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.

In England, 354 000 people were homeless on a given night in 2024. It has long been recognised that the physical and mental health of people who are homeless is poorer than for those who are stably housed. There are few peer-reviewed studies to inform health- and social care around depression or anxiety for people who are homeless in this setting.

To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe the distribution of symptoms across sociodemographic, health-related characteristics and indicators of social vulnerability.

We surveyed 311 adults between August and December 2021. We measured anxiety and depression symptoms using the four-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of sociodemographic, social vulnerability and health-related characteristics, and tested for associations with the Kruskal–Wallis test.

The median PHQ-4 score was 7 out of 12, with 38% having scores warranting clinical attention. While PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and marijuana use. The most common barrier to accessing healthcare related to transportation (60%).

People who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support further coordination between health- and social care sectors.

Social connections might be protective against depressive and anxious symptoms and dementia in later life. The extent to which social connections are heritable versus modifiable in older age remains unknown.

We aimed to investigate the heritability of social connections and their influence on mental and cognitive health over time among older adults in a longitudinal cohort.

We analysed data from the Older Australian Twins Study (333 monozygotic, 266 dizygotic twins; 65+ years) at three time-points over 6 years. We examined the factor structure and heritability of baseline social connections and their associations with mental and cognitive health longitudinally.

We found three weakly heritable social connections factors: (a) interacting with friends/neighbours/community (h2 = 0.09, 95% CI: 0.00, 0.44); (b) family interactions/childcare (h2 = 0.13, 95% CI: 0.00, 0.43); (c) involvement in religious groups/caregiving (h2 = 0.00, 95% CI: 0.00, 0.19). Strong genetic correlations were observed between depressive symptoms and factors a (r = −0.96) and b (r = −0.60). More frequent baseline interactions with friends/neighbours/community were associated with fewer depressive symptoms cross-sectionally (B = −0.14, p = .004) and longitudinally (B = −0.09, p = 0.006), but the associations between social connections and cognitive health were not significant.

Social connections were weakly heritable, suggesting large environmental determination. Connections with friends/neighbours/community were associated with better mental health cross-sectionally and over time.

The Maudsley 3-item visual analogue scale (M3VAS) was developed as a novel and intuitive patient-reported measure for depression, focusing on core symptoms and suicidality.

To evaluate the longitudinal validity of M3VAS for capturing symptom change over time.

Both M3VAS and the Patient Health Questionnaire (PHQ-9, as reference standard) were administered in an observational study (RHAPSODY, no. NCT04939818) at weeks 0, 2 and 4 to both depressed patients (n = 50) and matched controls (n = 24). We serially tested factor structure, internal consistency and convergence (correlation) over time, assessing responsiveness by both correlation of change in score and effect of time across scales (analysis of variance and effect size).

M3VAS exhibited strong factor loadings and high item interrelatedness (Cronbach’s alpha 0.78–0.83) at all time points. Total scores correlated strongly with PHQ-9 at each time point (r > 0.8, P < 0.001). Correlation of score change over the study period (r = 0.65, P < 0.001) also confirmed responsiveness. In the depressed group, an effect of time on score was seen for both M3VAS (F = 4.942, P = 0.010) and PHQ-9 (F = 12.505, P < 0.001), with standard response mean (Cohen’s d) of 0.58 and 0.74, respectively. No effect of time was seen in the control group.

Following previous cross-sectional validation against the Quick Inventory of Depressive Symptomatology–Self-report, this present study demonstrated appropriate longitudinal measurement properties for M3VAS as a measure of depression, including responsiveness. Evaluating the ability of M3VAS to discern responses with a variety of treatments is a key future goal.

Children displaced by armed conflict are at high risk of experiencing psychological distress. The ongoing war in Gaza has resulted in widespread trauma among Palestinian youth, yet limited data exist on their mental health following displacement. This study assessed the prevalence and correlates of anxiety and depressive symptoms among war-displaced Palestinian refugee children and adolescents resettled in Qatar.

To estimate the prevalence of clinically significant anxiety and depressive symptoms and to identify psychosocial and trauma-related factors associated with symptom severity in this population.

A cross-sectional study was conducted among 350 Palestinian children (aged 8–17 years) residing in a residential compound in Qatar. Symptoms of anxiety and depression were measured using the Screen for Child Anxiety Related Emotional Disorders-Child Version and the Short Mood and Feelings Questionnaire-Child Version, respectively. A Resilience and Demographic Questionnaire was devised to assess trauma exposure and psychosocial variables. Multiple linear regression identified factors associated with symptom severity.

Clinically significant anxiety and depressive symptoms were found in 70.9 and 46.0% of participants, respectively. Separation anxiety was the most common subtype. Female gender, witnessing death, physical injury and disrupted caregiving were significantly associated with worse outcomes.

This study highlights the urgent need for trauma-informed, culturally sensitive mental health services for displaced Palestinian children and young people. While clinical interventions are vital, a sustainable resolution to the conflict is essential to mitigate further psychological harm.

Non-suicidal self-injury (NSSI) displays an alarmingly high prevalence rate among university students, placing them at high risk for adverse long-term outcomes, including suicide.

This study aimed to achieve a better understanding of factors contributing to NSSI in university student populations by examining reasons for NSSI and histories of stressful events and coping strategies.

A total of 185 university students with a lifetime history of NSSI were assessed for depressive symptoms and NSSI characteristics. They completed three questionnaires on NSSI reasons, stressful events and coping strategies during childhood and adolescence. Each questionnaire included an ‘others’ option combined with an open-ended response box. After descriptive analysis of the closed questions, these open-ended responses were qualitatively categorised and analysed as predictors of depression severity and NSSI continuation from adolescence into adulthood.

Qualitative analysis identified eight, five and ten categories from the open-ended responses for NSSI reasons, stressful events and coping strategies, respectively, with substantial to almost perfect interrater reliability. Two qualitative reason categories, one stressful event category and two coping strategy categories significantly predicted depression severity (β = 0.21–0.23). Participants reporting events in the stressful events category ‘Traumatisation and experiences of violence’ were three times more likely to continue NSSI into adulthood (f 2 = 0.07).

This study demonstrates the value of mixed-methods approaches. Stable qualitative categories highlight the need to capture individual variations in NSSI-related factors. It emphasises trauma-related stressors due to their influence on depression severity and persistence of NSSI into adulthood.

Various key events characterise experiences in later life, such as retirement, bereavement, caregiving, developing long-term conditions and hospital admission. Given their potential to disrupt lives, such events may affect older people’s mental health, but research on the associations between such events and depression has produced inconsistent findings.

To investigate the impact of key events in later life on depression trajectories in a representative cohort of people aged 50–69 in England.

Our sample draws on 6890 respondents aged 50–69 in Wave 1 (2002/2003) of the English Longitudinal Study of Ageing, following them through to Wave 9 (2018/2019). We measured depression using the eight-item Center for Epidemiological Studies Depression scale. Later life events included retirement, spouse/partner death, becoming an unpaid caregiver, developing a limiting long-term illness and hospital admissions because of a fall or non-fall causes. Piecewise mixed-effects logistic regression models tested for changes in the trajectories of depression before and after each event.

Statistically significant improvements in the trajectory of depression were observed following spousal bereavement, one’s own retirement and hospital admission because of causes other than falls, with reductions in the odds of depression of 48% (odds ratio: 0.52 (95% CI: 0.44–0.61)), 15% (0.85 (0.78–0.92)) and 4% (0.96 (0.94–0.99)), respectively. No changes were associated with developing a limiting long-term illness, becoming an unpaid caregiver or following spousal retirement or a hospital admission because of a fall.

The findings highlight the relative resilience among older adults in England in terms of depression following key later life events. There is still a role to play in delivering mental health support for older people following such events, particularly by improving the identification of those at risk of certain events as part of a broader strategy of prevention. Findings also underscore the importance of partner/spousal circumstances on individual mental health.

Depression is the most common psychiatric disorder among patients with end-stage renal disease (ESRD), yet the risk factors for mortality in this population remain unclear.

To identify risk factors for mortality in ESRD patients with depression and assess the incidence of suicide attempts.

We used Taiwan’s National Health Insurance Research Database to identify adult patients who initiated maintenance dialysis between 1997 and 2012. Two ESRD cohorts were established at a depression-to-non-depression ratio of 1:8, matched by age and gender (n = 3289 with depression; n = 26 312 without depression). Outcomes included all-cause mortality and suicide attempts, with additional subgroup analyses by baseline depression severity.

ESRD patients with depression had a higher mortality risk (hazard ratio 1.15, 95% CI: 1.10–1.21) than those without. Risk factors for mortality included male gender, older age, diabetes and cardiovascular disease. Patients with depression also had a higher risk of suicide attempts (hazard ratio 3.02, 95% CI: 1.68–5.42). ESRD patients with severe depression had a significantly higher rate of hospital admissions for depression compared to those with non-severe depression (incidence rate ratio (IRR): 1.82, 95% CI: 1.14–2.93). Furthermore, patients with severe depression were associated with a significantly higher mortality rate compared to those without depression (IRR: 1.42, 95% CI: 1.15–1.76).

Depression is linked to poor survival in ESRD patients, with underlying comorbidities playing a key role in mortality. Given the increased risk of mortality, suicide attempts and hospital admissions, these high-risk patients require enhanced medical attention, particularly those with severe depression.

Psychotic symptoms in depression are linked to worse outcomes, and treatment options are limited. Ketamine and esketamine are effective antidepressants, yet most studies have excluded patients with a history of psychotic symptoms.

To evaluate by systematic review the efficacy and safety of ketamine and esketamine in treating patients with unipolar or bipolar depressive episodes with psychotic features.

A comprehensive search of the PubMed, Ovid and Web of Science databases was conducted up to 2 November 2023. We included any study that reported the use of ketamine or esketamine in patients with depressive episodes with psychotic symptoms. The primary outcomes assessed were variations in depressive and psychotic symptoms and the incidence of adverse events. The protocol was preregistered in PROSPERO (CRD42023488524).

Ten studies were included, encompassing 60 patients with unipolar depression with psychotic symptoms and 19 patients with bipolar depression with psychotic symptoms. Treatment with (es)ketamine showed mean score changes on the Montgomery–Åsberg Depression Rating Scale ranging from −13.7 to −18.2 points in open-label studies of patients with unipolar depression with psychotic symptoms. Up to 50% of participants achieved remission. The largest study with patients with bipolar depression with psychotic symptoms reported a mean Montgomery–Åsberg Depression Rating Scale score change of −14.9 points. Adverse events were mostly mild and transient. There were no reports of switches to (hypo)mania or deterioration of psychotic symptoms, and in six studies there was substantial improvement of the latter.

The available evidence suggests that (es)ketamine shows antidepressant effects in patients with depressive episodes with psychotic features and has a reasonable safety profile. However, the heterogeneity of the studies included in this review and the high risk of bias warrant caution in interpreting the findings and underscore the need for further trials to confirm these preliminary results.

Accommodation of treatment preferences is known to improve treatment outcomes and increase patient satisfaction, and is further advised in several national guidelines.

The aim of this study was to systematically review studies that elicited treatment preferences and related determinants among adults with depressive or anxiety disorder for out-patient mental healthcare.

The systematic review was registered in PROSPERO (CRD42024546311). Studies were retrieved from Web of Science, PubMed, CINAHL and PsycINFO. We included studies of all types that assessed treatment preferences of adults with depressive or anxiety disorder for out-patient care. Extracted data on preferences and determinants were summarised and categorised. Preferences were categorised into treatment approaches, psychotherapy delivery and setting, and psychotherapy parameters. Study quality was assessed with the Mixed-Methods Appraisal Tool.

Nineteen studies were included in the review. Preferences examined related to treatment approaches (n = 13), psychotherapy delivery and setting (n = 10), and psychotherapy parameters (n = 7). High heterogeneity in statistical methods and preference types restricted the derivation of robust conclusions, but tendencies toward a preference for psychotherapy (compared with medication), and particularly individual and face-to-face therapy, were observed. Regarding determinants, results were highly diverse and many findings were derived from single studies.

Our review synthesised evidence on treatment preferences and related determinants in out-patient mental healthcare. Results showed considerable heterogeneity regarding preference types, determinants and statistical methods. We highly recommend to develop and use standardised instruments to assess treatment preferences. Care providers should consider preference variance among patients, and provide individualised care.

Peer-supported Open Dialogue (POD) integrates peer practitioners within mental health teams, fostering a collaborative, person-centred and social network approach to care. Although peer practitioners are increasingly involved in Open Dialogue, the role of peer practitioners within such teams remains underexplored.

This study aimed to explore (a) the experiences of peer practitioners working within Open Dialogue teams in the Open Dialogue: Development and Evaluation of a Social Intervention for Severe Mental Illness trial, and (b) the perspectives of non-peer Open Dialogue practitioners regarding peer involvement. Our further objectives were to understand the nature, degree and perceived impact of peer practitioner involvement in Open Dialogue.

A qualitative study was conducted using semi-structured interviews and joint interviews with peer practitioners (n = 9). Additionally, excerpts from 11 interviews and 4 focus groups (n = 18), in which non-peer practitioners discussed peer practitioners’ contributions in Open Dialogue, were analysed. Thematic analysis was employed to identify key themes.

Three themes were developed. The first focuses on the perceived influence of peer practitioners on Open Dialogue network meetings; the second explores the opportunities and challenges of working as a peer practitioner in Open Dialogue, while the third details the perceived impact of peer practitioners on team and organisational culture.

Open Dialogue’s emphasis on a flattened hierarchy facilitates the integration of peer practitioners, enabling them to contribute meaningfully to network meetings and team culture. Despite the overall positive experiences, peers still faced common challenges faced by those in other services, such as low pay and occasional instances of a compromised, flattened hierarchy.

Providing psychotherapy at 50 sessions in a year (starting twice weekly) led to faster and greater improvements in depression and personality functioning compared to 25 sessions, starting weekly for patients with depression and personality disorder (PD). This study reports long-term dosage effects at 18 and 24 months.

In a pragmatic, double-randomized clinical trial, 246 outpatients with depression and PD were assigned to (1) 25 or 50 sessions and (2) Short-term Psychodynamic Supportive Psychotherapy (SPSP) or Schema Therapy (ST). Depression severity was assessed with the Beck Depression Inventory-II. Secondary outcomes included diagnostic remission of depression (MINI-plus), PD (SCID-II/SCID-5-P), and treatment-specific measures. Intention-to-treat analyses were conducted.

At 18 and 24 months, BDI-II means did not differ between dosage groups (19.0 for 25 sessions versus 19.1 for 50 sessions; d = −0.01; 95% CI = −0.35-0.37, p = 0.96). The lower-dosage group improved during follow-up (−2.6 BDI points, p = 0.031), which may be partly attributed to additional therapy received by a subgroup. Remission rates at 24 months were 66% for depression and 76% for PD, with no differences between conditions.

Higher psychotherapy dosage led to faster initial improvements, but long-term outcomes were not superior to those achieved with a lower dosage. These results should be interpreted with caution, as unregulated treatment during follow-up reduced the power to detect significant dosage effects. Both SPSP and ST provide viable alternatives to treatments focused solely on depression.