Early-life adverse experiences can elevate the magnitude of the risk of developmental psychopathology, but the potential synergistic effects of multiple factors have not been well studied.

To determine whether prenatal exposures to maternal stress (Superstorm Sandy) and maternal cannabis use synergistically alter the risk of developmental psychopathology.

The study included 163 children (53.4% girls), longitudinally tracked (ages 2–5 years) in relation to the effects of two early-life adverse exposures (Superstorm Sandy and maternal cannabis use). Offspring were grouped by exposure status (neither, only maternal cannabis use, only Superstorm Sandy or both). DSM-IV disorders for offspring were derived from structured clinical interviews; caregiver-reported ratings of family stress and social support were also assessed.

A total of 40.5% had been exposed to Superstorm Sandy and 24.5% to maternal cannabis use. Offspring exposed to both (n = 13, 8.0%), relative to those exposed to neither, had a 31-fold increased risk of disruptive behavioural disorders (DBDs) and a seven-fold increased risk of anxiety disorders. The synergy index demonstrated that offspring with two exposures had synergistic elevation in risk of DBDs (synergy index, 2.06, P = 0.03) and anxiety disorders (synergy index, 2.60, P = 0.004), compared with the sum of single risks. Offspring with two exposures had the highest parenting stress and lowest social support.

Our findings are consistent with the double-hit model suggesting that offspring with multiple early-life adverse exposures (Superstorm Sandy and maternal cannabis use) have synergistically increased risks of mental health problems. Given the increasing frequency of major natural disasters and cannabis use, especially among women under stress, these findings have significant public health implications.

There are no longitudinal studies investigating determinants of incident and persistent depressive symptoms in Southeast Asia.

To estimate the proportion and correlates of incident and persistent depressive symptoms in a prospective cohort study among middle-aged and older adults (≥45 years) in Thailand.

We analysed longitudinal data from the Health, Aging, and Retirement in Thailand (HART) surveys in 2015 and 2017. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to calculate predictors of incident and persistent depressive symptoms.

In total, 290 of 4528 participants without depressive symptoms in 2015 had incident depressive symptoms in 2017 (9.8%) and 76 of 640 adults had persistent depressive symptoms (in both 2015 and 2017) (18.3%). In adjusted logistic regression analysis, having diabetes (adjusted odds ratio AOR = 1.48, 95% CI 1.07–2.05), musculoskeletal conditions (AOR = 1.56, 95% CI 1.01–2.41) and having three or more chronic conditions (AOR = 2.55, 95% CI 1.67–3.90) were positively associated and higher subjective economic status (AOR = 0.47, 95% CI 0.31–0.72) and social participation (AOR = 0.66, 95% CI 0.49–0.90) were inversely associated with incident depressive symptoms. Having a cardiovascular disease (AOR = 1.55, 95% CI 1.01–2.39) and having three or more chronic conditions (AOR = 2.47, 95% CI 1.07–5.67) were positively associated and social participation (AOR = 0.48, 95% CI 0.26–0.87) was inversely associated with persistent depressive symptoms.

One in ten middle-aged and older adults had incident depressive symptoms at 2-year follow-up. The prevalence of incident and/or persistent depression was higher in people with a lower subjective economic status, low social participation, diabetes, musculoskeletal disorders, cardiovascular conditions and a higher number of chronic diseases.

Emergency departments are key settings for suicide prevention. Most people are deemed to be at no or low risk in final contacts before death.

To micro-analyse how clinicians ask about suicidal ideation and/or self-harm in emergency department psychosocial assessments and how patients respond.

Forty-six psychosocial assessments between mental health clinicians and people with suicidal ideation and/or self-harm were video-recorded. Verbal and non-verbal features of 55 question–answer sequences about self-harm thoughts and/or actions were micro-analysed using conversation analysis. Fisher's exact test was used to test the hypothesis that question type was associated with patient disclosure.

(a) Eighty-four per cent of initial questions (N = 46/55) were closed yes/no questions about self-harm thoughts and/or feelings, plans to self-harm, potential for future self-harm, predicting risk of future self-harm and being okay or keeping safe. Patients disclosed minimal information in response to closed questions, whereas open questions elicited ambivalent and information rich responses. (b) All closed questions were leading, with 54% inviting no and 46% inviting yes. When patients were asked no-inviting questions, the disclosure rate was 8%, compared to 65% when asked yes-inviting questions (P < 0.05 Fisher's exact test). (c) Patients struggled to respond when asked to predict future self-harm or guarantee safety. (d) Half of closed questions had a narrow timeframe (e.g. at the moment, overnight) or were tied to possible discharge.

Across assessments, there is a bias towards not uncovering thoughts and plans of self-harm through the cumulative effect of leading questions that invite a no response, their narrow timeframe and tying questions to possible discharge. Open questions, yes-inviting questions and asking how people feel about the future facilitate disclosure.

The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in this context is not well documented.

To evaluate a stepped-care psychological support pathway for HSCWs from Homerton Healthcare Foundation Trust in London, which offered psychological first aid, evidence-based psychological therapies and group-based well-being workshops.

The service evaluation used a pre–post approach to assess depression, anxiety, functional impairment and post-traumatic stress disorder symptom change for those who attended sessions of psychological first aid, low- or high-intensity cognitive–behavioural therapy or a combination of these. In addition, the acceptability of the psychological first aid sessions and well-being workshops was explored via feedback data.

Across all interventions, statistically significant reductions of depression (d = 1.33), anxiety (d = 1.37) and functional impairment (d = 0.93) were observed, and these reductions were equivalent between the interventions, as well as the demographic and occupational differences between the HSCWs (ethnicity, staff group and redeployment status). HSCWs were highly satisfied with the psychological first aid and well-being workshops.

The evaluation supports the utility of evidence-based interventions delivered as part of a stepped-care pathway for HSCWs with common mental health problems in the context of the COVID-19 pandemic. Given the novel integration of psychological first aid within the stepped-care model as a step one intervention, replication and further testing in larger-scale studies is warranted.

Lithium has long been recognised as an effective treatment for bipolar disorder. Its relative efficacy has been measured with a diverse range of clinical outcomes, resulting in differences in efficacy reporting that have not been systematically reviewed.

We aimed to identify and compare the various measures of lithium efficacy employed in interventional studies for people with bipolar disorder.

Database (PubMed, Web of Science) and hand searches were performed to identify studies that assessed a clinical response in patients with bipolar disorder who received lithium, up to the end of 2021. We included primary human interventional studies without excluding specific study designs, bipolar disorder subtypes, duration or dosage of lithium treatment. Continuous outcome effects were meta-analysed; binary outcomes were synthesised visually and narratively. The Cochrane risk-of-bias tool was used to assess study-level risk of bias.

Seventy-one studies were included (N = 30 542). Approximately two-thirds of participants attained a clinically significant improvement in manic or depressive symptoms, and over 50% achieved remission. About a third required hospital admission (study length 2–12 years) and around 50% needed further treatment to stay well or had recurrence of symptoms; the latter two outcomes tended to be assessed over long-term maintenance periods.

An abundance of measurements have been used to assess lithium's clinical effects, across several study designs. Despite the resultant high heterogeneity, an overall picture of lithium's effects emerges that supports previous literature; between half and two-thirds of patients respond well to lithium across varying outcome measures, baseline mood states, study durations and bipolar disorder subtypes.

Suicide is a serious public health problem.

To investigate the sociodemographic and clinical features of callers (patients) classed by the Qatar National Mental Health Helpline (NMHH) as moderate to high priority based on the risk of self-harm or suicide during the COVID-19 pandemic.

The study design was a retrospective chart review of patients who contacted the helpline in the first 12 months, starting 1 April 2020. Data of those classed as moderate to high priority based on risk to self were collected using a specifically designed form. Absolute and relative frequencies for each of the studied categorical variables were determined.

Four hundred and ninety-eight patients were included. More than half were female. The mean age was 32 years (range 8–85 years). Two-thirds of patients were from Arab countries and more than half of all patients had contacted mental health services for the first time. The most common symptoms elicited included suicidal thoughts, depressed mood and disturbed sleep. The most common psychiatric disorders were depression and generalised anxiety disorder. Most patients were seen within 4 h and received psychiatric interventions. Virtually all patients received non-pharmacological interventions; only 38.5% received pharmacological interventions. The majority had follow-up appointments arranged with mental health services.

People from the Indian subcontinent and males proportionally approached services less, which may reflect stigma. The NMHH improved access to care for patients considered at risk to self and prevented hospital admissions. The NMHH offers a valuable additional choice to patients and assists in prevention and management of suicidal behaviour and other mental health difficulties.

Current assessment and management models often do not adequately address the many aspects of managing complex brain disorders involving disordered affect, behaviour and cognition (ABC). A more collaborative model of care, where several specialties can jointly assess and manage patients with complex brain disorders, is gaining attention.

In this case report, we present two cases that highlight the benefits of the ‘brain medicine’ clinical model.

The Brain Medicine Clinic employs an integrated clinical model in which psychiatrists and neurologists provide integrated interdisciplinary assessments of patients with complex brain disorders, leading to comprehensive assessment. We describe the clinical model and the trajectories of two patients with complex brain disorders seen in this clinic. In these case descriptions, we explain how the brain medicine clinical approach leads to an improved patient experience.

The Brain Medicine Clinic assessments resulted in a neurobiopsychosocial formulation of symptoms and, consequently, holistic individualised treatment plans for two patients with complex brain disorders. This approach to patients’ conditions emerges from the understanding that there are multifactorial causes of brain disorders at the social, cultural, psychological and biological level.

Integrated interdisciplinary assessments allow for tailored treatment plans for individuals experiencing complex brain disorders, while creating efficiencies for the patient and the healthcare system.

The research on the role of father in the foetal programming of health and behaviour has received increasing attention. However, the influences of paternal depressive symptoms and couple relationship satisfaction during pregnancy – potentially mediated via maternal well-being – on the offspring's risk of infections in early life is still seldom assessed.

The aim was to investigate if paternal psychological distress during pregnancy is associated with elevated risk of recurrent respiratory infections (RRIs) for offspring at 12 months of age, and whether maternal distress mediates the association between paternal distress and offspring RRIs.

The study population was drawn from the nested case–control cohort of the FinnBrain Birth Cohort Study. Children with RRIs (n = 50) were identified by maternal reports at the age of 12 months, whereas mothers did not report RRIs for the comparison group (n = 716). Parental depressive symptoms were measured with the Edinburgh Postnatal Depression Scale and couple relationship satisfaction was measured with the Revised Dyadic Adjustment Scale.

The association between paternal depressive symptoms during pregnancy and offspring RRIs was mediated by maternal prenatal depressive symptoms. Additionally, paternal poorer relationship satisfaction was associated with child RRIs independently of maternal distress.

The results suggest different pathways through which paternal distress during pregnancy may contribute to elevated risk of offspring RRIs, and more research is needed to study their underlying mechanisms. Paternal distress and couple relationship satisfaction during pregnancy should be assessed and screened as a contributor to offspring health.

Patients with ‘underlying’ autism spectrum disorder (ASD) constitute a significant minority in adult out-patient psychiatry. Diagnoses of previously unrecognised ASD are increasing in adults. Characteristics of patients with autism within adult out-patient psychiatry have not been sufficiently explored, and there have not been any systematic comparisons of characteristics between patients with and those without autism within adult out-patient psychiatric populations.

To examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients.

We assessed 90 patients who were referred to a Swedish psychiatric out-patient clinic and screened for ASD during 2019–2020. Sixty-three patients met the DSM-5 criteria for ASD or ‘subthreshold’ ASD. The 27 who did not meet the criteria for ASD were used as a comparison group. Assessments were made with structured and well-validated instruments, including parent ratings of developmental history.

No differences were found between the groups regarding self-reported sociodemographic variables. The ASD group showed a higher number of co-occurring psychiatric disorders than the non-ASD group (t(88) = 5.17, 95% CI 1.29–2.91, d = 1.19). Functional level was lower in the ASD group (t(88) = −2.66, 95% CI −9.46 to −1.27, d = −0.73), and was predicted by the number of co-occurring psychiatric disorders.

The results underscore the need for thorough assessment of psychiatric disorders in autistic patients in adult psychiatric services. ASD should be considered as a possible ‘underlying’ condition in adult psychiatry, and there is no easy way of ruling out ASD in this population.

There are limited longitudinal studies on the effects of the COVID-19 pandemic on mental health and well-being, including the effects of imposed restrictions and lockdowns.

This study investigates how living in a pandemic, and related lockdowns and restrictions, affected the mental health of people living in Australia during the first year of the COVID-19 pandemic.

A total of 875 people living in Australia participated in a longitudinal survey from 27 May to 14 December 2020. This time period includes dates that span pre-, during and post-wave 2 lockdowns in Australia, with strict and sustained public health measures. Linear mixed models were fitted to investigate the effect of lockdown on depression and anxiety symptoms.

Symptoms of depression and anxiety improved over time, during and after lockdowns. More adverse mental health symptoms were observed for people with a history of medical or mental health problems, caring responsibilities, more neurotic personality traits or less conscientiousness, and for people who were younger. People who reported being more conscientious reported better mental health.

Despite notoriously strict lockdowns, participants did not experience a deterioration of mental health over time. Results suggest a lack of significant adverse effects of lockdown restrictions on mental health and well-being. Findings highlight cohorts that could benefit from targeted mental health support and interventions, so that public policy can be better equipped to support them, particularly if future strict public health measures such as lockdowns are being considered or implemented for the COVID-19 pandemic and other disasters.

Little is known about the safety of mental healthcare provided remotely by digital mental health services (DMHS), which do not offer face-to-face contact.

To examine the circumstances of suicide by patients registered with a national DMHS.

Data from 59 033 consenting patients registered with a national DMHS, the MindSpot Clinic, between 1 January 2013 and 31 December 2016 were linked with the Australian National Death Index and documents held by the National Coronial Information System (NCIS). Data extracted included demographic information, the nature of contact, duration between last contact and death, symptom scores and information in police, autopsy, toxicology and coroners’ reports.

Of the 59 033 patients, 90 (0.15%) died by suicide in a follow-up period of up to 5 years. The mean time between last contact and death was 560 days. Coroners’ reports were located for 81/90 patients. Most (87.0%) were receiving face-to-face care around the time of death, 60.9% had a documented previous suicide attempt, 52.2% had been in hospital in the previous 6 months and 22.2% had severe mental illness, mainly schizophrenia or bipolar disorder. Other common findings were current treatment with psychotropic medication (79.2%) and the presence of alcohol (41.6%), benzodiazepines (31.2%), and illegal drugs and non-prescribed opioids (20.8%) at time of death.

Those who died by suicide after contact with the DMHS had more severe illness, were mostly engaged with face-to-face services and often had disinhibiting substances, especially benzodiazepines, present at the time of death.

Digital interventions based on cognitive–behavioural therapy and relapse prevention can increase treatment access for people with problematic alcohol use, but for these interventions to be cost-effective, clinician workload needs to remain low while ensuring patient adherence and effects. Digital psychological self-care is the provision of a self-guided digital intervention within a structured care process.

To investigate the feasibility and preliminary effects of digital psychological self-care for reducing alcohol consumption.

Thirty-six adults with problematic alcohol use received digital psychological self-care during 8 weeks, including telephone assessments as well as filling out self-rated questionnaires, before, directly after and 3 months after the intervention. Intervention adherence, usefulness, credibility and use of clinician time were assessed, along with preliminary effects on alcohol consumption. The study was prospectively registered as a clinical trial (NCT05037630).

Most participants used the intervention daily or several times a week. The digital intervention was regarded as credible and useful, and there were no reported adverse effects. Around 1 h of clinician time per participant was spent on telephone assessments. At the 3-month follow-up, preliminary within-group effects on alcohol consumption were moderate (standardised drinks per week, Hedge's g = 0.70, 95% CI = 0.19–1.21; heavy drinking days, Hedge's g = 0.60, 95% CI = 0.09–1.11), reflecting a decrease from 23 to 13 drinks per week on average.

Digital psychological self-care for reducing alcohol consumption appears both feasible and preliminarily effective and should be further optimised and studied in larger trials.

Depression is a major cause of disability worldwide. Recent data suggest that, in industrialised countries, the prevalence of depression peaks in middle age. Identifying factors predictive of future depressive episodes is crucial for developing prevention strategies for this age group.

We aimed to identify future depression in middle-aged adults with no previous psychiatric history.

To predict a diagnosis of depression 1 year or more following a comprehensive baseline assessment, we used a data-driven, machine-learning methodology. Our data-set was the UK Biobank of middle-aged participants (N = 245 036) with no psychiatric history.

Overall, 2.18% of the study population developed a depressive episode at least 1 year following baseline. Basing predictions on a single mental health questionnaire led to an area under the curve of the receiver operating characteristic of 0.66, and a predictive model leveraging the combined results of 100 UK Biobank questionnaires and measurements improved this to 0.79. Our findings were robust to demographic variations (place of birth, gender) and variations in methods of depression assessment. Thus, machine-learning-based models best predict diagnoses of depression when allowing the inclusion of multiple features.

Machine-learning approaches show potential for being beneficial for the identification of clinically relevant predictors of depression. Specifically, we can identify, with moderate success, people with no recorded psychiatric history as at risk for depression by using a relatively small number of features. More work is required to improve these models and evaluate their cost-effectiveness before integrating them into the clinical workflow.

Euthanasia review committees (Regionale Toetsingscommissies Euthanasie, RTE) scrutinise all Dutch cases of euthanasia and physician-assisted suicide (EAS) to review whether six legal ‘due care’ criteria are met, including ‘unbearable suffering without prospect of improvement’. There are significant complexities and ethical dilemmas if EAS requests are made by people with intellectual disabilities or autism spectrum disorders (ASD).

To describe the characteristics and circumstances of people with intellectual disabilities and/or ASD who were granted their EAS request; investigate the main causes of suffering that led to the EAS request; and examine physicians’ response to the request.

The online RTE database of 927 EAS case reports (2012–2021) was searched for patients with intellectual disabilities and/or ASD (n = 39). Inductive thematic content analysis was performed on these case reports, using the framework method.

Factors directly associated with intellectual disability and/or ASD were the sole cause of suffering described in 21% of cases and a major contributing factor in a further 42% of cases. Reasons for the EAS request included social isolation and loneliness (77%), lack of resilience or coping strategies (56%), lack of flexibility (rigid thinking or difficulty adapting to change) (44%) and oversensitivity to stimuli (26%). In one-third of cases, physicians noted there was ‘no prospect of improvement’ as ASD and intellectual disability are not treatable.

Examination of societal support for suffering associated with lifelong disability, and debates around the acceptability of these factors as reasons for granting EAS, are of international importance.

Compulsory community treatment orders (CTOs) are controversial because the right to refuse treatment is overridden, even when patients may not be acutely unwell. Scrutiny of outcomes associated with CTOs is therefore required. This editorial provides an overview of the evidence for CTOs. It also discusses recent papers reporting outcomes associated with CTOs and makes recommendations for researchers and clinicians to consider.

A variety of psychosocial factors have been shown to affect the quality of life of families (FQoL).

This study aimed to assess the impact of mother's demographic characteristics, parental stress, illness perceptions about autism spectrum disorder (ASD), coping strategies, ASD severity and time since diagnosis on FQoL during the initial period following diagnosis (≤6 months).

Fifty-three mothers of children newly diagnosed with ASD completed the Beach Center Family Quality of Life Scale, the Autism Parenting Stress Index, the Brief Illness Perception Questionnaire and the Brief Coping Orientation to Problems Experienced Inventory. A descriptive analysis was conducted on the demographic characteristics of the family. Eta coefficients and Pearson's analysis were used to determine the associations between the variables and the FQoL dimensions. Hierarchical regression was used to determine whether variables explained a statistically significant family quality of life variance.

Pearson's analysis and eta coefficients indicated several correlations. Hierarchical regression analysis showed that higher parental stress related to core autism symptoms was associated with poorer FQoL (95% CI −0.08 to −0.02, P = 0.001), and higher perceived treatment control was associated with better FQoL (95% CI 0.04–0.16, P = 0.001). In addition, stronger perceived personal control was associated with higher physical/material well-being (95% CI 0.01–0.16, P = 0.022) and higher disability-related support (95% CI 0.30–0.61, P = 0.001). Higher family monthly income was associated with better FQoL (95% CI 0.08–0.027, P = 0.000), whereas marital status (divorced mother) was correlated with poorer FQoL (95% CI −0.68 to −0.16, P = 0.002).

Interventions should emphasise managing the disorder's characteristics and implementing psychoeducational and supportive programmes for parents, immediately after the diagnosis, to enhance FQoL.

Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues.

To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy.

Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data.

Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The ‘healthy/normative’ trajectory had the largest sample size for all health indicators (73–86%). A stable (moderate) ‘ill health’ trajectory was identified for all health indicators (7–17%), except anxiety. An ‘improving’ trajectory was found for PTSD and anxiety symptoms (5–14%). A minority of staff (4–15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the ‘healthy’ trajectory. Female biological sex was associated with higher odds of belonging to the ‘worsening’ depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the ‘worsening’ depressive symptoms trajectory.

Most iHAWs stayed healthy during their assignment; a stable ‘ill health’ trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the ‘healthy’ profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs’ ability to remain healthy under stress.

Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people.

The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK.

Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach.

Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. ‘Behind self-harm’ refers to factors associated with self-harm and suicide. ‘Functions of self-harm’ captures the meaning attributed to self-harm and suicide. ‘Recovery from self-harm’ encapsulates personal and professional help, and practical suggestions for the improvement of mental health services.

Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.

Depressive symptoms are often comorbid with chronic pain. These conditions share aberrant emotion processing and regulation, as well as having common brain networks. However, the relationship between depressive symptoms and chronic pain and the effects on emotional brain function are unclear.

The present study aimed to disentangle the effects of chronic pain and depressive symptoms on functional connectivity between regions implicated in both these conditions.

Twenty-six individuals with chronic pain (referred to as the pain group) and 32 healthy controls underwent resting-state functional magnetic resonance imaging and completed the Beck Depression Inventory. Main effects of group, depressive symptoms (total severity score) and their interaction on the functional connectivity of three seed regions (the left and right amygdalae and the medial prefrontal cortex; mPFC) with the rest of the brain were evaluated. In cases of significant interaction, moderation analyses were conducted.

The group × depressive symptoms interaction was significantly associated with changes in connectivity between the right amygdala and the mPFC (family-wise error-corrected P-threshold (pFWEc = 0.008). In the moderation analysis, the pain group showed weaker connectivity between these regions at lower levels of depressive symptoms (P = 0.020), and stronger connectivity at higher levels of depressive symptoms (P = 0.003), compared with the healthy controls. In addition, the strength of connectivity decreased in the healthy controls (P = 0.005) and increased in the pain group (P = 0.014) as the severity of depressive symptoms increased.

Depressive symptoms moderate the impact of chronic pain on emotional brain function, with potential implications for the choice of treatment for chronic pain.

Perinatal depression is the most undertreated clinical condition during the perinatal period. Knowledge about women's decision-making in seeking and receiving treatment is scarce.

To investigate and compare treatment option uptake in perinatal women with depressive symptoms in Portugal and Norway, and to identify sociodemographic and health-related factors associated with treatment uptake.

Participants were women resident in Portugal or Norway (≥18 years) who were pregnant or had given birth in the past 12 months, who presented with active depressive symptoms (Edinburgh Postnatal Depression Scale score ≥10). In an electronic questionnaire, women reported treatment received and sociodemographic and health-related factors.

The sample included 416 women from Portugal and 169 from Norway, of which 79.8% and 53.9%, respectively, were not receiving any treatment. Most Portuguese women were receiving psychological treatment, either alone (45.2%) or combined with pharmacological treatment (21.4%). Most Norwegian participants were receiving only pharmacological (36.5%) or combined treatment (35.4%). Compared with the Portuguese sample, a higher proportion of Norwegian women started treatment before pregnancy (P < 0.001). In Portugal, lower depressive symptoms and self-reported psychopathology were significantly associated with higher likelihood of receiving treatment.

We found that, in both Norway and Portugal, a substantial number of perinatal women with depressive symptoms do not receive any treatment. Differences exist regarding the chosen treatment option and timing of treatment initiation in the two countries. Only mental health-related factors were associated with treatment uptake for perinatal depression in Portugal. Our results highlight the importance of implementing strategies aimed to improve help-seeking behaviours.