Work stress levels rose among health and educational workforces during the COVID-19 pandemic, and can affect employee well-being and organisational efficiency.

To explore the association of work stress with mental health, including suicidal ideation and physical health, as well as presenteeism, as aspects of organisational efficiency in UK healthcare and university workers.

A total of 328 UK participants completed self-report questionnaires between April 2022 and September 2023 in the context of the European Platform to Promote Wellbeing and Health in the Workplace (EMPOWER) study. Cross-sectional analyses were conducted.

Two hundred and ninety-two (90%) employees reported work-related stress (Mini-Psychosocial Stressors at Work Scale). Depressive, anxiety and somatic symptoms were reported (61, 55 and 75%, respectively); 11% of the participants reported suicidal ideation (Patient Health Questionnaire 9) and 56% reported presenteeism (iMTA Productivity Cost Questionnaire). Psychological and somatic symptoms were worse when suicidal ideation or presenteeism was reported. Stressful work factors included having too much work to do (63%), a bad working atmosphere (28%), poor work–home balance (32%) and working hours hindering private life (35%). Spearman correlations showed significant associations between work stress and suicidal ideation (0.225), depressive (0.290), anxiety (0.299) and somatic symptoms (0.245) and presenteeism (0.311), but not with having a chronic medical condition.

Given the association between work stress, suicidal ideation and presenteeism, research should explore how psychosocial risk factors linked to work stress could be reduced for healthcare and higher education employees. The findings warrant the development of policies to address work stress, and to provide employee support for suicidal ideation and presenteeism in the work setting.

Auditory hallucinations (hearing voices in the absence of physical stimuli) are present in clinical conditions, but they are also experienced less frequently by healthy individuals. In the non-clinical population, auditory hallucinations are described more often as positive and not intrusive; indeed, they have received less attention.

The present study explores the phenomenology of non-clinical auditory hallucinations and their possible relationship with religiosity.

Starting from previous findings suggesting that non-clinical auditory hallucinations are often described as a gift or a way to be connected with ‘someone else’, we administered standardised questionnaires to quantify proneness to experiencing auditory hallucinations, religiosity and anxiety/depression scores.

Regression analysis carried out using an auditory hallucinations, index as the dependent variable on a final sample of 680 responders revealed that a total of 31% of the variance was explained by a five-steps model including demographic characteristics (i.e. being young, a woman and a non-believer) and negative (e.g. being afraid of otherworldly punishments) and positive (e.g. believing in benevolent supernatural forces) components of religiosity, anxiety and depression. Crucially, compared with believers, non-believers revealed higher scores in depression, anxiety and in a specific questionnaire measuring proneness to auditory hallucinations.

Results suggests that religiosity acts as a potential protective factor for proneness to paranormal experiences, but a complex relationship emerges between religious beliefs, mood alterations and unusual experiences.

There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.

Estimate the cost–utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.

We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive–behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18–65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.

Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.

Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.

Previous studies have found substantial costs to be associated with depression and insomnia (as separate entities).

To estimate healthcare service use and costs associated with insomnia in Australian adults experiencing subthreshold depression or major depressive disorder (MDD).

Healthcare service use and productivity loss were extracted from the cross-sectional 2020–2022 National Survey of Mental Health and Wellbeing data. Insomnia and depression were assessed using questions aligned with DSM-IV criteria. Weighted two-part models were used to calculate average annual costs (presented as 2021–2022 Australian dollars).

The analytical sample meeting subthreshold depression or MDD criteria consisted of 1331 adults (aged 40.5 ± 16.1 years; 59% female; insomnia prevalence: 84%). Healthcare service use and healthcare costs between individuals with insomnia and those without insomnia were similar in the MDD group. For subthreshold depression, healthcare costs were significantly higher for those with insomnia compared with those without insomnia (Δ = A$990, 95% CI: 234 to 1747), but healthcare resource use was not significantly different. Productivity loss among employed people and reduced employment were much greater (although the difference did not reach statistical significance) in adults with insomnia compared with those without insomnia.

Healthcare resource use among adults with depression was similar in those with and without insomnia. However, higher healthcare costs associated with insomnia were observed in adults with subthreshold depression. Further studies are encouraged to understand the nature of the increased healthcare cost associated with insomnia in individuals with subthreshold depression and to optimise healthcare service use in people with comorbid depression and insomnia.

Individuals with schizophrenia experience significantly higher rates of chronic physical health conditions, driving a 20-year reduction in life expectancy. Poor diet quality is a key modifiable risk factor; however, owing to side-effects of antipsychotic medication, cognitive challenges and food insecurity, standard dietary counselling may not be sufficient for this population group.

To evaluate the feasibility, acceptability and preliminary effectiveness of two dietary interventions – pre-prepared meals and meal kits – for individuals with schizophrenia.

The Schizophrenia, Nutrition and Choices in Kilojoules (SNaCK) study is a 12-week, three-arm, cross-over, randomised controlled trial. Eighteen participants aged 18–64 years diagnosed with schizophrenia or schizoaffective disorder will be recruited from community mental health services in Australia. Participants will be randomised to receive pre-prepared meals, meal kits or a supermarket voucher as a control, crossing-over at the end of weeks 4 and 8, so that all participants experience all three study arms. Primary outcomes include feasibility (recruitment rate and retention, number of days participants use pre-prepared meals or meal kits, adherence to meals as prescribed, difficulty in meal preparation and meal wastage) and acceptability (meal provision preference ranking and implementation) of the nutrition interventions. Secondary outcomes include the effects of the intervention on metabolic syndrome components, dietary intake, quality of life and food security measures.

Feasible, acceptable and effective dietary interventions for people with schizophrenia are urgently needed. Findings from this trial will inform future larger randomised controlled trials that have the potential to influence policy and improve health outcomes for this vulnerable population.

The heterogeneity of chronic post-COVID neuropsychiatric symptoms (PCNPS), especially after infection by the Omicron strain, has not been adequately explored.

To explore the clustering pattern of chronic PCNPS in a cohort of patients having their first COVID infection during the ‘Omicron wave’ and discover phenotypes of patients based on their symptoms’ patterns using a pre-registered protocol.

We assessed 1205 eligible subjects in Hong Kong using app-based questionnaires and cognitive tasks.

Partial network analysis of chronic PCNPS in this cohort produced two major symptom clusters (cognitive complaint–fatigue and anxiety–depression) and a minor headache–dizziness cluster, like our pre-Omicron cohort. Participants with high numbers of symptoms could be further grouped into two distinct phenotypes: a cognitive complaint–fatigue predominant phenotype and another with symptoms across multiple clusters. Multiple logistic regression showed that both phenotypes were predicted by the level of pre-infection deprivation (adjusted P-values of 0.025 and 0.0054, respectively). The severity of acute COVID (adjusted P = 0.023) and the number of pre-existing medical conditions predicted only the cognitive complaint–fatigue predominant phenotype (adjusted P = 0.003), and past suicidal ideas predicted only the symptoms across multiple clusters phenotype (adjusted P < 0.001). Pre-infection vaccination status did not predict either phenotype.

Our findings suggest that we should pursue a phenotype-driven approach with holistic biopsychosocial perspectives in disentangling the heterogeneity under the umbrella of chronic PCNPS. Management of patients complaining of chronic PCNPS should be stratified according to their phenotypes. Clinicians should recognise that depression and anxiety cannot explain all chronic post-COVID cognitive symptoms.