Cognitive behavioural therapy (CBT) is the first-line treatment for anxiety and related disorders. Limited research has explored long-term outcomes following CBT for anxiety-related disorders in naturalistic settings, particularly for generalized anxiety disorder (GAD), social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD).

This study examined long-term outcomes and attrition after group CBT for GAD, SAD, and PTSD in a naturalistic sample. Across disorders, it was hypothesized that gains would be maintained long-term, with a gradual return of clinically relevant symptoms observed at later follow-up points.

Data were collected from individuals completing CBT at a tertiary anxiety treatment clinic. Symptom changes pre- to post-treatment and over a 2-year follow-up were examined, as well as the influence of baseline depressive symptoms on change over time. Worry, social anxiety, and post-traumatic stress symptoms were assessed at pre- and post-treatment and 3, 6, 9, 12, and 24 months.

On average, symptom improvements were maintained over the 2-year follow-up for all disorders. Higher pre-treatment depression was associated with greater symptom severity throughout the study but generally did not affect the magnitude of symptom change. The exception was PTSD, where baseline depression was also associated with changes in symptom severity across the whole study period. This effect was not observed for those with SAD and GAD. Attrition was high across the follow-up period.

This study provides preliminary evidence for the long-term efficacy of CBT in a naturalistic setting. It also highlights challenges with retaining clients in long-term follow-up in naturalistic settings.

Few studies have examined how differing diagnostic criteria for mild cognitive impairment (MCI) relate to neuroimaging markers of cerebrovascular disease and neurodegeneration in Veterans. We compared three MCI diagnostic schemes on their associations with white matter hyperintensity (WMH) burden, hippocampal volume, and cortical thickness in nondemented Vietnam-era Veterans.

228 Veterans (mean age = 69.65) were classified using: (1) Alzheimer’s Disease Neuroimaging Initiative (ADNI) criteria (subjective memory concerns, impaired Logical Memory, global Clinical Dementia Rating = 0.5); (2) neuropsychological criteria (>1 standard deviation [SD] below norms on two tests within a domain or one test across three domains); and (3) typical criteria (subjective memory concerns and >1.5 SD below norms on one test). Regression models predicting WMH burden adjusted for age and intracranial volume and included MCI status and hippocampal volume; ADNI-based models also included posttraumatic stress disorder symptom severity.

Neuropsychological criteria were associated with greater WMH burden (β = 0.45, p = .024), whereas typical and ADNI criteria were not. Sensitivity analyses found that meeting neuropsychological criteria for amnestic MCI interacted with lower hippocampal volume to predict greater WMH burden (β = −0.001, p = .028). No criteria were associated with cortical thickness.

Neuropsychological criteria more sensitively identified Veterans with greater WMH burden and demonstrated a small, hippocampal volume-dependent effect in amnestic MCI. These findings support the clinical utility of multi-test neuropsychological approaches for detecting complex brain changes in high-comorbidity populations, with implications for risk stratification and targeted intervention in aging Veterans.

Difficulties with social cognition, particularly with mentalising, have been hypothesised to increase the risk of, and affect recovery from, trauma and post-traumatic stress disorder (PTSD). We lack a comprehensive picture of the nature of social cognitive impairments in people with PTSD.

To assess whether variation in social cognition is associated with trauma and PTSD.

Ninety-eight participants with PTSD symptoms and 99 controls were recruited from tertiary PTSD services and the Prolific online platform. All participants completed a battery of social cognition tasks covering face emotion recognition, social attribution and mentalisation. They also completed a trauma measure, PTSD screening measure and verbal IQ task. Logistic regression analyses were used to examine the relationship between social cognition and PTSD, and were adjusted for age, gender, autism and verbal IQ.

There was some evidence that hypomentalisation, measured via the Reflective Functioning Questionnaire, was associated with exposure to trauma (adjusted odds ratio 1.80, 95% CI 1.03–3.14, p = 0.040) and increased odds of PTSD symptoms (adjusted odds ratio 4.29, 95% CI 2.76–6.66, p < 0.001). Higher scores for use of mentalising language on a naturalistic video-based spontaneous mentalising task (Modified-STOMP; potentially reflecting hypermentalising) were also associated with increased odds of PTSD symptoms (adjusted odds ratio 1.65, 95% CI 1.17–2.33, p = 0.004) in the main analysis, but not in the sensitivity analysis restricted to the Prolific-only sample.

Our results show an association between mentalising difficulties and PTSD symptoms, indicating mentalising might be a target for future risk prediction.

The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns.

Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership.

The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that being female, younger, single, working as a nurse, or having a pre-existing mental health diagnosis increased the odds of belonging to a high symptom class. Perceived support from colleagues and managers was protective.

While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.

The COVID-19 pandemic has been described as a prolonged societal trauma providing new understanding of long-term post-traumatic stress reactions, both generally and in specific at-risk populations.

The present study examined the longitudinal course of post-traumatic stress disorder (PTSD) symptoms within one of the most high-profile risk groups (i.e. healthcare staff).

The sample comprised 439 healthcare staff who completed the Northern Ireland longitudinal COVID-19 Staff Wellbeing Survey on a minimum of 3 out of 4 distribution time points. The survey was administered repeatedly over 4 years, spanning both peri- and post-pandemic periods (2020–2023), and contained the Impact of Event Scale-Revised, as well as bespoke items on COVID-19, demographics, occupational issues and support factors.

Three distinct classes emerged from a three-class, latent class growth analysis model. A ‘resilient’ group (74%) displayed symptoms that remained below cut-offs for clinically significant moderate–severe post-traumatic stress throughout the pandemic, whereas a ‘recovering’ group (23%) exhibited moderate–severe symptoms during the pandemic, which then decreased to subthreshold levels post-pandemic. A key at-risk group was the ‘chronic’ class (4%), which had moderate–severe post-traumatic stress symptoms peri-pandemic that continued to increase post-pandemic. Significant predictors of the ‘recovering’ and ‘chronic’ classes included perception of poor communication within the healthcare organisation; increased exposure to COVID-19 outside their work; and increased personal health risk factors for COVID-19.

Post-pandemic PTSD monitoring and support for healthcare staff may be warranted alongside the development of internal communication strategies within healthcare systems to protect staff and services going forward.

Significant sex disparities in mental health have been observed amongst resettled refugees, yet how these disparities and their determinants evolve over time remains unclear. This study sought to quantitatively unravel determinants and changes in mental health disparities by sex.

Data were drawn from Waves 1 (2013–2014), 5 (2017–2018) and 6 (2023) of the 10-year Building a New Life in Australia (BNLA) cohort. Post-traumatic stress disorder (PTSD) and high risk of severe mental illness (HR-SMI) were measured using the PTSD-8 and Kessler-6 scales. Fairlie method was used to quantify the disparity (total predicted probability difference by sex) and the contribution proportion of individual determinants (explained difference/total predicted probability difference × 100%).

A total of 2261 refugees were included at Wave 1, with 1833 (81.1%) and 905 (40.0%) followed up at Waves 5 and 6. Female refugees consistently experienced poor mental health, with the total predicted probability difference decreasing from the initial (Wave 1, 8.3%) to middle stage (Wave 5, 4.6%), then increasing in the long term (Wave 6, 6.3%). Determinants of disparities varied across waves, but poor status of physical health was a persistent contributor of disparities in PTSD (contribution proportion: 57.2%, 71.5% and 63.0% at each wave). Family conflict contributed at the initial (HR-SMI: 4.5%) and long-term stages (PTSD: 8.7%), while financial hardships (PTSD: 13.2%; HR-SMI: 23.2%), marital status (HR-SMI: 24.8%) and family concerns (PTSD: 8.0%) were key determinants at the middle stage. Unmet support or help during COVID-19 was a major contributor at Wave 6 (PTSD: 22.7%; HR-SMI: 8.0%).

Sex disparities exist in refugees’ mental health and require sustained attention and tailored strategies. To promote mental health equity, there is a long-term need to provide essential physical healthcare and financial assistance and address family-related stressors. Additionally, it is important to identify and address the specific psychosocial needs of women in times of crisis such as the COVID-19 pandemic.

While clinical research on psychedelics often reports mild and transient side effects, broader survey studies indicate that a subset of users experiences lasting adverse mental health effects. This study investigated whether some of these meet diagnostic criteria for post-traumatic stress disorder (PTSD).

A cross-sectional online survey (N = 243) was conducted with individuals reporting distressing psychedelic experiences with effects persisting beyond the acute phase (convenience sampling). It assessed characteristics of the acute experience, post-traumatic stress, post-traumatic growth, and coping strategies.

A total of 31.3% of participants met the DSM-5 criteria for PTSD as measured by self-report measures. PTSD symptom severity was strongly associated with characteristics of the acute experience. Avoidance-related experiences significantly predicted greater PTSD symptoms, while acceptance-related experiences were linked to lower symptom severity. Post-traumatic growth was unrelated to the intensity of the challenging experience or avoidance but positively predicted by acceptance-related experiences. Post-psychedelic help-seeking behavior was common: most consulted online resources or spoke with friends and family, though psychotherapy was rated the most helpful intervention.

Findings provide the first systematic evidence that difficult psychedelic experiences can be associated with later PTSD symptoms and highlight the critical role of acute psychological processes in shaping long-term outcomes. Since the survey targeted individuals with highly challenging acute experiences, the data do not allow the extrapolation of prevalence estimates to the broader population of psychedelic users. As psychedelic use expands beyond clinical settings, access to trauma-informed care and targeted integration support will be essential to minimize harm and support recovery.

The impact of combat injury on the development of chronic pain and mental health concerns in combat-exposed populations is unknown. This study examined associations of combat injury and injury–related pain with pain-related factors and mental health outcomes, and potential mediation of the relation between combat injury and mental health outcomes by pain-related factors.

Pain interference, pain catastrophizing, pain intensity, post-traumatic stress disorder (PTSD), and major depressive episode (MDE) were assessed in (1) a probability sample of US Army soldiers and veterans cross-sectionally and (2) US Army soldiers before and 1, 3, and 9 months after deployment to Afghanistan. Associations among these variables were modeled using logistic regression and multiple mediation analyses.

Among 5003 service members with cross-sectional data, combat injury–related pain was associated with increased odds of clinically significant pain intensity (OR=2.69), pain interference (OR=3.69), MDE (OR=2.17), and PTSD (OR=3.96) relative to pain from other injuries and conditions. Among 4645 service members assessed pre- and post-deployment, combat injury was associated with increased odds of new-onset pain interference (OR=2.78), pain catastrophizing (OR=2.75), PTSD (OR=4.06), and MDE (OR=2.56) 3 months post-deployment, and PTSD (OR=2.86) and MDE (OR=1.74) 9 months post-deployment. Pain-related factors mediated the relations of combat injury with post-deployment PTSD and MDE.

Combat injury is associated with greater odds of pain interference, pain catastrophizing, PTSD, and MDE compared to other sources of pain in a cohort of US service members. Efforts to address pain-related factors following combat injury may mitigate the risk of subsequent chronic pain and mental health disorders.

Accurate trauma recollections are essential in legal and research contexts; however, studies frequently reveal significant inconsistencies in trauma reporting over time.

To investigate the trauma-reporting patterns among healthcare workers (HCWs) following their exposure to the Beirut port blast.

This longitudinal study examined trauma memory alteration among 296 HCWs at 6 months (wave 3) and 2–2.5 years (wave 4) post-blast. Participants reported trauma exposure prior to the event, and probable post-traumatic stress disorder (PTSD) secondary to the Beirut port blast. Depression and psychological distress were analysed as potential predictors of memory alteration using multinomial models.

The majority of participants (72.4%) exhibited inconsistent trauma reporting, with 36.43% exaggerating and 35.71% diminishing their trauma accounts over time. Developing probable depression and screening positive for PTSD at wave 4 were predictors of memory exaggeration (respectively odds ratio 5.71, 95% CI: 1.19–27.32; odds ratio 8.04, 95% CI: 0.98–65.73), while remitted psychological distress was protective (odds ratio 0.08, 95% CI: 0.01–0.99). No significant predictors were found for memory diminishment.

A substantial portion of HCWs exposed to the Beirut port blast demonstrated inconsistent trauma reporting, with mental health conditions such as depression and PTSD influencing memory exaggeration. These findings underscore the importance of considering memory reliability in trauma research, particularly in populations with mental health disorders and exposed to major disasters.