Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met.

To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden.

We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness).

Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16, 95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD =–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD =–1.57, 95% CI −1.79 to −1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive.

Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.

Little is known about the relative extent of crime against people with severe mental illness (SMI).

To assess the prevalence and impact of crime among people with SMI compared with the general population.

A total of 361 psychiatric patients were interviewed using the national crime survey questionnaire, and findings compared with those from 3138 general population controls participating in the contemporaneous national crime survey.

Past-year crime was experienced by 40% of patients v. 14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0–3.8); and violent assaults by 19% of patients v. 3% of controls (adjusted OR = 5.3, 95% CI 3.1–8.8). Women with SMI had four-, ten- and four-fold increases in the odds of experiencing domestic, community and sexual violence, respectively. Victims with SMI were more likely to report psychosocial morbidity following violence than victims from the general population.

People with SMI are at greatly increased risk of crime and associated morbidity. Violence prevention policies should be particularly focused on people with SMI.

Little is known about gender differences in the long-term outcomes of people with schizophrenia living in the community.

To explore gender differences in the 14-year outcome of people with schizophrenia in rural China.

A 14-year follow-up study among a 1994 cohort (n = 510) of participants with schizophrenia was conducted in Xinjin County, Chengdu, China. All participants and their informants were followed up in 2004 and 2008 using the Patients Follow-up Schedule.

Compared with female participants, male participants were significantly younger, had significantly higher rates of mortality, suicide and homelessness, and poorer family and social support. There was no significant gender difference in Positive and Negative Syndrome Scale scores, previous suicide attempts, those never treated, previous hospital admission or inability to work. Longer duration of illness was associated with functional decline and comparatively poorer family economic status.

The long-term outcomes of men with schizophrenia is worse than those of women with the disorder in rural China. Higher mortality, suicide and homelessness rates in men may contribute partly to the higher prevalence of schizophrenia in women in China. Policies on social and family support and gender-specific intervention strategies for improving long-term outcomes should be developed for people with this disorder.

Evidence on mortality in severe mental illness (SMI) comes primarily from clinical samples in high-income countries.

To describe mortality in people with SMI among a population cohort from a low-income country.

We followed-up 919 adults (from 68 378 screened) with SMI over 10 years. Standardised mortality ratios (SMR) and years of life lost (YLL) as a result of premature mortality were calculated.

In total 121 patients (13.2%) died. The overall SMR was twice that of the general population; higher for men and people with schizophrenia. Patients died about three decades prematurely, mainly from infectious causes (49.6%). Suicide, accidents and homicide were also common causes of death.

Mortality is an important adverse outcome of SMI irrespective of setting. Addressing common natural and unnatural causes of mortality are urgent priorities. Premature death and mortality related to self-harm should be considered in the estimation of the global burden of disease for SMI.

The use of antidepressant drugs in patients with ischaemic heart disease (IHD) has been debated owing to scarcity of data and conflicting results regarding the effect of these drugs on mortality.

To evaluate the association between adherence to antidepressant therapy and all-cause mortality in a population-based cohort of patients with IHD.

A total of 63 437 patients with IHD who purchased antidepressants at least once during the years 2008–2011 were retrospectively followed for all-cause mortality over 4 years. Adherence was measured as a ratio between claimed and prescribed durations of medication and modelled as non-adherence (<20%), poor (20–50%), moderate (50–80%) and good (>80%). We used multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality.

The moderate and good adherence groups had significantly reduced adjusted mortality hazard ratios of 0.83 (95% CI 0.78–0.88) and 0.86 (95% CI 0.82–0.90) respectively, compared with the non-adherence group.

Adherence to antidepressant pharmacotherapy is associated with reduced all-cause mortality in a population-based large sample cohort of patients with IHD. Physicians and health policy decision-makers should step up their efforts to sustain and enhance these patients' adherence to their antidepressant regimen.

Previous evidence has shown positive associations between post-traumatic stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes mellitus, which are all risk factors for stroke, but the role of PTSD in the subsequent development of stroke is still unknown.

To investigate the temporal association between PTSD and the development of stroke.

Identified from the Taiwan National Health Insurance Research Database, 5217 individuals aged 18 years, with PTSD but with no history of stroke, and 20 868 age- and gender-matched controls were enrolled between 2002 and 2009, and followed up until the end of 2011 to identify the development of stroke.

Individuals with PTSD had an increased risk of developing any stroke (hazard ratio (HR) 3.37, 95% CI 2.44–4.67) and ischaemic stroke (HR = 3.47, 95% CI 2.23–5.39) after adjusting for demographic data and medical comorbidities. Sensitivity tests showed consistent findings (any stroke HR = 3.02, 95% CI 2.13–4.28; ischaemic stroke HR = 2.89, 95% CI 1.79–4.66) after excluding the first year of observation.

Individuals with PTSD have an increased risk of developing any stroke and ischaemic stroke. Further studies are required to investigate the underlying mechanisms.

Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure.

To examine lifetime blood pressure as a predictor of brain structure in old age.

A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985–2013). In 2012–2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities.

Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P<0.002). Cross-sectionally, hypertensive participants had increased automated white matter hyperintensities and visually rated deep white matter hyperintensities. There was no significant association with global or hippocampal atrophy.

Long-term exposure to high blood pressure predicts hyperintensities, particularly in deep white matter. The greatest changes are seen in those with severe forms of hypertension, suggesting a dose–response pattern.

Medication-resistant depression (MRD) is associated with poorer attentional performance and immense socioeconomic costs.

We aimed to investigate the central pathophysiology of MRD, previously linked to impaired prefrontal cortex function.

A total of 54 participants (22 with MRD, 16 with non-resistant depression, 16 healthy controls) were recruited. Non-MRD status was confirmed by a prospective 6-week antidepressant trial. All medication-free participants underwent a go/no-go task to study prefrontal cortical function (attention) and positron emission tomography scans to study regional cerebral glucose metabolism (rCMglu) at rest.

The MRD group had worse attentional ratings and decreased rCMglu compared with the non-MRD and control groups. Attentional performance was positively associated with prefrontal cortex rCMglu. The prefrontal cortex differences between MRD and non-MRD groups remained after adjusting for past depressive episodes (F (1,35) = 4.154, P = 0.043).

Pronounced hypofrontality, with the associated attentional deficits, has a key role in the neuropathology of medication-resistant depression.

Homocysteine-lowering nutrients may have preventive/ameliorative roles in depression.

To test whether long-term B-vitamin/folate supplementation reduces depression risk.

Participants were 4331 women (mean age 63.6 years), without prior depression, from the Women's Antioxidant and Folic Acid Cardiovascular Study – a randomised controlled trial of cardiovascular disease prevention among 5442 women. Participants were randomly assigned to receive a combination of folic acid (2.5mg/d), vitamin B6 (50mg/d) and vitamin B12 (1 mg/d) or a matching placebo. Average treatment duration was 7 years. The outcome was incident depression, defined as self-reported physician/clinician-diagnosed depression or clinically significant depressive symptoms.

There were 524 incident cases. There was no difference between activev. placebo groups in depression risk (adjusted relative risk 1.02, 95% CI 0.86–1.21, P = 0.81), despite significant homocysteine level reduction.

Long-term, high-dose, daily supplementation with folic acid and vitaminsB6 and B12 did not reduce overall depression risk in mid-life and older women.

Depression can adversely affect employment status.

To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial.

Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined.

At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ2 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16–27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment(χ2 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75–4.17); however, we observed a site×treatment interaction(χ2 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other.

Cognitive therapy may produce greater improvements in employmentv. medication, particularly over the longer term.