Despite the high prevalence of mental disorders, knowledge about mental health, its promotion, prevention, and pathways to care in the general population remain limited. Mental Health First Aid (MHFA) seeks to increase mental health literacy in the general population and enable individuals to support others with mental health problems until professional help is available. This study aimed to investigate the feasibility and initial effects of MHFA training on (i) mental health literacy, (ii) stigmatizing attitudes toward individuals with mental health problems, (iii) social distance, (iv) trainees’ mental health, and (v) quality of life.

In an uncontrolled pilot study, individuals aged 18–75 years who participated in MHFA courses in Germany were recruited. Outcomes were assessed at baseline, post-training, and 6-month follow-up.

In total, 362 participants (mean age 43 years, 78% female) enrolled in the study at baseline. Retention was about 50% for post-training and 60% for follow-up assessment. At post-training, mental health literacy was increased (adjΒ = 6.77, 95% CI = 5.69 to 7.84) and social distance (adjΒ = −2.30, 95% CI = −2.73 to −1.87) and stigmatizing attitudes (adjΒ = −2.61, 95% CI = −3.25 to −1.97) were reduced. These effects were also evident at 6-month follow-up. There were no effects on trainees’ mental health. At the 6-month follow-up, 89% of trainees had talked to someone with mental health problems at least once, and 65% of trainees were quite or very confident in offering help.

Our findings suggest initial beneficial effects of MHFA training as implemented in Germany. A randomized controlled trial of MHFA in Germany is now warranted.

A better mechanistic understanding of schizophrenia spectrum disorders is crucial to developing efficient treatment approaches. Therefore, this study investigated longitudinal interrelations between clinical outcomes, brain structure, and somatic health in post-acute individuals from the schizophrenia spectrum.

A sample of 63 post-acute patients from two independent physical exercise studies was included in the final analyses. Demographic, clinical, cognitive, and somatic data were acquired at baseline and follow-up, as were structural magnetic resonance imaging scans. Multivariate cross-lagged panel modeling including mediators was used to study the mutual interrelations over time between the clinical, neural, and somatic levels.

A higher baseline global gray matter volume and larger regional gray matter volumes of the hippocampal formation, precuneus, and posterior cingulate predicted improved clinical outcomes, such as daily-life functioning, negative symptoms, and cognition. Increases in white matter volume from baseline to follow-up resulted in significantly reduced positive symptoms and higher daily-life functioning.

Our findings suggest that stimulating neuroplasticity, especially in the hippocampal formation, precuneus, and posterior cingulate gyrus, may represent a promising treatment target in post-acute schizophrenia spectrum disorders. Physical exercise therapies and other lifestyle interventions, and brain stimulation approaches reflect potential treatment candidates. Given the exploratory character of the statistical analysis performed, these findings need to be replicated in independent longitudinal imaging cohorts of patients with schizophrenia spectrum disorders.

Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.

We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.

Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).

These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.

The aim of this study is to determine the prevalence and type of mental disorders associated with pathological gambling/gambling disorder (GD) in the general population.

Systematic review and meta-analysis of adult population-based studies reporting on psychiatric comorbidity of GD according to International Classification of Diseases (ICD-10/ICD-11), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV/DSM-5) criteria, or widely used assessment instruments. PubMed, Scopus, and Web of Science databases were searched for relevant studies in English. The study’s protocol was preregistered in PROSPERO (CRD42024574210).

Of 454 articles published between 1993 and 2024, 12 met the inclusion criteria. Most studies used DSM-IV or DSM-5 criteria (only two ICD-10 criteria), and were evenly distributed across Europe, North America, and Southeast Asia. The weighted average prevalence of any mental disorder in individuals with GD was 82.2%. High comorbidity rates were found for substance use disorders (SUDs) (34.2%), mood disorders (30.9%), and anxiety disorders (29.9%), followed by personality (14.3%) and psychotic (5.9%) disorders. Meta-analysis indicates that individuals with GD are 10.7 (95% confidence interval [CI]: 5.7;20.1) times more likely to develop any mental disorder than the general population. The odds ratio for mental disorders associated with GD were 5–12 times higher for nicotine dependence, drug use disorder, alcohol use disorder, and SUD, and 3–4 times higher for anxiety and mood disorders.

These findings add weight to the view that GD is associated with a significantly increased risk for addictive behaviors, mood, and anxiety disorders.

Psychosocial interventions are vital in treating severe mental illness, yet their use remains limited, and patients often lack adequate information about them. Patient-focused versions of clinical guidelines are designed to enhance mental health literacy and inform patients about available treatments, but these resources are underutilized. This study evaluated the impact of implementing a patient-focused psychosocial intervention guideline on empowerment, knowledge, and use of psychosocial interventions among individuals with severe mental illness.

Multicentre, cluster-randomised trial. The study population comprised adult patients with a severe mental disorder. The intervention group received a multimodal, structured, and protocol-led patient-focused guideline implementation, whereas the control group received treatment as usual. Data were analysed using hierarchical linear models. The primary outcome was the change in patients’ empowerment.

There was no significant intervention effect on empowerment (effect size=0.13, p=0.605), which increased slightly in both groups. The number of psychosocial interventions familiar to patients increased significantly more in the intervention group. Exploratory analyses suggest that patient empowerment could have been influenced by COVID-19-related stress, patient age, the severity of functional impairment, and migration background. The improvement in the utilisation of psychosocial interventions did not differ significantly between the intervention group (M=1.1, SD=2.5) and the control group (M=1.3, SD=2.4).

The implementation of a patient-focused psychosocial intervention guideline failed to enhance empowerment among service users. However, our analyses indicate that the intervention led to an improvement in patient knowledge with respect to guideline content. The availability of psychosocial interventions may have been significantly constrained by the COVID-19 pandemic.

Childhood maltreatment (CM) increases the risk for psychopathology and CM type, severity and timing are considered important modulating factors in this relationship. However, reported associations are heterogeneous and hardly considered vulnerable groups broadly exposed to CM.

We investigated the association between CM types and timing and psychopathology in formerly out-of-home placed young adults (N = 185; 32% women, age mean = 26.38 years, SD = 3.49). CM was assessed using the Maltreatment and Abuse Chronology of Exposure Scale. Conditional random forest regression was used to estimate the importance of CM types (abuse, neglect, peer victimization, and sexual abuse), timing (ages 3–18), and global measures (severity, multiplicity, and duration) on adult general, internalizing, and externalizing problems (Achenbach System of Empirically Based Assessment). We validated the results using diagnoses of mental disorders clustered with the Hierarchical Taxonomy of Psychopathology model.

Global CM measures were stronger predictors of internalizing problems than CM type and timing. Abuse in early childhood was a stronger predictor of externalizing problems compared to global CM measures.

Considering CM type and timing might be valuable to guide maltreatment-informed interventions in therapeutic settings.

Adverse childhood experiences (ACEs) can cause morphological brain alterations across the lifespan, contributing to increased vulnerability to mental and physical disorders. Despite extensive research on ACEs-related brain alterations, the protective or augmenting role of modifiable lifestyle factors such as physical activity has been largely underexplored, representing a key gap in our understanding of trauma-related neuroplasticity. To close this gap, we aimed to investigate how lifetime physical activity (LPA) influences the relationship between ACEs and morphological brain alterations.

Moderation analyses using Hayes’ PROCESS macro examined the interaction between ACEs and LPA on the volume of limbic system-related regions – hippocampus, amygdala, anterior cingulate cortex (n = 81).

While LPA showed no moderating effect on hippocampal or anterior cingulate volume, the model concerning the volume of the amygdala was significant. This model explained 8.1% of the variance in amygdala volume (p = 0.002) and the interaction of LPA and ACEs contributed 7.9% of this variance, with a significant effect (β = −0.221 p ≤ 0.001). That indicated LPA moderates ACEs-related structural changes in the amygdala, a key component of the central circuitry of emotion and stress sensitization. Notably, only in individuals with low physical activity were ACEs associated with increased volume of amygdala.

Our findings underscore the behavioral dependency of the structural adaptations of the amygdala following childhood adversities. These results emphasize the therapeutic potential of incorporating physical activity into interventions for trauma-exposed individuals, offering a behavioral approach to mitigating stress-related neurobiological changes.

Clinical response and remission may not fully reflect patient priorities in treatment-resistant depression (TRD). Health-related quality-of-life (HRQoL) outcomes should be assessed to comprehensively capture treatment benefits.

ESCAPE-TRD (NCT04338321) was a 32-week randomized, phase IIIb trial comparing esketamine nasal spray (NS) versus quetiapine extended release (XR), both alongside an ongoing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor, in patients with TRD. Symptom and HRQoL improvements were assessed using the Patient Health Questionnaire-9 (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life in Depression Scale (QLDS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) measures.

Esketamine NS-treated patients (N=336) reached PHQ-9 remission (score ≤4) quicker than quetiapine XR-treated patients (N=340), and more had remission by Week 32 (34.5% vs. 18.2%; odds ratio [OR]: 2.39 [1.67, 3.41], p<0.0001). “Role Emotional”, “Mental Health”, and “Social Functioning” SF-36 domains showed significantly greater improvements in esketamine NS-treated patients compared with quetiapine XR-treated patients at Week 32 (p<0.05), returning to levels close to general population norms. More esketamine NS-treated patients had a meaningful improvement in their QLDS score by Week 32 (60.7% vs. 41.8%; OR: 2.16 [1.59, 2.94], p<0.0001), and reached this improvement quicker than quetiapine XR-treated patients. Proportions of patients reporting an EQ-5D-5L score of 1 (no problems) were significantly higher across all domains with esketamine NS versus quetiapine XR at Week 32 (p<0.05).

Esketamine NS produced superior improvements in HRQoL compared with quetiapine XR, indicating positive impacts on aspects of patients’ lives that matter to them, alongside clinical symptoms of TRD.

There is preliminary evidence that childhood trauma (e.g., abuse) is associated with subclinical hypomania reported in adolescence. These findings need replicating in early adulthood, as clinical conditions emerge, and the mechanisms underlying this association need elucidating. This study aimed to examine the magnitude of shared genetic and environmental underpinnings of the association between childhood trauma with hypomanic symptoms and high-risk status for bipolar disorder (BD) using a twin design. Gene–environment correlations and interactions between childhood trauma and polygenic scores (PGS) for psychiatric and neurodevelopmental conditions were also investigated.

Childhood trauma was reported using the Avon “Life at 22+” questionnaire by 8,464 individuals from a community twin sample. Self-reported hypomanic symptoms were assessed using the Mood Disorder Questionnaire at age 26 by 7,748 participants. PGS for psychiatric and neurodevelopment conditions were derived from independent published discovery samples.

Childhood trauma was significantly associated with hypomanic symptoms (β = 0.23, 95% CI: 0.20–0.25) and being at high-risk for BD (OR = 1.77, 95% CI: 1.59–1.98). These associations were strongly influenced by genetic factors (bivariate heritability range: 0.51–0.90). Gene–environment correlations were found between childhood trauma and the PGS for six conditions: Major Depressive Disorder (MDD), schizophrenia, Attention-Deficit Hyperactivity Disorder, anxiety disorders, Post-Traumatic Stress Disorder, and BD II (β range = −0.19–0.11). The MDD-PGS was found to significantly interact with childhood trauma in hypomania (β = 0.01, p < .05).

The associations between childhood trauma and subclinical hypomania and high-risk for BD were partially attributed to shared genetic factors. These associations were also moderated by MDD-PGS. Gene–environment correlations were detected between childhood trauma and polygenic vulnerability to psychiatric and neurodevelopmental conditions. The etiology of hypomania and BD is likely the result of a confluence of genetic and environmental factors, and research in this area should account for potential genetic confounding.

Schizophrenia is a chronic severe mental illness affecting 24-million people globally, associated with a life expectancy 15 years shorter than the general population. Approximately 70% of people with schizophrenia experience auditory verbal hallucinations (AVHs), i.e. ‘hearing voices’. Current treatment approaches remain unsuccessful in up to 30% of cases.

This systematic review and meta-analysis evaluated randomised controlled trials (RCTs) of non-pharmacological treatments for AVHs in schizophrenia spectrum disorders, assessing emerging treatment effectiveness and identifying research gaps.

A literature search was performed between 2013-2024 across five databases: PubMed, Embase, PsycINFO, Medline, and Web of Science. The meta-analysis included 45 studies based on predefined criteria and bias assessment. Effect sizes (Hedge’s g) were calculated using a random effects model with 95% confidence intervals. The study followed PRISMA guidelines and was pre-registered (PROSPERO ID: CRD42024598615).

Our sample included 2,314 patients and fourteen interventions. The overall mean effect size was -0.298 (95% CI, [-0.470, -0.126]), representing a medium, statistically significant effect. Subgroup analyses revealed medium, statistically significant effects for both AVATAR therapy and cognitive behavioural therapy (CBT). Conversely, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed small, non-significant effects.

AVATAR therapy has the strongest evidence for treating AVHs, highlighting the need for large-scale RCTs and integration into treatment guidelines. CBT requires methodological standardisation. Acceptance and commitment therapy shows promise but needs further high-quality RCTs. Non-invasive brain stimulation techniques require additional trials before clinical implementation.

The functional outcome of patients with psychotic disturbances is associated with several overlapping premorbid, societal, neuropsychological, and clinical factors. Extracting the factors associated with functional outcomes is important for designing effective mental health interventions.

In a naturalistic prospective European multicentre study, we analysed the effects of sociodemographic, preadmission, admission, and postadmission precursors on functional outcomes in 296 patients with recent-onset psychosis (ROP) and 262 patients at clinically high risk of psychosis (CHR-P). Functioning was assessed with the Global Assessment of Functioning—symptoms and deficits version—at baseline and at the 9- and 18-month follow-ups.

In the overall sample, male sex, childhood adversities, poor sociability, scholastic problems, neurocognitive deficits, and greater severity of baseline and follow-up symptoms were associated with poor functional outcomes. In contrast, a favourable work/educational situation and preadmission treatment for nonpsychotic disorders were associated with better functional outcomes. Among ROP patients, neurocognitive deficits and the severity of baseline and follow-up affective and psychotic symptoms were strongly associated with functional outcomes. Among CHR-P patients, premorbid sociability, previous treatment for affective disorders, and follow-up affective symptoms played more significant roles.

To improve functioning in patients in the early stages of psychosis, several factors should be considered, such as sex, childhood adversities, psychosocial development, baseline neurocognitive deficits, work/educational situation, clinical presentations, and follow-up symptoms. Personalized and integrated treatment and rehabilitation measures should be actively continued beyond the first admission period, with a particular focus on addressing both baseline and follow-up affective disturbances.

Epigenetic mechanisms might play a role in modulating susceptibility to bipolar disorder (BD) and response to lithium, the mainstay treatment for BD. Additionally, individuals with BD experience accelerated biological aging.

We compared blood DNA methylation profiles measured with EPIC v.2.0 arrays between patients with BD (33 lithium responders and 31 nonresponders) and nonpsychiatric controls (n = 32), as well as based on long-term lithium response. In addition, we compared cellular aging between these groups using epigenetic age, pace of aging, and, for the first time, transcriptional age acceleration based on bulk RNA sequencing in 93 patients and 56 controls.

We identified 191 differentially methylated positions (DMPs) and 8 differentially methylated regions between patients with BD and controls, located in genes enriched for “Postsynaptic Density” (odds ratio = 6.81, p = 0.001). No DMP was significantly associated with lithium response after multiple testing correction. Patients showed a significantly higher biological age acceleration than controls based on two epigenetic clocks (GrimAge, Mann–Whitney U = 551, p = 0.0009; GrimAge2: U = 477, p = 9.0E-05) and pace of aging (DunedinPACE, t = 3.01, p = 0.003), but not on transcriptional age. While we observed no significant difference in epigenetic aging based on lithium response, lithium responders showed lower epigenetic acceleration using all clocks, with a trend observed using the PhenoAge clock (t = 1.97, p = 0.053).

Our findings point to methylation patterns characterizing BD and support the hypothesis of accelerated cellular aging in BD.

Climate change has contributed to an increase in extreme temperatures globally, with mounting evidence suggesting a relationship between extreme temperature exposure and mental health. This review synthesizes findings on the impacts of extreme temperatures on several aspects of mood disorders.

This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline. Major databases (MEDLINE/PubMed, PsycINFO, Scopus, and Web of Science) were searched for eligible studies. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool.

From the 471 identified reports, 22 were included in the final review. The included studies were set in Asia (n = 8), North America (n = 7), Europe (n = 5), and Oceania (n = 2), encompassing diverse designs (case-crossover, cohort, and cross-sectional). High temperatures were linked to increased hospital admissions for mood disorders, especially among adolescents, women, and the elderly. Seventeen studies identified significant correlations between extreme heat and emergency department visits, whereas others reported minimal associations. Short-term exposure to humidity was a risk factor for increased mood disorder symptoms. Extreme cold exposure was associated with increased outpatient visits and heightened symptom severity for depressive disorders, particularly among older adults and females. The included studies were generally of moderate quality.

The evidence from this review underscores the need for multi-pronged interventions, innovative practices, and public health strategies – including urban planning, patients’ and public education, use of telemedicine, and policy measures – to mitigate the mental health consequences of climate change-driven extreme temperature events.

Youth exposed to poverty and adversities like violence are at higher risk of mental health problems (MHP), but whether antipoverty interventions can reduce this risk remains unclear. We examined the association between participation in the Brazilian Cash Transfer Program (BFP) and mental health of children/adolescents exposed to different levels of adversity.

Observational study using nearest-neighbor propensity score matching to compare BFP participants and non-participants from the Itaboraí study, a community-based cohort of 1,189 children/adolescents (6–15 years) assessed at two waves (meaninterval: 12.9 months).Measures included the Child Behaviour Checklist (CBCL) externalizing, internalizing, and total problems scales; an adversity score derived from a confirmatory factor analysis on violence victimization at home (WorldSAFE), school (threat/maltreatment/being chased by peers) and community (Survey of Exposure to Community Violence), and stressful life events (UCLA Posttraumatic Stress Disorder Reaction Index); and BFP exposure for at least 12 months (yes/no). Latent change score models tested whether BFP participation predicted changes in CBCL T-scores, moderated by adversity levels.

A total of 330 BFP participants were matched with 330 non-participants with similar sociodemographic characteristics. Decreases in total (b=−0.124, SE=0.034, p<0.001), externalizing (b=−0.122, SE=0.036, p=0.001), and internalizing problems (b=−0.141, SE=0.033, p<0.001) between baseline and follow-up were observed among BFP participants exposed to higher levels of adversity compared with non-participants.

BFP participation was associated with reduced MHP only among children/adolescents facing high adversity, suggesting the program may help break the cycle between poverty and mental health problems—but benefits are concentrated among the most vulnerable.