[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-studies-list:{\"conditionNormalized\":\"depressionanxiety\",\"overallStatus\":[\"RECRUITING\",\"AVAILABLE\",\"NOT_YET_RECRUITING\"],\"orderBy\":\"LastUpdateSubmitDate:desc\",\"size\":25,\"offset\":0}":3,"health-study-condition:depressionanxiety":27},{"pageToken":4,"total":5,"offset":6,"count":5,"results":7},null,7,0,[8,45,82,109,138,174,203],{"id":9,"slug":10,"hasResults":11,"nctId":12,"briefTitle":13,"officialTitle":13,"acronym":4,"eligibilityCriteria":14,"healthyVolunteers":11,"sex":15,"minAge":16,"maxAge":4,"enrollmentInfo":17,"targetDuration":4,"studyType":20,"phases":21,"briefSummary":23,"conditions":24,"keywords":28,"overallStatus":32,"whyStopped":4,"lastUpdateSubmitDate":33,"lastUpdatePostDateStruct":34,"startDateStruct":37,"completionDateStruct":39,"leadSponsor":41,"locationsCount":44},"100540601","examining-the-efficacy-of-a-digital-therapeutic-to-prevent-suicidal-behaviors-100540601",false,"NCT06318962","Examining the Efficacy of a Digital Therapeutic to Prevent Suicidal Behaviors","Inclusion Criteria:\n\n* at least 18 years old\n* suicidal ideation within the past week and\u002For a suicide attempt within the past 30 days\n* ability to complete the informed consent process\n* ownership of either an Apple iPhone iOS 11 or higher or an Android smartphone OS 8.1 or higher\n\nExclusion Criteria:\n\n* an inability to complete informed consent procedures (e.g., acute intoxication, altered consciousness)\n* experiencing active psychosis or mania requiring hospitalization; (3) and inability to use a smartphone.","ALL","18 Years",{"count":18,"type":19},400,"ESTIMATED","INTERVENTIONAL",[22],"NA","The primary aim of the project is to test the efficacy of BCBT delivered via a digital platform (i.e., smartphone) to Servicemembers with recent suicidal ideation and\u002For suicide attempts presenting to primary care clinics. Given existing challenges of scaling empirically-supported treatments\u002Finterventions for suicidality with fidelity, this project could lead to markedly expanded access to BCBT, along with improving our understanding about what intervention strategies are most effective and how they can be delivered with meaningful fidelity. Aviva, the digital version of BCBT, was developed for use with patients across the full spectrum of healthcare settings, including primary care. Aviva is not an emergency alert system, rather a digital platform for delivery of the full scope of BCBT treatment components. An open-label single group Phase I clinical trial has demonstrated the safety, tolerability, feasibility, fidelity, and potential efficacy of Aviva, with participants completing modules over 8 weeks, and follow-up assessments at weeks 1, 4, and 8. Subsequent refinements included the addition of technical features that would allow patients to revisit and\u002For repeat previously completed modules, along with integration of more characters for delivering video vignettes and greater opportunities for skills practice and treatment engagement. These modifications have further enhanced Aviva safety, tolerability, and fidelity, consistent with the original BCBT protocol. Not only is it hypothesized that Aviva will result in significantly larger reductions in severity of suicidal ideation than participants randomized to the control condition, but also that greater app engagement will be negatively correlated with severity of suicidal thinking. Moderators and mediators (i.e. suicidal beliefs, wish to live, impulsive decision-making) of intervention effects will also be examined. The study will be conducted at the primary care clinics at Fort Carson, with a goal of enrolling 720 patients across a two-year timeframe. Participants will be identified using each clinic's existing suicide risk assessment methods, including the PHQ-9 suicide risk item and a score of 1 or higher on the CSSRS Screener (Recent). Participants will be randomly assigned to one of two treatment conditions, Aviva or control (i.e., development of a safety plan consistent with local procedures and policies, along with referral for standard mental health care and suicide risk management in accordance with local policies and procedures). In an effort to address potential performance bias specific to smartphone use, participants in the control condition will download the Suicide Safety Plan app to their smartphones. Those in the Aviva condition will also complete weekly check-ins with Project 2 research clinicians to review treatment adherence, identify and respond to any logistical\u002Foperational problems, and respond to any unexpected emergencies and\u002For participant safety concerns. Participants will have up to five data points: baseline, 3, 6, 9, and 12 months. All data available from all participants and all time points will be included in the analyses, consistent with the intent-to-treat principle. Across our two previous clinical trials and our in-progress RCT, attrition during the first 12 months postbaseline was \\<30% and we anticipate similar rates in this trial.",[25,26,27],"Suicidal Behaviors","Suicide Ideation","Depression\u002FAnxiety",[29,26,30,31],"BCBT","Suicide Attempts","Depression and Anxiety","RECRUITING","2026-05-04",{"date":35,"type":36},"2026-05-05","ACTUAL",{"date":38,"type":36},"2024-02-07",{"date":40,"type":19},"2027-08-01",{"name":42,"class":43},"University of Memphis","OTHER",1,{"id":46,"slug":47,"hasResults":11,"nctId":48,"briefTitle":49,"officialTitle":50,"acronym":4,"eligibilityCriteria":51,"healthyVolunteers":11,"sex":15,"minAge":52,"maxAge":16,"enrollmentInfo":53,"targetDuration":4,"studyType":20,"phases":55,"briefSummary":56,"conditions":57,"keywords":65,"overallStatus":32,"whyStopped":4,"lastUpdateSubmitDate":72,"lastUpdatePostDateStruct":73,"startDateStruct":75,"completionDateStruct":77,"leadSponsor":79,"locationsCount":44},"100541054","start-now-adapted-culturally-adapted-version-of-start-now-100541054","NCT06324864","START NOW Adapted: Culturally Adapted Version of START NOW","Testing the Effectiveness of the Culturally Adapted Skills Training START NOW to Reduce Mental Health Problems in Adolescent Refugees","Inclusion Criteria:\n\n* Being a migrant resettled in Switzerland temporarily or permanently\n* Aged between 14 and 18\n* Able to speak, read and understand one of the following languages: German, English, Turkish, Farsi, Dari, Ukrainian, Algerian Arabic or Pashto\n* Able to give informed consent as documented by signature\n* At least sub-clinical depressive symptoms assessed by the Hopkins Symptom Checklist-25 (HSCL-25); total score \\> 1.75, OR\n* Having elevated levels of psychological distress assessed by Kessler Psychological Distress Scale (K10); total score \\> 20\n\nExclusion Criteria:\n\n* Suicidality assessed in self-report by the Suicide Behaviors Questionnaire-Revised (SBQ-R; total score \\> 6) and external report by telephone clarification\n* Planning to leave Switzerland in the next 6 months\n* Concurrent CBT-based skills-training similar to START NOW","14 Years",{"count":54,"type":19},80,[22],"The goal of this clinical trial is to test the effectiveness of the culturally adapted skills-training START NOW in youth migrant populations. The main question it aims to answer is: Is the culturally adapted skills training START NOW more effective than treatment as usual (TAU) in reducing mental health problems in migrants? Participants will be randomly assigned to the intervention group receiving the skills training START NOW Adapted or the control group receiving TAU. Researchers will compare both groups to see if START NOW Adapted is more effective than TAU in reducing mental health problems in migrants.",[58,27,59,60,61,62,63,64],"Depression","Anxiety","Adolescent","Emotion Recognition","Mental Health","Resilience,Psychological","Refugee Health",[66,67,68,69,70,71],"randomized controlled trial","effectiveness trial","refugee health","cultural adaptation","skills-training","adolescent migrants","2026-02-17",{"date":74,"type":36},"2026-02-19",{"date":76,"type":36},"2024-03-13",{"date":78,"type":19},"2026-12",{"name":80,"class":81},"Prof. Christina Stadler","NETWORK",{"id":83,"slug":84,"hasResults":11,"nctId":85,"briefTitle":86,"officialTitle":87,"acronym":88,"eligibilityCriteria":89,"healthyVolunteers":90,"sex":15,"minAge":16,"maxAge":91,"enrollmentInfo":92,"targetDuration":4,"studyType":20,"phases":94,"briefSummary":95,"conditions":96,"keywords":97,"overallStatus":32,"whyStopped":4,"lastUpdateSubmitDate":100,"lastUpdatePostDateStruct":101,"startDateStruct":103,"completionDateStruct":105,"leadSponsor":107,"locationsCount":44},"100574327","acceptability-and-feasibility-of-an-in-person-8-week-mindfulness-based-cognitive-therapy-program-among-undergraduates-100574327","NCT06757842","Acceptability and Feasibility of an In-person 8-week Mindfulness-Based Cognitive Therapy Program Among Undergraduates","Acceptability and Feasibility of an 8-week In-person Mindfulness-Based Cognitive Therapy Program in a University Population: a Quasi-experimental Pilot Study","MFS","Inclusion Criteria:\n\n* Undergraduate students at the Universidad de los Andes.\n* Aged 18 or older.\n* Capable of reading and speaking Spanish.\n* With a score on the PHQ-9 depression scale between 0 and 14.\n* Have participated in an informational meeting about the study and the implications of the intervention.\n* Availability to attend 1 weekly session of 90 minutes for 8 consecutive weeks, and time to practice mindfulness exercises at home for at least 15 minutes daily during the intervention period.\n\nExclusion Criteria:\n\n* With a PHQ-9 score greater than or equal to 15.\n* With active suicidality, defined as score ≥ 3 in Columbia suicide severity scale.\n* Currently undergoing psychiatric treatment for a severe condition, understood as: psychotic disorders and\u002For substance abuse.\n* History of hospitalization for psychiatric conditions in the last 2 years.\n* History of having participated in a previous MBI course, such as: MBCT, MBSR, MMB, among others.\n* History of sexual abuse in their lifetime.",true,"30 Years",{"count":93,"type":19},45,[22],"Mental health among university students has emerged as a significant global issue. Recent meta-analyses reveal that 25% of students experience depressive symptoms and 14% exhibit suicidal behaviors. A study involving 19 universities across 8 countries found that 31.4% reported psychiatric disorders in the past year, particularly major depressive episodes and anxiety disorders.\n\nIn Chile, research on university mental health is limited. A 2014 study at Universidad Austral reported a 27% prevalence of depression and a 5.3% risk of moderate to severe suicide risk. The \"First National Survey of University Mental Health\" in 2019 revealed that 46% of students had depressive symptoms, while health surveys from Universidad de los Andes in 2020 and 2022 showed a decrease in these symptoms, although suicide risk remained high.\n\nGiven this situation, preventive interventions are urgently needed. \"Mindfulness-Based Interventions\" (MBIs) have shown effectiveness in university settings. Mindfulness, defined by Jon Kabat-Zinn, involves deliberate, non-judgmental attention to the present moment. Programs like \"Mindfulness-Based Stress Reduction\" (MBSR) have proven effective in reducing symptoms of depression, anxiety, and stress. Studies indicate that MBIs can effectively alleviate mental health symptoms in university populations.\n\nSome of the MBIs include \"Mindful Mood Balance\" (MMB) and \"Mindfulness Skills for Students\". The latter has shown effectiveness in reducing depressive and anxious symptoms among university students.\n\nA 2021 pilot study at Universidad de los Andes on an online 8-session intervention combining mindfulness with cognitive-behavioral techniques yielded positive results in reducing symptoms and enhancing students' quality of life.\n\nIn the current proposal we want to evaluate the feasibility and acceptability of the \"Mindfulness Skills for Students\" program delivered in-person by two trained facilitators. Additionally, we want to explore the efficacy of this intervention in reducing depressive, anxious, and stress symptoms among undergraduate students at Universidad de los Andes, using a quasi-experimental study design.",[27],[58,59,98,99],"Undergraduates","Mindfulness","2025-05-23",{"date":102,"type":36},"2025-05-30",{"date":104,"type":36},"2024-10-01",{"date":106,"type":19},"2026-03-31",{"name":108,"class":43},"Universidad de los Andes, Chile",{"id":110,"slug":111,"hasResults":11,"nctId":112,"briefTitle":113,"officialTitle":114,"acronym":4,"eligibilityCriteria":115,"healthyVolunteers":11,"sex":15,"minAge":16,"maxAge":4,"enrollmentInfo":116,"targetDuration":4,"studyType":20,"phases":118,"briefSummary":119,"conditions":120,"keywords":121,"overallStatus":128,"whyStopped":4,"lastUpdateSubmitDate":129,"lastUpdatePostDateStruct":130,"startDateStruct":132,"completionDateStruct":134,"leadSponsor":136,"locationsCount":4},"100586861","is-less-more-dosing-and-sequencing-effect-100586861","NCT06920888","Is Less More? Dosing and Sequencing Effect","Is Less More? Dosing and Sequencing Effects of Cognitive Therapies for Anxiety and Depression","Inclusion Criteria:\n\n(i) age ≥ 18 years, (ii) Clinically relevant symptoms of an anxiety disorder (with the exception of specific phobia) and\u002For depressive disorder according to GAD-7≥10, SIAS ≥37, PHQ-9 ≥10, or PDSS ≥9, (iii) Danish language proficiency, (iv) ability and willingness to give informed consent, (v) no or stable antidepressant\u002Fantianxiety medication (i.e., same dosage for ≥ 6 weeks), (vi) access to either a smartphone, tablet, or computer with video camera.\n\nExclusion Criteria:\n\n(i) severe depression deemed to require more intense psychotherapy or medication (PHQ-9-score of 20 or more combined with a clinical evaluation), (ii) currently receiving other psychotherapy or counseling, (iii) a history of bipolar disorder, (iv) current or past psychotic episode, (v) substance abuse or dependence judged to require treatment, (vi) suicide risk requiring immediate hospitalization.",{"count":117,"type":19},180,[22],"The investigators want to evaluate core components from cognitive behavioral psychotherapies (CBTs) with the aim of investigating dosing and combinatory effects on conditions of anxiety and depression.",[27],[122,123,124,125,126,127],"CBT","Combinatory effects","MOST","Optimizing","Dosing","Sequencing effects","NOT_YET_RECRUITING","2025-04-02",{"date":131,"type":36},"2025-04-10",{"date":133,"type":19},"2025-04-01",{"date":135,"type":19},"2027-12-31",{"name":137,"class":43},"University of Aarhus",{"id":139,"slug":140,"hasResults":11,"nctId":141,"briefTitle":142,"officialTitle":143,"acronym":4,"eligibilityCriteria":144,"healthyVolunteers":11,"sex":15,"minAge":16,"maxAge":4,"enrollmentInfo":145,"targetDuration":4,"studyType":20,"phases":147,"briefSummary":148,"conditions":149,"keywords":155,"overallStatus":32,"whyStopped":4,"lastUpdateSubmitDate":165,"lastUpdatePostDateStruct":166,"startDateStruct":168,"completionDateStruct":170,"leadSponsor":172,"locationsCount":44},"100585068","act-for-mental-health-in-neurological-disorders-100585068","NCT06897553","ACT for Mental Health in Neurological Disorders","Acceptance and Commitment Therapy- Based Group Therapy for Mental Health in Neurological Disorders","Inclusion Criteria:\n\n* Value above a cut-off of the DASS-21 subscales (depression \\> 10, anxiety \\> 6, and stress \\> 10)\n* Sufficient cognition and language ability (clinical rating)\n* Sufficient therapy motivation (clinical rating)\n\nExclusion Criteria:\n\n* Behavioral disorders (e.g., high irritability or apathy in clinical rating)\n* Other severe mental disorder (dementia, psychosis, personality disorders, intellectual disability)\n* Simultaneous psychotherapy or neuropsychological therapy",{"count":146,"type":19},44,[22],"The goal of this clinical trial is to examine the efficacy of this manual for mental health in people with mixed neurological disorders, including post-COVID. These conditions are often associated with cognitive impairment, which may hamper the effects of psychoterapy. Executive functioning and especially the ability to abstract thinking may be useful for individuals using Acceptance and Commitment Therapy. Therefore, the main questions research questions are:\n\n* Is this intervention effective in improving mental health?\n* Do executive functions predict the extent of social participation and mental health at the end of therapy? Participants will take part in 8 weekly group therapy sessions of 100 minutes each.",[150,62,151,27,152,153,154],"Neurological Disorders","Executive Function (Cognition)","Stress","Brain Injury","Post-COVID",[156,157,158,159,160,161,162,163,164,154],"Acceptance and Commitment Therapy (ACT)","group therapy","neurological disorders","brain injury","anxiety","stress","depression","executive functioning","abstraction ability","2025-03-25",{"date":167,"type":36},"2025-03-27",{"date":169,"type":36},"2024-12-01",{"date":171,"type":19},"2026-12-31",{"name":173,"class":43},"Bielefeld University",{"id":175,"slug":176,"hasResults":11,"nctId":177,"briefTitle":178,"officialTitle":179,"acronym":180,"eligibilityCriteria":181,"healthyVolunteers":11,"sex":15,"minAge":16,"maxAge":4,"enrollmentInfo":182,"targetDuration":4,"studyType":184,"phases":4,"briefSummary":185,"conditions":186,"keywords":189,"overallStatus":128,"whyStopped":4,"lastUpdateSubmitDate":194,"lastUpdatePostDateStruct":195,"startDateStruct":197,"completionDateStruct":199,"leadSponsor":201,"locationsCount":44},"100578562","urban-and-insular-study-on-treatment-experiences-and-stigma-in-people-living-with-hiv-100578562","NCT06812910","Urban and Insular Study on Treatment Experiences and Stigma in People Living with HIV","Clinical Characterization and Cross-Sectional Comparison of Stigma, Mental Health, and Treatment Experience Among People Living with HIV in Urban and Insular Settings in Portugal","SUNRISE","Inclusion Criteria:\n\n* Individuals diagnosed with HIV\n* Aged 18 years or older.\n* On antiretroviral therapy (ART) for at least six months.\n* On a daily oral treatment regimen (single or multiple pills).\n* Able to provide informed consent.\n\nExclusion Criteria:\n\n* Individuals under 18 years of age.\n* Individuals who have switched antiretroviral regimen in the previous six months.\n* Individuals unable to provide informed consent (e.g., due to cognitive impairment or lack of capacity).\n* Individuals with limited understanding of the study procedures or questionnaires (e.g., language barriers or cognitive limitations).\n* Individuals who are incarcerated or deprived of liberty.\n* Pregnant individuals.",{"count":183,"type":19},300,"OBSERVATIONAL","Study Title: SUNRISE Study: Urban and Island Experiences of HIV Treatment and Stigma\n\nWhat is this study about? This study aims to understand how living in urban areas versus islands affects the experiences of people living with HIV (PLWH) in Portugal. Specifically, the investigators want to explore how stigma and mental health (such as depression and anxiety) differ between these two settings. The investigators are also interested in understanding how the number of pills a person takes daily (called \"pill burden\") impacts their mental health and satisfaction with treatment.\n\nWhy is this study important? Stigma related to HIV can make it harder for people to stick to their treatment and can negatively affect their mental health and overall well-being. By comparing urban and island settings, the investigators hope to identify unique challenges faced by PLWH in different environments. This information will help the investigators to develop better strategies to support people living with HIV, no matter where they live.\n\nWho can participate? Adults (18 years or older) who have been diagnosed with HIV. People who have been on antiretroviral therapy (HIV treatment) for at least six months.\n\nIndividuals living in urban areas or island region.\n\nWhat will happen during the study?\n\nParticipants will complete a one-time interview during their regular HIV care visit. The interview will include questions about:\n\nTheir experiences with HIV-related stigma. Their mental health (including depression and anxiety). Their satisfaction with their current HIV treatment. The number of pills they take daily and how this affects their daily life. All information will be kept confidential, and participation is voluntary.\n\nWhat are the potential benefits of participating? This study will help to understand the challenges faced by people living with HIV in different parts of Portugal. This knowledge can lead to improved support services and treatment options for PLWH in the future.\n\nWhat are the risks of participating? There are no physical risks associated with this study. However, some questions may touch on sensitive topics, such as stigma or mental health.\n\nHow will the results be used? The results of this study will be shared with the scientific community, healthcare providers, and organizations that support people living with HIV. The goal is to use this information to improve care and reduce stigma for PLWH in Portugal and beyond.\n\nWho is conducting this study? This study is led by researchers from the Faculty of Medicine of Lisbon, in collaboration with hospitals in Portugal mainland, the Azores, and Madeira.",[187,188,27],"HIV","Stigma",[187,190,191,192,193],"HIV related stigma","mental health","pill burden","treatment experience","2025-02-15",{"date":196,"type":36},"2025-02-19",{"date":198,"type":19},"2025-03-01",{"date":200,"type":19},"2026-02-27",{"name":202,"class":81},"Fábio Cota Medeiros",{"id":204,"slug":205,"hasResults":11,"nctId":206,"briefTitle":207,"officialTitle":208,"acronym":209,"eligibilityCriteria":210,"healthyVolunteers":11,"sex":15,"minAge":16,"maxAge":4,"enrollmentInfo":211,"targetDuration":4,"studyType":20,"phases":213,"briefSummary":214,"conditions":215,"keywords":222,"overallStatus":32,"whyStopped":4,"lastUpdateSubmitDate":228,"lastUpdatePostDateStruct":229,"startDateStruct":231,"completionDateStruct":233,"leadSponsor":235,"locationsCount":237},"100545076","psychiatric-consultation-liaison-intervention-in-primary-care-a-pilot-study-100545076","NCT06377189","Psychiatric Consultation-Liaison Intervention in Primary Care: A Pilot Study","A Pilot Study on the Impact of a Psychiatric Consultation-Liaison Intervention in Primary Care Medical Consultations in French Speaking Switzerland (PLIMeC-P): A Mixed Method Randomized Controlled Trial","PLIMeC-P","Inclusion Criteria:\n\n* Aged more than 18 years\n* Signed informed consent to study protocol\n* Referred by their PCP due to mental distress, psychiatric symptoms, or complexity of medical care\n* Having fluent knowledge of the local language or being accompanied by an interpreter\n\nExclusion Criteria:\n\n* Not being able to give an informed consent and follow the procedure of the study (due to dementia, restriction of intellectual capacity, acute confusional state, language problem)\n* Presenting an acute psychotic symptomatology, a hetero-aggression risk or an acute suicidality\n* Having an ongoing psychiatric follow-up",{"count":212,"type":19},30,[22],"The pilot study on the impact of a Psychiatric Consultation-Liaison Intervention in Primary Care Medical Consultations in French-speaking Switzerland (PLIMeC-P), is a mixed method randomized controlled trial. The investigated health-related intervention is a brief Consultation-Liaison (CL) psychiatry intervention in primary care.\n\nPrimary Care Physicians (PCPs) have a key role in preventing, detecting, and managing mental disorders. Therefore, the optimization of both the quality of their interventions and their cooperation with psychiatric and psychological care networks are important challenges. It is well demonstrated that multidisciplinary interventions improve the efficacy of mental health care, CL psychiatry being one such type of intervention. Therefore, community CL-psychiatry, for example in private primary care group practices, are rare. The impact of such community, primary care CL-psychiatry interventions, should be investigated.\n\nThe mixed methods randomized controlled trial PLIMeC study will examine the impact of a CL-psychiatric intervention in primary care settings, for newly reported mental illness, versus a Treatment As Usual (TAU) control arm. The intervention consists of a CL-psychiatric intervention into private medical practices, provided to patients suffering from mental health problems, a group of patients generally under-treated. The CL-psychiatrist will receive and discuss PCPs' referrals for patients with mental distress, who don't have a psychiatric follow-up. After a brief intervention (1-4 sessions), feedback conjoint (PCP-psychiatrist) session will be organized, to complete the intervention and provide proposals.\n\nThe pilot study (PLIMeC-P) will determine whether the main planned study (PLIMeC) is feasible and practicable. It will be conducted on two sites, the Neuchâtel Psychiatry Centre (CNP) and the North-west Adult Psychiatry Service (SPANO), Department of Psychiatry of CHUV, Yverdon. For the pilot study (PLIMeC-P), 15 eligible participants are expected for each group, 30 participants in total. They will be recruited in three private primary care group practices. After eligibility and randomization 15 participants will be included for the intervention arm (brief CL-psychiatric intervention) and 15 for the control arm (TAU). The expected number of participants for the main trial (PLIMeC) will be estimated through analysis of the initial results of the PLIMeC-P.",[216,27,217,218,219,220,221],"Mental Health Issue","Quality of Life","Psychosomatic Disorders","Patients Lived Experiences","Doctor-Patient Relation","Collaboration",[223,224,225,226,227],"Consultation-Liaison psychiatry","Mental health","Mixed method","Primary Care","Healthcare Complexity","2025-02-11",{"date":230,"type":36},"2025-02-13",{"date":232,"type":36},"2024-05-01",{"date":234,"type":19},"2025-12-01",{"name":236,"class":43},"Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland",3]