Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.

This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of ‘THRIVE-like’ features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.

Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in ‘THRIVE-like’ features, with an average increase of 16.41 points (95% confidence interval: 1.69–31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (−2.76, 95% confidence interval: − 18.25–12.73, P-value: 0.708).

The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.

Mental health problems in adolescence are increasingly prevalent and have tremendous impacts on life-long health and mortality. Although household poverty is a known risk factor for adolescent mental health, evidence of the timing hypothesis is scarce. We aimed to examine the longitudinal associations of poverty across childhood with mental health in adolescence, focusing on the timing of exposure.

We used the data of 5,671 children from a Japanese population-based longitudinal cohort, which recruited the first graders (aged 6–7 years) and followed biannually until eighth grade (aged 13–14 years) in Adachi, Tokyo. Household poverty was defined as households having any of the following experiences: annual income less than Japanese yen 3 million, payment difficulties and material deprivations, measured in first, second, fourth, sixth and eighth grades. Adolescent mental health included parent-report internalizing and externalizing problems (the Strengths and Difficulties Questionnaire), self-report depression (the Patient Health Questionnaire-9) and self-esteem (the Japanese version Children’s Perceived Competence Scale) in eighth grade. We applied g-estimation of structural nested mean modelling to account for time-varying confounders.

If adolescents were exposed to household poverty at any grade across childhood, on average, they would report more severe depressive symptoms (ψ = 0.32 [95% CI 0.13; 0.51]) and lower self-esteem (ψ = −0.41 [−0.62; −0.21]) in eighth grade. There were also average associations of household poverty at any grade with more internalizing (ψ = 0.19 [0.10; 0.29]) and externalizing problems (ψ = 0.10 [0.002; 0.19]). Although the associations between household poverty and mental health were stronger in younger ages (e.g., poverty in the second grade → depression: ψ = 0.54 [−0.12; 1.19] vs. poverty in the eighth grade → depression: ψ = −0.01 [−0.66; 0.64]), overlapping 95% CIs indicated no statistically significantly different associations by the timing of exposure.

We found the average effect of exposure to household poverty at any grade on mental health outcomes in eighth grade, failing to support the timing hypothesis. The findings indicate that the effects of household poverty accumulate over time in childhood and impact adolescent mental health (cumulative hypothesis) rather than the effects differ by the timing of exposure. While cumulative effects suggest a persistent intervention in poor households across childhood, we highlight intervention at any timing in childhood may be effective in alleviating adolescent mental health problems.

Aims. Parental postpartum depressive symptoms have been extensively studied, but the combined longitudinal depression trajectories of parents and their long-term development beyond the postpartum period remain largely underexplored. We identified dyadic longitudinal depressive symptom trajectories in new parents, followed over an 11-year period, and compared parental characteristics, as well as child temperament and mental health factors, across different parental trajectory classes.

Methods. A prenatal cohort of 5,518 couples was studied. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale at eight time points: in the prenatal stage, in the newborn stage, and at 6 months, 18 months, 3 years, 5 years, 7 years and 11 years after the birth of the child.

Results. Dyadic Latent Class Growth Modelling identified five classes of couples: (1) mother has elevated depressive symptoms, father is non-depressed (24%); (2) both mother and father have elevated depressive symptoms (20%); (3) both mother and father are constantly non-depressed (42%); (4) both mother and father are constantly depressed (5%); and (5) mother is constantly depressed, father has elevated depressive symptoms (9%). Relationship maintenance (particularly being married or separated) was the most strongly associated with the classes. Socio-economic resources, emotional well-being, health, obstetric history and parental background also served as meaningful covariates. Child temperament and mental health showed weak correlations with parental trajectory classes.

Conclusions. Parents with postpartum depressive symptoms often experience depressive symptoms long-term. Separated parents are particularly vulnerable to adverse depressive trajectories. Our findings underscore the importance of dyadic methods in estimating unique combinations of parental depression trajectories.

Only little empirical evidence exists on mental health in LGBTIQ+ refugees. In the present study, trauma exposure, experiences of sexual violence and current treatment needs for physical and mental health were investigated in association with symptoms of anxiety, depression, post-traumatic stress disorder (PTSD) and somatic symptom burden in LGBTIQ+ asylum-seekers resettled in Germany and seeking psychosocial support.

Data was collected in cooperation with a counselling centre for LGBTIQ+ asylum-seekers between Mai 2018 and March 2024, with a total of 120 completed questionnaires of adult clients. The questionnaire (11 different languages) included sociodemographic and flight-related questions as well as standardized instruments for assessing PTSD (PCL-5), depression (PHQ-9), somatic symptom burden (SSS-8), and anxiety (HSCL-25). Prevalence rates were calculated according to the cut-off scores of each questionnaire. Four logistic regression analyses were conducted to test for potential associations between being screened positive for anxiety, depression, somatic symptom burden or PTSD and the number of traumatic events, experiences of sexual violence as well as current treatment needs for physical and mental health.

The great majority, 74.2% (95% CI: 66–82) of the respondents, screened positive for at least one of the mental disorders investigated, with 45% (95% CI: 36–54) suffering from somatic symptom burden, 44.2% (95% CI: 35–53) from depression, 58.3% (95% CI: 50–67) from PTSD, and 62.5% (95% CI: 54–71) from anxiety; 69.5% participants reported having been exposed to sexual violence. Current treatment needs for physical health problems were reported by 47% and for mental health problems by 56.7%. Participants with experiences of sexual violence were more likely to be screened positive for depression (OR: 6.787, 95% CI: 1.45–31.65) and PTSD (OR: 6.121, 95% CI: 1.34–27.95).

The study provides initial insights on mental health and associated factors in a highly burdened and hard-to-reach population. The findings are important for healthcare systems and political authorities in terms of assuring better protection and healthcare for LGBTIQ+ refugees and asylum-seekers.

A systematic review and meta-analysis was conducted to investigate the prevalence and antecedents/outcomes of loneliness and social isolation among individuals with severe mental disorders (SMD), such as schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder.

Five well-known electronic databases (PubMed, PsycINFO, CINAHL, Web of Science and Scopus) were searched (plus a hand search). Observational studies that report the prevalence and, if available, antecedents and consequences of loneliness/isolation among individuals with SMD were included. Key characteristics were extracted, and a meta-analysis was performed. Our systematic review was preregistered on PROSPERO (ID: CRD42024559043). The PRISMA guidelines were followed. The Joanna Briggs Institute (JBI) standardized critical appraisal tool developed for prevalence studies was applied to assess the quality of the included studies.

The initial search yielded 4506 records, and after duplicate removal and screening, a total of 10 studies were finally included. The studies included used data from Europe, Asia, North America, and Oceania. Two studies employed a longitudinal design, while all other studies had a cross-sectional design. Most of the studies included between 100 and 500 individuals with SMD. All studies involved both male and female participants, with women typically comprising about 40% of the sample. The average age of participants often ranged from approximately 30 to 40 years. The estimated prevalence of loneliness was 59.1% (95% CI: 39.6% to 78.6%, I2 = 99.3, P < .001) among individuals with any diagnosis of SMD. Furthermore, the estimated prevalence of objective social isolation was 63.0% (95% CI: 58.6% to 67.4%) among individuals with schizophrenia or schizophrenia spectrum disorder. The quality of the studies was moderate to good. Subjective well-being and depressive symptoms in particular were found to contribute to loneliness in the included studies.

The present systematic review with meta-analysis identified high levels of loneliness and objective social isolation among those with SMD. These findings stress the importance of monitoring and addressing social needs in this vulnerable group, which may have a positive effect on the life quality of individuals with SMD. Future research in neglected regions (e.g. South America and Africa) is recommended. Different diagnoses within severe mental disorders should be distinguished in future studies. Furthermore, additional longitudinal studies are required to explore the antecedents and consequences of loneliness and social isolation among individuals with SMD.

HOPE (National Institute for Health and Care Research Global Health Research Group on Homelessness and Mental Health in Africa) aims to develop and evaluate interventions that address the unmet needs of people who are homeless and have severe mental illness (SMI) living in three African countries in ways that are rights-based, contextually grounded, scalable and sustainable.

We will work in the capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and the capital city (Nairobi) and a rural county (Makueni) in Kenya to understand different approaches to intervention needed across varied settings.

We will be guided by the MRC/NIHR framework on complex interventions and implementation frameworks and emphasise co-production. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercise) on interventions and approaches to homelessness and SMI. We will map contexts; conduct focused ethnography to understand lived experiences of homelessness and SMI; carry out a cross-sectional survey of people who are homeless (n = 750 Ghana/Ethiopia; n = 350 Kenya) to estimate prevalence of SMI and identify prioritised needs; and conduct in-depth interviews and focus group discussions with key stakeholders to understand experiences, challenges and opportunities for intervention. This global and local evidence will feed into Theory of Change (ToC) workshops with stakeholders to establish agreement about valued primary outcomes, map pathways to impact and inform selection and implementation of interventions. Intervention packages to address prioritised needs will be co-produced, piloted and optimised for feasibility and acceptability using participatory action research. We will use rights-based approaches and focus on community-based care to ensure sustainability. Realist approaches will be employed to analyse how contextual variation affects mechanisms and outcomes to inform methods for a subsequent evaluation of larger scale implementation. Extensive capacity-strengthening activities will focus on equipping early career researchers and peer researchers. People with lived experience of SMI and policymakers are an integral part of the research team. Community engagement is supported by working closely with multisectoral Community Advisory Groups.

HOPE will develop evidence to support action to respond to the needs and preferences of people experiencing homelessness and SMI in diverse settings in Africa. We are creating a new partnership of researchers, policymakers, community members and people with lived experience of SMI and homelessness to enable African-led solutions. Key outputs will include contextually relevant practice and policy guidance that supports achievement of inclusive development.

Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.

A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.

Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.

The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.

Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model’s predictive accuracy.

This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May–July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision–recall curve. Shapley’s additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.

The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision–recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).

Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.

NCT04556565

The literature on persistent antidepressant withdrawal symptoms is sparse. This systematic review is the first to examine the prevalence, duration, severity, risk/protective factors and treatment strategies for post-acute withdrawal syndrome (PAWS) following the discontinuation of antidepressant medications.

We searched PubMed, Web of Science and PsycInfo, focusing on newer-generation antidepressants. The electronic database search was complemented with handsearching reference lists of pivotal studies. We included original studies in adults reporting on PAWS and providing data about epidemiology and clinical management of withdrawal symptoms persisting for at least 6 weeks.

The literature search yielded 1286 results, with 26 records assessed for eligibility, and seven studies fulfilled our selection criteria. Prevalence data were sparse, with one small cohort study reporting a 15% prevalence rate for PAWS in patients with panic disorder and agoraphobia. The duration of PAWS varied considerably across studies, ranging from 1.5 to 166 months. Long-term paroxetine use emerged as a potential risk factor for the development of PAWS. There was no reliable evidence to support the effectiveness of various treatment strategies, including the reinstatement of antidepressant medication, the use of benzodiazepines and the provision of cognitive-behavioral therapy.

The current evidence on PAWS is sparse and predominantly of low certainty. The presence of withdrawal symptoms, lasting several months and possibly even years in some patients, underscores the need for further research with rigorous methodology. Large prospective cohort studies are needed to assess the epidemiology of PAWS, while randomized controlled trials are quired to test the efficacy of clinical interventions to treat PAWS.

CRD42023461793

Previous studies have estimated the lifetime incidence, age of onset and prevalence of mental disorders, but none have used nationwide data covering both primary and secondary care, even though mental disorders are commonly treated in primary care. We aimed to determine lifetime incidence, age-specific incidence, age of onset and service utilization for diagnosed mental disorders.

This register-based cohort study followed the entire population of Finland from 2000 to 2020. We estimated the cumulative incidence of diagnosed mental disorders with the Aalen–Johansen estimator, accounting for competing risks such as death and emigration. We also calculated age-specific incidence and 12-month service utilization as of 31 December 2019, providing diagnosis-, age- and gender-specific estimates.

We followed 6.4 million individuals for 98.5 million person-years. By age 100, lifetime incidence of any diagnosed mental disorder was 76.7% (95% CI, 76.6–76.7) in women and 69.7% (69.6–69.8) in men; in psychiatric secondary care, it was 39.7% (39.6–39.8) and 31.5% (31.4–31.6). At age 75, stricter estimates for non-organic disorders (ICD-10: F10–F99) were 65.6% (65.5–65.7) for women and 60.0% (59.9–60.1). Anxiety disorders (F40–F48) had the highest cumulative incidence. Median age of onset of non-organic mental disorders was 24.1 (interquartile range, 14.8–43.3 years) in women and 20.0 (interquartile range, 7.3–42.2 years) in men. Service utilization within 12 months was 9.0% for women and 7.7% for men.

Most, though not all, individuals experience at least one type of mental disorder, often during youth. Capturing the overall occurrence of mental disorders requires including both primary and secondary care data.

Opioid use disorder (OUD) is a medical condition associated with problematic opioid use, leading to addiction and severe life impairments. This research delivers an in-depth evaluation of OUD burden and trends at global, regional and national levels.

This study analysed the global burden of OUD from 1990 to 2021 using data from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study. Key metrics included age-standardized prevalence, incidence, mortality and disability-adjusted life years (DALYs), disaggregated by gender, age, region, country and socio-demographic index (SDI) quintiles. The average annual percentage change described trends, while the age-period-cohort model evaluated age, period and cohort effects. A Bayesian Age-period-cohort model predicted future OUD trends from 2022 to 2040.

In 2021, the global burden of OUD remained substantial, with a total of 16,164,876 cases and a prevalence of 154.59 cases per 100,000 population (95% uncertainty interval [UI]: 131.06–181.26). In 2021, the global incidence of OUD reached 1,942,525 cases (95% UI: 1,643,342–2,328,363), and its global mortality reached 99,555 deaths (95% UI: 92,948–108,050), with DALYs amounting to 11,218,519 (95% UI: 9,188,658–13,159,551). Regionally, high SDI regions, particularly in the High-income North America, exhibited the greatest burden. Among countries, the United States faced the most severe burden and increase, with the highest prevalence (2014.62 per 100,000), incidence (151.84 per 100,000), mortality (15.37 per 100,000) and DALYs (1594.63 per 100,000), and all APPC values exceeding 5%. Males aged 20–39 years were the most affected demographic. However, forecasts indicate that the OUD burden among females will significantly increase over the next 20 years, with the prevalence and incidence expected to rise by 39% and 49%, respectively.

The global burden of OUD has statistically significantly increased from 1990 to 2021. There are marked disparities across regions, countries and SDI levels. High-SDI regions, particularly High-income North America, bear the heaviest burden, with young males (aged 20–39 years) being the most affected groups. However, caution should be exercised regarding the female population, as the number of affected individuals is rapidly increasing.

This study aims to examine the different aspects of socio-economic status (SES) patterns in mental health from adolescence into adulthood by investigating the mean, prevalence, cumulative incidence and trajectories of several mental health measures, including depressive symptoms, mental disorder diagnosis and medication use. The different aspects of SES are investigated through the measures of subjective social status (SSS) in school, SSS in society, income and parental educational level.

Individuals born in 1989 were followed from 2004 to 2021 with surveys at ages 15, 18, 21, 28 and 32 years, supplied with yearly register data. The mean level of depressive symptoms, yearly prevalence of medication use and cumulative incidence of mental disorder diagnosis were calculated for each SES group (low, middle and high) across each measure. Group-Based Trajectory Modelling (GBTM) was used to identify depressive symptom trajectories and logistic regressions were used to analyse the relative odds ratios (ROR) of membership to the different trajectory groups by characteristics.

Individuals with low SES at age 15 years across all SES measures showed higher mean depressive symptoms, prevalence of medication use and cumulative incidence of mental disorder diagnosis through adolescence and adulthood (age 15–32 years). Four depressive symptom trajectories were identified: low stable, moderate stable, decreasing and increasing trajectories. Being female, receiving medication or a mental disorder diagnosis in early adulthood and during the study period, having low SSS in school, parents not living together, being bullied, lacking support from teachers or classmates, lower levels of parents’ support or higher school pressure resulted in higher RORs of membership to the other trajectory groups compared to the low stable trajectory, while having high SSS in society resulted in a lower ROR.

This is the first study to detect the role of social support in relation to depressive symptom trajectories. While individuals with low social status consistently experienced more negative mental health outcomes than those with middle and high social status in the study period (age 15–32 years), low SSS showed the strongest associations. This indicates that SSS may capture vulnerable individuals not identified by traditional SES. Being female, having low SES, low social support, and other mental health outcomes were associated with higher odds of being in trajectories with more depressive symptoms. Preventive initiatives should therefore target individuals with such characteristics. It is worth exploring whether adolescents with increasing depressive symptoms could benefit from increased social support.

First-year postpartum depression is a common mental health problem among first-time mothers. A younger age of pregnancy often compounds the challenge due to underlying factors such as poverty and limited educational achievement. This study aimed to examine the minimal number of interpersonal supporters during pregnancy associated with lower levels of postpartum depressive symptoms among first-time mothers.

We obtained data from the population-based Mother–Infant/Newborn Tokyo Cohort (MINT cohort) in four municipalities in Tokyo on 429 first-time mothers who responded to two waves of surveys (early pregnancy and one month postpartum). They completed self-report measures of interpersonal support using one item from the Social Support Questionnaire and depressive symptoms using the Edinburgh Postnatal Depression Scale. Segmented regression analyses were conducted to determine the threshold at which the strength of the association changed between the number of interpersonal supporters and postpartum depressive symptoms, with adjustment for depressive symptoms in pregnancy. This analysis was also conducted with the sample stratified into young mothers (≤ 25 years) and older mothers (≥ 26 years).

In the overall sample, postpartum depressive symptoms were found to be lower among individuals with more than 3.0 supportive individuals (prepartum). Among young mothers, this threshold was higher, with lower symptom levels observed among those with at least 5.3 supporters. Only 22.9% of young first-time mothers had this level of interpersonal support, compared to 54.8% of all first-time mothers.

Our results suggest that having four or more interpersonal supporters in early pregnancy is associated with lower levels of postpartum depressive symptoms among first-time mothers. Additionally, among young mothers, having six or more supporters was associated with lower postpartum depressive symptoms. These findings suggest that tailored strategies to increase supporters around first-time pregnant women might be beneficial depending on their age.

Little is known about the effects of both financial hardship and people’s perception of it on mental health. This study aimed to evaluate the effect of perceived financial hardship on individuals’ depressive symptoms across several strata of objective financial situations.

We used data from a four-wave French national population-based cohort (N = 14,236, 2020–2022) to assess the relationship between depressive symptoms and perceived financial hardship. Multi-state models (MSM) were used on a three-level scale for depressive symptom severity based on the Patient Health Questionnaire (PHQ-9). Analyses were stratified by household income to study the interaction with the objective financial situation.

We showed a link between perceived financial hardship and the onset and deterioration of depressive symptoms in subsequent waves, with effect sizes ranging from HR = 1.29 (0.87-1.90) to 2.23 (1.66-2.98). This association was stronger in the high-income population. There was no significant link between perceived financial hardship and the improvement of depressive symptomatology.

This study confirms that perceived financial hardship is linked to the onset and deterioration of depressive symptoms. Furthermore, it suggests a stronger effect in high-income households, which could mean that the experience of financial hardship and the objective financial situation interact in their effect on mental health.

Understanding patterns and predictors of elevated psychological distress (EPD) among humanitarian migrants compared to the host population is critical for designing effective mental health interventions. However, existing research presents conflicting findings on the prevalence of EPD. This study examined EPD prevalence and associated factors in humanitarian migrants and Australian-born adults using large population-level datasets.

Kessler 6 scores (range 6–30) were dichotomised, and scores above 19 were defined as EPD and indicative of probable serious mental illness. Comparative 1:2 matched analysis used humanitarian migrant data from the Building a New Life in Australia and Australian-born comparators from the National Health Survey. Each humanitarian migrant was matched by age, sex and location with two Australian-born residents. Modified Poisson regression identified predictors of EPD in both groups.

EPD was higher among humanitarian migrants (17.2%, 95% CI: 15.5, 18.9) compared to Australian-born (14.5%, 95% CI: 13.3, 15.6), with an adjusted relative risk (aRR) with 95% confidence intervals (1.16%, 95% CI: 1.11, 1.21) after adjusting for key factors. In both groups, females had a higher aRR than males, with similar effect sizes: 1.06 (95% CI: 1.04, 1.08) among Australian-born and 1.04 (95% CI: 1.02, 1.07) among humanitarian migrants. The impact of age on distress was more pronounced in Australian-born individuals: compared to the 65+ age group, the youngest group (18–24 years) had an aRR of 1.36 (95% CI: 1.28, 1.43) for Australian-born and 1.19 (95% CI: 1.12, 1.27) for humanitarian migrants. Compared to excellent health, poor and fair self-rated health condition had an aRR of 2.13 (95% CI: 2.03, 2.26) and 1.69 (95% CI: 1.61, 1.79), respectively, for humanitarian migrants and 1.94 (95% CI: 1.82, 2.05) and 1.48 (95% CI: 1.43, 1.56), respectively, for Australian born. Australian-born individuals in the lowest-income quintile had higher distress (aRR: 1.11 [95% CI: 1.06–1.15]) compared to the highest-income quintile, with no significant income effect for humanitarian migrants. In both groups, females with poorer self-rated health had higher aRRs than females reporting excellent health.

Although distress prevalence was higher in the humanitarian migrants, age and sex differences followed similar patterns in both groups. Income level was a factor in Australian-born adults but not in humanitarian migrants. Clinically, this highlights the need for culturally sensitive and group-specific mental health support. From a policy perspective, the use of matching methodology from large, separate datasets offers a valuable model for generating actionable insights, supporting the development of targeted and equitable mental health programmes.

Existing evidence on the association between combined lifestyle and depressive symptoms is limited to the general population and is lacking in individuals with subthreshold depression, a high-risk group for depressive disorders. Furthermore, it remains unclear whether an overall healthy lifestyle can mitigate the association between childhood trauma (CT) and depressive symptoms, even in the general population. We aimed to explore the associations of combined lifestyle, and its interaction with CT, with depressive symptoms and their subtypes (i.e. cognitive-affective and somatic symptoms) among adults with subthreshold depression.

This dynamic cohort was initiated in Shenzhen, China in 2019, including adults aged 18–65 years with the Patient Health Questionnaire-9 (PHQ-9) score of ≥ 5 but not diagnosed with depressive disorders at baseline. CT (present or absent) was assessed with the Childhood Trauma Questionnaire-Short Form. Combined lifestyle, including no current drinking, no current smoking, regular physical exercise, optimal sleep duration and no obesity, was categorized into 0–2, 3 and 4–5 healthy lifestyles. Depressive symptoms were assessed using the PHQ-9 during follow-up. This cohort was followed every 6 months, and as of March 2023, had been followed for 3.5 years.

This study included 2298 participants (mean [SD] age, 40.3 [11.1] years; 37.7% male). After fully adjusting for confounders, compared with 0–2 healthy lifestyles, 3 (β coefficient, −0.619 [95% CI, −0.943, −0.294]) and 4–5 (β coefficient, −0.986 [95% CI, −1.302, −0.671]) healthy lifestyles were associated with milder depressive symptoms during follow-up. There exists a significant synergistic interaction between a healthy lifestyle and the absence of CT. The CT-stratified analysis showed that compared with 0–2 healthy lifestyles, 3 healthy lifestyles were associated with milder depressive symptoms in participants with CT, but not in those without CT, and 4–5 healthy lifestyles were associated with milder depressive symptoms in both participants with and without CT, with a stronger association in those with CT. The lifestyle-stratified analysis showed that CT was associated with more severe depressive symptoms in participants with 0–2 healthy lifestyles, but not in those with 3 or 4–5 healthy lifestyles. Cognitive-affective and somatic symptoms showed similar results.

In this 3.5-year longitudinal study of adults with subthreshold depression, an overall healthy lifestyle was associated with subsequent milder depressive symptoms and their subtypes, with a stronger association in adults with CT than those without CT. Moreover, an overall healthy lifestyle mitigated the association of CT with depressive symptoms and their subtypes.

The aim of the article is to undertake the first economic analysis exploring the costs of illness (COIs) and factors affecting COIs in people living with mental disorders using individual patient-level data across five countries with different national income levels. This is done by investigating diagnosis-related and sociodemographic factors for country-specific medical and psychosocial service use in these high, lower-middle and low-income countries.

Using data from the Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) study, a pragmatic randomized controlled trial, costs for medical and psychosocial services have been estimated over 6 months in 615 people with severe mental illness from Germany (n = 171), Uganda (n = 138), Tanzania (n = 110), India (n = 93) and Israel (n = 103). The primary economic analysis included (1) total COI expressed in 2021 international dollars and (2) proportional cost-type expenditures. Generalized linear regression models were also used to estimate the impact of psychiatric diagnosis, social disability, age and gender on the total COI.

Of the 615 participants (mean [SD] age 38.3 [11.2] years; 335 [54.5%] women), the total 6-month COI ranged from $311.48 [±547.47] in Tanzania to $10,493.19 [±13324.10] in Germany. High-income Germany and low-income Uganda both concentrated >70% of COIs on inpatient care. High-income Israel had the most balanced COI, with the lowest mean share (15.40%) on inpatient care, compared with community (35.12%) and primary care (33.01%). Female gender was associated with lower COI (eb = 0.215; p = 0.000) in Tanzania, while in India diagnosis of depression was associated with lower costs than schizophrenia (eb = 0.363; p = 0.017). Health of the Nation Outcome Scale scores (social disability) were not significantly associated with COIs in any country. In Tanzania, the total mean COI increased by 3.6% for every additional year of age. Compared to Germany, mean COIs were significantly lower by 90%, 99% and 86% in Uganda, Tanzania and India, respectively, and by 50% in Israel, although this difference was not significant.

National income is correlated with the total COI in people living with mental disorders but is a poor predictor of the sector-specific distribution of these expenditures.