Behavioural activation is effective for depression, but its effectiveness in treating adults with depression when delivered by lay workers remains unclear.

To examine the effectiveness of behavioural activation delivered by lay workers, compared with any control group, in reducing depressive symptoms in adults.

This systematic review searched six databases from inception to January 2025, for randomised controlled trials (RCTs) comparing behavioural activation and any control conditions for individuals with depression when delivered by lay workers. Additional searches were conducted in the international trial registries and reference lists (PROSPERO registration CRD42024625620). Risk of bias was assessed using the Cochrane Collaboration’s Risk-of-Bias 2 tool. Random effects meta-analysis was conducted using the Metafor package in R.

Of 9614 initial studies, six RCTs met the inclusion criteria and were included. A total of 1118 participants in the intervention groups and 1596 in the control groups. The findings demonstrated a small but statistically significant effect in reducing depressive symptoms in favour of the intervention group (standardised mean difference: −0.28, 95% CI −0.46 to −0.09; p = 0.0029). However, the risk of bias was high across all studies, with substantial heterogeneity (I2 = 76%).

Evidence from this review and meta-analysis suggests that behavioural activation, when delivered by trained lay workers, may offer an effective approach for reducing depressive symptoms in adults, particularly in settings with limited access to specialist mental healthcare professionals. However, high risk of bias and heterogeneity of the included studies means that these findings should be interpreted with caution.

Mental health problems among children in England are rising, with significant wait times and barriers preventing many from accessing timely support. Watch Me Play! (WMP) is a caregiver–child interaction intervention designed to enhance child development and promote mental health resilience through child-led play.

To assess the feasibility of delivering WMP remotely to parents and carers of children aged 0–8 years referred to UK early years and children’s services.

A non-randomised, single-group feasibility design with a mixed-methods process evaluation aimed to recruit 40 families. The study evaluated recruitment, retention, adherence, fidelity and acceptability. Outcomes were collected at baseline and 3 months; we conducted qualitative interviews to examine barriers and facilitators, and we used health economic data estimated intervention costs.

WMP was well-regarded and acceptable to families and service providers. Recruitment involved seven sites and 21 families, with 67% retention at 3 months. Self-reported adherence was 80%. Facilitators included the simplicity of the approach and quick access to support. Barriers included limited staff capacity and practitioner perceptions of readiness in families with complex needs. Hybrid delivery (online and face-to-face sessions) was feasible and acceptable. The average intervention cost was £209 per family.

Findings indicate core feasibility parameters – including acceptability, fidelity, data-collection procedures and delivery across diverse contexts – were met. WMP is a low-cost intervention suited for early years services. Although a full-scale effectiveness trial is not yet warranted, a future randomised feasibility trial is recommended to investigate the acceptability of randomisation and recruitment across a broader range of services.

Glucocorticoids are widely prescribed for autoimmune and inflammatory conditions, but their long-term use carries serious risks. Patients with psychiatric disorders have a high burden of medical comorbidities, which may be associated with higher odds of receiving sustained glucocorticoid therapy.

We examined whether psychiatric patients were more likely to receive sustained oral glucocorticoid therapy compared with controls, and assessed variation across psychiatric subgroups.

This retrospective, nationwide cohort study used South Korea’s National Health Insurance Service database. Adults diagnosed with a major psychiatric disorder in 2021 (n = 331 020) were compared with a sample without psychiatric disorders (n = 668 980). Propensity score matching generated 283 942 participants per group. The outcome was sustained oral glucocorticoid use in 2022, defined as ≥90 cumulative days with continuous therapy ≥90 days and prescription gaps ≤30 days.

Before propensity score matching, glucocorticoid use in 2022 was more frequent in psychiatric patients (13.8%) than controls (10.8%; odds ratio 1.32, 95% CI 1.31–1.34; P < 0.001). After matching, the difference persisted (14.7 v. 12.5%; odds ratio 1.18, 95% CI 1.16–1.19; P < 0.001). Multivariable analyses confirmed higher odds of glucocorticoid use (odds ratio 1.05, 95% CI 1.03–1.06; P < 0.001). Increased risk was observed for anxiety disorders (odds ratio 1.06) and obsessive–compulsive disorder (odds ratio 1.07), whereas major depressive disorder showed no significant association.

Psychiatric patients are more likely to receive sustained glucocorticoid therapy, underscoring the need for cautious prescribing and monitoring in this vulnerable population.

Adolescent mental health is a growing public health concern due to the high prevalence of mental disorders, many of which remain unrecognised and untreated. School staff are strategically positioned to promote mental health, recognise mental health problems and support pathways into care, but often lack sufficient mental health literacy (MHL) and confidence to act.

This study evaluated the effects of the WhySchool project, a school-based programme to promote MHL among teachers and school health professionals (SHPs).

We implemented WhySchool in 72 public middle and high schools across Portugal through a cascade training approach. With a pre–post design, we assessed 788 teachers and 201 SHPs on mental health knowledge (MHK), personal depression stigma, openness to seeking help and confidence in identifying/referring students. Paired-sample t-tests with Cohen’s d estimated changes, and generalised linear mixed models (GLMMs) accounted for confounders and within-subject variability.

The programme was associated with significant improvements in all outcomes across both professional groups, with moderate-to-large effect sizes (MHK d = 1.12 (95% CI 1.04 to 1.20); stigma d = −1.05 (95% CI −1.12 to −0.97); openness d = 0.44 (95% CI 0.37 to 0.51); confidence d = 0.87 (95%CI 0.79 to 0.94)). GLMMs confirmed these results. Gains varied across professional groups and demographic characteristics, with those having lower baseline scores generally benefiting most.

The WhySchool resulted in observable improvements in teachers’ and SHPs’ MHL, including increased knowledge, reduced stigma, improved help-seeking attitudes and strengthened confidence to support students. The cascade model provides a viable and sustainable strategy for large-scale implementation, empowering educational communities to better support student mental health.

Although all patient deaths affect clinicians, it remains unclear how the impact of suicides differs from other deaths. Is the trauma of losing a patient by suicide qualitatively distinct, or are the emotional, professional and organisational consequences of suicidal and non-suicidal deaths more similar than assumed?

To investigate the impact of patient suicide compared with other patient deaths on clinicians’ psychological well-being, clinical practice and career. To explore clinicians’ perspectives on how current support systems do, or do not, meet their needs.

A mixed-methods approach was used. An online survey with two subsets of questions (one for suicidal and one for non-suicidal patient deaths) was circulated to clinicians across South London and Maudsley NHS Foundation Trust.

A total of 122 responses were collected: two-thirds of respondents had experienced a patient suicide, with 53% reporting moderate and 12% reporting severe impact versus 36.6% reporting moderate and 4.2% severe for non-suicidal deaths. Non-suicidal death was associated with significantly lower impact (odds ratio 0.14, 95% CI [0.05, 0.41], p < 0.001) and less disruption to clinical practice. Blame emerged as a key factor shaping clinicians’ responses: 98% of respondents rated suicide as <60% predictable in secondary care, and 69% rated the ‘zero-suicide’ policy as unachievable.

Patient suicide has a heavier impact on clinicians, qualitatively distinct from other patient deaths. Blame shapes defensive responses in suicides, and internal questioning in non-suicidal deaths. The low-risk paradox and perceived unachievability of zero-suicide policies call for re-evaluation. Acknowledging predictability limits and clinicians’ support needs can help systems navigate the complex impact of patient suicides.

Recently, there has been a significant rise in potency (% tetrahydrocannabinol (THC)) of cannabis products globally. As such, there is a need for a better understanding of the relationship between cannabis potency and mental health outcomes, especially in a developmentally vulnerable population such as adolescents and young adults.

The objective of this scoping review was to summarise existing literature investigating the potency of cannabis products as it relates to mental health outcomes in adolescents and young adults aged 14–25.

Systematic searches of MEDLINE, Embase, CINAHL and PsycINFO were conducted for relevant manuscripts up to October 2025. Following PRISMA-ScR guidelines, retrieved studies were then screened and data extracted by two independent reviewers.

Out of 11 225 studies identified by our searches, 71 were included in the review after screening. Compared with low-potency cannabis, our findings suggest that high-potency cannabis is more strongly associated with severe mental health issues, such as cannabis dependence, psychosis and cognitive deficits.

Overall, it was found that high-potency cannabis use (>15% THC) was associated with a great number and magnitude of adverse mental health outcomes. As such, the potency of cannabis products should be measured in future cannabis research that investigates short- and long-term outcomes. Additionally, the potency of cannabis products should be a consideration in any future cannabis regulatory policy discussions.

Many people presenting to emergency departments after self-harm do not receive adequate care, even in well-resourced health systems.

To identify patterns of health care service use across two periods: (a) during and (b) up to 1 year after an index emergency department self-harm presentation.

A retrospective population-based cohort study including 4668 individuals aged ≥9 years who presented to the Royal Melbourne Hospital emergency department for self-harm between January 2012 and December 2019. Linked administrative data captured >1.3 million records across primary care, pharmacy, specialist mental and physical health services and emergency departments. Sequential pattern mining identified longitudinal service-use clusters. Multinomial regression explored associations with demographic, clinical, psychosocial and presentation characteristics. Cox proportional hazards models assessed associations between clusters and all-cause and suicide mortality.

Emergency department self-harm presentations triggered short-term increases in multi-sector contacts. However, most (68.7%) reverted to the same service-use cluster observed prior to their index presentation. Suicide risk was highest within 1 year, particularly among those in the specialist mental health services cluster (4.5% of the cohort).

A small subgroup engage intensively with specialist mental health services yet remain at high suicide risk, while one in ten remain disengaged altogether, suggesting that an acute presentation of self-harm often fails to alter patients’ care trajectories long-term. Policy alignment with national recommendations for integrated, community-based care could improve sustained, evidence-based support beyond acute crises.

People with severe mental illness (SMI) face significant challenges when reintegrating from correctional facilities back to the community. These include increased recidivism risk, homelessness and mental health deterioration. Although specialised reintegration programmes were developed to address the needs of this vulnerable population, their effectiveness remains unclear owing to mixed findings reported in the literature.

We performed a systematic review to synthesise and evaluate available evidence on reintegration programmes designed specifically for people with SMI.

Studies were included if they focused on adults with SMI transitioning from correctional facilities to community settings. The search was conducted through 10 January 2026. Two reviewers independently screened eligible studies and scored the appropriate risk of bias tools under supervision. A narrative analysis was adopted given the heterogeneity of methodologies and outcomes.

We identified 26 eligible studies, of which 11 were longitudinal, seven were randomised controlled trials, 3 had an AB design, 2 quasi-experimental, 2 retrospective and 1 brief report. The median number of participants involved in these studies was 207 (range: 22–3086). Studies employed various interventions, including peer mentoring, critical time intervention models, case management and therapeutic community. Results showed mixed effectiveness: some programmes demonstrated reduced recidivism and improved mental health service engagement, whereas others had minimal impact or even counterintuitive increases in re-imprisonment. Programmes generally showed better outcomes with a longer duration and comprehensive aftercare components.

Reintegration programmes show promise, but current approaches demonstrate variable efficacy. Successful interventions appear to require comprehensive, sustained support addressing multiple domains including mental health treatment, housing, employment and social support.

Dementia affects approximately 6–13% of adults aged 65 years and older, with Alzheimer’s disease accounting for most cases. Established symptomatic therapies, including acetylcholinesterase inhibitors and memantine, provide limited benefit and do not modify disease progression. Multiple monoclonal antibodies (mABs) targeting different amyloid-β species have been developed as potential disease-modifying therapies; because some agents have entered clinical use whereas others remain investigational, a continuously updated synthesis of their efficacy and safety is needed.

To evaluate the efficacy and safety of all anti-amyloid mABs for adults with Alzheimer’s disease, using a living systematic review and meta-analysis.

We will conduct a living systematic review and meta-analysis in accordance with the Cochrane Handbook, Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 and the PRISMA extension for living systematic reviews. Randomised controlled trials comparing any approved or investigational anti-amyloid mAB with placebo, standard care or active comparators will be included. Searches of Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be updated every 6 months. Meta-analyses will be conducted separately for each antibody molecule using random-effects models. Critical outcomes include global clinical change and disease severity, cognitive abilities, functional ability and dependency, and safety (serious adverse events, treatment discontinuation and amyloid-related imaging abnormalities). Important outcomes include neuropsychiatric symptoms, quality of life and health system outcomes. Certainty of evidence will be assessed using the methodology Grading of Recommendations, Assessment, Development and Evaluation.

This article describes a protocol; therefore, no review findings are available at this stage.

This living systematic review will provide an up-to-date synthesis of the benefits and harms of anti-amyloid monoclonal antibodies to inform clinical decision-making and health-system planning in Alzheimer’s disease.

Growing research has underscored the elevated prevalence and burden of psychiatric morbidity among adults living with long COVID. The severity of acute SARS-CoV-2 infection may predict the prevalence and severity of psychiatric symptoms in long COVID. Although Global South countries have faced among the highest incidence rates and burden of COVID-19, little is known about the psychiatric symptoms of long COVID in these regions, especially in Sub-Saharan Africa.

This study aimed to (a) compare the prevalence of long-term psychiatric symptoms between acute COVID-19 infection groups, (b) estimate the associations between COVID-19 severity and long-term psychiatric symptoms, (c) determine the association between long COVID symptoms and psychiatric symptoms, and (d) test the potential mediating effect of long COVID symptoms in the association between acute COVID-19 infection and psychiatric symptoms.

This case–control study took place in Johannesburg, South Africa, between August 2022 and July 2023. A total of 360 adults were categorised into one of four case groups based on initial COVID-19 symptoms: asymptomatic, symptomatic, admitted to hospital and vaccinated controls.

Prevalence rates of post-traumatic stress disorder (21.1%) and somatic symptoms (22.9%) were elevated. Individuals with symptomatic COVID-19 exhibited the greatest psychiatric morbidity out of all groups, exhibiting the highest levels of depression, suicidality, anxiety, post-traumatic stress disorder, bipolar disorder and somatisation. Acute COVID-19 severity was associated with worse symptoms of depression, somatisation and physical fatigue. Severity of long COVID symptoms was directly associated with psychiatric sequelae.

These results call attention to the long-term psychiatric sequelae of SARS-CoV-2 infection and early identification and management of emerging psychiatric symptoms in high-risk COVID-19 survivors.

Relationships between maternal mental health and breastfeeding outcomes are complex, with evidence of bi-directional effects complicated by culturally specific residual confounding and selection bias.

This study aimed to examine, for the first time, associations between maternal genetic liability for neuroticism and breastfeeding intention, initiation and maintenance.

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective birth cohort. Maternal genotype data were used to create polygenic scores (PGS) for neuroticism. Mothers self-reported breastfeeding intentions at 32 weeks gestation, breastfeeding initiation within the first week after birth and maintenance of breastfeeding to 6 months after birth. We examined associations between maternal genetic liability for neuroticism and breastfeeding outcomes by using unadjusted logistic regression models (n = 4611). We also examined associations between paternal genetic liability for neuroticism and breastfeeding outcomes as a negative control (n = 1446).

There was evidence that genetic liability for neuroticism was associated with lower odds for breastfeeding maintenance (odds ratio 0.86, 95% CI 0.83–0.94, p < 0.001), with no evidence for associations with intention or initiation. That is, mothers with higher genetic liability for neuroticism were less likely to maintain breastfeeding to 6 months postpartum. There were no associations between paternal PGS for neuroticism and breastfeeding outcomes.

The specificity of links between neuroticism and maintenance of breastfeeding could direct targeting of efforts to support women with emotional difficulties in maintaining breastfeeding. This is important because currently, most efforts to support breastfeeding women focus on intention and initiation.

Neuroimaging research in autism often excludes individuals with co-occurring intellectual impairment or minimally verbal status, limiting the generalisability of findings. Understanding magnetic resonance imaging (MRI) scan success predictors in a representative autistic sample is crucial for equitable research.

This study identified factors predicting successful brain MRI acquisition and data quality in diverse autistic individuals, focusing on including those with intellectual impairment or minimally verbal status.

A total of 122 participants (83 autistic individuals (27 with intellectual impairment, 19 with minimally verbal status) and 39 typically developing controls) received multi-modal brain MRI scans (including structural, resting-state functional and diffusion MRI). Scan success, assessed using both binary criteria and quantitative data-quality metrics, was related to participant characteristics.

Although overall scan success was high, specific factors differentiated success within subgroups. Key factors contributing to scan success included age, non-verbal intelligence and attention-deficit hyperactivity disorder (ADHD) symptoms. Older participants, those with fewer ADHD symptoms and those with higher non-verbal intelligence were more likely to achieve successful scans, regardless of autism diagnosis. Higher data quality, particularly in structural and functional MRI, was associated with higher intelligence, better adaptive functioning, fewer autistic and ADHD symptoms, and fewer behavioural problems.

Identifying these factors is key to designing more inclusive and effective neuroimaging protocols. This work paves the way for more comprehensive research into the neurobiology of the full autism spectrum, and offers insights for improving the clinical MRI experience for autistic individuals with diverse support needs. Individualised strategies may also be useful in clinical settings, helping to improve the experience of MRI scanning for autistic individuals.

Mental health remains a low health priority globally. Despite the high burden of mental health in Ghana, little is known about the extent of financing and prioritisation by policymakers and other relevant stakeholders.

This study aims to understand the determinants of low domestic public financing and the prioritisation of mental health in Ghana, and to identify opportunities and strategies to increase policy attention.

Kingdon’s multiple streams framework was used to map barriers to domestic financing for mental health. We conducted a document analysis of relevant policies, strategies and articles, and carried out semi-structured interviews with relevant national stakeholders. We analysed interview transcripts deductively following the key domains for the multiple streams framework.

We found that low public financing for mental health stems from several issues at the level of the ‘problem stream’: low awareness and misunderstandings in general society, stigma and discrimination, insufficient public funding of the health sector in general, catastrophic healthcare expenditure insufficiently documented, limited political attention to mental health and limited donor interest. There is clear evidence of dynamism on the ‘policy solution stream’, including development of national laws, policies, strategies and institutions; adoption of international strategies and recommendations; and existence of policy entrepreneurs and windows. The democratic system of Ghana creates opportunities in the ‘politics stream’, but also raises the issue of continuity across governments.

In Ghana, mental health is not yet sufficiently recognised as a societal issue, which affects demand for services and contributes to the low policy priority and resource allocation by the government. Greater investment is therefore needed to raise public awareness through coalition building, research, campaigns and education activities.

Autistic women and birthing people (AWBP) are at heightened risk of perinatal mental health difficulties such as perinatal anxiety and depression, yet little is known about their experiences of support from specialist perinatal mental health teams (SPMHTs).

We aimed to understand the experiences of AWBP engaging with support from SPMHTs.

We conducted semi-structured interviews with 18 participants from 4 SPMHTs in England to explore their experiences and perceptions of care. We used codebook thematic analysis to identify and develop themes that captured and explained patterns within the data.

We identified three themes: (a) seeing the whole person: for many, SPMHT involvement was the first time autism was recognised or explored in a mental health context. Participants valued opportunities for formal assessment, which supported self-understanding and highlighted the need for integrated care addressing both autistic and mental health needs. (b) Experiencing SPMHT care as an autistic person: participants valued care that accommodated their needs and preferences, particularly practical interventions, although several reported unmet needs and many found discharge challenging. (c) Ideas for service improvement: participants recommended access to autism-informed practitioners and peer groups tailored for AWBP.

This study highlights how SPMHT care that recognises and responds to the distinct needs of AWBP can make a meaningful difference. AWBP valued holistic, autism-informed perinatal mental healthcare that recognised their communication, sensory and cognitive needs. Accessing assessment for a formal diagnosis supported the development of identity as an autistic person, helping to make sense of challenges in the perinatal period.