As the global shift towards autocracy continues and soft political repression rises, it is crucial to understand its long-term health implications. Typical tactics of soft political repression are surveillance, denunciation and harassment, operating beneath the threshold of criminal or violent persecution. Despite its prevalence, soft repression remains underexplored, particularly in terms of its psychobiological health consequences.

The current study investigates the long-term sequelae of soft political repression in the German Democratic Republic (GDR: 1949–1990), focusing on psychological distress, systemic inflammation and cellular ageing.

The cross-sectional laboratory study included 100 50–78 years old participants from the states of Thuringia and Saxony in Germany. Participants in the repression group (n = 49) had experienced at least two forms of state-organised soft repression in the GDR. The age, gender and origin matched control group reported no such experiences. Psychological measures included depressive, anxiety and trauma symptoms. Physiological health outcomes were measured through the inflammatory markers interleukin-6 and high sensitivity C-reactive protein (hs-CRP), as well as telomere length as a marker of cellular ageing. Resilience, social support and socioeconomic status were included in the analyses as potential buffers of repression effects.

Participants with repression experience (versus control group) scored significantly higher on all psychological distress variables. Furthermore, they exhibited higher levels of interleukin-6, indicating increased systemic inflammation. No group differences were found for hs-CRP or telomere length. However, in the repression group, lower social support was associated with shorter telomeres.

This study is the first to explore the psychobiological health consequences of soft political repression. Findings emphasise its long-term consequences on the psyche and immune system and highlight the potential role of social support in mitigating cellular ageing. As authoritarian tactics are becoming more prevalent worldwide, understanding the impact of soft repression on health is essential for supporting affected individuals.

Anorexia nervosa is associated with high personal and financial costs for sufferers, carers and society in general, but little is known about the long-term health economic burden.

To examine healthcare utilisation, social assistance, sick leave and disability pension in individuals with anorexia nervosa over a period of 30 years.

Fifty-one individuals with adolescent-onset anorexia nervosa and 51 matched comparison cases (COMP) were recruited in the community and followed prospectively from 1985. All individuals were examined on five occasions. At the 30-year follow-up, mean age 44, data on in- and out-patient care, prescribed medications, social assistance, sick leave and disability pension were collected from Swedish national registers.

The anorexia nervosa group had more days of in-patient care (p < 0.001) and out-patient visits to psychiatry (p < 0.001), more days of sick leave (p = 0.006), more days of disability pension (p = 0.002) and were prescribed more psychotropic medication (p = 0.045) compared with the COMP group. Of the anorexia nervosa group, 22% had ever received a disability pension compared with 2% in the COMP group (p = 0.004) and less than half the anorexia nervosa group worked full-time at the 30-year follow-up. In the anorexia nervosa group, 45% had received social assistance at some point, compared with 22% in the COMP group (p = 0.02). Age at onset of anorexia nervosa emerged as a predictor of healthcare utilisation with significant odds ratios for psychiatric in-patient (odds ratio 0.61, 95% CI: 0.39, 0.94; p = 0.027) and out-patient care (odds ratio 0.63, 95% CI: 0.40, 0.98; p = 0.042), i.e. individuals with a later onset of anorexia nervosa were less likely to require psychiatric care.

The long-term burden of adolescent-onset anorexia nervosa comprises increased utilisation of healthcare and dependence on society for a significant minority. A later onset of anorexia nervosa predicted a lower healthcare utilisation.

Clinical progression during psychosis has been closely associated with grey matter abnormalities resulting from atypical brain development. However, the complex interplay between psychopathology and heterogeneous maturational trajectories challenges the identification of neuroanatomical features that anticipate symptomatic decline.

To investigate cortical volume longitudinal deviations in first-episode psychosis (FEP) using normative modelling, exploring their relationship with long-term cognitive and symptomatic outcomes, as well as their cytoarchitectural and neurobiological underpinnings.

We collected magnetic resonance imaging (MRI), cognitive and symptomatic data from 195 healthy controls and 357 drug-naïve or minimally medicated FEP individuals that were followed up 1, 3, 5 and 10 years following the first episode (1209 MRI scans and assessments in total). Using normative modelling, we derived subject-specific centile scores for cortical volume to investigate atypical deviations in FEP and their relationship to long-term cognitive and symptomatic deterioration. The resulting centile association maps were further characterised by examining their cytoarchitectural and neurobiological attributes using normative atlases.

FEP centiles demonstrated a widespread reduction at treatment initiation, with longitudinal analysis showing an increase during treatment time, indicating convergence towards normal maturation trajectories. Interestingly, this effect was reduced in highly medicated individuals. Additionally, we found that cognitive impairments experienced during early FEP stages worsened under long-term medication. Positive symptomatology was negatively associated with regional centiles, and individuals with higher centiles benefited most from treatment. Cytoarchitectural and neurobiological analyses revealed that regional centiles related to FEP, as well as to symptomatology, were associated with specific molecular features, such as regional serotonin and dopamine receptor densities.

Collectively, these findings underscore the potential use of centile-based normative modelling for a better understanding of how atypical cortical development contributes to the long-term clinical progression of neurodevelopmental conditions.

The prevalence of mental ill health is increasing in young people worldwide, with rising referrals to child and adolescent mental health services (CAMHS). The numbers and proportions of the youth population who present to CAMHS, however, including how those figures are changing over time, are unclear. Understanding trends in mental health service contacts for young people over time is crucial mental health surveillance data.

Our aim was to calculate both the lifetime and annual prevalence of CAMHS contact in Wales for young people up to age 18 years.

Using linked Welsh administrative healthcare records, we calculated the annual prevalence of CAMHS contacts between 2004 and 2023. We also calculated the lifetime prevalence of CAMHS contacts for sequential annual birth cohorts born between 1991 and 2005 and followed to age 18 (between 2009 and 2023).

In 2004, 0.8% (n = 4665) of the total child and adolescent population were in contact with CAMHS. By 2022, this had risen nearly five-fold to 3.9% (n = 19 870) of the total child and adolescent population. Among the 1991 birth cohort who turned 18 in 2009, 5.8% had contact with CAMHS at some stage in childhood or adolescence. For individuals born in 2005 who turned 18 in 2023, this figure had risen to 20.2%.

The number of the young people in contact with CAMHS has increased dramatically over the past 15 years, from 1 in 17 young people who turned 18 in 2009 to 1 in 5 young people who turned 18 in 2023.

Children and young people are increasingly being referred to specialist gender services, and available data on their characteristics are limited. The Longitudinal Outcomes of Gender Identity in Children (LOGIC) study is the first independently funded UK research programme to comprehensively assess quality of life, autism, service use and the psychological well-being of children and adolescents referred to gender services.

The aim of this baseline assessment is to obtain a multidimensional profile of children and young people on the waiting list for the gender service.

Data were obtained from 617 parents and caregivers and 565 children and young people, representing a quarter of those on the waiting list eligible to participate. Participants were assessed across a range of domains including gender identity, gender dysphoria, mental health and well-being, autism, physical health, service use and quality of life.

Gender dysphoria rates among our sample were high, particularly among adolescents. Almost all participants had socially transitioned. Compared with children, adolescents reported significantly poorer quality of life, particularly in relation to self-perception and psychological well-being. Relative to reference population samples, our cohort demonstrated elevated levels of mental ill health and reduced quality of life, although the magnitude of these differences varied. In addition, 59% of young people aged 11 years or over reported self-harm in the past year. Over half of the cohort had received a psychiatric diagnosis, and co-occurrence rates were high. A third of the cohort was either diagnosed with autism or undergoing assessment for autism.

Self-perception and psychological well-being represent particularly impaired quality of life dimensions for adolescents on the waiting list for the UK’s gender service. Complementing existing knowledge, differences emerged between young people and children, reflecting that the onset of puberty is a critical factor in the well-being of this cohort.

People living with severe mental illness (SMI) experience a shorter life expectancy and poorer physical health than those without SMI. Cardiometabolic illness accounts for a significant proportion of this health inequality. Pharmacological management could reduce the noted inequalities.

This umbrella review aimed to synthesise evidence from systematic reviews for pharmacological interventions to manage cardiometabolic outcomes in adults with SMI.

Databases (Embase, MEDLINE, Cochrane Database of Systematic Reviews) were searched from inception to 11 June 2024 for systematic reviews of pharmacological interventions for all cardiometabolic outcomes in adults. Titles, abstracts and full texts were independently screened by two reviewers. Corrected cover area was calculated, and quality was assessed using AMSTAR 2. Results were analysed and a narrative synthesis conducted.

Thirty-three systematic reviews were included following screening of 1723 titles. Metformin, the most commonly studied intervention (n = 18), was effective in preventing and treating weight gain, dyslipidaemia (total cholesterol and triglycerides) and dysglycaemia.

Topiramate and glucagon-like peptide-1 agonists demonstrated efficacy in treating weight gain, but the effect across other parameters was less consistent. Licensed treatments, such as statins for dyslipidaemia, were reviewed in low numbers (n = 2). Nicotine replacement, bupropion and varenicline were effective for smoking cessation, an outcome that can significantly lower cardiometabolic risk.

The corrected cover area was 6.3%, indicating moderate overlap. Most reviews (n = 16, 48%) were rated critically low quality using AMSTAR 2, and the remainder rated either low (n = 7, 21%), moderate (n = 2, 7%) or high quality (n = 7, 24%).

Pharmacological interventions can improve cardiometabolic outcomes in adults with SMI when non-pharmacological interventions are either insufficient alone, impractical or unacceptable. However, licensed treatments have been reviewed in relatively low numbers. Improving cardiometabolic outcomes is a key area in psychiatry, and the results of this review will be important in shaping future guidance.

Attention-deficit hyperactivity disorder (ADHD) in childhood is associated with various adverse long-term outcomes.

We aimed to examine the independent associations between ADHD symptoms at age 14–16 years and long-term mental health and psychosocial functioning outcomes in a 40-year birth cohort study.

Study members from the Christchurch Health and Development Study, a population-based New Zealand birth cohort study (N = 1265 at birth) were followed to age 40 years. Generalised estimating equations were used to model associations between ADHD symptoms at age 14–16 years and outcomes at age 18–40. Adjusted models were fitted to account for confounding by antecedent individual and familial risk factors, and coexisting symptoms of conduct disorder or oppositional defiant disorder.

Adolescents in the highest quartile for ADHD symptoms at age 14–16 years were at elevated risk of substance use disorder, depression, suicidal ideation, criminal offending and unemployment across early adulthood. They also had lower income, home ownership, relationship stability and living standards. The size of these associations attenuated after adjusting for confounding factors and the effect of coexisting conduct disorder and oppositional defiant disorder. However, in adjusted models, ADHD symptoms remained associated with elevated odds of substance use and criminal offending outcomes, with odds ratios ranging from 1.4 to 1.6.

Higher levels of adolescent ADHD symptoms are associated with substance use problems and criminal offending in adulthood. Long-term secondary prevention activities are needed to detect and manage coexisting problems among adults with a history of ADHD.