Compared with well-studied internal adaptive systems, there remains a lack of comprehensive exploration of external correlated factors of resilience, as well as the way in which each ingredient of resilience is influenced.

This study aims to explore the dimensional associations among resilience and several factors, including parenting rearing style, childhood trauma and negative life events.

A series of social demographic variables, parental rearing patterns, childhood trauma, negative life events and resilience were assessed. Multiple linear regression analysis was used to explore correlated factors of resilience, with all the above factors included in the model. Network analysis was conducted to identify the central factor and key associations, and to visualise complex interactions among resilience, parenting rearing style, childhood trauma and negative life events.

This cross-sectional study was conducted among 4302 freshmen (2388 females, 55.5%; mean 18.59; s.d. = 0.95) from three colleges between October and December 2020. Three key associations were discovered: ‘learning pressure and emotional control’ (r = −0.195, P < 0.05), ‘emotional neglect and family support’ (r = −0.129, P < 0.05) and ‘maternal care family support’ (r = 0.193, P < 0.05). ‘Emotional abuse’ (bridge expected influence, −0.588) was the core node of the estimated network.

This study found that learning pressure, emotional neglect and maternal care emerged as the most critical external correlates of resilience. Emotional abuse occupies the most central position in the external correlated network of resilience. Future longitudinal research should clarify the temporal impacts of these associations, and the key factors, in the dynamic resilience system.

People diagnosed with schizophrenia can have functional impairments in multiple domains. Cognitive impairment is central to schizophrenia and has substantial prognostic value compared with other symptoms of schizophrenia. However, no study has previously investigated directed relationships in a complex system of cognitive, sociodemographic, clinical and quality of life (QOL) variables in people diagnosed with schizophrenia.

To identify the complex relationships of components of cognition with other cognitive components, as well as with clinical and QOL variables.

This study included data from 1450 participants in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The present study reconstructed a Bayesian network from this data using cognition, clinical, sociodemographic and QOL variables.

Processing speed was centrally associated with all other cognitive domains. Cognitive domains were conditionally independent of positive symptoms but moderately associated with negative symptoms (β = −0.25; P < 0.001). The positive symptoms subscale was independent of QOL, conditioning on third variables. Negative symptoms were moderately associated with QOL (β = −0.33; P < 0.001), and processing speed had a weak association with QOL (β = −0.12; P < 0.001). Processing speed was a central variable in the network.

Intervening with respect to processing speed may be the most beneficial way of improving other cognitive functions. More research is needed on directed networks that include social cognition and global levels of functioning.

Effective implementation of novel digital technologies to improve health outcomes requires an in-depth understanding of end-users’ perspectives and experiences.

We sought the perspectives of people with schizophrenia and schizophrenia-related disorders (SSD) on the acceptability of a novel short text message-delivered intervention targeting metabolic health, called Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART).

Twenty-nine participants with SSD and either at risk of type 2 diabetes (T2D) or with T2D, were recruited from 3 mental health sites in Brisbane, Australia. They were provided, for 12 weeks, with SMART text messages that embedded psychoeducation and behaviour change techniques to facilitate lifestyle behaviours crucial for metabolic health. Interviews explored participants’ experiences of SMART, barriers to its use and suggestions for improvement. The qualitative data were collected by three mental health researchers and analysed using thematic analysis.

Three themes were generated: acceptability and user experience, feasibility and implementation considerations, and mechanisms supporting change. SMART was found to be highly accessible and engaging, and participants reported positive lifestyle changes, including healthier eating, increased physical activity, weight loss and smoking cessation. The messages reinforced learning and supported participants’ readiness for change.

SMART is a world-first digital intervention aimed at improving metabolic health and diabetes self-management in individuals with SSD. High levels of acceptability of SMART highlight its strong potential as a digital innovation that can support its users in protecting their metabolic health while limiting the detrimental side effects of antipsychotic medications.

In England, 354 000 people were homeless on a given night in 2024. It has long been recognised that the physical and mental health of people who are homeless is poorer than for those who are stably housed. There are few peer-reviewed studies to inform health- and social care around depression or anxiety for people who are homeless in this setting.

To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe the distribution of symptoms across sociodemographic, health-related characteristics and indicators of social vulnerability.

We surveyed 311 adults between August and December 2021. We measured anxiety and depression symptoms using the four-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of sociodemographic, social vulnerability and health-related characteristics, and tested for associations with the Kruskal–Wallis test.

The median PHQ-4 score was 7 out of 12, with 38% having scores warranting clinical attention. While PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and marijuana use. The most common barrier to accessing healthcare related to transportation (60%).

People who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support further coordination between health- and social care sectors.

Forensic mental health services need a reliable and repeatable outcome measure to assess the progression of self-rated recovery during the forensic journey. The Questionnaire about the Process of Recovery (QPR) was developed in individuals with psychosis, and has been used to assess recovery in people with severe mental illness; however, its psychometric properties have not been studied in a forensic psychiatric cohort.

This study aimed to assess the psychometric properties of the QPR in a sample of individuals who currently access, or formerly accessed, high-security psychiatric care, including internal consistency, test–retest reliability, factor structure and criterion validity.

Psychometric analysis was undertaken in a sample of 146 current or former high-security patients. Confirmatory and exploratory factor analysis examined the latent test structure. Non-parametric comparisons of QPR score indices tested for differences according to individuals’ current setting (high-, medium- or low-security or open wards; community) as evidence of criterion validity.

A unique two-factor structure related to self-actualisation/empowerment and growth/insight fit forensic patients’ QPR responses. Internal consistency and test–retest reliability were adequate for QPR all-item scores for the original and shortened scales, as well as for the new forensic factor scores. QPR score indices differentiated patients by current setting (eta2 = 0.03–0.04), although only the forensic factor related to growth/insight was significant in corrected post hoc comparisons.

The original QPR is recommended for use to assess recovery progress in a forensic psychiatric sample. Forensic patients’ scores may be best represented using the unique two-factor structure identified.

Treatment-resistant depression (TRD) poses a significant clinical challenge, with limited evidence guiding long-term pharmacological strategies. Esketamine, a glutamatergic modulator, has demonstrated short-term efficacy in TRD, but data on its extended use in real-world settings remains scarce.

This study aimed to evaluate the long-term effectiveness and side-effects of intranasal esketamine in adults with TRD over more than 100 treatment sessions.

We conducted a retrospective, single-arm, pre–post study of 20 patients with TRD at a psychiatric out-patient clinic in the United Arab Emirates. All participants received ≥100 sessions of intranasal esketamine alongside oral antidepressants. Depression and anxiety symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) scales. Side-effects were monitored through blood pressure, sedation, dissociation, urinary symptoms and psychiatric symptoms.

After an average of 129 esketamine sessions (mean duration 2.5 years), PHQ-9 and GAD-7 scores significantly decreased (P < 0.001). A total of 85% of patients improved in depressive severity, with 25% achieving remission; 65% improved in anxiety severity, and 20% reached remission. Esketamine was generally well tolerated; side-effects were mild and transient, with no serious adverse events. However, urinary symptoms suggestive of cystitis occurred in 20% of patients, highlighting the need for ongoing monitoring in long-term treatment.

Intranasal esketamine demonstrated sustained effectiveness and an acceptable side-effect profile in a real-world TRD cohort with extensive psychiatric comorbidity. These findings support its long-term use in complex clinical populations, and underscore the need for further prospective, multi-site studies.