Subjective cognitive decline (SCD) is defined as self-reported increase in confusion or memory loss. There is limited research on the interplay between rural–urban residence and education on SCD.

Examine rural–urban differences in SCD, and whether education moderates this relationship.

Respondents aged ≥45 years were queried about SCD in the 2022 Behavioral Risk Factor Surveillance System data, creating a sample size of 63 890. A logistic regression analysed the association between rural–urban residence and SCD, and moderation was tested by an interaction with education.

SCD was more common among rural (12.0%) compared with urban (10.7%) residents. Rural residence was associated with 9% significantly higher odds of SCD compared with urban residence after adjusting for sociodemographic and health covariates (adjusted odds ratio (aOR) = 1.09, P = 0.01). There was a negative relationship between education level and SCD, including the association of college degree with 15% lower odds of SCD compared with less than high school degree (aOR = 0.85, P < 0.01). Education was a significant moderator, with higher education associated with lower odds of SCD for urban, but not rural, residents.

Rural setting and lower education were associated with higher odds of SCD, but higher education was protective for only urban residents. These results indicate that higher education may be a gateway for more opportunities and resources in urban settings, with cascading impacts on cognition. Future research should examine reasons for the diverging cognitive benefits from education depending on rural–urban residence.

Noradrenergic activation in the central and peripheral nervous systems is a putative mechanism explaining the link between hypertension and affective disorders.

We investigated whether these stress-sensitive comorbidities may be dependent on basal noradrenergic activity and whether vascular responses to centrally acting stimuli vary according to noradrenergic activity.

We examined the relation of affective disorders and stress-mediated vascular responses to plasma concentrations of normetanephrine, a measure of noradrenergic activity, in subjects with primary hypertension (n = 100, mean ± s.d. age 43 ± 11 years, 54% male). The questionnaires Patient Health Questionnaire-9 (PHQ-9), 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDSSR-16) and Generalized Anxiety Disorder-7 (GAD-7) were used for evaluation of symptoms of depression and anxiety. Forearm blood flow (strain gauge plethysmography) was used to assess vascular responses to mental stress and to device-guided breathing (DGB), interventions that respectively increase or decrease noradrenergic activity in the prefrontal cortex and locus coeruleus.

Low mood and high anxiety were two- to threefold higher for hypertensive subjects in the highest compared with the lowest normetanephrine tertiles (each P < 0.005). Forearm vasodilator responses to mental stress and vasoconstrictor responses to DGB were attenuated in those with high compared with low normetanephrine (28.3 ± 21% v. 47.1 ± 30% increases for mental stress and 3.7 ± 21% v. 18.6 ± 15% decreases for DGB for highest versus lowest tertiles of normetanephrine, each P ≤ 0.01).

A hyperadrenergic state in hypertension is associated with mood disturbance and impaired stress-modulated vasomotor responses. This association may be mediated by chronic stress impinging on pathways regulating central arousal and peripheral sympathetic nerve activity.

Psychotic symptoms in depression are linked to worse outcomes, and treatment options are limited. Ketamine and esketamine are effective antidepressants, yet most studies have excluded patients with a history of psychotic symptoms.

To evaluate by systematic review the efficacy and safety of ketamine and esketamine in treating patients with unipolar or bipolar depressive episodes with psychotic features.

A comprehensive search of the PubMed, Ovid and Web of Science databases was conducted up to 2 November 2023. We included any study that reported the use of ketamine or esketamine in patients with depressive episodes with psychotic symptoms. The primary outcomes assessed were variations in depressive and psychotic symptoms and the incidence of adverse events. The protocol was preregistered in PROSPERO (CRD42023488524).

Ten studies were included, encompassing 60 patients with unipolar depression with psychotic symptoms and 19 patients with bipolar depression with psychotic symptoms. Treatment with (es)ketamine showed mean score changes on the Montgomery–Åsberg Depression Rating Scale ranging from −13.7 to −18.2 points in open-label studies of patients with unipolar depression with psychotic symptoms. Up to 50% of participants achieved remission. The largest study with patients with bipolar depression with psychotic symptoms reported a mean Montgomery–Åsberg Depression Rating Scale score change of −14.9 points. Adverse events were mostly mild and transient. There were no reports of switches to (hypo)mania or deterioration of psychotic symptoms, and in six studies there was substantial improvement of the latter.

The available evidence suggests that (es)ketamine shows antidepressant effects in patients with depressive episodes with psychotic features and has a reasonable safety profile. However, the heterogeneity of the studies included in this review and the high risk of bias warrant caution in interpreting the findings and underscore the need for further trials to confirm these preliminary results.

Alcohol use in autism spectrum disorder (ASD) is under-researched. Previous reviews have explored substance use as a whole, but this neglects individual characteristics unique to different substances. Alcohol use in non-clinical samples is associated with diverse responses. To advance practice and policy, an improved understanding of alcohol use among people with ASD is crucial to meet individual needs.

This was a narrative systematic review of the current literature on the association between alcohol use and ASD, focusing on aetiology (biological, psychological, social and environmental risk factors) and implications (consequences and protective factors) of alcohol use in autistic populations who utilise clinical services. We sought to identify priority research questions and offer policy and practice recommendations.

PROSPERO Registration: CRD42023430291. The search was conducted across five databases: CINAHL, EMBASE, MEDLINE, PsychINFO and Global Health. Included studies explored alcohol use and ASD within clinical samples.

A total of 22 studies was included in the final review. The pooled prevalence of alcohol use disorder in ASD was 1.6% and 16.1% in large population registers and clinical settings, respectively. Four components were identified as possible aetiological risk factors: age, co-occurring conditions, gender and genetics. We identified ten implications for co-occurring alcohol use disorder in ASD, summarised as a concept map.

Emerging trends in the literature suggest direction and principles for research and practice. Future studies should use a standardised methodological approach, including psychometrically validated instruments and representative samples, to inform policy and improve the experience for autistic populations with co-occurring alcohol use.

The transfer from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) can be challenging, particularly for adolescents with neurodevelopmental disorders (NDDs) requiring long-term follow-up.

To examine the transfer process from CAMHS to AMHS in a university hospital in Türkiye, focusing on challenges, service gaps and barriers to transfer for individuals with NDDs.

Hospital records of children with NDDs followed in CAMHS for at least 5 years were reviewed. Children with at least one annual admission until 2017–2018 were included. A total of 211 patients were categorised into two groups: those who transferred to AMHS by 2018–2019 (transferred group, 81 patients) and those who did not transfer (non-transferred group, 130 patients). Clinical features, such as primary diagnosis and treatments, were compared, and parental views on the transfer process were collected via telephone interviews.

The transferred group included 81 patients (38.4%), whereas the non-transferred group had 130 patients (61.6%). Of the total sample, 55 (26.1%) were female, and 156 (73.9%) were male. Primary diagnoses were similar between groups; however, the transferred group had more comorbidities (P < 0.001) and more frequent antipsychotic prescriptions (P = 0.006). Proactive information from CAMHS doctors (B = 2.46, s.e. = 0.68, P < 0.001) and psychiatric comorbidities predicted transfer. In addition, attention-deficit hyperactivity disorder diagnoses changed during transfer in the transferred group (P = 0.002).

These findings emphasise the need for tailored transition support to enhance mental healthcare for NDD patients and indicate areas where further research is required to address healthcare barriers.

A systematic review/meta-analysis synthesising the existing evidence regarding the prevalence of loneliness and social isolation among individuals with mild cognitive impairment (MCI) or dementia is lacking.

A systematic review and meta-analysis was conducted to investigate the prevalence and factors associated with loneliness and social isolation among individuals with MCI or dementia.

A search was conducted in five established electronic databases. Observational studies reporting prevalence and, where available, factors associated with loneliness/isolation among individuals with MCI and individuals with dementia, were included. Important characteristics of the studies were extracted.

Out of 7427 records, ten studies were included. The estimated prevalence of loneliness was 38.6% (95% CI 3.7–73.5%, I2 = 99.6, P < 0.001) among individuals with MCI. Moreover, the estimated prevalence of loneliness was 42.7% (95% CI 33.8–51.5%, I² = 90.4, P < 0.001) among individuals with dementia. The estimated prevalence of social isolation was 64.3% (95% CI 39.1–89.6%, I² = 99.6, P < 0.001) among individuals with cognitive impairment. Study quality was reasonably high. It has been found that living alone and more depressive symptoms are associated with a higher risk of loneliness among individuals with dementia.

Social isolation, and in particular loneliness, are significant challenges for individuals with MCI and dementia. This knowledge can contribute to supporting successful ageing among such individuals. Future research in regions beyond Asia and Europe are clearly required. In addition, challenges such as chronic loneliness and chronic social isolation should be examined among individuals with MCI or dementia.

Immune dysregulation contributes to the pathophysiology of depression and is a potential link between depression and comorbid medical conditions. DNA methylation is a dynamic transcriptional regulator of the immune system.

To study changes in DNA methylation of disease- and comorbidity-associated immune genes in patients with and without depression diagnoses from the German BiDirect Study.

We performed a cross-sectional (baseline, y0) and longitudinal (consecutive assessments at 3-year intervals, y0, y3, y6) differential methylation analyses of 382 immune-related genes associated with depression, obesity, diabetes and/or gout in 276 patients with depression and in 207 individuals without a lifetime depression diagnosis from the BiDirect Study. In addition, we applied unsupervised clustering to identify subgroups of individuals with depression based on longitudinal methylation patterns.

There were no significant methylation changes between individuals with depression and controls at baseline. Follow-up analyses used to assess the top (P < 0.05) 151 methylation probes longitudinally identified 42 CpG sites that showed time-dependent changes associated with depression, and defined 3 depression clusters with differential profiles of serum inflammation markers at baseline. The implicated genes corresponded in the majority to those associated with diabetes risk, and were enriched in processes relevant for haematopoiesis.

Our results suggest that immune dysregulation associated with DNA methylation profiles contributes to the pathophysiology of depression and is a plausible link to chronic medical conditions such as diabetes.

Research shows initial COVID-19 lockdowns increased population mental distress. Yet, the mental health impact of repeated lockdowns in England remains unknown.

To: (a) explore changes in population mental health symptoms over the COVID-19 pandemic period (March 2020 to March 2021) in England, comparing this with trends from a decade before (2009–2019) as well as after (2021–2023); (b) compare the mental health impact of each of the three lockdowns in England with periods of eased restrictions, determining who was most affected; (c) examine the impact of demographics and distinct time periods on the prevalence of mental health symptoms.

A secondary analysis of a national longitudinal cohort study, utilising data from Waves 1–13 of the UK Household Longitudinal Study and from Waves 1–9 of the COVID-19 Survey. Mental health was assessed using the 12-item General Health Questionnaire. Student t-tests and logistical regressions were conducted.

There was a significant increase in the prevalence of self-reported symptoms of mental health during England's pandemic period, encompassing three lockdowns, compared with the average of rates from 10 years before. Rates of reported mental health symptoms were not significantly different across each lockdown, but were significantly higher than pre-pandemic rates, declining with eased restrictions. Rates from the end of lockdown to May 2023 revealed elevated mental health symptoms compared with pre-pandemic. Elevated symptoms were observed for women, people homeworking, those with health conditions, individuals aged 30–45 years and those experiencing loneliness.

Repeated lockdowns in England had a substantial impact on mental health, indicating requirements for ongoing mental health support.

No research has assessed Hamilton Rating Scale for Anxiety (HRSA) psychometric properties in Ethiopian university students, using item response theory (IRT) and classical theory.

This study aimed to assess psychometric properties of the English HRSA in Ethiopian students, using IRT and classical theory.

University students (N = 370, age 21.44 ± 2.30 years) in Ethiopia participated in a cross-sectional study. Participants completed a self-reported measure of anxiety, a sociodemographics tool and interviewer-administered HRSA.

Confirmatory factor analysis (CFA) favoured a one-factor structure because fit indices for the one-factor model; and two distinct two-factor models were similar, but high interfactor correlations violated discriminant validity criteria in two-factor models. This one-factor structure showed structural invariance as evidenced by multi-group CFA across gender groups. No ceiling/floor effects were seen for the HRSA total scores. Infit and outfit mean square values for all the items were within the acceptable range (0.6–1.4). Four threshold estimates (τi1, τi2, τi3 and τi4) for each item were ordered as expected. Differential item functions showed item-level measurement invariance for all the 14 HRSA items across gender for both uniform and non-uniform estimates. McDonald’s ω and Cronbach’s α for the HRSA tool were both 0.88. The convergent validity of the interviewer-administered HRSA with self-reported anxiety subscale of the 21-item Depression, Anxiety and Stress Scale was weak to moderate.

The findings favour the validity of a one-factor structure of the HRSA with adequate item properties (classical and rating scale model), convergent validity, reliability and measurement invariance (structural and item level) across gender groups in Ethiopian university students.

Depression in individuals with type 2 diabetes mellitus (T2DM) is associated with worse clinical prognosis; however, evidence regarding the relationship between depression and hypoglycaemic risk remains limited and inconclusive.

Our study aimed to evaluate the association between depressive symptoms and hypoglycaemic events.

Depressive symptoms were assessed in participants of the ACCORD-HRQL study at baseline and during follow-up visits at 12, 36 and 48 months using the nine-item Patient Health Questionnaire (PHQ-9). Symptom severity was categorised into three levels: none (0–4 points), mild (5–9 points) or moderate to severe (10–24 points). The primary outcomes included hypoglycaemia requiring any assistance (HAA) and hypoglycaemia requiring medical assistance (HMA).

Over a median follow-up of 4.3 years, 220 individuals developed HAA (incidence rate: 27.0 per 1000 person-years) and 157 individuals experienced HMA (incidence rate: 18.8 per 1000 person-years). Depressive symptoms exhibited dynamic fluctuations during the study period, and participants with depression consistently demonstrated less effective glycaemic control compared to those without depression. However, each one-unit increase in PHQ-9 score was not associated with elevated risks of HAA (hazard ratio, 1.00; 95% CI, 0.97–1.03) or HMA (hazard ratio, 0.98; 95% CI, 0.95–1.02).

Depressive symptoms in individuals with T2DM are dynamic and correlate with suboptimal glycaemic control. However, no significant association was observed between depression severity and increased hypoglycaemic events. These findings highlight the importance of integrated clinical strategies for continuous mental health monitoring and glucose management in T2DM individuals.

A lifetime history of non-suicidal self-injury (NSSI) is a risk factor for subsequent behavioural and emotional problems, including depression, aggression and heightened emotional reactivity. Traumatic experiences, which are frequently reported by individuals with NSSI, also show predictive links to these mental health problems. However, the exact connections between these areas and their subdomains remain unclear.

To explore in detail the relationships of specific characteristics of NSSI (e.g. termination in adolescence, duration, frequency, reinforcement mechanisms) and various types of traumatic experience (emotional, physical, sexual) with distinct aspects of emotional reactivity (sensitivity, intensity, persistence), aggression (behavioural, cognitive, affective) and severity of depression in university students.

Via online survey, 150 university students aged 18 to 25 years, who had self-injured at least once, provided information on NSSI, and completed questionnaires including the Childhood Trauma Questionnaire, Patient Health Questionnaire, Emotion Reactivity Scale, and Aggression Questionnaire. Regression analyses were conducted to determine risk factors linked to increased depression scores, aggression and emotional reactivity. The study was pre-registered in the German Clinical Trials Register (DRKS00023731).

Childhood emotional abuse contributed to emotional reactivity, aggression and depressive symptom severity (β = 0.33–0.51). Risk factors for sustained NSSI beyond adolescence included increased automatic positive reinforcement (odds ratio: 2.24).

Childhood emotional abuse significantly contributes to emotional and behavioural problems and needs to be considered in NSSI therapy. NSSI was found to persist into adulthood when used as an emotion regulation strategy.

Lesbian, gay, bisexual, transgender, queer and related community (LGBTQ+) individuals have significantly increased risk for mental health problems. However, research on inequalities in LGBTQ+ mental healthcare is limited because LGBTQ+ status is usually only contained in unstructured, free-text sections of electronic health records.

This study investigated whether natural language processing (NLP), specifically the large language model, Bi-directional Encoder Representations from Transformers (BERT), can identify LGBTQ+ status from this unstructured text in mental health records.

Using electronic health records from a large mental healthcare provider in south London, UK, relevant search terms were identified and a random sample of 10 000 strings extracted. Each string contained 100 characters either side of a search term. A BERT model was trained to classify LGBTQ+ status.

Among 10 000 annotations, 14% (1449) confirmed LGBTQ+ status while 86% (8551) did not. These other categories included LGBTQ+ negative status, irrelevant annotations and unclear cases. The final BERT model, tested on 2000 annotations, achieved a precision of 0.95 (95% CI 0.93–0.98), a recall of 0.93 (95% CI 0.91–0.96) and an F1 score of 0.94 (95% CI 0.92–0.97).

LGBTQ+ status can be determined using this NLP application with a high success rate. The NLP application produced through this work has opened up mental health records to a variety of research questions involving LGBTQ+ status, and should be explored further. Additional work should aim to extend what has been done here by developing an application that can distinguish between different LGBTQ+ groups to examine inequalities between these groups.

Youth suicidal ideation and behaviour are major significant concerns, with suicide being the third leading cause of death among youth. In recent years, the trend toward deinstitutionalisation has caused parents of high-risk youth to face increasing emotional and practical challenges, including managing lethal means restriction (LMR) to reduce suicide risk.

This qualitative study explores the experiences of parents instructed by mental health professionals to restrict their child’s access to lethal means in managing suicidal behaviours.

Twelve Israeli parents of youth aged 12–21 years participated in in-depth interviews. Using interpretative phenomenological analysis, the study investigated the emotional, psychological and relational challenges parents face when implementing LMR.

Findings indicate that parents struggle to understand and implement LMR guidance, experience emotional strain from their role as protectors, and face pervasive anxiety about their child’s safety. The study also highlights feelings of helplessness and the erosion of trust between parents and children. Many parents criticise LMR, viewing it as potentially harmful to their relationship with their child or ineffective at keeping their child safe.

This study underscores the emotional and practical challenges parents face when implementing LMR. To improve its effectiveness, guidance should be re-evaluated and communicated more flexibly, emphasising shared responsibility between the parent and child, and address the emotional toll on parents during this critical period.

Research suggests that those caring for a loved one with an eating disorder in the UK report unmet needs and highlight areas for improvement. More research is needed to understand these experiences on a wider, national scale.

To disseminate a national survey for adults who had experience caring for a loved one with an eating disorder in the UK, informed by the findings of a smaller scale, qualitative study with parents, siblings and partners in the UK.

A cross-sectional web-based survey was disseminated to adults who had experience caring for a loved one with an eating disorder in the UK.

A total of 360 participants completed the survey. Participants described experiences of care received in both children and young people's, and adult services. Those receiving care from children and young people's services generally reported more timely care, greater involvement in care and more confidence managing their loved one's symptoms post-discharge. In both settings, participants identified a number of areas for improvement, including more timely access to care, improved transition processes and discharge planning, and increased involvement in their loved one's care.

This survey captures the experiences of individuals caring for a loved one with an eating disorder in the UK. There are identified discrepancies between experiences of care in children and young people services compared with adult services. Clinical implications and recommendations for improvement are discussed, including improved transition and discharge processes, increased involvement of and/or support for carers themselves, and more timely access to support services for the unwell individual.

Understanding the effect(s) of the COVID-19 pandemic is key for planning for future pandemics.

This study examines change in self-reported mental health difficulties during three months of the pandemic among adolescent (10- to 15-year-olds) participants from the UK Household Longitudinal Study (waves 7, 9 and 11 of the main survey and waves 4, 5 and 8 of the COVID-19 surveys).

We focused on mental health difficulties using the Strengths and Difficulties Questionnaire (SDQ), using repeated cross-sectional and longitudinal analyses to examine data among 6471 adolescents who responded to at least one survey since 2015, and 2,300 who responded to at least one COVID-19 survey during July 2020, November 2020 or March 2021.

Repeated cross-sectional data showed similar mean total SDQ across surveys before and during the pandemic (range during pandemic 11.4 to 11.9; range pre-pandemic 11.1 to 11.8). Longitudinal analyses provided no evidence of mental health change compared with pre-pandemic trends (estimated change mean SDQ (β) = 0.05, 95% CI −0.42 to 0.51; p = 0.85), or differential sociodemographic effects, except greater effects in rural households (β = 0.67, 95% CI −0.08 to 1.41) than urban environments (β = −0.18, 95% CI −0.69 to 0.33). Though subscales generally saw higher scores during the pandemic than before, these were consistent with pre-pandemic trends, excepting a slight improvement in conduct problems (β = −0.26, 95% CI 0.12 to 0.40).

The study offers evidence among a representative sample that mental health difficulties did not, on average, deteriorate for adolescents during three months of the pandemic.

Functional cognitive disorder is an increasingly recognised subtype of functional neurological disorder for which treatment options are currently limited. We have developed a brief online group acceptance and commitment therapy (ACT)-based intervention.

To assess the feasibility of conducting a randomised controlled trial of this intervention versus treatment as usual (TAU).

The study was a parallel-group, single-blind randomised controlled trial, with participants recruited from cognitive neurology, neuropsychiatry and memory clinics in London. Participants were randomised into two groups: ACT + TAU or TAU alone. Feasibility was assessed on the basis of recruitment and retention rates, the acceptability of the intervention, and signal of efficacy on the primary outcome measure (Acceptance and Action Questionnaire II (AAQ-II)) score, although the study was not powered to demonstrate this statistically. Outcome measures were collected at baseline and at 2, 4 and 6 months post-intervention, including assessments of quality of life, memory, anxiety, depression and healthcare use.

We randomised 44 participants, with a participation rate of 51.1% (95% CI 40.8–61.5%); 36% of referred participants declined involvement, but retention was high, with 81.8% of ACT participants attending at least four sessions, and 64.3% of ACT participants reported being ‘satisfied’ or ‘very satisfied’ compared with 0% in the TAU group. Psychological flexibility as measured using the AAQ-II showed a trend towards modest improvement in the ACT group at 6 months. Other measures (quality of life, mood, memory satisfaction) also demonstrated small to modest positive trends.

It has proven feasible to conduct a randomised controlled trial of ACT versus TAU.