Terrorist incidents lead to a range of mental health outcomes for people affected, sometimes extending years after the event. Secondary stressors can exacerbate them, and social support can provide mitigation and aid recovery. There is a need to better understand distress and mitigating factors among survivors of the Manchester Arena attack in 2017.

We explored three questions. First, what experiences of distress did participants report? Second, how might secondary stressors have influenced participants’ psychosocial recoveries? Third, what part has social support played in the relationships between distress and participants’ recovery trajectories?

We conducted a cross-sectional online survey of a convenience sample of survivors of the Manchester Arena bombing (N = 84) in January 2021 (3 years 8 months post-incident), and a longitudinal study of the same participants’ scores on mental health measures over 3 years from September 2017.

Survivors’ mental well-being scores in early 2021 were significantly lower than general population norms. Longitudinal follow-up provided evidence of enduring distress. Secondary stressors, specifically disruptions to close relationships, were associated with greater post-event distress and slower recovery. We found an indirect relationship between identifying with, and receiving support from, others present at the event and mental well-being >3 years later.

The Arena attack has had an enduring impact on mental health, even in survivors who had a mild response to the event. The quality of close relationships is pivotal to long-term outcome. Constructive support from family and friends, and people with shared experiences, are key to social cure processes that facilitate coping and recovery.

Doctors have a higher prevalence of mental ill health compared with other professional occupations but incidence rates are poorly studied.

To determine incidence rates and trends of work-related ill health (WRIH) and work-related mental ill health (WRMIH) in doctors compared with other professions in Great Britain.

Incidence rates were calculated using an occupational physician reporting scheme from 2005–2010. Multilevel regression was use to study incidence rates from 2001 to 2014.

Annual incidence rates for WRIH and WRIMH in doctors were 515 and 431 per 100000 people employed, respectively. Higher incidence rates for WRIH and WRMIH were observed for ambulance staff and nurses, respectively. Doctors demonstrated an annual average incidence rates increase for WRIH and WRMIH, especially in women, whereas the other occupations demonstrated a decreasing or static trend. The difference in trends between the occupations was statistically significant.

WRIH and WRMIH incidence rate are increasing in doctors, especially in women, warranting further research.

Judging whether we can trust other people is central to social interaction, despite being error-prone. A fear of others can be instilled by the contemporary political and social climate. Unfounded mistrust is called paranoia, and in severe forms is a central symptom of schizophrenia.

To demonstrate that individuals without severe mental illness in the general population experience unfounded paranoid thoughts, and to determine factors predictive of paranoia using the first laboratory method of capturing the experience.

Two hundred members of the general public were comprehensively assessed, and then entered a virtual reality train ride populated by neutral characters. Ordinal logistic regressions (controlling for age, gender, ethnicity, education, intellectual functioning, socio-economic status, train use, playing of computer games) were used to determine predictors of paranoia.

The majority agreed that the characters were neutral, or even thought they were friendly. However, a substantial minority reported paranoid concerns. Paranoia was strongly predicted by anxiety, worry, perceptual anomalies and cognitive inflexibility.

This is the most unambiguous demonstration of paranoid ideation in the general public so far. Paranoia can be understood in terms of cognitive factors. The use of virtual reality should lead to rapid advances in the understanding of paranoia.