Severe Mental Health Screening Signals Among Multinational Hajj Pilgrims in 2025: Implications for Multilingual Healthcare Encounters and Referral Planning.

Background/Objectives: Large multinational mass gatherings can create healthcare encounters in which severe mental health screening signals require rapid recognition, confidential assessment, language support, and referral. During Hajj, culturally and linguistically diverse pilgrims may first disclose severe psychological symptoms in general medical or field settings rather than through specialist psychiatric pathways. This study estimated the prevalence, overlap, and adjusted correlates of severe screen-positive mental health symptom signals among adult multinational Hajj pilgrims in 2025 and considered implications for multilingual healthcare encounters and referral planning. Methods: This cross-sectional field screening study analyzed de-identified coded data from 2171 adult pilgrims aged 18-95 years. Participants completed a structured, interview-administered multilingual mental health screening survey comprising 23 binary symptom items. The analysis focused on suicide-related symptoms, psychotic-like symptoms, and mood-instability/bipolar-spectrum symptoms. A severe symptom cluster was defined as positivity in at least one of these domains. Prevalence estimates with Wilson 95% confidence intervals, domain overlap, and multivariable logistic regression models were used. Results: Severe symptom cluster positivity was identified in 428 participants (19.7%; 95% CI 18.1-21.4). Mood-instability/bipolar-spectrum signals were most frequent (13.3%; 95% CI 11.9-14.8), followed by psychotic-like symptoms (8.0%; 95% CI 6.9-9.2) and suicide-related symptoms (5.6%; 95% CI 4.7-6.6). Among cluster-positive participants, 297 endorsed one severe domain, 108 endorsed two domains, and 23 endorsed all three. Current physical illness was independently associated with all severe outcomes, whereas prior psychiatric history was not independently associated with suicide-related symptoms. Conclusions: Severe screen-positive mental health signals were present in a clinically relevant minority of pilgrims. The findings support integrating confidential severe symptom screening, interpreter-supported assessment, psychological first aid, and clear referral pathways into general Hajj healthcare encounters, while emphasizing that screen-positive findings are not psychiatric diagnoses.