Improving media adherence to World Health Organization (WHO) guidelines is crucial for preventing suicidal behaviors in the general population. However, there is currently no valid, rapid, and effective method to evaluate the adherence to these guidelines.

This comparative effectiveness study (January–August 2024) evaluated the ability of two artificial intelligence (AI) models (Claude Opus 3 and GPT-4O) to assess the adherence of media reports to WHO suicide-reporting guidelines. A total of 120 suicide-related articles (40 in English, 40 in Hebrew, and 40 in French) published within the past 5 years were sourced from prominent newspapers. Six trained human raters (two per language) independently evaluated articles based on a WHO guideline-based questionnaire addressing aspects, such as prominence, sensationalism, and prevention. The same articles were also processed using AI models. Intraclass correlation coefficients (ICCs) and Spearman correlations were calculated to assess agreement between human raters and AI models.

Overall adherence to WHO guidelines was ~50% across all languages. Both AI models demonstrated strong agreement with human raters, with GPT-4O showing the highest agreement (ICC = 0.793 [0.702; 0.855]). The combined evaluations of GPT-4O and Claude Opus 3 yielded the highest reliability (ICC = 0.812 [0.731; 0.869]).

AI models can replicate human judgment in evaluating media adherence to WHO guidelines. However, they have limitations and should be used alongside human oversight. These findings may suggest that AI tools have the potential to enhance and promote responsible reporting practices among journalists and, thus, may support suicide prevention efforts globally.

Psychotic disorders are frequently preceded by depressive disorders, and it has been hypothesized that treatment of depression in youth may reduce risk for later psychosis. Using quasi-experimental methods, we estimated the causal relationship between the treatment of adolescent depression with selective serotonin reuptake inhibitors (SSRIs) and the risk of later psychosis.

We used data linkage from multiple national Finnish registries for all individuals (n = 697,289) born between 1987 and 1997 to identify depression diagnosed before age 18, cumulative SSRI treatment within three years of diagnosis, and diagnoses of non-affective psychotic disorders by end of follow-up (age 20–29). We used instrumental variable analyses, exploiting variability in prescribing across hospital districts to estimate causal effects. Analyses were conducted using two-stage least squares modelling. Sensitivity analyses examined effects stratified by confounders and effects of specific SSRIs.

Our final sample included 22,666 individuals diagnosed with depression in adolescence, of whom 60.2% (n = 13,650) had used SSRIs. 10.7% of adolescents with depression went on to be diagnosed with a non-affective psychotic disorder. SSRI treatment for adolescent depression was not associated with a reduced risk of developing a psychotic disorder (one-year β = 0.04,CI:−0.01 to 0.09; two-years β = 0.02,CI:−0.06 to 0.09; three-years β = −0.02,CI:−0.08 to 0.05).

Our quasi-experimental investigation does not support the hypothesis that treatment of adolescent depression reduces the subsequent risk of psychosis. Our findings question the assumption that treatment of common mental health disorders in youth may impact the risk of developing severe mental illnesses in adulthood.

The focus of suicide research changes from traditional risk factors to acute warning signs. Patient self-reported suicidal ideation (SI) is not a reliable measure of acute suicide risk. Presuicidal syndromes such as suicide crisis syndrome (SCS) attempt to describe measurable syndromes based on warning signs other than SI.

Seven hundred and ten acutely admitted patients were included in the study. Identification of symptoms describing the five components of SCS was done by performing a retrospective text analysis of the patient records (electronic medical records). Patients were grouped according to high or low level of SCS symptoms. We performed statistical tests for group differences in demographics, traditional risk factors, and clinical variables, including agitation assessed by the Positive and Negative Symptom Scale-Excited Component (PANSS-EC).

Seventy-two patients had high levels of SCS symptoms. They reported less SI the last month before admission; suicidality was less relevant for referral, the intake suicide assessment more often concluded with high suicide risk, they were more often referred and admitted involuntarily, and they had higher total scores on PANSS-EC.

The individual SCS symptoms may provide useful information in the evaluation of acute suicide risk at intake. A high level of SCS symptoms suggests more severe conditions. The lower reports among high-level than low-level SCS patients of self-reported SI last month before admission, shows the limitation of using SI as a warning sign. The association between the level of SCS symptoms and PANSS-EC total score suggests that agitation could give valuable additional information for suicide risk assessments.

Difficult-to-treat depression (DTD) is a common clinical challenge for major depressive disorder and bipolar disorders. Electro convulsive therapy (ECT) has proven to be one of the most effective treatments for this condition. Although several studies have investigated individually the clinical factors associated with the DTD response, the role of their interplay in the clinical response to ECT remains unknown. In the present study, we aimed to characterize the network of symptoms in DTD, evaluate the effects of ECT on the interrelationship of depressive symptoms, and identify the network characteristics that could predict the clinical response.

A network analysis of clinical and demographic data from 154 patients with DTD was performed to compare longitudinally the patterns of relationships among depressive symptoms after ECT treatment. Furthermore, we estimated the network structure at baseline associated with a greater clinical improvement (≥80% reduction at Montgomery–Åsberg Depression Rating Scale total score).

ECT modulated the network of depressive symptoms, with increased strength of the global network (p = 0.03, Cohen’s d = −0.98, 95% confidence interval = [−1.07, −0.88]). The strength of the edges between somatic symptoms (appetite and sleep) and cognitive-emotional symptoms (tension, lassitude, and pessimistic thoughts) was also increased. A stronger negative relationship between insomnia and pessimistic thoughts was associated with a greater improvement after ECT. Concentration difficulties and apparent sadness showed the greatest centrality.

In conclusion, ECT treatment may affect not only the severity of the symptoms but also their relationship; this may contribute to the response in DTD.

Individuals who die by suicide tend to share more characteristics with those who attempt suicide using violent methods than with those who employ nonviolent means. To date, limited research has been published on the demographic characteristics of individuals who engage in violent suicide attempts.

This study aimed to examine trends in the characteristics of violent suicidal behavior in comparison to nonviolent suicidal behavior.

Patients included in the study were consecutively admitted between 2016 and 2021 to the Dr. Manninger Jenő National Trauma Center and the Psychiatric and Toxicology Wards of Péterfy Sándor Hospital in Budapest, Hungary, for medical treatment following violent or nonviolent suicide attempts. Differences in demographic characteristics, risk factors associated with violent suicidal behavior, and methods of attempt were analyzed using Chi-square tests and logistic regression models.

A total of 298 inpatients (46.1% male, 53.9% female), aged between 18 and 65 – representing the economically active population – were included in the study. The sample comprised 145 individuals who attempted suicide using nonviolent methods (73% female, 27% male) and 153 who used violent methods (64.7% male, 35.3% female). Of the total sample, 22 individuals (12.1%) died during treatment due to severe medical complications. Among male attempters, the highest proportion fell within the economically active age range of 18–55 years, whereas among female attempters, the 18–35 age group represented the highest proportion. The most common violent methods, in descending order of frequency, were stabbing (49.7%), jumping from a height (29.8%), and jumping in front of a train (7.7%). The most frequently diagnosed psychiatric disorders among the sample were major depressive disorder (42.2%), anxiety disorders (44.9%), and bipolar disorder (12%). The leading reported motives for violent suicide attempts, in decreasing order of frequency, were marital conflict (32.4%), divorce/separation/break-up (30.2%), and severe or chronic somatic illnesses (12%). When comparing the two subgroups, the strongest risk factors associated with violent suicide methods included male gender, older age, and residence in the capital city.

Previous studies suggest that risk factors are largely indistinguishable between individuals who engage in violent versus nonviolent suicide attempts. However, individuals who attempted suicide using violent methods exhibited characteristics more closely aligned with those who died by suicide than with the remainder of the sample. The majority of data in this study were collected during the COVID-19 pandemic – a period marked by multiple overlapping crises – which may have played a disproportionately large role in the emergence of suicide risk.

Childhood maltreatment (CM) is a risk factor for mental and physical health problems in adulthood, potentially mediated by long-term autonomic nervous system (ANS) dysregulation. To explore this link, the association between CM and vagal-sensitive heart rate variability (HRV) metrics in adults was examined, accounting for biopsychosocial factors.

Data from 4,420 participants in the Study of Health in Pomerania were analyzed, with CM assessed using the Childhood Trauma Questionnaire. HRV was derived from 10-second electrocardiograms and 5-minute pre-sleep polysomnographic recordings. Post hoc analyses examined abuse and neglect.

CM was associated with reduced HRV (logRMSSD: β = −0.20 [95%-CI: −0.28, −0.12], p = 1.2e−06), driven by neglect (β = −0.27 [−0.35, −0.18], p = 1.9e−09) rather than abuse (β = 0.01 [−0.12, 0.14], p = 1). Adjustments for age, sex, and medication attenuated these effects, which remained robust after additionally controlling for socioeconomic, lifestyle, body mass index, and depressive symptoms (fully adjusted model: CM β = −0.08 [−0.15, −0.001], p = .047; neglect β = −0.11 [−0.19, −0.03], p = .009; abuse β = −0.08 [−0.20, −0.04], p = .174). Age-related differences were found, with reduced HRV in both young and older participants but not in middle-aged participants (fully adjusted: F(2,743) = 6.75, p = .001).

This study highlights long-term ANS dysregulation following CM, particularly neglect, indicated by altered vagal-sensitive HRV metrics. Although small in magnitude, the effect on the ANS was independent of adult biopsychosocial factors. This long-term dysregulation may contribute to an increased risk of adverse health outcomes in adulthood.

Violence and suicidality are common in forensic inpatients, most commonly with schizophrenia (SZ), personality disorder (PD), or comorbid SZ and PD (dual diagnosis, DD). There are no biological markers used in risk assessment tools. Lipids may provide a useful biomarker to aid violence prediction, but the roles of diagnosis and sex remain unclear. We therefore investigated lipids in adult forensic inpatients in association with the risk of violence and suicidality by primary diagnosis and sex.

Anonymized data were obtained for all eligible inpatients [n = 230; 114 SZ (75 males), 77 PD (40 males), 39 DD (20 males)] who had been admitted (2002–2021) to Elysium Healthcare (UK-wide) medium/low-secure facilities on lipids, age, sex, diagnosis, medication, risk of violence and suicidality, as well as days in seclusion and on high observations due to violence.

Mean total cholesterol (TC) in the patient sample (4.57, s.d. = 1.09) was lower, relative to the age- and sex-corrected UK population norm (4.91 mmol/l). PD (4.46 ± 1.08 mmol/l) and DD (4.24 ± 0.82 mmol/l), compared to SZ patients (4.77 ± 1.14 mmol/l), had significantly lower TC (not explained by statin use; no effect or interaction involving sex). Lower TC had significant though small associations with more days in seclusion or high observation levels due to violence across all patients, and marginally with suicidality in females.

A low TC-violence (towards others) link exists not only for SZ but also for PD and DD and for males and females, encouraging further enquiry into lipids as a biomarker to aid violence prediction in secure care.

Psychotherapy plays a crucial role in mental healthcare. Integrating evidence-based practices into treatment guidelines highlights the need for basic psychotherapy competence in psychiatry training. While programs set minimum requirements for psychotherapy training in line with the recommendations of the World Psychiatric Association or accreditation bodies like the European Union of Medical Specialists, implementation is often inconsistent, and resources are limited. This systematic review explores early career psychiatrists’ (ECPs) views, interests, and available opportunities for psychotherapy training worldwide.

We systematically searched MEDLINE, Scopus, and PubPsych for survey-based studies on ECPs’ perspectives on psychotherapy training, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 31,281 studies screened, 48 articles were included. Quality assessment was conducted using the Quality Assessment Checklist for Survey Studies on Psychology, and the findings were summarized through narrative synthesis.

Included studies were from Europe (24, 50%), United States (12, 25%), Western Pacific (6, 12.5%), South-East Asia (4, 8.3%), Eastern Mediterranean (1, 2%), and Africa (1, 2%), with a total of 7,196 participants. Thirty-one studies on ECPs’ interest in psychotherapy training found that 57–80% were interested in psychotherapy, 67–92% viewed being a psychotherapist as part of their psychiatrist identity, and 88–97.7% supported its inclusion in psychiatry training. Training opportunities varied by country and institution, with cognitive behavioral therapy and psychodynamic psychotherapy being primary modalities.

Improving psychiatrists’ access to evidence-based, culturally adapted psychotherapy training is essential. Educational activities offered by training institutions and professional organizations can play a key role in supporting ongoing professional development.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood, significantly impacting daily functioning and quality of life. Sex differences influence ADHD presentation, with females experiencing delayed diagnosis and distinct patterns of severity and comorbidities. Exploring these differences is essential for improving diagnostic accuracy and developing tailored interventions. This study examines ADHD severity, psychiatric comorbidities, and functional impairment by ADHD subtype and sex.

This population-based study included 900 adults diagnosed with ADHD. ADHD severity, comorbidities, and functional outcomes were assessed using validated tools. Bivariate analyses and General Linear Models (GLMs) were applied to examine sex- and subtype-specific effects and their interactions.

Females exhibited greater ADHD severity (p < 0.001), higher levels of depression (p = 0.003) and anxiety (p < 0.001), lower substance use (p < 0.001), poorer functioning (p = 0.039), and greater disability (p = 0.001) than males. No significant sex differences were found in ADHD subtype distribution or age of symptom onset; however, females were diagnosed with ADHD later than males (p < 0.001). The combined ADHD subtype was associated with greater clinical severity, higher levels of depression, anxiety, and impulsive symptoms, increased substance use, and greater disability. A significant interaction between sex and subtype was observed only for disability, with females in the combined subtype exhibiting the most pronounced impairment.

ADHD presents differently across sexes and subtypes, with specific interactions influencing disability. These findings emphasize the importance of considering sex and ADHD subtype independently to enhance diagnostic accuracy and develop targeted treatment strategies.

Decisional capacity is an important requirement for assisted suicide, which has been legalized in an increasing number of countries. While several instruments have been developed over the past few decades to assess the capacity to consent to treatment, little is known about their applicability to assessing capacity in the context of requests for assisted suicide.

Systematic review of instruments assessing decisional capacity published up to March 2024. Data concerning criteria for determining decisional capacity, psychometric properties, and other aspects were extracted from all instruments included. Selected instruments were analyzed regarding their applicability to requests for assisted suicide.

We identified 23 instruments assessing the capacity to consent to treatment. There is considerable heterogeneity regarding the criteria utilized for assessing decisional capacity and their operationalization. Next to more cognitive abilities, some instruments directly incorporated emotions and values. Five instruments were assessed for applicability to requests for assisted suicide. The framing of decisional capacity within the context of disease and treatment options frequently limits the application of instruments to assess decisional capacity in the context of requests for assisted suicide.

No instrument could be identified that could be applied to assessing decisional capacity in the context of requests for assisted suicide without any limitations or without necessitating adjustments. Further normative and empirical work is required for developing an instrument that could be applicable in this context.

Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.

This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.

Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.

This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.

Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS).

Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored.

There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012].

Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI.

Loneliness is a global public health concern. Investigating loneliness in the general population offers a greater generalizability across various levels of health-related impairments, the identification of at-risk individuals, the detection of different loneliness severity levels, and broader insights into social determinants. Previous studies have shown that loneliness might be a transient or chronic experience, depending on how consistently it is reported across at least two timepoints. This study aimed to assess differential associations of chronic and transient with various domains of psychopathology.

Participants were enrolled from the general population and assessed at two timepoints spanning 6–7 months. Depressive symptoms, generalized anxiety, social anxiety, and paranoid thoughts were measured using self-reports. The data were analyzed using binary logistic regressions.

Altogether, 3,275 participants completed both assessments with a retention rate of 64.2%. Chronic loneliness was associated with higher baseline and follow-up scores across all symptom domains. The strongest association was observed for social anxiety. Transient loneliness was not robustly associated with symptom scores. It was not significantly associated with depressive symptoms (at either of timepoints) and paranoid ideation (at baseline). The strongest association was observed for generalized anxiety. Chronic loneliness, compared to transient loneliness, was associated with significantly higher odds of social anxiety, depressive symptoms, and paranoid ideation, but not generalized anxiety.

Both transient and chronic loneliness are associated with mental health outcomes, with the latter one showing generally stronger associations. Risk stratification and early intervention among individuals experiencing loneliness might be needed to prevent the development of more severe psychopathology.

Cognitive deficits and immune system dysregulation are core features of psychotic disorders. Among inflammatory markers, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) have been linked to both psychosis pathophysiology and related cognitive impairments.

We investigated associations among IL-6, TNF-α, and neurocognitive performance in 107 participants: individuals at clinical high risk for psychosis (CHR-P, n = 35), first-episode psychosis (FEP, n = 39), and healthy controls (HC, n = 33). Assessments included memory, processing speed, executive function, and social cognition. Cytokines were measured from fasting serum samples. Analyses included ANOVA, correlations, and multivariate regressions controlling for age, sex, IQ, group, and symptom severity.

TNF-α levels were significantly elevated in FEP compared to CHR-P (p = 0.0251); IL-6 differences were non-significant. FEP showed poorer performance in multiple cognitive domains, especially social cognition. CHR-P individuals exhibited intermediate profiles between FEP and HC in cognition. In adjusted regression models, IL-6 was significantly associated with undermentalization on the MASC task (β = 0.28, p = 0.0337) and showed a trend-level association with slower processing speed (β = 0.98, p = 0.075). TNF-α levels predicted poorer facial emotion recognition (β = −1.37, p = 0.0022). IQ and group were significant covariates in most models.

Our findings suggest that peripheral inflammation, particularly IL-6 and TNF-α, may selectively impact social cognitive functioning in early psychosis. Though modest, these associations highlight potential inflammatory contributions to functional impairment and support further investigation of immunological targets in early intervention.

The large-scale Russian invasion of Ukraine in early 2022 resulted in a humanitarian crisis with hundreds of thousands of children exposed to traumatic events. To date, trauma-focused evidence-based treatments (EBTs) for children and youth have not been systematically evaluated and implemented in Ukraine. This study aims at evaluating 1) the feasibility of a training program for Ukrainian therapists on Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and 2) the feasibility and effectiveness of the treatment for children, youth, and their families in and from Ukraine during the ongoing war.

The project “TF-CBT Ukraine” was implemented between March 2022 and May 2024, in close collaboration with local and international partners. Therapists completed questionnaires before/after the training, and patients were asked to complete a measure on PTSD before and after treatment.

Altogether 138 therapists started the training program and 44.9% were certified as TF-CBT therapists. The program completers reported overall high satisfaction with the training program, a positive change in their attitude towards EBTs and trauma-related knowledge gain. The patients (age 3–21, 37% male) reported significant improvement in symptoms of PTSD at the end of treatment with large pre-post effect sizes for DSM-5 PTSD (dselfreport = 2.36; dcaregiverreport = 2.27), ICD-11 PTSD (dselfreport = 1.97; dcaregiverreport = 1.77), ICD-11 CPTSD (dselfreport = 2.04; dcaregiverreport = 1.99), and DSM-5 pre-school PTSD (dcaregiverreport = 3.14).

The results of this study are promising in regard to the general implementation of trauma-focused EBTs in active conflict areas. Future studies need to replicate these findings in a randomized controlled study design.

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.