Understanding how suicide rates vary across age, sex, and geography is essential to designing effective prevention strategies. We examined long-term trends in suicide mortality across European countries over three decades, with a focus on age-specific trajectories.

Using the WHO mortality database, we computed annual sex- and age-specific suicide rates (10–14 to 85+ age groups) from 1990 to 2022, for the most populous European countries, and aggregated rates for the EU-27 and four geographical areas (North, West, South, and Centre-East Europe). We also calculated percentage differences across four time periods (1990–1994, 2000–2004, 2010–2014, and 2020–2022), according to data availability.

Suicide rates increased with age, peaking in older individuals (85+) in most countries (e.g., 82.0/100,000 in France in 2020–2022, 77.1/100,000 in Germany among males, in 2020), except in the UK and Northern Europe, where rates peaked at middle age (∼22/100,000 at 45–49, in 2020). EU-27 suicide rates in 2020 ranged from 5.5/100,000 (age 15–19) to 58.2/100,000 (85+) among males, and from 2.6 (15–19) to 8.6/100,000 (85+) among females. Male suicide rates were 3 to 8 times higher than female rates across all ages. While overall rates declined since 1990 in most countries, youth suicide increased after 2010 in Western (e.g., +12%, girls 15–19), Southern (+24.5%, girls 15–19), and Northern (+44%, girls 15–19 and 20–24) Europe. Rates among young and middle-aged adults recently rose in Spain, the UK, and Northern Europe, while they declined in Eastern Europe after the 1990s.

Despite overall declines, our findings highlight marked heterogeneity in sex- and age-specific trends in suicide mortality across Europe. These patterns call for age-tailored prevention strategies that address evolving psychosocial stressors and structural determinants across the lifespan.

Suicide involves an act of volition on the part of the deceased, making it unlike deaths from physical disorders such as cancer or stroke. The latter occur passively and often despite the efforts of the patient to stay alive. Yet when there is a suicide, clinicians involved may often be blamed and families may often feel guilt. This contrasts with the default response of praise and thanks to clinicians following treatment preceding deaths from physical disorders.

Comparative standardized mortality rate (SMR) data are analyzed to demonstrate the impact of developments in care over the past two decades in the United Kingdom (UK), and similar United States (USA) SMR data are noted. The evidence is reviewed regarding our ability to predict who will die by suicide, when and where to target intervention, and practical and effective prevention methods.

Data from the UK are presented that reflects the relative lack of impact of prevention efforts on suicide mortality rates when compared to the reductions seen in various physical disorders. This narrative review comments on the causes and consequences of this difference.

The challenge for psychiatry is that SMR data suggest that we have been unable to significantly reduce suicide SMR unlike that for physical disorders. This needs to be fully acknowledged and the biased assumption of blame needs to stop. The focus needs to be on evidence-based interventions that do work, such as medications, psychological treatments, psychological interventions, and suicide prevention research.

There is limited evidence on the association between psychiatric morbidity and COVID-19 mortality.

We used deidentified electronic health records from the Catalan public health system to evaluate the association between number of mental disorders and COVID-19 mortality. Adults diagnosed with a mental disorder in Catalonia’s mental health services (from to 2017–2019) were compared to a matched (1:1) control group by sex, age, and area of residence. COVID-19 mortality risk was evaluated from February to December 2020. Odds ratios (OR) with 95% confidence intervals (CI) were estimated for the association between the number of mental disorders and COVID-19 mortality. To examine if different patterns of psychiatric comorbidity were related to COVID-19 death, we performed K-means cluster analysis on individuals with ≥2 disorders, stratified by COVID-19 death.

The final sample included 785,378 adults (392,689 with ≥1 mental disorder). Mortality risk increased with the number of mental disorders: OR 1.23 (95% CI: 1.11–1.35) for one mental disorder, up to 5.21 (95% CI: 1.34–20.27) for four or more. Cluster analysis (n=84,207) identified seven psychiatric comorbidity profiles among those who did not die of COVID-19, and six profiles among those who died, with substantial comparability between cohorts.

An increasing number of psychiatric diagnoses was associated with greater COVID-19 mortality, while specific comorbidity patterns showed limited differential influence. This suggests that it is not the specific combination of mental disorders that influences COVID-19 death outcomes, but rather the overall burden of multiple diagnoses.

Sleep disorders are closely linked to the onset, progression and severity of psychiatric disorders, yet large-scale data from real-world inpatient settings remain limited. Evaluating the impact of chronic sleep disorders (CSD) in this context is essential for improving care.

We conducted an analysis of adult inpatients hospitalized from January 1, 2021, to December 31, 2023, using data from the Paris Psychiatry Hospital Group’s health data warehouse. Sleep disorders were identified via ICD-10 codes, hypnotic prescriptions, or mentions in medical record. CSD was defined using an Index of Length of Stays with Disorders (ILSD) >0.5, and no sleep disorders (NSD) with an ILSD of zero.

Among 13,913 psychiatric inpatients, 81% were classified as having CSD. Compared to NSD patients, those with CSD had a higher number of hospitalizations (1.84 vs 1.33, p<0.001) and increased use of seclusion (17.6% vs 13.3%, p<0.001) and physical restraint (6.6% vs 5.3%, p=0.003). Individuals with CSD were more frequently hospitalized than the NSD group for depressive disorders (15.6% vs13.1%, p<0.001), bipolar disorders (11.4% vs5.6%, p<0.001), personality disorders (5.3% vs4.3%, p=0.009), alcohol abuse (3.3% vs2.4%, p=0.005), other substance use disorders (2.9% vs2.2%, p=0.018), manic episode (2.0% vs0.9%, p<0.001), and anxiety disorders (1.4% vs0.9%, p=0.012). Hypnotics were prescribed in 50.5% of SD-related stays. The CSD group had more psychiatric and non-psychiatric comorbidities.

CSD are highly prevalent in psychiatric inpatients and associated with more severe clinical profiles, greater hospitalization burden, and increased restraint use. Targeted sleep management strategies may help improve outcomes and care.

The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a performance-based measure developed to assess functional capacity through simulations of daily activities. This study examined its psychometric properties in a Spanish sample, including individuals with first-episode psychosis (FEP), schizophrenia, and healthy controls.

A total of 370 participants (99 FEP, 116 schizophrenia, and 155 controls) completed the VRFCAT in a multicenter study. Internal consistency (McDonald’s omega), discriminative validity (group comparisons and ROC curves), and convergent validity via correlations with cognitive performance and clinical symptoms were examined. Reference percentiles were calculated from the healthy control sample using quantile regression, stratified by age and education.

Item-level VRFCAT completion times showed acceptable to good internal consistency overall and in controls and schizophrenia samples, but poor in FEP. Differences in VRFCAT performance emerged (χ2 = 108.88, p < .001), with controls performing best, schizophrenia worst, and FEP in between. ROC analyses indicated good discriminative accuracy in distinguishing patients from controls (area under the curve [AUC] = 0.779, sensitivity = 80.0%, specificity = 64.2%); but limited discrimination between schizophrenia and FEP. Age and education, but not sex, significantly affected performance. VRFCAT showed small-to-moderate correlations with cognitive performance, and no significant associations with symptom severity.

The VRFCAT is a reliable and valid tool for assessing functional capacity in Spanish-speaking individuals with psychotic disorders. Its ecological validity, objectivity, psychometric properties, brief administration time, and ease of use support its potential use in clinical and research settings for evaluating functional recovery and treatment outcomes.

Little is known about the interrelationships among adverse childhood experiences (ACEs), post-traumatic stress disorder (PTSD), dissociative disorders, depression, and dementia risk. We sought to investigate associations of ACEs, PTSD, dissociative disorders, and depression with incident dementia and explore whether these associations may be interrelated through mediation.

This prospective cohort study used population-based UK Biobank data, including 502 355 participants recruited at 22 assessment centres who completed questionnaires, an interview, and physical assessments at baseline (2006–2010). Data are linked to participants’ electronic health records from primary care, hospital admissions, and death registers through November 30, 2022, and to the results of the UK Biobank online mental health survey (2016–2017). Cox regression and g-formula-based mediation analyses were used to examine associations between self-reported ACEs, self-reported PTSD symptoms, diagnosed PTSD, dissociative disorders, depression, and dementia.

In the final sample (n = 434 215, mean (SD) age 56.58 (8.07) years), ACEs (hazard ratio (HR)1point: 1.10; 95% CI 1.02–1.20), diagnosed PTSD (HR: 2.09; 95% CI 1.38–3.18), dissociative disorders (HR: 3.96; 95% CI 2.55–6.15), depression (HR: 2.17; 95% CI 2.05–2.30), and self-reported PTSD symptoms (HR1point: 1.09; 95% CI 1.06–1.11) were associated with increased dementia risk, after adjusting for sociodemographic characteristics. Self-reported PTSD symptoms explained 75.26% (P < .001) of the excess dementia risk associated with ACEs. Depression explained 4.51% (P = .02) of the ACEs-dementia link, 8.42% (P < .001) of the diagnosed PTSD-dementia link, and 10.29% (P < .001) of the dissociative disorders-dementia link.

Individuals with ACEs, PTSD, dissociative disorders, or depression appear to be at increased risk of dementia, potentially through both shared and unique associations. However, these findings should be interpreted with caution due to potential limitations in statistical power.

Despite the high prevalence of mental disorders, knowledge about mental health, its promotion, prevention, and pathways to care in the general population remain limited. Mental Health First Aid (MHFA) seeks to increase mental health literacy in the general population and enable individuals to support others with mental health problems until professional help is available. This study aimed to investigate the feasibility and initial effects of MHFA training on (i) mental health literacy, (ii) stigmatizing attitudes toward individuals with mental health problems, (iii) social distance, (iv) trainees’ mental health, and (v) quality of life.

In an uncontrolled pilot study, individuals aged 18–75 years who participated in MHFA courses in Germany were recruited. Outcomes were assessed at baseline, post-training, and 6-month follow-up.

In total, 362 participants (mean age 43 years, 78% female) enrolled in the study at baseline. Retention was about 50% for post-training and 60% for follow-up assessment. At post-training, mental health literacy was increased (adjΒ = 6.77, 95% CI = 5.69 to 7.84) and social distance (adjΒ = −2.30, 95% CI = −2.73 to −1.87) and stigmatizing attitudes (adjΒ = −2.61, 95% CI = −3.25 to −1.97) were reduced. These effects were also evident at 6-month follow-up. There were no effects on trainees’ mental health. At the 6-month follow-up, 89% of trainees had talked to someone with mental health problems at least once, and 65% of trainees were quite or very confident in offering help.

Our findings suggest initial beneficial effects of MHFA training as implemented in Germany. A randomized controlled trial of MHFA in Germany is now warranted.

A better mechanistic understanding of schizophrenia spectrum disorders is crucial to developing efficient treatment approaches. Therefore, this study investigated longitudinal interrelations between clinical outcomes, brain structure, and somatic health in post-acute individuals from the schizophrenia spectrum.

A sample of 63 post-acute patients from two independent physical exercise studies was included in the final analyses. Demographic, clinical, cognitive, and somatic data were acquired at baseline and follow-up, as were structural magnetic resonance imaging scans. Multivariate cross-lagged panel modeling including mediators was used to study the mutual interrelations over time between the clinical, neural, and somatic levels.

A higher baseline global gray matter volume and larger regional gray matter volumes of the hippocampal formation, precuneus, and posterior cingulate predicted improved clinical outcomes, such as daily-life functioning, negative symptoms, and cognition. Increases in white matter volume from baseline to follow-up resulted in significantly reduced positive symptoms and higher daily-life functioning.

Our findings suggest that stimulating neuroplasticity, especially in the hippocampal formation, precuneus, and posterior cingulate gyrus, may represent a promising treatment target in post-acute schizophrenia spectrum disorders. Physical exercise therapies and other lifestyle interventions, and brain stimulation approaches reflect potential treatment candidates. Given the exploratory character of the statistical analysis performed, these findings need to be replicated in independent longitudinal imaging cohorts of patients with schizophrenia spectrum disorders.

Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.

We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.

Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).

These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.