Suicidal ideation and behaviours are common among adolescents, posing significant challenges. Parents have a protective role in mitigating this risk, yet they often feel ill-equipped to support their adolescents, and their specific support needs are not well understood.

To explore the lived experiences of parents with suicidal adolescents and identify their support needs in the context of a therapist-assisted online parenting programme.

Semi-structured interviews were conducted with three stakeholder groups based in Australia: nine parents with lived experience caring for a suicidal adolescent, five young people who experienced suicidality during adolescence and five clinical/research experts in youth mental health/suicide prevention. Inductive thematic analysis was used to analyse and interpret findings.

Three key themes highlight the experience of parenting a suicidal adolescent: the traumatising emotional experience, uncertainty and parent empowerment. Six themes described parents’ support needs: validation and support, practical and tailored strategies, rebuilding the parent–adolescent relationship, parental self-care, flexible and accessible modes of delivery, and understanding non-suicidal self-injury.

Findings highlight key themes of parenting a suicidal adolescent and parental support needs. An online parenting programme could offer parents flexible access to evidence-based parenting strategies. Yet, a purely digital approach may not address the complexities of the parent-adolescent dynamic and provide adequate tailoring. As such, a hybrid approach incorporating therapist support can provide parents with both the compassionate support and practical guidance they seek.

CD33 has been implicated in the pathogenesis of Alzheimer’s disease primarily through its role in inhibiting the clearance of beta-amyloid (Aβ). However, genetic studies yield mixed results and it is unclear whether the impact of CD33 is specific to Alzheimer’s disease or related to broader neurodegenerative processes. Interestingly, CD33 has also been shown to interact with the hepatitis B (HBV) and C viruses (HCV).

This study aims to investigate the effects of CD33 single-nucleotide polymorphisms (SNPs) on cognitive functions across diverse populations, including healthy controls, individuals with chronic HBV or HCV and those diagnosed with Parkinson’s disease.

We genotyped CD33 SNPs in 563 participants using the Affymetrix platform. Participants’ cognitive functions were cross-sectionally assessed using a neuropsychological test battery spanning six domains.

Our analysis revealed that CD33 SNP variations had no significant cognitive impact on healthy individuals or Parkinson’s disease patients. However, chronic HBV and HCV patients exhibited significant cognitive differences, particularly in memory, related to CD33 SNP genotypes. Moderation analysis indicated a heightened influence of CD33 SNPs on cognitive functions in chronic HBV and HCV individuals. Our data also suggest that inflammation severity may modulate the cognitive effects in hepatitis patients with specific CD33 SNPs.

This study highlights the importance of CD33 SNPs in cognitive outcomes, emphasising their role in the context of chronic viral hepatitis. It contributes to understanding the cognitive profiles influenced by CD33 SNPs and posits CD33’s potential contribution to neurodegenerative disease progression, potentially intensified by HBV/HCV-induced inflammation.

Inequality can increase the risk of poor mental health. Objective measures explain the effects of socioeconomic disparities, but individuals may perceive inequality differently.

We aimed to investigate the association between the perception of economic inequality and depressive symptoms and suicide ideation.

We used data from the Survey of Korean Youths’ Lives, a nationally representative cross-sectional study of 14 918 young adults aged 19−34 years in South Korea. Multivariate logistic regression analysis was conducted to assess the association between perceived economic inequalities (i.e. income inequality and inequality of intergenerational mobility) and depressive symptoms/suicide ideation. Additionally, subgroup analyses were performed based on objective and subjective income levels.

Young adults with a high perception of economic inequality were more likely to experience depressive symptoms and suicide ideation. For example, those with a high perception of intergenerational mobility inequality had higher odds of depressive symptoms (odds ratio 1.82, 95% CI 1.49, 2.23) and suicide ideation (odds ratio 1.87, 95% CI 1.35, 2.60). Statistical evidence showed no interaction between the perception of inequalities and income, suggesting that a high perception of inequalities is associated with depressive symptoms and suicidal ideation, regardless of income. Nevertheless, the strongest association with poor mental health was observed in those with high perceived inequality and low income.

This study shows that the way young adults perceive economic inequality could affect their depressive symptoms and suicidal ideation. The findings highlight the importance of reducing these perceptions and addressing economic inequalities to improve mental health.

Asylum seekers have difficulty gaining access to mental healthcare. Lack of understanding of asylum seekers’ mental illness explanatory models appears to be an important barrier. Gaining a better understanding of these explanatory models is crucial for ensuring the inclusion of asylum seekers in healthcare services. The Cultural Formulation Interview (CFI) might help to explore asylum seekers’ explanatory models of mental illness.

To analyse asylum seekers’ explanatory models as elicited by the CFI.

The CFI and its first supplementary module were carried out with asylum seekers with mental health problems. Transcriptions of the interviews underwent reflexive thematic analysis within a social constructivist framework.

In the analysis of 25 illness narratives, three major themes characterising asylum seekers’ explanatory models were identified: a burden of the past, a disenabling current reality, and a personal position and individual experience.

The interplay among pre-, peri- and post-migration experiences, having a continuous impact on asylum seekers’ mental health, was highlighted by the themes ‘a burden of the past’, and ‘a disenabling current reality’. The theme ‘a personal position and individual experience’ revealed how the CFI enables self-determination in clinical encounters by embracing uncertainty and questioning the medicalisation of distress. The analysis characterises asylum seekers’ symptoms as a personal idiom of distress within socio-relational contexts. The CFI provides a clinically useful framework for exploring asylum seekers’ explanatory models and fostering dynamic understanding.

Some individuals experience abnormally persistent and intense symptoms of grief that significantly interfere with daily functioning. This condition has been described using terms such as complicated or prolonged grief and prolonged grief disorder (PGD).

To identify the availability of evidence addressing a range of policy relevant issues related to grief, bereavement and PGD. In this paper we focus on the availability of evidence from systematic reviews.

We searched 12 databases and the websites of 18 grief- or bereavement-related organisations. Using key characteristics extracted from included reviews, we produced a high-level overview of the available evidence that enabled potential research gaps to be identified.

We identified 212 reviews – 103 focused on people’s experiences of grief/bereavement including service use; 22 reported on PGD prevalence, 42 on PGD risk factors, 37 on factors that influence grief more broadly and 80 on the effectiveness of grief-related interventions. Fifty-five reviews focused on multiple issues of interest. Half of reviews focused on a specific cause/type of death (n = 108). Of these reviews, most focused on three main causes/types of death: a specific health condition or terminal illness (n = 36), perinatal loss (n = 34) and suicide (n = 20).

We identified a large number of reviews, but key evidence gaps exist, particularly in relation to intervention cost-effectiveness and social, organisational or structural-level interventions that are needed for addressing inequities and other modifiable factors that can impair grieving and potentially increase the risk of PGD.

Extreme events (e.g. floods and disease outbreaks) can overwhelm healthcare workers (HCWs) and healthcare systems. During the COVID-19 pandemic, high levels of distress and mental ill health were reported by HCWs.

To examine and synthesise research findings reported in the qualitative literature regarding the stressors, and their psychosocial impacts, faced by HCWs in the UK during the COVID-19 pandemic, and to provide lessons for future support.

Qualitative articles were identified in EMBASE and OVID (preregistered on PROSPERO: CRD42022304235). Studies were required to have been published between January 2021 and January 2022 and to have examined the impact of COVID-19 on UK HCWs. We included 27 articles that represented the experiences of 2640 HCWs, assessed their quality using National Institute for Health and Care Excellence criteria and integrated their findings using thematic synthesis.

Several secondary stressors were identified, including lack of personal protective equipment, ineffective leadership and communication, high workloads and problems stemming from uncertainty and a lack of knowledge. Stressors were related to adverse psychosocial outcomes including worry, fatigue, lack of confidence in oneself and senior managers, impacts on teamwork and feeling unappreciated or that one’s needs are not recognised.

Our thematic synthesis moves beyond simply mapping stressors faced by HCWs by considering their antecedents, origins and psychosocial impacts. Utilising a theoretical framework that points towards systemic deficiencies, we argue that secondary stressors can be modified to remove their negative effects. Consequently, workforce planning should shift from focusing on individual change towards amending psychosocial environments in which HCWs work.

Forming ‘if-then’ plans has been shown to reduce self-harm among people admitted to hospital following an episode of self-harm.

To explore whether the same intervention, delivered online, could prevent future self-harm among a large community sample who had previously self-harmed.

UK adults were recruited to a randomised controlled trial and received either an intervention to reduce self-harm or one to reduce sedentariness (control group). Randomisation was stratified to ensure both groups were representative of the UK population. There were three primary outcomes: non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts, assessed at baseline and 6 months post-intervention.

Participants (1040) were randomised to the intervention (n = 520) or control (n = 520) group. The vast majority of people formed implementation intentions in both the experimental (n = 459 (88.3%)) and control (n = 520 (100%)) condition. Overall, the intervention did not significantly reduce the frequency of NSSI, suicidal ideation or suicide attempts. Among people who had self-harmed in the past week at follow-up, mixed analysis of covariance revealed a significant interaction between time and condition for reflective motivation, F(1,102) = 7.08, P < 0.01, pn2 = 0.07, such that significantly lower levels of reflective motivation were reported at follow-up in the control condition, t(57) = 2.42, P = 0.02.

This web-based intervention has limited utility for reducing self-reported self-harm or suicidal ideation in adults with a history of self-harm. Further work is needed to improve the effectiveness of brief interventions for self-harm aimed at adults living in the community and to understand the conditions under which the intervention may or may not be effective.

Understanding the factors influencing alcohol use disorder (AUD) treatment outcomes is essential. More knowledge about patient characteristics that predict treatment outcomes can help personalise interventions, improve treatment planning and address the needs of specific subgroups. The frequency of treatment attendance may also affect drinking outcomes after treatment. Despite research efforts, uncertainty remains about how patient factors and treatment attendance influence treatment outcomes.

To examine how patient factors and treatment attendance predict high- or low-risk drinking at the end of treatment.

We used data (N = 92) from a multisite observational study of treatment-seeking individuals with AUD attending group treatment. Sociodemographic measures, alcohol and substance use measures, cognitive functioning, psychological distress, personality functioning and quality of life were screened in univariate analyses. Significant variables were entered into a binary logistic regression model.

Individuals with a higher percentage of treatment attendance (odds ratio 0.96 [95% CI 0.93, 0.96]) and with greater responsiblity scores on the Severity Indices of Personality Functioning (odds ratio 0.30 [95% CI 0.14, 0.64]) had a decreased likelihood of high-risk drinking at treatment end. Substance use, psychological distress and cognitive functioning were not associated with drinking levels at the end of treatment.

A higher percentage of treatment attendance has a minor effect on drinking levels. Being more responsible, as reflected in higher scores on the responsibility domain, reduces the likelihood of high-risk drinking at the end of treatment. Clinicians are encouraged to screen and assess personality functioning when planning treatment for individuals with AUD.

The COVID-19 pandemic and lockdowns had a significant impact on mental well-being and (mental) healthcare systems globally.

To describe trends and dynamics of out-patient prescribing of psychotropic medications during the COVID-19 pandemic in The Netherlands.

Dispensed psychotropic medication prescriptions during the COVID-19 pandemic from March 2020 to March 2022 were retrieved from national registry data. Numbers of total and incident dispensed prescriptions and defined daily doses (DDDs) were identified for six medication groups. Overall pandemic-related changes in prescribing trends were analysed using interrupted time-series analyses. Lockdown-related prescribing dynamics were described using monthly risk ratios.

No overall pandemic-related changes in prescribing were detected, except for alcohol addiction medication, for which a pre-pandemic decline in total dispensed prescriptions and DDDs levelled off during the pandemic: +10 prescriptions per week (95% CI 7–11, P ≤ 0.001) and +111 DDDs per week (95% CI 56–165, P = 0.001). Monthly prescribing dynamics showed transient increases in all medication groups during the second and third lockdown periods. There were decreases in dispensed incident antidepressant and opioid addiction medication prescriptions during the first lockdown (average risk ratios: 0.87 and 0.88 respectively), and DDDs of dispensed incident and total attention-deficit hyperactivity disorder medication prescriptions and incident benzodiazepine prescriptions were elevated from the end of the second lockdown (average risk ratios: 1.40, 1.12 and 1.17, respectively).

These findings raise concerns regarding possible over- and under-prescribing during the pandemic. Further understanding of specific factors driving these changes is necessary to help prepare for future mental health(care) challenges.

User engagement is recognised as a critical and pervasive challenge that has limited the potential evidence base being developed for mental health apps.

To understand young people’s motivations for participating in a randomised controlled trial for a mental health app and the role of intrinsic (e.g. improving well-being) and extrinsic (e.g. financial incentives) drivers in engagement.

Emotional Competence for Well-Being (ECoWeB) was a superiority parallel three-arm randomised cohort trial recruiting a cohort of 16–22 year-olds across the UK, Germany, Spain and Belgium, who, depending on risk, were allocated respectively to the PREVENT (n = 1262) versus PROMOTE (n = 2532) trials. We conducted in-depth semi-structured interviews in the UK (n = 18, mean age = 17.7, s.d. = 1.5) and Spain (n = 11, mean age 20.6, s.d. = 1.7) to explore participants’ self-reported motivations and engagement. The trial was registered at ClinicalTrials.gov: NCT04148508.

Across arms, 21% of participants never set up an account to access the app and approximately 50% did not complete the 3-month follow-up assessment. Engagement was not significantly higher in the intervention arm compared to the control arms across metrics. Qualitative findings demonstrated that although extrinsic factors alone may be enough to prompt someone to sign up to research, intrinsic drivers (e.g. finding the app useful) are needed to ensure longer-term engagement.

Incentivising participation in clinical trials needs to be consistent with incentives that might be utilised at the point of dissemination and implementation to ensure that findings are replicated if that intervention is adopted at scale.

Early detection of psychosis is paramount for reducing the duration of untreated psychosis (DUP). One key factor contributing to extended DUP is service delay – the time from initial contact with psychiatric services to diagnosis. Reducing service delay depends on prompt identification of psychosis. Patients with schizophrenia and severe social impairment have been found to have prolonged DUP. Whether service delay significantly contributes to prolonged DUP in this group is unclear.

To examine and compare the course of illness for patients with schizophrenia who are homeless or domiciled, with a focus on service delay in detecting psychosis.

In this case–control study, we included out-patients with a schizophrenia spectrum diagnosis and who were homeless or domiciled but in need of an outreach team to secure continuous treatment. Interviews included psychosocial history and psychopathological and social functioning scales.

We included 85 patients with schizophrenia spectrum disorder. Mean service delay was significantly longer in the homeless group (5.5 years) compared with the domiciled group (2.5 years, P = 0.001), with a total sample mean of 3.9 years. Similarly, DUP was significantly longer in the homeless group, mean 15.5 years, versus 5.0 years in the domiciled group (P < 0.001). Furthermore, the homeless group had an earlier onset of illness than the domiciled group but were almost the same age at diagnosis.

Our findings point to the concerning circumstance that individuals with considerable risk of developing severe schizophrenia experience a substantial delay in diagnosis and do not receive timely treatment.

Mental health literacy can potentially be improved through a public mental health campaign. The aim of the campaign Every Mind Matters (EMM) was to support adults to help address common subclinical mental health problems and improve their mental well-being and literacy, by using its National Health Service-endorsed digital resources.

Although not an objective of the campaign itself, this study aims to (a) address the relationship of EMM through the use of general practitioners and mental health therapists and (b) explore the association of EMM with symptom management knowledge.

Health Survey for England 2019 data were obtained on campaign awareness, uptake of campaign materials and the use of general practitioners and therapists. Logistic regression models were used to explore the impact of the campaign on whether services were used, and ordered logistic models explored the impact on the number of contacts. Campaign costs were viewed alongside symptom management outcomes.

The analyses included 2023 individuals. Of those campaign aware, 16% had contact with a general practitioner for mental health reasons compared with 9% of those who were campaign unaware. Those who were campaign aware were also significantly more likely to have seen a mental health therapist. The campaign cost per unit improvement in symptom management knowledge was below £20.

Contact with general practitioners and therapists was associated with campaign awareness. If even a small proportion of symptom management knowledge improvement is due to the campaign, then it has the potential to be cost-effective. Further work is required to establish this.

Myocardial bridge contributes to chest pain, often accompanied by non-specific complaints.

Our study aims to determine somatic symptom disorder (SSD) prevalence in patients with myocardial bridge, investigating associated clinical and psychological features.

In this prospective cross-sectional study, we enrolled 1357 participants (337 with and 1020 without myocardial bridge) from Shanghai Renji Hospital. The Somatic Symptom Scale-China questionnaire was used to assess SSD. Depressive and anxiety disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7).

The prevalence of SSD in the myocardial bridge group was 63.2%, higher than the group without myocardial bridge (53.8%). Patients with myocardial bridge were at an increased risk of SSD (odds ratio 1.362, 95% CI 1.026–1.809; P = 0.033). There were no differences in the mean PHQ-9 scores (3.2 ± 3.4 v. 3.2 ± 4.1; P = 0.751) or GAD-7 scores (2.5 ± 3.0 v. 2.3 ± 3.7; P = 0.143) between the two groups. Among patients with myocardial bridge, gender was the only independent risk factor for SSD. Women were 3.119 times more likely to experience SSD compared with men (95% CI 1.537–6.329; P = 0.002).

Our findings emphasise the high prevalence and severity of SSD among patients with myocardial bridge. The screening for SSD should be of particular concern, especially among female patients.

Antipsychotics are primarily indicated for psychotic disorders. There is increasing concern regarding their potential overuse for other conditions.

To examine the change in the number of community prescriptions and corresponding costs for antipsychotics per head of population over 25 years (1998–2022) in England.

The data for 1998–2022 were obtained from two separate resources from the OpenPrescribing database: from 1998 to 2016 from their long-term trends data-set; and for 2017–2022 from the monthly medication prescribing data. The relevant British National Formulary subcategories 4.2.1 ‘antipsychotic drugs’ and 4.2.2 ‘antipsychotic depot injections’ were selected. The annual differences in prescriptions and the mean average annual increase were calculated. Scatter plots to visualise the yearly trend and Spearman testing to assess the strength of the correlations were done. The total annual costs of these medications were calculated for this time period.

The annual mean increase in the number of prescriptions was 287 548 in raw numbers and 4.27 per 1000 population. There is a statistically significant and strong positive relationship between time and the prescriptions of antipsychotics per 1000 population (Spearman correlation coefficient 0.995, P ≤ 0.001). This increasing trend is driven by the increase in oral antipsychotic drug prescriptions over time (Spearman correlation coefficient 0.995, P ≤ 0.001). Antipsychotic drug costs increased until 2011, reduced until 2016 and rose again during 2020–2022.

This analysis suggests a worrying increasing trend in antipsychotic medication prescribing. Potential causal factors include off-licence use. Clinical practice and research implications are discussed.