International migration is a complex phenomenon of global and historical relevance. It includes voluntary, forced, and workforce migration, shaped by diverse determinants. Push factors comprise war, persecution, and political instability, while pull factors include stability, economic opportunities, education, and favorable living conditions. Forced migration is frequently associated with displacement and a disproportionate burden of mental health disorders, which are urgent yet difficult to address due to structural, cultural, and legal barriers.

Evidence demonstrates that restricted health care access exacerbates psychiatric disorders, while treatment delays contribute to poorer outcomes. Barriers include administrative limitations, linguistic and cultural differences, stigma, and resource shortages. This policy paper was developed by the Committee on Ethics and the Task Force on Migration and Mental Health of the European Psychiatric Association (EPA). Relevant literature was reviewed and combined with the professional expertise of committee members. The draft was subsequently evaluated by the Publication Committee and the EPA Board, and revised accordingly.

Ethical principles in refugee care are insufficiently implemented in many European countries. Core principles of medical ethics – beneficence, respect for autonomy, non-maleficence, and justice – as well as the obligation to advance psychiatric standards and apply psychiatric expertise for societal benefit, are inconsistently upheld.

The primary duty of physicians is to promote health and well-being through competent, timely, and compassionate care. The EPA therefore advocates coordinated strategies to mitigate the mental health consequences of war, displacement, and trauma, and to secure equitable access to psychiatric services for migrants and refugees.

Mental disorders affect nearly 970 million people worldwide, impacting individuals and healthcare systems. Large population databases offer insights often unattainable in smaller studies, but their findings may not always generalize across diverse regions. To address this, we introduce a European cohort from Catalonia, Spain, allowing for comparisons between individuals with mental disorders and the general population.

Data were obtained from the “Programa d’analítica de dades per a la recerca i la innovació en salut” (PADRIS). The cohort included all individuals who accessed public specialized mental health services between 2015 and 2019, with retrospective follow-up extending to 2010. These individuals, referred to as cases, were matched by age, sex, and health region with controls, individuals who had no interactions with mental health services during the same period. Sociodemographic and clinical characteristics, including psychiatric diagnoses, comorbidities, smoking status, healthcare utilization, and prescribed treatments, were analyzed.

The study included 1,421,510 individuals (mean age: 41.6±22.1; 53.6% female), with 473,812 cases and 947,698 controls. Cases were more likely to be exempt from income reporting, be ever-smokers, and have musculoskeletal comorbidities. A total of 1,547,374 psychiatric diagnoses were recorded, with anxiety (31.38%) and mood disorders (18.83%) being the most frequent. Over the follow-up, 76.2 million primary care visits and 67.1 million prescriptions were recorded.

This cohort enhances our understanding of mental health service use, diagnostic trends, and treatment patterns in Catalonia. The insights derived from this cohort have the potential to inform mental health policies, improving outcomes within and beyond the region.

The medical profession is associated with high demands and occupational stressors – including confrontation with illness and death, extended work hours, and high workload – which may increase the risk of traumatization and posttraumatic stress disorder (PTSD). This systematic review aimed to synthesize evidence on prevalence of PTSD among physicians and examine potential moderators, including the COVID-19 pandemic, specialties, and geographic regions.

A systematic search was conducted in PubMed, Web of Science, PsychINFO, and PubPsych up to April 2025. Included studies were English-language, peer-reviewed, observational studies, reporting PTSD prevalence in physicians, using validated instruments. Studies focusing on preselected PTSD cases or mixed healthcare samples were excluded. Data extraction included study methodology, measurement tools, geographic region, specialty, and survey timing (pre-/“post”-COVID). Risk of bias was assessed using the JBI critical appraisal checklist for prevalence studies. Quantitative synthesis and moderator analyses were performed. The review was registered with PROSPERO (ID CRD42023401984).

Based on 81 studies (N = 41,051), the pooled PTSD prevalence using a random-effects model was 14.9% (95% CI [0.132–0.168]). Prevalence estimates were lower in high-income (13.6%) compared to middle-income countries (21.1%) (p < 0.036). Studies employing brief screening tools (≤10 items) yielded significantly lower prevalence estimates (10.2%) than those using longer instruments (16.4%) (p < 0.027). No other significant moderators were identified.

PTSD prevalence among physicians is elevated relative to the general population, with notable variation across regions and measurement approaches. Future research should address gaps in representativeness and geographic coverage to improve prevalence estimates and guide prevention strategies.

Bipolar disorder (BD) is assumed to follow a progressive course, conceptualized through staging models. It is unclear whether white matter (WM) microstructure abnormalities, central to BD pathophysiology, parallel this development throughout disease progression. This study explored the link between WM and disease progression in BD, using a comprehensive approach based on clinical staging models.

This cross-sectional diffusion tensor-imaging study included 153 BD patients and 153 healthy controls (HCs) matched for age, sex, and study site. Using tract-based spatial statistics (TBSS), we examined associations between WM integrity and three criteria: (1) number of manic episodes, (2) remission quality between episodes, and (3) inter-episode global functioning.

Analyses revealed significant fractional anisotropy (FA) differences between early and late stages of BD based on the number of manic episodes (ptfce-FWE = 0.003), but not on remission quality (ptfce-FWE = 0.075). However, compared to HC, BD patients with persistent symptoms between episodes showed more widespread FA differences (ptfce-FWE < 0.001) than those with stable remission (ptfce-FWE = 0.031). Regression analyses indicated a positive association between global functioning and FA in euthymic BD patients (ptfce-FWE < 0.001).

Results indicated more severe WM disruptions in patients at advanced stages compared to earlier stages of the disease. While these findings may imply changes occurring with disease progression, the cross-sectional design cannot rule out that they instead reflect stable clinical subtypes of varying severity. The results highlight the clinical relevance of WM alterations and the need for longitudinal studies to better understand the neurobiology and complexity of BD.

People with severe mental disorders (SMDs) have about 15 years shorter life expectancy than the general population. Cardiovascular disease (CVD) is among the leading causes of premature mortality and shares genetic underpinnings with SMDs. We investigated the link between clinical traits in SMDs and time to the first CVD diagnosis.

The study included 1,627 well-characterized participants with schizophrenia spectrum (SCZ, N = 998) and bipolar spectrum disorders (BDs, N = 629), and a reference group of 1,201 healthy controls. CVD diagnoses were obtained from two Norwegian national registries (covering both primary and specialist health care) for the period of 2006–2020. Applying Cox proportional hazard models, we investigated associations between SMD clinical traits and time to first CVD diagnosis in SMD participants, adjusting for age, sex, diagnosis, and tobacco use.

Among individuals with SMD, recurring self-harming behavior (SHB) was associated with a shorter time to first CVD diagnosis (p = .029) relative to those without SHB. In the subgroup with SHB and a history of attempted suicide(s), more suicide attempts were associated with shorter time to first CVD diagnosis (p = .041). Significant associations of time to first CVD diagnosis with age at SMD onset and comorbid substance use disorder were not demonstrated.

SHB and a history of suicide attempts in individuals with SMD seem to be associated with earlier CVD onset, and may improve the prediction of CVD, in addition to standard cardiovascular risk factors.

The prevalence of prolonged symptoms following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represents a significant health challenge with potentially severe individual and societal costs. Our study investigates the long-term cognitive and mental health consequences associated with post-coronavirus disease 2019 (COVID-19) condition (PCC) following a mild SARS-CoV-2 infection.

We conducted longitudinal assessments of cognitive performance and mental health in 50 post-COVID-19 patients and 48 matched healthy controls across 10 months, starting on average 2 years after infection. Cognitive function was evaluated using a comprehensive neuropsychological battery of standardized tests, while mental health was assessed via self-reported questionnaires. Data were analyzed with linear mixed models.

Initial group differences in cognitive performance were observed for memory, executive functioning, and perceptual speed, with worse performance in patients. Improvement across the follow-up period occurred for most tasks, with PCC patients displaying greater improvement compared to healthy controls for some memory and executive function tasks, reaching performance levels of the control group. Fatigue and mental health measures remained elevated in the patient group, with worsening in general fatigue and a small improvement in fatigue after cognitive testing. Factors such as male sex, absence of burnout history, and lower depression scores at baseline predicted cognitive recovery in the patient group.

Our study underscores the importance of addressing cognitive and psychological effects following mild SARS-CoV-2 infection, as persistent fatigue, low mental health, and cognitive impairments significantly impact individuals’ ability to return to their pre-COVID professional and personal lives.

Psychosocial interventions for people with mental illness are increasingly focusing on facilitating recovery and self-care. Despite evidence from Europe on the short-term effects of recovery self-planning programs for people discharged from crisis resolution teams, similar programs and supporting evidence in other countries or healthcare contexts are lacking, particularly regarding cultural adaptation and long-term assessment. This randomized controlled trial compared a 4-month peer-facilitated, recovery-focused self-illness management (Peer-RESIM) program for Chinese adults with first-episode psychosis with psychoeducation (PE) and treatment as usual (TAU).

Patients (N = 198) were recruited from four Integrated Community Centres for Mental Wellness in Hong Kong and randomly assigned to the Peer-RESIM, PE, or TAU group (66/group). The primary outcomes were recovery and functioning levels; the secondary outcomes were psychotic symptoms, problem-solving ability, rehospitalization rate, and service satisfaction. Assessments were conducted at baseline and immediate, 9, and 18 months postintervention.

The generalized estimating equation test revealed that the Peer-RESIM group reported significantly greater improvements in recovery, functioning, problem-solving ability, psychotic symptoms, average duration of rehospitalizations, and service satisfaction (p = 0.01–0.04, small to large effect sizes) than the TAU group at all three posttests and the PE group at 18 months postintervention.

The Peer-RESIM can enhance long-term recovery and self-care in adults with early-stage psychosis.

Maternal depressive symptoms can influence brain development in offspring, prenatally through intrauterine programming, and postnatally through caregiving related mother–child interaction.

The participants were 5-year-old mother–child dyads from the FinnBrain Birth Cohort Study (N = 68; 28 boys, 40 girls). Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at gestational week 24, 3 months, 6 months, and 12 months postnatal. Children’s brain imaging data were acquired with task-free functional magnetic resonance imaging (fMRI) at the age of 5 years in 7-min scans while watching the Inscapes movie. The derived brain metrics included whole-brain regional homogeneity (ReHo) and seed-based connectivity maps of the bilateral amygdalae.

We found that maternal depressive symptoms were positively associated with ReHo values of the left amygdala. The association was highly localized and strongest with the maternal depressive symptoms at 3 months postnatal. Seed-based connectivity analysis did not reveal associations between distal connectivity of the left amygdala region and maternal depressive symptoms.

These results suggest that maternal depressive symptoms soon after birth may influence offspring’s neurodevelopment in the local functional coherence in the left amygdala. They underline the potential relevance of postnatal maternal distress exposure on neurodevelopment that has received much less attention than prenatal exposures. These results offer a possible thus far understudied pathway of intergenerational effects of perinatal depression that should be further explored in future studies.

Knowledge of the impact of perimenopause on women with attention-deficit/hyperactivity disorder (ADHD) is lacking. We compared levels of perimenopausal symptoms and prevalence of severe perimenopausal symptoms among women with and without ADHD across age groups.

In this cohort study, we used data from the population-based Stress-and-Gene-Analysis cohort study. ADHD diagnosis was self-reported at baseline and 5-year follow-up. At follow-up, we assessed ADHD symptoms using the Adult ADHD Self-Report Scale, perimenopausal symptoms (psychological, somatic, and urogenital) using Menopause Rating Scale (MRS), and general physical symptoms using Patient Health Questionnaire. We described mean scores and mean difference on MRS among women with and without ADHD with linear regression models and contrasted the prevalence of severe perimenopausal symptoms among women with and without ADHD, calculating prevalence ratios (PRs) with 95% confidence intervals (CIs) using modified Poisson regression models.

Women with ADHD (n = 535) had higher total perimenopausal symptom scores (18.0 vs. 13.0, p < 0.01) than women without ADHD (n = 4,857). The difference was most pronounced among women aged 35–39 years (19.0 vs. 12.5, p < 0.01). The prevalence of severe perimenopausal symptoms was significantly higher among women with ADHD compared to those without, both overall (54.2% vs. 30.1%, PR = 1.80, 95% CI = 1.64–1.98) and on all subdimensions (psychological: 58.6% vs. 36.0%, PR = 1.63, 95% CI = 1.51–1.76; somatic: 30.4% vs. 13.9%, PR = 2.20, 95% CI = 1.88–2.57; uro-genital: 43.2% vs. 27.5%, PR = 1.57, 95% CI = 1.40–1.77).

Women with ADHD have higher prevalence of severe perimenopausal symptoms. These symptoms present at an earlier age than among women without ADHD, indicating an earlier onset age of perimenopause in ADHD.

Benzodiazepines (BZ) are widely prescribed to patients with severe mental illnesses, yet their long-term impact on global health remains underinvestigated. While their symptomatic benefits are acknowledged, data on their associations with quality of life (QoL), metabolic comorbidities, and side effects are limited.

In this cross-sectional study, we analyzed clinical data from 1,248 patients with schizophrenia, bipolar disorder (BD), or major depressive disorder at a psychiatric center in Marseille, France. Associations between BZ use and key outcomes – including QoL (Short Form Health Survey [SF-36], EuroQol-5 Dimensions [EQ-5D], and Schizophrenia Quality of Life Questionnaire - 18 items [SQoL-18]), metabolic parameters, and treatment side effects (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale [UKU scale]) – were examined using multivariate regression analyses.

BZ use was significantly associated with lower QoL scores on physical and mental health domains of the SF-36 (p < 0.001), increased impairment across EQ-5D dimensions, and reduced subjective well-being (SQoL-18, p = 0.043). BZ users also presented higher rates of obesity, diabetes, and metabolic syndrome (all p < 0.05). Furthermore, BZ use was independently associated with a higher burden of side effects across UKU subscales, particularly in the psychiatric domain (emotional blunting, anxiety, and depressive symptoms; p = 0.003).

These findings suggest that BZ use in severe psychiatric disorders may be linked to a substantial multidimensional health burden, including reduced QoL, greater side effect profile, and increased metabolic risk. These results highlight the need for evaluation of long-term BZ use and the promotion of safer alternative treatments.

Late-life depression (LLD) is prevalent in older adults and linked to increased disability, mortality, and suicide risk. Insomnia symptoms are considered common remaining symptoms of LLD following treatment. However, the multivariate relationship between insomnia and depressive symptoms and the impact of psychotherapy on their interrelationship is insufficiently assessed.

We conducted a secondary analysis of data from 185 patients with LLD, recruited from seven university hospitals in Germany as part of a larger original cohort study. Participants had undergone eight-week psychotherapy interventions (cognitive behavioral therapy or supportive unspecific intervention). Three regularized canonical correlation analyses (rCCA) assessed the multivariate association between insomnia and depressive symptoms at baseline, post-treatment, and six-month follow-up. rCCA was conducted within a machine learning framework with 100 repeated hold-out splits and permutation tests to ensure robust findings. Canonical loadings and cross-loading difference scores were calculated to examine symptom changes before/after psychotherapy (Holm-Bonferroni corrected p-value <0.05).

At baseline, a moderate association was observed between insomnia and depressive symptoms (r = 0.24). Interestingly, this association slightly increased after the eight-week treatment period (r = 0.42, pcorrected = 0.064) and remained significantly elevated at the follow-up session (r = 0.48, pcorrected = 0.018). At baseline, anxiety-related depressive symptoms were mainly associated with insomnia, while at post-treatment and follow-up sessions, somatic and negative affective symptoms showed the strongest correlation with insomnia symptoms. While the relative relationship of depressive symptoms with insomnia altered after psychotherapy, the pattern of insomnia symptoms remained stable.

The observed changes in the association between insomnia and depressive symptoms after psychotherapy highlight the necessity to consider targeting insomnia for effective LLD treatment.

Urbanization, the shift of a growing population into urban areas, is shaping global development across infrastructure, health, and sustainability. Although it brings economic growth, innovation, and improved access to services, it may also impact mental health.

The present article was prepared on behalf of the European Psychiatric Association and explores the complexity of associations between urbanization and mental health, highlighting both potential risks and opportunities for improvement.

Urban growth often leads to increased population density, social fragmentation, and environmental stressors, including noise, pollution, and reduced green spaces, all of which might account for worsening mental health. Urban residents might be at risk of various mental disorders due to these stressors, accompanied by the risk of social disconnection. Moreover, socioeconomic disparities in urban settings can lead to unequal healthcare access, further contributing to these challenges. However, urbanization also offers unique opportunities to improve mental health through better resource allocation, innovative healthcare solutions, and community-building initiatives. Indeed, cities might serve as areas for mental health promotion by integrating mental health services into primary care, utilizing digital health technologies, and fostering environments that promote social interactions and well-being. Urban planning that prioritizes green spaces, safe housing, and accessible public transportation holds the potential to mitigate some risks related to urban living.

While urbanization presents significant challenges to mental health, it also provides grounds for transformative interventions. Addressing the mental health needs of urban populations requires a multifaceted approach that includes policy reform, community engagement, and sustainable urban planning.

Telomere shortening is shared by all psychiatric disorders and is hypothesized as resulting from decreased telomerase activity (TA) or expression of the TERT (Telomerase Reverse Transcriptase) gene.

A search in four English databases was conducted from inception to November 2024 to evaluate the association between psychiatric disorders and telomerase activity (TA) or TERT gene expression in peripheral blood. We performed two separate meta-analyses to generate pooled effect size (ES) for TA and TERT gene expression, followed by meta-regression.

The systematic review included 16 studies, 14 of which were included in the meta-analyses. When considering all psychiatric disorders, no associations were found for TA (ES = 0.08 [−0.50–0.67], p = 0.78 – I-squared = 95%), nor TERT gene expression (ES = 0.00 [−0.56–0.57], p = 0.99 – I-squared = 91%). However, TA was elevated in mood disorders (ES = 0.61 [0.06–1.16] – p = 0.03), while decreased in non-mood disorders (ES = −0.70 [−1.37 – −0.03] – p = 0.04). ES for TA were larger in mood disorders as compared to other disorders (p = 0.003).

This meta-analysis shows that psychiatric disorders – taken together – are not associated with peripheral blood TA or TERT gene expression. Nevertheless, we find that TA is increased in depressive disorders (unipolar or bipolar), whereas decreased in non-mood psychiatric disorders. The paucity of studies and small sample sizes are important limitations, especially for TERT gene expression. Further research is needed, incorporating a broader spectrum of psychiatric disorders and larger sample sizes.

Transition from a categorical to a dimensional approach has been proposed in the field of psychosis. However, whether key features of schizophrenia, such as cognitive deficits, really do lie along a linear continuum remains uncertain. To explore this, we compared for the first time verbal learning impairments in six entities of the psychosis spectrum using linear, nonlinear, and categorical models.

Studies involving verbal learning tests in familial high risk, clinical high risk, schizotypy/schizotypal, ultra-high risk, first episode of psychosis (FEP), and chronic schizophrenia populations were systematically searched in three databases in September 2024. Studies were included if they reported an immediate, delayed, or total recall measure in subclinical or clinical entities and healthy controls. The metafor package was used to compute effect sizes for the comparison between cases and control groups, categorized by psychosis entities. Model comparisons were also performed to compare linear, nonlinear, and categorical distributions of the effect sizes.

The meta-analysis aggregated a total of 262 studies in the psychosis spectrum. Effect sizes were moderate in at-risk populations (<0.50) and large in clinical populations (−1.00 for FEP and >1.00 for chronic schizophrenia). A nonlinear model best explained our data in immediate recall, while the results in delayed and total recall suggest the inferiority of linear models.

Our findings suggest a discontinuity in verbal learning between at-risk populations and clinical entities, challenging a purely linear dimensional model of cognitive impairment in the psychosis spectrum.

Lithium treatment is associated with reduced mortality in bipolar disorder (BD), but the role of treatment continuity remains underexplored. This study investigated the association between patterns of lithium exposure and all-cause mortality in a population-based cohort.

We analyzed electronic health records from 15,384 individuals with BD in Catalonia, Spain (2010–2019). Patients were classified as having sustained, partial/intermittent, or no lithium exposure based on annual defined daily doses (DDDs). All-cause mortality was the primary outcome. Kaplan–Meier and Cox regression analyses (adjusted for sociodemographic, clinical, and treatment-related variables) estimated hazard ratios (HRs) for mortality risk. Interaction and sensitivity analyses were conducted to assess the role of comorbidity burden and dose effects.

Over the study period, 715 deaths were recorded. In fully adjusted models, sustained lithium exposure was associated with a significantly lower mortality risk compared to no exposure (HR = 0.69, 95% confidence interval [CI]: 0.51–0.93, p = 0.016). In the lithium-exposed subgroup, sustained use was also protective compared to partial/intermittent exposure (HR = 0.70, 95% CI: 0.51–0.97, p = 0.03). No significant interaction was observed between sustained lithium use and comorbidity burden. Sensitivity analyses confirmed this effect at lower dose thresholds but not at higher ones.

Sustained lithium use is associated with improved survival in BD. Discontinuous exposure does not confer the same benefit. Ensuring treatment continuity may maximize lithium’s protective effect and improve long-term outcomes.