Local protein synthesis at the synapse is a key determinant of learning and memory and is predicted to be severely disrupted in Alzheimer's disease (AD). Omics approaches have played a key role in deciphering molecular mechanisms underlying AD pathology. However, isolating the transcriptome may be biased due to inherent variations in transcript levels, or by transcription-on-demand models employed by several genes, whereas mass-spec based proteomics approaches fail to capture low abundance peptides. The translatome bypasses these inherent limitations of other omics methods by capturing actively translating mRNA species trapped inside ribosomes and subjecting them to unbiased RNA-seq analysis capturing even very low abundance transcripts.

Isolating the neuronal ribosomes from human post-mortem brains without interference from non-neuronal cells remains a challenge. We used frozen brain tissue from Alzheimer's patients and healthy controls obtained from the Cambridge Brain Biobank. Synaptoneurosomal fractions were prepared using sucrose gradients in non-denaturing buffers with RNAse inhibitors to preserve ribosomal composition and trapped mRNA. We isolated functional ribosomes on affinity columns following recombinant RNAse digestion. Finally, actively translating ribosome-trapped mRNAs were sequenced using RNA-seq, aligned to human genome using STAR alignment and analysed for differential expression using DeSeq2 followed by pathway analysis.

We have successfully isolated ribosome-associated RNA transcripts in the dendritic spines from cortical neurons of postmortem Alzheimer's brains with little interference from glial and non-neuronal material. The novel AD translatome disruptions identified by isolating endogenous ribosome bound mRNA will help detect downstream molecular targets. We will also integrate targeted translatome data with published transcriptome and GWAS DNA variant data to identify novel biomarkers.

This is the first successful isolation of the dendritic translatome from human postmortem AD brains. Future studies will verify functional significance of key targets using gain- and loss-of-function studies in animal models of AD and human iPSCs.

• • Identify themes in experience of Postpartum Psychosis (PP) recovery in Mother and Baby Units (MBUs) from the perspective of mothers, partners and MBU professionals.

• • Develop a Conceptual Framework of recovery from PP in the MBU setting.

Systematic review using published and unpublished literature identified through database searches and grey literature sources. A narrative synthesis approach was taken and used to form a Conceptual Framework of recovery from PP in the MBU setting.

Four databases were searched, yielding 8 includable studies. A further 3 grey literature sources met the inclusion criteria. Most of the sources focussed on the womens' experience of recovery.

Stakeholders experienced MBUs as providing a positive therapeutic milieu for recovery. The broad themes identified for improvement encompassed: knowledge of PP, accessibility of services and discharge practises.

This review provides valuable insights into the experience of recovery from PP within UK MBUs from the perspectives of multiple stakeholders. Areas for improvement identified include antenatal education on PP, knowledge of PP amongst non-specialist healthcare professionals, partner involvement in care, and discharge processes.

The outcomes of this review have the potential to shape the design, implementation, and expansion of MBUs and their practices both nationally and internationally.

To systematically review current quantitative evidence for psychological and behavioural outcomes for children with drug-resistant epilepsy being treated with either the ketogenic diet (KD) or vagal nerve stimulation (VNS).

The review was conducted with a systematic review methodology and the Preferred Reporting Items for Systematic Reviews (PRISMA) tool. The methodology was developed by the author using the PICOS (population, intervention, comparison, outcome, study, design) framework.

Eligibility criteria included children up to 18 years old with epilepsy treated with KD or VNS, and studies which assessed psychological and behavioural outcomes, with validated tools, before and after treatment. Any quantitative design was included. Review articles, meta-analyses, case studies, and case series without a reported mean were excluded. Searches were conducted in four main databases (GlobalHealth, Medline, PsychInfo, Embase) and two grey literature databases (Scopus, Web of Science).

Duplicates were screened using automated processes and then manually. Titles and abstracts were reviewed against eligibility criteria, followed by full texts. Risk of bias was assessed using tools appropriate for the study (the Risk of Bias-2 tool for randomised controlled trials, the JBI checklist for quasi-experimental studies, and the JBI checklist for case series). Included articles were grouped by intervention and by study design for data extraction.

22 studies were identified: 11 for KD, comprising of two randomised controlled trials, one retrospective quasi-experimental study, one retrospective study, two prospective studies, one cross-sectional survey, and four case series; and 11 for VNS, comprising of one randomised controlled trial, two longitudinal observational studies, one prospective observational study, one retrospective study, and six case series.

These studies included a total of 655 participants (523 KD, 132 VNS). There was weak evidence for an improvement in cognitive and behavioural outcomes with both KD and VNS although most studies had methodological weaknesses and were at risk of bias. For both interventions, some studies showed that improvements in outcomes were not related to improvement in seizures, or to reduction in medications.

The evidence base for cognitive and behavioural outcomes following KD or VNS treatment is limited and studies are generally weak and underpowered. Psychological measures used across studies are heterogeneous and difficult to compare. There are little data, but studies raise the possibility that both VNS and KD may affect psychological and behavioural outcomes independently of their effect on seizures. This review supports the need for further research into this area with larger, methodologically robust studies.

This systematic review aimed to quantify the prevalence of substance use among female sex workers (FSWs) in low- and middle-income countries (LMICs).

Design: The review protocol was registered with PROSPERO (CRD42021242048). We searched Ovid, PubMed and Web of Science databases for peer-reviewed, quantitative studies from inception to 6th March 2023. Study designs included: cross-sectional, case–control, cohort study, case series analysis, or experimental studies. Study quality was assessed using the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool.

Setting: FSWs in LMICs.

Participants/Inclusion criteria: any measure of prevalence or incidence of substance use (not alcohol or tobacco) among FSWs aged 18+ years.

Measurements: A narrative synthesis was conducted across all studies meeting the inclusion criteria. Pooled prevalence estimates for ‘ever’ and ‘recent’ drug use were calculated using a random effects model.

3135 papers were identified; 161 papers reporting on 102 studies with 167,333 FSWs from 39 LMICs met the inclusion criteria. 26 studies scored high, 61 scored moderate, and 15 scored in the lower quality range. Only 4/102 studies used a validated measurement tool to assess levels of substance use dependence. The mean age of study participants was 28.9 years (SD 7.7). The pooled prevalence for recent (past month to past year) substance use among FSWs in LMICs is: illicit drug use 29% (95% CI: 14–34%), cannabis 20% (95% CI: 8–30%), cocaine 21% (95% CI: 9–32%), amphetamine type stimulants 19% (95% CI: 12–26%), opioids 8% (95% CI: 4–12%), sedatives and sleeping pills 6% (95% CI: 0–12%), inhalants 4% (95% CI: –4–12%), hallucinogens 0% (95% CI: 0–0%), and recent drug use during sex work 42% (95% CI: 15%–68%). Only 5/102 studies reported a substance use intervention. Key study limitations include the lack of a validated measurement tool by most studies (96%) meaning it was not possible to distinguish between any drug use vs. harmful drug use. The criminalisation of drug use may have led to under-reporting and an underestimate of true substance use prevalences.

FSWs in LMICs report a high prevalence of recent drug use – including during sex work – with cannabis, cocaine and amphetamine type stimulants the most commonly used. There is an urgent need for effective low-cost substance use interventions. Future studies should use validated substance-use measurement tools to assess the burden of substance use disorders.

The aim of this systematic review is to identify and describe the experiences, barriers and provision of post-diagnostic support in UK rural areas; from the perspective of people living with dementia, healthcare professionals and informal family caregivers.

People living with dementia in rural areas experience numerous barriers to accessing post-diagnostic support.

Systematic Review.

Systematic searches will be conducted in the following databases; SCOPUS, PubMed, PsychINFO and CINAHL Plus. Systematic review tool Rayyan.ai will be used to screen titles and abstracts, prior to full-text review. Following data extraction, The Critical Appraisal Skills Programme (CASP) tool will be used to appraise the quality of studies and assess risk of bias. The data will be deductively analysed through the lens of the Candidacy Framework's 6 dimensions, with a secondary inductive analysis capturing any themes that fall outside of the framework.

242 papers have been screened by first and second reviewer. 15 papers included. Papers still being analysed for full review. Will be complete by March 2024.

This systematic review will help improve understanding of the rural barriers and experiences of post-diagnostic support, and allow researchers and stakeholders to develop and optimise specially tailored dementia interventions in line with the needs of people residing in UK rural communities.

First reviewer: Danielle Bilkey, Second Reviewer: Dr Ellena Businge, Supervisor: Dr Nicolas Farina.

1. 1. To study the neural correlates of OCD using functional MRI.

2. 2. To compare the neural correlates of the pure washer dimension of OCD with other dimensions of OCD and healthy controls.

It was a cross-sectional, case-control study conducted from 2018 to 2021. OCD patients were recruited with purposive sampling from outpatient attendance at All India Institute of Medical Sciences, New Delhi following the inclusion and exclusion criteria. The patients were divided into two groups i.e. washing sub-type and non-washing/other sub-type based on dimensional YBOCS score. The healthy control group consisted of age and sex-matched healthy individuals. Each group had 10 individuals. The participants underwent functional MRI with resting fMRI and activation task-based MRI. Activation tasks included a cognitive task i.e. Stroop test and an affective task which included trigger words for OCD tailored according to the patient's triggers for OCD.

The results were studied for significance within a group and also compared among the three groups and between OCD patients and healthy controls as well.

In OCD-specific task using trigger words, the right frontal gyrus, right medial frontal gyrus, and left cingulate gyrus showed hyperactivation in the washer OCD subtype group. After correction for family-wise error, p-FWE (<0.05) corrected < 0.05, there was so significant result. The non-washing subtype had no significant areas of activity on the OCD specific task.

But the combined OCD patient group (compared with controls), had hypoactivation of the right inferior frontal gyrus and fusiform gyrus at p-unc (<0.001) in the OCD task.

In the Incongruent part of the Stroop task, the non-washer subtype had hypoactivation of the right caudate body compared with healthy controls at p-FWE (<0.05).

In the congruent Stroop task, washer OCD subtype, the right insula was found to be hyperactive at p-FWE (<0.05).

Previous studies comparing activation on cognitive tasks in OCD patients and healthy controls have revealed differences in CSTC circuits as well as cerebellum and parietal areas. The washing symptom dimension is associated with insular hyperactivity in both emotional and cognitive tasks. It is associated with stimuli related to disgust. The role of the insula is being researched in functions like attention and response inhibition. Our study, with all its limitations, could replicate the insular findings in washing-subtype of OCD. With a better sample size, we may be able to explore further the findings that have not attained levels of significance in our study.

Breast cancer is major cause of mortality in females, affecting 2.1m women annually. Annual mortality rates are double within south Asian women compared with high-income countries. Pakistan has very high rates of breast cancer. Co-morbid depression and anxiety is reported in more than one third of breast cancer survivors and predict higher recurrence and poorer survival.

Objective:

To evaluate the clinical effectiveness of Moving on After Breast Cancer Plus Cognitive Behaviour Therapy (Moving on ABC Plus) to reduce depression and anxiety in breast cancer survivors in Pakistan.

A mixed method randomized controlled trial with 354 survivors of breast cancer recruited from the in- and out-patient services of oncology departments both from public and private hospitals of 5 major cities in Pakistan.

Individuals scoring 10 or higher on either the Patient Health Questionnaire-9 (PHQ-9) or the Generalized Anxiety Disorder scale (GAD-7) were enrolled. All participants underwent assessments using the PHQ-9, GAD-7, Functional Assessment of Cancer Therapy—Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale at the baseline and were randomly assigned to one of two trial groups: Moving on ABC plus or routine care. Those in the intervention group received 12 individual sessions of Moving on ABC plus, facilitated by trained master-level psychologists over 4 months. Follow-up assessments were conducted at 3- and 6-months after randomization. Individuals in routine care group continued their standard care. Qualitative interviews were conducted with 15 participants from the intervention group upon completion of the intervention.

The trial established the effectiveness of the integrated intervention, at 6-month follow up preserving 96% of retention. Intervention group reported a significantly higher reduction in depression, anxiety and intrusive thoughts, and improvement in health-related quality of life and self-esteem compared with routine care arm at end of the intervention. They endorsed the usefulness of intervention during qualitative interviews with improvement in psychological well-being, social support network, and interpersonal relationships. Fatigue was reported as a potential barrier to participating in the intervention.

Results of this trial are in favour of psychological intervention; therefore, such programs should be implemented as part of routine care to reduce psychological distress and improve quality of life of this vulnerable population.

First Episode Psychosis (FEP) emerges at a young age, significantly shaping the trajectory of the disorder. Literature indicates a 60% increased risk of suicide within the initial year of diagnosis in FEP, early intervention in psychosis reduces the risk of suicide. Therefore, this study aims to co-adapt an existing culturally appropriate suicide prevention intervention (CMAP) and integrate this with a culturally adapted Cognitive Behavioral Therapy for Psychosis (CaCBTp) for individuals with FEP experiencing suicidal ideation and to test its feasibility and acceptability in Pakistan.

This is a mixed-method study that involves two stages. Stage 1 was co-adaptation of the CMAP intervention for people with FEP patients. This involved one-to-one, in-depth interviews with individuals with FEP (n = 5), carers (n = 5) and a focus group discussion with 10 healthcare professionals. The second stage involves feasibility testing of the intervention. Participants are being recruited (n = 90) from outpatient psychiatric units across the cities of Karachi, Lahore, Rawalpindi, Multan, and Hyderabad in Pakistan. Eligible, consented participants are being randomized into either of two trial arms; intervention arm or treatment as usual arm (TAU). All participants are being assessed at baseline and at 3-month post-randomization on assessing participants on severity of suicidal ideation, severity of symptoms, functionality and quality of life using different scales. The intervention is comprised of 12 one-to-one sessions delivered over 3 months by trained therapists. Participants (n = 15) from the intervention arm will be interviewed at the end of intervention to explore the acceptance.

Qualitative analysis of stage 1, utilizing thematic framework analysis, highlights barriers to help-seeking such as lack of awareness, inadequate social support, and mental health stigma. To adapt CMAP intervention, participants suggested changes in the use of Urdu words to make content simple for patients to understand, increase number of family sessions, include information about possible risk and protective factors of self-harm in this population and emphasize the addition of resilience-building messages in the manual. Stage 2 is currently ongoing, and we have successfully recruited healthcare facilities across all sites and randomized 12 participants into the trial.

This study will add valuable insights for refinement of existing interventions to address the unique needs of individuals with FEP in Pakistan. Intervention with suicide preventive strategies may help in reducing the risk of suicide. The culturally grounded approach ensures relevance, contributing to the global discourse on evidence-based mental health interventions.

Suicide is a global public health concern, affecting not only the individuals but also families. It is the leading cause of maternal death during pregnancy and up to one year after birth and commonly occurs after a period of suicidal ideation (SI). It is imperative to have interventions to help with SI and behaviors. We therefore aimed to adapt and test the feasibility and acceptability of a culturally adapted intervention for SI in women during postnatal period in Pakistan.

This is a two phase, mixed method Randomized Controlled Trial (RCT). First phase included adaptation of an existing Culturally Adapted Manual-Assisted Problem-Solving intervention (CMAP) for women experiencing SI. Adaptation process included two focus group discussion (FGDs), one with lived experience experts (women who experienced suicidal ideation during postnatal period), the other with health professionals (n = 8 in each group). Second phase involves a feasibility RCT with aim to recruit and randomize a total of 90 postnatal women experiencing suicidal ideation (screened using the Beck Scale for Suicidal Ideation), randomize into either of two study arms: CMAP (n = 45) or Treatment as usual (n = 45). Potential participants are being recruited from hospitals, communities, and self-referrals from 5 major cities in Pakistan. Culturally adapted CMAP is a brief problem-solving therapy of 6 individually delivered sessions, lasting about 50 minutes. The primary outcome is to assess the feasibility of CMAP through semi-structured qualitative interviews. Secondary outcomes include measuring SI, self-harm, depression, social support, and quality of life. Assessments will be conducted at baseline and 3rd month post randomization.

Analysis of qualitative data from FGD with lived experience experts highlighted importance of incorporating additional techniques of trust building, modifying thinking behavior, mindfulness, distraction exercises including religious practices as a preventive measure of self-harm, child safety measures, and involvement of partner in intervention. Analysis of FGD with healthcare professionals emphasized addition of visualized content, re-assessing depression and suicidal ideation in-between the sessions to monitor relapse, involving family, and capacity building of health professionals to improve their understanding about perinatal mental health problems.

Women in postnatal period are at high risk of SI, specifically those women from low- and middle-income countries, due to limited resources and mental healthcare provision. The earlier detection of SI, early intervention for suicide risk by delivery of culturally sensitive interventions can help reduce maternal mortality rates.

Rates of stillbirth and neonatal deaths are high in low- and middle-income countries including Pakistan and these are one of the most stressful life-events for parents and families. Society does not appropriately recognize perinatal loss and support from healthcare professionals is often very limited or non-existent in Pakistan. Therefore, we aimed to co-develop and assess the feasibility of a bereavement support program for parents who experienced stillbirth/neonatal death in a public health facility in Pakistan.

This study adopted a sequential mixed-method design. The first phase involved co-development of a bereavement support program through a consensus process involving multidisciplinary health professionals, stakeholders and parents with previous experience of perinatal death (n = 23) using the Nominal Group Technique. Phase 2 includes a feasibility assessment using before and after cohort design. Sixty women (30 per phase) with recent experience of stillbirth and/or neonatal death will be recruited, from a public hospital in Pakistan. The main outcome measures will include recruitment and retention and acceptability of the study processes and data collection.

Following the consensus process, agreed intervention components included an educational workshop for healthcare staff, creation of a bereavement champion group of health workers in the facility and offering post-natal telephone peer support to bereaved mothers. The educational component for healthcare staff includes Advance Bereavement Care (ABC) workshop for all staff and bereavement champions (n = 15 healthcare workers) who later received one day's training and one-day training refresher. This component aims to improve care, act individually and as a group to identify areas for development, encourage good practice and support colleagues. The peer support component includes telephone support provided by women with previous experience of perinatal death (n = 7) trained by the research team. Supervision arrangements are in place for champions and peer supporters. The feasibility study is ongoing.

The co-development process ensured the cultural relevance of both components of the bereavement support program. The process also contributed to improving the sense of ownership by healthcare facility. Feasibility study will confirm whether parents are willing to take part, acceptability and whether future research to assess the effectiveness of the intervention on improving care after SB/NND is feasible.

A worldwide public health concern is major depressive disorder (MDD) with limited availability and access to evidence-based treatment in low- and middle-income countries (LMICs) such as Pakistan. Measurement-based care (MBC) is a low-cost strategy to improve clinical outcomes for people with MDD that involves the systematic administration of validated outcome measures to inform treatment decisions. However, research on MBC's effectiveness in LMICs is scarce. This paper aims to evaluate the feasibility and clinical effectiveness of MBC against standard care for patients with moderate to severe MDD in Pakistan.

This is a multicenter randomized control trial. Participants (n = 154) of 18 to 65 years of age recruited from psychiatric units of teaching and non-teaching hospitals and primary care settings such as General Physician (GP) clinics and Basic Health Units (BHUs) from 6 cities were randomised to receive MBC (guided by a schedule), or standard treatment (guided by clinicians’ judgement). Patients were prescribed by treating clinicians either with mirtazapine (7.5–45 mg/day) or paroxetine (10–60 mg/day) for a period of 12 weeks. All participants, regardless of their treatment arm, were followed-up till 24 weeks post-randomization and assessed for severity of depression. Side effects were regularly monitored using standard checklist. Outcome assessors were blind to treatment allocation.

The Pakistani National Bioethics Committee (NBC) has granted complete ethical approval. A total of 15 psychiatrists and 4 General Practitioners (GPs) were approached and invited to participate in the study and consent was given by 9 psychiatrists and 2 GPs. A total of 351 patients were screened against eligibility criteria and 177 were eligible to participate. A total of 154 eligible participants consented (87%) to participate and were recruited and randomized into the trial. A total of 131 randomized participants (85%) completed 24-month follow-up. Only two adverse events were reported during the trial period. Recruitment, retention and safety analysis indicates feasibility of the trial in Pakistani healthcare context. The data are being analyzed for effectiveness outcomes.

It is essential to investigate the viability, usefulness, and efficacy of MBC for MDD in low-resource settings due to mounting data from high-income settings confirming its effectiveness. The planned trial's outcomes may help build a scalable, low-cost method for effectively improving outcomes for MDD patients in Pakistan.

The COVID-19 pandemic has significantly impacted healthcare systems, economies, and global health, raising concerns about its potential effects on mental health. A recent systematic review found a 40% prevalence of poor sleep quality, with 34%, 26%, and 27% prevalence for psychological distress, depression, and anxiety. The systematic review investigated COVID-19-related stress, suicidal ideation, and self-harm thoughts among low- and lower-middle-income countries (LLMICs).

We search four electronic databases (PsycINFO, Medline, Embase, and PubMed). Quantitative studies, including both published and grey literature, from LLMICs focused on the prevalence of suicidal ideation or psychological distress during COVID-19 were included. Qualitative studies, non-English studies without full-text English translation, meta-analysis, commentary, books, and discussion articles were excluded.

1157 titles and abstracts were screened for inclusion and exclusion, resulting in 79 full-text articles. After full text screening, 11 articles were included. In Bangladesh, 12.8% of university students reported suicidal ideation (SI), while 19% of young adults had SI, and 18.5% reported suicidal planning. In addition to this, in Iran, 12.8% of pregnant women and in the Philippines, 24.9% of the general population reported SI. Mental health conditions like depression and anxiety, female gender, younger age groups, economic loss or financial stress, fear of COVID-19 infection, lack of social support, family problems, lower education levels, smoking, and substance use are identified as risk factors. Moreover, anosmia and dysgeusia symptoms were associated with a 30–80% increased risk of transitioning to suicidal ideation or depression in India. A study from Nepal reported a 44% increase in suicide attempts during lockdown compared with pre-pandemic periods in Nepal.

The findings of this review suggest that the impact of the COVID-19 pandemic on mental health in LLMICs is substantial. In addition to the increased risk of SI and suicide attempts, there was a significant rise in depression and SI associated with anosmia and dysgeusia symptoms. These results underscore the urgent need for increased psychosocial support in LLMICs to address the growing mental health burden caused by the pandemic. Moreover, understanding the long-term effects of the pandemic is crucial for developing effective interventions and support systems. Further research is needed to examine the lasting impact of the pandemic on mental well-being and identify future strategies.

The burden of mental health difficulties is a global problem and preventing them from childhood is paramount. Children living in challenged and underserved settings can suffer various harmful lifelong consequences including alcohol and substance abuse, low self-esteem, health issues, poor school performance, self-harm and suicide. This study aims to assess the feasibility, acceptability and efficacy of the culturally adapted Strong Families program in improving child behaviour and family functioning in families living in a challenged setting i.e. Gilgit-Baltistan (GB), Pakistan.

This is a two-arm, multisite feasibility randomised controlled trial with 90 families (n = 45 in intervention, and n = 45 in waitlist group) including a female primary caregiver (mostly mother) and at least one of their children between the age of 8–15 years in three districts of GB. There will be three raters’ blind assessments: at baseline, week 2, and 6 weeks after Strong Families Program sessions.

Strong Families Program is a brief evidence-based prevention programme designed to improve parenting skills, child well-being and family mental health. The primary outcome measures include the feasibility of Strong Families, as determined by families' recruitment, attendance rates, and program completeness (mean number of sessions attended, attrition rates). Additionally, purposefully selected participants, including up to 5 caregivers from each study site, researchers, and facilitators delivering the intervention, will be interviewed. Descriptive statistics will be used to analyse primary and secondary outcomes. The process evaluation will be conducted in terms of program context, reach, fidelity, dose delivered and received, implementation, and recruitment.

The findings from this feasibility trial hold the potential to carry out the large multicentre trial of clinical and cost-effectiveness and scale-up across Pakistan and other similar settings to meaningfully impact child behaviour and family dynamics in culturally diverse contexts.

Suicide is one of the leading causes of death among young people. For adolescents, schools are considered as the best place to identify and respond to youth suicide risk but evidence on culturally sensitive, school-based suicide prevention programs is limited in low-resource settings such as Pakistan. This study aims to explore the perspectives of students, parents, teachers, and general practitioners regarding cultural adaptation, participation experiences, identified areas for improvement, and recommendations for scaling up the school-based suicide prevention program in Pakistan.

This qualitative study was nested in a pilot randomized controlled trial that aimed at exploring the feasibility, acceptability and preliminary effectiveness of three suicide prevention interventions: (1) Linking Education and Awareness of Depression and Suicide-LEADS training for students (12–17 years), (2) Question-Persuade-Refer (QPR) training for teachers and parents and (3) Professional screening of at-risk students (ProfScreen) for health practitioners. A total of 8 focus group discussion (FGDs) were conducted at pre- and post-intervention stage with each type of stakeholder (students, teachers, parents and health professionals) by trained qualitative researchers using the semi-structured topic guides. Each FGDs involved a detailed presentation on intervention, sharing videos and educational posters.

As a result of pre-intervention FGDs, adaptations were made in the content of the interventions and were further refined through consultations with Patient and Public Involvement and Engagement group. All stakeholders who participated in post-intervention FGDs marked this suicide prevention program as feasible, acceptable and helpful in both identifying the risk of and preventing self-harm and suicide among young individuals, while also enhancing treatment pathways. Stakeholders perceived the interventions as valuable in augmenting knowledge about mental health, understanding the impact of mental health challenges on functioning, reducing stigma, and providing stakeholders with the necessary skills to identify and guide at-risk individuals. Teachers and parents endorsed the importance of discussing issues with children. Improvement in clinical practice of clinicians and teaching practice of teachers as well as understanding others’ behaviors were also reported.

This study highlights potential role of culturally adapted school-based youth suicide prevention program for settings where rates of suicide are high and there are limited mental healthcare resources in addition to limited access to healthcare. School-based suicide prevention program is perceived as helpful in improving knowledge, attitudes, and help-seeking behaviours in adolescents.

Suicide poses a significant public health issue, and the presence of suicidal thoughts stands out as a prominent risk factor, highlighting the importance of addressing this aspect for early intervention and prevention efforts. While older adults face an elevated risk of attempted suicide, research in this domain is currently constrained. This study aims to enhance and evaluate the efficacy of an E-CMAP (Culturally Manual Assisted psychological intervention for Elderly) in mitigating suicidal ideation among individuals aged 55 years and older in Pakistan.

The study will be carried out in 2 phases. Phase 1 is cultural adaptation and refinement of the intervention and phase 2 is exploratory randomised control trial. In Phase 1, focus groups were conducted (N = 2) with Health professionals and service users and carers for adaptation of CMAP manual for suicidal ideation. In Phase 2 randomized exploratory trial will be conducted with 192 older adults with suicidal ideation randomized either to 1) E-CMAP added to Treatment As Usual (TAU) or TAU arm. ECMAP is a problem solving intervention comprising 6 sessions delivered one to one over 3 months by trained therapists. All participants will be assessed at baseline and after intervention (i.e. 3 months) for suicidal ideation, hopelessness, depression, health-related quality of life, coping resources, satisfaction with intervention, and episodes of self-harm.

Thematic Analysis of focus group discussions indicates that participants expressed a preference for incorporating a religious element into distraction techniques, delivering information about the significance of medical treatment, showcasing recorded sessions illustrating problem-solving techniques, and involving family throughout the intervention period.

A culturally tailored psychosocial intervention that incorporates problem-solving and cognitive components has the potential to decrease the risk of suicide among older adults.

The Mediterranean diet has shown to improve mental health outcomes in people with depressive disorder. However, little is known of the impact of the Mediterranean diet on severe mental illness. The aim of this systematic review was to evaluate the impact of a Mediterranean diet on mental health and quality of life outcomes in adolescents and adults with severe mental illness (as defined by schizophrenia spectrum disorders, at risk mental states for psychosis, bipolar affective disorder and severe depression with psychosis).

The following databases were systematically searched: MEDLINE and EMBASE via Ovid, CINAHL via EBSCO, PsychInfo via ProQuest, PubMed and Clinicaltrials.gov, using relevant subject headings and free text search terms to encompass severe mental illness and the Mediterranean diet. Screening, data extraction and quality assessment were completed by two independent reviewers. Eligible study designs included randomised controlled trials, other non-controlled or controlled interventional or experimental studies, cohort studies, case-control studies and cross-sectional studies that included adults and adolescents. The search was not limited to a specific time frame or language. The Mediterranean diet and mental health and quality of life outcomes were defined by primary paper author definitions.

Thirteen eligible studies were identified: 4 interventional, 2 cohort, 2 case-control and 4 cross-sectional studies and 1 mixed methods (interventional and observational) study. Diagnoses in most studies were psychotic illness, schizophrenia, schizoaffective disorder, bipolar affective disorder and depression with psychosis. There was a lack of studies found that included adolescents or participants with at-risk mental states for psychosis. A range of Mediterranean diet adherence scoring systems were used across studies, indicating a notable heterogeneity in the way adherence was evaluated. Most studies included other lifestyle exposures or interventions alongside the Mediterranean diet. There was a marked heterogeneity between studies in how mental health and quality of life outcomes were assessed. Although there was an overall trend towards improved mental health or quality of life outcomes in some studies, others reported no change or a negative association with the dietary/lifestyle exposure or intervention.

The association between Mediterranean diet adherence and mental health outcomes and quality of life in adults and adolescents with severe mental illness remains inconsistent. Lifestyle-based interventions for the treatment of mental illness are cost-effective and relatively easy to implement with less concern about side effects. Therefore, this area requires further research.

Non-Suicidal Self-Injury (NSSI) occurs when direct, deliberate harm is caused to one's physical body without intention of suicide. Approximately 22.1% of youth worldwide would engage in NSSI in their lifetimes. Due to the increased risk of harm and future suicide attempts, NSSI is a behaviour that warrants attention and has been identified as a condition in need of further study. While some studies have examined the prevalence and experiences of NSSI in Singapore, there is a lack of detailed studies on the presentation and overall phenomenology of NSSI in the local context. This study aims to assess the characteristics of NSSI using the Non-Suicidal Self-Injury – Assessment Tool (NSSI-AT) in a cross-sectional design. We investigated the functions, characteristics, and personal experiences of local youths who engage in NSSI for the development and improvement of patient-centred care.

121 youths between 12 and 25 years old were recruited from the National University Health System. The study included patients seeking treatment for mood disorders and have self-reported NSSI behaviours such as cutting, hitting, and scratching prior to or at the time of visit. Outcomes for the NSSI–AT, including the actions, functions, frequency, age of onset, initial motivations, severity, practice patterns, disclosure, and treatment experiences of self-harm, were reported using descriptive analysis. Personal reflections were analysed using thematic analysis.

Participants were mostly female (n = 86, 71.1%) with a mean age of 16.2 years (SD = 2.33). Many participants engaged in NSSI actions such as cutting, scratching, and banging on objects, to manage high-pressure agitating and low-pressure depressive emotional states. Most participants started engaging in NSSI in early adolescence (mean = 13.0 years old, SD = 2.37, range = 7–23) and have hurt themselves more severely than intended (n = 79, 65.3%). When reflecting on overall NSSI experiences, participants had similar levels of ambivalence toward NSSI and growth due to NSSI. Participants also gave encouragement to others going through similar experiences and reported the negative aspects of self-harm.

Findings support emotional regulation as a function of NSSI in the local population, where self-harm was not generally used for social communication purposes. Findings also suggest that youths may be more vulnerable to NSSI during early adolescence, corresponding to a time of substantial life changes. This study also demonstrated the individuality of NSSI experiences among the local youth, highlighting the importance of having a person-centred approach in NSSI treatment. Taken together, this highlights the need to develop interventions that can effectively serve this age group and their specific challenges.

Heat exposure can negatively impact mental health. Evidence for the effect of temperature on mood disorders is inconsistent. Current studies exploring the link between temperature and mood disorders are limited by poor temporal and geographical resolution. We aimed to use ecological momentary assessment (EMA) to investigate the effect of real-time temperature on depressive and manic symptoms. We hypothesised higher temperatures would be associated with increased depressive and manic symptoms.

We used EMA data from the digital platform and smartphone app juli to investigate the effect of real-time mean and maximum ambient temperature on depressive and manic symptoms in adults with depression and bipolar disorder. Depressive and manic symptoms were assessed using the Patient Health Questionnaire-8 and the Altman Self Rating Mania score, respectively. Time- and location-specific temperature data were collected from participants’ smartphone geolocation on a 5-by-5 km resolution grid. We analysed data using negative binomial mixed-effects regression models, controlled for demographic and weather variables, and stratified by season.

We analysed data from 4,000 participants with depressive symptoms and 2,132 with manic symptoms, between July 2021 and March 2023. We found that each 1°C increase in mean daily temperature in the preceding two weeks was associated with a 0.2% reduction in depressive symptom scores (IRR 0.998, 95%CI 0.997–0.999). This association was most pronounced in the spring (IRR 0.995, 95%CI 0.992–0.999). For manic symptoms, we found that each 1°C increase in mean temperature in the preceding two weeks was associated with a 0.4% increase in manic symptom scores (IRR 1.004, 95%CI 1.001–1.007), with the strongest association observed in the autumn (IRR 1.011, 95%CI 1.002–1.020). Associations between maximum temperature and depressive and manic symptoms followed a similar pattern.

We found evidence that higher temperatures were associated with decreased depressive symptoms and increased manic symptoms, indicating a complex relationship between temperature and mood disorder symptoms. With globally rising temperatures due to climate change, there is a need to understand the impact of heat on mental health symptoms to provide targeted support. This study demonstrates the potential for using novel data sources and EMA methods to inform our understanding of the link between climate and mental health, although there is a need for improved data collection to realise the potential of these methods. Clinically, our findings highlight opportunities for risk stratification and targeted interventions based on local temperature patterns.

To find how best to integrate religion/spirituality (R/S) into clinical care.

This was a qualitative study. 41 mental health patients of varying diagnoses in secondary care underwent semi-structured interviews describing their mental health and spiritual journeys and how these have interacted, before, during and after a period of acute illness. Grounded theory was used. Detailed coding was carried out and themes extracted.

Preliminary results from this project have already been reported, (submitted for publication). 5 main processes by which R/S interacted positively or negatively with mental health recovery were identified:

• • R/S experiences, (+ve or -ve),

• • Existential crisis, (-ve),

• • Influence of faith community, (+ve or -ve),

• • Finding a personally meaningful faith, (+ve),

• • Changing priorities to a more spiritual outlook, (+ve).

1. 1. Those who described themselves most as being in recovery tended to have more positive R/S experiences, support from a faith community, a personally meaningful faith and have changed their priorities. Most have also found clinical care helpful. However, often R/S was considered more helpful both for personal recovery and symptom relief. For others in this group, R/S enables living a satisfying life despite limitations of illness partially controlled by medication.

2. 2. Those who described themselves most as struggling with mental illness were much less likely to have a personally meaningful faith or had changed their priorities. They tended to have negative R/S experiences, persistent existential crisis and/or rejection from a faith community. Most of these people find both clinical care and R/S issues unhelpful. Some people were finding clinical care helpful but R/S barriers were blocking their recovery.

Spiritual health may be important for recovery from many mental health problems and needs to be addressed according to the 5 themes.

• • Possible R/S barriers identified, even if symptoms seem to be responding to clinical treatment.

• • Positive R/S experiences and/or support from a faith community used to help overcome R/S barriers.

• • Support made available to find a personally meaningful faith and change priorities.

• • Referral to spiritual care offered more frequently.

To establish the usability and tolerability, as well as accuracy of measurements of a handheld KardiaMobile ECG device in an inpatient older adult dementia ward.

Between February 2023 and April 2023, KardiaMobile ECGs and 12-lead ECGs were taken for patients admitted within a dementia ward in Liverpool. The standard 12-lead ECGs were analysed as per current practice, by Broomwell Health Watch. The KardiaMobile ECGs were read manually, by two independent raters, for heart rate and QTc. The user-rated tolerability was measured out of 5, 5 being the most tolerable, and was measured for both KardiaMobile and 12-lead ECGs, allowing comparison. The QTc and heart rate were calculated for both methods, and then compared. QTc was calculated using Bazett's formula.

13 inpatients had a 12-lead ECG, and a KardiaMobile ECG performed. Both were tolerated by all patients, except one who tolerated neither, leaving 12 ECGs for comparison. KardiaMobile ECGs were quicker to obtain, more well tolerated, and easy to use. However, manual calculation of QTc, versus expert and computer analysis for 12-lead ECGs, led to some variability between QTc measurements. Inter-rater reliability between raters for the KardiaMobile QTc was poor, however, when both were combined, correlation with 12-lead ECG QTc was moderate. KardiaMobile ECGs were harder to obtain in those with tremors, and the lack of computerised readings made interpretation more difficult. 12-lead ECGs also offer reassurance in the form of a fully interpreted, more detailed ECG.

KardiaMobile devices are faster to use and as/more tolerable in a dementia ward setting than 12-lead ECGs. The ECG trace is fed back instantly to the mobile device, however, automatic interpretation is limited and QTc calculation relies on the operator. Visual inspection of QTc can be difficult, and unreliable. However, the combination of two different raters led to more reliable results. The device has potential for use in this setting, however, an increase in automatic interpretation, or interpretation by a third party such as with Broomwell Health Watch, would increase its usability.