The COVID-19 pandemic and lockdowns had a significant impact on mental well-being and (mental) healthcare systems globally.

To describe trends and dynamics of out-patient prescribing of psychotropic medications during the COVID-19 pandemic in The Netherlands.

Dispensed psychotropic medication prescriptions during the COVID-19 pandemic from March 2020 to March 2022 were retrieved from national registry data. Numbers of total and incident dispensed prescriptions and defined daily doses (DDDs) were identified for six medication groups. Overall pandemic-related changes in prescribing trends were analysed using interrupted time-series analyses. Lockdown-related prescribing dynamics were described using monthly risk ratios.

No overall pandemic-related changes in prescribing were detected, except for alcohol addiction medication, for which a pre-pandemic decline in total dispensed prescriptions and DDDs levelled off during the pandemic: +10 prescriptions per week (95% CI 7–11, P ≤ 0.001) and +111 DDDs per week (95% CI 56–165, P = 0.001). Monthly prescribing dynamics showed transient increases in all medication groups during the second and third lockdown periods. There were decreases in dispensed incident antidepressant and opioid addiction medication prescriptions during the first lockdown (average risk ratios: 0.87 and 0.88 respectively), and DDDs of dispensed incident and total attention-deficit hyperactivity disorder medication prescriptions and incident benzodiazepine prescriptions were elevated from the end of the second lockdown (average risk ratios: 1.40, 1.12 and 1.17, respectively).

These findings raise concerns regarding possible over- and under-prescribing during the pandemic. Further understanding of specific factors driving these changes is necessary to help prepare for future mental health(care) challenges.

Understanding what psychosocial interventions can reduce self-harm and suicide within in-patient mental health settings can be challenging, due to clinical demands and the large volume of published reviews.

To summarise evidence from systematic reviews on psychosocial and ward-level interventions (excluding environmental modifications) for self-harm and suicide that may enhance patient safety in in-patient mental health settings.

We systematically searched Medline, Embase, CINAHL, PsycINFO and CDSR (2013–2023) for systematic reviews on self-harm and suicide prevention interventions that included in-patient data. Review quality was assessed using AMSTAR-2, primary study overlap via an evidence matrix, and evidence strength evaluated (GRADE algorithm). Findings were narratively synthesised, with input from experts-by-experience throughout (PROSPERO ID: CRD42023442639).

Thirteen systematic reviews (seven meta-analyses, six narrative), comprising over 160 000 participants, were identified. Based on quantitative reviews, cognitive–behavioural therapy reduces repeat self-harm by follow-up, and dialectical behaviour therapy decreases the frequency of self-harm. Narrative review evidence suggested that post-discharge follow-up, as well as system and ward-based interventions (e.g. staff training) may reduce suicide and/or self-harm. However, review quality varied, patient involvement was lacking and methodological quality of trials informing reviews was predominately low. Overlap was slight (covered area 12.4%).

The effectiveness of interventions to prevent self-harm and suicide in in-patient settings remains uncertain due to variable quality reviews, evidence gaps, poor methodological quality of primary studies and a lack of pragmatic trials and co-production. There is an urgent need for better, co-designed research within in-patient mental health settings.

Some psychotic experiences in the general population show associations with higher schizophrenia and other mental health-related polygenic risk scores (PRSs), but studies have not usually included interviewer-rated positive, negative and disorganised dimensions, which show distinct associations in clinical samples.

To investigate associations of these psychotic experience dimensions primarily with schizophrenia PRS and, secondarily, with other relevant PRSs.

Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort participants were assessed for positive, negative and disorganised psychotic experience dimensions from interviews, and for self-rated negative symptoms, at 24 years of age. Regression models were used to investigate associations between psychotic experience dimensions and schizophrenia and other PRSs (2500+ participants for each analysis).

Against expectation, none of the positive, negative or disorganised dimensions was associated with schizophrenia PRS. In secondary analysis, self-rated negative symptoms were associated with higher depression (β = 0.10 [95% CI 0.06–0.15]), anxiety (β = 0.09 [95% CI 0.04–0.13]), neuroticism (β = 0.11 [95% CI 0.06–0.15]) and autism (β = 0.09 [95% CI 0.05–0.13]) PRSs (all P < 0.001); and first-rank delusions were nominally associated with higher schizophrenia PRS (odds ratio 7.35 [95% CI 2.10–25.77], P = 0.002), although these experiences/symptoms were rare.

Positive, negative and disorganised psychotic experiences are probably not strongly associated with polygenic liability to schizophrenia in this general population cohort of young adults. Self-rated negative symptoms may indicate social withdrawal/low motivation due to higher polygenic liability to affective disorders or autism, and first-rank delusions may indicate higher polygenic liability to schizophrenia, but these findings require independent confirmation.

Understanding the factors influencing alcohol use disorder (AUD) treatment outcomes is essential. More knowledge about patient characteristics that predict treatment outcomes can help personalise interventions, improve treatment planning and address the needs of specific subgroups. The frequency of treatment attendance may also affect drinking outcomes after treatment. Despite research efforts, uncertainty remains about how patient factors and treatment attendance influence treatment outcomes.

To examine how patient factors and treatment attendance predict high- or low-risk drinking at the end of treatment.

We used data (N = 92) from a multisite observational study of treatment-seeking individuals with AUD attending group treatment. Sociodemographic measures, alcohol and substance use measures, cognitive functioning, psychological distress, personality functioning and quality of life were screened in univariate analyses. Significant variables were entered into a binary logistic regression model.

Individuals with a higher percentage of treatment attendance (odds ratio 0.96 [95% CI 0.93, 0.96]) and with greater responsiblity scores on the Severity Indices of Personality Functioning (odds ratio 0.30 [95% CI 0.14, 0.64]) had a decreased likelihood of high-risk drinking at treatment end. Substance use, psychological distress and cognitive functioning were not associated with drinking levels at the end of treatment.

A higher percentage of treatment attendance has a minor effect on drinking levels. Being more responsible, as reflected in higher scores on the responsibility domain, reduces the likelihood of high-risk drinking at the end of treatment. Clinicians are encouraged to screen and assess personality functioning when planning treatment for individuals with AUD.

Early detection of psychosis is paramount for reducing the duration of untreated psychosis (DUP). One key factor contributing to extended DUP is service delay – the time from initial contact with psychiatric services to diagnosis. Reducing service delay depends on prompt identification of psychosis. Patients with schizophrenia and severe social impairment have been found to have prolonged DUP. Whether service delay significantly contributes to prolonged DUP in this group is unclear.

To examine and compare the course of illness for patients with schizophrenia who are homeless or domiciled, with a focus on service delay in detecting psychosis.

In this case–control study, we included out-patients with a schizophrenia spectrum diagnosis and who were homeless or domiciled but in need of an outreach team to secure continuous treatment. Interviews included psychosocial history and psychopathological and social functioning scales.

We included 85 patients with schizophrenia spectrum disorder. Mean service delay was significantly longer in the homeless group (5.5 years) compared with the domiciled group (2.5 years, P = 0.001), with a total sample mean of 3.9 years. Similarly, DUP was significantly longer in the homeless group, mean 15.5 years, versus 5.0 years in the domiciled group (P < 0.001). Furthermore, the homeless group had an earlier onset of illness than the domiciled group but were almost the same age at diagnosis.

Our findings point to the concerning circumstance that individuals with considerable risk of developing severe schizophrenia experience a substantial delay in diagnosis and do not receive timely treatment.

User engagement is recognised as a critical and pervasive challenge that has limited the potential evidence base being developed for mental health apps.

To understand young people’s motivations for participating in a randomised controlled trial for a mental health app and the role of intrinsic (e.g. improving well-being) and extrinsic (e.g. financial incentives) drivers in engagement.

Emotional Competence for Well-Being (ECoWeB) was a superiority parallel three-arm randomised cohort trial recruiting a cohort of 16–22 year-olds across the UK, Germany, Spain and Belgium, who, depending on risk, were allocated respectively to the PREVENT (n = 1262) versus PROMOTE (n = 2532) trials. We conducted in-depth semi-structured interviews in the UK (n = 18, mean age = 17.7, s.d. = 1.5) and Spain (n = 11, mean age 20.6, s.d. = 1.7) to explore participants’ self-reported motivations and engagement. The trial was registered at ClinicalTrials.gov: NCT04148508.

Across arms, 21% of participants never set up an account to access the app and approximately 50% did not complete the 3-month follow-up assessment. Engagement was not significantly higher in the intervention arm compared to the control arms across metrics. Qualitative findings demonstrated that although extrinsic factors alone may be enough to prompt someone to sign up to research, intrinsic drivers (e.g. finding the app useful) are needed to ensure longer-term engagement.

Incentivising participation in clinical trials needs to be consistent with incentives that might be utilised at the point of dissemination and implementation to ensure that findings are replicated if that intervention is adopted at scale.

Mental health literacy can potentially be improved through a public mental health campaign. The aim of the campaign Every Mind Matters (EMM) was to support adults to help address common subclinical mental health problems and improve their mental well-being and literacy, by using its National Health Service-endorsed digital resources.

Although not an objective of the campaign itself, this study aims to (a) address the relationship of EMM through the use of general practitioners and mental health therapists and (b) explore the association of EMM with symptom management knowledge.

Health Survey for England 2019 data were obtained on campaign awareness, uptake of campaign materials and the use of general practitioners and therapists. Logistic regression models were used to explore the impact of the campaign on whether services were used, and ordered logistic models explored the impact on the number of contacts. Campaign costs were viewed alongside symptom management outcomes.

The analyses included 2023 individuals. Of those campaign aware, 16% had contact with a general practitioner for mental health reasons compared with 9% of those who were campaign unaware. Those who were campaign aware were also significantly more likely to have seen a mental health therapist. The campaign cost per unit improvement in symptom management knowledge was below £20.

Contact with general practitioners and therapists was associated with campaign awareness. If even a small proportion of symptom management knowledge improvement is due to the campaign, then it has the potential to be cost-effective. Further work is required to establish this.

Dissociative disorders frequently co-occur with post-traumatic stress disorder (PTSD), yet many individuals lack adequate treatment. Existing interventions often prioritise reducing arousal over promoting safety and self-soothing, tending to neglect the bodily experience.

This randomised clinical within-person pilot study examined the effects of the nest position, a physiotherapeutic intervention designed to enhance safety and self-soothing, on patients with dissociative disorders and healthy controls (German Clinical Trials Register No.: DRKS00030669).

Eighteen patients with dissociative disorders and 18 healthy controls alternated between the nest position and a neutral supine position across two rounds of a measurement session. The order of the experimental conditions (nest position or supine only) was randomised for each participant. We assessed self-reported distress and comfort (Subjective Units of Distress and Comfort) and autonomic nervous system activity during three baseline phases and imagination of stressful and comforting situations.

Both patients and healthy controls experienced lower distress and greater comfort in the nest position. Heart rate and sympathetic tone decreased, particularly in the healthy controls. There were no significant changes in parasympathetic tone in both groups. Linear mixed models revealed a significant effect of the nest position on distress, comfort and sympathetic tone.

The nest position is a potentially promising additional intervention for highly dissociative patients. Our findings help to better understand the importance of self-soothing and safety in these individuals and to address the research gap in physiotherapy within in-patient mental health care.

Antipsychotics are primarily indicated for psychotic disorders. There is increasing concern regarding their potential overuse for other conditions.

To examine the change in the number of community prescriptions and corresponding costs for antipsychotics per head of population over 25 years (1998–2022) in England.

The data for 1998–2022 were obtained from two separate resources from the OpenPrescribing database: from 1998 to 2016 from their long-term trends data-set; and for 2017–2022 from the monthly medication prescribing data. The relevant British National Formulary subcategories 4.2.1 ‘antipsychotic drugs’ and 4.2.2 ‘antipsychotic depot injections’ were selected. The annual differences in prescriptions and the mean average annual increase were calculated. Scatter plots to visualise the yearly trend and Spearman testing to assess the strength of the correlations were done. The total annual costs of these medications were calculated for this time period.

The annual mean increase in the number of prescriptions was 287 548 in raw numbers and 4.27 per 1000 population. There is a statistically significant and strong positive relationship between time and the prescriptions of antipsychotics per 1000 population (Spearman correlation coefficient 0.995, P ≤ 0.001). This increasing trend is driven by the increase in oral antipsychotic drug prescriptions over time (Spearman correlation coefficient 0.995, P ≤ 0.001). Antipsychotic drug costs increased until 2011, reduced until 2016 and rose again during 2020–2022.

This analysis suggests a worrying increasing trend in antipsychotic medication prescribing. Potential causal factors include off-licence use. Clinical practice and research implications are discussed.

People with functional disorders often receive high levels of healthcare resource use yet have poor outcomes. The health service costs and productivity losses of functional cognitive disorders (FCD) is unknown.

This study aims to report the cost to health services and productivity losses of FCD.

Examination of healthcare service use and productivity losses in a sample of individuals with FCD who had attended a specialist out-patient clinic in south London.

The findings revealed high rates of healthcare use, including frequent contact with general practitioners, psychologists and hospital services, as well as work absences. The total estimated cost of healthcare and productivity losses per individual over 6 months was £1114.

These results highlight the need for effective and efficient diagnostic pathways, targeted and effective interventions, and improved support for individuals with FCD.

A family history of mental illness, particularly parental depression, is a risk factor for mental health difficulties in young people, with this heightened risk extending into adulthood. Evidence suggests low rates of formal mental health support in children/adolescents with depressed parents, but it is unknown whether this pattern persists into adulthood and applies to informal support.

We examined the prevalence of formal and informal mental health support accessed by young adults with recurrently depressed parents. We identified factors associated with access to different support, and report satisfaction with support.

The sample included 144 young adults (mean age 23 years, range 18–28 years) who completed psychiatric assessments and reported on their use of mental health support in a cross-sectional analysis of a longitudinal cohort study (wave 4). Regression analyses explored predictors for support.

Young adults accessed a range of formal (29%) and informal (56%) support. Among those with a psychiatric disorder, nearly half had not accessed formal support and a fifth had not accessed any support. Predictors of support included psychiatric disorder, severity indicators (e.g. self-harm/suicidal thoughts, impairment) and demographic factors (e.g. education, gender). Predictors varied by type of support. Most participants reported satisfaction with support.

Young adults at high risk of mental disorders accessed various mental health support. However, many did not access/receive support when needed. Further work is required to improve access to tailored support.

The association between cannabis use and suicidality has been established, but details on impacts of legalisation, as well as long-term service use, have had limited attention.

To examine if changes are present in suicide presentations with access to legal cannabis.

This study employed administrative database and medical record reviews to identify two cohorts of patients presenting with suicidal ideation/attempts and cannabis use to emergency departments, for two periods: 17 October 2018 to 30 April 2019, and 17 October 2020 to 30 April 2021. Demographic and clinical outcome data were obtained, and emergency department healthcare usage for 2 years before and 2 years after index encounter were compared, to further understand emergency department presentations for the same complaint.

Number of emergency department encounters following the index visit and number of emergency department encounters specifically relating to suicidality following the index visit were significantly different between cohorts (t = 2.05, P = 0.042; t = 2.23, P = 0.027, respectively), with the immediate post-cannabis legalisation period demonstrating greater numbers of subsequent emergency department visits for suicidality. Additional associations were found between personality disorders and repeat emergency department visits related to cannabis use.

There appears to be stability in the patient profile of those presenting to the emergency department with a complaint relating to suicide while reporting cannabis use from the period directly following legalisation in Canada, to a similar time frame 2 years later despite reported increased use of cannabis in the general population over this period. Despite the rising potency and access to legal cannabis, suicide risk remains stable, although concerning.

Myocardial bridge contributes to chest pain, often accompanied by non-specific complaints.

Our study aims to determine somatic symptom disorder (SSD) prevalence in patients with myocardial bridge, investigating associated clinical and psychological features.

In this prospective cross-sectional study, we enrolled 1357 participants (337 with and 1020 without myocardial bridge) from Shanghai Renji Hospital. The Somatic Symptom Scale-China questionnaire was used to assess SSD. Depressive and anxiety disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7).

The prevalence of SSD in the myocardial bridge group was 63.2%, higher than the group without myocardial bridge (53.8%). Patients with myocardial bridge were at an increased risk of SSD (odds ratio 1.362, 95% CI 1.026–1.809; P = 0.033). There were no differences in the mean PHQ-9 scores (3.2 ± 3.4 v. 3.2 ± 4.1; P = 0.751) or GAD-7 scores (2.5 ± 3.0 v. 2.3 ± 3.7; P = 0.143) between the two groups. Among patients with myocardial bridge, gender was the only independent risk factor for SSD. Women were 3.119 times more likely to experience SSD compared with men (95% CI 1.537–6.329; P = 0.002).

Our findings emphasise the high prevalence and severity of SSD among patients with myocardial bridge. The screening for SSD should be of particular concern, especially among female patients.

Hong Kong’s 3-year dynamic zero-COVID policy has caused prolonged exposure to stringent, pervasive anti-epidemic measures, which poses additional stressors on emotional well-being through pandemic fatigue, beyond the incumbent fear of the pandemic.

To investigate how major policy shifts in the zero-COVID strategy have corresponded with changing relationships between emotional well-being, pandemic fatigue from policy adherence, and pandemic fear, following the pandemic peak to a living-with-COVID policy.

A three-wave repeated cross-sectional study (N = 2266) was conducted on the Chinese working-age population (18–64 years) during the peak outbreak (Wave 1), and subsequent policy shifts towards a living-with-COVID policy during the initial relaxation (Wave 2) and full relaxation (Wave 3) of anti-epidemic measures from March 2022 to March 2023. Non-parametric tests, consisting of robust analysis of covariance tests and quantile regression analysis, were performed.

The severity of all measures was lowered after Wave 1; however, extreme pandemic fears reported in Wave 2 (n = 38, 7.7%) were associated with worse emotional well-being than the pandemic peak (Wave 1), which then subsided in Wave 3. Pandemic fatigue posed greater negative emotional well-being in Wave 1, whereas pandemic fear was the dominant predictor in Waves 2 and 3.

Pandemic fatigue and pandemic fear together robustly highlight the psychological cost of prolonged pandemic responses, expanding on a framework for monitoring and minimising the unintended mental health ramifications of anti-epidemic policies.