Cannabis use has been increasing among women of reproductive age in the last few decades. In-utero cannabis exposure could be associated with an increased risk of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) during childhood and adolescence; however, existing evidence was generated based on maternal self-report of cannabis use in pregnancy. We conducted a large-scale with data linkage cohort study, in which both exposure and outcome of interests were confirmed using diagnostic tools, ICD-10-AM.

This study aimed to examine the association between prenatal cannabis use disorder (CUD) and neurodevelopmental disorders in offspring using a large-scale cohort study.

We conducted an administrative health data-based cohort study of 222,569 mother-offspring pairs using linked data obtained from health registries in New South Wales (NSW), Australia. Data were drawn from the NSW Perinatal Data Collection (PDC), which included all live births in the Australian state of NSW between January 2003 and December 2005. These were linked with the NSW in-patient and ambulatory data collections for mothers and offspring. The prenatal cannabis use disorder (exposure) and neurodevelopmental disorders in offspring (outcomes of interest) were measured by using ICD-10-AM. Generalized linear regression with a binomial family model was used to explore the association. We also carried out a modification/interaction effect of low birth weight (LBW), smoking and premature births (PTB), which enhanced the methodological robustness of the study.

This study found that offspring from mothers with prenatal CUwD had a 98%, 94% and 46% increased risk of ADHD [aRR = 1.98: 95 % CI 1.36 – 2.88], ASD [aRR = 1.94: 95 % CI 1.34 – 2.82], and ID [aRR = 1.46: 95 % CI 1.01 – 2.63] compared to those non-exposed offspring, respectively. We observed a significant interaction effect between CUD during pregnancy and maternal smoking on the risk of childhood ADHD, ASD and ID [CUD*smoking: RR = 5.62: 95 % CI 3.77 – 8.39, RR = 2.72: 95 % CI 1.78 – 4.18, and RR = 2.84: 95 % CI 1.54 – 5.22, respectively]. Furthermore, we also found significant associations between PCUD and ADHD, ASD and ID when interacting with LBW, and PTB.

Maternal prenatal CUD is associated with a higher risk of ADHD, ASD, and ID in offspring. The effect of maternal CUD on neurodevelopmental disorders was also found to be stronger when mothers also reported smoking during pregnancy, compared to the individual effects of cannabis use or smoking alone. The findings highlight the importance of implementing preventive strategies to reduce cannabis use in pregnancy.

None Declared

Individual Placement and Support (IPS) is a supported employment method used for the vocational inclusion of individuals with mental disorders. There is vast evidence that IPS is effective for finding jobs. However, evidence concerning the applicability of IPS for persons with mental disorders receiving a disability pension and concerning the sustainability of IPS is scarce.

The aim of the studies included in this report was to a) control for the applicability of IPS for persons receiving a disability pension and b) to gain insight in the sustainability of IPS in this context.

A randomized controlled trial with 250 participants was conducted. The participants in the intervention group received job coaching according to the IPS standard. Members of the control group received no organized support but were allowed to seek assistance on their own. The initial phase of the study lasted 24 month. Job coaching was delivered only in the first phase of the study and discontinued after 24 month. A follow up was performed six years after the start of the study to clarify the further course (number of employment relationships, degree of employment, duration of employment, salary).

In the first phase of the study, the overall dropout rate was 32%. 114 participants (46% of the original number of participants) took part in the follow-up survey. The intervention was superior to the control condition in the first phase. There were no significant differences between the groups in terms of number of employment relationships, degree of employment, length of employment, and salary in the follow up.

The effect of a clear superiority of the IPS intervention with regard to the number of employment relationships, which was measured during the originally planned duration of the study, was only slightly detectable six years after the start of the study and up to four years after the end of the intervention and was no longer statistically significant. This result underlines the importance of continuing job coaching for an unlimited period of time, as called for in the IPS concept, in order to perpetuate the positive effects such as finding and maintaining a job in the primary labor market.

None Declared

Lack of adherence to pharmacological treatment is considered a multifactorial phenomenon, remarkably frequent in clinical practice. Non-adherence is associated with increased number of relapses, poor clinical and functional outcomes, and worsening of patient health status, with a resulting increase in healthcare costs, particularly in people with severe mental disorders (SMD). Treatment adherence rates remain extremely low, highlighting the need to develop innovative and integrated strategies; one of these is represented by the promotion of healthy lifestyle behaviours, including regular physical activity.

The aim of this study is to assess how the rates of treatment adherence vary in patients with SMD after receiving a psychosocial intervention, focusing on the positive relationship between treatment adherence and physical activity.

LIFESTYLE is a randomized controlled trial comparing the efficacy of a structured psychosocial lifestyle intervention involving moderate physical activity exercises over a brief psychoeducational intervention. Levels of physical activity was assessed thorough the IPAQ scale, while treatment adherence was evaluated by the Morisky Medication Adherence Scale (MMAS).

The sample includes 401 patients, with a mean duration of illness was 16.3 (±17.8) years. All patients were receiving a pharmacological drug treatment; in particular, 59.6% (N=239) were treated with a second-generation antipsychotic and 54.9% (N=220) with a mood stabilizer. Our results show that moderate physical activity improves rates of treatment adherence. After 6 months, adherence to treatment increased from 35.8% at baseline to 47.6% at baseline in the experimental group, along with improvement in clinical health parameters (reduction in BMI, weight, and metabolic parameters). Another significant inverse correlation was found between adherence and quality of life (Rho di Person: -.140, p<.005). Furthermore, this study indicates that having a diagnosis of major depression, a better cognitive functioning, a shorter duration of illness and contact time with the local mental health centre are factors that positively influence treatment adherence. Remarkably, treatment adherence was not influenced by symptom severity and type of pharmacological treatment.

Moderate physical activity can represent a valid strategy to increase treatment adherence in patients with SMD. Therefore, promoting physical activity exercises in our clinical practice may be associated with better outcomes. However, further studies that evaluate patients with acute mental disorders are needed.

None Declared

Mental health-related stigma occurs not only within the public community but is also an issue among healthcare professionals. The relationship between national culture and provider stigma remains yet to be empirically attested.

We performed a cross-sectional multicentre study across 32 European countries to investigate the attitudes of psychiatrists towards patients with mental health problems. We aimed to examine the relationship of attitude with country-specific indicators.

We measured stigmatizing attitudes using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) within an online survey among specialists and trainees in general adult, child and adolescent psychiatry. Its total score was correlated with the Human Development Index (HDI), the Democracy Index (DI), the Social Progress Index (SPI), the number of psychiatrists per 100,000 people, and the Hofstede dimensions. Latent class analysis was done to find subgroups of countries according to the stigmatizing attitudes of psychiatrists and the six Hofstede dimensions.

Altogether, n=4245 participants completed the survey. The total score of the OMS-HC significantly correlated with the long-term orientation (r=0.453, p=0.015) and indulgence dimensions (r=-0.629, p<0.0001) and with the HDI (r=-0.503, p=0.005), DI (r=-0.418, p=0.024), SPI (r=-0.348, p=0.040). The latent class analysis separated high- and low-stigma countries. High stigma was associated with high power distance and uncertainty scores.

Findings from this study not only expand knowledge of factors related to stigmatizing attitudes of healthcare professionals, but also enlighten the cultural aspects of the stigma that could contribute to the further development of anti-stigma programs.

D. Őri Grant / Research support from: Research grant form the Fulbright Association, P. Szocsics: None Declared, T. Molnár: None Declared, L. Bankovska Motlova: None Declared, O. Kazakova: None Declared, S. Mörkl: None Declared, M. Wallies: None Declared, M. Abdulhakim: None Declared, S. Boivin: None Declared, K. Bruna: None Declared, C. Cabaços: None Declared, E. A. Carbone: None Declared, E. Dashi: None Declared, G. Grech: None Declared, S. Greguras: None Declared, I. Ivanovic: None Declared, K. Guevara: None Declared, S. Kakar: None Declared, K. Kotsis: None Declared, I. Klinkby: None Declared, J. Maslak: None Declared, S. Matheiken: None Declared, A. Mirkovic: None Declared, N. Nechepurenko: None Declared, A. Panayi: None Declared, A. Pereira: None Declared, E. Pomarol-Clotet: None Declared, S. Raaj: None Declared, P. Rus Prelog: None Declared, J. Soler-Vidal: None Declared, R. Strumila: None Declared, F. Schuster: None Declared, H. Kisand: None Declared, A. Reim: None Declared, G. Ahmadova: None Declared, M. Vircik: None Declared, H. Yilmaz Kafali: None Declared, N. Grinko: None Declared, Z. Győrffy: None Declared, S. Rózsa: None Declared

Open-door policy (ODP) is an approach to reduce coercion in psychiatric wards recommended by the World Health Organization and the Council of Europe. Observational studies from Switzerland and Germany have shown promising results in reducing coercion, but no RCTs have been conducted. Skeptics have been concerned the observational evidence could mask that ODP could increase risks and harms and / or increase the use of coercive measures staff use to assist patients with psychoses, while proponents have argued that de-escalation and alliance-building will result in no such increase.

To evaluate open-door policy in an openly randomised, ethical-board approved trial of all patients referred to ward care at the Lovisenberg Diaconal Hospital in Oslo, Norway.

A 12-month pragmatic, randomised-controlled non-inferiority trial comparing two ODP and three TAU acute psychiatric wards. The trial was pre-registered (ISRCTN16876467) and conformed to CONSORT. Ethical committee exemption enabled waiver of consent rules for the study, meaning all regular patients were included. Patients were randomly assigned (2:3 ratio) by a clinical admissions team using an open list. The non-inferiority margin was 15 % on the primary outcome: the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation/seclusion, and physical and mechanical restraints. Primary and safety analyses were based on intention-to-treat. Safety analyses included suicides and violent events against staff. Secondary outcomes were individual coercive measures, intensive care, resource use, and patient feedback.

N=556 patients were included and randomised and were similar on all pre-admission demographics: Around 75% of patients were diagnosed with a psychotic disorder and were involuntarily admitted. Primary outcome: Use of coercive measures was within the non-inferiority margin (see table 1). Safety outcomes: No suicides occurred during ward care in any group. Violence against staff did not differ between study wards. Secondary outcomes: Use of intensive care (‘skjerming’) and number of days admitted was significantly less on open-door policy wards. Patients on open-door policy wards rated their experience of coercion and ward atmosphere better than patients on control wards.Table 1.

Absolute and relative risk of being subjected to coercion on open-door policy or usual-treatment wards.

This first RCT found open-door policy does not increase use of coercion or resource use. It does not harm staff or patients and is experienced as better by patients.

None Declared

Chronic stress, anxiety, and depression can interfere with young adults’ everyday function, academic achievement, and interpersonal relationships. Interventions aimed at preventing the deterioration or possibly onset of these mental disorders among young people are timely.

To assess the impact of a supportive text messaging program (Text4Hope) on the psychological well-being of young adults.

This study adopted both longitudinal and naturalistic controlled trial designs. Longitudinal study: compared baseline and 6th week outcomes in the same group of young adult subscribers. Naturalistic controlled study: compared clinical parameters in two groups of Text4Hope young adult subscribers: (i) intervention group (IG), subscribers who received once-daily supportive text messages for 6-weeks and completed 6th-week evaluation between 26 April and 12 July 2020, and (ii) control group (CG), subscribers who joined Text4Hope the same time frame, completed a baseline survey and were yet to receive text messages. The prevalence and severity of moderate-high stress, anxiety, and depression was measured using standardized scales. Inferential statistics, including the t-test, McNemar test, chi-square, and binary logistic regression analyses, were used to evaluate the differences in the prevalence and severity of the psychological symptoms.

Longitudinal study: subscribers who completed both the baseline and 6th-week surveys, had significant reduction in the prevalence of moderate-high stress (8%) and likely GAD (20%) from baseline to six weeks. The largest reduction in mean scores was for the GAD-7 scale (18.4%). Naturalistic study: significantly lower prevalence for likely Moderate Depressive Disorder (25.2%) and suicidal thoughts/thoughts of self-harm (48.4%), with a small effect size in the IG compared to CG.

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TheText4Hope program has been demonstrated as an effective e-mental health tool for mental health support for young adult subscribers. This is particularly encouraging, as young adults have already adapted to SMS text messaging and texting. Therefore, this mode of intervention can be used to supplement existing treatments for psychological problems impacting young adults. In addition, the cost effectiveness and easy scalability of supportive text message interventions mean that policymakers and governments can quickly implement similar programs as part of national youth suicide prevention strategies.

None Declared

The incorporation of artificial intelligence (AI) in healthcare, especially in mental health services, offers potential advancements in efficiency and personalization. As AI technologies like machine learning and natural language processing (NLP) continue to evolve, it’s vital to evaluate their applications in psychiatry comprehensively.

This review aims to summarize and characterize studies that used AI, particularly machine learning and NLP, in mental health. Additionally, it endeavors to understand how these technologies may enhance diagnostic tools, symptom monitoring, and delivery of personalized treatment in psychiatry.

Adhering to PRISMA guidelines, a systematic search was executed across multiple medical databases, including PubMed, Scopus, ScienceDirect, and PsycINFO. Keywords encompassed machine learning, data mining, psychiatry, and mental health. Exclusion criteria included non-English papers, anonymization process descriptions, case studies, conference papers, and other reviews. Data from various segments in the provided information were synthesized to capture the broader picture of AI’s application in psychiatry.

From the 327 articles initially identified, 58 were chosen for detailed review. Studies predominantly revolved around three main populations: patients in medical databases, emergency room visitors, and social media users. The primary applications of AI entailed symptom extraction, illness severity classification, therapy effectiveness comparison, and psychopathological insights derivation. Data sources mainly included medical records and social media, with Python emerging as the preferred platform for most studies.

While AI shows immense promise in revolutionizing mental health care, its current applications largely confirm existing clinical hypotheses. Ethical concerns, such as patient privacy and data biases, remain paramount. Future work should delve deeper into these challenges while further exploring AI’s potential in clinical psychiatry practice.

None Declared

Previous research demonstrated that disasters have adverse mental health outcomes. Preventive mental health interventions in the golden hours/days after a disaster may reduce psychological harm by getting in the way of emerging mental disorders or alleviating existing ones. The widespread use of smartphones and broad internet access enabled remote mental health interventions during disasters. After the 2023 Turkey earthquake, observing the mental health burden of the earthquake, The Psychiatric Association of Turkey conducted an online platform for psychological first aid. The aim was to unite volunteer psychiatrists and disaster survivors.

This study presents the organization of an online mental health service during a disaster while reporting the characteristics of the service users.

The Psychiatric Association of Turkey called its members to volunteer for an Online Support System for Mental Problems After the Earthquake. The group regularly united to set standards of care. An action plan and algorithm were set up for applicants with acute suicidal, homicidal risk, or active psychotic symptoms in collaboration with local institutions and field volunteers. Volunteer psychiatrists were asked to collect information on the applicant’s sociodemographic characteristics, disaster experience, and mental health status.

Volunteer psychiatrists collected data on 180 applications. Most cases applied for themselves (%95.5), and some asked for advice to care for their relatives (%4.5). Earthquake survivors have the highest psychopathology rate (%64.9), followed by healthcare workers and search and rescue personnel (%61.1). Figure 1 summarizes the subgroups of the service users. The earthquake survivors group had a mean age of 34.45, % and 76.1 of them were female. Only %15.7 of them had lower educational levels than high school. %75 cases reached safe places on the 5th day of the disaster. Applicants reported discrimination and aggression after the catastrophe, related to experiencing mental health problems, owning a pet, looting, and being seen as less traumatized since their relatives are alive.

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The present experience of the Psychiatric Association of Turkey is an example of a fast and collaborative response to a disaster regarding mental health. Our results also represent the characteristics of online mental health service users during a disaster.

None Declared

Digital technologies and interventions (defined as patient-facing or self-administered interventions delivered through a digital platform) have an increasing role in mental health care. It is key to ensure that appropriate patient and public involvement (PPI) is not overlooked when developing new digital mental health interventions (DMHIs). The unique perspective offered by those with lived experience can improve study conduct and design as well as ensure that interventions meet the needs of users, which may improve their quality and acceptability.

To develop guidance for the involvement of people with lived experience of severe mental illness in designing and conducting research on DMHIs.

Four co-production workshops were arranged online with people who have lived experience of severe mental illness. Initial ideas were formulated in the first workshop and were then prioritised in the second workshop using the nominal group technique. The prioritised ideas were then refined in workshops three and four. Minutes were generated from each workshop and were validated by the those who took part. These minutes were analysed using thematic analysis.

Nineteen people with lived experience participated in the co-production workshops overall. Six people took part in one workshop only and 13 took part in multiple workshops. Two main themes were identified in this study: why do people become and remain involved in PPI?; and what areas should be discussed within PPI consultations? Three subthemes associated with the second theme were also identified. These are: areas related to specific types of DMHI; areas related to any type of DMHI; and what can make a difference within DMHIs? To ensure that people become and remain interested in PPI around DMHIs, it is important to provide a non-judgemental space for people with lived experience to discuss any concerns and ensure they feel valued during consultations. Aspects to consider discussing in PPI consultations around the development of DMHIs include the provision of safety and security within DMHIs, issues around digital exclusion and the potential impact of people’s symptoms on DMHI use. Finally, points that were identified as important to consider when developing DMHIs include offering encouragement throughout the DMHI, accommodating for individual and collective needs within DMHIs and developing a structure within the DMHI which includes adding in attainable goals.

If used, the information provided from this study can generate positive and productive PPI consultations where those with lived experience can make significant contributions to the development of DMHIs. Such contributions will increase the acceptability and efficacy of the DMHIs developed.

None Declared

Violence in psychiatric inpatient settings is a global challenge. Several methods have been developed and tested to help staff prevent the occurrence of violence on the wards. One novel and effective method is eDASA+APP, originating from Australian forensic psychiatric settings (Maguire et al. Int J Ment Health Nurs 2019; 281186-1197, Griffith et al. Psychiatr Serv 2021; 72 885-890). This electronic method contains an instrument (DASA) to assess the risk for imminent violence and includes evidence-based violence risk management methods for risk levels. It is important to ensure that this electronic intervention is integrated into daily clinical practice. This can be done in co-design between all that are involved e.g., staff and experts by experience, and by encouraging them to achieve a common goal and gain benefits by working together.

This prevention gives an overview of how the Finnish version of eDASA+APP was co-designed with healthcare staff and experts by experience, focusing on integration into the electronic patient health record system. The presentation is part of a larger research project testing eDASA+APP in Finnish psychiatric inpatient care.

Co-design workshops focusing on three major themes: 1) identifying current practices and how eDASA+APP would fit in those, 2) producing a linguistically and culturally appropriate version of eDASA+APP, and 3) preferred use of eDASA+APP in an electronic patient health record system. Notes were kept during the workshops by researchers. Qualitative material were analysed with deductive content analysis. Results from the third theme are shared in this presentation.

Staff and experts by experience described that integration of eDASA+APP in electronic patient health record system is supported if it 1) brings clear and fast information to the staff about the violence risk of a patient, 2) is a visible measure that is concretely in sight in electronic patient health record system, 3) provides information about which violence prevention and management interventions have worked with a patient, 4) involves patient preferences, and 5) consist of joint decisions that have been agreed multi-professionally.

Integration of eDASA+APP in the electronic patient health record system has the potential to succeed if it is realized in cooperation with staff and experts by experience, is technically easy to use, and the users have an understanding of its benefits to everyone involved.

None Declared

Deliberate self-harm (DSH) is a strong indicator of psychological distress and constitutes a significant risk factor for subsequent mortalities.

In this study we want to gain insights into cause-specific mortalities in self-harming patients and to disentangle important factors differentiating the risks so that to inform follow-up care and mortality prevention.

Retrospective data from nationwide registries were interlinked to follow all patients presenting to specialist healthcare with non-fatal DSH from January 2008 through December 2018. Data on cause of death, personal socioeconomic status, clinical features of DSH and other medical covariates were retrieved. The Fine and Gray competing risks model was used to identify significant factors impacting subsequent mortality risk by specific causes of death in the cohort.

The cohort of 43153 DSH patients comprised 24286 females and 18867 males, with 45.3% being 10-34 years old, 38.1% being 35-64 years old and 16.6% above 65 years old at index DSH episode. Of these patients, 7041 died during the follow-up period, including 2290 within the first 1-year, corresponding to a mortality rate of 31.9 per 1000 person-years in the follow-up period and 54.9 per 1000 person-years in the first year. Common causes of death included suicide (n=911), other external causes (n=1020), cancer (n=896), cardiovascular diseases (n=1523), respiratory disease (n=787) and mental and substance misuse disorders (n=463), but the causes of death varied greatly by age groups and other factors. The risk of dying by suicide was highly associated with middle-age, male gender, tertiary education, psychiatric history, and DSH by injury, clear intent of self-harm, comorbid affective or personality disorder, referral to psychiatric treatmen, as well as DSH repetition during the period of follow-up. Significant risk factors for death by other external causes included male gender, old or middle age, single marital status, lowest quartile income, history of psychiatric treatment, and DSH by injury and comorbid substance misuse. For death by natural causes, the relative risk was highest among the elderly and the middle-aged, with other significant risk factors including male gender, single marital status, low education, lowest quartile income, and comorbid substance misuse. Attendance in psychiatric treatment after DSH appeared to be beneficial reducing the risk for mortality by suicide, other external causes and natural causes as well.

Patients with DSH represent a high-risk group for suicide, other external and natural cause mortalities. Mental healthcare is essential in follow-up care and personalized care should take into account patients´ socio-demographic background and clinical features of self-harm.

None Declared

A growing body of research have devoted into suicide and deliberate self-harm in immigrant population, but no study has examined how reason for immigrating to the host country differentiates the risks.

To gain firm insight into suicide and deliberate self-harm among peopel with immigrant background.

Norwegian registers were interlinked to identify all individuals who died by suicide in 1992-2018 and who received emergency treatment for non-fatal deliberate self-harm (DSH) in 2008-2018, and to construct the respective databases via a nested case-control design. Rates and relative risks of suicide and DSH were assessed according to immigrant background, country of birth and reasons of immigration, and in the context of personal socioeconomic status.

People with an immigrant background accounted for 11.6% of all suicides in 1992-2018 and 17.9% of all DSH incidents treated in hospital emergency departments in 2008-2018. The rates of both suicide and DSH were highest in people born abroad with two Norway-born parents (mean rate: 19.4/100 000 for suicide and 280.9/100 000 for DSH) and lowest in the second-generation immigrants. Compared with the native Norwegians, suicide risk was significantly higher for those foreign-born with two Norway-born parents (HR=1.50) and those born in Norway with 1 one foreign-born parent (HR=1.20), but was significantly lower for the first- and second-generation immigrants. The associated risks remained almost unchanged when the data were adjusted for personal differences in education, marital status, income and place of residence in Norway. The analyses on deliberate self-harm exhibited similar patterns of results as for suicide, although the estimated reduced risks in the first- and second-generation immigrant is somewhat smaller. Evidently, the risks for suicide and DSH varied significantly by reason of immigration and country of origin. Immigrants coming for education had the lowest risk for suicide and self-harm, and those coming for work the second lowest. The risks for immigrants coming for family unity were lower than the natives, but significantly higher than counterparts coming for job or education from the same country. Among immigrants coming to Norway as a refugee or asylum seeker, the risk of suicide was comparably high as those coming for work, but the relative risk for self-harm was significantly higher. The increased risks associated with the mixed immigration background tended to be slightly higher in females than in males, and were likely confined to adoptee population.

Risks for suicide and deliberate self-harm in people with an immigrant background differs significantly by reason of immigration and country of origin. The findings should be taken into account in efforts of mental healthcare and suicide prevention targeting immigrant population.

None Declared

Suicide is one of the leading causes of preventable deaths worldwide. The psychiatric disorder that is most strongly associated with suicide is depression. It is crucial to develop clinical tools that can provide objective data to assess suicide risk in clinical settings. Depression and high suicide risk may lead to physiological changes that can affect the speech pattern. Prior research has indicated that the acoustic and prosodic characteristics of speech may hold potential clues for assessing suicide risk. Additionally, specific speech parameters may serve as discriminators for identifying individuals at risk. In recent years, deep learning-based models have yielded successful results in identifying such alterations in speech signals.

The aim of our study was to examine specific voice analysis parameters between control, depressive and high suicide risk groups. We also aimed to investigate the effect of voice-related variables in predicting suicidal behavior in patients with depression using an artificial intelligence model. The results of voice analysis are intended to serve as a starting point for the development of future artificial intelligence algorithms.

The study sample consisted of 30 near-term suicidal patients, 30 patients with major depression and 30 healthy controls. The participants were presented with a pre-determined text and a voice recording was carried out. Feature extraction and model training for three tasks, namely depression or not, suicide or not, and depression or suicide were carried out. Mel-Frequency Cepstral Coefficients (MFCCs), deep learning-based (VGGish), formant and prosodic features were extracted to analyze the sound characteristics of the participants. The Support Vector Machine was used as the machine learning algorithm for classification and the three models were trained for each task. A 10-fold cross-validation was carried out and presented by metrics including accuracy, precision, sensitivity and specificity.

Among the metrics examined, MFCCs for the “Suicide or not” task were found to be more successful with rates of 0.90, 0.88, 0.93 and 0.86 for accuracy, precision, sensitivity, and specificity, respectively. MFCCs were also more successful for the “Depression or suicide” task with rates of 0.68, 0.66, 0.76, and 0.60 for accuracy, precision, sensitivity, and specificity, respectively. Among the metrics examined for the “Depressed or not” task, VGGish was more successful with rates of 0.73, 0.81, 0.70, and 0.76 for accuracy, precision, sensitivity, and specificity, respectively.

To the best of our knowledge, our study is the first to compare the VGGish and other features of speech (MFCCs, prosodic, formant features) between high suicide risk, depression and control groups. Classification parameters developed using the VGGish and MFCCs features of speech could be useful in predicting suicide risk in future studies.

None Declared

Psychotic disorders present a significant lifetime risk for suicide. Past estimates suggest that up to 25-50% of individuals with schizophrenia (SCZ) may attempt suicide during their lifetime. A growing body of literature indicates that the level of cognitive performances may be associated with a differing level of lifetime suicide attempts, albeit inconsistently depending on the diagnostic category and study setting. However, the vast majority of the literature in the field is composed of cross-sectional studies, limiting the overall interpretation of the available evidence.

In the present study, we probed the possible association of BDNF plasma levels, cognitive functions assessed through the Brief Assessment of Cognition in Schizophrenia (BACS) and lifetime suicide ideation and/or attempts (LSI+LSA). More specifically, we tested whether such association would persist during the 2 years follow-up divided in 5 different timepoints at 6-month intervals, if present.

The present study represents a secondary analysis of a previously described cohort (Manchia et al. Brain Sci. 2022 Dec 4;12(12):1666). The sample comprised 105 subjects with SZC or schizoaffective disorder. We employed the 1) Wilcoxon test for non-parametric data 2) linear modelling to test the possible association of BACS-defined cognitive task performances with LSI+LSA. We also investigated if either BDNF plasma levels or four tested BDNF SNP genes would mediate this association.

From a total of 105 subjects, data relevant to the analysis were available for 89 subjects. We observed a significant association between BACS-Letter fluency task (BACS-LF) with LSI+LSA, persisting even when adjusting for gender, duration of untreated psychosis, total Positive and Negative Syndrome Scale score, age, chlorpromazine equivalents of antipsychotic therapy and for the effect of time. The association remained significant even when adjusting with the Bonferroni-Holms method for multiple comparisons (p=0.002). No association was found either for BDNF plasma levels or the tested BDNF genes for the tested outcomes.

In our sample, higher BACS-LF performances appeared to be associated with a higher lifetime risk of LSI+LSA. This report adds to the previous literature suggesting that different cognitive performance levels may represent one of the many chronic risk factors associated with LSI+LSA, and that may ultimately complexly interact with more proximal ones.

None Declared

Stigma towards mental health has been described as a major obstacle to seek help and access to mental health services. This could result in a worsened Quality of Life (QoL). There is a little evidence of stigma in Mental Health Professionals and its consequences, especially in Early Career ones (ECMPH), who can be a more vulnerable group. There is even more lack of studies with multicultural approaches. Exploring stigma, support systems and access to these, and the link of these factors with QoL is essential to develop effective strategies to support ECMHP, for both their own mental health and providing care to patients.

This study aims to explore the association between ECMHP’s stigma towards mental health and their QoL, and to identify predictors of QoL among this population.

In this cross-sectional study, we designed an online survey to collect data among ECMHP, identified as having completed training since less than 7 years. QoL was assessed using the WHO-QoL. Stigma towards mental health was measured with the Opening Minds Stigma Scale for Health Care Providers (OMS-HC). Other general sociodemographic data were also collected. Descriptive results are resumed in absolute and relative frequencies for categorical variables. Student’s t-test and ANOVA were used to analyse scores in WHO-QoL and OMS-HC according to categorical variables. Pearson’s correlation coefficient was used to assess the association between WHO-QoL and OMS-HC. Simple and multiple linear regression were used to study the effect of stigma on QoL, taking into account potential confounders.

We collected data from 277 ECMHP from Europe (54.15%) and Asia (45.85%). Only 20% of our sample knew that their workplace has staff dedicated for mental health practitioners support, and among those, only 44% had visited it. OMS-HC total scores were significantly higher (p<0,05) in nurses and practitioners without a sufficient support system and without a mental disorder. WHO-QoL total scores were significantly higher in participants with sufficient support systems, and without a mental or physical illness. There was a negative correlation between OMS-HC and WHO-QoL total scores. Univariate analysis showed that OMS-HC total scores predicted WHO-QoL total scores. In the multivariate analysis, OMS-HC total scores, having a mental illness and having sufficient support, independently predicted WHO-QoL total scores, even when adjusted for sociodemographic variables.

Stigma towards mental health is related to QoL in ECMHP. Also, having sufficient support in the workplace improves QoL in this population. More studies are needed to help clarify the relationship between stigma and QoL using a longitudinal design.

None Declared

Cardiovascular disease (CVD) is a leading cause of excess mortality in people with severe mental illness (SMI). Physical activity (PA) is widely acknowledged with multiple health benefits, but associations of PA with incident CVD, all-cause and CVD mortality in people with SMI remain unclear.

To determine dose-response and intensity-specific associations of PA with incident CVD, all-cause and CVD mortality in people with SMI.

This prospective cohort study was conducted on 6313 SMI participants with accelerometry data from UK Biobank (mean age 61.05 years) from February 2013 to November 2021 (median 7-year follow-up). Moderate-to-vigorous PA (MVPA) was categorized by meeting the guideline level or not, while total PA and light-intensity PA (LPA) were grouped by tertiles. Incident CVD, all-cause and CVD mortality ascertained by hospital and death registries were main outcomes.

PA was inversely associated with the risk for incident CVD (Poverall < 0.05 for total PA and MVPA, Pnonlinearity > 0.05 for all PA), all-cause mortality (Poverall < 0.05 for all PA, Pnonlinearity < 0.05 for total PA and LPA), and CVD mortality (Poverall < 0.001 for total PA and LPA, Pnonlinearity < 0.05 for all PA). Performing guideline-recommended volume of MVPA was associated with a reduced risk of 19% for incident CVD (95% CI, 0.67-0.98), 42% for all-cause mortality (95% CI, 0.43-0.79), and 50% for CVD mortality (95% CI, 0.31-0.82). A combination of recommended MVPA and a moderate volume of LPA was associated with the lowest risk, mitigating 21% risk for incident CVD, 59% for all-cause mortality, and 78% for CVD mortality.

Primary engagement of guideline-recommended MVPA, supplemented with moderate amount of LPA, was associated with lower risks for incident CVD, all-cause and CVD mortality among people with SMI.

This research has been conducted using the UK Biobank Resource under Application Number 58082.

This work was supported by the National Natural Science Foundation of China (grant number 32100880), Guangzhou Municipal Key Discipline in Medicine (2021-2023), Guangzhou High-level Clinical Key Specialty, and Guangzhou Research-oriented Hospital. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

None Declared

Fat plays an important role in brain function; 60% of the brain’s dry weight is fat. Among fats, omega-3 fatty acids, which are long-chain fatty acids, have been reported to reduce depressive symptoms. On the other hand, there are few studies on short-chain fatty acids (SCFAs), and those that do exist are mostly animal studies, with only a few human studies (about 100 cases). This is the first study to examine the association between fecal short-chain fatty acids and depressive symptoms on a large scale in the general population.

We examined the association of fecal SCFAs with depressive symptoms. In addition, we analyzed the associations stratified by age and examined differences in the associations.

This study was conducted using data from the Dynamics of Lifestyle and Neighborhood Community on Health Study (DOSANCO Health Study). The target population was all residents of the city of Suttu, Hokkaido, Japan, excluding residents of special nursing homes (n=2638). 579 individuals (22% of the target population) aged 18 years and older who were able to measure fecal SCFA participated in this study with written informed consent. Approval was obtained from the Ethics Committee of Hokkaido University School of Medicine (15-002 and 15-045). Fecal SCFA was measured by high-performance liquid chromatography. We examined the association of fecal concentrations of SCFA subtypes (i.e., acetate, butyrate, and propionate) and total SCFA concentrations (mg/g wet weight as a continuous variable) with total Patient Health Questionnaire-9 (PHQ-9) scores using multiple regression analysis. We adjusted for age, sex, habitual exercise, total energy intake, and total dietary fiber intake. We performed additional multiple regression analyses with stratification by age group (18-59 years and 60 years or older). Two-tailed tests were used for all analyses with a significance level of P < 0.05.

The mean age (standard deviation) of the study participants (n=534) was 58.3 (16.0) years. Among them, 48% were 18-59 years old and 54% were female. Fecal propionate concentration was significantly associated with total PHQ-9 score (beta=0.62, p<0.01). Other SCFAs and total SCFA were not significantly associated with total PHQ-9 score. In addition, using stratification analyses by age group, the associations between fecal propionate concentration and total PHQ-9 score showed a different trend by age group (beta=0.18, p=0.62 for 18-59 years; beta=0.80, p<0.01 for 60 years or older).

The study showed an association between higher concentrations of fecal propionic acid and higher levels of depressive symptoms. The association was particularly pronounced in older people, those aged 60 years and older. The results suggest that improving dietary habits to reduce fecal propionic acid may be effective in preventing depression in the elderly.

R. Okubo Shareolder of: None, Grant / Research support from: A Grant-in-Aid for Scientific Research from Japan Society for the Promotion of Science (No. 22K17844), Consultant of: None, Employee of: None, Paid Instructor of: None, Speakers bureau of: Speakers bureau from Takeda Pharmaceutical Company Limited, R. Yamamura: None Declared, S. Ishikawa: None Declared, T. Kimura: None Declared, S. Ukawa: None Declared, K. Nakamura: None Declared, A. Tamakoshi: None Declared

Implementing research projects on community-based health care interventions in low-ressource settings is feasible with specific methods and applications. In order to critically understand all ins and outs of influencing factors involved in health care pathways for children and their mothers, we must consider to implement more than one research in the same context.

The objective of this presentation is to showcase the continuum of research projects starting from the assessment of the effectiveness of a combined nutrition and psychosocial intervention and its economic evaluation, and how that led to exploring social representations of malnutrition in order to better understand the link with health care seeking behaviours.

The FUSAM cluster randomized control trial included 427 were severe acutely malnourished (SAM) children and their mothers. They were divided in two groups receiving the standard nutrition treatment while the intervention group benefited from five psychosocial sessions. A battery of tests for child development and maternal mental health was administered pre and post intervention. For the economic evaluation, a data collection was conducted with 98 community members and District Public Health Office personnel in Saptari and 17 Action contre la Faim and government personnel in Kathmandu. Finally, a mixed-method study comparing social representations of malnutrition included 376 adults in Saptari and Nuwakot district. Data analysis was performed according to the study design: a multivariate model analysis for the CRCT, a micro-costing methodology to cost data collection and analysis was favored. For the mixed-method analysis, descriptive and inductive analysis were performed.

Regarding the child development, children in the intervention group showed higher scores than children in the control group at all time points. And the economic evaluation showed that the costs of adding psychosocial counselling to an existing CMAM program was approximately EUR 28,788 for 6 centers per year. However, referrals of children through the community-based screening were not optimal. The findings related to health seeking behaviors showed that different meaning categories were simultaneously resorted to by community members leading to different representations of SAM children and that relevant health advises were neither systematically nor uniquely associated to medical categories but are linked to different meaning categories depending on the cultural context.

Multiplying research projects is crucial to mitigate the limitations of the studies often facing numerous contextual challenges and ultimately to leverage further opportunities.

None Declared

Compulsory mental health care remains a controversial practice. The many difficulties in performing Randomised Controlled Trials (RCT) on the topic means there is limited evidence to support its effectiveness. For ethical and legal reasons, compulsory mental health care should only be used when necessary. Yet, geographical variations, which can indicate both overuse and underuse, have been observed. In the funded research project “Controversies in Psychiatry” we intend to use this variation as a source of knowledge production. We propose that this naturally occurring variation mimics randomisation, and can therefore permit causal inference from registry data.

We will estimate the causal effect of compulsory inpatient mental health care on a range of outcomes, including injuries, self-harm, and all-cause mortality; violent crime; employment vs benefit allowance; rehospitalisation and outpatient commitment.

Observed variation in register data on all episodes of compulsory inpatient mental health care in Norway between 2015-2016 (N ≈ 300 000), will serve as a source of as-random variation. Provider-preference for compulsion usage will be used as an instrumental variable (IV).

Outcomes will be observed from 2017-2025. If assumptions underlying IV-analysis do not hold, the project will still provide important and complete descriptive data on long-term outcomes for a whole population.

Geographical variation is a cause for concern if people are treated differently depending on area of residence. But it also presents an opportunity to use differences in service provider’s preference for using compulsory care as an instrumental variable to estimate the causal effect of compulsory care on multiple short and long-term outcomes. This approach can help resolve controversies that are difficult or even impossible to investigate through RCTs. After presenting the project plan we invite to a discussion of the feasibility of using an instrument variable approach to explore if relatively low versus high rates of compulsory care produce favorable outcomes for patients.

None Declared

The European Alliance for Sport and Mental Health (EASMH) is a partnership of scientific institutions, charity associations and sport organizations, funded by EU-Erasmus+. It aimed at developing good clinical practice in psychiatric rehabilitation through sport-based interventions as an integration of pharmacological and psychological therapies. Within the framework of the EASMH projects, several actions have been promoted including an assessment of the dissemination of sport-based interventions, a training course for specialized coaches and the implementation of pilot actions in four European Countries.

To briefly describe EASMH pilot actions performed in Finland, Italy, Romania and United Kingdom, where trained coaches delivered sport-based interventions to patients with severe mental disorders.

After completing pilot actions, charity associations and sport organizations belonging to EASMH network described general and specific aims, sport activities, composition of staff, timing and tools for assessing the outcomes.

In Italy, “Crazy for Rugby”, including adolescents and young patients, and “Not only headshots”, a football project for adults with severe mental disorders were performed. In UK, a football-based activity called “Imagine Your Goal” and a walking-football program for participants aged more than 40 were delivered. In Romania, two courses including gymnastics, yoga and pilates called “Get fit!” were provided. Different team sport-based activities were implemented in Finland, where “Multiple Sport Group” and “Rehabilitating Sports” aimed at increasing patients’ autonomy. Assessment of psychopathological, social, cognitive and sport/fitness outcomes confirmed the overall beneficial effects of sport on mental health.

Pilot actions represent the final step of EASMH project, which showed improvement of mental health outcomes by also delivering sport-based rehabilitation to patients with severe mental disorders. Institutions and stakeholders are now called to promote the implementation of such initiatives on a broader scale.

None Declared