Ethnic inequalities in compulsory psychiatric hospital detentions are well-documented in the UK and internationally. It is unknown how UK coronavirus disease 2019 (COVID-19) lockdown measures, which led to restrictions in public movement, gatherings, in-person health service delivery and changes to police powers, further impacted inequalities.

In this study, we assessed whether national lockdown measures impacted ethnic inequalities in voluntary and compulsory psychiatric hospital admissions during the COVID-19 pandemic.

Daily counts of admissions and detentions to psychiatric hospitals were extracted from a large population-level sample of secondary mental health service users in South East London. Changes during two COVID-19 lockdown periods, over 2020–2021, were compared with pre-pandemic periods (2016–2019) with the use of a regression discontinuity in time design to assess ethnic inequalities in voluntary and compulsory mental health admissions.

Compared to the pre-pandemic reference (2016–2019), after adjusting for seasonal and weekly trends, overall admissions to mental health units dropped during the first COVID-19 lockdown (incidence rate ratio (IRR) 0.87 (95% CI: 0.75–1.00)), but compulsory detentions rose (IRR 1.25 (1.05–1.54)). This was mostly due to higher compulsory detentions in the Black Caribbean group (IRR 1.54 (1.08–2.19)). During the second COVID-19 lockdown, whereas total daily admissions remained similar to the pre-pandemic reference (IRR 1.03 (0.92–1.15)), total new daily detentions was elevated (IRR 1.28 (1.11–1.49)), specifically in Black Caribbean (IRR 1.53 (1.14–2.06)) and Black African (IRR 1.57 (1.06–2.34)) groups.

COVID-19 lockdown measures exacerbated pre-existing ethnic inequalities in compulsory psychiatric detention, particularly for those from Black Caribbean and Black African backgrounds. There is a need to address ethnic inequalities in compulsory psychiatric detentions and attend to exacerbations of pre-existing inequalities during health emergencies like the COVID-19 pandemic. This cannot be achieved without addressing systemic racism within criminal justice and healthcare systems and tackling inequalities in wider social and economic determinants of mental health.

Clozapine is licensed for treatment-resistant schizophrenia (TRS). Because of the risk of clozapine-induced agranulocytosis, its use requires regular haematological monitoring. Substantive evidence supports revisions of absolute neutrophil counts (ANCs) for clozapine discontinuation and ceasing of indefinite haematological monitoring.

To examine the cost-effectiveness and budget impact of different haematological monitoring schemes compared with the current UK monitoring practice for patients using clozapine.

We performed a cost-effectiveness and budget impact analysis from the healthcare system perspective over a 3-year period, comparing the current UK clozapine monitoring practice with extended haematological monitoring and a revision of ANC criteria. Costs and quality-adjusted life years (QALYs) were estimated using a semi-Markov model that followed a simulated cohort of 100 000 adults with TRS. Sensitivity analyses were conducted.

Extended haematological monitoring would lead to lower mean total costs per patient (6388.34 v. 5569.77 GBP) and not compromise quality of life (in QALYs 795.83 v. 795.79 days). A revision of ANC criteria for clozapine discontinuation would not substantially lower costs (6388.34 v. 6390 GBP), but lead to a slight increase in QALYs (795.83 v. 797.08 days), through patients benefitting from longer clozapine treatment. A combination of extended haematological monitoring and revision of ANC criteria would be the dominant strategy, which means that costs are lower (6388.34 v. 5548.50 GBP) and QALYs slightly increase (795.83 v. 797.03 days) compared with the current UK monitoring practice.

A revision of current UK clozapine monitoring practice would be beneficial from both a clinical and an economic perspective. Adjusting ANC criteria for clozapine cessation avoids unnecessary early discontinuation of clozapine treatment and has a positive impact on quality of life. An extension of monitoring intervals reduces costs borne by the healthcare system. Safety is not compromised by these changes.

Research suggests there are alterations in the cortisol awakening response (CAR) in patients with premenstrual dysphoric disorder (PMDD), as demonstrated by delayed cortisol peaks and flatter diurnal cortisol slopes compared to healthy controls. While inconsistent, previous work also demonstrates a relation between alterations in CAR, prefrontal serotonin transporter (5-HTT) binding and severity of depressive symptoms.

This longitudinal study explores CAR in relation to midbrain and prefrontal 5-HTT binding and depressive symptoms in patients with PMDD and in healthy controls across the menstrual cycle.

Thirty patients with PMDD and 29 controls each provided 3 saliva samples for assessment of CAR (awakening, +30 min, +60 min) and 5 to assess the diurnal cortisol slope (09.00, 12.00, 15.00, 18.00, 21.00 h) during the periovulatory and premenstrual phases. [11C]DASB positron emission tomography scans were performed to measure 5-HTT non-displaceable binding potential (BPND). Depressive symptoms were assessed using the Hamilton Depression Rating Scale. Associations between cortisol measures, 5-HTT BPND and depressive symptoms were examined using linear mixed-effects models, independent t-tests, mixed analysis of variance (ANOVA) and Spearman rank correlations.

A significant interaction effect between group and cycle phase was found for cortisol peak concentrations (estimate = 0.78, p = 0.05, d = 0.62, 95% CI: [0.01, 1.56]; and corrected for awakening cortisol concentration: estimate = 0.90, p = 0.02, d = 0.77, 95% CI: [0.15, 1.66]). Cortisol peak concentrations correlated negatively with both midbrain 5-HTT BPND (r = −0.34, p < 0.01, R2 = 0.12) and depressive symptoms (r = −0.30, p = 0.02, R2 = 0.09) during the premenstrual phase.

Patients with PMDD showed attenuated cortisol peaks in the periovulatory phase compared with healthy controls, who demonstrated plastic changes across the cycle. Results point towards an interplay between the stress and the serotonergic system, as well as to the severity of depressive symptoms during the premenstrual phase.

Eating disorders are severe psychiatric conditions associated with high mortality rates, particularly among young people. These disorders often co-occur with self-harm and suicidal ideation, yet the temporal dynamics between these variables remain poorly understood.

This study aims to elucidate the longitudinal associations between symptoms of body dissatisfaction and disordered eating, self-harm and suicidal ideation using structural equation modelling.

Repeated measures of these phenotypes were used to construct a hypothetical model that includes cross-path analyses within and between the variables in two cohorts: the Twins Early Development Study (TEDS; ages 16, 21 and 26 years; N = 5196), representing a general population sample, and the COVID-19 Psychiatry and Neurological Genetics study (COPING; data collected between June 2020 and July 2021; N = 490), which focused on individuals with a history of anxiety or depression. In the TEDS cohort, symptoms of disordered eating, self-harm and suicidal ideation showed limited continuity across adolescence and young adulthood, with peak symptom severity at age 21 years.

Cross-domain associations revealed that both self-harm and suicidal ideation at age 21 years were more strongly associated with disordered eating at 26 years than the reverse. In contrast, the COPING cohort exhibited greater stability in symptoms over time but showed minimal cross-domain effects.

The effects of self-harm and suicidal ideation on disordered eating in early adulthood are stronger than the influence of disordered eating on suicidality.

An increase in mental disorders has been suggested, but the interpretation of such trends remains unclear. This study examines changes in the 12-month prevalence of anxiety and mood disorders over 12 years and evaluates whether clinical characteristics or sociodemographic, vulnerability and health-lifestyle risk factors contributed to these trends.

To assess trends in the 12-month prevalence of anxiety disorders (i.e. panic disorder, agoraphobia, social anxiety disorder or generalised anxiety disorder) and mood disorders (major depressive disorder, dysthymia or bipolar disorder) and explore whether changes in clinical profiles or risk factors influenced these trends.

Data from 11 615 respondents (mean age 43.5 years, 53.5% female) in the Netherlands Mental Health Survey and Incidence Studies (NEMESIS) were analysed, covering 2007–2009 (NEMESIS-2, n = 6646) and 2019–2022 (NEMESIS-3, n = 4969). Diagnoses were determined using the Composite International Diagnostic Interview 3.0.

The 12-month prevalence of all anxiety and mood disorders was significantly higher in 2019–2022 compared to 2007–2009, with relative increases across disorders ranging from approximately a half to more than double their previous rates. Any anxiety or mood disorder increased from 10.2 to 16.7%. Clinical profiles were equally severe in 2019–2022; rather, there was increased mental health care use, a higher number of comorbid disorders and earlier onset. Examination of 14 risk factors showed no consistent evidence of greater prevalence or increased relative impact over time.

There was a consistent rise in the 12-month prevalence of anxiety and mood disorders over 12 years. This increase was not explained by changes in risk factors or less severe disorder reporting. Instead, these findings suggest a concerning decline in public mental health, highlighting the need for effective prevention strategies, timely interventions and better mental health resource allocation to address growing clinical demands.

While various delivery formats of cognitive–behavioural therapy (CBT) for obsessive–compulsive disorder (OCD) are available, comprehensive evidence on their comparative effectiveness and acceptability is lacking.

To examine the comparative effectiveness and acceptability of different CBT delivery formats for OCD.

An existing database of psychological interventions for OCD was utilised, with randomised controlled trials (RCTs) comparing CBT delivery formats with each other/control groups were included. Pairwise and network meta-analyses were conducted using a random-effects model. Comparative standard mean differences (SMDs) were calculated for effectiveness in reducing OCD symptom severity post-treatment. Relative risks were calculated for acceptability (conceptualised as any cause discontinuation in the acute treatment phase).

A total of 61 RCTs involving 3710 patients with OCD were included. All CBT treatment formats were significantly more effective than control groups (SMDs: −0.39 to −1.66). No significant differences were found among individual, remote-delivery, guided self-help, time-intensive and family-involved formats. However, individual, remote-delivery and family-involved formats were more effective than group (SMDs, −0.38 to −0.60), and most treatment formats were more effective than unguided self-help (SMDs, −0.58 to −0.80). Regarding acceptability, most CBT formats showed no significant differences among themselves, although they were generally more acceptable (relative risks: 1.11–1.18) than unguided self-help.

Most CBT delivery formats serve as potential alternatives to conventional individual CBT. Unguided self-help has lower but still moderate effects in reducing OCD symptom severity, and it holds important potential for assisting a larger number of individuals with OCD who face barriers to accessing treatments.

Observational studies suggested an association between childhood maltreatment and neuropsychiatric disorders; however, mediators remain disputed.

We aimed to confirm the relationship between childhood maltreatmen and neuropsychiatric disorders, and to identify addiction-related, biological, behavioural, cognitive, socioeconomic and epigenetic mediators.

We used two-sample Mendelian randomisation and publicly available genome-wide association data to evaluate the effect of genetically predicted childhood maltreatment (N = 143 473) on the risk of six neuropsychiatric disorders (up to N = 500 199). We used two-step Mendelian randomisation to determine the proportion of the effect of childhood maltreatment on disorders that was mediated by mediators. We used multivariable Mendelian randomisation to determine the direct effect of childhood maltreatment on disorders accounting for mediators. We used epigenetic Mendelian randomisation to determine the effect of DNA methylation at childhood maltreatment-associated CpG sites on disorders.

Childhood maltreatment was significantly associated with higher risk of attention-deficit/hyperactivity disorder (ADHD) (odds ratio 10.09, 95% CI: 4.76–21.40), major depressive disorder (MDD) (odds ratio 1.89, 95% CI: 1.32–2.70) and schizophrenia (odds ratio: 5.89, 95% CI: 1.46–23.78). We determined that 4.14–22.17% of the effect of childhood maltreatment was mediated by addiction-related behaviours (smoking initiation, leisure screen time and substance abuse), cognitive traits (executive functioning, intelligence and risk tolerance) and educational attainment. We found that the direct effects of childhood maltreatment on ADHD (odds ratio 2.57) and schizophrenia (odds ratio 5.10) were less than the total effects, while the direct effect on MDD (odds ratio 1.95) remained relatively unchanged. We found altered DNA methylation levels at 3, 4 and 19 CpG sites to be significantly associated with ADHD, MDD and schizophrenia, respectively.

These results emphasise the need for preventative strategies to reduce childhood maltreatment prevalence, including strengthening support for high-risk families and responsive strategies to mitigate consequences for victims, with clinical screening for childhood maltreatment history and holistic approaches addressing addiction-related, cognitive and socioeconomic mediators.

Research exploring delusions among individuals with psychosis often focuses on form, rather than content, and on prevalence, rather than change in a cohort over time. While delusional forms are mostly consistent across cultures and historical periods, the content of delusions is shaped by sociopolitical factors.

We explored the form and content of delusions in a modern sample of individuals with psychosis, examining the extent to which the internet and new technologies become incorporated into delusional frameworks. We investigated whether there was a change in the prevalence of technology delusions over time and how gender, age and education level impacted the probability that a subject would experience technology delusions.

We reviewed the medical records of 228 adults with psychosis who were seeking treatment at a large academic medical centre between 2016 and 2024 and extracted any description of delusional thought content. We characterised delusions into subtypes and explored the ways these delusions feature the internet and new technologies. To examine temporal trends in the content of delusions, we conducted a binary logistic regression analysis with year as the predictor variable and the presence of technology-related content in delusions as the outcome variable.

Most subjects (88.2%) reported delusional thought content, with over half (51.7%) describing technology delusions. Logistic regression between the year and technology-related delusion outcome revealed statistically significant (β = 0.139, p = 0.038, 95% CI (0.008, 0.270)) correlation. For each 1-year increase, the odds of a subject presenting with technology delusions increased by approximately 15% (odds ratio 1.15).

Among individuals with psychotic disorders, the internet and new technologies are increasingly salient in delusional frameworks. Clinicians should be aware of these themes while eliciting symptoms from patients and also while educating trainees.

In low- and middle-income countries (LMICs), suicide is a major problem. Research on the effectiveness of large-scale suicide prevention interventions is limited.

To test the effectiveness of an integrated intervention (school-based prevention; reducing access to means of suicide; increased identification and management of suicide risk) in reducing deaths by suicide and suicide attempts; and to evaluate the implementation and effectiveness of sub-interventions.

In this pragmatic cluster randomised controlled trial, 124 villages from Mehsana, India, were randomly assigned to either intervention or control arm. The intervention comprised school-based awareness intervention, community pesticide storage and training of community health workers (CHWs) to recognise, support, refer and follow up people at risk. Intention-to-treat analysis using mixed-effects Poisson regression tested the primary outcome (suicide attempts plus deaths by suicide), and multilevel linear models assessed sub-interventions. The primary outcome was captured through a novel suicide surveillance system.

There was no statistically significant difference in the primary outcome between the intervention (54 of 62 consenting villages) and control (62 villages) arms. Separately, the intervention arm showed a 43% reduction in risk of death by suicide at 12 months (suicide rate 30.7 versus 43.6 per 100 000 person-years in intervention versus control arm; incidence rate ratio 0.57, 95% CI: 0.32–1.02, adjusting for baseline and clustering). Most students (≥90%, n = 2330/2560) from 47 schools received the intervention and had lower depression and suicidal ideation than controls at month 3. Nearly all villages (52/54, 96.2%) provided pesticide lockers (n = 8370 households, 88.83% uptake). Compared with controls, CHWs in the intervention arm had significantly higher knowledge, confidence and skills, and identified 108 at-risk individuals.

The intervention increased identification without significantly reducing suicide attempts, but reduced suicide deaths. This trial, involving 116 villages and a multicomponent intervention implemented at scale, advances suicide prevention and complex intervention research, especially in LMICs.

Mental health problems among university students have been on the rise, with particularly high levels reported during the COVID-19 pandemic. While many studies have examined the immediate effects of the pandemic, long-term trends in anxiety, depression, non-suicidal self-harm (NSSH) and suicidality remain less explored.

To investigate trends in mental health problems among Norwegian higher education students before, during and after the COVID-19 pandemic, focusing on anxiety, depression, NSSH and suicidality.

The Students’ Health and Wellbeing Study (SHOT) is a national survey of Norwegian students, with data from six waves (2010–2023). Four primary waves (2010, 2014, 2018 and 2022) were supplemented by two additional waves during the COVID-19 pandemic (2021 and 2023), including nearly 200 000 students across all waves. Mental health outcomes were measured using the Hopkins Symptom Checklist(HSCL). Sex-specific cut-offs were applied to estimate the prevalence of major depressive episodes (MDE) and generalised anxiety disorder (GAD). Secondary outcomes included NSSH, suicidal thoughts and suicide attempts.

Mental health problems increased consistently over the 13 years, with a more pronounced rise among women. Mean HSCL scores significantly increased for both sexes from 2010 to 2023, peaking during the COVID-19 lockdown in 2021, followed by a slight decline in 2022, but remaining higher than pre-pandemic levels. The prevalence of MDE and GAD followed similar patterns, increasing from 12.5 to 33.7% in women and 9.4 to 26.8% in men. Reports of NSSH also surged post-lockdown, particularly among women, while suicidal thoughts and attempts increased, especially in women, between 2021 and 2022.

Student mental health has worsened over the past decade. Although there was some post-pandemic improvement, rates of anxiety, depression and suicidality remain high. These findings underscore the continued importance of tiered mental health support and structural interventions within higher education to address student mental health.

Research suggests that there may be an association between prescribed opioid use and suicide-related behaviours.

This 15-year retrospective population-based cohort study examines the relationship between opioid use, self-harm and suicide.

The study was based on the POPPY II study, a population-based cohort of 3 268 282 adults who initiated a prescription opioid between 1 July 2003 and 31 December 2018, in Australia. Prescription dispensing data were linked to hospitalisation, death and other data collections. Opioid use was defined as current opioid exposure, cumulative duration of exposure and estimated daily dose. Outcomes were self-harm hospitalisation and suicide mortality, categorised as overall and according to the method (opioid poisoning, non-opioid substance poisoning and other methods). Time-varying generalised estimating equations were used to assess the relationship with self-harm hospitalisation, and Cox proportional hazard models were used to assess the relationship with suicide mortality, controlling for known suicide-related risk factors.

There were 49 215 self-harm hospitalisations at a crude rate of 262 per 100 000 person-years and 3087 suicide deaths at a crude rate of 16.5 per 100 000 person-years. Intentional opioid poisoning was the least common method for both self-harm hospitalisation and suicide. Following multivariable adjustment, current opioid exposure, longer cumulative duration and higher doses were significantly associated with a greater risk of opioid-related self-harm or suicide. In adjusted models, associations for other methods of self-harm and suicide were not as strong or consistent.

Opioid poisoning was the least common method of self-harm and suicide. Despite this, for the minority of people prescribed high doses and/or a long duration of prescription opioids, there is an increased risk for opioid-related self-harm and suicide after controlling for known covariates. Suicide-related behaviours should be screened and monitored in people prescribed opioids, particularly among those on long-term and/or high-dose opioids.

Postnatal depression (PND) affects up to one in four mothers. However, they may experience barriers to access to conventional treatments, indicating a need for alternatives such as arts-based interventions. A previous trial showed that a 10-week singing intervention could alleviate symptoms of PND.

To evaluate, in a larger sample and across a longer timeframe than previously, the clinical effectiveness, implementation effectiveness and cost-effectiveness of the Melodies for Mums (M4M) singing intervention for symptoms of PND.

One-hundred and ninety-nine mothers experiencing symptoms of PND (Edinburgh Postnatal Depression Scale score ≥10) and their babies were randomised to 10 weeks of in-person singing sessions (M4M, n = 133) or an active control (existing community-based mother–baby activities, n = 66). Mothers were re-assessed at weeks 6, 10, 20 and 36 for depression, healthcare use for themselves and their babies, and health-related quality of life according to the EQ5D-3. The perceived acceptability (Acceptability of Intervention Measure), appropriateness (Intervention Appropriateness Measure) and feasibility (Feasibility of Intervention Measure) of the activity were also assessed at week 6. Trial registration number: NCT04834622.

Mothers in both groups experienced attenuation of depressive symptoms by week 10; however, those in the singing group maintained lower EPDS scores than those in the control group at week 20 (10.7 v. 12.2 (mean difference 95% CI [−2.96, −0.22]), P = 0.023) and week 36 (9.85 v. 11.4 [−2.93, −0.19], P = 0.026). Mothers in the singing group were also more likely to remain in the study (77 v. 57%, χ2(1) = 12.92, P < 0.001) and found their programme more acceptable (4.75 v. 4.0 [0.25, 0.83], U = 2436.5, P < 0.001), appropriate (4.25 v. 3.88 [0.12, 0.62], U = 2241.5, P < 0.001) and feasible (4.75 v. 4.0 [0.41, 0.91], U = 2568.0, P < 0.001). Finally, M4M was associated with 15 extra days of health and was found to be cost-effective (£126–539 per dyad).

M4M had a long-lasting effect on symptoms of PND and was perceived to be more suitable than existing activities; thus, M4M represents a worthwhile investment for healthcare systems as an intervention for mothers experiencing symptoms of PND.

Agitation and aggression occur in up to half of people living with dementia over the course of the disease. Although non-pharmacological interventions are used as first-line treatment strategies, antipsychotics may be indicated in severe cases. A major adverse effect of antipsychotics in dementia is stroke; the mechanism of action of atypical antipsychotic risperidone has been linked to cardiovascular disease (CVD) biological pathways in preclinical studies.

To evaluate the risk of stroke associated with risperidone across different patient subgroups defined by stroke and CVD history.

Anonymised primary care data from the UK-based Clinical Practice Research Datalink were used to identify individuals diagnosed with dementia after the age of 65 years between 2004 and 2023. Risk of stroke over 1 year was compared between individuals initiating risperidone and propensity-score-matched controls across subgroups with and without history of stroke and any CVD.

In the overall cohort (28 403 risperidone users and 136 324 mtatched controls), risperidone was associated with increased risk of stroke (adjusted hazard ratio: 1.28; 95% CI: 1.20–1.37). In the risperidone user group, the incidence rate of stroke was substantially higher in those with a prior history of stroke (incidence rate: 222 per 1000 person-years) and CVD (incidence rate: 94.1 per 1000 person-years) than in the overall cohort (incidence rate: 53.3 per 1000 person-years). Relative risks related to risperidone were similar across all CVD and stroke subgroup comparisons (hazard ratios between 1.23 and 1.44).

People with dementia with a prior history of CVD are at a significant increased risk of stroke, and risperidone further exacerbates this risk. Moreover, risperidone increases risk of stroke in patients without a prior history of CVD. This quantification of stroke risk across subgroups with and without history of CVD may help with communication of risk and aid more judicious prescribing.

Clozapine remains underused despite its unparalleled efficacy in treatment-refractory schizophrenia. One of the reasons for its underuse is the fear of severe neutropenia and its consequences.

To scrutinise the association between severe neutropenia and clozapine in a cohort of patients clinically diagnosed with clozapine-induced severe neutropenia.

We used data from the South London and Maudsley National Health Service Foundation Trust’s anonymised case register, known as the Clinical Record Interactive Search. We extracted details of cases where clozapine use was associated with two consecutive neutrophil counts below 1.5 × 109/L. A panel of clinicians independently assessed each case. Agreement was reached on which cases clozapine was the likely or definite cause of the severe neutropenia, the risk to life and whether or not rechallenge with clozapine could be attempted.

There were 96 cases where two consecutive neutrophil counts below 1.5 × 109/L were registered. The panel judged that 9 (9.4%) were definitely caused by clozapine and a further 11 (11.5%) were probably caused by clozapine. Overall, 18 (18.8%) patients should be precluded from ever receiving clozapine again according to the panel (all from the 20 cases where clozapine was the definite or probable cause). Of the remaining 76 cases of severe neutropenia the cause could not be determined in 60 cases, but in 11 cases the cause was benign ethnic neutropenia, in 2 others the cause was cancer chemotherapy, in 2 it was infections and in 1 it was laboratory error. In almost 80% of cases, clozapine was not the clear cause of the neutropenia observed.

The large majority of severe neutropenia episodes mandating cessation of clozapine may not be caused by clozapine. Threshold-based monitoring systems cause unnecessary stopping of clozapine because they lack the necessary specificity for clozapine-related blood disorders.

Pulmonary embolism is said to be more common in clozapine-treated patients than either in patients treated with other antipsychotics or in the general population.

To explore clinical features and outcomes of clozapine-related pulmonary embolism in the UK.

We studied UK Yellow Card reports recorded as clozapine-related respiratory, thoracic and mediastinal disorders, 1990–2022.

Of 474 unique reports of people with clozapine-associated pulmonary embolism, 339 (59% male) remained after applying strict exclusion criteria. Of these, 164 patients (48%) died. The mean clozapine dose was 336.7 (range 25–1000) mg d−1 (N = 126). There was no difference in dose between the fatal and non-fatal outcomes. The median age at onset of pulmonary embolism was 45 years (range 21–82 years; N = 309). The median duration of clozapine treatment until onset was 2.9 years (range 2 days–22.7 years; N = 306). Sixty-five (39%) non-fatal and 36 (22%) fatal emboli occurred within 1 year of treatment. People who died were more likely to be obese (adjusted odds ratio 2.61; 95% CI 1.44–4.91) and to be noted as sedentary (adjusted odds ratio 6.07; 95% CI 1.58, 39.9). The 3 year moving average of cases was 0–5 per year, 1990–1999, 26 in 2010 and 16 in 2022. There was no change in the proportion of deaths by year of report (p = 0.41).

Clozapine-related pulmonary embolism is a significant concern with a high fatality rate. This risk necessitates a proactive approach to not only prevention, but also early recognition and management.

The Resilience Hub was established to support people in need of psychological/psychosocial support following the 2017 Manchester Arena terrorist attack.

To use mental health screening measures over 3 years following the Arena event to examine the variation in symptoms reported by adults registered with the Hub, and whether this was associated with treatment access characteristics.

Adults engaging with Hub services were separated into eight cohorts depending on when they registered post-incident. Participants completed screening measures for symptoms of trauma, depression, generalised anxiety and work/social functioning. Baseline and follow-up scores over 3 years were compared among the eight admission groups. All types of appointment were recorded in terms of the number of minutes of clinical ‘contact time’ involved, to explore associations with time taken to register.

Overall, baseline screening scores increased as time to register post-event increased. Over the 3 years of follow-up, a decrease in scores was observed for all 4 screening measures, indicating improvement in mental well-being. Those taking longer to register had higher follow-up scores. However, they showed a slightly stronger decrease in average change of score per follow-up month. Mean contact time per month was greater (apart from the 18-months admission group) in individuals delaying registration. Increased contact time was associated with decreased follow-up screening scores for depression and anxiety.

People who registered earlier were less symptomatic, suggesting there may be a potential beneficial impact of early engagement with support services following traumatic events. All who registered showed improvement in symptoms, including those delaying registration, with increased contact time being beneficial. This reinforces the benefits of encouraging early and sustained engagement with services as soon as possible post-incident.

Children in care who experience frequent placement changes face an increased risk of negative mental health outcomes. Emerging evidence suggests a bidirectional relationship, where placement instability can both predict and result from mental health difficulties. Understanding the strength and direction of this relationship is crucial for informing policy and practice, yet UK-based evidence remains unconsolidated.

To conduct the first systematic review and meta-analysis examining the relationship between placement instability and mental health in the UK care system.

This review was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024493617). We searched five databases (up to August 2024) for peer-reviewed UK studies that included a care-experienced sample, measured placement (in)stability, measured mental health, and quantitatively examined the relationship between placement instability and mental health. A random-effects meta-analysis was conducted, and study quality was assessed using the Newcastle–Ottawa Scale.

Fifteen studies (N = 6905) were included, with twelve studies (n = 5536) contributing to the meta-analysis. Children with unstable placements were more than twice as likely to experience mental health difficulties compared to those with stable placements (odds ratio 2.07, 95% CI 1.65–2.59). However, evidence on the causal direction of this relationship was limited.

Placement instability doubles the risk of mental health difficulties for care-experienced children, who already face elevated rates of mental disorders. Further research is urgently needed to clarify the bidirectional nature of this relationship and guide targeted intervention. Meanwhile, policymakers should prioritise collaborations between mental health services and local authorities to prevent the cycle of instability and mental health deterioration.