Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear.

To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes.

Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP.

Ten RCTs (N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [−0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [−0.115, 0.504], p = 0.219), diastolic blood pressure (SMD = −0.21, 95% CI [−0.854, 0.434], p = 0.522), HDL (SMD = 0.157, 95% CI [−0.36, 0.674], p = 0.551), triglycerides (SMD = −0.041, 95% CI [−0.461, 0.38], p = 0.849), or glucose (SMD = −0.071, 95% CI [−0.213, 0.071], p = 0.326). Heterogeneity was moderate to high.

Exercise interventions did not significantly improve metabolic syndrome components in SMI. Future trials must prioritize tailored regimens, adjunctive therapies, and rigorous control of medication effects.

This study aimed to cross-compare European countries’ responsiveness to their populations’ mental health (MH) needs.

For the EU-27 countries and the United Kingdom, the 2023 Headway Initiative collected data on 15 key performance indicators (KPIs) in responsiveness in healthcare, including workforce, facilities, quality of care, and MH expenditure, and 14 KPIs in responsiveness in workplaces, schools, and society. Bivariate correlations between Headway-transformed KPI scores, which were standardised in a 1–10 Likert Scale (1: worst performance; 10: best performance), tested for putative associations.

Responsiveness in healthcare: Sweden (10), Denmark (8.8), and Finland (8.3) showed the best performance, while Romania (1.0), Slovakia (1.1), and Latvia and Bulgaria (1.2) had the poorest performance. Responsiveness in workplaces: schools, and society, Germany (10.0), France (9.1), and Denmark (9.1) were the most responsive countries, while Greece and Slovakia (1.0) had the poorest responsiveness. MH status total scores negatively correlated with global scores on responsiveness in healthcare (r = −0.34, p = .075), workplaces (r = −0.46, p = .014), schools (r = −0.59, p = .003), and society (r = −0.53, p = .003) – poorer MH status, greater responsiveness.

European countries significantly differed in their responsiveness to the populations’ MH needs, although the real effectiveness of their MH policies remains to be elucidated. Whether more responsive countries, which achieved poorer MH outcomes, successfully met greater preexisting MH needs, they failed to do so, or the relationship is driven by other third variables (e.g., quality of MH assessment) requires future investigation.

This study aimed to provide an up-to-date cross-national comparison of the European population mental health (MH) status and its determinants.

For the European Union (EU) 27 countries and the UK 6 Key Performance Indicators (KPIs) in MH status (e.g., prevalence of mental disorders) and 19 KPIs in individual (e.g., smoking), environmental (e.g., air pollution) and socioeconomic (e.g., poor housing conditions) determinants of MH were measured. KPIs scores were standardised in a 1–10 Likert Scale (1: worst performance; 10: best performance), thus allowing between-country comparisons of the relative performance. Exploratory unadjusted bivariate correlations between KPIs-transformed scores were run.

Based on the KPIs-transformed scores, Slovakia (8.3), Cyprus (7.8), and Greece (7.1) had the best MH status, while Sweden (3.1), UK (2.6), and The Netherlands (2.1) had the poorest MH status. Regarding determinants of MH Finland (8.0), Sweden, and Estonia (7.5) had the lowest MH risk, while France (3.1) and Romania (2.8) had the highest risk.

Smoking (r = −0.43, p = .021), alcohol use (r = 0.57, p = .002), daylight hours (r = 0.74, p < .001), ecoanxiety (r = −0.51, p = .005), air pollution (r = −0.46, p = .015), commuting time (r = 0.42, p = .026), and Fragile State Index (r = −0.44, p = .018) correlated with overall MH status.

Population-level MH status and its determinants varied across European countries, including “low-risk, poor MH status” and “high-risk, good MH status” countries. Further non-tested determinants of MH and/or between-country differences in responsiveness to MH needs may explain this discrepancy. These results should guide future evidence-based public MH policymaking and universal preventive strategies in Europe.

Considering the high likelihood of chronicity, it is imperative to understand the risk factors and outcomes associated with severe anorexia nervosa (AN), for which Danish registers provide a unique opportunity. We developed a measure of AN severity adapted from clinical literature for use in register-based research.

The study population included all Danish individuals born between 1963 and 2007 who were diagnosed with AN from 1969 to 2013. Using register data, we constructed the anorexia nervosa register-based severity index (AN-RSI), incorporating early or late illness onset, number of inpatient admissions and outpatient treatments, cumulative treatment length, and illness duration, each weighted based on clinical importance. Associations between AN-RSI scores, evaluated 5 years after first AN diagnosis, and mortality were estimated using survival analysis.

Among 9167 individuals diagnosed with AN, 132 died during follow-up: 17 from AN, 30 from suicide, and 85 from other causes. Higher AN-RSI scores were associated with increased rates of mortality from AN, somatic anorexia diagnosis, suicide, alcohol-related causes, and any cause. AN cases who scored in the top 20% of AN-RSI had especially high mortality rates. Furthermore, severe AN cases were also more likely to be in treatment in the next 5 years after severity was established.

AN-RSI effectively captures mortality and long-term treatment in the absence of detailed patient records and is associated with later mortality in AN patients. AN-RSI could serve as a tool to examine epidemiological and genetic risk factors associated with AN course and outcomes.

The use of artificial intelligence (AI) in psychiatry holds promise for diagnosis, therapy, and the categorization of mental disorders. At the same time, it raises significant theoretical and ethical concerns. The debate appears polarized, with proponents and critics seemingly irreconcilably opposed. On the one hand, AI is heralded as a transformative force poised to revolutionize psychiatric research and practice. On the other hand, it is depicted as a harbinger of dehumanization. To better understand this dichotomy, it is essential to identify and critically examine the underlying arguments. To what extent does the use of AI challenge the theoretical assumptions of psychiatric diagnostics? What implications does it have for patient care, and how does it influence the professional self-concept of psychiatrists?

To explore these questions, we conducted 15 semi-structured interviews with experts from psychiatry, computer science, and philosophy. The findings were analyzed using a structuring qualitative content analysis.

The analysis focuses on the significance of AI for psychiatric diagnosis and care, as well as on its implications for the identity of psychiatry. We identified different lines of argument suggesting that expert views on AI in psychiatry hinge on the types of data considered relevant and on whether core human capacities in diagnosis and treatment are viewed as replicable by AI.

The results provide a mapping of diverse perspectives, offering a basis for more detailed analysis of theoretical and ethical issues of AI in psychiatry, as well as for the adaptation of psychiatric education.

Cognitive impairment represents a central component of major depressive disorder (MDD), affecting a large proportion of people living with MDD and showing a consistent negative impact on social, interpersonal, and occupational functioning and subjective quality of life. Cognitive remediation (CR) is a training-based psychosocial intervention targeting cognitive performance and psychosocial functioning that has shown consistent evidence of effectiveness in individuals with schizophrenia and that could provide significant benefits also in people with MDD: this study aimed to assess the effects of a computerized CR intervention in adults living with MDD.

Participants recruited in this single blind multicentric randomized controlled trial were allocated to receive a computerized CR intervention delivered by an active and trained therapist or to an active control condition (computer games – CG). Outcomes were measured with validated instruments by blind assessors and included cognitive performance, depressive symptoms, and psychosocial functioning. Outcomes were assessed using mixed models for repeated measures, considering baseline and end-of-treatment scores.

Hundred and one participants (CR=52 and CG=49) were included and 81 (CR=45 and CG=36) completed the study. CR produced superior results in clinician-rated depressive symptoms (p=0.023, d=042), global clinical severity (p=0.025, d=0.39), subjective depressive symptoms (p=0.005, d=0.45), working memory performance (p=0.004, d=0.34), executive functions/cognitive flexibility (p=0.020, d=0.43), and subjective cognitive impairment (p=0.006, d=0.48).

CR represents an effective intervention in MDD, improving clinical outcomes and cognitive performance in a clinician-rated and in a subjective manner, which should be more consistently implemented in clinical practice and included in MDD treatment recommendations.

We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations – the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects – while assessing clinicians’ adherence to guidelines.

A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A–F). Additionally, a review of multiple guidelines/guidance papers was performed.

The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.

These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians’ unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.

Shared decision-making (SDM) is a collaborative process between clinicians and service users to select treatment, guided by evidence and service user preferences. SDM has clinical, economic, and ethical benefits compared to clinician-led decision-making; yet, implementation remains challenging. An important knowledge gap is the influence of culture on implementation. Cultural impacts on service user decision-making preferences have been documented, but little is known about how culture impacts clinician preferences. This study examined associations between country-level cultural characteristics and decision-making preferences of psychiatrists in routine care settings across Europe.

We analysed data from 751 psychiatrists and trainees in 38 European countries, who completed the Clinical Decision-Making Style–Staff (CDMS-S) scale. Country-level Hofstede cultural dimensions were linked to CDMS-S scores using univariate and multivariate regression models. Mixed-effects models were used to account for country-level clustering and controlling for professional and economic variables.

In univariate analyses, all six dimensions were associated with SDM preferences. However, only three remained significant in mixed-effects models. Higher levels of Indulgence and Individualism were associated with stronger preferences for SDM, while higher Power Distance was associated with more clinician-led decision-making. These associations did not remain significant in fully adjusted multivariate models, suggesting professional and systematic factors mediate cultural influences.

Indulgence, Individualism, and Power Distance are associated with psychiatrists’ decision-making preferences across Europe. Culturally sensitive SDM interventions should address not only clinician attitudes but also healthcare structures and patient expectations. Findings offer an empirical foundation for tailoring SDM training and policy to diverse cultural contexts within European psychiatry.

Antenatal depression symptom is a global health concern, but the trajectories of antenatal depression symptom vary across different studies. Additionally, the influencing factors and adverse pregnancy outcomes of antenatal depression symptom may differ across heterogeneous subtypes, which requires further exploration.

A prospective cohort study was conducted in Hubei province, China, from July 2022 to September 2023. Pregnant women (<14 weeks) were enrolled and followed up at 16, 21, 28, and 37 gestational weeks, with depressive symptom measured using the Edinburgh Postnatal Depression Scale (EPDS). Latent class growth modeling and logistic regression were used for data analysis.

Of 1034 women enrolled, 725 completed all follow-ups. Four depressive symptom trajectories were identified: no depression group (32.13%), persistent subclinical depression group (42.48%), persistent moderate depression group (19.17%), and persistent high depression group (6.21%). Risk factors of depressive symptom trajectories included low social capital, unplanned pregnancy, primiparity, mental illness history, high perceived stress, and low resilience (p < 0.05). Compared to the no depression group, gestational diabetes mellitus (GDM) risk was 1.90 times higher in the persistent moderate group and 2.59 times higher in the persistent high group; small for gestational age (SGA) risk was 2.42 times higher in the persistent moderate group and 3.98 times higher in the persistent high group.

This study identified four antenatal depressive symptom trajectories. Persistent moderate and high depression groups were linked to GDM and SGA, highlighting the importance of mental health assessments and intervention for pregnant women, especially those with higher depression severity, to prevent adverse outcomes.

Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents.

A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors.

After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045].

While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.

While risk factors for children’s internalizing and externalizing symptom trajectories have been widely studied, their association with parental depressive symptom trajectories has yet to be explored.

We used data from a prospective birth cohort of 2,542 Czech children and their parents. Children reported internalizing and externalizing symptoms at ages 11, 15, and 18 years. Parental depressive symptoms were assessed eight times from the prenatal period to the child’s age of 11 years. Latent Class Growth Mixture Modeling identified parallel trajectories of children’s symptoms. Five parental depressive symptom trajectories were adopted from previous research.

We identified four distinct classes of children’s symptom trajectories: (1) low internalizing and low externalizing (64%), (2) low internalizing and high externalizing (8%), (3) elevated internalizing and elevated externalizing (19%), and (4) high internalizing and elevated externalizing symptoms (9%). Children were more likely to experience any symptoms if their mothers had elevated depressive symptoms. High maternal and paternal depressive symptoms were associated with high internalizing and elevated externalizing symptoms in children. Constantly depressed mothers with elevated depressive symptoms in fathers had a high likelihood of any symptom trajectories in children. Other strong predictors of children’s symptom trajectories included parental relationship status (e.g., divorce), prior abortion, as well as children’s sex, urban versus rural residence, stressful life events, and self-esteem.

Parents’ and children’s mental health trajectories are interconnected. Given the strong influence of parental relationship dynamics on both parental and child mental health, interventions should prioritize mitigating relationship strains to support family well-being.