The ICD-11 introduced a new diagnosis of complex post-traumatic stress disorder (CPTSD) defined by disturbances in self-organisation in addition to traditional post-traumatic stress disorder symptoms. The International Trauma Questionnaire (ITQ) is the established measure of this construct and has been validated for use in a variety of populations and languages; however, evidence for the measure's use in Latin America is limited.

This study sought to validate the factor structure of the Latin American Spanish version of the ITQ in a trauma-exposed sample in Colombia.

Confirmatory factor analysis was used to assess a range of factor models validated previously, including first- and second-order factor models.

Assessment of fit indices demonstrated that a correlated six-factor model comprised of re-experiencing, avoidance, sense of threat, affect dysregulation, negative self-concept and disturbed relationships provided the best fit for these data. Factor loadings for this model were found to be high and statistically significant.

Results concur with prior research validating the use of alternative language versions of the ITQ internationally, and with the theoretical underpinnings of the CPTSD diagnostic category. The ITQ is therefore a valid measure of CPTSD in this Latin American sample. Further validation research is needed in clinical populations in this region.

It is now accepted that social factors affect not only onset but also mental health treatment outcomes. One such factor is financial difficulty. Within National Health Service (NHS) Talking Therapies, problem debt has been shown to interfere significantly with recovery from mental health problems, estimated as 22% versus 50% recovered with no problem debt. One solution is a combined money advice and psychological therapy intervention to improve treatment outcomes.

The aim of the current study was to trial a combined money advice and psychological therapy service within NHS Talking Therapies, to ascertain its feasibility and acceptability.

This study employed a mixed methods case series of individuals attending high-intensity cognitive–behavioural treatment who were provided with a combined intervention (money advice service plus NHS Talking Therapies). Acceptability and feasibility were evaluated through interviews, and benefit was assessed from comparisons of routinely collected symptom measures and compared to historical recovery estimates.

Some 32 participants, with similar gender distribution but more representation from ethnic minorities, were recruited from NHS Talking Therapies. One-third demonstrated complete recovery on both depression and anxiety, while half showed symptom improvement and modest improvements on the financial outcomes measure. Our interviews with patients, therapists and money advisors suggested the combined intervention was acceptable and beneficial, but that money worries should be identified earlier.

The combined service is acceptable, accessible and could deliver benefit, even in the short term, to those with mental health and debt problems.

Decision-making capacity (DMC) is key to capacity-based mental health laws. In 2017, Norway introduced a lack of DMC as an additional criterion for involuntary care and treatment to strengthen patient autonomy and reduce involuntary care. Health registry data reveal an initial reduction followed by rising involuntary care and treatment rates post-2017. Despite jurisdictions moving towards capacity-based mental health laws, little is known about their impact.

To explore the impact of introducing a capacity-based mental health law governing involuntary care and treatment.

Semi-structured interviews and focus groups were conducted in 2018 with 60 purposively sampled stakeholders, including patients, families, health professionals and lawyers. Of these, 26 participated in individual follow-up interviews in 2022–23. The transcribed interviews were thematically analysed following Braun and Clarke.

Four themes emerged: (a) increased awareness of patient autonomy and improved patient involvement; (b) altered thresholds for involuntary admission and discharge and more challenging to help certain patient groups; (c) more responsibility for primary health services; and (d) increased family responsibility but unchanged involvement by health services.

Introducing a capacity-based mental health law appears to raise awareness of patient autonomy, but its impact depends on an interplay of complex health, social and legal systems. Post-2017 changes, including rising involuntary care and treatment rates, higher thresholds for admissions and increased pressure on primary health services and families, may be influenced by several factors. These include implementation of decision-making capacity, legal interpretations, formal measures for care of non-resistant incompetent individuals, reduced in-patient bed availability, inadequate voluntary treatment options and societal developments. Further research is needed to better understand these changes and their causes.

In-patient mental health rehabilitation services provide specialist treatment to people with complex psychosis. On average, rehabilitation admissions last around a year and usually follow several years of recurrent and often lengthy psychiatric hospital admissions.

To compare in-patient service use before and after an in-patient rehabilitation admission, using electronic patient healthcare records in one National Health Service Trust in London.

We carried out a retrospective cohort study comprised of individuals with an in-patient rehabilitation admission lasting ≥84 days between 1 January 2010 and 30 April 2019, with at least ≥365 days of records available before and after their rehabilitation admission. We used negative binomial regression models to compare the number of in-patient days before and after the rehabilitation admission.

A total of 172 individuals met our eligibility criteria. The median percentage of days spent as an in-patient before the rehabilitation admission was 29% (interquartile range 18–52%), and 8% (interquartile range 0–31%) after the admission. The regression model adjusted for potential confounder variables produced an incidence rate ratio of 0.520 (95% CI 0.367–0.737).

The rate of in-patient service use was halved in the period after an in-patient rehabilitation admission compared with the period before. This suggests that in-patient rehabilitation is a clinical and cost-effective intervention in the treatment and support of people with complex psychosis.

The use of amphetamine-type stimulants such as khat has been spreading quickly in eastern parts of Africa, the Arabian region and Asia. However, screening for the provision of early intervention has been inadequate, primarily because of the lack of culturally acceptable and valid screening tools.

To evaluate the the accuracy of the Problematic Khat Use Screening Tool (PKUST-17) in screening for khat use disorder against the DSM-5 criteria for substance use disorder.

A cross-sectional validation study was conducted in Ethiopia from February to December 2018, among a randomly selected sample of 506 individuals. The study subsample comprised 236 participants. We used the DSM-5 criteria for stimulant use disorders as the standard for determining the criterion validity and optimal cut-off score for the PKUST-17, using the receiver operating characteristic (ROC) curve. The DSM-5 criteria for substance use disorders were examined by researchers in a subsample of 232 participants. The PKUST-17 uses a five-point Likert scale (0–4), with total scores ranging from 0 to 68. At the optimal cut-off scores, sensitivity and specificity were determined. In addition, we conducted multivariate logistic regression analysis to evaluate potential convergent validity of the tool.

The area under the ROC curve showed good performance of the PKUST-17 (0.78, 95% CI 0.70–0.85, P < 0.001). A cut-off score above 17 demonstrated a sensitivity of 72% and specificity of 73%. The positive predictive value was 77.6% and the negative predictive value was 65.8% in identifying stimulant use disorder, as per the DSM-5 criteria. Among others, problematic khat use was significantly associated with higher World Health Organization Disability Assessment Schedule 2.0 scores (adjusted odds ratio 1.78, 95% CI 1.04–3.03, P < 0.01) and more depressive symptoms (adjusted odds ratio 4.10, 95% CI 2.36–7.12, P < 0.05).

We found that the PKUST-17 is a valid tool for screening for khat use disorder against the DSM-5 criteria for substance use disorder, and identifying high-risk problematic khat users.

Little is known about the prevalence of post-traumatic stress disorder (PTSD) in emerging adults living with HIV in low-income countries.

Determine prevalence of trauma exposure, prevalence of probable PTSD and conditional prevalence of probable PTSD for different traumatic events; and better understand the experiences of individuals with HIV and PTSD.

This mixed method study used secondary data from a cross-sectional survey of people (N = 222) aged 18 to 29 living with HIV in Zimbabwe and primary qualitative data collection. The PTSD Checklist for DSM-5 (PCL-5) and the Life Events Checklist for DSM-5 (LEC-5) were used to measure PTSD and exposure to traumatic events, both translated to Shona. In-depth interviews (n = 8) with participants who met the criteria for probable PTSD were analysed using thematic analysis.

In all, 68.3% [95% CI (61.4–74.1)] of participants reported exposure to at least one traumatic event. The observed prevalence of probable PTSD was 8.6% [95% CI (5.2–13.0)], most observed following exposure to fire or explosion 29.0% [95% CI (13.0–45.0)] and sexual assault 27.8% [95% CI (7.2–48.7)]. Probable PTSD was also more prevalent following multiple exposure to trauma; four and six events, N = 4 (21%) [95% CI (5.1–8.8)] each, two and three events N = 3 (15.7%) [95% CI (5.9–9.2)] each, and five events N = 1 (5.4%) [95% CI (7.5–9.6)]. Qualitative results indicated that HIV stigma exacerbated psychological distress from trauma.

Despite trauma exposure being common, prevalence of probable PTSD was not high, but was higher in those with multiple exposures. Participants described coping strategies, including social support and religious thinking.

Impulsivity and aggression are known risk factors for suicide, with observed age and sex differences in their impact.

To explore variations in impulsivity and aggression based on sex and age and examine their roles in predicting suicide.

We examined 582 participants (406 individuals who died by suicide, 176 non-suicidal sudden-death controls) using the psychological autopsy method. Measures of impulsivity and aggression included the Barratt Impulsiveness Scale (BIS) and the Brown–Goodwin History of Aggression (BGHA). Participants were categorised into four groups: suicide male, control male, suicide female and control female. For group comparisons, we used analyses of variance and Spearman’s rank correlation to assess the relationship between age and BIS and/or BGHA ratings. Stepwise logistic regression was used to identify predictors of suicide for each sex.

Higher levels of BIS and BGHA ratings were found in the suicide group compared with controls (BIS: 51.3 v. 42.2, P = 0.002, η2 = 0.017; BGHA: 7.1 v. 4.1, P < 0.001, η2 = 0.028), with no significant sex differences. BIS and BGHA ratings decreased with age in the suicide groups (suicide male: impulsivity ρ = −0.327, P < 0.001; suicide female: aggression ρ = −0.175, P = 0.038) but not among controls. Logistic regression analysis revealed that for men, aggression (odds ratio 1.072, 95% CI: 1.032–1.112) was a key predictor. For women, younger age (odds ratio 0.970, 95% CI: 0.948–0.993), low BIS impulsivity ratings (odds ratio 1.018, 95% CI: 1.001–1.036) and living with children (odds ratio 0.448, 95% CI: 0.208–0.966) were protective factors.

Impulsive and aggressive behaviours are critical factors in suicide risk among younger individuals, indicating an age effect but no sex dimorphism, with aggressive behaviours being a better predictor for men and impulsive and aggressive behaviours for women.

Group cognitive stimulation therapy (CST) has been shown to improve cognition and quality of life of people with dementia in multiple trials, but there has been scant research involving people with intellectual disability and dementia. This study aimed to assess the feasibility of conducting a randomised controlled trial of group CST for this population.

To assess the feasibility of participant recruitment and retention, the appropriateness of outcome measures, and the feasibility of group CST (adherence, fidelity, acceptability), as well as the feasibility of collecting data for an economic evaluation.

Participants were recruited from six National Health Service trusts in England and randomised to group CST plus treatment as usual (TAU) or TAU only. Cognition, quality of life, depression, and use of health and social care services were measured at baseline and at 8–9 weeks. Qualitative interviews with participants, carers and facilitators were used to explore facilitators of and barriers to delivery of CST. Trial registration number: ISRCTN88614460.

We obtained consent from 46 participants, and 34 (73.9%) were randomised: 18 to CST and 16 to TAU. All randomised participants completed follow-up. Completion rates of outcome measures (including health economic measures) were adequate; 75.7% of sessions were delivered, and 56% of participants attended ten or more. Fidelity of delivery was of moderate quality. CST was acceptable to all stakeholders; barriers included travel distance, carer availability and sessions needing further adaptations. The estimated cost per participant of delivering CST was £602.

There were multiple challenges including recruitment issues, a large dropout rate before randomisation and practical issues affecting attendance. These issues would need to be addressed before conducting a larger trial.

Parents of children with autisma demonstrate elevated traumatic stress symptoms, but seldom receive diagnoses of post-traumatic stress disorder (PTSD) or complex PTSD. An accurate assessment of Criterion A is essential for a valid diagnosis of these disorders, yet it is uncertain whether Criterion A, as defined by the two primary international diagnostic systems (DSM-5-TR and ICD-11), yields consistent interrater reliability, when psychologists rely solely on self-report from these parents for assessing PTSD or complex PTSD.

This study aims to investigate interrater reliability across psychologists when assessing Criterion A events against the ICD-11 and DSM-5-TR.

Ten Australian psychologists rated parents’ self-reported traumatic events related to parenting, using the Life Events Checklist for DSM-5-TR and ICD-11 Criterion A. Data from 200 randomly selected parents of children, all meeting symptom thresholds for PTSD or complex PTSD, were analysed. Bootstrapping calculated kappa coefficients, differences between ICD-11 and DSM-5-TR criteria, and self-reports of threat/no threat, with 95% confidence intervals for these differences.

Interrater reliability varied from poor to moderate. The ICD-11 had significantly higher reliability than the DSM-5-TR for Criterion A (κdifference = 0.105, 95% CI 0.052–0.153, P < 0.001). The interrater reliability was lower when parents reported life threat, serious injury or death (κdifference = 0.096, 95% CI 0.019–0.176, P = 0.007).

This study highlights challenges in assessing PTSD and complex PTSD Criterion A in parents of children with autism, using DSM-5-TR and ICD-11 criteria with the Life Events Checklist, revealing less than adequate interrater reliability.

Bipolar disorder often goes unrecognised for several years, leading to delayed treatment and negative outcomes. To help address this, we have developed a novel telehealth-based group psychoeducational and resilience enhancement programme for individuals at high risk for bipolar disorder (PREP-BD), aimed at improving help-seeking among adolescents and young adults at risk of developing bipolar disorder.

The purpose of the current study was to explore the perspectives of at-risk youth, their families and group facilitators who participated in the feasibility trial of PREP-BD.

Group and individual semi-structured feedback sessions were conducted with the participants (n = 21) of the programme, their family members and the facilitators of PREP-BD. The questions covered their experiences, opinions on the programme’s structure and content and suggestions for improvement. Feedback sessions were transcribed and analysed qualitatively using inductive content analysis.

Overall feedback was positive, with participants and facilitators appreciating the informative and engaging nature of the sessions. Some participants desired more actionable resources and complex content. Family members sought greater involvement and information about the programme. The online format was valued for convenience, but was also viewed as a barrier by some to fostering deeper connections.

PREP-BD shows promise as a psychoeducational intervention for individuals at high risk for bipolar disorder. To enhance the programme’s effectiveness, future iterations should incorporate more nuanced content, provide additional practical guidance and address the limitations of the virtual setting. Continued evaluation and optimisation are crucial for ensuring the programme’s effectiveness as a tool for early intervention in bipolar disorder.

The novel South London and Maudsley Brain Health Clinic (SLaM BHC) leverages advances in remote consultations and biomarkers to provide a timely, cost-efficient and accurate diagnosis in mild cognitive impairment (MCI).

To describe the organisation, patient cohort and acceptability of the remote diagnostic and interventional procedures.

We describe the recruitment, consultation set-up, the clinical and biomarker programme, and the two online group interventions for cognitive wellbeing and lifestyle change. We evaluate the acceptability of the remote consultations, lumbar puncture, saliva genotyping, and remote cognitive and functional assessments.

We present the results of the first 68 (mean age 73, 55% female, 43% minoritised ethnicity) of 146 people who enrolled for full remote clinical, cognitive, genetic, cerebrospinal fluid and neuroimaging phenotyping. A total of 86% were very satisfied/satisfied with the remote service. In all, 67% consented to lumbar puncture, and 95% of those were very satisfied, all having no significant complications. A total of 93% found taking saliva genotyping very easy/easy, and 93% found the cognitive assessments instructions clear. In all, 98% were satisfied with the Cognitive Wellbeing Group, and 90% of goals were achieved in the Lifestyle Intervention Group.

The SLaM BHC provides a highly acceptable and safe clinical model for remote assessments and lumbar punctures in a representative, ethnically diverse population. This allows early and accurate diagnosis of Alzheimer's disease, differentiation from other MCI causes and targets modifiable risk factors. This is crucial for future disease modification, ensuring equitable access to research, and provides precise, timely and cost-efficient diagnoses in UK mental health services.

There are ethnic differences, including differences related to indigeneity, in the incidence of first episode psychosis (FEP) and pathways into care, but research on ethnic disparities in outcomes following FEP is limited.

In this study we examined social and health outcomes following FEP diagnosis for a cohort of Māori (Indigenous people of New Zealand) and non-Māori (non-Indigenous) young people. We have focused on understanding the opportunities for better outcomes for Māori by examining the relative advantage of non-Māori with FEP.

Statistics New Zealand's Integrated Data Infrastructure was accessed to describe mental health and social service interactions and outcomes for a retrospective FEP cohort comprising 918 young Māori and 1275 non-Māori aged 13 to 25 at diagnosis. Logistic regression models were used to examine whether social outcomes including employment, benefit receipt, education and justice involvement in year 5 differed by indigeneity.

Non-Māori young people were more likely than Māori to have positive outcomes in the fifth year after FEP diagnosis, including higher levels of employment and income, and lower rates of benefit receipt and criminal justice system involvement. These patterns were seen across diagnostic groups, and for both those receiving ongoing mental healthcare and those who were not.

Non-Māori experience relative advantage in outcomes 5 years after FEP diagnosis. Indigenous-based social disparities following FEP urgently require a response from the health, education, employment, justice and political systems to avoid perpetuating these inequities, alongside efforts to address the disadvantages faced by all young people with FEP.

Gambling-related harm is a global public health concern. Suicide mortality is increased among people who experience gambling harm, and people who die by suicide often have contact with mental health treatment services in the months preceding their death.

To assess via a case–control study how gambling diagnosis predicts suicidal death and mental healthcare utilisation using linked routinely collected healthcare data.

We linked the Welsh Longitudinal General Practice Dataset, Annual District Death Extract, Patient Episode Database for Wales, and Outpatient Appointments Dataset Wales using the Secure Anonymised Information Linkage (SAIL) Databank. A sample of individuals with gambling diagnosis who died by suicide and an age- and sex-matched comparator group of all-cause decedents between 1993 and 2023 were extracted. Predictors of suicidal death, including mental health diagnosis and treatment contacts, were analysed using binary logistic regression models and chi-squared tests.

A matched cohort of 92 individuals diagnosed with a gambling diagnosis (mean age 61.5 years, s.d. 13.1; 71% male) who died by suicide and 2990 comparators were identified. Gambling diagnosis status was a significant predictor of suicide (odds ratio 30.94; 95% CI 3.57–268.28; P = 0.002). Individuals with gambling disorder had significantly more mental health treatment contacts (P < 0.001), particularly in-patient contacts (P < 0.001). No difference in out-patient contacts was found.

Historical diagnosis of gambling harm is a significant predictor of suicidal death and mental health treatment utilisation. Improved screening and coding practices would facilitate greater data linkage research on gambling-related suicide and suicide prevention.