The association between cannabis use and suicidality has been established, but details on impacts of legalisation, as well as long-term service use, have had limited attention.

To examine if changes are present in suicide presentations with access to legal cannabis.

This study employed administrative database and medical record reviews to identify two cohorts of patients presenting with suicidal ideation/attempts and cannabis use to emergency departments, for two periods: 17 October 2018 to 30 April 2019, and 17 October 2020 to 30 April 2021. Demographic and clinical outcome data were obtained, and emergency department healthcare usage for 2 years before and 2 years after index encounter were compared, to further understand emergency department presentations for the same complaint.

Number of emergency department encounters following the index visit and number of emergency department encounters specifically relating to suicidality following the index visit were significantly different between cohorts (t = 2.05, P = 0.042; t = 2.23, P = 0.027, respectively), with the immediate post-cannabis legalisation period demonstrating greater numbers of subsequent emergency department visits for suicidality. Additional associations were found between personality disorders and repeat emergency department visits related to cannabis use.

There appears to be stability in the patient profile of those presenting to the emergency department with a complaint relating to suicide while reporting cannabis use from the period directly following legalisation in Canada, to a similar time frame 2 years later despite reported increased use of cannabis in the general population over this period. Despite the rising potency and access to legal cannabis, suicide risk remains stable, although concerning.

Given the complex challenges facing people experiencing homelessness, existing mental health recovery models are probably insufficient for this population.

To investigate qualitative accounts of mental health personal recovery in people with experience of homelessness, and to adapt the widely adopted connectedness, hope, identity, meaning and empowerment (CHIME) model of personal recovery to better represent the experiences of this population.

PROSPERO registration no. CRD42023366842. A systematic review identified qualitative studies investigating first-person accounts of mental health personal recovery in people with experience of homelessness. Nine databases were searched: CINAHL, SCOPUS, Embase, Medline, PsychINFO, PubMed, Web of Science, ASSIA and Social Services Abstracts. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist. Included studies underwent ‘best fit’ framework synthesis, comprising deductive analysis using the CHIME first- and second-order themes, as well as inductive analysis to capture aspects not covered by the a priori framework.

The review expanded the CHIME model and identified the following recovery processes in this population: security and stability; encouragement and hope; constructing identity; understanding and meaning; relationships and connectedness; and empowerment and dual recovery (SECURED). Importantly, security and stability were identified as a necessary prerequisite for the other recovery processes. Challenges within each recovery process were also identified.

SECURED offers a transdiagnostic framework to support understanding of mental health personal recovery in the context of homelessness. Findings support the Housing First model of service provision. However, findings also highlight that housing alone is not sufficient and that the other processes must also be supported.

Professionals engaged in community work within their own communities frequently encounter challenges associated with dual relationships. The psychological impacts of dual roles are often overlooked.

This study explores the experiences of Muslim professionals in Christchurch, New Zealand, following the 15 March 2019 mosque terrorist attacks. It examines how they balance their community roles with their professional responsibilities while also safeguarding their personal well-being.

Semi-structured interviews were conducted with 20 Muslim professionals engaged in dual relationships within their community. Participants were selected through purposive sampling from diverse sectors, including government agencies, research positions and community support services. Reflexive thematic analysis was utilised to identify key themes.

Participants reported significant emotional strain, including vicarious trauma and burnout, driven by their dual roles. Faith emerged as a key motivator, with altruism framed as a spiritual duty. Identity struggles were common, shaped by societal scrutiny and a desire for validation. While formal support systems were sometimes inadequate, peer support and culturally attuned leadership provided relief. The findings highlight the complex interplay of psychological, spiritual and structural factors in sustaining professionals following a disaster.

This research highlights the emotional toll on Muslim professionals supporting their community following a terrorist attack, with broader implications for minority groups responding to similar incidents. The findings highlight the need for culturally competent, trauma-informed support systems within community care organisations. Recommendations include strengthening of peer support, training supervisors in cultural responsiveness and ensuring tailored mental health resources to support well-being and professional effectiveness in high-impact roles.

Hong Kong’s 3-year dynamic zero-COVID policy has caused prolonged exposure to stringent, pervasive anti-epidemic measures, which poses additional stressors on emotional well-being through pandemic fatigue, beyond the incumbent fear of the pandemic.

To investigate how major policy shifts in the zero-COVID strategy have corresponded with changing relationships between emotional well-being, pandemic fatigue from policy adherence, and pandemic fear, following the pandemic peak to a living-with-COVID policy.

A three-wave repeated cross-sectional study (N = 2266) was conducted on the Chinese working-age population (18–64 years) during the peak outbreak (Wave 1), and subsequent policy shifts towards a living-with-COVID policy during the initial relaxation (Wave 2) and full relaxation (Wave 3) of anti-epidemic measures from March 2022 to March 2023. Non-parametric tests, consisting of robust analysis of covariance tests and quantile regression analysis, were performed.

The severity of all measures was lowered after Wave 1; however, extreme pandemic fears reported in Wave 2 (n = 38, 7.7%) were associated with worse emotional well-being than the pandemic peak (Wave 1), which then subsided in Wave 3. Pandemic fatigue posed greater negative emotional well-being in Wave 1, whereas pandemic fear was the dominant predictor in Waves 2 and 3.

Pandemic fatigue and pandemic fear together robustly highlight the psychological cost of prolonged pandemic responses, expanding on a framework for monitoring and minimising the unintended mental health ramifications of anti-epidemic policies.

Depression is one of the most common mental diseases, leading to a decline in both psychiatric and physical functions. One non-pharmacological therapeutic strategy for the management of psychiatric disorders is music therapy.

To assess the clinical effectiveness of music therapy and its various subscales for managing depressive symptoms (primary outcome) and related problems (secondary outcome) in comparison with other conventional treatments.

A comprehensive search of MEDLINE, Embase, Cochrane Review, CINAHL, PsyInfo and KMbase was conducted to identify randomised controlled trials published up to 31 August 2023. Studies assessing the clinical effectiveness of music therapy for individuals with depression were included, and data on participants, music therapy and clinical measurement scores were extracted. This study was registered with PROSPERO (no. CRD42023466833).

Music therapy was significantly more effective than controls in reducing depressive symptoms (standardised mean difference (SMD) −0.97 [95% CI: −1.23 to −0.71], P < 0.01). This benefit was consistent regardless of music therapy types, delivery methods or provider professionalism. In addition, music therapy was significantly better than controls in improving quality of life (SMD 0.51 [95% CI: 0.19−0.83], P < 0.01) and sleep quality (SMD −0.61 [95% CI: −1.03 to −0.19], P < 0.01), although it showed only a non-significant trend towards reducing anxiety (SMD −0.98 [95% CI: −2.01 to 0.06], P = 0.06). The evidence level was very low due to high risk of bias, inconsistency due to high heterogeneity and imprecision.

Despite the very low evidence level, music therapy may be recommended with weak strength for patients with depression, considering the results of the meta-analysis and the high accessibility and broad applicability of music.

The effects of pandemic-related restrictions on people in prisons who tend to have multiple complex health needs are not well understood.

We aimed to measure changes in adjudications and self-harm among people in prisons before and during the pandemic.

We examined effects of time and demographic characteristics on odds and counts of adjudications and self-harm over a three-year period, starting one year before the COVID-19 pandemic, in 861 individuals from 21 Offender Personality Disorder Pathway prison sites.

The odds of adjudicating were lower in people of older age (odds ratio 0.98 (95% CI: 0.96–0.99)), and during COVID-19 year one (odds ratio 0.37 (95% CI: 0.23–0.60)) and year two (odds ratio 0.40 (95% CI: 0.25–0.65)) compared to pre-COVID-19. Being of White ethnicity was associated with increased odds (odds ratio 4.42 (95% CI: 2.06–9.47)) and being older was associated with reduced odds (odds ratio 0.97 (95% CI: 0.95–0.99)) of self-harm. The odds of self-harm were significantly reduced during COVID-19 year two (odds ratio 0.45 (95% CI: 0.26–0.78)), but not during COVID-19 year one (odds ratio 0.68 (95% CI: 0.40–1.14)), compared with the 12 months before COVID-19.

Although adjudications and self-harm were generally lower during the pandemic, younger people showed increased odds of adjudications and self-harm compared with older people, while White people showed increased odds of self-harm compared with people of the global majority. Our findings highlight the importance of considering potential health inequities and environmental effects of lockdowns for people in prisons.

Auditory hallucinations (hearing voices in the absence of physical stimuli) are present in clinical conditions, but they are also experienced less frequently by healthy individuals. In the non-clinical population, auditory hallucinations are described more often as positive and not intrusive; indeed, they have received less attention.

The present study explores the phenomenology of non-clinical auditory hallucinations and their possible relationship with religiosity.

Starting from previous findings suggesting that non-clinical auditory hallucinations are often described as a gift or a way to be connected with ‘someone else’, we administered standardised questionnaires to quantify proneness to experiencing auditory hallucinations, religiosity and anxiety/depression scores.

Regression analysis carried out using an auditory hallucinations, index as the dependent variable on a final sample of 680 responders revealed that a total of 31% of the variance was explained by a five-steps model including demographic characteristics (i.e. being young, a woman and a non-believer) and negative (e.g. being afraid of otherworldly punishments) and positive (e.g. believing in benevolent supernatural forces) components of religiosity, anxiety and depression. Crucially, compared with believers, non-believers revealed higher scores in depression, anxiety and in a specific questionnaire measuring proneness to auditory hallucinations.

Results suggests that religiosity acts as a potential protective factor for proneness to paranormal experiences, but a complex relationship emerges between religious beliefs, mood alterations and unusual experiences.

People with an intellectual disability are vulnerable to additional disorders such as dementia. Psychometrically sound and specific instruments are needed for assessment of cognitive functioning in cases of suspected dementia.

To evaluate the construct and item validity, internal consistency and test–retest reliability of a new neuropsychological test battery, the Dementia Test for People with Intellectual Disability (DTIM).

The DTIM was applied to 107 individuals with intellectual disability with (n = 16) and without (n = 91) dementia. The psychometric properties of the DTIM were assessed in a prospective study. The assessors were blinded to the diagnostic assignment.

Confirmatory factor analysis at the scale level showed that a one-factor model fitted the data well (root mean square error of approximation < 0.06, standardised root mean square residual < 0.08, comparative fit index > 0.9). At the domain level, one-factor models showed reasonable-to-good fit index for five of seven domains. Internal consistency indicated excellent reliability of the overall scale (Cronbach’s α: 0.94 for dementia and 0.95 for controls). Item analysis revealed a wide range of difficulties (0.19–0.75 for dementia, 0.31–0.87 for controls), with minimal floor and ceiling effects. Eleven items (26%) had discrimination value ≤ 0.50. Test–retest reliability (n = 82) was high, with intraclass correlations of 0.95 (total score) and 0.69–0.96 (domains).

The DTIM fits a one-factor model and demonstrates internal and test–retest reliability; thus, it is suitable for use in cases of suspected dementia in people with various intellectual disabilities.

Asylum seekers face significant mental health challenges but underutilise mental health services and are at increased risk of misdiagnosis. The Cultural Formulation Interview (CFI) could be helpful by introducing individuals’ culture and context to psychiatric evaluation. However, its impact on the diagnostic process for asylum seekers remains underexplored.

This study aims to evaluate the added value of the CFI in the psychiatric diagnostic assessment of asylum seekers.

A mixed-methods design was applied. Diagnostic shifts from the CFI were quantitatively described in 63 participating asylum seekers. The CFI’s value was explored using qualitative content analysis.

In about a third of cases, diagnoses were either confirmed (34.9%), changed (25.4%) or narrowed (33.3%), with notable shifts from depressive and psychotic disorders to either trauma- and stressor-related disorders or no psychopathology. Qualitative analysis revealed that the CFI enhanced understanding of participants’ experiences, including the impact of trauma, migration and social context. It provided insights into their strengths and therapeutic needs. The shift towards stress-related diagnoses and away from other common DSM categories reflects the CFI’s ability to provide a more nuanced, contextual understanding of asylum seekers’ mental health.

This study underscored the CFI as a valuable tool in asylum seekers’ diagnostic assessment. The CFI facilitated a shift towards a more holistic, recovery-oriented approach. It prompted conceptual reflections on psychopathology in asylum seekers. The CFI presents a promising yet underutilised tool for addressing diagnostic challenges in cross-cultural settings. The findings highlight its potential for broader clinical implementation.

Work stress levels rose among health and educational workforces during the COVID-19 pandemic, and can affect employee well-being and organisational efficiency.

To explore the association of work stress with mental health, including suicidal ideation and physical health, as well as presenteeism, as aspects of organisational efficiency in UK healthcare and university workers.

A total of 328 UK participants completed self-report questionnaires between April 2022 and September 2023 in the context of the European Platform to Promote Wellbeing and Health in the Workplace (EMPOWER) study. Cross-sectional analyses were conducted.

Two hundred and ninety-two (90%) employees reported work-related stress (Mini-Psychosocial Stressors at Work Scale). Depressive, anxiety and somatic symptoms were reported (61, 55 and 75%, respectively); 11% of the participants reported suicidal ideation (Patient Health Questionnaire 9) and 56% reported presenteeism (iMTA Productivity Cost Questionnaire). Psychological and somatic symptoms were worse when suicidal ideation or presenteeism was reported. Stressful work factors included having too much work to do (63%), a bad working atmosphere (28%), poor work–home balance (32%) and working hours hindering private life (35%). Spearman correlations showed significant associations between work stress and suicidal ideation (0.225), depressive (0.290), anxiety (0.299) and somatic symptoms (0.245) and presenteeism (0.311), but not with having a chronic medical condition.

Given the association between work stress, suicidal ideation and presenteeism, research should explore how psychosocial risk factors linked to work stress could be reduced for healthcare and higher education employees. The findings warrant the development of policies to address work stress, and to provide employee support for suicidal ideation and presenteeism in the work setting.

People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear.

To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs.

We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk-of-bias 2 tool’. We calculated a random-effects, inverse-variance weighting meta-analysis.

Of the 21 386 initial studies, 12 RCTs (with 2144 patients) comparing behavioural activation with any comparator on treatment outcomes for depression with comorbid NCD met the inclusion criteria. Six studies rated as low risk of bias. For short-term follow-ups (up to 6 months), meta-analysis showed behavioural activation had little effect on depression symptom improvement in people with NCDs (Hedges’ g = −0.24; 95% CI, −0.62 to 0.15), compared to comparators, with high heterogeneity (I2 = 91.91%). Of the 12 included studies, three RCTs provided data on adverse events occurring during the trial.

Evidence from this systematic review is not sufficient to draw clear conclusions about the efficacy and safety of behavioural activation for reducing depression symptoms in people with NCDs. Future reviews need to include more high-quality, well-designed RCTs to better understand the potential benefits of behavioural activation for comorbid depression.

There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.

Estimate the cost–utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.

We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive–behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18–65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.

Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.

Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.