In individuals with severe mental illness (SMI), low muscle strength heightens the risk of mortality and chronic disease development. Routine muscle strength assessments could identify vulnerabilities, thereby reducing the growing burden associated with SMI. However, integration into clinical settings faces obstacles because of limited resources and inadequate healthcare staff training. The 5 sit-to-stand (5-STS) test offers an alternative for measuring muscle strength compared with more complex or demanding tests. Nevertheless, its validity in individuals with SMI remains unexplored.

This study aimed to analyse the criterion validity of the 5-STS test in SMI, considering potential age, gender and body mass index influences.

In a cross-sectional study following the ‘STrengthening the Reporting of OBservational studies in Epidemiology’ (STROBE) guidelines, 82 adults with SMI (aged 18–65, 24 women) were assessed. Participants underwent both the 5-STS test and the isometric knee extension strength (KES) test.

Analysis revealed a significant moderate correlation coefficient and intraclass correlation coefficient (−0.58 for both) for all participants, indicating that the measures are valid and assess related aspects of the same construct. Strong agreement was observed in women and the older age groups. The 5-STS test demonstrated accuracy, with a standard error of estimate lower than the within-subject variability on the KES test. Bland–Altman plots showed limits of agreement values of −3.39 and 3.52 for the entire sample, and heteroscedasticity analyses indicated consistent differences between the 5-STS and KES tests across all groups analysed, except in the women's group.

The 5-STS test seems to be a valid test for assessing muscle strength in individuals with SMI, supporting its usefulness for routine assessment in clinical settings, facilitating detection and intervention in critical situations.

British South Asians have a greater incidence of psychotic illness, which is associated with cognitive deficits. Computerised cognitive remediation aims to improve cognition.

We aimed to culturally adapt computerised cognitive remediation for British South Asians with first-episode psychosis, and assess its feasibility.

Qualitative interviews were analysed using thematic analysis to guide cultural adaptation of cognitive remediation, followed by a case series to determine feasibility. Our sample comprised 20 participants: ten in the qualitative interviews and ten in the feasibility evaluation. The sample was generated via purposive sampling from early intervention services in England, and was an entirely Muslim cohort, who were mainly Pakistani and born in the UK. Our intervention was computerised interactive remediation of cognition training for schizophrenia (CIRCuiTS), which was culturally adapted based on formative qualitative interviews and using an established framework. Participants engaged with 40 h of tasks over 12 weeks, with the aim of improving attention, memory and executive functioning. Feasibility was explored by assessing acceptability, engagement and retention in the study, and a range of measures were used to assess impact on cognition and mental state.

The cultural adaptation of CIRCuiTS was found to be acceptable, with high levels of engagement and satisfaction. Despite the small sample, the intervention led to improved cognition and mental state.

This is the first study to culturally adapt computerised cognitive remediation for British South Asians who are Muslim, and it had high acceptability with good retention, engagement and satisfaction. Future effectiveness testing is recommended.

Clinical placements are essential in healthcare education, offering practical experience and skill development under experienced supervision. However, little research has explored the characteristics of effective psychiatry placements. Understanding the factors considered vital by psychiatry core trainees for a successful placement is crucial amid concerns about trainee attrition in psychiatry programmes.

This study aims to identify key elements that contribute to a successful psychiatric placement, as perceived by final-year core trainees.

This qualitative study uses one-hour, semi-structured interviews with 15 core trainees in their final placement within the South London and Maudsley Training Programme. Interviews were guided by appreciative inquiry principles, and two independent researchers employed a classic thematic analysis method while maintaining appropriate reflexivity throughout.

A central theme emerges regarding the importance of a well-designed learning environment, which includes a robust training infrastructure, psychological safety, active learning opportunities, access to role models and structured feedback. The supervisor–supervisee relationship is emphasised, with the ideal supervisor being both knowledgeable and empathetic and offering mentorship and pastoral support. These factors are key to professional growth, well-being and job satisfaction, and they are strongly linked to retention in the field.

Core trainees value placements that address foundational training needs and cultivate psychological safety while facilitating experiential learning. Addressing these aspects in training programmes enhances the educational experience and improves retention. Future research should explore supervisors’ perspectives and examine how to balance ideal and practical supervisory roles.

Mood and anxiety disorders co-occur and share symptoms, treatments and genetic risk, but it is unclear whether combining them into a single phenotype would better capture genetic variation. The contribution of common genetic variation to these disorders has been investigated using a range of measures; however, the differences in their ability to capture variation remain unclear, while the impact of rare variation is mostly unexplored.

We aimed to explore the contributions of common genetic variation and copy number variations associated with risk of psychiatric morbidity (P-CNVs) to different measures of internalising disorders.

We investigated eight definitions of mood and anxiety disorder, and a combined internalising disorder, derived from self-report questionnaires, diagnostic assessments and electronic healthcare records (EHRs). Association of these definitions with polygenic risk scores (PRSs) of major depressive disorder and anxiety disorder, as well as presence of a P-CNV, was assessed.

The effect sizes of both PRSs and P-CNVs were similar for mood and anxiety disorder. Compared to mood and anxiety disorder, internalising disorder resulted in higher prediction accuracy for PRSs, and increased significance of associations with P-CNVs for most definitions. Comparison across the eight definitions showed that PRSs had higher prediction accuracy and effect sizes for stricter definitions, whereas P-CNVs were more strongly associated with EHR- and self-report-based definitions.

Future studies may benefit from using a combined internalising disorder phenotype, and may need to consider that different phenotype definitions may be more informative depending on whether common or rare variation is studied.

National policy in England recommends that young people be admitted to mental health wards that are age-appropriate. Despite this, young people continue to be admitted to adult wards.

To explore the impact of young people’s admissions to adult wards, from the perspectives of young people, parents/carers and mental health professionals working in adult services.

Semi-structured interviews were conducted with 29 participants to explore experiences of receiving and delivering care in adult mental health wards. Participants were four young people (aged 16–17 years), four parents/carers and 21 mental health professionals from adult mental health services in England. Data were analysed using framework analysis.

Young people’s admissions to adult wards tend to occur out of hours, at a time of crisis and when no suitable adolescent bed is available. Admissions were conceptualised as a short-term safety measure rather than for any therapeutic input. Concerns were raised about safeguarding, limited treatment options and a lack of education provision for young people on adult wards. However, exceptionally, for older adolescents, an adult ward might be clinically or socially appropriate. Recommendations to reduce adult ward admissions included better integration of adolescent and adult services, having more flexible policies and increasing community provision.

Our findings emphasise the importance of young people being admitted to age-appropriate in-patient facilities. Earlier intervention and increased provision of specialist care in the community could prevent young people’s admissions to adult wards.

There is an urgent need to address the poor quality of mental healthcare and human rights violations within mental health systems and communities. To achieve this, efforts must focus on changing the attitudes that perpetuate stigma and discrimination against individuals with mental health conditions, as well as psychosocial, intellectual and cognitive disabilities. The World Health Organization (WHO) QualityRights e-training on mental health, recovery and community inclusion is tackling these issues in several countries; however, its global impact has yet to be evaluated.

This study aims to assess the changes in attitudes following the completion of the WHO QualityRights e-training in countries worldwide.

Data from 3026 participants were analysed in this pre-post intervention study. Changes in scores on the WHO QualityRights Attitudes questionnaire were evaluated with the paired t-test and Wilcoxon signed-rank test.

The mean differences from baseline to post-training on the WHO QualityRights Attitudes questionnaire were 9.91 (95% CI 9.58–10.24, d = 1.07) for the total sample, 8.95 (95% CI 8.59–9.31, d = 0.99) for the high-income countries sample; and 12.75 (95% CI 12.03–13.47, d = 1.33) for the low- and middle-income countries sample. These findings indicate that participants, after completing the e-training, showed a decrease in negative attitudes toward individuals with mental health conditions and psychosocial, intellectual and cognitive disabilities.

This study suggests that the WHO QualityRights e-training has a positive, large effect in reducing negative attitudes toward individuals with mental health conditions and psychosocial, intellectual and cognitive disabilities, and can contribute to reduced stigma and greater alignment with rights-based approaches. These findings support the scale-up of the WHO QualityRights e-training programme.

Developmental regression in children, in the absence of neurological damage or trauma, presents a significant diagnostic challenge. The complexity is further compounded when it is associated with psychotic symptoms.

We discuss a case series of ten children aged 6–10 years, with neurotypical development, presenting with late-onset developmental regression (>6 years of age), their clinical course and outcome at 1 year. A comprehensive clinical evaluation, laboratory investigations and neuroimaging ruled out any identifiable neurological cause.

Mean age at regression was 7.65 (s.d. 1.5) years and mean illness duration was 10.1 (s.d. 8.5) months. The symptom domains included regression (in more than two domains – cognitive, socio-emotional, language, bowel and bladder incontinence), emotional disturbances, and hallucinatory and repetitive behaviours. Response to treatment was gradual over 6 months to 1 year. At 1-year follow-up, nine children did not attain pre-regression functioning, and residual symptoms included not attaining age-appropriate speech and language, socio-emotional reciprocity and cognitive abilities.

These cases demonstrate a unique pattern of regression with psychiatric manifestations, distinct from autism spectrum disorder and childhood-onset schizophrenia. The diagnostic dilemma arises from the overlap of symptoms with childhood disintegrative disorder (CDD), childhood-onset schizophrenia and autism. This study underscores the diagnostic intricacies of this clinical presentation and highlights the need for longitudinal follow-up to unravel the transitions in phenomenology, course and outcome. For severe manifestations such as developmental regression, where the illness is still evolving, considering CDD as a non-aetiological and transitory/tentative diagnosis would aid against premature diagnostic categorisation and provide scope for ongoing aetiological search.

Racism is increasingly recognised as a key contributor to poor mental health. However, the existing literature primarily focuses on its effects on adults.

To identify literature on the association between experiences of racism and mental health in children and young people in the UK.

Inclusion criteria were: (a) peer-reviewed publications containing original data; (b) UK-based research; (c) included examination of associations between mental health and experiences of direct or indirect racism (quantitative or qualitative); (d) inclusion of an assessment of mental health outcomes; (e) participant ages up to and including 18 years of age or (if the range went beyond 18) with a mean age of 17 years or less. Six databases were searched between 2000 and 2022; an initial 11 522 studies were identified with only eight meeting the inclusion criteria.

Five of the identified studies provided quantitative data and three provided qualitative data. The majority of studies (7/8) focused on children and young people aged 10 years and over; only one focused on children under the age of 10 years. Measurements of racism varied among the studies providing quantitative data. Only four studies directly focused on the effects of racism on the mental health of children and young people.

Although the included studies highlighted potential negative impacts of experiences of racism on children and young people in the UK, this review shows the lack of available literature to inform policy and practice. No studies examined the impact of internalised racism, systemic and institutional racism, or intersectionality.

Limited access to health services and overwhelmed healthcare systems created a challenging environment for those in need of mental health support during the COVID-19 pandemic, and the pandemic impacted suicide risk in several ways.

The present study aimed to analyse how the quality of the health security systems in 12 countries affected suicide crisis syndrome (SCS) during the pandemic. We hypothesised that countries with robust health systems were better able to respond to the increased demand for (mental) health support, resulting in fewer cases of SCS.

From June 2020 to September 2021, 11 848 participants from 12 different countries took part in an online survey. Besides asking about sociodemographic information, the survey assessed the severity of SCS with the Suicide Crisis Inventory (SCI). The Global Health Security Index and the Legatum Prosperity Health Index were used to operationalise the quality of the national health systems. Multilevel analyses were performed to evaluate the impact of health system quality and COVID-19-associated factors on SCI scores.

SCS was more prevalent among participants with COVID-19 symptoms and in countries with high rates of COVID-19-associated deaths. Multilevel analyses revealed a significant interaction effect of COVID-19 symptoms and national health indices. SCS occurred significantly less frequently in participants with COVID-19 symptoms living in countries with good health security systems.

The challenges posed by the pandemic highlight the necessity to promote accessible and affordable health services to mitigate the negative impact of the pandemic on suicidal ideation and behaviour.

Constipation is a significant problem for people with intellectual disabilities, with a prevalence of 33–50%, causing at least five deaths annually in England. Individualised bowel care plans (IBCP) are recommended in England and Wales.

We evaluated the feasibility and impact of IBCPs for people with intellectual disabilities who are in in-patient psychiatric units, and the effect on clinical outcomes.

People with intellectual disabilities who were at risk of constipation were recruited from four specialist in-patient psychiatric units in England and Wales. A constipation questionnaire was used to capture relevant data to devise IBCPs. Baseline, 3- and 6-monthly Health of the Nation Scales – Learning Disability (HoNOS-LD) were completed after the intervention. Descriptive statistics, Wilcoxon signed-rank, Mann-Whitney U, repeated-measures analyses of variance, with Bonferroni adjustment and Mauchly’s tests were conducted. Significance was taken at P < 0.05.

Of 24 people with intellectual disabilities recruited from four units, all three data points were available for 18 patients. Constipation rates showed no statistically significant decline. The total HoNOS-LD score (18 items) did not decline. HoNOS-LD item 12 for physical functioning showed significant improvement for PwID with constipation compared with those without, between baseline and 6 months.

This quality improvement project suggests that a bigger study of IBCPs is feasible. Most outcomes examined via the HoNOS-LD, particularly those linked with mental illness, challenging behaviour and quality of life, did not show significant change, possibly because of the small sample size. However, people with intellectual disabilities and constipation showed positive changes in their physical functioning outcomes compared with those without constipation. Further in-depth evaluation of this intervention is needed.

Easily accessible, impactful, evidence-based resources are needed to assist mental health workers to best support voice-hearers in managing and living well with voices. Let’s Talk About Voices (LTAV) is an innovative suite of resources designed for mental health workers to use in supporting voice-hearers.

This study aimed to assess the impact of LTAV on mental health workers’ self-reported capacity to work with voice-hearers.

A randomised, controlled crossover design was used, with assessment at three time points. The assessment measure was co-developed by researchers, clinicians, peer workers and voice-hearers based on the aims of LTAV and the Theory of Planned Behaviour. Participants were randomised into two groups. The immediate group received access to LTAV following the first assessment; the delayed group received access following the second assessment. In total, 256 mental health workers commenced the study, with 120 completing all assessments.

Between-group comparisons for change between times 1 and 2 found a significant difference with a large effect size (F = 40.2, P < 0.001, ηp2 = 0.19). Significance remained on intention-to-treat analysis (F = 22.9, P < 0.001, ηp2 = 0.08). Pairwise repeated-measures comparisons found a significant increase in scores for both groups following access to LTAV, which was sustained at follow-up. Fourteen of 24 individual items showed significant change. Changes were consistent across professions, work settings and experience working with voice-hearers, but those with less confidence in working with voice-hearers on intake showed significantly stronger improvements.

This research indicates that LTAV has the potential to substantially improve mental health workers’ attitudes and confidence in supporting voice-hearers.

Acknowledging the impact of chronic kidney disease on caregivers’ quality of life (QoL) and psychological well-being has become a global priority, highlighting the need for supportive interventions specifically aimed at caregivers.

This study aimed to assess the prevalence of stress, anxiety and depression among family caregivers of Omani patients undergoing haemodialysis and to explore its association with QoL.

The study employed a cross-sectional design. A sample of 326 participants completed the study’s surveys, including the Depression Anxiety Stress Scale, WHOQOL-BREF scale and a demographic scale.

The survey indicated that 68.4% of the participant caregivers experienced varying degrees of depression. In addition, 48.4% of caregivers reported experiencing stress levels ranging from mild to extremely severe. For anxiety, 65.6% (n = 214) of caregivers noted varying levels, from mild to extremely severe anxiety. Significant negative associations were found among caregiver age, number of chronic illnesses, number of medications, daily hours spent on caregiving, physical health, stress, anxiety and depression, on the one hand, and the physical domain of QoL, on the other hand. Regarding the psychological domain of QoL, significant negative associations were observed with daily caregiving hours, physical health, stress, anxiety and depression.

This study highlights the significant psychological burden faced by caregivers of patients undergoing haemodialysis. Systematic screening and practical interventions, such as support groups and mental health programmes, are essential to improve caregiver well-being. Future research should explore the effectiveness of these interventions and the long-term impact of caregiving.

Physical activities are widely implemented for non-pharmacological intervention to alleviate depressive symptoms. However, there is little evidence supporting their genotype-specific effectiveness in reducing the risk of self-harm in patients with depression.

To assess the associations between physical activity and self-harm behaviour and determine the recommended level of physical activity across the genotypes.

We developed the bidirectional analytical model to investigate the genotype-specific effectiveness on UK Biobank. After the genetic stratification of the depression phenotype cohort using hierarchical clustering, multivariable logistic regression models and Cox proportional hazards models were built to investigate the associations between physical activity and the risk of self-harm behaviour.

A total of 28 923 subjects with depression phenotypes were included in the study. In retrospective cohort analysis, the moderate and highly active groups were at lower risk of self-harm behaviour. In the followed prospective cohort analysis, light-intensity physical activity was associated with a lower risk of hospitalisations due to self-harm behaviour in one genetic cluster (adjusted hazard ratio, 0.28 [95% CI, 0.08–0.96]), which was distinguished by three genetic variants: rs1432639, rs4543289 and rs11209948. Compliance with the guideline-level moderate-to-vigorous physical activities was not significantly related to the risk of self-harm behaviour.

A genotype-specific dose of light-intensity physical activity reduces the risk of self-harm by around a fourth in depressive patients.

Digital addiction among adolescents is an escalating concern with profound psychological implications, yet validated tools to measure it and studies exploring its relationship remain limited.

To validate the Bangla Digital Addiction Scale for Teenagers (Bangla DAST) and identify factors of digital addiction among Bangladeshi adolescents.

Using a two-stage stratified cluster sampling method, data from 1496 adolescents in Bangladesh were collected and analysed using non-parametric tests, Spearman correlations and multiple regression models.

The two-factor structure, encompassing attachment to digital devices (Factor 1) and compulsive use in different places (Factor 2) was supported by confirmatory factor analysis (comparative fit index 0.97, Tucker–Lewis index 0.95, root mean square error of approximation 0.06 [90% CI: 0.056–0.07] and standardised root mean square residual 0.048). McDonald’s omega was 0.81 for the total scale, 0.77 for Factor 1 and 0.63 for Factor 2. Convergent validity was supported by significant associations between digital addiction and psychological symptoms. Factors of digital addiction included age (b = 0.517, P = 0.020), academic grade (b = 0.737, P = 0.021), depression (b = 0.334, P < 0.001), anxiety (b = 0.400, P < 0.001) and insomnia (b = 0.504, P < 0.001). In contrast, female gender (b = −1.250, P = 0.001), not sleeping alone (b = −0.846, P = 0.029) and reduced smartphone usage (b = −1.895, P < 0.001) were associated with lower digital addiction scores. The model accounted for 23.1% of the variance in digital addiction.

The Bangla DAST appears to be a psychometrically valid and reliable tool and can be used for further studies assessing digital addiction among Bangladeshi adolescents. The study highlights the need for targeted preventive measures, particularly focusing on at-risk groups.