This study aims to find out how alcohol use disorder (AUD) correlates to personal well-being and life satisfaction.

AUD is prevalent and leads to significant physical, physiological, and social-occupational impairment. Mental well-being involves the overall positive psychological state of a person – being well adjusted, socially engaged, and emotionally healthy. Despite the paradigm shift from purely treating mental illness to promoting positive mental health, there is limited literature describing the relationship between alcohol use disorder and mental well-being.

This cross-sectional study was conducted in a general hospital in Singapore. Patients admitted across a span of two years were screened for possible alcohol use disorder. Patients were included if they were male, aged 21 years and above, and had the mental capacity to give consent. They were excluded if they had illicit drug use, acute mental illness, inability or refusal to give consent, or if they were already receiving intervention for addiction issues. Participants were administered the Alcohol Use Disorders Identification Test (AUDIT). Those who scored 8 or above were classified as being at risk for AUD, while those who scored 7 or less were classified as at low risk. They were also administered the Personal Wellbeing Index (PWI) and the “Satisfaction with Life as a Whole” question. The PWI measures individuals’ subjective well-being across seven domains. The “Satisfaction with Life as a Whole” question measures, on an eleven-point Likert scale, how satisfied the respondent feels with life in general. Demographic data were also collected and STATA v. 12.1 was used for statistical analysis.

Among a total of 134 participants, 25 of them scored ≥8 on the AUDIT and 109 scored 7 or less. On the PWI, the group at risk scored significantly lower at 71.3 (95% CI: 66.0–76.7) compared to the group not at risk at 77.9 (95% CI: 75.8–79.9), p < 0.01. The results were similar on the “Satisfaction with Life as a Whole” item. The group at risk had a mean of 6.72 (95% CI: 6.03–7.41) while the group not at risk had a mean of 7.67 (95% CI: 7.41–7.93), both p < 0.01. The differences between the high risk and low risk groups remained statistically significant even after adjusting for differences in age, race, education level, and employment status.

This study demonstrated a statistically significant association between AUD and personal well-being as well as satisfaction with life among males.

Previous studies suggest that migrants tend to utilise antipsychotics less often than their native-born peers. However, studies examining antipsychotic use among refugees with psychosis are lacking.

To compare the prevalence of antipsychotic drug use during the first 5 years of illness among refugees and Swedish-born individuals with a newly diagnosed non-affective psychotic disorder, and to identify sociodemographic and clinical factors associated with antipsychotic use.

The study population included refugees (n = 1656) and Swedish-born persons (n = 8908) aged 18–35 years during 2007–2018, with incident diagnosis of non-affective psychotic disorder recorded in the Swedish in-patient or specialised out-patient care register. Two-week point prevalence of antipsychotics use was assessed every 6 months in the 5 years following first diagnosis. Factors associated with antipsychotic use (versus non-use) at 1 year after diagnosis were examined with modified Poisson regression.

Refugees were somewhat less likely to use antipsychotics at 1 year after first diagnosis compared with Swedish-born persons (37.1% v. 42.2%, age- and gender-adjusted risk ratio 0.88, 95% CI 0.82–0.95). However, at the 5-year follow-up, refugees and Swedish-born individuals showed similar patterns of antipsychotic use (41.1% v. 40.4%). Among refugees, higher educational level (>12 years), previous antidepressant use and being diagnosed with schizophrenia/schizoaffective disorder at baseline were associated with an increased risk of antipsychotics use, whereas being born in Afghanistan or Iraq (compared with former Yugoslavia) was associated with decreased risk.

Our findings suggest that refugees with non-affective psychotic disorders may need targeted interventions to ensure antipsychotic use during the early phase of illness.

Mental health transition-related disengagement is a major public health problem. This study aims to review children in care (CIC) and adopted children's transitions from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). This study aims to illustrate the often overlooked complexities that are associated with this population's transitions.

It is hypothesised that this population is at an increased risk for disengagement post-transition. Such is hypothesised as a result of the population's increased prevalence of complex mental health problems, neuro-developmental needs and developmental trauma. This population would benefit from a transition (optimal), as opposed to a transfer of care (suboptimal).

This retrospective case study included young people from Lewisham CAMHS's team for looked after and adopted children. Optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer.

A total of 34 cases (male = 14, female = 20) were included, 88% of which were CIC (12% were adopted children). 85% of the cases included reports of at least one form of abuse and/or neglect. 59% of the cases were categorised as having more than one diagnostic group of mental health problems.

30% (n = 11) of the cases were discharged and were not recorded to have re-engaged with Lewisham AMHS. 12% of the cases had an outcome as 'unknown' due to miscellaneous reasons.

Only 18% (n = 6) of the cases had an ‘optimal’ transition. 18% (n = 6) had a suboptimal transfer and of those cases, 66% (n = 4) did not engage with AMHS beyond three months post-transfer. 21% (n = 7) were re-referred to Lewisham AMHS after being discharged from CAMHS. None of the re-referred cases engaged with AMHS post-referral.

In conclusion, these findings demonstrate that this population is highly complex and can often experience suboptimal transitions from CAMHS to AMHS. Anything less than an 'optimal' transition yields a low ratel of therapeutic engagement. Recommendations for clinical practice includes an extended period of ‘overlap time’ between CAMHS to AMHS for CIC and adopted children. This overlap period will enable mental health practitioners to provide more informed and consistent support that incorporates the needs of CIC and adopted children. Such a provision will enhance therapeutic engagement and subsequently, promote better outcomes for CIC and adopted children. These findings have important resource implications for both CAMHS and AMHS teams.

To evaluate a multidisciplinary inpatient treatment programme for Functional Neurological Disorder (FND) and Non-Epileptic Attack Disorder (NEAD), focussing on clinical effectiveness and patient experience. To produce recommendations for service development and future evaluation.

We conducted a service evaluation of the multidisciplinary inpatient programme for FND and NEAD at the Rosa Burden Centre. We contacted all inpatients discharged between December 2019 and March 2020 via telephone in August/September 2020. Quantitative outcomes were gathered on quality of life and psychological distress using the EQ-5D-5L and Core10 tools. Scores were compared to those gathered routinely at admission and discharge, using Wilcoxon's test for differences. Qualitative feedback on patient experience was gathered using open-ended prompts, and thematic analysis of this data was conducted independently by two researchers. Approval was gained from Southmead Clinical Audit Department (CE10237).

19 of 22 patients successfully completed the service evaluation. Quantitative results tended toward improvement on all measures between admission and discharge. Following discharge, there was a mixed pattern - sustained improvement in overall quality of life, but regression in other scores. Improvement in overall quality of life between admission and follow-up was statistically significant (p = 0.012, Z = 2.52). Changes in psychological distress (Core10) were also statistically significant, reducing between admission and discharge (p = 0.004, Z= –2.84) and increasing between discharge and follow-up (p = 0.016, Z = 2.42). Changes in other scores were not statistically significant at the p < 0.05 level. Qualitative results highlighted the value of the individual therapies offered, the multidisciplinary approach, and the supportive environment. Participants reported improved understanding of their diagnosis, and of self-management strategies. There was demand for greater access to psychological therapies, and increased provision of follow-up post-discharge. Some expressed dissatisfaction with the ward round format and excess “down-time”. The programme was described as a “turning point” for 9 participants.

Quantitative results suggest the programme is associated with global improvement in quality of life, and post-discharge, some benefits are sustained while others are transient. However, interpretation is limited by sample size. We recommend further evaluation with a larger sample to replicate findings, assess effect sizes, and assess which patients or symptoms benefit most. To support this, we recommend improved collection of outcome measures, including routine collection of follow-up data. Positive qualitative findings highlight the strengths of the service and its value to patients. Recommendations for service development include recruiting a psychologist to provide further psychological therapy sessions; expanding the nurse-led follow-up service; and adjustments to the ward round format and activity programme.

A recent government white paper sets out proposals for reforms to the Mental Health Act 1983 (MHA). Some of these proposals affect people with intellectual disabilities and/or autism.

To explore both positive and unintended negative effects of the proposed reforms by gathering the perspectives of healthcare workers from multiple disciplines, working with intellectual disability and/or autism in community and in-patient settings.

A 14-question electronic questionnaire, comprising free-text, multiple choice and five-point Likert scale responses, was sent out via email between April and July 2021, to all multidisciplinary team professionals working in specialist intellectual disability community and in-patient teams in Hertfordshire Partnership University NHS Foundation Trust.

There were 45 responders, of whom 53% worked in in-patient settings and 47% in out-patient teams. Respondents comprised healthcare professionals from multiple disciplines, 80% of which were non-medical. Most responders agreed with the general principles of the proposed reforms. However, 80% felt there would be potentially unintended consequences, and 76% thought that substantial investment in community services was required in advance of the proposed reforms.

The proposed MHA reforms may have unintended consequences for people with intellectual disabilities and/or autism. The findings of this study raised key concerns that need to be explored further and addressed before the MHA reforms are implemented. These include community provision, safeguards and use of the Mental Capacity Act, the potential for under or overdiagnosis of mental illness, and effects associated with the criminal justice system.

There has been a significant change in the way we see patients during psychiatric consultations, this has led to challenges we face in delivering safe and effective care to patients under our care. “Telepsychiatry” has been used in literature from countries like Australia and India, there is very little around coming from the UK but there appears to be many ongoing research making the rounds. It is interesting to know that the existing literature on remote/virtual consultations during the COVID-19 pandemic are on the rise. The idea of this study was conceived during outpatient clinics after making an observation that many patients were likely to miss their appointments when they had telephone appointments compared to video consultations. This prompted a study to know if this is more likely to be observed in other outpatient clinics. The purpose of this study was to establish if virtual/remote consulting has affected patient attendance rate and whether this is also affected by the type of virtual consultation.

The data were collected using the “2020 stats sheets” for inpatient appointments between North Fife consultants from January to October 2020. This was registered with the NHS Fife clinical effectiveness team in January 2021.

The results were categorized for the purpose of this survey as January – March (Pre-lockdown) and April – October (lockdown). It is important to note that some face-to-face appointments occurred during lockdown because there were emergency assessments and drug monitoring appointments scheduled.

The results of this survey showed that there was a clear reduction in clinic appointments made during lockdown compared to pre-lockdown and slight observable improvement in attendance rates during the lockdown. There was no statistical significance seen using t-test comparing attendance rates between video and telephone consultations including new patient virtual consultations.

The large sample size over this period suggests that the results are reliable and valid, we can therefore say virtual/telephone consultation does not affect attendance. It should be noted that the attendance rate may be a good indicator but we should also consider patient/clinician satisfaction, communication quality/effectiveness and other factors which could influence patient's compliance to outpatient follow-up. It is important to acknowledge the lack of a control group and the COVID-19 pandemic were major cofounding factors. Mental health services should continue the use of virtual consultation post-pandemic and possibly integrate it with in person consultations (hybrid), this may help with attendance rate of patients with difficulty attending face-to-face appointments.

We aim to explain more about PMDD in young people and explore the evidence looking at the role of CBT as an intervention. We aim to develop high-quality psychoeducation material with the involvement of young people, to be able to offer clinically relevant information and empower young people with PMDD.

A literature search was conducted in 2019 and updated in February 2022 using the Cochrane Library, Psych-info, MEDLINE, Cinahl, EMBASE and Google Scholar, to look at the evidence available for CBT in young people with PMDD or PMS. The search included PMS as well as PMDD due to the heterogeneity in definitions used in studies.

Focus groups with young people are underway to develop high quality written psychoeducation material about PMDD.

There were no specific studies looking at CBT as an intervention in young women under the age of 18 with PMS or PMDD. There was one intervention study with a treatment arm of psychoeducation in 62 young people under 18 with PMS versus a no treatment group (Taghizadeh 2013), with improvement in symptoms after 3 months from baseline reported.

There were more studies available in women over the age of 18. The search identified 3 meta- analyses in 2009 and 2012 (Busse 2009, Lusty, 2009; Kleinstauber 2012) and a more recent systematic review (Landolt 2020). Kleinsteiber et al included 22 RCTs, with a median age of 39, and broadly showed CBT to have a small to medium positive effect size, although any conclusions were limited due to the small numbers involved in the individual trials and methodological flaws. Landolt 2020 looked at CBT or elements of CBT as an intervention arm over the last 30 years or so in woman of all ages. Variations of CBT including virtual, group, couple and psychoeducation alone were included, and all were reported to have favourable outcomes.

There is a huge gap in research looking at PMDD in the adolescent population. Translating research from adults is not ideal. Increasing awareness and developing psychoeducation is a step in the right direction.

To compare current trust practice to NICE clinical guideline 91. To identify patients with a history of depression or chronic physical illness on admission to acute medical services. To assess such patients for evidence of new or ongoing depression and establish prevalence of depressive symptoms in high risk patient groups. To establish appropriate pathways for referral to mental health services

Cycle one: Eligible adult medical patients were screened for self-reported symptoms of low mood and anhedonia over the 2 weeks prior to admission. Inclusion criteria required patients to have either a past history of a chronic physical health condition or a past history of depression.

For those who answered “YES” to depressive symptoms, clinicians were prompted to refer to mental health services.

Intervention:

Screening questions were added to the adult medical clerking proforma for routine screening of admitted patients.

Patients self-identifying as depressed were triaged as requiring either inpatient liaison psychiatry team support or were referred to Improving Access to Psychological Therapies (IAPT) team on discharge with GP follow up.

Acute Medical departmental teaching session held on CG91 and new referral pathway created with input from liaison psychiatry team.

Cycle two:

Audit cycle repeated, including audit of outcomes following identification of patients with depressive symptoms.

In cycle one, of 123 patients, 90 were eligible for inclusion (PPHx depression n=39; PMHx chronic physical condition n=51).

Of those with a past history of depression, 85% reported YES to current symptoms.

Of patients with a chronic physical condition, without prior history of depression, 48% reported low mood or anhedonia in the past two weeks.

Following introduction of electronic screening questions, completion rate by clinicians was 65% (eligible patients n=102; PPHx depression n=43; PMHx chronic physical condition n=59). 44% of patients with a chronic physical health problem self-reported symptoms of depression.

After local educational meeting, 84% of identified patients had a planned referral to primary or secondary care for further mental health assessment and support.

Around half of patients with chronic physical health conditions self-report high levels of depressive symptoms, without a known mental health diagnosis or support in place.

Screening of patients on admission provides an opportunity for appropriate intervention.

Establishing clear referral pathways and ongoing education is needed to ensure all identified patients are referred for further assessment.

The psychiatry ‘bootcamp’ forms part of the psychiatry induction for junior doctors within NHS Lanarkshire. It was developed to better prepare them for common scenarios on-call and therefore alleviate any anxieties. The session is based upon a weekend on call where a fictional patient is admitted to the psychiatry ward with a psychotic presentation. It introduces the participant to the topics of Mental Health Act utilisation, capacity, acute behavioural disturbance management, and adverse effects of psychotropic medications.

Focussed teaching regarding fundamental theory for each topic is provided. Following this the facilitators engage the audience through reflective group discussion. Relevant parts of the session involve practical work including individual completion of detention paperwork. Targeted teaching is provided by the facilitators for any knowledge gaps identified.

Pre and post course questionnaires are completed by participants where they provide both written feedback and score various domains between 0 (least confident) and 10 (most confident). Domains are capacity assessment, assessing detention criteria, the process of detaining a patient, and recognition and management of extrapyramidal side-effects.

This course has been run on two separate occasions with a total of 28 participants. All domains assessed on feedback questionnaires have shown an increase in confidence amongst the participants. Following analysis of all pre and post course questionnaires session one showed an average improvement from 4.87/10 to 7.56/10 across all domains. Session two showed an average improvement from 5.34/10 to 8.6/10.

Themes identified on participant feedback included the benefit of having the opportunity to individually practice completing detention paperwork. Another theme identified was that participants found the case used for session delivery relevant to their practice. A final theme identified was the engaging nature of the session which encouraged the participants to ask questions. If a didactic approach was used this could restrict such discussion.

Feedback received suggested that this session was well received by all participants and was felt to be beneficial in both preparing them for and alleviating anxieties ahead of their first shift on-call within psychiatry. Feedback demonstrated that running the session in small groups with a blended approach of direct teaching, reflective discussion, and practical work maximised engagement and was an appropriate approach for session delivery. Feedback suggests that this session has the potential to be an essential part of future junior doctor inductions due to it identifying and meeting the learning needs of the participant.

One of the effective interventions in reducing stress and burnout and increasing the job satisfaction and relationship of doctors is participation in Balint groups. The purpose of this study is to design, implement and evaluate the use of Balint groups in improving doctor-patient relationships among first-year psychiatry residents at the University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran.

This study was a pretest-posttest study conducted in 2022. First-year psychiatry residents at USWR were invited to join a Balint group through the Department of Psychiatry, and then they were called to attend an interview. During the interview, the inclusion and exclusion criteria for the study were reviewed. The requirements for participating in an online Balint group, including having a strong internet connection and the ability to work and communicate properly with the group, as well as ethical considerations such as the ability to keep confidential information within the group were examined.

12 group meetings were held for 6 months. The group leader had previously led various Balint groups for medical staff. Due to the COVID-19 pandemic, the sessions were held online on Skype.

The participants completed the demographic information questionnaire, the Jefferson Scale of Physician Empathy, and the patient communication questionnaire before and after participating in the Balint group. Next, data analysis was done using SPSS software version 25.

The average (standard deviation) age of the participants in the study was 30.70 (±4.54) years. Ten Participants included both male and female first-year psychiatry residents, eight of which were females, and eight were married. They all worked at the university. 70% had a high interest and 30% had an average interest in their field. Intra-group comparisons using the paired t-test showed that the the participants’ scores in the following areas significantly increased after the intervention: verbal communication skills (t=−6.26, P < 0.001), non-verbal communication skills (t=−9.76, P < 0.001) and total communication skills (t = −5.72, P <0.001). Also the results showed a significant increase in the scores of the Jefferson Scale of Physician Empathy after the intervention (t =−10.67, P < 0.001).

The results of the present study showed that participating in Balint group work can have a significant effect on the communication skills and the level of empathy among psychiatry residents. The results of this study are in line with Parker and Leggett's study (2012) and confirm the effectiveness of the Balint group work . Also, the results of this study are consistent with the studies of Airagnes et al. (2014) and Gajree (2021) and show that adding the Balint group work to the Iranian psychiatry residency curriculum can be useful.

Balint group work, psychiatry residency, doctor-patient relationship, empathy.

Psychiatric illnesses are prevalent in general hospitals and associated with length of stay (LOS). Liaison psychiatry teams provide psychiatric care in acute hospitals and can improve mental health-related outcomes but, to achieve ambitious policy targets, services must understand local need.

Using electronic patient records, we investigate associations between psychiatric diagnoses and LOS in South East London hospitals.

Patient records were extracted using the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register Interactive Search system. There were 6378 admissions seen by liaison psychiatry aged <65 years between 2011 and 2016. Linear mixed-effects models investigated the impact of psychiatric diagnoses on LOS. Potential confounders included medical diagnoses, gender, age, ethnicity, social deprivation, hospital site and investment per admission.

According to marginal means, longer LOS is associated with primary diagnoses of organic disorders (mean: 23 days, 95% CI 20.39–25.61), depressive disorders (mean: 11.03 days, 95% CI 9.74–25.61) and psychotic disorders (mean: 10.63 days, 95% CI 8.75–12.51). Shorter LOS is associated with personality disorders (mean: 6.28 days, 95% CI 4.12–8.45), bipolar affective disorders (mean 6.81 days, 95% CI 3.49–10.14) and substance-related problems (mean 7.53 days, 95% CI 6.01–9.05).

Psychiatric diagnoses have differential associations with in-patient LOS. Liaison psychiatry teams aim to mitigate the impact of psychiatric illness on patient and hospital outcomes but understanding local need and the wider context of care provision is needed to maximise potential benefits.

M.H. is a consultant liaison psychiatrist for King's College Hospital adult liaison psychiatry team. At the time of writing, H.T. was senior business manager at SLaM psychological medicine and integrated care clinical academic group. These may be considered financial and/or non-financial interests given the implications of findings for service funding.

Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear.

To describe the emergency department presentation patterns of a help-seeking youth mental health cohort.

Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12–30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other).

During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86–0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086–1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation.

Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.

Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.

To investigate the clinical and cost-effectiveness of IST models.

We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.

We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable.

The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency.

We aimed to investigate the interrater reliability of the HoNOSI.

Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes.

Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7).

There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease.

To investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG).

Data from patients with schizophrenia spectrum disorder (n = 126) were retrospectively compared with propensity-matched (1:20) control patients without schizophrenia spectrum disorder (n = 2520) in a multicentre study in Finland. All patients were treated with CABG. The median follow-up was 7.1 years. The primary outcome was all-cause mortality.

Patients with diagnosed schizophrenia spectrum disorder had an elevated risk of 10-year mortality after CABG, compared with control patients (42.7 v. 30.3%; hazard ratio 1.56; 95% CI 1.13–2.17; P = 0.008). Schizophrenia spectrum diagnosis was associated with a higher risk of major adverse cardiovascular events during follow-up (49.9 v. 32.6%, subdistribution hazard ratio 1.59; 95% CI 1.18–2.15; P = 0.003). Myocardial infarction (subdistribution hazard ratio 1.86; P = 0.003) and cardiovascular mortality (subdistribution hazard ratio 1.65; P = 0.017) were more frequent in patients with versus those without schizophrenia spectrum disorder, but there was no difference for stroke. Psychiatric ward admission, antipsychotic medication, antidepressant use and benzodiazepine use before CABG were not associated with outcome differences. After CABG, patients with schizophrenia spectrum disorder received statin therapy less often and had lower doses; the use of other cardiovascular medications was similar between schizophrenia spectrum and control groups.

Patients with schizophrenia spectrum disorder have higher long-term risks of death and major adverse cardiovascular events after CABG. The results underline the vulnerability of these patients and highlight the importance of intensive secondary prevention and risk factor optimisation.

Various effective psychotherapies exist for the treatment of depression; however, only approximately half of patients recover after treatment. In efforts to improve clinical outcomes, research has focused on personalised psychotherapy – an attempt to match patients to treatments they are most likely to respond to.

The present research aimed to evaluate the benefit of a data-driven model to support clinical decision-making in differential treatment allocation to cognitive–behavioural therapy versus counselling for depression.

The present analysis used electronic healthcare records from primary care psychological therapy services for patients receiving cognitive–behavioural therapy (n = 14 544) and counselling for depression (n = 4725). A linear regression with baseline sociodemographic and clinical characteristics was used to differentially predict post-treatment Patient Health Questionnaire (PHQ-9) scores between the two treatments. The benefit of differential prescription was evaluated in a held-out validation sample.

On average, patients who received their model-indicated optimal treatment saw a greater improvement (by 1.78 PHQ-9 points). This translated into 4–10% more patients achieving clinically meaningful changes. However, for individual patients, the estimated differences in benefits of treatments were small and rarely met the threshold for minimal clinically important differences.

Precision prescription of psychotherapy based on sociodemographic and clinical characteristics is unlikely to produce large benefits for individual patients. However, the benefits may be meaningful from an aggregate public health perspective when applied at scale.