Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions.

The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective.

Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes.

Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia.

The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.

Functional neurological disorder (FND) is characterised by disabling motor, sensory and/or seizure symptoms. Contemporary models highlight the possible involvement of altered affective and autonomic regulation and interoceptive processing in FND. However, accessible, mechanism-informed interventions remain limited.

This study sought to examine the feasibility, acceptability and possible benefits of tailored somatic yoga for people with FND, aiming to directly target altered emotional and bodily regulation in this group.

This single-site, two-arm randomised feasibility trial allocated adults with FND to 6 weeks of either somatic yoga (weekly remote sessions plus home practice manual) or a music-based relaxation control. Feasibility outcomes included recruitment, retention, adherence and acceptability. Secondary outcomes, assessed at baseline, week 3, week 6 and 3-month follow-up, included FND symptom burden, psychological symptoms (anxiety, depression, dissociation), general functioning, health-related quality-of-life, interoceptive awareness and autonomic symptoms.

Seventy-six enquiries were received. Thirty participants consented (100%), 27 were randomised (90%), 23 commenced the trial (77%) and 21 completed it (70%). Recruitment and retention targets were met, with 100% retention in the yoga arm. Adherence was high across both groups, although digital logging of home practice posed usability challenges. Exploratory analyses indicated large effect sizes for self-reported FND symptom improvement and interoceptive awareness in the yoga group, with effects sustained at follow-up.

Individually delivered somatic yoga was found to be feasible, acceptable and safe for people with FND. Our results also suggest potential benefits of somatic yoga for FND symptom improvement and interoceptive awareness, supporting progression to a fully powered trial.

There is currently no national approach to physical health and activity management for individuals under forensic mental healthcare.

This study aims to document the physical health and activity management of in-patients under forensic mental healthcare across Australia, physical activity opportunities and how data are recorded. It also explores staff perspectives on physical health and activity needs of forensic in-patients.

Forensic hospital staff with expertise in managing the physical health and activity of in-patients were invited to participate in a mixed-methods study.

Twenty-two surveys were completed and 64 staff members participated in 17 focus groups. Eight themes were identified: (a) lack of a standardised approach to physical health and activity; (b) inconsistent monitoring and documentation; (c) importance of general practitioners and multidisciplinary teams; (d) need for structured, adaptable programmes and engaged staff; (e) challenges related to patients, staff, ethics and infrastructure; (f) gaps in education, engagement and awareness; (g) need to balance nutrition and eating autonomy; and (h) importance of developing and implementing interventions.

Forensic hospitals in Australia lack a standardised approach to physical health and activity management, with inconsistent monitoring. Physical activity interventions require engaged staff, resources and flexibility, yet ethical and logistical barriers complicate implementation. Solutions include investing in specialised staff, scheduling physical activity into patients’ routines and integrating information technology systems. Comprehensive policies for assessment, monitoring, nutrition, physical activity and interventions are important for improving in-patient forensic mental healthcare, and key performance indicators should be developed.

Difficulties with social cognition, particularly with mentalising, have been hypothesised to increase the risk of, and affect recovery from, trauma and post-traumatic stress disorder (PTSD). We lack a comprehensive picture of the nature of social cognitive impairments in people with PTSD.

To assess whether variation in social cognition is associated with trauma and PTSD.

Ninety-eight participants with PTSD symptoms and 99 controls were recruited from tertiary PTSD services and the Prolific online platform. All participants completed a battery of social cognition tasks covering face emotion recognition, social attribution and mentalisation. They also completed a trauma measure, PTSD screening measure and verbal IQ task. Logistic regression analyses were used to examine the relationship between social cognition and PTSD, and were adjusted for age, gender, autism and verbal IQ.

There was some evidence that hypomentalisation, measured via the Reflective Functioning Questionnaire, was associated with exposure to trauma (adjusted odds ratio 1.80, 95% CI 1.03–3.14, p = 0.040) and increased odds of PTSD symptoms (adjusted odds ratio 4.29, 95% CI 2.76–6.66, p < 0.001). Higher scores for use of mentalising language on a naturalistic video-based spontaneous mentalising task (Modified-STOMP; potentially reflecting hypermentalising) were also associated with increased odds of PTSD symptoms (adjusted odds ratio 1.65, 95% CI 1.17–2.33, p = 0.004) in the main analysis, but not in the sensitivity analysis restricted to the Prolific-only sample.

Our results show an association between mentalising difficulties and PTSD symptoms, indicating mentalising might be a target for future risk prediction.

AWARE (Approaches for Wellbeing and Mental Health Literacy: Research in Education) is a three-arm, parallel-group, cluster randomised controlled trial. It assessed the effectiveness of two interventions – the Youth Aware of Mental Health (YAM) programme and Mental Health and High School Curriculum Guide – in addressing emotional well-being, compared with usual practice, among year 9 students in England.

To evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools.

Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – at 3–6 months after the start of intervention, and at 9–12 months post-intervention. Quality of life was measured with the Child Health Utility Index. Intervention delivery costs were calculated with data provided by the delivery teams. Service use costs were calculated with a short version of the Client Service Receipt Inventory, with unit costs obtained from publicly available sources.

For both interventions, difference in outcomes (change in quality-adjusted life-years over time) between the intervention group and control group were close to zero, with the largest change being an improvement of 0.0055 quality-adjusted life-years at the second follow-up for students in schools randomised to YAM. Changes in costs were likewise small.

At first follow-up, neither intervention is likely to be considered cost-effective. At second follow-up, YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio of around £23 000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20 000 to £30 000) as used by the National Institute for Health and Care Excellence.

Anxiety is the most prevalent mental health condition, causing significant distress, disability and cost.

This pilot study assessed the feasibility and acceptability of an eight-week self-directed online exercise intervention, supported by wearable activity monitors (WAMs), for mid-life and later-life adults with clinically significant anxiety, and provided preliminary estimates of effectiveness.

The Exercise Therapy to Reduce Anxiety (ExTRA) project recruited 21 participants aged 40–77 years with Depression, Anxiety and Stress Scales (DASS-21) anxiety scores >7. The ExTRA online platform integrated with the WAMs, and provided information about anxiety, exercise programmes and strategies to help meet national physical activity guidelines, overcome barriers and set goals.

ExTRA was feasible, with a 63% recruitment rate and 100% retention rate. Overall, evaluation questionnaire responses demonstrated high acceptability. At week 8, WAM average steps/day increased by 1358 (p = 0.036, Hedge’s g = −0.47), and fairly/very active minutes (3/6 metabolic equivalents) increased by 81.2 min/week (p = 0.024, g = −0.51), with moderate effect sizes. There was no statistically significant change on the self-report Global Physical Activity Questionnaire. The DASS-21 anxiety score reduction of 2.3 (p = 0.060, g = 0.42) from baseline to week 8 approached statistical significance. DASS-21 stress and depression scores were significantly reduced by 3.9 (p = 0.013, g = 0.57) and 3.7 (p = 0.02, g = 0.53), respectively, from baseline to week 8. There was no significant change in self-efficacy or dementia risk.

The ExTRA intervention is feasible and acceptable, with positive signals for increasing objectively measured physical activity and improving mental health. Findings support and inform the design of randomised controlled trials to assess efficacy of this potentially automated and scalable intervention.

The primary effect parameter in depression trials is usually a measure of depressive symptoms, e.g. the Hamilton Depression Rating Scale (HDRS). Such measures have been criticised for not covering patient-relevant domains, such as quality of life, and hence not accurately reflecting patient-experienced efficacy.

To investigate the relation between clinician-rated depressive symptoms and patient-reported quality of life measured by the Quality-of-Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF).

We included data from six acute-phase trials (n = 918) comparing mirtazapine to another antidepressant (amitriptyline, fluoxetine, paroxetine or venlafaxine) where both HDRS and Q-LES-Q-SF had been administered. No study included a placebo arm. Correlations between instruments (scales, subscales and items) were assessed after six weeks. Q-LES-Q-SF outcomes for participants who were in HDRS-defined remission were contrasted to those from participants with more severe depressive symptoms.

Q-LES-Q-SF ratings correlated strongly with HDRS-17 (r = −0.73, p < 0.0001) and HDRS-6 (r = −0.72, p < 0.0001), but somewhat weaker to HDRS-11 (r = −0.64, p < 0.0001). Depressed mood (r = −0.66, p < 0.0001) and work and activities (r = −0.65, p < 0.0001) showed the strongest item-level correlations to Q-LES-Q-SF. Participants in HDRS-remission had average Q-LES-Q-SF scores on the lower end of those reported by healthy controls, whereas patients with mild depressive symptoms (or worse) had average life-quality scores corresponding to severe impairment.

HDRS and Q-LES-Q-SF showed considerable agreement in depressed study participants treated with antidepressants, suggesting that HDRS meaningfully reflects patient-reported improvement.

Household dysfunction represents one of the most prevalent adverse childhood experiences worldwide, and has been previously associated with an increased risk for mental health problems. However, little is known about the protective role of emotional intelligence in this association.

To explore whether emotional intelligence mediates the relationship between household dysfunction and (a) substance use (age at first use and severity index) and (b) psychopathological status (behavioural/emotional problems, global functioning and number of lifetime psychiatric diagnoses and pharmacological treatments).

A simple mediation model was employed. A total of 187 children and adolescents aged 7–17 years, from the multicentre EPI-Young-Stress Project, were included in the study. Household dysfunction was assessed following the validated Tool for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) criteria and emotional intelligence was evaluated with the Trait Emotional Intelligence Questionnaire for Children Short Form (TEIQue-CSF) parent version.

There is an indirect-only mediation effect of emotional intelligence on the relationship between household dysfunction and children’s and adolescents’ age at first substance use (proportion mediated: 31.40%, 99% CI −0.53 to −0.02) and severity index (proportion mediated: 23.69%, 99% CI 0.50−0.34), as well as the number of lifetime psychiatric diagnoses (proportion mediated: 45.38%, 99% CI 0.19−0.60) and psychiatric drugs prescribed (proportion mediated: 48.75%, 99% CI 0.19−0.57). A complementary mediation effect of emotional intelligence was found between household dysfunction and emotional/behavioural problems (proportion mediated: 56.37%, 99% CI 0.32−0.80), as well as global functioning (proportion mediated: 54.20%, 99% CI −0.72 to −0.28).

Emotional intelligence emerges as a putative protective factor against the negative consequences of household dysfunction on mental health and substance use. Emotional intelligence should be considered a primary target in preventing and promoting the health of youth exposed to household dysfunction.

Earthquakes present significant threats to community mental health, yet post-disaster resource limitations and high demand restrict access to care. The 2023 Türkiye–Syria earthquakes affected millions, increasing psychological problems and highlighting the urgent need for scalable interventions.

This study assessed (a) the feasibility of procedures prior to a fully powered randomised controlled trial (RCT) and (b) the potential effectiveness of Problem Management Plus (PM+), a scalable psychological intervention, in reducing common mental health problems among Turkish earthquake survivors.

A two-arm, single-blind pilot RCT was conducted with survivors residing in temporary housing in Türkiye. Participants were randomly allocated (1:1) to PM+ (n = 38) or enhanced care-as-usual (E-CAU; n = 38) and assessed at baseline, 1 week post intervention and at the 1-month follow-up. The primary outcome was depression (Patient Health Questionnaire, PHQ-9); secondary outcomes were self-identified problems (Psychological Outcome Profiles, PSYCHLOPS), functional impairment (World Health Organization Disability Assessment Schedule, WHODAS 2.0), psychological distress (Kessler-10 Psychological Distress Scale, K-10), anxiety (Generalised Anxiety Disorder Scale, GAD-7) and post-traumatic stress (Post-traumatic Stress Disorder Checklist, PCL-5). The trial was prospectively registered (NCT06026306).

Recruitment, retention (74%) and treatment adherence (79%) supported feasibility. At post-assessment, PM+ showed greater reductions than E-CAU across all outcomes: PHQ-9 (adjusted mean difference −5.91, 95% CI –8.23 to –3.58), PSYCHLOPS (−6.94, –8.88 to –5.01), WHODAS 2.0 (−8.77, –12.50 to –5.03), K-10 (−9.66, –13.35 to –5.97), GAD-7 (−4.31, –6.39 to –2.24) and PCL-5 (−18.72, –25.97 to –11.47). At follow-up, improvements remained significant for psychological distress and self-identified problems.

Findings provide preliminary evidence that PM+ is a feasible and potentially effective intervention for alleviating common mental health problems among Turkish earthquake survivors.

Various biomarkers have been identified as being associated with the pathophysiology of major depression, with the potential to be utilised within an objective laboratory test for the diagnosis of depression, based on machine learning techniques.

This study aims to build on previous results by modelling, in a larger and more heterogeneous cohort, the joint diagnostic accuracy of urine and serum-based biomarkers that showed predictive value for depression in our previous work.

A novel, multivariable, machine learning-based diagnostic tool for depression was tested on a combination of 34 urine- and serum-based biomarkers among 160 people diagnosed with major depressive disorder (MDD) and 120 controls, split into 3 different cohorts. Quantile-based prediction was applied to construct a biomarker-based diagnostic model (BDM) yielding a score for each biomarker. The sum score for each participant was used to calculate an area under the receiver operating characteristic curve (AUC) as a measure of discriminatory power.

We demonstrated that the BDM after internal validation had good discriminatory power, with an AUC of 0.81. Further internal–external validation by calculating individual depression probability scores for each separate cohort resulted in an AUC of between 0.62 and 0.72.

In terms of clinical applicability, the present study shows that the combination of biomarkers and a machine learning model can discriminate between MDD and healthy controls with a modest level of diagnostic accuracy. A biomarker test could have potential added value for the future diagnostic toolkit, but this does require further research.

Healthcare personnel exhibit higher levels of anxiety and depression, with differences in the use of coping strategies to manage stressful situations.

To assess which coping strategies, sociodemographic factors and job-related variables predict anxiety and/or depression among healthcare professionals.

A total of 744 participants, including physicians, nurses and nursing assistants were involved in a cross-sectional study.

The ordinary least squares estimator was used to estimate the parameters. The results identified negative self-focus (β = 0.42, β = 0.45, p < 0.001), positive reappraisal (β = −0.20, β = −0.30, p < 0.001) and open emotional expression (β = 0.12, p < 0.001; β = 0.08, p < 0.01), as coping strategies significantly associated with anxiety and depression. Additionally, seeking social support was related to depressive symptoms (β = −0.02, p < 0.01), but not of anxiety. Interestingly, avoidant coping was associated with lower levels of both anxiety and depression (β = −0.14, p < 0.001). The absence of family responsibilities was associated with lower levels of anxiety and depression (β = −0.11, β = −0.10, p < 0.001). Being male was linked to lower anxiety levels (β = −0.11, p < 0.001), while being female was associated with greater depressive symptoms (β = 0.09, p < 0.01). Holding the position of nursing assistant was identified as a variable associated with anxiety and depression (β = 0.08, p < 0.05; β = 0.06, p < 0.05).

These results are essential for tailoring interventions aimed at occupational health.

Virtual reality is a promising intervention for schizophrenia spectrum disorders (SSDs), offering immersive environments to support therapy. However, evidence for its effectiveness across symptom domains remains inconsistent.

To assess the effectiveness of virtual reality-based therapies (VRT) for SSDs on symptomatology and psychosocial functioning compared with control conditions.

A systematic review and meta-analysis of controlled trials using virtual reality for individuals with SSDs was conducted. Searches were conducted across PubMed, PsychINFO, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials, from inception to March 2025. Random-effects models estimated pooled effect sizes (Hedges’ g) across outcomes, including Positive and Negative Symptom Scale, depression, paranoia and cognition. Risk of bias was assessed using the Joanna Briggs Institute Risk of Bias Tool.

From 2878 unique studies, 9 trials were eligible for meta-analysis. VRT was significantly more effective than control conditions in reducing overall psychotic symptoms (Hedges’ g = 0.53, p = 0.037). No significant effects were found for other domains (positive, negative, depressive or paranoia symptoms).

Virtual reality therapies are moderately effective at reducing overall psychotic symptoms. Unlike prior reviews, this study did not find significant effects on positive symptoms, possibly due to the heterogeneity of outcomes reported in existing interventions.

PROSPERO: CRD42023470849

Community treatment orders (CTOs) permit compulsory mental healthcare outside hospital. Such orders have become part of an increasing number of mental health laws, even if there is a lack of consensus on their effects, negative personal experiences, diverging ethical positions and expectations that governments should reduce or abandon coercive practices. It is therefore surprising that there is limited research describing the availability and restrictiveness of CTO legislation, and we found no comprehensive European study. Such studies could contribute to clarification of differing positions and, through that, informing further research and discussions of how to promote voluntary options in clinical practice.

To establish the availability of CTO legislation across Europe, and how regimes in different ways restrict the person.

Data were collected from 33 European countries through a network of researchers and practitioners, and links to relevant legislation were provided.

We found 13 CTO regimes across the 33 countries: two-thirds therefore managed without them. Despite some variation, most law texts specified restrictions related to legal criteria, enforcement mechanisms and safeguards. Restrictions on the person were often specified in separate tailored plans, and most regimes permitted indefinite renewals, which means that the duration of restrictions can be ascertained only in retrospect.

CTO law texts preclude scrutiny of overall restrictiveness, which might add to current uncertainties regarding the proportionality of CTOs and their role in balancing individuals’ rights to both autonomy and care. The current policy drive towards community care should not automatically lead to new CTO regimes until their effectiveness and de facto restrictiveness are established.

Evidence shows that advance care planning has the potential to reduce involuntary admissions and empower service users. The perinatal period is a time of heightened risk of relapse of mental illness, and, in this context, many perinatal mental health services routinely offer pre-birth mental health care planning meetings.

We aimed to explore the experience of perinatal mental health service users and their partners following a pre-birth planning meeting and the writing of a perinatal care plan that included advance care plans for birth, postpartum and in case of crisis.

We interviewed pregnant perinatal mental health service users and their partners at two large, urban maternity hospitals in Dublin, Ireland. We used thematic analysis to identify key themes relevant to their experiences of pre-birth planning meetings and written perinatal mental health care plans.

Ten service users and three partners were interviewed. We identified five themes: theme 1, Hoping for change; theme 2, A wish to be heard; theme 3, Individualised care; theme 4, Security of ‘a plan in place’ and theme 5, Role of the support network.

Women and their partners value pre-birth planning meetings and these should routinely be offered within services, with consideration as to the size and timing of the meeting, and who is in attendance. These findings are relevant to general adult and liaison psychiatrists who should also incorporate advance care planning into routine practice.

Adolescent depression often presents with somatic complaints, and its clinical manifestation is strongly shaped by cultural context. In non-western districts, psychological distress is frequently expressed through physical symptoms; a tendency that, combined with mental health stigma and culturally influenced health beliefs, complicates accurate detection, diagnosis and treatment. Standardised diagnostic tools developed in Western populations may overlook culturally specific symptom patterns, contributing to under-recognition and inadequate care. Despite the global impact of adolescent depression, cross-cultural symptom-level studies remain limited, hindering the development of culturally responsive mental health strategies.

This study aims to compare somatic-depressive symptom networks in Chinese and Rwandan adolescents using symptom-level network analysis, to identify culturally distinct central and bridge symptoms, and to assess structural differences between symptom networks across groups.

A cross-sectional sample of 3830 adolescents (China: n = 2017, mean age 15.35 ± 1.56; Rwanda: n = 1813, mean age 15.80 ± 1.90) completed culturally adapted versions of the Patient Health Questionnaires for somatic symptoms (PHQ-15) and depression (PHQ-9). Gaussian Graphical Models were estimated in R to construct symptom networks. Centrality measures (expected influence and bridge expected influence) were used to identify influential symptoms within each group. Network Comparison Tests were conducted to examine differences in global strength and network structure, and bootstrapping was employed to assess network stability.

Depressive symptoms were more prevalent among Rwandan adolescents (54.6%) than among Chinese adolescents (29.2%), whereas somatic symptoms were more commonly reported by Chinese participants (71.0% v. 64.0%). Low energy and sleep problems emerged as key bridge symptoms in both groups. Cultural differences were observed in central symptoms: psychomotor impairment and chest pain were central symptoms in Rwanda, whereas dizziness and headaches were central in China. Network structure differed significantly between groups (S = 0.99, p < 0.05), with culturally specific symptom connections.

The findings revealed distinct central and bridge symptoms in Chinese and Rwandan adolescents, reflecting culturally patterned architectures of symptom expression and distress reporting. These results highlight the need for culturally adapted screening tools and symptom-level interventions that target culture-specific symptoms to improve adolescent mental health care globally.