Mental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors’ mental health needs are limited.

Describe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.

Observational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.

Of the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.

The findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce.

Human papillomavirus (HPV) infection has a negative impact on quality of life (QoL) and sexual function, mainly owing to increased levels of anxiety and distress.

To examine the potentially moderating effects of general psychological health on the relationships between (a) HPV-related psychosocial burden and QoL and (b) HPV-related psychosocial burden and sexual function.

The HPV Impact Profile, Female Sexual Function Index, General Health Questionnaire-28 and Life Satisfaction Inventory questionnaires were completed by 151 women.

HPV-related psychosocial burden and general psychological health accounted for 23.2% of QoL variability. There was not strong evidence for a moderating effect of general psychological health on the relationship between HPV-related psychosocial burden and QoL. Higher HPV-related psychosocial burden predicted worse sexual function on average. However, HPV-related psychosocial burden accounted for only 4.1% of sexual function variability.

Higher HPV-related psychosocial burden is associated with lower QoL as well as worse sexual function. General psychological health predicts changes in QoL over and above HPV-related psychosocial burden; thus, a deep understanding of emerging mental health issues soon after diagnosis is crucial to improve counselling and enhance women’s mental empowerment to achieve a better psychological response.

Emergency department mental health practitioners (MHPs) decide onward care for individuals presenting with self-harm or suicidal ideation. However, their experiences and practices in making these decisions remain underexplored.

To synthesise research on MHPs’ experiences and practices in making decisions about onward care for patients presenting to emergency departments with self-harm or suicidal ideation.

We searched six databases (inception to July 2024) for empirical studies of MHPs making care decisions for self-harm or suicidal patients in emergency departments. We used a segregated mixed-methods design, applying narrative synthesis of quantitative data and thematic synthesis of qualitative data.

Eleven studies were included (one quantitative, one mixed-methods, nine qualitative). Narrative synthesis of quantitative data produced two themes: (a) subjective decision-making and variability among MHPs and (b) impact of the institutional mandate to discharge within 4 h on referral outcomes. Thematic synthesis of qualitative data generated five themes: (a) risk-centric culture is anti-therapeutic and shapes defensive practice, scepticism toward patients and burnout; (b) time and environmental pressures impact therapeutic potential of assessments; (c) ‘battling’ to access services: gatekeeping, cycles of repeat attendances affecting patient safety and staff moral injury; (d) strategies to facilitate access and extending care to overcome challenges in the emergency department and (e) potential for training to counter negative attitudes and stereotypes.

Intersecting institutional, systemic and emotional pressures shape MHPs’ practices, undermining assessment quality and access to care. System-level reforms and training should promote relational, compassionate care. Limited quantitative evidence restricted integration, and the review reflects high-income Western settings.

Depression screening in primary care has been widely discussed, but its economic implications have remained largely unexplored. The GET.FEEDBACK.GP randomised controlled trial evaluated feedback interventions after depression screening in primary care. The study arms were (a) feedback provided to the general practitioner; (b) feedback to both the patient and the treating general practitioner; and (c) a control group without feedback. Analysis of clinical effectiveness revealed that feedback interventions were not associated with decreased depression severity. Their economic implications were the subject of this study.

To evaluate the economic impact of general-practitioner- and patient-targeted feedback following depression screening for adults in German primary care.

A cost-effectiveness analysis from a societal perspective of feedback interventions after depression screening with a time horizon of 12 months was conducted. Direct and indirect costs were estimated. Quality-adjusted life years were calculated on the basis of the EQ-5D-5L, and incremental cost-effectiveness ratios and cost-effectiveness acceptability curves based on the net monetary benefit were constructed. Sensitivity analyses and post hoc explorative subpopulation analyses were performed. Trial registration: ClinicalTrials.gov, NCT03988985.

In total, 987 participants who screened positive for at least moderate depression were included. Feedback provision was not significantly associated with changes in costs or quality-adjusted life years during follow-up. Cost-effectiveness probabilities of feedback interventions were lower than 50% compared with no feedback. Higher cost-effectiveness probabilities were observed in patients whose suspected depression was confirmed 1 month post-screening and in those with previous depression.

The analysed feedback interventions cannot be considered to be cost-effective for the investigated population. Patient-targeted feedback was potentially cost-effective for subpopulations, particularly patients with a later confirmed depression diagnosis; this requires further research.

Patients with major depressive disorder (MDD) are known to be at a heightened risk of suicide. Research indicates that comorbid anxiety may further elevate this risk. However, studies specifically examining the prevalence of anxiety and its associated factors among patients with MDD and history of a recent suicide attempt (RSA) remain limited.

To investigate the prevalence of anxiety and the factors associated with its severity in patients with MDD.

A total of 1718 patients with MDD were included. Hypothesis testing and binary logistic regression were employed to examine differences in anxiety severity and clinical factors between patients with and without an RSA, as well as the association between anxiety severity and RSA. Subsequently, patients with MDD were categorised into three subgroups based on anxiety severity. One-way analysis of variance and multivariate logistic regression were then conducted to identify factors associated with anxiety symptoms.

Anxiety severity was identified as an independent correlate of RSA. Compared with patients with anxiety, patients with MDD and significant or severe anxiety had a 2.9-fold and 11.8-fold increased risk of RSA, respectively. Furthermore, Hamilton Rating Scale for Depression score, Positive and Negative Syndrome Scale positive subscale score, and thyroid function indices (free triiodothyronine and thyroid-stimulating hormone levels) were also determined to be independent correlates of anxiety severity.

Anxiety is associated with risk of RSA in patients with MDD, and depressive symptoms, positive psychotic symptoms and thyroid function may be related factors for severity of anxiety.

Studies have shown that klotho, a neuroprotective protein, plays a crucial role in neurodevelopment. However, its association with attention-deficit hyperactivity disorder (ADHD), the most prevalent neurodevelopmental disorder, remains uncertain.

To elucidate klotho levels in adolescents with ADHD and to clarify its association with executive function.

The present study enrolled 92 adolescents (mean approximate age 14 years) diagnosed with ADHD and 80 age-matched healthy adolescents. All participants had their klotho levels measured and underwent the Wisconsin Card Sorting Test (WCST); their parents fulfilled the Swanson, Nolan and Pelham IV (SNAP-IV) scale and the Child Behavior Checklist-Dysregulation Profile (CBCL-DP).

Results from generalised linear models (GLMs), with adjustments for age, gender, body mass index, clinical symptoms (SNAP-IV and CBCL-DP scores) and ADHD medication use, indicated that adolescents with ADHD had significantly lower klotho levels (P = 0.044) and performed worse on WCST (P = 0.027) compared with healthy adolescents. The GLMs further indicated a negative association between klotho levels and the percentage of non-perseverative errors on WCST (P = 0.002).

Klotho may serve as a novel biomarker of ADHD and play a key role in ADHD-related executive dysfunction.

Mental health issues are prevalent among children and young people (CYP) with chronic conditions like epilepsy, yet few access evidence-based psychological therapies. Evidence from the Mental Health Intervention for Children with Epilepsy (MICE) trial supports the effectiveness of a personalised modular psychological intervention, but cost-effectiveness is unknown.

To assess the cost-effectiveness of the MICE intervention compared with assessment-enhanced usual care at 12-months follow-up, taking a health and social care perspective.

We conducted a within-trial economic evaluation. Outcomes were the Strengths and Difficulties Questionnaire (SDQ; primary) and quality-adjusted life years (QALYs; secondary) for CYP, caregivers, and CYP and caregivers combined. Sensitivity analyses examined missing data and intervention-costing assumptions.

Cost-effectiveness results for the SDQ indicated that MICE had a higher probability of being cost-effective compared with control at a willingness to pay ≥£368 per unit improvement. For QALYs, MICE had a lower probability of being cost-effective for CYP compared with control (35 to 42%) across the £20 000–£30 000 per QALY threshold range. However, at the upper threshold this finding was reversed in sensitivity analyses with missing data imputed (45 to 58%) and with MICE costed at 75%, assuming the intervention partly substituted standard services (46 to 55%). Furthermore, MICE had a higher probability of being cost-effective for caregiver QALYs (52 to 63%) and combined CYP and caregiver QALYs (62 to 75%).

MICE appears to be cost-effective compared with assessment-enhanced usual care when considering QALYs for CYP and caregivers combined, though uncertainty exists across willingness-to-pay thresholds.

Schizophrenia and psychosis have high twin heritability (approximately 80%), but these general estimates may hide aetiological variation. This can be investigated by using syndromes based on key psychotic symptom combinations.

To investigate concordance, and heritability where calculable, of psychotic syndromes in multiple schizophrenia and psychosis twin samples.

We investigated concordance for positive, negative and disorganised psychotic syndromes, based on lifetime symptom ratings, in three classical schizophrenia twin samples (Fischer, Kringlen and Slater) and two psychosis samples (Maudsley register and non-register), the first four being systematically ascertained (total 317 monozygotic and 145 dizygotic probandwise pairs). We assessed concordance differences with logistic regression in generalised linear mixed models, and heritability from twin-modelling in the Maudsley register sample.

The positive syndrome, comprising delusions plus hallucinations, had 37.7–41.4% monozygotic and 6.0–6.3% dizygotic concordance, and heritability of 0.81 or 81% (95% CI 0.58–0.88), with similar results for negative and disorganised syndromes. In the systematically ascertained samples, delusions and hallucinations occurring without disorganised symptoms had nominally lower monozygotic twin concordance than when disorganised symptoms were also present (in the three schizophrenia samples: 89 pairs, odds ratio 3.47 (95% CI 1.04–1.54), p = 0.043; and the Maudsley register psychosis sample: 70 pairs, odds ratio 7.68 (95% CI 1.49–39.70), p = 0.016).

In schizophrenia and psychosis, the syndrome of delusions plus hallucinations has high twin heritability overall. Positive symptoms without disorganised symptoms may indicate relatively high environmental influences, and positive symptoms with disorganised symptoms, relatively high familial and probably genetic influences, but further confirmation is needed.

Understanding premorbid socioemotional trajectories in schizophrenia is crucial for early identification and potential primary prevention. Studies in adults with schizophrenia suggest similar socioemotional premorbid difficulties, but are limited by their retrospective design.

To contribute new insights into the premorbid socioemotional characteristics of schizophrenia, beyond the biases of retrospective studies, this research investigates three educational socioemotional dimensions in children who later developed the disorder.

We conducted a case–control study using prospectively collected data, examining childhood differences in perceived parental support, self-esteem and school motivation, and growth mindset (intelligence can improve through effort) among individuals who later developed schizophrenia (n = 341) and their classmates (n = 20 567). We constructed z-normalised indicators based on standardised national tests administered in fourth, eighth and tenth grades in Chile. Mixed linear models accounted for repeated measures and adjusted for educational level, gender, grade point average, school and year.

Children later diagnosed with schizophrenia reported less parental educational support compared with their classmates (β = −0.276, 95% CI −0.388 to −0.163). Only girls who later developed schizophrenia reported lower self-esteem and school motivation than their peers (β = −0.290, 95% CI −0.498 to −0.131). Contrary to our hypothesis, children who later developed schizophrenia showed a higher growth mindset (β = 0.287, 95% CI 0.077–0.497).

Our results suggest that premorbid socioemotional characteristics in schizophrenia are detectable in childhood and may vary by gender. These findings highlight the potential of educational settings as platforms for preventive interventions aimed at enhancing parental support and monitoring students’ psycho-emotional well-being, while acknowledging gender-specific developmental trajectories and heterogeneity in premorbid functioning.

According to existing evidence, during menopause transition, women with psychosis may present with exacerbated psychiatric symptoms, due to age-related hormonal changes.

We aimed to (a) replicate this evidence, using age as a proxy for peri/menopausal status; (b) investigate how clinical presentation is affected by concomitant factors, including hyperprolactinaemia, dose and metabolism of prescribed antipsychotics using cross-sectional and longitudinal analyses.

Secondary analysis on 174 women aged 18–65, from the IMPaCT (Improving physical health and reducing substance use in psychosis) randomised controlled trial. We compared women aged below (N = 65) and above 40 (N = 109) for (a) mental health status with the Positive and Negative Syndrome Scale (PANSS) and Montgomery Asberg Depression Rating Scale; (b) current medications and (c) prolactin levels, at baseline and at follow-up (12/15 months later).

Women aged above 40 showed higher baseline PANSS total score (mean ± s.d. = 53.4 ± 14.1 v. 48.0 ± 13.0, p = 0.01) and general symptoms scores (28.0 ± 7.4 v. 25.7 ± 7.8, p = 0.03) than their younger counterparts. Progressive sub-analysis revealed that this age-related difference was observed only in women with non-affective psychosis (n = 93) (PANSS total score: 57.1 ± 13.6 v. 47.0 ± 14.4, p < 0.005) and in those prescribed antipsychotic monotherapy with olanzapine or clozapine (n = 25) (PANSS total score: 63 ± 16.4 v. 42.8 ± 10.9, p < 0.05).

Among all women with hyperprolactinaemia, those aged above 40 also had higher PANSS positive scores than their younger counterparts. No longitudinal differences were found between age groups.

Women aged above 40 showed worse psychotic symptoms than younger women. This difference seems diagnosis-specific and may be influenced by antipsychotics metabolism. Further longitudinal data are needed considering the menopause transition.

Depressive and anxiety disorders often co-occur with insomnia, creating complex treatment challenges. Although clinical guidelines recommend psychotherapy as first-line treatment for these comorbid conditions, limited access to psychological services in primary healthcare facilities in China often leads to heavy reliance on pharmacological therapy.

To the appropriateness of psychotropic medications for patients with insomnia comorbid with depressive or anxiety disorders at primary healthcare facilities in China.

This cross-sectional study included patients with documented diagnoses of insomnia comorbid depressive or anxiety disorders in 2022 at all 67 primary healthcare facilities in Dongcheng District, Beijing, China. The primary outcome was the prescribing rate of guideline-recommended psychotropic medications.

Among 842 patients with insomnia and depressive disorders and 1014 patients with insomnia and anxiety disorders, over 90% received psychotropic medications. Benzodiazepines were the most frequently prescribed classes (55.9 and 69.6%), followed by non-benzodiazepine hypnotics (42.5 and 42.4%), whereas medications recommended by the guideline, including antidepressants with sedative effects, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, were used infrequently. Only 29.9% of patients with insomnia and depressive disorders and 11.5% of those with insomnia and anxiety disorders received guideline-recommended pharmacotherapy, with lower concordance among older adults.

Guideline-recommended pharmacotherapy for insomnia comorbid with depressive or anxiety disorders was rarely implemented at primary care in China. This highlights the need to facilitate evidence-based practices and improve management of comorbid mental health conditions, particularly for older adults.

In 2018, the UK government commissioned National Health Service Talking Therapies (NHS TT) services to provide integrated mental and physical health care for individuals with a long-term condition (LTC) and coexisting depression and/or anxiety. Nevertheless, evidence on the effectiveness of NHS TT in physical LTCs remains inconsistent.

This review aims to evaluate the impact of NHS TT on mental health outcomes among adults with physical LTCs.

We conducted a systematic review and meta-analysis of quantitative studies published between 2008 and 2024. We used several databases for the search, including Embase, MEDLINE, Cochrane Library, NHS Evidence, PsycINFO, Bielefeld Academic Search Engine and ProQuest. We combined terms related to NHS TT, LTCs and mental health outcomes to identify eligible studies. The Population, Intervention, Comparison, Outcomes and Study framework guided the development of the inclusion criteria. We employed the random-effects model for meta-analysis and assessed heterogeneity bias using the I2 statistic, and the Newcastle–Ottawa scale to evaluate the overall quality of the evidence.

Twenty-four studies met the inclusion criteria. The meta-analysis revealed a significant pre–post NHS TT intervention effect on reliable improvement (odds ratio 0.77, 95% CI: 0.60–0.98) and reliable recovery (odds ratio 0.80, CI: 0.68–0.95). There were no significant differences in NHS TT accessibility (e.g. treatment engagement) between participants with and without LTCs (odds ratio 0.97, 95% CI: 0.82–1.14). However, heterogeneity between the studies was high (>90%).

The observed evidence provides reassurance for individuals with LTCs engaging with treatment; however, the association with post-treatment distress is still of concern. Furthermore, extensive and rigorous research is needed to strengthen and guide service development for individuals with LTCs, thereby improving effectiveness.

Paranoia is a transdiagnostic symptom and is associated with cognitive and social impairments. Attentional bias toward threat is thought to maintain paranoia.

Despite many studies, attentional biases in paranoia have not been systematically summarised, which was the aim of the current work.

We conducted a systematic review and meta-analysis, identifying 10 964 studies, of which 35 met inclusion criteria for review and 15 for meta-analysis.

Findings showed a significant negative attentional bias (average standardised effect size 0.26; 95% CI 0.01–0.52; p = 0.046). Preliminary indications suggested bias was strongest for paranoia-related stimuli (average effect size 0.30; 95% CI 0.03–0.57; p = 0.027) and stronger for words than faces (average effect size 0.41; 95% CI 0.05–0.77; p = 0.027), but more data is needed to confirm these effects. Limitations were primarily statistical and included likely underestimation of the overall effect size of the association between negative attentional bias and paranoia and a lack of sufficient studies to robustly examine moderators.

Summarising this literature provides a rationale for existing and new interventions for paranoia that target biased attentional mechanisms.

Haiti is experiencing a severe humanitarian crisis characterised by political instability and economic and security hardship. These adversities contribute to significant mental health challenges, which are also exacerbated by poor access to psychological support due to a shortage of specialised professionals. Problem Management Plus (PM+), a scalable and low-intensity intervention developed by the World Health Organization, is based on a task-sharing approach to address the treatment gap by training non-specialist helpers to provide psychosocial support.

This study aimed to explore the implementation process of PM+ in Haiti, focusing on the barriers and facilitators that influenced its delivery. Specifically, the study focused on understanding the contextual factors affecting intervention accessibility, participant experiences and potential adaptations to enhance its effect.

A qualitative study was conducted across three Haitian cities, where trained helpers delivered PM+. Data were collected through the PSYCHLOPS tool with end-users and via cognitive interviews with stakeholders. Thematic analysis was conducted incorporating Lund’s social determinants of mental health model and Bronfenbrenner’s ecological systems theory to interpret findings.

Sixteen end-users and five stakeholders participated in the study. Key barriers to implementation and its success mainly included economic constraints and safety concerns. Facilitating factors included strong community engagement, adaptive implementation strategies (such as flexible scheduling, remote supervision and culturally responsive adjustments), alongside strong organisational support. End-users described substantial difficulties in managing everyday problems and emotional distress, as reported during pre-intervention qualitative assessments.

PM+ appeared feasible in the Haitian context from an implementation perspective; however, its implementability depends on cultural adaptations, economic considerations and sustained support for facilitators. Addressing systemic barriers and integrating task-sharing interventions within existing health structures could enhance the long-term impact.

Known influences on tic severity include medical, biological and contextual factors.

We aimed to further understanding of contextual factors by exploring if tic severity is influenced by calendar month.

This study used data from the Calgary Child Tic Registry. Children are extensively clinically phenotyped at their first visit and followed prospectively until adulthood. We evaluated the mean Yale Global Tic Severity Scale-Revised (YGTSS-R) total tic severity score based on the calendar month. Multivariable linear regression models were fit to assess the individual months adjusted for age, gender, comorbidity and tic treatment variables.

The study included 370 participants, with 549 assessments of tic severity performed. In the univariable analysis based on calendar month, August had the lowest tic severity, with a mean YGTSS-R total tic severity score of 15.68 (95% CI 13.41–17.95). This was significantly lower than the month with the highest tic severity, February, with a mean score of 20.41 (95% CI 18.19–22.63). In multivariable models adjusted for age, gender, comorbidity and treatment for tics, the omnibus test for whether month contributes to a better fit were not significant (YGTSS-R total tic score P-value: 0.495). The only significant predictors of increased tic severity were treatment for tics (P < 0.0001), diagnosis of depression (P = 0.003) and diagnosis of obsessive–compulsive disorder (P = 0.02).

While our univariate analysis of tic severity by calendar month supported significantly lower tic severity in August compared with February, this association was no longer statistically significant when controlling for other variables known to impact tic severity.