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.

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.

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.

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.

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.

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.

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.

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.

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.

Suicidal ideation following trauma exposure is frequently associated with depressive and post-traumatic stress disorder (PTSD) symptoms; however, the interactive effects of depression and distinct PTSD symptom clusters on suicidal ideation remain poorly understood.

To examine whether specific PTSD symptom clusters – namely intrusion, avoidance and hyperarousal – moderate the association between depressive symptoms and suicidal ideation, and whether these effects vary across different trauma types.

Medical records of 127 psychiatric out-patients with a history of at least one traumatic event were analysed. All participants had completed the Hamilton Rating Scale for Depression, the Impact of Event Scale-Revised, and the suicidal ideation item of the Beck Depression Inventory II. Trauma types were categorised into early versus late, single versus multiple, and interpersonal versus non-interpersonal.

Hierarchical regression analyses identified a significant moderating effect of avoidance symptoms on the relationship between depression and suicidal ideation (β = 0.19, P = 0.012), whereas intrusion and hyperarousal symptoms did not show such effects. Specifically, higher levels of avoidance were associated with a stronger positive relationship between depression and suicidal ideation. This moderating effect was observed only among individuals with late (β = 0.28, P = 0.002), single (β = 0.29, P = 0.002) or non-interpersonal trauma (β = 0.34, P = 0.018); it was not evident among those with early, multiple or interpersonal trauma.

These findings underscore the relevance of targeting avoidance symptoms to mitigate suicidal ideation, particularly in individuals with late-onset, single-incident or non-interpersonal trauma exposure. Exposure-based therapeutic interventions may offer particular benefit for reducing suicidal ideation among trauma-exposed individuals with depressive symptoms.

The COVID-19 pandemic caused by the SARS-CoV-2 virus was the biggest global health emergency in the past century. The impact of the pandemic on society, and demand for health services, especially mental health services is not fully understood.

We describe the change in activity in a single UK NHS mental health trust during and following the pandemic.

We conducted a retrospective service evaluation using a population-based referral rates and clinical activity for mental health disorders in Cambridgeshire over the period 1 January 2017 to 31 December 2023. We divided the time period into pre-pandemic period, during the pandemic, and post-pandemic months. A negative binomial regression model was fitted to the monthly rates to yield incidence rate ratios. Subgroup analyses were performed by age, gender, ethnicity, and level of deprivation.

There was a steep decline in both referrals and clinical contacts during the lockdowns with a subsequent and steep increase in these measures during the immediate post-pandemic period. Increased numbers of referrals and contacts have been sustained well into the post-pandemic period.

In a single county-wide mental health service in the UK, the prolonged and sustained increase in both referrals and activity post-pandemic was not matched by equal increase in resource to meet demand. Our findings may be useful to effectively plan mental health services before, during and after any future pandemics.