The Columbia Suicide Severity Rating Scale (C-SSRS) is a predominant tool for screening and scoring suicidal ideation and behaviour to identify individuals at risk. No meta-analysis has examined its predictive significance.

To evaluate the C-SSRS assessment of suicidal ideation and suicidal behaviour as predictors of future fatal and non-fatal suicide attempts.

A systematic search of Medline, PsycInfo, Embase, and Health and Psychosocial Instruments databases was conducted from January 2008 to February 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study was registered in PROSPERO (CRD42022361944). Two independent reviewers screened and extracted data, and assessed the risk of bias. Pooled odds ratios were calculated using random-effects models, and heterogeneity was assessed with the I2 statistic. Publication bias was evaluated with Egger’s test and funnel plots.

The search identified 1071 unique records, of which 28 studies met inclusion criteria. The meta-analysis included 27 studies with independent samples. Suicidal behaviour (pooled odds ratio 3.14, 95% CI 1.86–5.31) and suicide attempts (pooled odds ratio 2.78, 95% CI 1.82–4.24) were predictors of future non-fatal suicide attempts. Suicidal ideation severity (odds ratio 1.46/point, 95% CI 1.28–1.77) was a stronger predictor of future non-fatal suicide attempts than suicideal ideation intensity (odds ratio 1.11/point, 95% CI 1.04–1.18). Two studies linked higher suicidal ideation severity and a history of suicidal behaviour with an increased risk of fatal suicide attempts, though meta-analysis was not feasible for only two studies.

Suicidal behaviour, suicide attempts and to a lesser extent suicidal ideation, identified using the C-SSRS, predicted future non-fatal suicide attempts. These findings support the use of the C-SSRS to detect individuals at higher-risk requiring enhanced preventive interventions.

Individuals with a family history of bipolar disorder are at increased risk of developing affective psychopathology. Longitudinal imaging studies in young people with familial risk have been limited, and cortical developmental trajectories in the progression towards illness remain obscure.

To establish high-resolution longitudinal differences in cortical structure that are associated with risk of bipolar disorder.

Using structural magnetic resonance imaging data from 217 unrelated ‘Bipolar Kids and Sibs study’ participants (baseline n = 217, follow-up n = 152), we examined changes over a 2-year period in cortical area, thickness and volume, measured at each vertex across the cortical surface. Groups comprised 105 ‘high-risk’ participants with a first-degree relative with bipolar disorder (female n = 64; age in years: M (mean) = 20.9, s.d. = 5.5) and 112 controls with no familial psychiatric history (females n = 60; age in years: M = 22.4, s.d. = 3.7).

Accelerated thickness and volume reductions over time were observed in ‘high-risk’ individuals across multiple cortical regions, relative to controls, including right lateral orbitofrontal thickness (β = 0.033, P < 0.001) and inferior frontal volume (β = 0.021, P < 0.001). These differences were observed after controlling for age, sex, ancestry, current medication status, lifetime psychiatric diagnoses and measures of gross brain morphology.

Longitudinal group differences suggest the presence of thicker cortex in familial ‘high-risk’ individuals at earlier developmental stages, followed by accelerated thinning towards the typical age of bipolar disorder onset. Future examination of genetic and environmental components of familial risk and the mechanistic nature (pathological or protective) of cortical-trajectory differences over time may facilitate the identification of prodromal biomarkers and opportunities for early clinical intervention.

Although current prescribing guidelines suggest continuation of psychotropic drugs in pregnant women, population-based evidence supporting their safety is limited.

This study aims to clarify the plausible causal links between maternal psychotropic drug exposures and obstetric complications.

This cohort study investigated all births by Hong Kong residents ≥18 years of age in public hospitals between 2004 and 2022. Birth episodes were classified according to whether they were unexposed to psychotropic drugs, exposed but discontinued before conception or exposed during pregnancy. Firth’s penalised logistic regression was employed in all analysis, and negative control analysis was conducted to assess causality. False discovery rate correction and sensitivity analyses were performed.

Among 587 419 births, 7182 episodes involved psychotropic prescriptions (antipsychotics, antidepressants, anticonvulsants, benzodiazepines) during pregnancy. In broad drug class analysis, all significant associations observed in the exposed group were also observed in negative control analysis (psychotropics discontinued before conception), suggesting that elevated risks could be attributed to unmeasured confounders. Nevertheless, in subclass analyses, certain psychotropic drugs showed increased risks of obstetric complications, i.e. significant associations between atypical antipsychotics and genito-urinary infection (odds ratio 2.70, 95% CI 1.46–4.83), and between valproate and low birth weight (odds ratio 1.68, 95% CI 1.16–2.37). These associations became non-significant in negative control analysis, and the high E-values (atypical antipsychotics and genito-urinary infection, 4.84; valproate and low birth weight, 2.75) suggested that the results were unlikely to have been driven by unmeasured confounders. Maternal diagnoses of schizophrenia and depression were independently associated with increased risk of obstetric complications, after controlling for the effects of psychotropics.

The population-based data and meticulous analyses did not support any clear causal link between broad-class psychotropic exposure during pregnancy and increased risk of obstetric/neonatal complications. However, some psychotropic subclasses may increase obstetric/neonatal complications. The limited number of episodes involving discontinuation of some psychotropic subclasses may have resulted in false negative findings in the negative control analysis.

During puberty, sex-specific processes shape distinct mental health outcomes. However, research on puberty and psychosis has been limited, and the findings are conflicting.

To explore how puberty status and timing and oestradiol levels influence psychotic experiences and whether they interact with genetic and exposomic vulnerabilities to schizophrenia in female adolescents.

We analysed data from female participants in the Adolescent Brain Cognitive Development Study at baseline (n = 5673) and two annual follow-up assessments. Psychotic experiences were assessed using the Prodromal Psychosis Scale and puberty status with the Pubertal Development Scale. Age at menarche and salivary oestradiol concentration were recorded. Exposomic vulnerability to schizophrenia (ES-SCZ) and polygenic risk score for schizophrenia (PRS-SCZ) were calculated. Longitudinal mixed logistic regression models were used to test associations of psychotic experiences with hormone levels and puberty status. Age of menarche was analysed using second follow-up data.

Earlier menarche (odds ratio 0.68, 95% CI: 0.59 to 0.78) and higher oestradiol concentration (odds ratio = 1.08, 95% CI: 1.01 to 1.16) were associated with greater likelihood of psychotic experiences, as were mid-pubertal (odds ratio 1.41, 95% CI: 1.18 to 1.69) and late to post-pubertal (odds ratio 2.23, 95% CI: 1.74 to 2.86) compared with pre-pubertal stage. ES-SCZ and PRS-SCZ were associated with greater likelihood of psychotic experiences. No significant interactions of puberty factors with ES-SCZ or PRS-SCZ were detected.

Physical and hormonal puberty factors have critical roles in development of psychosis. The absence of interaction effects could be attributed to the age range of the cohort. Further research during follow-ups is essential.

Being diagnosed with cancer can be stressful and has been linked to suicide. However, an updated analyses where a wide range of cancers are compared is lacking.

To examine whether individuals first-time diagnosed with cancer within the past 5 years had higher suicide rates than those with no such diagnosis. Associations with time since diagnosis, and stage and site of cancer, were analysed.

A population-based cohort study design applied to nationwide, longitudinal data on all persons aged 15 years or above (N = 6 987 998) and living in Denmark between 2000 and 2021. Specific sites of cancer first-time diagnosed were considered as exposure for the subsequent 5 years, and death by suicide was examined as outcome. Adjusted incidence rate ratios (aIRRRs) were calculated using Poisson regression models and adjusted for sociodemographics, psychiatric disorders and suicide attempts prior to cancer diagnosis.

In total, 707 513 (10%) individuals were included. While 12 800 individuals died by suicide in the non-cancer group, 601 died of suicide in the cancer group, resulting in an aIRR of 2.0 (95% CI: 1.9–2.1). The highest rate was found in the period immediately following diagnosis (<6 months: 3.9, 95% CI: 3.6–4.2 versus 4–5 years: 1.8, 95% CI: 1.5–2.0). Also, higher rates were found for high-stage tumours (3.1, 95% CI: 2.8–3.4). The highest aIRRs were found for pancreatic cancer (7.5, 95% CI: 5.8–9.7) and oesophageal cancer (7.1, 95% CI: 5.4–9.3). Almost all sites of cancer analysed showed elevated rates of suicide compared with individuals without cancer.

Several recently diagnosed cancers were linked to elevated rates of suicide, especially during the first period following diagnosis. High tumour stage was associated with the highest rates, as were cancer sites with poor prognosis, suggesting prioritisation of these patient groups for suicide prevention efforts.

Despite increasing awareness and understanding of children’s victimisation through experiences of domestic violence (EDV), little attention has been given to the associated health outcomes.

Examine associations between four different forms of childhood EDV (physical violence, threats of harm, property damage and intimidation or control) and four mental disorders and six health risk behaviours.

Data were drawn from the Australian Child Maltreatment Study. Associations were examined using survey-weighted logistic regression models. Estimates were calculated adjusting for each other form of EDV, as well as other types of child maltreatment and socio-economic factors. Each model was stratified for men and women.

All mental disorders and health risk behaviours were more common among those with any childhood EDV compared to those without. Intimidation or control and damage to property or pets independently predicted most mental disorders and health risk behaviours. The strongest association was found between intimidation or control and post-traumatic stress disorder (adjusted odds ratio (aOR) 2.30, 95% CI 1.77–2.98) and generalised anxiety disorder (aOR 1.65, 95% CI 1.36–1.99), and damage to property or pets and severe alcohol use disorder (aOR 1.76, 95% CI 1.36–2.27).

Childhood EDV characterised by intimidation or control and property damage or harm to pets significantly increases the risk of mental disorders and health risk behaviours in adulthood. Urgent investment is needed in child-centred and trauma- and family-violence-informed interventions that support children’s recovery and stronger legal protections to prevent children from being weaponised in post-separation coercive control.

With numbers of very old adults (85+ years) expected to increase, and very old adults often being excluded from research and clinical trials, further knowledge about depressive disorders, antidepressant treatment and mortality among this demographic is of pressing importance.

To investigate the impact of depressive disorders and antidepressant treatment on 2-year mortality among very old adults and to explore any differences between men and women.

This cross-sectional study used data from the Umeå 85+/Gerontological Regional Database home visit interviews. The data were collected between 2000 and 2017. The total sample consisted of 2551 participants, of whom 918 had a depressive disorder. Logistic and Cox regression models were used to explore factors associated with depressive disorders and time to death. Mortality rates were illustrated and analysed using Kaplan–Meier curves and log-rank tests.

Having a depressive disorder both with and without antidepressant treatment was associated with increased risk of death within 2 years for both men and women. No survival differences were found between responders and non-responders to treatment. Depressive disorders were significant predictors of 2-year mortality in men. Antidepressant treatment was not independently associated with mortality.

Depressive disorders are significantly associated with increased 2-year mortality among very old adults, especially men, and measures to reduce mortality are urgently needed. Further exploration of the effects of antidepressant treatment among very old adults is warranted.

Depressive symptoms are common in mild cognitive impairment (MCI). These may be associated with poorer cognitive function and increased risks of dementia transition.

We aimed to examine the cognitive patterns associated with variations in depressive symptoms in neurodegenerative MCI without a primary mood disorder.

Individuals with MCI (n = 123), including MCI due to Alzheimer’s disease (n = 54) and MCI with Lewy bodies (n = 69), underwent repeated annual assessment of cognitive function and concurrent depressive symptoms using the Addenbrooke’s Cognitive Examination-Revised and the Geriatric Depression Scale-15, respectively.

Between- and within-person differences in depressive symptoms were disaggregated and related to between- and within-person cognitive differences and modification of cognitive performance trajectories over time.

There was strong evidence of a state-based association between depressive symptoms and cognitive function. Intra-individual differences in depressive symptoms were negatively associated with concurrent cognitive performance such that a 2-point increase in depressive score explained a 1-point decrease in cognitive score, on average (point estimate −0.56, 95% credibile interval (CrI) −1.05 to −0.08).

The data did not support a trait-based association between depressive symptoms and cognitive performance (point estimate 0.10, 95% CrI −0.42 to 0.59), nor any between- or within-person trajectory modification associated with depressive symptoms.

Within-person variations in depressive symptom severity are associated with acute cognitive performance differences. Cognitive scores derived during active depressive periods may underestimate longer-term cognitive capabilities. Treating depressive symptoms in MCI may clarify underlying cognitive performance capacity, and help maintain optimal cognitive function for longer.

Previous studies investigating the association between pubertal timing and depression in girls primarily use self-reported age at menarche (AAM). This study examines a range of pubertal timing indicators, including anthropometric and self-reported measures.

Compare associations of multiple indicators of pubertal timing with depressive symptoms and depression in girls and explore whether these associations persist into early adulthood.

The sample comprised 4607 girls from UK-based Avon Longitudinal Study of Parents and Children. Seven measures of pubertal timing were assessed between ages 7 and 17 (age at: peak height velocity (aPHV); peak weight velocity; peak bone mineral content velocity; Tanner pubic hair and breast development stage 3; axillary hair; and AAM). Depressive symptoms were measured at 14, 17, 18 and 24 years using the Short Mood and Feelings Questionnaire. Depression was assessed at 15, 18 and 24 years using the Development and Well-Being Assessment and Clinical Interview Schedule-Revised. Multivariable logistic regression models were adjusted for socioeconomic status and pre-pubertal body mass index.

Later pubertal timing was associated with lower odds of depressive symptoms at age 14 across six measures, including aPHV (adjusted odds ratio (AOR): 0.82; 95% CI 0.72, 0.95) and AAM (AOR: 0.84; 95% CI 0.76, 0.92). Later AAM and Tanner breast stage 3 were associated with lower odds of depression at age 18 (AOR: 0.85; 95% CI 0.75, 0.97 and AOR: 0.83; 95% CI 0.72, 0.95, respectively). Associations attenuated by age 24.

Later pubertal timing was associated with reduced odds of depressive symptoms during mid-adolescence, with associations attenuating by adulthood.

Although workplace mental health screening is often implemented to aid early identification of mental health symptoms and facilitate access to treatment, supporting evidence is limited.

We aimed to evaluate the effect of independently conducted, confidential, online mental health screening, paired with automated tailored feedback recommending referral services, on help-seeking and psychological distress.

We conducted a cluster-randomised controlled trial with firefighters from an Australian fire and rescue service. Randomisation occurred by station (N = 264). Firefighters at stations allocated to the intervention group received tailored information detailing suitable mental health services based on their Kessler-6 psychological distress score (K6). The control group received generic feedback on services irrespective of K6 score. The primary outcome was help-seeking at 3-months post-intervention for those with at least moderate levels of psychological distress at baseline (K6 ≥14). The study was registered with Australian New Zealand Clinical Trials Registry (no. ANZCTR 12621001457831).

Of the 459 firefighters screened, 141 (30.72%) scored ≥14 on K6. Among this subgroup at 3 months, no differences were observed in rates of overall help-seeking between the intervention and control groups (P = 0.31). In contrast, levels of psychological distress remained high in the intervention group but declined in the control group (t[111] = 2.29, 95% CI: 0.24, 3.23, P = 0.024). The difference in psychological distress associated with workplace mental health screening equated to an effect size of −0.42 (95% CI: −0.04, −0.79).

Our findings suggest that independent, confidential online mental health screening, paired with tailored online feedback and information on available treatment, does not significantly increase help-seeking and may sustain psychological distress over time compared with receiving generic information. As such, it should not be implemented to promote help-seeking and reduce levels of psychological distress. These findings are relevant for workplaces, mental health researchers and practitioners alike, highlighting the potential risk and potential harm of mental health screening conducted in this way on individuals.

Post-traumatic stress disorder (PTSD) and depression are highly comorbid. A comprehensive meta-analysis on the efficacy of PTSD-specific psychotherapies in reducing comorbid depression is lacking.

To examine the short-, mid- and long-term efficacy of PTSD-specific psychotherapies in reducing comorbid depression.

We performed a preregistered (Prospero-ID: CRD42023479224) meta-analysis and followed PRISMA guidelines. PsycINFO, MEDLINE, Web of Science and PTSDpubs were searched. Randomised controlled trials (RCTs) examining psychotherapies for PTSD in samples with ≥70% PTSD diagnosis rate, mean age of sample ≥18 years, ≥10 participants per group and reporting of depression outcome data were included in the meta-analysis.

In total, 136 RCTs (N = 8868) assessed depression. Most data concerned trauma-focused cognitive behaviour therapy (TF-CBT), followed by eye movement desensitisation and reprocessing and non-trauma-focused and other trauma-focused interventions. At post-treatment, TF-CBT was associated with large reductions in depression relative to passive controls (Hedges’ g = 0.97, 95% CI 0.80–1.14, k = 46 trials) and moderate reductions relative to active controls (Hedges’ g = 0.50, 95% CI 0.35–0.65, k = 29). Effects relative to control conditions were similar across the other interventions. Response rates for comorbid depression were three times higher in psychological interventions relative to passive controls (odds ratio 3.07, 95% CI 1.18–7.94, k = 4). In head-to-head comparisons, there was evidence for TF-CBT producing higher short-, mid- and long-term reductions in depression than non-trauma-focused interventions. Results at mid- and long term were generally similar to those at treatment end-point.

PTSD-specific psychotherapies are effective in reducing depression. TF-CBT presented with the highest certainty of results. More long-term data for other interventions are needed. Results are encouraging for clinical practice.

Lurasidone is a second-generation antipsychotic with antidepressant properties, but its effect on depressive symptoms across diagnostic domains is not known.

This systematic review aims to synthesise the evidence for the transdiagnostic efficacy of lurasidone in reducing depressive symptoms.

Electronic databases were searched up to October 2024 to identify randomised controlled trials comparing the effects of lurasidone and placebo on depressive symptoms, as measured by any standardised scale, in populations with different psychiatric diagnoses. Acceptability, tolerability and safety were also measured. The Cochrane risk of bias tool was used to assess study quality, and the GRADE tool to evaluate certainty of evidence. A random-effects meta-analysis was performed to estimate standardised mean differences (SMDs, for continuous outcomes) or relative risks (for dichotomous outcomes) with 95% CI.

Fourteen trials met inclusion criteria. Pooled analysis of 5239 participants found lurasidone to be more efficacious than placebo in improving depression scores (SMD −0.26, 95% CI −0.37, −0.15) across multiple diagnoses (including schizophrenia, bipolar disorder and major depressive disorder). Secondary analyses showed better acceptability (relative risk 0.55, 95% CI 0.43, 0.71) and safety (relative risk 0.73, 95% CI 0.58, 0.91) and comparable tolerability (relative risk 0.74, 95% CI 0.54, 1.02) between lurasidone and placebo. The main limitations were the high risk of bias of several included studies and the high heterogeneity observed in our findings.

Lurasidone is a potentially efficacious and safe strategy for reducing depressive symptomatology across a range of psychiatric diagnoses. Further long-term, robust trials employing precision psychiatry methods are needed to support its broader use to target depressive symptoms transdiagnostically.