The Resilience Hub was established to coordinate mental health and psychosocial support for anyone affected by the 2017 Manchester Arena terrorist attack.

To use the Hub’s mental health screening data to examine the variation in symptoms reported by children and young persons (CYP) and their parent/guardian and explore any association with time delay in post-event registration or parental distress.

CYP engaging with Hub services were separated into eight ‘admission’ groups depending on when they registered post-incident. CYP were screened for trauma, depression, and generalised and separation anxiety. Parents/guardians also completed screening measures for their own and their child’s anxiety. Baseline and follow-up scores were compared between admission groups. Parental and CYP assessments of the CYP’s anxiety score was compared with the measure of parental distress.

Almost half of CYP registered in the first 3 months of service launch, with numbers of new registrations falling during each subsequent screening cycle. Generally, there was an increase in baseline screening scores as Hub registration time increased. The Children’s Impact of Event scale score decreased by 0.11 (95% CI: −0.17, −0.05) per month, but the score for depression increased by 0.06 (95% CI: 0.03, 0.10). Longitudinal patterns in anxiety and separation were difficult to discern. Screening scores of CYP registering later reduced at a faster rate than those of the first registrants. Higher levels of parental mental distress were correlated with increased anxiety scores assigned to the CYP in relation to the anxiety score reported by the CYP themselves.

CYP who registered earlier were less symptomatic, although those registering later did show increased improvement in their symptoms, indicating that the Hub was beneficial. Parental well-being was associated with child mental distress, indicating that shared family trauma should be considered when planning care.

3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) has shown promising safety and efficacy in phase 3 studies of post-traumatic stress disorder, but has not been investigated for a primary diagnosis of major depressive disorder (MDD).

We aimed to explore the proof of principle and safety as a first study with MDMA-AT for MDD, and to provide preliminary efficacy data.

Twelve participants (7 women, 5 men) with moderate to severe MDD received MDMA in 2 open-label sessions 1 month apart, along with psychotherapy before, during and after the MDMA sessions, between January 2023 and May 2024. The primary outcome measure was mean change in Montgomery–Asberg Depression Rating Scale (MADRS), and the secondary outcome measure was mean change in functional impairment as measured with the Sheehan Disability Scale (SDS), both from baseline to 8 weeks following the second MDMA session. We used descriptive statistics and the two-tailed Wilcoxon signed-rank test to compare baseline and outcome scores. Repeated measures were analysed by a mixed-effects model.

Baseline MADRS was 29.6 (s.d. 4.9). Feasibility was demonstrated with sufficient recruitment and retention. MADRS scores were significantly reduced post treatment compared with baseline (mean difference –19.3, s.e. 2.4, CI –14.8 to –23.8, P < 0.001). SDS scores significantly decreased from baseline (mean difference –11.7, s.e. 2.2, CI –7.5 to –15.9, P = 0.001). There were no adverse events of special interest, and no unexpected or serious adverse events.

The study met the primary objectives of safety and feasibility, and provided indications of efficacy for MDMA-AT for MDD. Further studies with a randomised design are required to confirm these findings.

EudraCT no. 2021-000805-26.

Mood disorders are among the leading causes of disease burden worldwide, with 20–70% of affected individuals experiencing comorbid premenstrual disorders. This systematic review and meta-analysis investigated the comorbidity of premenstrual dysphoric disorder (PMDD) or premenstrual syndrome (PMS) with non-reproductive mood disorders.

We aimed to determine the pooled prevalence of PMDD/PMS with adult mood disorders, assess the impact of comorbidity on clinical course and summarise the associated neurobiological findings.

Eligible studies were identified through Embase, MEDLINE and APA PsycINFO from inception to 22 January 2024 (PROSPERO, no. CRD42021246796). Studies on women (‘females‘) with diagnoses of PMDD/PMS and mood disorders were included. Risk of bias was assessed using National Institutes of Health quality assessment tools. A random-effects, pooled-prevalence meta-analysis was conducted using the Comprehensive Meta-Analysis software, categorising diagnostic sampling strategies as follows: mood disorders diagnosed first, PMDD/PMS diagnosed first or concurrent diagnoses. A narrative synthesis explored secondary outcomes, including illness course and biomarkers.

A total of 39 studies were included, with 36 of these (n = 3646) contributing to the meta-analysis. Seven studies focused on bipolar disorders, 18 on unipolar depressive disorders and 14 on mixed samples of bipolar and unipolar disorders. Random-effects pooled-prevalence meta-analyses showed consistently high comorbidity rates between PMDD/PMS and mood disorders, ranging from 42% (95% CI: 30%, 55%) to 49% (95% CI: 38%, 60%) across sampling strategies. Risk of bias varied, with methodological heterogeneity noted.

This review underscores high comorbidity rates between PMDD/PMS and mood disorders, regardless of sampling strategy, and highlights the need for research into clinical and neurobiological characteristics specific to this comorbidity. Limitations include study heterogeneity, reliance on cross-sectional designs and provisional PMDD/PMS diagnoses. Future research should address these gaps to inform diagnostic and therapeutic advancements tailored to this population.

Bipolar depression remains difficult to treat, and people often experience ongoing residual symptoms, decreased functioning and impaired quality of life. Adjunctive therapies targeting novel pathways can provide wider treatment options and improve clinical outcomes. Garcinia mangostana Linn. (mangosteen) pericarp has serotonogenic, antioxidant anti-inflammatory and neurogenic properties of relevance to the mechanisms of bipolar depression.

The current 28-week randomised, multisite, double-blind, placebo-controlled trial investigated mangosteen pericarp extract as an adjunct to treatment-as-usual for treatment of bipolar depression.

This trial was prospectively registered on the Australia New Zealand Clinical Trials Registry (no. ACTRN12616000028404). Participants aged 18 years and older with a diagnosis of bipolar I or II and with at least moderate depressive symptoms were eligible for the study. A total of 1016 participants were initially approached or volunteered for the study, of whom 712 did not progress to screening, with an additional 152 screened out. Seventy participants were randomly allocated to mangosteen and 82 to a placebo control. Fifty participants in the mangosteen and 64 participants in the placebo condition completed the treatment period and were analysed.

Results indicated limited support for the primary hypothesis of superior depression symptom reduction following 24 weeks of treatment. Although overall changes in depressive symptoms did not substantially differ between conditions over the course of the trial, we observed significantly greater improvements for the mangosteen condition at 24 weeks, compared with baseline, for mood symptoms, clinical impressions of bipolar severity and social functioning compared with controls. These differences were attenuated at week 28 post-discontinuation assessment.

Adjunctive mangosteen pericarp treatment appeared to have limited efficacy in mood and functional symptoms associated with bipolar disorder, but not with manic symptoms or quality of life, suggesting a novel therapeutic approach that should be verified by replication.

Acid attacks, a harrowing form of violence often involving intimate partners, are prevalent in South and South-East Asia and are on the rise in the global north. There are major psychosocial and mental health sequelae for survivors and their families.

This ethnographic study, set in Cambodia, aims to identify the cultural and emotional dynamics surrounding acid attacks. The objectives are to define a taxonomy of acid attacks through the identification of the patterns of attack in intimate relations, and to explore the subjective experience of the informants to elucidate the cultural context of the complex emotions of jealousy and envy.

Over 2 decades, ethnographic fieldwork was conducted with 87 survivors and their families and perpetrators in rural and urban Cambodia. Qualitative analysis was used to identify the taxa and enable a cultural understanding of the attacks.

Three taxa were identified. (a) The most prevalent pattern (n = 56) was driven by romantic jealousy, fuelled by perceived infidelity in the context of an explicit ‘love triangle’ involving a married couple and a rival. (b) The second was intimate partner violence (n = 18), for example, a possessive husband maiming his wife after she had fled the coercive control of an abusive marriage. And (c) the last involved attacks within the community (n = 13), perpetrated acts of envy and vengefulness often arising from disputes and pointing at dysfunctional conflict resolution mechanisms.

Acid attacks are a grotesque example of direct violence that leads to severe mental health consequences, including suicidal ideation. The taxa reveal, ‘inside out’, the cultural construction of the causes and consequences of attacks while demonstrating the cultural architecture of envy and romantic jealousy. This study is relevant to transcultural psychiatry and global health, with implications for culturally responsive psychiatric intervention informed by the intrapsychic, interpersonal and structural dimensions of violence.

Exposure to childhood trauma or adverse adulthood experiences (AAEs) may increase depression risk. However, the relationships between these factors and age of depression onset remain unclear.

We aimed to investigate the associations of childhood trauma and AAEs with depression risk across life stages, and their joint effects on lifetime depression risk.

A total of 118 164 participants without prior depression from UK Biobank (UKB) were included. Adverse experiences during childhood and adulthood were assessed through the online mental health questionnaire in 2016, primarily including physical neglect, physical abuse, emotional neglect, emotional abuse and sexual abuse. Cox proportional hazard regression models were used to explore the independent and joint effects of childhood trauma and AAEs on the age of depression onset.

In the multivariable-adjusted models, compared with low childhood trauma, high childhood trauma was associated with higher risk of depression occurring in early adulthood [hazard ratio 2.35, 95% CIs: 2.12–2.59] and middle adulthood (hazard ratio 1.86, 95% CIs: 1.67–2.07). Likewise, in comparison with lower levels of AAEs, higher levels were significantly associated with an elevated risk of depression during middle adulthood (hazard ratio 2.71, 95% CIs: 2.26–3.25). In joint analyses we found that, compared with individuals with low AAEs and low childhood trauma, those with low AAEs and high childhood trauma (hazard ratio 1.80, 95% CIs: 1.41–2.30) and those with high AAEs and low childhood trauma (hazard ratio 1.74, 95% CIs: 1.35–2.26) exhibited similarly significant effects on the risk of depression, suggesting that childhood trauma and AAEs had contributed equally to lifetime depression (P > 0.05).

Exposure to childhood trauma or AAEs presented a more detrimental effect on the early onset of depression compared with later stages throughout the lifespan. Our findings advise paying attention to traumatic events at any life stage, and the instigation of prompt intervention strategies following traumatic events, to minimise the risk of lifetime depression.

The quality of news reports about suicide can influence suicide rates. Although many researchers have aimed to assess the general safety of news reporting in terms of adherence to responsible media guidelines, none have focused on major US cable networks, a key source of public information in North America and beyond.

To characterise and compare suicide-related reporting by major US cable television news networks across the ideological spectrum.

We searched a news archive (Factiva) for suicide-related transcripts from ‘the big three’ US cable television news networks (CNN, Fox News and MSNBC) over an 11-year inclusion interval (2012–2022). We included and coded segments with a major focus on suicide (death, attempt and/or thoughts) for general content, putatively harmful and protective characteristics and overarching narratives. We used chi-square tests to compare these variables across networks.

We identified 612 unique suicide-related segments (CNN, 398; Fox News, 119; MSNBC, 95). Across all networks, these segments tended to focus on suicide death (72–89%) and presented stories about specific individuals (61–87%). Multiple putatively harmful characteristics were evident in segments across networks, including mention of a suicide method (42–52%) – with hanging (15–30%) and firearm use (12–20%) the most commonly mentioned – and stigmatising language (39–43%). Only 15 segments (2%) presented a story of survival.

Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines. Further engagement with networks and journalists is thus warranted.

People with opioid use disorder (OUD) have substantially higher standardised mortality rates compared with the general population. However, lack of individualised prognostic information presents challenges in personalisation of addiction treatment delivery.

To develop and validate the first prognostic models to estimate 6-month all-cause and drug-related mortality risk for people diagnosed with OUD using indicators recorded at baseline assessment in addiction services in England.

Thirteen candidate prognostic variables, including sociodemographic, injecting status and health and mental health factors, were identified from nationally linked addiction treatment, hospital admission and death records from 1 April 2013 to 1 April 2022. Multivariable Cox regression models were developed with a fractional polynomial approach for continuous variables, and missing data were addressed using multiple imputation by chained equations. Validation was undertaken using bootstrapping methods. Discrimination was assessed using Harrel’s C and D statistics alongside examination of observed-to-predicted event rates and calibration curve slopes.

Data were available for 236 064 people with OUD, with 2427 deaths due to any cause, including 1289 due to drug-related causes. Both final models demonstrated good optimism-adjusted discrimination and calibration, with all-cause and drug-related models, respectively, demonstrating Harrell’s C statistics of 0.73 (95% CI 0.71–0.75) and 0.74 (95% CI 0.72–0.76), D-statistics of 1.01 (95% CI 0.95–1.08) and 1.07 (95% CI 0.98–1.16) and calibration slopes of 1.01 (95% CI 0.95–1.08) and 1.01 (95% CI 0.94–1.10).

We developed and internally validated Roberts’ OUD mortality risk, with the first models to accurately quantify individualised absolute 6-month mortality risks in people with OUD presenting to addiction services. Independent validation is warranted to ensure these models have the optimal utility to assist wider future policy, commissioning and clinical decision-making.

Treatment guidelines recommend evidence-based psychological therapies for adults with intellectual disabilities with co-occurring anxiety or depression. No previous research has explored the effectiveness of these therapies in mainstream psychological therapy settings or outside specialist settings.

To evaluate the effectiveness of psychological therapies delivered in routine primary care settings for people with intellectual disability who are experiencing co-occurring depression or anxiety.

This study used linked electronic healthcare records of 2 048 542 adults who received a course of NHS Talking Therapies for anxiety and depression in England between 2012 and 2019 to build a retrospective, observational cohort of individuals with intellectual disability, matched 1:2 with individuals without intellectual disability. Logistic regressions were used to compare metrics of symptom improvement and deterioration used in the national programme, on the basis of depression and anxiety measures collected before and at the last attended therapy session.

The study included 6870 adults with intellectual disability and 2 041 672 adults without intellectual disability. In unadjusted analyses, symptoms improved on average for people with intellectual disability after a course of therapy, but these individuals experienced poorer outcomes compared with those without intellectual disability (reliable improvement 60.2% for people with intellectual disability v. 69.2% for people without intellectual disability, odds ratio 0.66, 95% CI 0.63–0.70; reliable deterioration 10.3% for people with intellectual disability v. 5.7% for those without intellectual disability, odds ratio 1.89, 95% CI 1.75–2.04). After propensity score matching, some differences were attenuated (reliable improvement, adjusted odds ratio 0.97, 95% CI 1.91–1.04), but some outcomes remained poorer for people with intellectual disability (reliable deterioration, adjusted odds ratio 1.28, 95% CI 1.16–1.42).

Evidence-based psychological therapies may be effective for adults with intellectual disability, but their outcomes may be similar to (for improvement and recovery) or poorer than (for deterioration) those for adults without intellectual disability. Future work should investigate the impact of adaptations of therapies for those with intellectual disability to make such interventions more effective and accessible for this population.

Patients with schizophrenia have a significantly elevated risk of mortality. Clozapine is effective for treatment-resistant schizophrenia, but its use is limited by side-effects. Understanding its association with mortality risk is crucial.

To investigate the associations of clozapine with all-cause and cause-specific mortality risk in schizophrenia patients.

In this 18-year population-based cohort study, we retrieved electronic health records of schizophrenia patients from all public hospitals in Hong Kong. Clozapine users (ClozUs) comprised schizophrenia patients who initiated clozapine treatment between 2003 and 2012, with the index date set at clozapine initiation. Comparators were non-clozapine antipsychotic users (Non-ClozUs) with the same diagnosis who had never received a clozapine prescription. They were 1:2 propensity score matched with demographic characteristics and physical and psychiatric comorbidities. ClozUs were further defined according to continuation of clozapine use and co-prescription of other antipsychotics (polypharmacy). Accelerated failure time (AFT) models were used to estimate the risk of all-cause and cause-specific mortality (i.e. suicide, cardiovascular disease, infection and cancer).

This study included 9,456 individuals (mean (s.d.) age at the index date: 39.13 (12.92) years; 50.73% females; median (interquartile range) follow-up time: 12.37 (9.78–15.22) years), with 2020 continuous ClozUs, 1132 discontinuous ClozUs, 4326 continuous non-ClozUs and 1978 discontinuous Non-ClozUs. Results from adjusted AFT models showed that continuous ClozUs had a lower risk of suicide mortality (acceleration factor 3.01; 99% CI: 1.41–6.44) compared with continuous Non-ClozUs. Continuous ClozUs with co-prescription of other antipsychotics exhibited lower risks of suicide mortality (acceleration factor 3.67; 1.41–9.60) and all-cause mortality (acceleration factor 1.42; 1.07–1.88) compared with continuous Non-ClozUs. No associations were found between clozapine and other cause-specific mortalities.

These results add to the existing evidence on the effectiveness of clozapine, particularly its anti-suicide effects, and emphasise the need for continuous clozapine use for suitable patients and the possible benefit of clozapine polypharmacy.