The optimal duration for maintaining antidepressant treatment in individuals with obsessive-compulsive disorder (OCD) who achieve symptom stabilization remains unclear.

This systematic review and pairwise meta-analysis of double-blind randomized placebo-controlled trials (DBRPCTs) compared antidepressant maintenance and antidepressant discontinuation groups in terms of relapse rate at each DBRPCT study endpoint (primary outcome), OCD symptom improvement, all-cause discontinuation, and adverse event-related discontinuation. Furthermore, relapse rates at 4, 8, 12, 16, 20, and 24 weeks were compared between the groups. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The absolute risk reduction (ARR) and number needed to treat to benefit (NNTB) for relapse rates were also estimated.

Nine trials (n = 1084; mean age: 32.8 years; proportion of males: 53.3%) were included. The antidepressant maintenance group had lower relapse rates at each DBRPCT study endpoint (RR [95% CI] = 0.53 [0.42–0.68]; ARR = 21.0%; NNTB = 5) and lower all-cause and adverse event-related discontinuation rates than the antidepressant discontinuation group. The maintenance group also exhibited lower relapse rates at 4 weeks (RR [95% CI] = 0.47 [0.31–0.70]; ARR: not significant; NNTB: not significant), 8 weeks (0.42 [0.31–0.57]; 12.0%; 8), 12 weeks (0.43 [0.32–0.56]; 18.0%; 6), 16 weeks (0.41 [0.32–0.52]; 25.0%; 4), 20 weeks (0.43 [0.34–0.53]; 26.0%; 4), and 24 weeks (0.42 [0.33–0.52]; 27.0%; 4) than the discontinuation group. Moreover, the maintenance group outperformed the discontinuation group regarding OCD symptom improvement.

Individuals with OCD may benefit from continued antidepressant treatment, provided that it is well tolerated.

The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. This survey assessed which criteria in the EGPRN concept of multimorbidity could detect decompensating patients in residential care within a primary care cohort at a six-month follow-up.

Family physicians included all multimorbid patients encountered in their residential care homes from July to December 2014. Inclusion criteria were those of the EGPRN definition of multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Decompensation was defined as the occurrence of death or hospitalization for more than seven days. Statistical analysis was undertaken with uni- and multi-variate analysis at a six-month follow-up using a combination of approaches including both automatic classification and expert decision. A multiple correspondence analysis and a hierarchical clustering on principal components confirmed the consistency of the results. Finally, a logistic regression was performed to identify and quantify risk factors for decompensation.

Findings: About 12 family physicians participated in the study. In the study, 64 patients were analyzed. On analyzing the characteristics of the participants, two statistically significant variables between the two groups (decompensation and Nothing To Report): pain (p = 0.004) and the use of psychotropic drugs (p = 0.019) were highlighted. The final model of the logistic regression showed pain as the main decompensation risk factor.

Action should be taken by the health teams and their physicians to prevent decompensation in patients in residential care who are experiencing pain.

Obsessive–compulsive disorder (OCD) is associated with an increased risk of cardiometabolic disorders. We developed a lifestyle intervention, named LIFT, aimed at improving lifestyle habits (physical activity, diet, alcohol and tobacco use, stress, sleep) and reducing cardiometabolic risk factors in OCD.

This study aimed to establish the feasibility and acceptability of LIFT, evaluate its preliminary efficacy and explore experiences of participation.

Individuals with OCD and at least three cardiometabolic risk factors (e.g. physical inactivity, unhealthy diet, overweight/obesity, dyslipidaemia) were offered LIFT, consisting of one individual session to set individual goals, six educational group sessions and 12 exercise group sessions, delivered over 3 months. We collected baseline, post-intervention and 3-month follow-up measures. Preliminary efficacy variables were analysed with linear mixed models and within-group effect sizes. Qualitative interviews were conducted.

Out of 147 screened individuals, 25 were included (68% women, mean age 37.4, s.d. = 10.9). Credibility and satisfaction were high, attrition rates were low (16%) and the programme was generally safe. Recruitment and adherence to the intervention were challenging. Statistically significant improvements were observed in dietary habits, alcohol consumption, stress, OCD symptom severity and general functioning (within-group effect sizes ranging from 0.27 to 0.56). No changes were observed in physical activity, sleep or any physiological or laboratory measures.

Overall, LIFT was a feasible intervention for individuals with OCD. Effects on lifestyle habits, mental health and functioning are promising. Fully powered randomised controlled trials are needed to evaluate its efficacy and cost-effectiveness.

Peripartum depression (PPD) is a prevalent mental health disorder in the peripartum period. However, a recent systematic review of clinical guidelines relating to PPD has revealed a significant inconsistency in recommendations.

This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD.

A series of umbrella reviews on the effectiveness of PPD prevention, screening and treatment interventions was conducted. A search was performed in five databases from 2010 until 2023. The guidelines were developed according to the GRADE framework and AGREE II Checklist recommendations. Public stakeholder review was included.

One hundred and forty-five systematic reviews were included in the final analysis and used to form the guidelines. Forty-four recommendations were developed, including recommendations for prevention, screening and treatment. Psychological and psychosocial interventions are strongly recommended for preventing PPD in women with no symptoms and women at risk. Screening programmes for depression are strongly recommended during pregnancy and postpartum. Cognitive–behavioural therapy is strongly recommended for PPD treatment for mild to severe depression. Antidepressant medication is strongly recommended for treating severe depression in pregnancy. Electroconvulsive therapy is strongly recommended for therapy-resistant and life-threatening severe depression during pregnancy. Other recommendations are offered to healthcare professionals, stakeholders and researchers in managing PPD in different contexts.

Treatment recommendations should be implemented after carefully considering clinical severity, previous history, risk–benefit for mother and foetus/infant and women’s values and preferences. Implementation of evidence-based clinical practice guidelines within country-specific contexts should be facilitated.

Psychotic disorders are frequently preceded by depressive disorders, and it has been hypothesized that treatment of depression in youth may reduce risk for later psychosis. Using quasi-experimental methods, we estimated the causal relationship between the treatment of adolescent depression with selective serotonin reuptake inhibitors (SSRIs) and the risk of later psychosis.

We used data linkage from multiple national Finnish registries for all individuals (n = 697,289) born between 1987 and 1997 to identify depression diagnosed before age 18, cumulative SSRI treatment within three years of diagnosis, and diagnoses of non-affective psychotic disorders by end of follow-up (age 20–29). We used instrumental variable analyses, exploiting variability in prescribing across hospital districts to estimate causal effects. Analyses were conducted using two-stage least squares modelling. Sensitivity analyses examined effects stratified by confounders and effects of specific SSRIs.

Our final sample included 22,666 individuals diagnosed with depression in adolescence, of whom 60.2% (n = 13,650) had used SSRIs. 10.7% of adolescents with depression went on to be diagnosed with a non-affective psychotic disorder. SSRI treatment for adolescent depression was not associated with a reduced risk of developing a psychotic disorder (one-year β = 0.04,CI:−0.01 to 0.09; two-years β = 0.02,CI:−0.06 to 0.09; three-years β = −0.02,CI:−0.08 to 0.05).

Our quasi-experimental investigation does not support the hypothesis that treatment of adolescent depression reduces the subsequent risk of psychosis. Our findings question the assumption that treatment of common mental health disorders in youth may impact the risk of developing severe mental illnesses in adulthood.

It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.

To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.

Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.

IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).

Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.

This study aimed to provide an up-to-date cross-national comparison of the European population mental health (MH) status and its determinants.

For the European Union (EU) 27 countries and the UK 6 Key Performance Indicators (KPIs) in MH status (e.g., prevalence of mental disorders) and 19 KPIs in individual (e.g., smoking), environmental (e.g., air pollution) and socioeconomic (e.g., poor housing conditions) determinants of MH were measured. KPIs scores were standardised in a 1–10 Likert Scale (1: worst performance; 10: best performance), thus allowing between-country comparisons of the relative performance. Exploratory unadjusted bivariate correlations between KPIs-transformed scores were run.

Based on the KPIs-transformed scores, Slovakia (8.3), Cyprus (7.8), and Greece (7.1) had the best MH status, while Sweden (3.1), UK (2.6), and The Netherlands (2.1) had the poorest MH status. Regarding determinants of MH Finland (8.0), Sweden, and Estonia (7.5) had the lowest MH risk, while France (3.1) and Romania (2.8) had the highest risk.

Smoking (r = −0.43, p = .021), alcohol use (r = 0.57, p = .002), daylight hours (r = 0.74, p < .001), ecoanxiety (r = −0.51, p = .005), air pollution (r = −0.46, p = .015), commuting time (r = 0.42, p = .026), and Fragile State Index (r = −0.44, p = .018) correlated with overall MH status.

Population-level MH status and its determinants varied across European countries, including “low-risk, poor MH status” and “high-risk, good MH status” countries. Further non-tested determinants of MH and/or between-country differences in responsiveness to MH needs may explain this discrepancy. These results should guide future evidence-based public MH policymaking and universal preventive strategies in Europe.