Chronotype reflects individual variation in circadian rhythm (CR) (e.g., morningness versus eveningness). CR and chronotype have been associated with dementia pathology, and recent literature suggests that impaired sleep quality and CR disturbances may represent relevant causal factors for dementia. Current evidence is scarce and consists of just a small number of cross-sectional analyses and one longitudinal study. The aim of this study is to investigate the longitudinal association between chronotype and dementia risk in the older adult population, aged 60 years and older.

Linking data from the Lifelines Cohort Study and data from Vektis obtained by Statistics Netherlands led to a sample for analysis of n = 16,757 participants. Chronotype was measured with the Munich ChronoType Questionnaire (MCTQ) between 2011 and 2015. Chronotype was categorised into five categories: extremely early, slightly early, intermediate, slightly late, extremely late. Dementia incidence was based on having at least one dementia indicator from the Vektis dataset in the years 2018 until 2024. A discrete-time survival model was used to examine the association between chronotype and dementia. Age was specified as the underlying time scale in the discrete-time logistic survival analysis. Sex was included as a covariate. Interactions between age, sex, and educational attainment and chronotype were measured by including relevant interaction terms in the model.

The median age in the sample was 65 years old, and 54% was female. In total, 7% got dementia during a mean follow-up period of 6.6 years. Most individuals had an intermediate chronotype (56%), with about 20% of the individuals having a slightly early and late chronotype, and only about 3% having an extremely early and late chronotype. Individuals with a slightly early (HR, 1.26 [95% CI: 1.08, 1.46]) and an extremely late chronotype (HR, 1.42 [95% CI: 1.00, 2.02]) had an elevated risk of dementia. There were no significant interactions.

Having a slightly early as well as an extremely late chronotype was associated with an elevated risk of dementia.

Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels.

Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990–2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute’s APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010–2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data.

In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17–78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58–23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015–2019 was approximately 60% lower than 2000–2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68–0.78) in the 1980 cohort to 0.90 (95% CI: 0.70–1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010–2019.

Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.

The COVID-19 pandemic has exerted significant mental health impacts worldwide, with a major concern in the literature being its potential effect on suicide rates. Brazil, one of the countries most severely affected by the pandemic, still lacks clear evidence regarding the consequences of the crisis on self-inflicted deaths. This paper aims to estimate the impact of the COVID-19 pandemic on suicide rates in Brazil.

We employed an interrupted time series design with seasonal adjustments to estimate changes in suicide rates per 100,000 population. The analysis was based on deaths from all forms of self-inflicted injury, as classified by the International Classification of Diseases. We estimated trends for the total population, stratified by sex and administrative region.

Suicide rates increased significantly before the pandemic (β₁ = 0.00148, p < 0.001). No significant change in trend was observed after the onset of the pandemic at the national level (β₃ = 0.00092, p > 0.05). Among men, both the pre-pandemic trend (β₁ = 0.00236, p < 0.001) and the post-pandemic increase (β₃ = 0.00155, p < 0.05) were significant. For women, the pre-pandemic trend was modest (β₁ = 0.00065, p < 0.001), and the post-pandemic slope was not significant (β₃ = 0.00033, p = 0.10). Regionally, the Central-West (β₃ = 0.00217, p < 0.01) and North (β₃ = 0.00186, p < 0.05) experienced significant post-pandemic increases, while the Southeast (β₃ = 0.00087, p > 0.05) and South (β₃ = −0.00034, p > 0.05) showed no significant changes. Seasonal effects revealed consistent mid-year declines across all groups and regions.

The COVID-19 pandemic did not produce a statistically significant shift in national suicide trends but coincided with the persistence of pre-existing upward patterns in specific demographic and regional contexts. These findings underscore the need for targeted and region-specific suicide prevention strategies.

Homelessness is increasing and associated with poor mental health (MH). Few studies have examined how experiences of homelessness and sexual identity intersect to effect MH. We used an intersectional approach to examine MH inequalities related to sexual identity and past homelessness in a nationally representative private household sample, and whether associations were explained by discrimination.

Analysis of the 2007 and 2014 Adult Psychiatric Morbidity Surveys included 10,428 individuals aged 16–64 (58% female/3.8% non-heterosexual). The Clinical Interview Schedule-Revised (CIS-R) identified common mental disorders (CMDs). Self-harm, attempted suicide, alcohol dependence, substance use, sexual identity, discrimination/bullying, past homelessness and health behaviours were self-reported. Associations between sexual identity and homelessness were examined using multivariable Poisson regression. Prevalence ratios (PRs) for MH and health behaviours by intersectional sexual identity-past homelessness were examined using Poisson regression and adjusted for age, sex, area-level deprivation and further for discrimination/bullying.

Bisexual (adjusted PR [aPR]: 2.52, 95% CI: 1.48–4.29) and gay/lesbian (aPR: 1.76, 0.97–3.19) individuals were more likely to report past homelessness than heterosexual peers. Sexual minority (SM) and heterosexual individuals with past homelessness had higher prevalence of all MH outcomes compared to heterosexual peers without homelessness, with associations strongest in the SM-homelessness group (e.g., CMD: aPR: 2.67 [2.37–3.01] for heterosexual-homeless, aPR: 4.11 [3.00–5.63] for SM-homeless, aPR: 1.82 [1.45–2.28] for SM-not homeless groups), and similarly for depression/self-harm/attempted suicide. Likewise, the SM-homeless group had highest prevalence for drug dependence (aPR, 7.38 [3.15–17.29]) compared to the heterosexual-homeless (aPR, 4.03 [3.00–5.42]) and SM-not homeless (aPR, 2.19 [1.27–3.79]) groups. Adjustment for discrimination and bullying substantially attenuated point estimates, with the greatest attenuation (30–50%) in the SM-homeless compared to the heterosexual-homeless groups.

Individuals with past experiences of homelessness have significantly worse MH than heterosexuals without homelessness, with associations highest in the SM-homeless group. Considering experiencing homelessness and SM identity together identifies a group facing particular adversity, which is often lost when examined separately. Discrimination and bullying explained much of the worse MH in SM- and heterosexual-homeless groups, but especially the former. Investigation into the mechanisms leading to MH inequalities is needed, alongside policies and services to support this group.

Intolerance of uncertainty (IU) – a dispositional inability to react effectively to uncertain situations – has been increasingly conceptualized as a transdiagnostic risk factor for internalizing problems such as generalized anxiety and depression. However, evidence for its temporal role in the development of these conditions remains limited, particularly in adolescents, a group at heightened risk for psychopathology.

A total of 5,291 adolescents (46.2% boys; M age = 14.40 ± 1.56, range = 10–18 years) completed self-report measures of IU, generalized anxiety and depressive symptoms at baseline, 6 months and 12 months. Linear and logistic regression analyses examined whether baseline IU predicted subsequent symptom severity and elevated (above-cut-off) symptom levels over time.

Higher baseline IU significantly predicted increases in generalized anxiety and depressive symptoms, as well as higher odds of elevated generalized anxiety and depressive symptom levels at both 6- and 12-month follow-ups, even after adjusting for baseline symptom severity or baseline elevated symptom status. Baseline IU also predicted the new-onset and persistence of elevated symptoms across both intervals. Stratified analyses revealed developmental and sex differences: IU’s predictive effects were strongest in early adolescence for girls and in middle-to-late adolescence for boys.

IU emerged as a transdiagnostic longitudinal predictor of generalized anxiety and depressive symptoms in adolescents, supporting its value as an early screening marker of vulnerability. Interventions targeting IU may offer an effective strategy for reducing broad internalizing risk during this critical developmental period.

Reducing stigma and discrimination towards people with mental ill-health is a key priority in Australian mental health policy. Population-based surveys conducted in Australia between 2003 and 2011 showed some improvement in stigmatising attitudes, but also a deterioration in attitudes about dangerousness and unpredictability, particularly in relation to schizophrenia. This study aimed to investigate whether stigmatising attitudes have changed since the 2011 national survey.

Two large, nationally representative samples of Australian adults were surveyed in 2011 (n = 1967) and 2024 (n = 1984). At each time point, participants were presented with vignettes of a person in the early stages of depression or schizophrenia and completed questionnaires about stigmatising attitudes towards the person in the vignette (Personal Stigma Scale) and willingness to interact with them (Social Distance Scale). Using weighted data, logistic regressions assessed change from 2011 to 2024 while controlling for sociodemographic characteristics. Results were considered significant at p < .01.

There were significant reductions in endorsement of stigmatising attitudes towards depression and early schizophrenia. Notably, there were large reductions in beliefs about dangerousness (depression 22.5–4.8% and schizophrenia 37.1–18.1%). Conversely, the willingness to interact with a person with depression remained unchanged and had worsened for schizophrenia, with the odds of being unwilling to interact approximately doubling (11.0–26.9% unwilling to make friends and 18.8–33.2% unwilling to work closely with them).

The data show mixed findings regarding change in stigma in the Australian population. Despite negative beliefs diminishing over time, this has not translated into greater willingness to interact with people with depression or schizophrenia. Key action is needed on understanding the barriers to interacting with people with mental health conditions and reducing perceptions of unpredictability, particularly for schizophrenia, which remains more highly stigmatised.

Prevention of child maltreatment – incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence – is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributable to childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributable to child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors.

We estimated burden attributable to child maltreatment by age and gender for Australia in 2021. Risk–outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributable fractions (PAFs) were calculated. Attributable mortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributable burden estimates using Monte Carlo simulation methods.

Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2–6.9%) of all DALYs for women and 6.4% (95% UI, 6.0–6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributable to child maltreatment.

Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributable to child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.

The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7.

We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively.

Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible.

The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.

Significant sex disparities in mental health have been observed amongst resettled refugees, yet how these disparities and their determinants evolve over time remains unclear. This study sought to quantitatively unravel determinants and changes in mental health disparities by sex.

Data were drawn from Waves 1 (2013–2014), 5 (2017–2018) and 6 (2023) of the 10-year Building a New Life in Australia (BNLA) cohort. Post-traumatic stress disorder (PTSD) and high risk of severe mental illness (HR-SMI) were measured using the PTSD-8 and Kessler-6 scales. Fairlie method was used to quantify the disparity (total predicted probability difference by sex) and the contribution proportion of individual determinants (explained difference/total predicted probability difference × 100%).

A total of 2261 refugees were included at Wave 1, with 1833 (81.1%) and 905 (40.0%) followed up at Waves 5 and 6. Female refugees consistently experienced poor mental health, with the total predicted probability difference decreasing from the initial (Wave 1, 8.3%) to middle stage (Wave 5, 4.6%), then increasing in the long term (Wave 6, 6.3%). Determinants of disparities varied across waves, but poor status of physical health was a persistent contributor of disparities in PTSD (contribution proportion: 57.2%, 71.5% and 63.0% at each wave). Family conflict contributed at the initial (HR-SMI: 4.5%) and long-term stages (PTSD: 8.7%), while financial hardships (PTSD: 13.2%; HR-SMI: 23.2%), marital status (HR-SMI: 24.8%) and family concerns (PTSD: 8.0%) were key determinants at the middle stage. Unmet support or help during COVID-19 was a major contributor at Wave 6 (PTSD: 22.7%; HR-SMI: 8.0%).

Sex disparities exist in refugees’ mental health and require sustained attention and tailored strategies. To promote mental health equity, there is a long-term need to provide essential physical healthcare and financial assistance and address family-related stressors. Additionally, it is important to identify and address the specific psychosocial needs of women in times of crisis such as the COVID-19 pandemic.

Social functioning is a crucial aspect of psychosocial adaptation following forced displacement. Yet, it has received far less attention than understanding and addressing mental health problems among refugees and asylum-seekers. This study aimed to extend the ecological model of refugee distress – one of the most widely used frameworks in refugee mental health – to social functioning, and to identify direct and indirect pathways from established conflict- and displacement-related factors to social functioning alongside mental health problems.

An online study with 1,235 refugees in Indonesia was conducted over a 2-year period. Conflict-related traumatic experiences before arrival in Indonesia, post-displacement stressors in the past 12 months, were measured at the onset of the study, while social functioning and mental health outcomes (symptoms of posttraumatic stress disorder, depression, and anger) were assessed 1 year later.

Longitudinal Structural Equation Modelling analysis revealed that diversity of conflict-related trauma predicted more post-displacement stress (β = 0.45, SE = 0.03, p < 0.001), higher mental health problems (β = 0.13, SE = 0.05, p = 0.004), but increased social functioning 1 year later (β = 0.10, SE = 0.04, p = 0.011), while post-displacement stressors predicted poorer mental health (β = 0.46, SE = 0.05, p < 0.011) and reduced social functioning (β = −0.09, SE = 0.04, p = 0.041). The indirect pathway from traumatic experiences via post-displacement stressors was positive for mental health (β = 0.21, 95% CI = 0.162–0.257) and negative for social functioning (β = −0.04, 95% CI = −0.082 to −0.003).

This study conceptually and empirically extended the ecological model of refugee distress to social functioning by highlighting the dual influences of conflict-related traumatic experiences. The findings provide a springboard for advancing research and practice in the mental health and psychosocial field.

Mental–physical multimorbidity is an emerging prevalent global health challenge. This study aims to examine reciprocal relationships between depressive symptoms and multimorbidity, with the mediation role of functional dependence in activities of daily living.

Data were derived from the China Health and Retirement Longitudinal Study, which included 11,572 Chinese residents aged 45 years and older, surveyed in 2011, 2013, 2015 and 2018. Depressive symptoms were assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale (CESD-10) at baseline and each follow-up survey. Multimorbidity was operationalized as the condition count and the patterns identified via exploratory factor analysis. Four-wave cross-lagged panel models (CLPM) with bootstrapping were employed to estimate the path coefficients and the mediation effect of functional dependence.

Multimorbidity (cardiometabolic and respiratory-degenerative) and depressive symptoms exhibited bi-directional associations. Multimorbidity had a stronger impact on later depression (β: 0.042–0.130) than depression on multimorbidity (β: 0.005–0.064). Associations were stronger for respiratory-degenerative (β: 0.027–0.104) than cardiometabolic diseases (β: 0.005–0.065). Functional dependence partially mediated these links, with higher mediation for cardiometabolic (9–21%) than respiratory-degenerative diseases (4-6%). Additionally, some sex- and age-specific differences were identified in these dynamic associations.

The study revealed bi-directional links between multimorbidity and depressive symptoms among Chinese adults. Functional dependence was a significant pathway in the cycle of multimorbidity and depressive symptoms, especially for cardiometabolic diseases. These insights suggest that interventions aimed at preventing functional dependence may be beneficial in mitigating the risk of coexisting mental and physical disorders.

The development of psychopathology during childhood and adolescence is complex and likely to follow diverse patterns. Mapping trajectories of psychopathological difficulties may improve our understanding of the nature of emerging, resolving and persistent psychopathology. The purpose of this study is to examine trajectories of psychopathology throughout childhood and adolescence by examining multiple data sources, including questionnaire-based reports of emotional and behavioural difficulties, psychiatric diagnoses and prescribed psychotropic medications.

Group-based multi-trajectory modelling was used to identify the psychopathological trajectories. This study included 49,361 full-term live-born singleton children born between 1996 and 2003, recruited into the Danish National Birth Cohort. Strengths and Difficulties Questionnaire data were collected when the children/adolescents were 7, 11 and 18 years old. Annual information about psychiatric diagnoses and redeemed prescriptions for psychotropic medication was retrieved from nationwide registries between the ages of 1 and 18. We included six predefined dimensions to identify the trajectories: internalizing behavioural problems, externalizing behavioural problems, neurodevelopmental diagnoses, affective diagnoses, mixed psychiatric diagnoses and psychotropic medications.

Six distinct trajectory groups were identified for both boys and girls. Approximately 6% of the boys and 8% of the girls receive the bulk of the psychiatric diagnoses and psychotropic medications. We found no support for ‘pure’ internalizing or externalizing patterns in any identified trajectory, as problems in one dimension often indicated the presence of problems in another dimension.

Our results demonstrate substantial psychiatric comorbidity and add new insights to the understanding of child and adolescent well-being and the complex patterns of developmental psychopathology.

To examine mediators and modifiable psychosocial factors associated with psychological distress, depression, anxiety and self-rated health among Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as ‘Indigenous Australians’) aged ≥18 years.

This was a cross-sectional study based on the analysis of the 2018–19 National Aboriginal and Torres Strait Islander Health Survey dataset (N = 3942). Odds ratios (OR) and 95% confidence intervals (CI) for associations and indirect effects for mediation analyses were computed.

Our results showed that Indigenous Australians with higher levels of perceived social support were less likely to have psychological distress (OR = 0.36, 95% CI: 0.23, 0.56), depression (OR = 0.44, 95% CI: 0.29, 0.67), anxiety (OR = 0.43, 95% CI: 0.28, 0.65) and low self-rated health (OR = 0.52, 95% CI: 0.33, 0.82). Similarly, those with a high level of mastery were less likely to have psychological distress (OR = 0.14, 95% CI: 0.11, 0.19), depression (OR = 0.20, 95% CI: 0.15, 0.28), anxiety (OR = 0.26, 95% CI: 0.20, 0.36), and low self-rated health (OR = 0.37, 95% CI: 0.28, 0.50). Perceived social support mediated 33.7% of the association between removal from the natural family and psychological distress, 14.6% of the association between discrimination and psychological distress, 20.3% of the association between discrimination and depression, 14.8% of the association between discrimination and anxiety and 16.6% of the association between discrimination and low self-rated health. Both perceived social support and mastery mediated the association between physical harm and psychological distress, depression and anxiety.

We believe that community-driven psychosocial programs that enhance social support, self-efficacy and cultural connection may significantly improve the mental health and psychosocial well-being of Indigenous Australians.

Limited studies have conducted a comprehensive investigation on the impact of China’s birth policy change on the mental health among women of childbearing age. This study aimed to explore the potential impact of China’s Universal two-child policy on depressive symptoms among women of childbearing age, based on national-representative, longitudinal survey data.

Data we employed in this study were derived from the China Family Panel Study (CFPS) for the waves of 2012, 2014, 2016, 2018 and 2020. We included 7481 currently married females (17079 for pooled sample) aged 20–40 years. Depressive symptoms were assessed using the Kessler 6 Rating Scale (K6) and the Center for Epidemiologic Studies Depression Scale (CES-D). All scores were standardized for analysis. We employ the difference-in-difference model to investigate the association between the implementation of the Universal Two-child Policy (UTP) and women’s depressive symptoms.

Women in the exposed group, after implementing UTP, had a standardized score of depressive symptoms 0.10 higher (95% CI: 0.03–0.16, p = 0.007) than during the pre-intervention period after controlling for multiple covariates. They also faced a higher risk of having moderate or severe depressive symptoms (OR = 1.45, 95% CI: 1.12–1.87, p = 0.004). The stratified analysis revealed that the negative impact of UTP on mental health was pronounced among women with advanced age, low education, medium family income, only male offspring before UTP, and no new birth after UTP.

We observed that the implementation of the UTP was associated with increased depressive symptoms among married women of childbearing age in China, with significant heterogeneity across different sociodemographic groups. Greater attention should be paid to the complex psychological conditions of women of childbearing age when adjusting fertility policies, which is crucial to prevent women from suffering poor mental health and to advance high-quality development in population health.

This study aimed to assess the oral health status of individuals with schizophrenia and explore its association with behavioural and pharmacological factors, with particular focus on long-term antipsychotic treatment and cumulative anticholinergic burden.

A total of 153 adults with schizophrenia (18–65 years) from the Mental Health Network of Bizkaia (Spain), all under antipsychotic treatment for ≥12 months, were evaluated and compared with 153 controls from the general population. Data on socio-demographic variables, tobacco use and oral hygiene habits were collected. Oral health was assessed using the Decayed, Missing and Filled Teeth (DMFT) index and the Community Periodontal Index of Treatment Needs (CPITN). Unstimulated salivary flow was measured, and subjective xerostomia symptoms were recorded. Cumulative anticholinergic burden was estimated using the Drug Burden Index, considering both psychotropic and non-psychotropic medications. The association between dental health and clinical, behavioural and pharmacological variables was analysed in patients with schizophrenia.

Patients with schizophrenia exhibited significantly poorer oral health than controls, with higher mean DMFT scores (15.3 vs. 10.9; p < 0.001) and more advanced periodontal disease indicated by CPITN. Salivary hypofunction (<0.45 ml/min) was present in 31% of patients versus 12% of controls. In addition, high to very high anticholinergic burden was present in 71.9% of patients with schizophrenia, compared to only 3.3% of controls. In patients with schizophrenia, multivariate analyses identified the following as significant predictors of worse dental status (DMFT): age; smoking; female sex; illness duration; reduced salivary flow; poor tooth brushing; and anticholinergic burden. For periodontal health (CPITN), however, no variable was identified as a significant predictor of high-risk periodontal status.

Oral health is substantially compromised in individuals with schizophrenia, reflecting a multifactorial interplay of behavioural, systemic and pharmacological factors. Both cumulative anticholinergic burden and reduced salivary flow independently contribute to poorer dental health, while periodontal disease appears to result from more complex influences not fully captured with studied variables. These findings underscore the importance of proactive clinical strategies, including regular dental assessments, targeted oral hygiene interventions, interdisciplinary collaboration between mental health and dental care providers and careful review of psychopharmacological regimens to minimize unnecessary anticholinergic exposure. Such integrated approaches are essential to preserve oral health, enhance quality of life and improve long-term outcomes in this vulnerable population.

Intimate partner violence (IPV) victimization is associated with suicidal behaviour. Suicidal behaviour may also be raised among those who perpetrate IPV compared to those who do not; general population-based evidence is, however, lacking. We aimed to investigate the associations between using violence against an intimate partner with suicidal thoughts, suicide attempt and non-suicidal self-harm in the past year.

We analysed data from the 2014 Adult Psychiatric Morbidity Survey. Logistic regressions estimated associations between IPV perpetration and suicide attempt, suicidal ideation, and self-harm. Associations were estimated for men and women separately, and we explored interaction in estimates by IPV victimization.

After adjustment for demographic and socioeconomic covariates, lifetime IPV perpetration was strongly associated with past-year suicide attempt (men: odds ratio [OR] 3.6, 95% confidence interval 1.0–13.2, women: OR 4.2, 1.9–9.4), suicidal ideation (men: OR 2.7, 1.5–4.9, women: OR 2.6, 1.7–4.1) and self-harm (men: OR 4.9, 1.5–15.2, women: OR 3.3, 1.8–6.0). Estimates were substantially attenuated with adjustment for non-IPV life adversities, hazardous alcohol use, drug use and IPV victimization. Only the association with lifetime suicide attempt in women remained significant (OR 1.6, 1.1–2.3). Estimates were generally higher among those who had not experienced IPV victimization, although we found no evidence for interaction by IPV victimization on the association between IPV perpetration and suicidal behaviour.

There were greater odds of suicidality and self-harm among self-reported perpetrators of IPV compared to the general population. Many of these associations were accounted for by non-IPV life adversities, IPV victimization and substance use. Improving the identification and management of IPV perpetration, and developing targeted safety planning and interventions for this group could reduce suicide for perpetrators and victims of IPV.

Trauma-related psychopathology is markedly elevated among refugee populations, particularly those living in sustained displacement. While economic, social and psychological factors have been linked to the deterioration of mental health following trauma and displacement, these factors have rarely been investigated concurrently and longitudinally. Consequently, there is little information on the potential longitudinal mechanisms driving mental ill-health in displacement settings. This study explored the temporal association between economic stressors, social stressors, emotion dysregulation and psychopathology in 1,235 refugees displaced in Indonesia.

Refugee participants from Farsi, Dari, Arabic, Somali and English-speaking backgrounds completed an online survey at four timepoints, 6 months apart. Factors of interest were measured using validated instruments including the Patient Health Questionnaire (to assess depressive symptoms), Posttraumatic Diagnostic Scale (to assess posttraumatic stress [PTS] symptoms), Post-Migration Living Difficulties Checklist (to index economic and social stressors) and Difficulties in Emotion Regulation Scale (to assess emotion dysregulation).

Random-intercept cross-lagged panel analysis revealed that economic stressors and emotion dysregulation were central to the longitudinal course of trauma-related psychopathology. Specifically, economic stressors were associated with subsequent increases in PTS symptoms (B = 0.07, p = 0.047), depressive symptoms (B = 0.17, p < .001) and social stressors (B = 0.28, p < .001), while emotion dysregulation was antecedent to increases in PTS (B = 0.16, p < .001), depression symptoms (B = 0.13, p < .001), and social stressors (B = 0.10, p = .017). Additionally, depression was associated with subsequent increases in economic stressors (B = 0.18, p = .001) and social stressors were associated with subsequent increases in economic stressors (B = 0.12, p = .037).

The current study identified both economic stressors and emotion dysregulation as the main drivers of psychopathology for refugees. This indicates that both the structural barriers encountered in the environment and one’s internal capacity have a substantial impact on wellbeing. These findings highlight that alongside psychological interventions, policy changes that facilitate economic empowerment are critically, and equally, important.

Social anxiety disorder (SAD) is one of the most common anxiety disorders and is associated with significant impairment and societal costs. The association between SAD and mortality remains poorly understood, partly because in epidemiological research it is rarely studied independently from other anxiety disorders. In this population-based matched cohort and sibling control study, we estimated the risk of all-cause and cause-specific mortality in individuals with SAD.

From a population of individuals born from 1932 and living in Sweden between 1997 and 2020, we identified all cases of SAD (Swedish ICD-10 code F40.1) in the National Patient Register. Each of these individuals was matched on sex, birth year and county of residence with 10 individuals who had never received a diagnosis. Mortality data were extracted from the Cause of Death Register. Risks were estimated using Cox proportional hazards regression models. Models adjusted for sociodemographic covariates and other lifetime psychiatric disorders. We also identified all clusters of full siblings and conducted within-sibling comparisons to account for unmeasured familial confounding.

The matched cohort included 57,360 individuals with SAD and 573,600 unexposed individuals. During the follow-up, 2355 deaths were registered within the exposed cohort vs. 7800 deaths in the matched cohort (crude mortality rates, 5.25 and 1.73 per 1000 person-years, respectively). The full cohort was followed up for a mean of 7.87 years (standard deviation 5.23). In models adjusting for sociodemographic variables, individuals with SAD had a 2.24-fold increased hazard of all-cause mortality (95% confidence interval [CI], 2.13–2.35). The increased risk was observed for both natural (adjusted hazard ratio [HR], 1.62; 95% CI 1.52–1.72) and unnatural causes of death (HR, 4.18; 95% CI 3.82–4.58). The results were robust to additional adjustment for psychiatric comorbidities, but the magnitude of the associations was attenuated, particularly when adjusting for substance use disorders. In the sibling cohort, 39,993 individuals with SAD were compared with their 64,640 unaffected siblings. While the estimates were also attenuated, they remained statistically significant (HR for all-cause mortality, 1.40; 95% CI 1.36–1.45).

Individuals with SAD face an increased risk of mortality, attributable primarily to unnatural causes of death, such as suicide, but also to natural causes, even after adjusting for socioeconomic variables. Psychiatric comorbidities, particularly substance use disorders, and shared familial factors may also contribute to this excess death. Further study of underlying mechanisms may inform prevention and early intervention strategies to reduce mortality in this vulnerable population.

Existing reviews on mental health disparities between deaf and hard‐of‐hearing (DHH) and hearing populations have focused predominantly on children, adolescents, or older adults, leaving a gap for working-age adults. We conducted a systematic review comparing the prevalence, incidence, and severity of any DSM-5-TR or ICD-11 mental disorder between DHH and hearing adults aged 18–60 years. We aimed to quantify disparities and examine disorder-specific patterns to inform future research, policy, and service development.

On 13 December 2025, we searched Ovid Medline, Embase, APA PsycINFO and Web of Science. We included analytical observational studies involving DHH and hearing adults aged 18–60 years, reporting mental disorder prevalence, incidence, or severity. Two researchers independently extracted data, and risk of bias (RoB) was assessed using the modified CLARITY tool. We narratively synthesised findings by aggregating outcomes at the study level using two approaches: summary and majority of the effect directions within a study. Subgroup syntheses examined outcome type, study RoB, age group and mental disorder category.

Sixty studies (n = 8 578 466) met inclusion. In the summary-direction synthesis, 58.3% (35/60) of studies reported higher mental disorder outcomes for DHH adults, 21.7% (13/60) found no difference and 20.0% (12/60) had mixed findings; none indicated lower mental disorder outcomes for DHH. Under the majority-direction approach, 65.0% (39/60) showed higher mental disorder outcomes and 35.0% (21/60) no difference. These patterns were consistent across prevalence (62.8–72.1% higher) and severity (61.1% higher). Studies with higher RoB more often reported higher mental disorder outcomes (66.7–72.2%) than lower-RoB studies (54.8–61.9%), though both mirrored the overall synthesis. Effects were similar across younger (61.9–71.4%) and older adult samples (61.1–66.7% higher). Disorder-specific syntheses identified psychotic disorders, post-traumatic stress disorder and suicidal outcomes as having the strongest disparities (≥72.2% higher), followed by general mental disorders, anxiety and depression. Fewer than five studies examined each of the other disorders, thereby limiting conclusions for these disorders.

Most available evidence indicates that the prevalence and severity of mental disorders are higher among DHH adults aged 18–60 years than among hearing adults, with limited evidence on incidence. No studies reported lower aggregated mental disorder outcomes for DHH adults. Addressing these disparities requires targeted intervention research, supported by population-based, longitudinal and (quasi-)experimental studies including comprehensive reporting of participant characteristics. This will inform more tailored interventions, improve screening and ultimately contribute to better mental health and quality of life for DHH adults.

Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.

We used Taiwan’s National Health Insurance Research Database (2000–2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).

Over a mean follow-up of 8 years, PTSD was associated with excess all-cause mortality (AHR = 1.32, 95% CI 1.24–1.41) driven by markedly increased unnatural deaths (AHR = 5.93, 5.13–6.85), especially suicide (AHR = 10.36, 8.41–12.76) and accidental deaths (AHR = 2.18, 1.67–2.86). Natural-cause mortality showed no consistent increase (AHR = 0.91, 0.85–0.98). In sibling analyses, excess risks persisted for all-cause (AHR = 2.48, 2.04–3.01), unnatural deaths (AHR = 4.76, 3.58–6.34) and suicide mortality (AHR = 7.90, 5.21–11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.

PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.