Brain morphological alterations in bipolar disorder are well documented, particularly in chronic cases. This study focuses on first-episode mania (FEM) to quantify neuroanatomical changes at early stages of the disorder.

To assess deviations from normative brain morphometry and age-related brain changes in patients with FEM.

Pretrained models, based on large, independent healthy samples, were applied to structural brain images from FEM patients (n = 83) and healthy individuals (n = 61). Normative deviation z-scores were computed for regional brain morphometry, along with global and voxel-level brain–age-gap estimates (G-brainAGE and L-brainAGE, respectively). The proportions of infranormal (z < −1.96) and supranormal (z > 1.96) deviations were measured for both groups. Ridge regression and support vector machine models were used to evaluate whether z-scores predicted symptom severity, IQ or diagnosis. Case-control differences in L-brainAGE and correlations between G-brainAGE and clinical features were analysed.

Both FEM and healthy individuals showed similar proportions of infra- and supranormal deviations in regional measures. Morphometric data, whether observed or normative, did not significantly predict clinical outcomes or diagnosis. Mean G-brainAGE in FEM was −1.04 (s.d. 3.26) years and negatively correlated with age of onset, while L-brainAGE did not differ significantly between groups.

Regional morphometry and local brain-ageing metrics in FEM patients aligned with normative ranges, suggesting minimal abnormalities in early bipolar disorder. However, subtle delays in global brain ageing may reflect variation based on the age of onset, highlighting a potential area for further exploration.

Mental health conditions, particularly depression and anxiety, are highly prevalent and impose substantial health burdens globally. Despite advancements in machine learning, there is limited application of these methods in predicting common mental illnesses within community populations in low-resource settings.

This study aims to examine the prevalence and associated risk factors of common mental illnesses collectively (depression and anxiety) in a rural Bangladeshi community using machine learning models.

This cross-sectional study surveyed 490 adults aged 18–59 in a rural Bangladeshi community. Depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-2) and Generalised Anxiety Disorder (GAD-2) scales. Machine learning models, including Categorical Boosting, the support vector machine, the random forest and XGBoost (eXtreme Gradient Boosting), were trained on 80% of the data-set and tested on 20% to evaluate predictive accuracy, precision, F1 score, log-loss and area under the receiver operating characteristic curve (AUC-ROC).

Some 20.4% of participants experienced at least one common mental illness. Feature importance analysis identified house type, age group and educational status as the most significant predictors. SHAP (Shapley Additive exPlanations) values highlighted their influence on model outputs, and the XGBoost gain metric confirmed the importance of marital status and house type, with gains of 0.76 and 0.73, respectively. XGBoost delivered the best performance, achieving an F1 score of 71.01%, precision of 71.58%, accuracy of 71.15% and the lowest log-loss value of 0.56. The random forest had an accuracy of 78.21% and an AUC-ROC of 0.90.

The findings of this study suggest targeted interventions addressing housing and social determinants could improve mental health outcomes in similar rural settings. Further studies should consider longitudinal data to explore causal relationships.

Mood and anxiety disorders co-occur and share symptoms, treatments and genetic risk, but it is unclear whether combining them into a single phenotype would better capture genetic variation. The contribution of common genetic variation to these disorders has been investigated using a range of measures; however, the differences in their ability to capture variation remain unclear, while the impact of rare variation is mostly unexplored.

We aimed to explore the contributions of common genetic variation and copy number variations associated with risk of psychiatric morbidity (P-CNVs) to different measures of internalising disorders.

We investigated eight definitions of mood and anxiety disorder, and a combined internalising disorder, derived from self-report questionnaires, diagnostic assessments and electronic healthcare records (EHRs). Association of these definitions with polygenic risk scores (PRSs) of major depressive disorder and anxiety disorder, as well as presence of a P-CNV, was assessed.

The effect sizes of both PRSs and P-CNVs were similar for mood and anxiety disorder. Compared to mood and anxiety disorder, internalising disorder resulted in higher prediction accuracy for PRSs, and increased significance of associations with P-CNVs for most definitions. Comparison across the eight definitions showed that PRSs had higher prediction accuracy and effect sizes for stricter definitions, whereas P-CNVs were more strongly associated with EHR- and self-report-based definitions.

Future studies may benefit from using a combined internalising disorder phenotype, and may need to consider that different phenotype definitions may be more informative depending on whether common or rare variation is studied.

Limited access to health services and overwhelmed healthcare systems created a challenging environment for those in need of mental health support during the COVID-19 pandemic, and the pandemic impacted suicide risk in several ways.

The present study aimed to analyse how the quality of the health security systems in 12 countries affected suicide crisis syndrome (SCS) during the pandemic. We hypothesised that countries with robust health systems were better able to respond to the increased demand for (mental) health support, resulting in fewer cases of SCS.

From June 2020 to September 2021, 11 848 participants from 12 different countries took part in an online survey. Besides asking about sociodemographic information, the survey assessed the severity of SCS with the Suicide Crisis Inventory (SCI). The Global Health Security Index and the Legatum Prosperity Health Index were used to operationalise the quality of the national health systems. Multilevel analyses were performed to evaluate the impact of health system quality and COVID-19-associated factors on SCI scores.

SCS was more prevalent among participants with COVID-19 symptoms and in countries with high rates of COVID-19-associated deaths. Multilevel analyses revealed a significant interaction effect of COVID-19 symptoms and national health indices. SCS occurred significantly less frequently in participants with COVID-19 symptoms living in countries with good health security systems.

The challenges posed by the pandemic highlight the necessity to promote accessible and affordable health services to mitigate the negative impact of the pandemic on suicidal ideation and behaviour.

Acknowledging the impact of chronic kidney disease on caregivers’ quality of life (QoL) and psychological well-being has become a global priority, highlighting the need for supportive interventions specifically aimed at caregivers.

This study aimed to assess the prevalence of stress, anxiety and depression among family caregivers of Omani patients undergoing haemodialysis and to explore its association with QoL.

The study employed a cross-sectional design. A sample of 326 participants completed the study’s surveys, including the Depression Anxiety Stress Scale, WHOQOL-BREF scale and a demographic scale.

The survey indicated that 68.4% of the participant caregivers experienced varying degrees of depression. In addition, 48.4% of caregivers reported experiencing stress levels ranging from mild to extremely severe. For anxiety, 65.6% (n = 214) of caregivers noted varying levels, from mild to extremely severe anxiety. Significant negative associations were found among caregiver age, number of chronic illnesses, number of medications, daily hours spent on caregiving, physical health, stress, anxiety and depression, on the one hand, and the physical domain of QoL, on the other hand. Regarding the psychological domain of QoL, significant negative associations were observed with daily caregiving hours, physical health, stress, anxiety and depression.

This study highlights the significant psychological burden faced by caregivers of patients undergoing haemodialysis. Systematic screening and practical interventions, such as support groups and mental health programmes, are essential to improve caregiver well-being. Future research should explore the effectiveness of these interventions and the long-term impact of caregiving.

People at high risk for psychosis access primary care mental health services for depression and anxiety and are unlikely to recover from these affective symptoms. We report the first controlled trial of cognitive–behavioural therapy (CBT) for depression and anxiety, minimally adapted for psychosis risk, in primary care.

To evaluate feasibility, acceptability and signals of efficacy for CBT for depression and anxiety adapted for psychosis risk, designed in collaboration with people with psychosis.

A longitudinal controlled trial comparing best practice CBT for depression and anxiety (CBT-BP) with CBT adapted for psychosis risk (CBT-PR), in patients meeting criteria for UK primary care services and who are also clinically high risk for psychosis (trial registration no. ISRCTN40678).

Rates of recruitment (55 to CBT-BP, 44 to CBT-PR), completion of measures (90% CBT-BP, 94% CBT-PR) and retention in therapy (75% CBT-BP, 95% CBT-PR) demonstrate the feasibility and acceptability of the adapted therapy. Routine measures of depression and anxiety signal improved clinical and recovery outcomes for CBT-PR. Psychosis and relational measures signal sustained improvement (at 3 months) in the CBT-PR group. No serious adverse events were reported.

Primary care mental health services present a unique opportunity to identify and treat people at risk of psychosis at a time when they are help-seeking. CBT for depression and anxiety, minimally adapted for psychosis risk, can be delivered in routine services, and is likely to improve clinical and recovery outcomes and reduce psychosis risk. A definitive trial is needed to estimate clinical and cost-effectiveness.

People with severe mental illness (SMI) have a higher risk of premature mortality than the general population.

To investigate whether the life expectancy gap for people with SMI is widening, by determining time trends in excess life-years lost.

This population-based study included people with SMI (schizophrenia, bipolar disorder and major depression) alive on 1 January 2000. We ascertained SMI from psychiatric hospital admission records (1981–2019), and deaths via linkage to the national death register (2000–2019). We used the Life Years Lost (LYL) method to estimate LYL by SMI and sex, compared LYL to the Scottish population and assessed trends over 18 3-year rolling periods.

We included 28 797 people with schizophrenia, 16 657 with bipolar disorder and 72 504 with major depression. Between 2000 and 2019, life expectancy increased in the Scottish population but the gap widened for people with schizophrenia. For 2000–2002, men and women with schizophrenia lost an excess 9.4 (95% CI 8.5–10.3) and 8.2 (95% CI 7.4–9.0) life-years, respectively, compared with the general population. In 2017–2019, this increased to 11.8 (95% CI 10.9–12.7) and 11.1 (95% CI 10.0–12.1). The life expectancy gap was lower for bipolar disorder and depression and unchanged over time.

The life expectancy gap in people with SMI persisted or widened from 2000 to 2019. Addressing this entrenched disparity requires equitable social, economic and health policies, healthcare re-structure and improved resourcing, and investment in interventions for primary and secondary prevention of SMI and associated comorbidities.

Women from minoritised ethnic communities experience inequalities in access, experience and outcomes of psychological therapy. Understanding the factors associated with these inequalities could inform improvements to mental health services.

To explore therapists’ experiences of providing treatment to women from minoritised ethnic communities, including insights on adaptations made at the delivery, content and wider organisation levels, and to gather suggestions about potential treatment improvements.

Semi-structured interviews were conducted with 13 therapists working in two National Health Service Talking Therapies for anxiety and depression services and who had experience of treating women from minoritised ethnic communities. Data were analysed using thematic analysis.

Three high-order themes were identified: incorporating ethnicity and culture in the delivery of psychological therapies, challenges associated with delivering therapeutic interventions to women from minoritised ethnic groups and improvements to services that could support better access, engagement and outcomes for women from minoritised ethnic groups.

Findings indicate that therapists viewed cultural adaptation and cultural sensitivity as important to the delivery of appropriate care for minoritised ethnic women. Challenges to appropriate care included limited service resources, communication and language barriers, stigma and existing access and engagement inequalities. Therapists suggested that, to deliver high-quality care and optimise outcomes, improvements are required in cultural sensitivity training, flexibility of service delivery, outreach work with communities to encourage uptake and reduce stigma, support for staff and workforce diversity.

Little is known about the transition process for those returned to prison following treatment in secure psychiatric services. This study is the first internationally to explore the process of discharge/aftercare planning for this population.

To identify the current national discharge and aftercare planning procedures for people returned to prison in England and Wales.

A national survey of current service discharge planning and aftercare arrangement practices in low- and medium-secure psychiatric services and prison mental health teams in England and Wales.

We had a 72% response rate across prison-based and secure mental health services. A summative contents analysis highlighted that outstanding priority areas for improvement, include (a) relationship building to improve communication and understanding between secure psychiatric services, prison mental health services, and the prison estate and (b) significant reform and additional resources to achieve the expected standard of care and to provide people returned to prison with a care package tailored to meet their specific needs.

Effective care planning and management of return to prison from secure psychiatric services has the potential to improve patient health and well-being in prison and up to and beyond their subsequent prison release, with far-reaching effects on prevention of relapse, hospital readmission, reoffending and other adverse events.

More people than ever are receiving support for mental health crises, and instances of suicide continue to grow. Mental health funding has recently increased, focusing on improving services that provide an alternative to emergency departments, such as urgent helplines and crisis cafés. However, there is a lack of literature examining the efficacy of these services, despite research suggesting they may be associated with lower hospital admission rates.

We aimed to evaluate the perspectives of people with lived experience of accessing a variety of mental health crisis services in the UK.

One-to-one interviews were conducted with 25 individuals as part of a qualitative grounded theory analysis.

The following themes were identified as important for recovery: more than a diagnosis (a need for person-centred care); instilling hope for the future (access to creative spaces and community); and a safe space for recovery (out-of-hours crisis cafés). Many have credited crisis cafés with saving their lives and felt there should be increased funding provided for collaboration between the National Health Service (NHS) and the third sector. Participants highlighted the need for interim support for those awaiting therapy via the NHS and continuity of care as key areas for improvement.

NHS services are struggling to meet the mental health needs of the population, resulting in lengthy waiting times for therapy and an over-reliance on the third sector. While crisis cafés are currently provided at a low cost and appear to result in satisfaction, policymakers must ensure they receive adequate funding and do not become overburdened.

Hypochondriacal disorder involves persistent anxiety about suffering from an undetected serious medical condition, despite medical reassurance. Hypochondriacal disorder significantly affects social relationships, occupational functioning and personal well-being. In university settings, where mental health concerns are prevalent, insights into prevalence of hypochondriacal disorder and associations with depression and other health challenges are essential.

This study examines the prevalence and correlates of hypochondriacal disorder among Norwegian university students, focusing on its associations with depression, mental distress and somatic symptom burden.

The 2022 Students’ Health and Wellbeing Study, a national survey of Norwegian higher education students, included 59 536 participants aged 18–35. Participants were categorised based on a pre-defined diagnostic list of mental and somatic concerns, and participants were grouped as follows: hypochondriacal disorder only, depression only, comorbid hypochondriacal disorder and depression and controls. Validated instruments included the Somatic Symptom Scale-8, the Hopkins Symptoms Checklist, the Satisfaction With Life Scale, an abbreviated version of the University of California, Los Angeles, Three-Item Loneliness Scale and four items on suicidal ideation.

Hypochondriacal disorder was reported by 0.86% (n = 457) of participants, with 52% also reporting depression. Those with hypochondriacal disorder had significantly worse mental and somatic health outcomes, especially when comorbid with depression, including elevated distress, suicidality, insomnia and poor quality of life.

Although uncommon, hypochondriacal disorder is linked to severe mental and somatic health burdens, particularly when co-occurring with depression. These findings highlight the need for integrated mental health strategies in academic settings to address hypochondriacal disorder and its frequent comorbidities.

Extreme events (e.g. floods and disease outbreaks) can overwhelm healthcare workers (HCWs) and healthcare systems. During the COVID-19 pandemic, high levels of distress and mental ill health were reported by HCWs.

To examine and synthesise research findings reported in the qualitative literature regarding the stressors, and their psychosocial impacts, faced by HCWs in the UK during the COVID-19 pandemic, and to provide lessons for future support.

Qualitative articles were identified in EMBASE and OVID (preregistered on PROSPERO: CRD42022304235). Studies were required to have been published between January 2021 and January 2022 and to have examined the impact of COVID-19 on UK HCWs. We included 27 articles that represented the experiences of 2640 HCWs, assessed their quality using National Institute for Health and Care Excellence criteria and integrated their findings using thematic synthesis.

Several secondary stressors were identified, including lack of personal protective equipment, ineffective leadership and communication, high workloads and problems stemming from uncertainty and a lack of knowledge. Stressors were related to adverse psychosocial outcomes including worry, fatigue, lack of confidence in oneself and senior managers, impacts on teamwork and feeling unappreciated or that one’s needs are not recognised.

Our thematic synthesis moves beyond simply mapping stressors faced by HCWs by considering their antecedents, origins and psychosocial impacts. Utilising a theoretical framework that points towards systemic deficiencies, we argue that secondary stressors can be modified to remove their negative effects. Consequently, workforce planning should shift from focusing on individual change towards amending psychosocial environments in which HCWs work.

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.