Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains.

We investigated employment and relationship status changes among patients across the affective and psychotic spectrum – in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions.

The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status.

The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls.

Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.

Former prisoners are a vulnerable population, and suicide rates among this group are high, particularly following release from prison.

To explore former prisoners’ engagement with mental health services before death by suicide, and to examine the demographics, clinical history and clinical care of this patient group and compare them with patients who died by suicide who had not been to prison.

The clinical, sociodemographic and care characteristics of patients in contact with mental health services who died by suicide in the UK were examined in a national clinical survey between 1 January 2001 and 31 December 2021, and comparisons were made between former prisoners and patients with no history of being in prison.

Of the 33 381 (median age 46 years, range 10–100; 65.6% male) patients who died by suicide in the UK and had been in contact with mental health services in the 12 months before death, 3335 (11%) were ex-prisoners (male n = 2988, 90%; female n = 347, 10%). Compared with other patients, ex-prisoner patients had higher frequencies of personality disorder, schizophrenia and delusional disorders, as well as childhood abuse. Ex-prisoner patients were more likely to be male, to be aged between 45 and 65 years (median age 39, range 17–89), to live in deprived areas and to have a history of substance misuse. We found no differences in ethnicity.

Mental health services need to focus particularly on patients with a history of being in prison who are experiencing economic adversity and offer substance-use-related interventions to ensure continued patient engagement. The link with deprivation is striking at a time at which rising costs of living are resulting in more health inequalities.

Environmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities.

A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400.

Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months.

The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction.

The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.

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.

There is no clear evidence about how to support people with borderline personality disorder (BPD) during the perinatal period. Perinatal emotional skills groups (ESGs) may be helpful, but their efficacy has not been tested.

To test the feasibility of conducting a randomised controlled trial (RCT) of perinatal ESGs for women and birthing people with BPD.

Two-arm parallel-group feasibility RCT. We recruited people from two centres, aged over 18 years, meeting DSM-5 diagnostic criteria for BPD, who were pregnant or within 12 months of a live birth. Eligible individuals were randomly allocated on a 1:1 ratio to ESGs + treatment as usual (TAU), or to TAU. Outcomes were assessed at 4 months post randomisation.

A total of 100% of the pre-specified sample (n = 48) was recruited over 6 months, and we obtained 4-month outcome data on 92% of randomised participants. In all, 54% of participants allocated to perinatal ESGs attended 75% of the full group treatment (median number of sessions: 9 (interquartile range 6–11). At 4 months, levels of BPD symptoms (adjusted coefficient −2.0, 95% CI −6.2 to 2.1) and emotional distress (−2.4, 95% CI −6.2 to 1.5) were lower among those allocated to perinatal ESGs. The directionality of effect on well-being and social functioning also favoured the intervention. The cost of delivering perinatal ESGs was estimated to be £918 per person.

Perinatal ESGs may represent an effective intervention for perinatal women and birthing people with BPD. Their efficacy should be tested in a fully powered RCT, and this is a feasible undertaking.

ISRCTN80470632.

Refugee mothers represent a significant proportion of the migrant population worldwide. Their resilience has important implications for their health and the positive adjustment of their family units. However, refugee mothers have received little attention in research.

This review provides an overview of factors that may promote or hinder resilience among refugee mothers and a foundation for identifying potential targets for clinical and policy interventions.

A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, using pre-defined criteria and a relevant search strategy on four databases: Web of Science Core Collection, APA PsycINFO, Ovid Medline, and Ovid Embase Classic+Embase. Study characteristics and data on resilience promotion and hindrance factors were extracted, and results were narratively synthesised.

Five articles met our inclusion criteria. Four studies described resilience promotion factors, and two studies described resilience hindrance factors. External (social or instrumental, community or professional, economic, and cultural) and internal (individual or psychological, and spiritual or religious) resilience resources were perceived as important for building resilience among refugee mothers.

The most recurrent resilience promotion factors related to possessing strong social networks and instrumental support, while the most recurrent resilience hindrance factors related to community and professional stressors, such as accessing healthcare. These findings serve as a first step towards identifying potential clinical and policy intervention targets to strengthen resilience in refugee mothers – a vulnerable and currently under-studied population. This review can provide a guide for policymakers, health professionals, refugee charities and local communities in prioritising the efforts to address refugee mothers’ needs.

In the UK, around 1 in 4 adults over 65 years suffers from depression. Depression case finding followed by alerting patients and their general practioners (GPs) (screening + GP) is a promising strategy to facilitate depression management, but its cost-effectiveness remains unclear.

To investigate the cost-effectiveness of screening + GP compared with standard of care (SoC) in northern England.

Conducted alongside the CASCADE study, 1020 adults aged 65+ years were recruited. Participants with baseline Geriatric Depression Scale (GDS) ≥5 were allocated to the intervention arm and those >5 to SoC. Resource use and EQ-5D-5L data were collected at baseline and 6 months. Incremental cost-effectiveness ratio was calculated. Non-parametric bootstrapping was performed to capture sampling uncertainty. The results are presented using cost-effectiveness acceptability curves. Sensitivity analyses were conducted to assess the robustness of primary findings. Subgroup analyses were undertaken to examine the cost-effectiveness among participants with more comparable baseline characteristics across treatment groups.

Screening + GP incurred £37 more costs and 0.006 fewer quality-adjusted life years than SoC; the probability of the former being cost-effective was <5% at a £30 000 cost-effectiveness threshold. Sensitivity analyses confirmed the base-case findings. Subgroup analyses indicated that screening + GP was cost-effective when patients with baseline GDS 2–7, 3–6 and 4–5, respectively, were analysed.

Screening + GP was dominated by SoC in northern England. However, subgroup analyses suggested it could be cost-effective if patients with more balanced baseline characteristics were analysed. Economic evaluations alongside randomised controlled trials are warranted to validate these findings.

Oral contraceptive pills (OCP) have received increased critical attention recently owing to their perceived link with mental health, especially among adolescent girls. The empirical literature, however, includes mixed findings on whether OCP use is associated with poorer mental health.

To examine the association between the use of OCP and internalising problems in adolescent girls.

This study was embedded in the iBerry study, a population-based cohort of adolescents oversampled for behavioural and emotional problems from the greater Rotterdam area, The Netherlands. In 372 girls, internalising problems were measured using the Youth Self Report, and use of OCP was determined by parental interview and self-report questionnaire across two subsequent waves (mean ages 14.9 and 17.9 years, respectively). Multiple regression analyses were performed to determine the association. Analyses were adjusted for various sociodemographic factors and adjusted for previous internalising problems assessed at a mean age of 14.9 years.

In total, 204 girls (54.8%) used OCP. OCP use was associated with fewer internalising problems in adolescent girls compared with non-use (adjusted β = −2.22, 95% CI [−4.24, −0.20]; P = 0.031).

In this research, we found that adolescent girls using OCP reported fewer internalising problems compared with non-users. This association was most prominent for girls with pre-existing internalising problems. Although healthy user bias may have a role, our observations suggest a potential therapeutic benefit for those with greater baseline challenges.

There are critical gaps within implementation science concerning health equity, particularly for minoritised ethnic groups. Implementation framework adaptations are important to facilitate health equity, which is especially relevant for psychiatry due to ethnic inequities in mental health; however, the range of potential adaptations has yet to be synthesised.

This systematic scoping review aimed to identify and map the characteristics of adaptations to implementation frameworks for minority ethnic groups to improve health equity.

Bibliographic searches of the MEDLINE, Embase, PsycINFO and CINAHL databases were conducted, spanning the period from 2004 to February 2024 for descriptions of implementation frameworks adapted for minority ethnic groups. The characteristics of those meeting the criteria were narratively synthesised.

Of the 2947 papers screened, six met the eligibility criteria. Three different types of implementation frameworks were adapted across the six papers: evaluation, process and determinant frameworks. Most of the adaptations were made by expanding the original framework, and by integrating it with another model, theory or framework with an equity focus. The adaptations primarily focused on putting equity at the forefront of all stages of implementation from intervention selection to implementation sustainability. No studies measured the effectiveness of the adapted framework.

The findings demonstrate that implementation frameworks are modifiable, and different elements can be adapted according to the implementation framework type. This review provides a starting point for how researchers and healthcare providers can adapt existing implementation frameworks to promote health equity for minoritised groups across a range of healthcare settings.

Rates of childhood mental health problems are increasing in the UK. Early identification of childhood mental health problems is challenging but critical to children’s future psychosocial development. This is particularly important for children with social care contact because earlier identification can facilitate earlier intervention. Clinical prediction tools could improve these early intervention efforts.

Characterise a novel cohort consisting of children in social care and develop effective machine learning models for prediction of childhood mental health problems.

We used linked, de-identified data from the Secure Anonymised Information Linkage Databank to create a cohort of 26 820 children in Wales, UK, receiving social care services. Integrating health, social care and education data, we developed several machine learning models aimed at predicting childhood mental health problems. We assessed the performance, interpretability and fairness of these models.

Risk factors strongly associated with childhood mental health problems included age, substance misuse and being a looked after child. The best-performing model, a gradient boosting classifier, achieved an area under the receiver operating characteristic curve of 0.75 (95% CI 0.73–0.78). Assessments of algorithmic fairness showed potential biases within these models.

Machine learning performance on this prediction task was promising. Predictive performance in social care settings can be bolstered by linking diverse routinely collected data-sets, making available a range of heterogenous risk factors relating to clinical, social and environmental exposures.

History of prior mental disorder, particularly post-traumatic stress disorder (PTSD), increases risk for PTSD following subsequent trauma exposure. However, limited research has examined differences associated with specific prior mental disorders among people with PTSD.

The current study examined whether different prior mental disorders were associated with meaningful differences among individuals presenting to a specialist service for severe earthquake-related distress following the Canterbury earthquakes (N = 177).

Two sets of comparisons were made: between participants with no history of prior disorder and participants with history of any prior disorder; and between participants with history of prior PTSD and those with history of other prior disorders. Comparisons were made in relation to sociodemographic factors, earthquake exposure, peri-traumatic distress, life events and current psychological functioning.

Participants with any prior mental disorder had more current disorders than those with no prior disorder. Among participants with history of any prior disorder, those with prior PTSD reported more life events in the past 5 years than those with other prior disorders.

Findings suggest a history of any prior mental disorder contributes to increased clinical complexity, but not increased PTSD severity, among people with PTSD seeking treatment. Although post-disaster screening efforts should include those with prior mental disorders, it should also be recognised that those with no prior disorders are also at risk of developing equally severe PTSD.

Electroconvulsive therapy (ECT) is often used to treat severe mental disorders in individuals with impaired capacity to consent to the treatment. Little is known about how different types of electrode placement are used in consensual and nonconsensual ECT.

To investigate whether there was an association between ECT consent status and electrode placement, given that ECT electrode placement affects efficacy and cognitive outcomes.

Using a statewide database across 3 years in Victoria, Australia, we performed chi-squared tests to determine whether consent status (consensual versus nonconsensual) was associated with particular electrode placements. A three-way log–linear analysis was then conducted to examine whether age, gender, level of education and psychiatric diagnosis influenced the relationship between consent status and electrode placement. Given the comparable cognitive outcomes of right unilateral and bifrontal ECT, these electrode placements were combined in the analysis.

In total, 3882 participants received ECT in the Victorian public health service during the study period. In the nonconsensual ECT group, 722 of 1576 individuals (45.81%) received bitemporal ECT, compared with 555 of 2306 (24.06%) in the consensual group (χ2 = 200.53; P < 0.0001; odds ratio: 2.6673, 95% CI: 2.3244–3.0608). This association remained significant after adjustment for gender, age, level of education and diagnosis.

Significantly more participants in the nonconsensual ECT group received bitemporal ECT rather than right unilateral or bifrontal ECT compared with those in the consensual group. As bitemporal ECT is associated with more cognitive impairment, this choice of electrode placement in vulnerable patients who lack capacity to consent raises ethical considerations in the practice of ECT.

Evidence indicates that the COVID-19 pandemic has led to an increase in self-harm among adolescents; however, little is known about the trends in prevalence after the end of the pandemic.

This retrospective cross-sectional database study evaluates changes in the prevalence and clinical characteristics of self-harm among adolescents who sought attention from the emergency service of the largest children’s psychiatric hospital in Mexico before, during and after the COVID-19 pandemic.

After comparing the clinical characteristics of self-harm between the three periods, we calculated the monthly prevalence of self-harm among patients (n = 3520) visiting the hospital’s emergency psychiatric services over a period of 58 months. Using joinpoint regression, we evaluated temporal trends in self-harm prevalence.

Affective disorders and hitting as a method of self-harm were more frequent during and after the pandemic in comparison with the pre-pandemic period. The prevalence of self-harm diminished from March 2019 to March 2023, a trend followed by an increase coinciding with the end of the pandemic and the return to normal activities.

The significant increase in prevalence observed after the end of the pandemic suggests a long-term impact on mental health of adolescents. This underscores the need for monitoring this population during post-pandemic years to provide timely interventions.

Current empirical understanding of the relationship between psychopathology and terrorist behaviours in women is limited, because most research focuses on male perpetrators and relies on secondary sources. Addressing this gap is crucial, particularly given previous research that highlights significant differences in mental health problems between women and men involved in non-terrorist violent activities.

To empirically examine the presence of psychopathology in women exhibiting terrorist behaviours, as well as its potential role in these behaviours.

A case series study of 14 Dutch female convicts associated with the (so-called) Islamic State of Iraq and Syria (ISIS), examining the occurrence and types of mental disorders, psychopathological problems and pathological personality traits, and exploring their potential role in terrorist behaviours based on forensic mental health reports from psychiatrists and psychologists.

Half of the women (n = 7) exhibited mental disorders during terrorist activities, primarily personality disorders. Psychopathological problems included susceptibility to influence (71%, n = 10), identity problems (64%, n = 9), feelings of inferiority (57%, n = 8) and naivety (50%, n = 7). A significant link between terrorism and mental disorders, psychopathological problems or pathological personality traits was identified in almost half of the women (43%, n = 6).

Psychopathology is present in some women involved in terrorist behaviours, influencing their involvement, but is absent or irrelevant in others. Identifying psychopathology in women with terrorist tendencies is essential for early prevention and should be a core competency for psychiatrists.

The prevalence of psychiatric disorders in people with epilepsy is as high as 43% and, among them, psychoses represent a severe comorbidity.

This is a narrative review discussing the interplay between epilepsy and psychosis and identifying challenges in diagnosing and managing psychotic symptoms in epilepsy, focusing on the past 10 years.

Articles published between June 2014 and December 2024 were identified through searches in PubMed using the search terms ‘psychosis’, ’seizure, epilepsy and convulsion’, ‘epile*’, ’seizure*’ and ‘convuls*’.

The association between epilepsy and psychosis was shown to be bidirectional, with people with psychosis being at increased risk of epilepsy. In epilepsy, psychotic symptoms may occur in three clinical scenarios, with clinical presentation and management varying in relationship to these: seizure-related (peri-ictal), treatment-related or independent of the former.

There are no guidelines for the management of psychotic symptoms in epilepsy, but it is possible to apply policies for the treatment of psychoses, taking into account the peculiarities and needs of people with epilepsy.