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Until the COVID-19 pandemic, a working style in Japan that emphasized teamwork was predominant, and telework was not widespread. However, due to the COVID-19 pandemic, a majority of companies had no choice but to introduce telework. Telework, where individual workers operate independently rather than collectively, was an entirely new way of working for many Japanese individuals. To make telework function efficiently, a re-evaluation of Japan's traditional employment system, where job descriptions are not specified in employment contracts and individuals agree only to become members of a company, became necessary. While it was previously considered an obligation for workers to comply with employers’ transfer orders involving relocation, telework has introduced a new option of handling such orders without physically relocating. In this way, telework has the potential to be a game-changer in Japan's traditional employment system. However, there are diverse legal issues that need to be resolved when introducing telework.
Cardiovascular disease (CVD) is the leading cause of death worldwide. Research suggests people with Mental Health Disorders (MHDs) have increased CVD risk. However, knowledge gaps exist regarding CVD risk management for general practice patients with MHD, and interventions that might improve CVD prevention. This study examined the perspectives of general practice professionals in Ireland on cardiovascular risk assessment for patients already diagnosed with MHD and to describe current approaches to identifying this population using the Mental Health Finder (MHF) tool.
Methods:
An embedded mixed-methods design was adopted, guided by constructivist grounded theory and the Social Ecological Model. Aggregated anonymised data, including availability and use of the MHF tool, were collected from five practices and analysed in SPSS. In-depth semi-structured interviews were conducted with 12 general practitioners and three practice nurses. Qualitative data were analysed using Braun and Clarke’s Reflexive Thematic Analysis.
Results:
Of the five practices, two had access to the MHF tool. These reported combined prevalence of 18.7% for MHD compared with 0.5–11.5% in practices without the tool, highlighting the importance of systematic identification. Qualitative analysis generated four themes: (1) prevalence of MHD in general practice, (2) association between MHD and CVD risk, (3) CVD risk management in patients with MHD, and (4) holistic care.
Conclusion:
CVD risk assessment for patients with MHD in general practice is largely opportunistic and unstructured. Participants highlighted the need for structured frameworks, protocols, and enhanced supports to enable systematic cardiovascular assessment and management in this population.
The recovery model of mental health care is distinct from the biomedical model of mental health care. To promote one runs the risk of marginalising the other. Both approaches have merit. Values of hope and optimism, social inclusion, collaborative decision-making, retaining a personal identity beyond an identity simply defined by a diagnosis of mental illness, are all central to the recovery model. A reorientation of mental health services is required, a change in culture which embodies the principles of a recovery model within which, the perspectives of patients and families are heard together with the perspectives of mental health professionals who have knowledge and expertise to offer. In Meath Community Mental Health Services we have implemented such a recovery model, the model of open dialogue where principles of dialogue, social inclusion, immediate help and collaborative decision-making are paramount. We began this service in 2019 and carried out an audit of the first 6 months of our implementation. The audit illustrated overwhelming satisfaction from service users and their families with the new approach. On foot of our successful pilot project we have extended the model of open dialogue to other teams in Meath and Louth, including the in-patient unit in Drogheda. Our open dialogue project illustrates how a recovery model of mental health care can be successfully implemented in a public mental health system.
There is ample evidence that women do not progress in mental health publishing as quickly as men. The movement from first to last (senior) author is one indicator of progression.
Aims
To understand whether there are changes in women’s authorship position following our academic institution’s introduction of support mechanisms to reduce the gender gap in career development.
Method
Data from publicly held databases in three cohorts (2016, 2018 and 2020) were assessed for gender and authorship position at the Institute of Psychiatry, Psychology and Neuroscience. Regression analyses included authorship gender and change over time in authorship roles, by school and topic.
Results
We found substantial, statistically significant differences in gender between author roles (χ2(2) = 29.18, P < 0.0001), with women being mainly first authors (marginal mean 62.2:40.1%, respectively, odds ratio 2.463, 95% CI 1.807 to 3.357). The three schools differed (χ2(2) = 14.06, P < 0.001) and, although men were predominant as last authors in all topics in both 2016 and 2020, women did show a modest increase. The trend for an interaction between gender and first-author publications on the likelihood of last-author publications in 2018 (incidence rate ratio 1.839, 95% CI 0.914 to 3.698) had disappeared by 2020.
Conclusions
Although women were represented as first and corresponding authors, there was still a gender gap for last-author positions. Over time, women have increased their representation in many of the topic areas. The disappearance of any gender-moderating effect suggests that institutional policies may have had an effect, in addition to sector-wide changes.
Self-harm among UK prisoners has risen over the past decade.
Aims
To explore self-harm risk factors and mental health conditions in prisoners, pre- and during imprisonment, compared with the general population.
Method
This retrospective cohort study linked electronic health records and Ministry of Justice data for Welsh male prisoners (2019), and a comparison general population cohort. We examined imprisonment likelihood based on prior self-harm and mental health conditions using logistic regression. We also studied self-harm risk up to three years during imprisonment through Generalised Estimating Equations and time-stratified Cox regression, using a pre-imprisonment comparator (3 years before).
Results
Prisoners (N = 6095) had higher rates of self-harm and mental health conditions pre-imprisonment compared with non-prisoners (e.g. self-harm odds ratio: 2.1 (1.9, 2.2)). Self-harm risk was 5.25–6.47 times higher in prisoners than non-prisoners, both pre- and during imprisonment. Risk was highest shortly after incarceration, then declined, becoming lower than pre-imprisonment after 7 months. While most conditions correlated with higher self-harm risk during imprisonment (e.g. drug use, hazard ratios: 1.5–3.0), some (e.g. depression and alcohol use) showed weaker links in prisoners than non-prisoners, particularly from 7 months after imprisonment. Self-harm risk was seemingly higher in prisoners on remand compared with those sentenced.
Conclusions
Pre-imprisonment, self-harm in male prisoners is already high compared with the general population, potentially driving a saturation effect, where known general population risk factors have a weaker effect in prisoners. Self-harm prevention should target people in contact with criminal justice, irrespective of imprisonment. In prisons, prevention efforts deployed at inception should target those with prior self-harm, drug use, learning difficulties, bipolar disorder and those on remand.
Early in the SARS–CoV-2 pandemic, most jurisdictions implemented mandatory face covering policies across healthcare settings. This intervention, which lasted multiple years, was unprecedented in psychiatry. Masks may affect the delivery of mental healthcare, given its reliance on nuanced communication and establishing a therapeutic alliance.
Aims
This scoping review aimed to provide an overview of the current literature concerning the impact of face masks in mental health settings beyond infection control and identify research gaps to guide future research and policy.
Method
Systematic searches were completed in the MEDLINE, Embase, PsycINFO, Scopus and CINAHL databases on 14 August 2024. Articles were eligible if they described peer-reviewed empirical studies involving people with mental disorders or mental health clinicians that reported on impacts of face coverings.
Results
Twenty-eight studies were selected for inclusion, involving 5385 participants. There was considerable heterogeneity among studies. Negative effects of face masks were reported in 26 studies in at least one domain. Themes from the survey-based literature included face masks negatively affecting communication, the therapeutic relationship and overall assessment quality. Experimental studies using emotion recognition tasks showed that people with mental disorders were disadvantaged by masks when interpreting emotions from facial expressions. The most commonly studied population was people with autism spectrum disorder. Children and people with severe or acute mental illness were underrepresented. Only two studies expressly recruited psychiatrists.
Conclusions
Policy makers should be aware of adverse impacts of mask-wearing in mental health settings and consider these in evolving risk–benefit analyses. Further research is needed to establish the extent of impacts on population subgroups.
In England, psychological therapies provided in primary care are recommended as first-line treatment for people living with mild-to-moderate dementia experiencing depression or anxiety. It is known that people living with dementia experience more barriers to accessing therapy than people without dementia, but such inequalities in terms of rates of access to primary care services are yet to be characterised.
Methods
In this retrospective, observational study of linked electronic healthcare records, the national database of the National Health Service (NHS) Talking Therapies for anxiety and depression programme was used to compare pathways to accessing therapy between 6623 people living with dementia and 4 825 489 without dementia between 2012 and 2019. Outcomes included access to an assessment, to therapy and reasons for discharge. Primary analyses used a propensity-score matched cohort to compare outcomes. Exact matching was used for the NHS service entity.
Results
The prevalence of dementia in the study cohort was lower than the prevalence of dementia in a representative population, based on an estimation of prevalence in people with mild-to-moderate age over 35 (0.23% in our study vs 3.82% in previous research). Compared to people without dementia, people living with dementia were less likely to access an assessment (odds ratio [OR] = 0.60; 95% confidence interval [CI]: 0.55–0.65), to subsequently receive therapy (OR = 0.67; 95% CI: 0.61–0.73) and more likely to be discharged because services were deemed not suitable before having an assessment (relative rate ratio [RRR] = 4.90; 95% CI: 4.20–5.72) and starting therapy (RRR = 2.74; 95% CI: 2.24–3.35). Female gender, social deprivation, Asian ethnicity and less common dementia subtypes (such as frontotemporal dementia) were also associated with poorer access rates and a higher likelihood of services being deemed not suitable. Involvement of care partners in the referral process was associated with better access rates.
Conclusions
Pathways to accessing primary care psychological therapy services must be made more accessible for people living with dementia. Better access could be achieved by increasing referrer awareness and training for staff within services to promote access for people living with dementia (especially for groups under-represented in services), better understanding how to involve care partners in the process, as well as when specialist support might be more suited in secondary care. More granularity in the medical coding of rarer dementia diagnoses in electronic health records would also allow for better statistically powered research for these groups.
“Dual disorders” (DD) refers to the co-occurrence of addiction and other mental health conditions, which often interact and complicate care. Despite scientific evidence showing shared brain mechanisms, current diagnostic systems treat them separately, leading to fragmented treatment and stigma. The World Association on Dual Disorders urges adopting “dual disorders” as a unified term to improve clarity, care integration, and outcomes.
This article addresses the questions of when mental health advance planning documents are created, the points when circumstances which they are intended to address arise and what consequences should flow when such a situation does arise. It addresses these points primarily from the perspective of what the law could/should be at a conceptual level. It looks at three stages: (a) creation of the document; (b) the period between the creation of the document and the point at which the intended circumstances arise; and (c) the point at which the intended circumstances arise. It does not purport to provide solutions at each stage, but rather to frame the dilemmas to aid discussion. In similar vein, it draws upon case studies from England & Wales, not to purport to dictate similarities of approach, but to flesh out dilemmas that have arisen to stimulate consideration.
The burden of cancer worldwide is rising, with 20 million new cases diagnosed in 2022. In Europe, 1.2 million women are diagnosed with cancer annually and an estimated 600,000 women die from cancer each year. International research and data from Ireland demonstrate that women with cancer face a particular set of challenges, including increased psychological distress compared to men. As a result, Ireland’s Model of Care for Psycho-Oncology could usefully place greater emphasis on gender-specific provisions which address the increased psychological needs of women. To date, Ireland has made some progress in recognising the physical and mental healthcare needs of women and developing gender-informed policies. It is essential that such policies are implemented fully so as to reduce and eliminate disparities in care. A more tailored, gender-informed approach would also help ensure the provision of gender-aware psycho-oncological care for all women and men as they navigate their cancer journeys.
The co-occurrence of mental illness and substance use disorders (SUDs) presents a significant public health challenge with affected individuals facing compounded stigma that leads to poor health outcomes, social exclusion, and systemic neglect. Despite growing recognition of stigma as a social determinant of health in people with comorbid mental illness and SUDs, current responses remain largely confined to clinical and academic settings. This article argues that civil society, particularly groups led by individuals with lived experience, represents an underutilized yet powerful force in combating stigma. Drawing from historical movements such as HIV/AIDS activism and contemporary examples from peer-led movements, we highlight how civil society organizations (CSOs) have reshaped public discourse, influenced policy, and fostered inclusive research. We examine emerging efforts in low resource settings and explore the transformative potential of digital civil society spaces. We advocate for a shift in stigma reduction paradigms to those that center lived experience, supports cross-sectoral collaboration, and recognizes both physical and digital civil society as essential to inclusive and sustainable change. To addressing the complex and intersecting stigmas associated with comorbid mental illness and SUDs, we recommend investing in CSOs, especially those grounded in participatory, culturally relevant approaches, particularly in low- and middle-income settings.
A large body of evidence suggests that adolescent mental health has worsened in recent years, particularly amongst young women. We investigated three putative risk factors which are very prevalent in the modern-day life of adolescents: social media use, sexting, and body dissatisfaction We wanted to investigate how these potential risk factors influence adolescents’ mental health, and whether the effects differ between genders.
We used a population-based survey of predominantly students (mean age 15 years) conducted in secondary schools in Ireland (September–December 2021) in one urban area (North County Dublin) and two rural areas (Cavan, Monaghan) – The “Planet Youth North Dublin, Cavan and Monaghan study”. We examined three mental health outcomes (using the Strengths and Difficulties Questionnaire (SDQ)) and self-harm behaviours. We fitted linear mixed models to examine associations between risk factors and mental health outcomes in both genders separately, adjusting for confounders.
All three risk factors were associated with poorer mental health in both genders, with larger effects in females. High social media usage (>4 hrs/day) was associated with increased poor mental health risk. Body dissatisfaction was linked to self-harm and worse mental health, being more prevalent in females (60% vs 36%). Sending sexually explicit messages was associated with poor mental health and self-harm risk in both genders.
Our findings show that high digital use, body image disturbance and sexting behaviours in teenage life have a strong association with poor mental health and self-harm, with these factors being more prevalent in females.
Mental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors’ mental health needs are limited.
Aims
Describe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.
Method
Observational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.
Results
Of the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.
Conclusions
The findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce.
During the pivotal college years, mental health emerges as a paramount concern, with implications for academic success, personal growth and overall well-being.
Aims
To investigate the dynamics of mindfulness and self-compassion, exploring their roles in enhancing the mental well-being of 246 young Iranian adults in full-time university study during the academic year of 2022–2023.
Method
Utilising standardised questionnaires and structural equation modelling, we examined the relationships between participants’ mindfulness, self-compassion and cognitive emotion regulation and their mental health.
Results
Mindfulness, self-compassion and adaptive cognitive emotion regulation showed positive correlations with mental health. Adaptive cognitive emotion regulation emerged as a key mediator in the relationship between self-compassion and mental health (P < 0.05). However, maladaptive cognitive emotion regulation showed no significant relation.
Conclusions
Interventions aimed at enhancing mindfulness, self-compassion and adaptive cognitive emotion regulation hold promise in improving the mental health of young adults in full-time study.
Youth who are lesbian, gay, bisexual, transgender, queer or questioning, and other diverse sexual and gender identities (LGBTQ+) experience disproportionately high rates of suicidal thoughts and behaviors compared to heterosexual and cisgender peers, yet many face barriers to care. Data came from a national online survey of 18,663 LGBTQ+ youth aged 13–24 years in the United States (September–December 2023). Analyses focused on participants who reported wanting mental health care in the past year and assessed access, barriers, service modalities and suicidal ideation/attempts. Half of LGBTQ+ youth who wanted mental health care did not receive it. The most common barrier was fear of talking about mental health concerns (42%). Among those who received care, one-on-one therapy was most common (69% in-person and 53% online). Suicidal ideation was lower among youth in therapy (46% in-person and 40% online) compared to those using crisis lines (75%). After adjusting for demographics, hotline use remained strongly associated with elevated risk: adjusted odds ratio (aOR) = 3.77 (95% confidence interval [CI]: 3.11–4.56) for suicidal ideation; aOR = 3.21 (95% CI: 2.62–3.94) for attempts. Despite strong willingness to seek care, structural and identity-related barriers leave many needs unmet. Expanding culturally competent services is essential to reducing suicide risk.
The January 2025 Los Angeles wildland-urban interface wildfires represent a significant environmental disaster, resulting in widespread evacuations. Beyond the immediate physical and economic devastation, wildfires can have profound and lasting impacts on the mental well-being of affected populations. This study compared mental health outcomes between Southern California residents who evacuated due to the fires and those who did not evacuate.
Methods
Southern California residents (N = 739) were surveyed 2-3 months after the January 2025 wildfires. Logistic regression models assessed the association of evacuation status with depression, anxiety, and PTSD, adjusting for demographics and baseline pre-fire levels of depression and anxiety.
Results
Evacuating was significantly associated with higher odds of depression (AOR = 1.75 [1.08-2.85]) and PTSD (AOR = 2.44 [1.36-4.35]), after controlling for pre-fire mental health status and other demographic covariates. Evacuation status was not associated with anxiety.
Conclusions
These findings support previous research linking wildfire exposure to adverse mental health outcomes and highlight the importance of targeted mental health screening and support for wildfire evacuees, who are at increased risk for depression and PTSD.
For patients with primary malignant brain tumors, cognitive decline is incredibly common and contributes to reduced independence in daily functioning. These patients often rely on informal caregivers (e.g., family, friends) for functional support, shown to increase caregiver distress in other neurologic populations. However, few studies have investigated this relationship in neuro-oncology; thus, we explored whether neuro-oncology patients’ neurocognitive function was associated with caregiver burden.
Method:
Neuro-oncology patients completed neuropsychological tests assessing commonly affected cognitive domains, and caregivers completed a validated measure of caregiver burden including impact on daily schedule, self-esteem, and availability of family support. Dyads were selected from a previous randomized-controlled trial (SmartCare) for distressed neuro-oncology caregivers. Independent samples t-tests and hierarchical regressions were used to evaluate the relationship between patients’ neurocognitive performance and caregiver burden.
Results:
Seventy-eight neuro-oncology dyads were included for analyses (Patients: Mage = 53.4, 65.4% male, Caregivers: Mage = 52.5, 71.8% female, 84.6% spouse). Caregiver schedule burden, but not self-esteem or family support, was significantly higher for caregivers of patients with deficits in verbal memory and divided attention (p < .05). After controlling for disease-specific characteristics and motor dexterity, only patient verbal memory performance remained a significant predictor of caregiver burden (p < .05). Inhibition and verbal fluency were not related to caregiver burden domains (ps > .05).
Conclusions:
Patients’ verbal memory performance appears to be indicative of cognitive changes that contribute to increased caregiver demands on their daily schedule and time burden. Maximizing patients’ functioning through leveraging their continued cognitive strengths and implementing individualized cognitive rehabilitation programs may improve caregiver burden.
As populations age rapidly, understanding the psychological benefits of sustained employment has become increasingly important. In South Korea, where the suicide rate among older adults is one of the highest among Organisation for Economic Co-operation and Development (OECD) countries, identifying modifiable social determinants, such as employment, may inform effective prevention strategies.
Methods
This retrospective cohort study used data from the Korean Welfare Panel Study (2009–2024), a nationally representative longitudinal survey. Individuals with depressive symptoms or suicidal ideation at baseline were excluded. The main exposure was participation in a government-led senior employment program. We employed discrete-time survival analysis using a generalized linear model with a complementary log–log link function, which appropriately handled the interval-censored structure of the panel data.
Results
Older adults who participated in the employment program had a significantly lower risk of developing depressive symptoms (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI]: 0.67–0.86) and suicidal ideation (adjusted HR = 0.60, 95% CI: 0.45–0.81) compared to those who did not participate. Subgroup analyses revealed that the strength of the association was particularly strong among individuals aged ≥80 years, those with chronic illness, poor self-rated health, and those who were previously or never married.
Conclusion
Structured government-supported employment may mitigate the risk of depressive symptoms and suicidal ideation in later life. These findings support the potential of senior employment programs as effective mental health promotion and suicide prevention strategies for aging populations.
A phenomenon distinctive to attention-deficit hyperactivity disorder (ADHD) is that the effects of stimulants are evident in domains of attention, mood, energy and focus, independent of the presence of an ADHD diagnosis. This reflects recreational use of stimulants for these and other effects. Perceived treatment response probably reinforces diagnosis, and hence diagnostic and prescribing habits.
User engagement remains a challenge in digital mental health. This editorial reconsiders engagement as a process rather than an outcome, introducing a four-step model to define, measure and link engagement to outcomes. The approach promotes standardisation, interpretability and scalability, advancing the science and implementation of digital health interventions.