Psychotropic medication use has been shown to be associated with decreased bone mineral density (BMD) and quality, and increased fracture risk. Less is known about psychotropic use and associated bone loss over time.

To determine the association between psychotropic medication use and bone loss in men.

Data from 940 men (aged ≥20 years) participating in the Geelong Osteoporosis Study were used in this longitudinal study. BMD (g/cm2) at the spine and hip were measured with dual-energy X-ray absorptiometry at baseline, and 5 and 15 years post-baseline. Body mass index (BMI) was calculated, lifestyle factors and medication use was self-reported, and socioeconomic status was determined. Mood and anxiety disorders were identified through a clinical interview. Multivariable linear regression was used to determine the associations.

Over the study period (median 13.2 years), psychotropic use was associated with change in BMD at the spine (unadjusted mean difference −0.063 g/cm2, 95% CI −0.096 to −0.031, p < 0.001) and hip (−0.038 g/cm2, 95% CI −0.059 to −0.017, p < 0.001). BMI was identified as an effect modifier. Psychotropic use was associated with spine and hip bone loss at the 25th (adjusted mean difference −0.077g/cm2 (95% CI −0.122 to −0.033); and −0.058 g/cm2 (95% CI −0.084 to −0.032), respectively) and 50th percentile (adjusted mean difference −0.053 g/cm2 (95% CI −0.089 to −0.018) and −0.038 g/cm2 (95% CI −0.059 to −0.017), respectively), but not the 75th percentile of BMI (p = 0.121 and p = 0.106, respectively).

Psychotropic use was associated with bone loss in non-obese men, highlighting the need for regular monitoring and preventive strategies to protect bone health.

Attention-deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity, resulting in impaired functioning in multiple settings, including home, school and in social settings. Disparities exist in ADHD care among children, with White male children experiencing increased access to diagnosis and treatment. Other children remain underdiagnosed, undertreated and subject to poorer functional outcomes. Factors that impact equitable ADHD treatment include gender, race, ethnicity and social determinants of health (SDOH), including household income, parental education, insurance status, neighbourhood deprivation and discrimination. Medication is effective, yet little is known regarding the impact of medication type and trajectories of use on functional outcomes.

Data from the first 6 time points of the Adolescent Brain and Cognitive Development℠ Study® (N = 11 868) will be used to address the following aims. Aim 1: identify typologies of children with distinct trajectories of medication use using multivariate latent class growth analysis. Aim 2: identify typologies of children with distinct trajectories of child-reported functional outcomes using latent class growth analysis. Aim 3: examine relationships of gender, race, ethnicity, SDOH and medication use with trajectories of functional outcomes using multinomial logistic regression.

This study protocol describes the background and methods for an observational study seeking to better understand the impact of gender, race, ethnicity, SDOH and trajectories of medication use on child-reported functional outcome trajectories in a diverse group of US children with ADHD.

Findings will advance the understanding of effective ADHD treatment and highlight the importance of equitable treatment access.

The effectiveness of Community Treatment Orders (CTO) and the variability with which they are used remains the subject of ongoing debate.

To examine the associations between discharge from psychiatric in-patient care on to a CTO in New South Wales (NSW), Australia, and hospital admissions and bed-days in the following 12 months.

Retrospective matched case-control study using linked administrative health data from NSW between 1 January 2017 and 31 December 2023. Cases were individuals discharged on to a CTO after their first psychiatric hospital admission during the study period. We attempted to match controls 2:1 on age, gender and hospital discharge within 6 months of each other. Data were from the NSW Mental Health Ambulatory and Admitted Patient Data Collections.

There were 5506 individuals discharged on to CTOs and 9761 matched controls. Discharge on to a CTO did not affect the odds of hospital readmissions in the following 12 months (adjusted odds ratio (ORadj) = 1.06, 95% CI 0.97–1.14) though was associated with significantly greater bed-days (log βadj = 0.12, 95% CI 0.08–0.17, p < 0.0001). Individuals with a principal diagnosis of non-affective psychosis who were discharged on to a CTO had significantly lower odds of hospital readmissions in the following 12 months (ORadj = 0.67, 95% CI 0.59–0.77).

Discharge on to a CTO did not significantly affect hospital readmissions across the full sample, but did significantly lower the odds for individuals with non-affective psychosis. This suggests that targeted use of CTOs in specific populations (e.g., non-affective psychosis) warrants greater consideration, as the benefit of their use otherwise – especially from a human rights point of view – is unclear.

Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).

Non-suicidal self-injury (NSSI) is a major clinical and public health issue in adolescence. Although psychological factors such as depression, anxiety and emotion dysregulation have been widely examined, less is known about how pain perception and autonomic reactivity interact with these variables in NSSI.

This study aimed to compare pressure pain threshold (PPT), autonomic responses and psychological characteristics between adolescents with NSSI and healthy controls, and to explore associations between pain perception, psychopathology, emotion regulation and NSSI functions.

Sixty-eight adolescents (34 with NSSI, 34 controls) participated. PPT was assessed using a pressure algometer. Depressive symptoms, anxiety symptoms and emotion regulation difficulties were measured, and NSSI functions were evaluated using a standardised tool. Systolic (SBP)/diastolic blood pressure and heart rate were recorded before and after pain stimulation. Correlational analyses and mixed (repeated measures) analyses of variance were performed.

The NSSI group showed a significantly higher PPT than controls (mean difference 1.43 kg/cm2; 95% CI: 0.64–2.00; p < 0.001). A significant group × time interaction emerged for SBP (η2 = 0.09), indicating a blunted post-pain response in the NSSI group. Emotion regulation difficulties were positively associated with PPT (r = 0.28). PPT was also positively correlated with sensation seeking (r = 0.36), autonomy (r = 0.34) and peer bonding (r = 0.36) functions of NSSI.

Adolescents with NSSI demonstrate elevated pain thresholds and altered autonomic reactivity. These findings highlight the importance of considering pain processing alongside psychological characteristics and NSSI functions in clinical assessment and intervention planning.

Accurate trauma recollections are essential in legal and research contexts; however, studies frequently reveal significant inconsistencies in trauma reporting over time.

To investigate the trauma-reporting patterns among healthcare workers (HCWs) following their exposure to the Beirut port blast.

This longitudinal study examined trauma memory alteration among 296 HCWs at 6 months (wave 3) and 2–2.5 years (wave 4) post-blast. Participants reported trauma exposure prior to the event, and probable post-traumatic stress disorder (PTSD) secondary to the Beirut port blast. Depression and psychological distress were analysed as potential predictors of memory alteration using multinomial models.

The majority of participants (72.4%) exhibited inconsistent trauma reporting, with 36.43% exaggerating and 35.71% diminishing their trauma accounts over time. Developing probable depression and screening positive for PTSD at wave 4 were predictors of memory exaggeration (respectively odds ratio 5.71, 95% CI: 1.19–27.32; odds ratio 8.04, 95% CI: 0.98–65.73), while remitted psychological distress was protective (odds ratio 0.08, 95% CI: 0.01–0.99). No significant predictors were found for memory diminishment.

A substantial portion of HCWs exposed to the Beirut port blast demonstrated inconsistent trauma reporting, with mental health conditions such as depression and PTSD influencing memory exaggeration. These findings underscore the importance of considering memory reliability in trauma research, particularly in populations with mental health disorders and exposed to major disasters.

Despite young British Bangladeshis experiencing a higher prevalence of mental health problems than the White British population, they are comparatively underrepresented in mental health research and fewer access services.

This study aimed to identify priorities and preferences for mental health support among young British Bangladeshis, as well as strategies to enhance the cultural appropriateness and accessibility of services.

A qualitative study was conducted in London and Leicester, with participants recruited through voluntary and community organisations. In-depth interviews were held with young people with lived experience of mental health problems (n = 12), their family members (n = 7) and Bangladeshi community workers from voluntary sector organisations (n = 7). Data were analysed using thematic framework analysis.

Participants’ priorities for mental health support included reducing stigma, raising awareness, and addressing intergenerational and identity-related stressors. Preferences centred on culturally and linguistically appropriate care delivered by therapists familiar with Bangladeshi values in trusted community settings. Suggested strategies for improving existing services included enhancing access by providing support in trusted community spaces, building trust through the involvement of culturally aware professionals, and involving families and community leaders to reduce stigma and promote open discussion around youth mental health.

This study identifies a need for culturally tailored, linguistically accessible and community-rooted mental health support for British Bangladeshi youth. Representatives from these communities should be actively involved in the development of future programmes and policies, ensuring that support is both relevant and sustainable.

Limited data exist on factors influencing the length of hospital stay (HLoS) in patients with schizophrenia.

This study aimed to identify and quantify patient characteristics associated with HLoS.

A retrospective study was conducted on patients diagnosed with schizophrenia (F20, ICD-10) admitted to the County Emergency Hospital of Cluj-Napoca, Romania, from 2018 to 2022. Demographics, comorbidities, symptom severity (Positive and Negative Syndrome Scale/Brief Psychiatric Rating Scale), antipsychotic treatment and adverse effects data were collected from medical charts. Predictors of HLoS for patients with one hospitalisation were assessed using negative binomial regression.

The sample comprised 288 patients aged 18–65 years, with 75% over 30 years and a balanced gender distribution. Most patients had no comorbidities (64.24%) whereas 49.46% reported addictions. Men had higher rates of tobacco use (62.00 v. 53.49%) and self-reported use of substances/drugs (15.49 v. 3.91%). Independent predictors of HLoS (P < 0.05) in the multivariable model included gender, being retired, experiencing fear or violence in the context of psychotic decompensation, percentage score reduction in symptom severity score, first-generation antipsychotics treatment and the presence of reasons for late discharge. Men had an expected HLoS 39% longer than women. Experiencing fear (adjusted incidence rate ratio (aIRR) 1.13, 95% CI [1.01; 1.27]) and violence in the context of psychotic decompensation (aIRR 1.19, 95% CI [1.06; 1.34]), and first-generation antipsychotics treatment (aIRR 1.17, 95% CI [1.02; 1.35]) were associated with longer stay, whereas being retired predicted shorter HLoS (aIRR 0.83, 95% CI [0.70; 0.98]).

The length of hospital stay in patients with schizophrenia is influenced by demographic, clinical and treatment factors. Targeted interventions addressing these predictors may optimise the duration of hospitalisation.

Late-life depression (LLD) is associated with cognitive impairment and an elevated risk of dementia, yet the influence of age at depression onset on cognitive prognosis remains unclear. Emerging evidence suggests that late-onset depression, defined as first depressive episode in later adulthood, may reflect distinct neuropathological mechanisms and predict more severe cognitive decline and greater dementia risk than early-onset depression.

This study aimed to investigate whether late-onset depression is linked to domain-specific cognitive impairment and higher risk of incident dementia among older adults with major depressive disorder.

We analysed UK Biobank data from older adults (aged ≥60 years) with primary care linkage, classifying participants into depression-free controls, early-life depression, late-life depression with early onset (LLD-EO) and late-life depression with late onset (LLD-LO). Cognitive performance across these five domains was assessed cross-sectionally at baseline using touchscreen tasks. Incident dementia was evaluated prospectively using clinical records up to 2022. Multi-level models with inverse-probability weighting and survey-adjusted mixed modelling were applied to assess group differences in cognitive function, controlling for demographic covariates, lifestyle factors and physical and mental health conditions. A Cox regression model was employed to estimate dementia risk among groups.

Among 75 064 participants aged ≥60 years, the LLD-LO group (n = 4858) showed significantly worse cognitive performance than healthy controls, particularly on fluid intelligence and visuospatial memory. The LLD-LO group performed worse than LLD-EO on fluid intelligence. During follow-up, LLD-LO was associated with a higher risk of incident dementia (hazard ratio 1.42–1.52) across all adjusted models. Deficits in fluid intelligence and visuospatial memory partially mediated the link between LLD-LO and subsequent dementia.

Late-onset depression showed more severe impairment in fluid intelligence compared with LLD-EO. Late-onset depression was associated with increased incident dementia compared with depression-free individuals.

Adults with mental illness have higher smoking prevalence and face greater financial burdens from smoking compared with the general population.

This study explores how individuals’ psychological distress and smoking status are jointly associated with household expenditure patterns in Australia.

Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey over three waves. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10) and the mental health domain of Medical Outcomes Study Short-Form General Health Survey (SF-36 MHD). Household expenditure categories included alcohol, clothing, education, fuel, general insurance, medicines, health practitioners, groceries, meals eaten out, internet, utilities, public transport and rent. Regression models using the generalised estimating equation technique compared expenditure data, controlling for age, gender, household composition, socioeconomic position, education level and wave of data collection.

Smokers and ex-smokers showed significant differences in expenditure across K10 psychological distress levels. At low and moderate distress levels, smokers spent more on alcohol and rent and less on insurance, health practitioners, meals out and medicines. At high distress levels, only education expenditure was significantly lower for smokers. Across SF-36 MHD tertiles, smokers spent less on education, insurance and medicine, but more on alcohol, especially at lower and moderate distress levels.

Smoking cessation for those with moderate psychological distress may be associated with a reallocation of spending, benefiting both households and their local communities. Targeted interventions addressing smoking cessation and mental health are crucial for reducing financial and health inequities.

Substance use disorder (SUD) is frequently associated with cognitive impairment that negatively affects treatment adherence and clinical outcomes. Neuropsychological assessments provide detailed information but are often impractical in clinical settings, underscoring the value of brief but sensitive tools such as the Montreal Cognitive Assessment (MoCA).

This study aimed to evaluate the utility of MoCA in detecting cognitive impairment in SUD, examining cognitive recovery following sustained abstinence, exploring gender differences in cognitive progression and determining whether baseline cognitive performance predicts treatment dropout.

Ninety-five SUD patients and 57 healthy controls completed MoCA at baseline and were reassessed after 6 months.

At baseline, 72.60% of individuals demonstrated cognitive impairment compared with controls, with deficits evident in both global cognition and visuospatial/executive, attention, memory and language domains. Following 6 months of abstinence, deterioration rates decreased to 50%, indicating substantial but not complete recovery, because the improvement in overall cognition was moderate. Male patients showed significantly greater cognitive gains than female patients, particularly in visuospatial/executive and digit span performance. Patients impaired at baseline reported more severe alcohol use and earlier onset of cannabis use disorder. Patients with cocaine use disorder showed the poorest recovery and the highest rate of treatment dropout. Lower baseline language and fluency scores were strongly associated with treatment discontinuation. Language deficits, together with cocaine use disorder, predicted 69% of dropout cases.

Findings indicate MoCA as a practical screening tool for early detection of cognitive impairment, longitudinal monitoring and personalised treatment planning in SUD.

Promoting bystander interventions is a core strategy to prevent suicides in public places, but little is known about how people with lived experience perceive this intervention.

To explore people’s experiences of receiving an intervention during a suicide attempt on the railways.

Interviews were conducted with 28 people with experience of receiving a bystander intervention during a suicide attempt on the railways. Interview data were triangulated with an online ethnography exploring posts made on forums and similar platforms openly discussing suicide.

Using reflexive thematic analysis, five themes were generated: (a) ‘I’m a good actor… we all carry a mask’: concealing feelings and intentions; (b) ‘It kind of draws your attention away but it doesn’t almost shine a spotlight’: interventions should be gentle and not draw more attention; (c) ‘People that were getting in my way were just making me want to try harder’: interventions can trigger difficult feelings in the moment; (d) ‘I did feel different, I felt better’: the power of small talk; and (e) ‘You feel like a human being and you feel like they actually care’: wanting to feel cared for.

Findings suggested that some people actively avoid receiving an intervention by concealing how they are feeling in that moment. Interventions that are gentle and do not draw attention may be preferable, such as making small talk and simple gestures such as smiling or being near the individual. Conversely, more intrusive or aggressive interventions may be triggering and exacerbate suicidality.

Understanding the economic cost of self-harm is essential for evaluating intervention cost-effectiveness and guiding funding allocation and service planning.

To estimate the cost associated with self-harm presentations to hospital emergency departments and investigate key predictors of cost.

Data on presentations to hospital for self-harm in all Irish emergency departments were analysed for 2018 and 2019. Costs of hospital treatment following self-harm were identified (in 2019 euros) using top-down and bottom-up approaches. The perspective taken was that of the health service. Factors associated with costs were investigated using generalised linear models.

There were 25 053 self-harm presentations from 2018 to 2019. The average annual cost of self-harm was approximately €26.5 million; almost half of the total cost was due to repeat self-harm presentations (47.3%). The mean cost per presentation was €2117 (s.d. €1845), which incorporates acute hospital costs (mean €2067, s.d. €2127) and those of initial aftercare (mean €50, s.d. €69). Psychiatric and medical admissions were associated with highest costs, three times that of presentations resulting in emergency department discharge (incidence rate ratio (IRR) 3.01, 95% CI 2.72–3.36 and IRR 2.88, 95% CI 2.72–3.36, respectively). Other factors associated with higher costs included older age, emergency department medical assessment unit admission, receiving a psychosocial assessment and self-harm involving a firearm. Demographic and clinical predictors of cost varied according to care pathway.

Significant costs associated with repeat attendances and hospital admission provide evidence for investment in emergency department services providing comprehensive care for those presenting with self-harm, as well as in community-based mental health services.

Despite the high prevalence of mental health difficulties in young refugees and asylum seekers, evidence suggests that they underutilise mental health services. It is important that we understand their use of, and access to, mental health services.

To examine quantitative evidence on mental health service utilisation and access among young refugees and asylum seekers.

We searched MEDLINE, PsycINFO, Embase, Global Health and The International Bibliography of the Social Sciences. Searches were supplemented by reference list screening and forward-and-backward citation tracking of included studies. Results were synthesised narratively. Our review was pre-registered on PROSPERO (no. CRD42024540885) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Twenty-two studies were included. We found an overall pattern of underutilisation of services by young refugees in comparison with majority population peers, particularly for out-patient services and psychotropic medication. In contrast, there was evidence of increased emergency service use. Service use was particularly decreased for those from low- and middle-income countries, and increased in unaccompanied minors. Service use for trauma-related disorders and schizophrenia was most common, and less likely for neurodevelopmental disorders. Only one study contained data on access-related factors, which identified language as a potential barrier.

There is a disparity between the mental health needs and service use of young refugees, suggesting a need for greater efforts to increase access and use in this population. Future research should explore barriers and facilitators, and build on primary research examining service use in asylum seekers and unaccompanied minors, because both remain underrepresented within the literature.

Recent decades have seen a steady increase in antidepressant prescribing, but little is known about prescribing trends during and following the COVID-19 pandemic.

This preregistered systematic review, following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, aimed to investigate antidepressant prescribing trends for adults in the UK and Republic of Ireland during and after the pandemic. It also compared prescriptions by drug and location.

We searched six databases: APA PsycInfo, CINAHL, MEDLINE, Scopus, medRxiv and Preprints.org. The review included primary research articles reporting trends in antidepressant prescriptions, including at least one time point after March 2020 in the UK and Republic of Ireland. This review has been preregistered on PROSPERO (ID: CRD42024498503).

We identified 7,320 studies, of which ten met the search criteria for the review. Studies were grouped on the basis of time period (2020: n = 5; 2021: n = 3; 2022: n = 2), location (England, Scotland, Northern Ireland, Republic of Ireland, UK) and drug type (serotonin–noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclics, and others (e.g. monoamine oxidase inhibitors)). Most studies (eight of ten) demonstrated increased antidepressant prescribing over time. Two studies highlighted a decrease between March and May 2020. Demographic variables reflected higher rates of prescribing for women, and the modal group receiving antidepressants comprised middle-aged adults.

The commonly reported increase in antidepressant prescribing corroborates pre-pandemic trends and may suggest further, increased demands for mental health support to meet the unique challenges of the pandemic. Future research is required to evaluate the appropriateness of treatment decisions and to explore psychosocial factors that influence individual prescribing choices.

Little is known about self-harm in children involved in family justice proceedings, particularly in private family courts in England and Wales.

To examine records of self-harm in children involved in private and public law proceedings using population-level linked data.

A retrospective e-cohort study of children aged under 18 years, using linked health and family justice (Cafcass Cymru) data (2011–2018). Family court involvement was recorded from age 0 to 17 years. Incidence of self-harm was recorded from age 10 to 17 years to fit with the standard definition of self-harm. Annual incidence of self-harm over time across general practitioner (GP), emergency department and hospital admissions for individual children in private and public law proceedings were compared with a non-court cohort using Poisson regression. Self-harm following court proceedings was compared with an age- and gender-matched non-court cohort using Cox regression.

Adjusted self-harm rates were higher in court-involved children than the non-court cohort (incident rate ratios (IRRs) (95% CI), private: GP 1.8 (1.6–2.1); emergency department 1.4 (1.2–1.7); admissions 1.8 (1.5–2.1); public: GP 4.6 (4.1–5.3); emergency department 5.0 (4.3–5.8); admissions 5.0 (4.3–5.8)). Compared with matched comparison children, risk of self-harm was higher following private (adjusted hazard ratios 2.0 (1.7–2.2)) and public court proceedings (hazard ratio 2.3 (2.7–3.8)). Hazard ratios were greater for those from less deprived areas and those with no history of self-harm.

The elevated risk of self-harm in children involved in public law proceedings is well recognised. Our study highlights risk in children in private family justice proceedings. Elevated risk among those from less deprived areas and those with no history of self-harm may reflect circumstances associated with family justice involvement, resulting in rates comparable to children with other pre-existing vulnerabilities. Contact with family justice is an opportunity to offer preventative support.

Social anxiety is a common and impairing condition that often emerges in adolescence.

This study aimed to examine the prevalence and severity of social anxiety among Chinese youths in the post-COVID-19 era, and to develop a predictive model identifying key factors associated with social anxiety severity.

A total of 555 youths aged 15–25 years completed an online survey via WeChat on social anxiety (Social Phobia Inventory), depressive symptoms (Patient Health Questionnaire), sleep problems (Pittsburgh Sleep Quality Index), social support (Multidimensional Scale of Perceived Social Support) and internalised stigma (Internalized Stigma of Mental Illness Scale). Social anxiety severity and rates were described, and comparisons were made across sociodemographic groups. Hierarchical multiple regression was used to predict social anxiety severity from depression, sleep, social support and stigma. An additional regression examined which components of social anxiety (fear, avoidance, physical symptoms) predict internalised stigma.

In total, 69.55% of participants reported at least mild social anxiety, with 20% reaching severe or very severe levels. Female, younger participants and those with fewer close friends reported significantly higher anxiety. Depressive symptoms (β = 0.31, P < 0.05) and internalised stigma (β = 0.40, P < 0.05) were strong predictors of anxiety severity, while sleep problems and social support were not significant after controlling for these factors. Among social anxiety dimensions, only avoidance significantly predicted higher stigma (β = 0.17, P < 0.01).

The high post-pandemic prevalence of social anxiety among youths highlights the need for early identification, stigma reduction and interventions targeting depression and avoidance to prevent long-term impairments.

In the UK, clozapine is the only licensed treatment for treatment-resistant schizophrenia (TRS). However, it is underused because initiation is often limited by the need for in-patient admission, which is costly and unattractive to patients. Community clozapine services may address this.

To describe a targeted out-patient clinic (Treating Unmet Needs in Psychiatry (TUNE-UP)) for TRS management and assess its impact on community clozapine initiation rates.

We reviewed clozapine titrations of patients under four community mental health teams from September 2021 to January 2025, recording whether titration occurred as in- or out-patient. The TUNE-UP clozapine clinic operated for 12 months (September 2023 to September 2024). Initiation rates during the TUNE-UP period were compared with those when the service was unavailable, using Poisson regression. Clinical outcomes were assessed using scales including the Positive and Negative Syndrome Scale (PANSS).

Fifty-one individuals commenced clozapine during the study period. There was a significant increase in the rates of community initiation in the TUNE-UP period (11.0 per year) compared with those outside of this period (1.71 per year; incidence risk ratio 6.42 [95% CI 2.04–20.2, P = 0.0015]). Patients seen by TUNE-UP showed significant improvements in PANSS (n = 6, median improvement 21.5 [95% CI 7.0–33.0], P = 0.03).

A specialist service was associated with a significant increase in community clozapine initiations. This approach offers a strategy to improve TRS treatment in the community.

This longitudinal study examines the psychometric validity of the Subjective Traumatic Outlook (STO) questionnaire by evaluating its structural consistency and diagnostic performance in a conflict-affected context. The STO was used to measure trauma-related subjective distress at two time points following the terrorist attacks in Israel on 7 October 2023.

The primary aim of this study was to evaluate the STO as a concise and reliable assessment tool for populations affected by armed conflict.

A nationally representative sample of 4097 participants responded at T1, of whom 2005 completed the study at T2. Data were collected during the ongoing war in Israel. Participants completed the STO alongside validated measures of post-traumatic stress disorder (PTSD (PTSD Checklist for DSM-5) and International Trauma Questionnaire), depression, anxiety and adjustment disorder. Exploratory factor analyses were used to estimate one- to three-factor solutions using robust maximum likelihood estimation. Convergent validity was assessed through bivariate correlations with trauma- related measures. Receiver operating characteristic analyses were conducted to evaluate diagnostic utility for PTSD and complex PTSD per the ICD-11.

Exploratory factor analysis supported a stable two-factor structure across both waves. The STO demonstrated strong internal consistency and stable convergent validity over time. Receiver operating characteristic analyses indicated that the four-item version matched or slightly outperformed the five-item version, suggesting improved parsimony without loss of diagnostic accuracy.

The stable factor structure of the STO and its strong psychometric properties across both waves within a wartime context support its utility for large-scale screening and early detection of trauma-related distress.

Antipsychotics are essential for managing certain mental disorders; however, little is known about regional disparities in their prescribing or how these patterns are shaped by ethnic density and health inequalities.

To analyse national, regional and local integrated care board trends in antipsychotic prescribing in England from April 2019 to March 2025, and to explore their associations with health inequalities and ethnic density.

A population-level observational study was conducted using the English primary care prescription data from OpenPrescribing. Linear regression was used to assess trends in first-generation (FGA), second-generation (SGA) and total antipsychotic prescribing. Generalised additive models examined associations between prescription rates and health inequalities and ethnic density at the local level.

Antipsychotic prescribing increased from 185.55 to 199.85 prescriptions per 1000 population between April 2019 and March 2025. SGA use increased significantly (168.48 to 186.27) whereas FGA use declined (17.08 to 13.58). Regional annual increases ranged from 3.85% (95% CI = 3.53%, 4.16%) in London to −0.21% (95% CI = −0.72%, 0.31%) in the South-West region, with greater variation at the local level, from 6.62% (95% CI = 5.71%, 7.53%) in North Central London to −2.05% (95% CI = −2.71%, −1.40%) in Shropshire, Telford and the Wrekin. Higher Pakistani ethnic density was associated with lower prescribing rates, whereas greater health inequalities were linked to increased prescribing.

Antipsychotic prescribing patterns have shifted in recent years, with notable regional disparities influenced by health inequalities and ethnic composition. Targeted interventions are needed to promote equitable access and address prescribing disparities in mental healthcare.