AI health literacy as a foundation for responsible AI in healthcare: a framework for trustworthy implementation.

This study provides one of the first large-scale community-based examinations from Africa on the prevalence, structure and clinical relevance of dissociative experiences among youth. The findings contribute to the existing knowledge about the dissociative phenomenon in the non-Western environment and provide strong evidence regarding their correlation with the risk of psychosis. Notably, daydreaming and perceptual distortions were identified as the most prominent and clinically significant dimensions, differentiating high-risk participants and their low-risk counterparts. In contrast, dissociation was not significantly linked to mood disorder risk. These findings have implications for early detection and intervention methods in low-resource African contexts. By defining the presence of dissociative experiences as possible indicators of early detection, the study contributes to the creation of culturally sensitive screening tools and community-based prevention programs. This research provides a groundwork for longitudinal and intervention studies, which can help to screen youth who are at high risk of schizophrenia and enhance mental health outcomes among different African communities. Dissociative experiences encompass disruptions in consciousness, memory, identity and perception and can range from mild, everyday phenomena to pathological manifestations (Dell, ; Lyssenko et al., ). Globally, dissociative experiences such as perceptual distortions, intense daydreaming and memory lapses have been closely linked to trauma exposure and disruptions in identity integration (Soffer-Dudek and Somer, ). Within this spectrum, maladaptive daydreaming (MD) has emerged as a distinct condition characterized by excessive, immersive fantasy that causes significant distress and functional impairment. A major contribution is the Israeli epidemiological study (Soffer-Dudek and Somer, ), which used the Maladaptive Daydreaming Scale-16 (MDS-16) among approximately 1,000 community and student participants. The study reported a self-identified prevalence of 4.2%, particularly among younger adults and students, which decreased to about 2.5% following clinical interviews, highlighting the importance of diagnostic validation. The findings further demonstrated that MD is distinct from normative mind-wandering and attentional difficulties, supporting its classification as a dissociative phenomenon. Together with earlier scale development (Somer et al., ) and cross-cultural validation studies (Soffer-Dudek et al., ), this evidence supports arguments for the inclusion of MD within dissociative disorders in psychiatric diagnostic frameworks (Soffer-Dudek et al., ). In Hungary, a study involving over 700 participants found that individuals reporting MD also exhibited significantly higher dissociative tendencies, particularly in identity confusion and diminished control over mental processes (Sándor et al., ). Notably, dissociation mediated the relationship between childhood trauma and MD, suggesting that early adverse experiences may foster both self-detachment and immersive fantasy as coping mechanisms. Dissociative experiences are not evenly distributed across populations but vary systematically by sociodemographic factors, including gender, age, education and socioeconomic position (Ross et al., ; Van IJzendoorn and Schuengel, ; Kate et al., ; Saini et al., ). Low socioeconomic status and poverty-related adversity, often operationalized through wealth indices in low- and middle-income countries, are associated with increased exposure to trauma, chronic stress and reduced access to psychosocial resources, which in turn may elevate vulnerability to dissociative symptoms (Kohl, ; Klest, ; Boyer et al., ).