context (Supplement 1). They also indicated that many rights were familiar but only recognized after being mentioned in the instrument. Three participants noted that presenting these rights in instrument format helped with identification and \u0026ldquo;keeping each right more present\u0026rdquo; \u0026mdash; Woman, age 30.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAdditional scales used\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCaldas Scale: 33 dichotomous items assessing psychosocial disability related to mental disorders across five domains\u0026mdash;treatment adherence, personal and emotional disability, family functioning, social disability, and occupational disability. The occupational domain explores household contributions, satisfaction with daily tasks, and ability to work. Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;.81 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Developed in the study area and recommended in Colombia\u0026rsquo;s Community-Based Rehabilitation strategy.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUCLA Loneliness Scale (10-item version): Adapted for Colombia, measures perceived loneliness with scores ranging from 10 to 40; scores below 20 indicate severe loneliness, and scores between 20 and 30 indicate moderate loneliness (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEBS-8 (Brief Subjective Well-Being Scale): Assesses life satisfaction and affective states; Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;.958 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConnor-Davidson Resilience Scale (CD-RISC-10): Evaluates resilience; validated in Colombia with Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;.827, retaining original factorial structure (20).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePHQ-9 (Patient Health Questionnaire): Used to screen for depressive symptoms; reliability coefficients in Colombian populations range from α\u0026thinsp;=\u0026thinsp;.80 to .86 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAlberta Continuity of Services Scale for Mental Health (ACSS-MH): Assesses perceived continuity of care across relational, informational, and management dimensions; Spanish version validated in Colombia reported total alpha\u0026thinsp;=\u0026thinsp;0.86, with subscale alphas ranging from .63 to .85 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. All procedures involving human subjects/patients were approved by (Masked for review).\u003c/p\u003e\u003cp\u003eAfter learning the objectives of the study, participants signed the informed consent that authorized the use of the information collected for the current study, with restrictions on its availability. The privacy and confidentiality of the information was guaranteed.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData analysis was structured to address the main objectives of the study and was conducted using SPSS software. Data cleaning and quality control procedures were performed, including the identification of outliers and missing values. This included checking for duplicate entries, out-of-range values, and inconsistencies between responses. Missing data were managed using pairwise deletion to preserve the maximum amount of valid information for each analysis. All data were manually verified for accuracy by two independent researchers before statistical processing.\u003c/p\u003e\u003cp\u003eTo evaluate psychometric properties, an exploratory factor analysis (EFA) was performed using principal components extraction and Varimax rotation. Internal consistency for each subscale was calculated using Cronbach\u0026rsquo;s alpha. Spearman\u0026rsquo;s rank-order correlations were computed to explore relationships between variables, as the Kolmogorov-Smirnov test indicated non-normal distributions for most variables. To compare differences between individuals with knowledge of their rights and those without, Mann-Whitney U tests were conducted for each variable. The effect size for the Wilcoxon signed-rank test was calculated using the rank correlation coefficient, r, which is obtained by dividing the Z statistic by the square root of the sample size (Z/\u0026radic;N).\u003c/p\u003e\u003cp\u003eGiven the normal distribution of total PHQ-9 scores, exploratory multivariate linear regression models were applied to explain variability in depressive symptom scores (PHQ-9). In addition, PHQ-9 total scores were converted into dichotomous variables based on established cut-off points for depression, and binary logistic regression was performed for both mild and moderate depression thresholds.\u003c/p\u003e\u003cp\u003eWe report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study.\u003c/p\u003e\u003cp\u003eThis study was not preregistered.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive data\u003c/h2\u003e\u003cp\u003eThe sample consisted of 622 adults (\u0026ge;\u0026thinsp;18 years) who had attempted suicide and were receiving mental health care in the department of Caldas, Colombia. The mean age was 26.71 years (SD\u0026thinsp;=\u0026thinsp;13.89). In terms of education, most had incomplete secondary (39.1%) or completed primary education (34.7%). Clinically, 99% of participants had a prior diagnosis of mental illness.\u003c/p\u003e\u003cp\u003eAccess to mental health services was high: individual psychotherapy (86%), family psychotherapy (97.9%), support groups (97.6%), occupational therapy (98.7%), psychiatry (87.5%), neuropsychology (92.4%), and medication expenses (78.6%). Coercive practices were reported by 7.2% of participants. The human rights scale had a mean score of 14.21 (SD\u0026thinsp;=\u0026thinsp;12.18), indicating wide dispersion in levels of rights recognition and appropriation. Mean scores on the applied scales are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eMeans of Scales and Other Sociodemographic Data\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommon-law union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncomplete primary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompleted primary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncomplete secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompleted secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGraduate (specialization/master\u0026rsquo;s/PhD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiagnosed mental illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychoactive substance use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchizophrenia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttention Deficit Hyperactivity Disorder (ADHD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold spending\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndividual psychotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamily psychotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupport groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e607\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccupational therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeuropsychology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychiatric consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of coercive measures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHas received\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge of health-related rights\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartially\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWell-being\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEBS (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCDRISC (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePHQ-9 (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLoneliness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUCLA (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychosocial disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaldas (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaldas: Treatment adherence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaldas: Occupational disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaldas: Personal disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaldas: Family disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaldas: Social disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContinuity of care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlberta: Relationship with primary caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlberta: Follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlberta: Sensitive treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlberta: Access to health services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlberta: Treatment continuity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDays since last emotional crisis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e300.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e150.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHuman Rights Scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eInstrument Development and Validation\u003c/h2\u003e\u003cp\u003eApparent validity was assessed through expert judgment by individuals with lived experience in mental health. Although no direct pilot testing was conducted with the target population, individuals with lived experience assessed item clarity and accessibility, allowing inference of relevance and comprehensibility. All items received a Content Validity Coefficient (CVC) of 1. Internal reliability was high: Cronbach\u0026rsquo;s alpha for the full scale was .987, and McDonald\u0026rsquo;s omega was .922.\u003c/p\u003e\u003cp\u003eAn exploratory factor analysis (EFA) was conducted using principal components and Varimax rotation. Sampling adequacy was confirmed (KMO\u0026thinsp;=\u0026thinsp;0.968; Bartlett\u0026rsquo;s test of sphericity: χ\u0026sup2; (435)\u0026thinsp;=\u0026thinsp;36,533.86; p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The rotation converged in five iterations. Two components were identified: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Recognition of Personal Rights and Freedoms (α\u0026thinsp;=\u0026thinsp;0.973; 14 items), and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Institutional Participation and Linkage (α\u0026thinsp;=\u0026thinsp;.974; 17 items). Factor loadings ranged from 0.731 to 0.939 for the first component and from .312 to .843 for the second. The rotated component matrix is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003ePsychometric properties of Freedoms, Rights, Institutions (FRI)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecognition of Personal Rights and Freedoms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInstitutional Participation and Linkage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCommunalities\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEquality/Non-discrimination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.791\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.814\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to multiple aspects of society\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.881\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEquality before the law\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.872\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to justice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.861\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to Liberty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.909\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot to be subjected to torture, cruel or degrading treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.867\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.898\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProtection from any form of exploitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.864\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespect for integrity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.934\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFreedom of movement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.837\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.910\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo live independently and be included in the community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.939\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFreedom of expression and access to information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.783\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.901\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to privacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.786\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.947\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to home and family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.911\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.121\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.281\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to habilitation and rehabilitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.881\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to work and employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.712\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.915\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to an adequate standard of living and social protection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.938\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to participate in political and public life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.944\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to participate in cultural, recreational, sports, and leisure activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.940\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to participate in public data and information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.780\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.933\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you know the mechanisms to exercise your rights?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.749\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOmbudsman Office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.836\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttorney General\u0026rsquo;s Office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.760\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.943\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMunicipal Legal Office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.882\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColombian Family Welfare Institute (ICBF)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.810\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.850\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOffice of the United Nations High Commissioner for Human Rights\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.952\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInter-American Court of Human Rights\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.956\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLegal aid office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.803\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.895\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndicators\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCronbach\u0026rsquo;s Alpha\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.973\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.974\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.987\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMcDonald\u0026rsquo;s Omega\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.917\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.936\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlpha based on standardized items\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e.985\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExplained variance (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.375%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.834%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKMO measure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e.966\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBartlett\u0026rsquo;s test of sphericity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eχ\u0026sup2;=35653.172; df\u0026thinsp;=\u0026thinsp;406; Sig\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eA positive correlation was observed between the human rights scale and subjective well-being (ρ\u0026thinsp;=\u0026thinsp;.088; p\u0026thinsp;\u0026lt;\u0026thinsp;.05), and a negative correlation with depressive symptoms (ρ = \u0026ndash;.167; p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Statistically significant differences were found between groups based on exposure to coercive practices in total rights scores (U\u0026thinsp;=\u0026thinsp;9920; p\u0026thinsp;=\u0026thinsp;.007), subjective well-being (U\u0026thinsp;=\u0026thinsp;10068.5; p\u0026thinsp;=\u0026thinsp;0.012), and depressive symptoms (U\u0026thinsp;=\u0026thinsp;10109; p\u0026thinsp;=\u0026thinsp;.012), with small effect sizes (r\u0026thinsp;=\u0026thinsp;.10). A significant difference was also observed in health rights knowledge (U\u0026thinsp;=\u0026thinsp;3607; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with a large effect size (r\u0026thinsp;=\u0026thinsp;.54).\u003c/p\u003e\u003cp\u003eA multiple linear regression model was estimated with six predictors, explaining 49.4% of the variance in depressive symptoms (PHQ-9) (adjusted R\u0026sup2; = .494; F (6.614)\u0026thinsp;=\u0026thinsp;101.85; p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Significant coefficients included: institutional participation and linkage (B = \u0026ndash;.087; β = \u0026ndash;.134; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), subjective well-being (B = \u0026ndash;.292; β = \u0026ndash;.445; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), perceived loneliness (B\u0026thinsp;=\u0026thinsp;.190; β\u0026thinsp;=\u0026thinsp;.216; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), psychosocial disability (Caldas; B\u0026thinsp;=\u0026thinsp;.165; β\u0026thinsp;=\u0026thinsp;.133; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), anxiety diagnosis (B\u0026thinsp;=\u0026thinsp;.843; β\u0026thinsp;=\u0026thinsp;.092; p\u0026thinsp;=\u0026thinsp;.002), and family spending on support groups (B\u0026thinsp;=\u0026thinsp;1.824; β\u0026thinsp;=\u0026thinsp;.063; p\u0026thinsp;=\u0026thinsp;.028). Collinearity diagnostics showed acceptable tolerance and VIF values (VIF range: 1.01\u0026ndash;2.02); residuals were independent (Durbin-Watson\u0026thinsp;=\u0026thinsp;1.881). Full coefficients are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eLinear Regression Model for Depressive Symptoms (PHQ-9)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBeta\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% CI Lower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% CI Upper\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTolerance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.672\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.978\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTOTAL EBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.445\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-10.971\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.496\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTOTAL UCLA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstitutional Participation and Linkage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-4.641\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Caldas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.210\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety Diagnosis History\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.318\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.963\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.039\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Spending on Support Groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eNote\u003c/em\u003e: B\u0026thinsp;=\u0026thinsp;unstandardized coefficient; SE\u0026thinsp;=\u0026thinsp;standard error; Beta\u0026thinsp;=\u0026thinsp;standardized coefficient; 95% CI\u0026thinsp;=\u0026thinsp;95% confidence interval for B; VIF\u0026thinsp;=\u0026thinsp;variance inflation factor. Predictors with VIF\u0026thinsp;\u0026gt;\u0026thinsp;5 should be interpreted with caution due to potential multicollinearity. Dependent variable: Depressive symptoms (PHQ-9).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eSquared semi-partial correlations (sr\u0026sup2;) were calculated to estimate the unique contribution of each predictor: subjective well-being (sr\u0026sup2; \u0026asymp; .16), loneliness (sr\u0026sup2; \u0026asymp; .04), institutional participation (sr\u0026sup2; \u0026asymp; .03), and other predictors such as disability, anxiety diagnosis, and support group spending (sr\u0026sup2; \u0026asymp; .01\u0026ndash;.03). Additionally, an exploratory logistic regression model was estimated including total human rights knowledge scores. This predictor was statistically significant (B = \u0026ndash;.199; OR\u0026thinsp;=\u0026thinsp;082; p\u0026thinsp;=\u0026thinsp;.030).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to validate an instrument for assessing knowledge of human rights and the mechanisms for exercising them following a suicide attempt. The findings support this objective, demonstrating a coherent factorial structure aligned with the WHO QualityRights framework, strong internal consistency, excellent content validity, and optimal sample adequacy. Secondary analyses examined associations between rights knowledge, subjective well-being, and depressive symptoms, as well as differences between individuals who recognize their rights and those who do not. Knowledge of human rights was significantly associated with lower depressive symptoms and higher subjective well-being, suggesting a potential protective role in emotional recovery. These findings are consistent with recent reports indicating that rights-based agency in mental health may enhance autonomy and reduce emotional distress (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese results are contextualized within a regional landscape characterized by structural vulnerabilities, stigma, and limited access to mental health services, which hinder the recognition and exercise of mental health rights (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Latin America, poverty, social exclusion, structural violence, and lack of social protection have been identified as risk factors for suicidal behavior, particularly among adolescents and young adults (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMultivariate analysis revealed significant associations between depressive symptoms and variables including subjective well-being, loneliness, psychosocial disability, anxiety history, and household spending on support groups. These findings align with prior research identifying childhood adversity, economic hardship, and social exclusion as key risk factors for suicidal behavior (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSignificant differences were also observed between individuals who had experienced coercion and those who had not, across all variables analyzed. Effect sizes were small, except for knowledge of health-related rights, which showed a large effect. This supports the instrument\u0026rsquo;s sensitivity to experiences of rights violations and its potential utility in evaluating institutional practices from the perspective of individuals with lived experience. Studies emphasize that one way to reduce the harm that experiences of abuse often cause is to have effective mechanisms for making them visible (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Prior literature has documented systematic rights violations among individuals with mental health conditions, especially in institutional and coercive settings (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite growing international interest, measurement of human rights knowledge and exercise in mental health remains limited, particularly from the user perspective. The WHO QualityRights Tool Kit is the most widely recognized instrument, designed to assess compliance with human rights standards in mental health and social care services, in line with the Convention on the Rights of Persons with Disabilities (CRPD) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, its institutional focus does not address individual knowledge appropriation or lived experience (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOther tools, such as HRXSW and HRESW, have been used in educational contexts, particularly among medical and social work students in Colombia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). While useful for evaluating training interventions, their applicability to populations with lived experience is limited, and they do not directly assess mental health rights or institutional mechanisms. The HR-14 provides a broad assessment of perceived human rights status, including the health system (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (Wildner et al., 2002), but its general scope limits its utility in identifying specific mental health knowledge.\u003c/p\u003e\u003cp\u003eThe scale developed by Eiroa-Orosa and Limi\u0026ntilde;ana-Bravo en 2019 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) targets mental health professionals and assesses beliefs and attitudes toward the rights of individuals with lived experience. Although informative for care environments, it does not evaluate direct knowledge or the capacity to exercise rights in real-world settings. The instrument developed in this study represents a novel contribution by integrating principles of the CRPD (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and constructing its items from the perspective of individuals with lived experience. Its factorial structure revealed two solid components: recognition of personal rights and freedoms, and institutional participation. Unlike previous instruments, this questionnaire seeks to capture the degree of appropriation, understanding, and connection with institutional mechanisms, thereby expanding its applicability in both community and clinical settings.\u003c/p\u003e\u003cp\u003eTaken together, these findings affirm that the validated instrument not only meets the required psychometric criteria but also offers a valuable tool for identifying structural gaps in mental health systems and service delivery, guiding human rights\u0026ndash;centered interventions, and strengthening the empowerment of individuals in situations of psychosocial vulnerability. In this regard, the findings of the present study not only support the psychometric validity of the instrument but also reinforce the need for clinical and community teams to understand human rights knowledge from the standpoint of lived experience as part of comprehensive training\u0026mdash;placing lived experience at the center of professional development.\u003c/p\u003e\u003cp\u003eSuch understanding requires interpretive, ethical, and contextual competencies to address inseparable clinical, social, and structural challenges, advance sensitive lines of research, and improve care in complex settings. Training professionals with both clinical and humanistic competencies\u0026mdash;through a dual-model approach\u0026mdash;not only enhances clinical practice but also drives scientific innovation and contributes to closing structural gaps in mental health (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese findings are consistent with recent scholarship emphasizing the importance of participatory ethics and rights-based frameworks that prioritize individual agency and accountability in mental health systems (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) (Patterson, 2024). In this sense, the validated instrument contributes not only to psychometric evaluation but also to the advancement of inclusive, ethical, and transformative approaches in psychosocial care\u0026mdash;reinforcing the relevance of rights recognition as a foundation for recovery and empowerment.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study has limitations that should be considered. Its cross-sectional design precludes causal inferences between human rights knowledge and emotional well-being. Moreover, the focus on individuals with recent suicide attempts limits generalizability to broader populations with psychosocial disabilities. Although the instrument demonstrated robust psychometric properties, its application was restricted to a single department in Colombia, and intercultural validation is needed in other Latin American countries.\u003c/p\u003e\u003cp\u003eFurthermore, while the perspective of individuals with lived experience was incorporated, the inclusion of Indigenous, rural, or digitally excluded communities was not controlled for, which may affect representativeness. A significant portion of the sample had not been hospitalized or exposed to coercive practices, limiting the study\u0026rsquo;s ability to assess the instrument in clinical contexts where such experiences are more common. This lack of balance may restrict the generalization of findings to institutional settings.\u003c/p\u003e\u003cp\u003eThe study did not examine clinical or institutional factors\u0026mdash;such as type of care or treatment setting\u0026mdash;that may influence the appropriation of rights. Future research should address these variables and incorporate longitudinal designs to assess the sustained impact of rights knowledge on psychosocial recovery. Additional studies could also evaluate the scale\u0026rsquo;s applicability across diverse experiences of psychosocial distress in both clinical and community settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides strong evidence of the link between human rights knowledge and emotional well-being following a suicide attempt, highlighting its potential protective role against depressive symptoms during the recovery process. The psychometric validation of the instrument confirms its utility for assessing rights knowledge and exercise from the perspective of lived experience, moving beyond previous institutional approaches.\u003c/p\u003e\u003cp\u003eIn the Latin American context, marked by inequality, stigma, and exclusion, advancing human rights recognition and education in mental health is essential to strengthen personal agency, reduce psychosocial suffering, and guide more equitable public policies. The instrument developed represents a step toward guaranteeing rights in the field of psychosocial disability, with potential to close structural gaps and promote more dignified and participatory environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo Adiela Hern\u0026aacute;ndez-Guti\u0026eacute;rrez for the methodological support and insights. To Dr. Gloria In\u0026eacute;s Saldarriaga Toro, for allowing peer support to advance in mental health services in Caldas, Colombia, despite the barriers of the health system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare. The opinions and concepts expressed in this manuscript are the sole responsibility of the authors.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCRediT author statement\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eFelipe Agudelo-Hern\u0026aacute;ndez\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization\u003cbr\u003eData curation\u003cbr\u003eFormal analysis\u003cbr\u003eInvestigation\u003cbr\u003eMethodology\u003cbr\u003eSoftware\u003cbr\u003eSupervision\u003cbr\u003eValidation\u003cbr\u003eVisualization\u003cbr\u003eWriting \u0026ndash; original draft\u003cbr\u003eWriting \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAna Bel\u0026eacute;n Giraldo-\u0026Aacute;lvarez\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization\u003cbr\u003eFormal analysis\u003cbr\u003eMethodology\u003cbr\u003eValidation\u003cbr\u003eVisualization\u003cbr\u003eWriting \u0026ndash; original draft\u003cbr\u003eWriting \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis data is available for consultation upon request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. All procedures involving human subjects/patients were approved by the Bioethics Committee of the Caldas Territorial Directorate and the University of Manizales (acta CB_04-2025). After learning the objectives of the study, participants signed the informed consent that authorized the use of the information collected for the current study, with restrictions on its availability. The privacy and confidentiality of the information was guaranteed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKim S, Woo S, Kim N, Lee H, Park J, Kim T, Yon DK (2025) Global, regional and national trends in suicide mortality rates across 102 countries from 1990 to 2021 with projections up to 2050. Nat Mental Health 1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s44220-025-00474-8\u003c/span\u003e\u003cspan address=\"10.1038/s44220-025-00474-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLovero KL, Santos D, Come PF, Wainberg AX, M. L., Oquendo MA (2023) Suicide in Global Mental Health. Curr psychiatry Rep 25(6):255\u0026ndash;262. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11920-023-01423-x\u003c/span\u003e\u003cspan address=\"10.1007/s11920-023-01423-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeterkin D, Rogers ML, Lawrence OC, Richards J, Zheng S, Astudillo-Garc\u0026iacute;a CI, Levy YA, Barzilay S, Blum Y, Chistopolskaya K, \u0026Ccedil;inka E, Dudeck M, Husain MI, Jim\u0026eacute;nez A, Yilmaz FK, Kuśmirek O, Lee MB, Menon V, Peper-Nascimento J, Sadovnichaya V, Galynker I (2025) Rates and Reasons for Concealing Suicidal Ideation From Clinicians: A Cross-National Examination. Suicide Life-Threat Behav 55(4):e70039. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/sltb.70039\u003c/span\u003e\u003cspan address=\"10.1111/sltb.70039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePan American Health Organization (2023) \u003cem\u003eSuicide Mortality in the Americas: Regional Report\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.paho.org/en/enlace/burden-suicide\u003c/span\u003e\u003cspan address=\"https://www.paho.org/en/enlace/burden-suicide\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e5, Gallagher K, Phillips G, Corcoran P, Platt S, McClelland H, O'Driscoll M, Griffin E (2025) The social determinants of suicide: an umbrella review. Epidemiol Rev 47(1):mxaf004. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/epirev/mxaf004\u003c/span\u003e\u003cspan address=\"10.1093/epirev/mxaf004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited Nations (2006) Convention on the Rights of Persons with Disabilities. United Nations, New York. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.un.org/disabilities/documents/convention/convoptprot-e.pdf\u003c/span\u003e\u003cspan address=\"https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi ACM, Mak WWS, Chui H (2025) A qualitative study of service user reports of negative experiences regarding therapist practices. J Couns Psychol. Advance online publication \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/cou0000796\u003c/span\u003e\u003cspan address=\"10.1037/cou0000796\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahdanian AA, Laporta M, Drew Bold N, Funk M, Puras D (2023) Human rights in mental healthcare; A review of current global situation. Int Rev Psychiatry (Abingdon) 35(2):150\u0026ndash;162. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09540261.2022.2027348\u003c/span\u003e\u003cspan address=\"10.1080/09540261.2022.2027348\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatterson D (2024) Human Rights-based Approaches and the Right to Health: A Systematic Literature Review. J Hum Rights Pract 16(2):603\u0026ndash;623. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jhuman/huad063\u003c/span\u003e\u003cspan address=\"10.1093/jhuman/huad063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzmukler G, Daw R, Callard F (2014) Mental health law and the UN Convention on the rights of Persons with Disabilities. Int J Law Psychiatry 37(3):245\u0026ndash;252. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijlp.2013.11.024\u003c/span\u003e\u003cspan address=\"10.1016/j.ijlp.2013.11.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeames L, Onwumere J (2022) Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review. J Psychiatr Ment Health Nurs 29(2):220\u0026ndash;239. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jpm.12757\u003c/span\u003e\u003cspan address=\"10.1111/jpm.12757\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBartlett P (2012) The United Nations Convention on the Rights of Persons with Disabilities and Mental Health Law. Mod Law Rev 75(5):752\u0026ndash;778. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1468-2230.2012.00923.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1468-2230.2012.00923.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2021) \u003cem\u003eComprehensive Mental Health Action Plan 2013\u0026ndash;2030\u003c/em\u003e. World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240031029\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240031029\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2023) World Mental Health Report: Transforming Mental Health for All. World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240063600\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240063600\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgudelo-Hern\u0026aacute;ndez F, Cuadrado L, Delgado-Reyes AC (2025) The policies say something else': Psychiatric rehabilitation in Colombia, a necessity amid contradictory public policies. Glob Public Health 20(1):2541233. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/17441692.2025.2541233\u003c/span\u003e\u003cspan address=\"10.1080/17441692.2025.2541233\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCongreso de la Rep\u0026uacute;blica de Colombia (2019) ). \u003cem\u003eLey 1996 de 2019.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.secretariasenado.gov.co/senado/basedoc/ley_1996_2019.html\u003c/span\u003e\u003cspan address=\"http://www.secretariasenado.gov.co/senado/basedoc/ley_1996_2019.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgudelo-Hern\u0026aacute;ndez F, Andr\u0026eacute;s Romero E, Quintero-Pulgar Y (2023) Dise\u0026ntilde;o y validez de un instrumento para determinar discapacidad psicosocial asociada a trastornos mentales. Rev Iberoam Diagn Eval Aval Psicol 69(3):161\u0026ndash;171. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dialnet.unirioja.es/servlet/articulo?codigo=9164168\u003c/span\u003e\u003cspan address=\"https://dialnet.unirioja.es/servlet/articulo?codigo=9164168\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRussell D, Peplau LA, Cutrona CE (1980) The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Personal Soc Psychol 39(3):472\u0026ndash;480. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037//0022-3514.39.3.472\u003c/span\u003e\u003cspan address=\"10.1037//0022-3514.39.3.472\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCalleja N, Mason TA, P\u0026eacute;rez OG (2022) Escala de Bienestar Subjetivo, versi\u0026oacute;n corta (EBS-8): Revalidaci\u0026oacute;n, invarianza de medici\u0026oacute;n y teor\u0026iacute;a de respuesta al \u0026iacute;tem. Acta Colombiana de Psicolog\u0026iacute;a 25(1):203\u0026ndash;217. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.14718/acp.2022.25.1.13\u003c/span\u003e\u003cspan address=\"10.14718/acp.2022.25.1.13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eV\u0026eacute;lez-Botero H, Agudelo-Hern\u0026aacute;ndez F (2023) Validez y confiabilidad de la Escala Breve de Resiliencia Connor-Davidson para poblaci\u0026oacute;n adulta colombiana. \u003cem\u003eTesis Psicol\u0026oacute;gica\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.37511/tesis.v18n1a8\u003c/span\u003e\u003cspan address=\"10.37511/tesis.v18n1a8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCassiani-Miranda CA, Cuadros-Cruz AK, Torres-Pinz\u0026oacute;n H, Scoppetta O, Pinz\u0026oacute;n-Tarrazona JH, L\u0026oacute;pez-Fuentes WY, Paez A, Cabanzo-Arenas DF, Ribero-Marulanda S, Llanes-Amaya ER (2021) Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia. Revista Colombiana de psiquiatria 50(1):11\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.rcp.2019.09.001\u003c/span\u003e\u003cspan address=\"10.1016/j.rcp.2019.09.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgudelo-Hern\u0026aacute;ndez F, V\u0026eacute;lez-Botero H, Rojas-Andrade R (2023) Alberta en un contexto latinoamericano. Revista Chil de neuro-psiquiatr\u0026iacute;a 61(3):258\u0026ndash;269. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.doi.org/10.4067/s0717-92272023000300258\u003c/span\u003e\u003cspan address=\"10.4067/s0717-92272023000300258\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Traducci\u0026oacute;n y adaptaci\u0026oacute;n de la Escala de Continuidad de Servicios de Salud Mental de\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2023) World Mental Health Report: Transforming Mental Health for All. World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240063600\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240063600\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeda N, Angelozzi L, Poletto M, Patane' A, Zammarrelli J, Slongo I, Sambataro F, De Leo D (2025) How many people die by suicide each year? Not 727,000: a systematic review and meta-analysis of suicide underreporting across 71 countries over 122 years. Front Psychiatry 16:1609580. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2025.1609580\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2025.1609580\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2012) WHO QualityRights Tool Kit: Assessing and Improving Quality and Human Rights in Mental Health and Social Care Facilities. World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241548410\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241548410\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFunk M, Bold ND (2020) WHO's QualityRights Initiative: Transforming Services and Promoting Rights in Mental Health. Health Hum Rights 22(1):69\u0026ndash;75\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWildner M, Fischer R, Brunner A (2002) Development of a questionnaire for quantitative assessment in the field of health and human rights. Soc Sci Med 55(10):1725\u0026ndash;1744. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0277-9536(01)00300-8\u003c/span\u003e\u003cspan address=\"10.1016/s0277-9536(01)00300-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEiroa-Orosa FJ, Limi\u0026ntilde;ana-Bravo L (2019) An Instrument to Measure Mental Health Professionals' Beliefs and Attitudes towards Service Users' Rights. Int J Environ Res Public Health 16(2):244. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph16020244\u003c/span\u003e\u003cspan address=\"10.3390/ijerph16020244\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain V, Zamanian K, Krishnan L (2025) The New Clinician-Scholars-Dual Training in Medicine and Humanities Drives Health Research Innovation. \u003cem\u003eJAMA\u003c/em\u003e, 10.1001/jama.2025.15526. Advance online publication. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2025.15526\u003c/span\u003e\u003cspan address=\"10.1001/jama.2025.15526\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"social-psychiatry-and-psychiatric-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sppe","sideBox":"Learn more about [Social Psychiatry and Psychiatric Epidemiology](http://link.springer.com/journal/127)","snPcode":"127","submissionUrl":"https://submission.nature.com/new-submission/127/3","title":"Social Psychiatry and Psychiatric Epidemiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Psychosocial Recovery, Suicide, Mental Health, Rights-Based Approach","lastPublishedDoi":"10.21203/rs.3.rs-7948517/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7948517/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis community-based, population-level study aimed to validate an instrument for assessing knowledge of human rights and mechanisms for exercising them, and to explore its relationship with subjective well-being and depressive symptoms in Colombia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 622 adults participated in an analytical cross-sectional and population study. Participants completed the Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health, alongside validated scales for subjective well-being, resilience, depressive symptoms, loneliness, psychosocial disability, and continuity of care.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe FRI instrument demonstrated excellent content validity (IVC\u0026thinsp;=\u0026thinsp;1), high internal consistency (α\u0026thinsp;=\u0026thinsp;0.987; ω\u0026thinsp;=\u0026thinsp;0.922), and a robust factorial structure (KMO\u0026thinsp;=\u0026thinsp;0.968; Bartlett p\u0026thinsp;\u0026lt;\u0026thinsp;.001), revealing two components: recognition of personal rights and freedoms, and institutional participation. Significant correlations were found between human rights knowledge and lower depressive symptoms (ρ = \u0026minus;\u0026thinsp;0.167; OR\u0026thinsp;=\u0026thinsp;0.82; p\u0026thinsp;=\u0026thinsp;.030), as well as higher subjective well-being (ρ\u0026thinsp;=\u0026thinsp;0.088; p\u0026thinsp;\u0026lt;\u0026thinsp;.05). A linear regression model explained 49.4% of the variance in depression, underscoring the protective role of institutional participation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThese findings support the validity of the FRI instrument and its relevance for designing rights-based mental health interventions. By strengthening individual agency and promoting dignified, participatory environments, this tool offers a pathway for advancing psychosocial recovery and equity in mental health at the population level.\u003c/p\u003e","manuscriptTitle":"Freedoms, Rights, Institutions (FRI): A Tool for Human Rights in Mental Health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 14:18:11","doi":"10.21203/rs.3.rs-7948517/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-08T17:38:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T13:56:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-03T12:48:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15034524762851892459522813342752122705","date":"2025-11-19T11:16:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20064810340533838877323097565903179276","date":"2025-11-17T10:52:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227322280674456470522291586347248028571","date":"2025-11-17T07:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-17T02:36:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-11T05:10:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-31T11:21:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Social Psychiatry and Psychiatric Epidemiology","date":"2025-10-25T22:54:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"social-psychiatry-and-psychiatric-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sppe","sideBox":"Learn more about [Social Psychiatry and Psychiatric Epidemiology](http://link.springer.com/journal/127)","snPcode":"127","submissionUrl":"https://submission.nature.com/new-submission/127/3","title":"Social Psychiatry and Psychiatric Epidemiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"59f04383-7f1b-4f82-b58e-c40728970015","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-13T12:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 14:18:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7948517","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7948517","identity":"rs-7948517","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}