The mental healthcare workforce supporting people with dementia and comorbid mental disorders requires specific skills and knowledge.

We co-designed and conducted a survey to understand key issues facing community mental healthcare services accessed by older adults.

We invited all English National Health Service (NHS) older people’s community mental health teams (OPCMHTs) in England to complete the survey. We compared service structures, resourcing and waiting times between regions, and considered how responses might inform current policy priorities.

A total of 182 out of 242 (75.2%) English NHS OPCMHTs participated. We estimated there were 120 233 referrals to OPCMHT services per year, with 77.5% of services reporting increasing referral rates. In a quarter of services (n = 46, 25.3%), clients waited over a month from referral to initial assessment. Most services (107/181, 59.1%) experienced difficulties accessing in-patient beds for people with dementia, with rural regions more likely to report these difficulties. Half of the services (n = 100, 55.2%) reported providing higher-quality care for people with dementia than 5 years ago, despite increasing caseload complexity. Resource limitations challenged opportunities for prevention, care quality and collaborative working, and respondents rated team relationships with social services (n = 86, 47.8%), general hospital in-patient (n = 74, 41.4%) and out-patient (n = 54, 30.2%) services, and primary care (n = 54, 30.2%) as poor or requiring improvement.

OPCMHT service leads are committed to integrated working, but services are insufficiently resourced to realise their potential. Addressing challenges related to workforce retention, training and ways of working could optimise OPCMHT contributions to integrated care for people with dementia.

Although the short-term preventive effects of mHealth consultation intervention on postpartum depressive symptoms have been demonstrated, the long-term effects and role of alleviating loneliness on depressive symptoms remain unclear.

This follow-up study extended our previous trial, which ended at three months postpartum, by continuing observation to 12 months. Participants in the original trial were randomized to the mHealth group (n = 365) or the usual care group (n = 369). Women in the mHealth group had access to free, unlimited mHealth consultation services with healthcare professionals from enrollment through four months postpartum. The primary outcome of this study was the risk of elevated postpartum depressive symptoms at 12 months post-delivery (Edinburgh Postnatal Depression Scale score of ≥9). The mediation effect of alleviating loneliness on the primary outcome was also evaluated, using the UCLA loneliness scale at three months postpartum.

A total of 515 women completed the follow-up questionnaires (mHealth group, 253/365; usual care group, 262/369; 70.2% of the original participants). Compared to the usual care group, the mHealth group had a lower risk of elevated postpartum depressive symptoms at 12 months post-delivery (36/253 [14.2%] vs. 55/262 [21.0%], risk ratio: 0.68 [95% confidence interval: 0.46–0.99]). Mediation analysis showed that reducing loneliness at three months post-delivery mediated approximately 20% of the total effect of the intervention on depressive symptoms 12 months post-delivery.

mHealth consultation services provided during the early perinatal period may help alleviate depressive symptoms at 12 months postpartum.

Existing research demonstrates that insomnia is common, with significant negative impacts on health and quality of life. Cognitive–behavioural therapy for insomnia (CBT-I), the first-line treatment, is highly cost-effective. However, healthcare records have not been used in the UK to establish real-world insomnia prevalence, inequalities or unmet need.

This study’s aim was to establish the above in North Central London.

Data were extracted from primary care records across three London boroughs for 765 035 patients. Prevalence was determined by identifying those with a recent code for insomnia, insomnia treatment or sleeping tablet prescription.

Insomnia prevalence was 4.3%. Prevalence increased steadily with age, and was highest for women (4.9%), those of Bangladeshi ethnicity (7.3%) and those in the most deprived quintile (5.2%). Prevalence was significantly higher in patients with comorbidities (including chronic obstructive pulmonary disease (17.5%), severe mental illness (16.6%) and depression (14.1%)). Only 1.7% of people with insomnia had been referred for CBT-I.

Findings suggested that insomnia is at least as common as illnesses receiving high levels of focus and resourcing in the UK, and that prevalence estimates were probably underestimates. Variation in prevalence by demographic factors and deprivation may represent health inequalities. Insomnia was particularly common among patients with certain comorbidities and of advancing age, indicating that those groups should be actively screened. Concerningly, referral rates for CBT-I were extremely low. This has important implications regarding population health management, commissioning and training. Prevalence and unmet need are likely to be high in many other areas and should be investigated locally.

In the ultra-high risk for psychosis (UHR) field, it is unknown whether understanding symptom relationships, beyond symptom severity alone, may hold prognostic value and inform preventive care. In this study, network analysis was performed to examine the interconnections between baseline symptoms in UHR youth who did and did not transition to psychosis over three years.

In a sample selected from the UHR1000+ cohort, positive and basic symptoms were assessed using the Comprehensive Assessment of At-Risk Mental States. Network analyses and network comparison tests were performed.

195 UHR youth transitioned to psychosis within three years and 346 did not. The two groups did not differ in the network structure, global strength (i.e., the overall level of connectivity between symptoms), or centrality of symptoms (i.e., their importance within networks). The transitioned group was characterized by unusual thought content not being connected to other symptoms; however, its centrality between networks was comparable. Across networks, impaired cognitive functioning connected disorganized speech to impaired emotional functioning, motor functioning, and tolerance to normal stress. Impaired bodily sensation connected perceptual abnormalities to other symptoms.

The networks of youth who transitioned and who did not transition were similar, indicating similar baseline symptom relationships. Across groups, unusual thought content, despite being traditionally associated with transition, had little to no interactions with other symptoms. Clinical manifestations that may need attention include impaired cognitive functioning, which connected several symptoms, and impaired bodily sensation. Future research using time series data may support progress toward individualized care.

Depression severity is a well-established risk factor for suicidal ideation, but the extent to which sociodemographic and employment-related factors contribute independently remains unclear.

Complete data from doctors (N = 4055) presenting to National Health Service Practitioner Health (NHS-PH) in 2022–2023 were used to test the hypothesis that depression severity is the largest determinant of suicide ideation risk (defined by Patient Health Questionnaire 9 (PHQ-9) question 9 score) among doctors.

Using PHQ-8 score (PHQ-9, excluding the item on suicide ideation) as a proxy for depression severity, the case–control discriminatory capacity of receiver operating characteristic curves (AUCs) were evaluated for (a) a univariable model studying modified PHQ-9 alone as the predictor of severe suicide ideation; and (b) a multivariable model integrating modified PHQ-9 and multiple sociodemographic and employment factors as the predictor of severe suicide ideation. Models were compared both descriptively and through a likelihood ratio test.

The univariable model using depression severity alone as the predictor of severe suicide ideation yielded an AUC of 0.921. The addition of sociodemographic and employment factors improved the fit significantly (likelihood ratio test with (χ2(14) = 50.26, P < 0.001), amended AUC 0.930). Having both a disability and a relationship status of ‘no partner’ was significantly independently associated with suicide ideation in the multivariable model.

In this national cohort of doctors, depression severity was strongly associated with suicidal ideation. However, disability and lack of a partner were also independently linked to increased risk, suggesting that suicidal ideation is not solely driven by symptom severity. Social and functional factors may help identify higher-risk individuals and inform targeted support.

Promoting mental health, preventing mental disorders and providing effective treatments are public health priorities. Randomized controlled trials (RCTs) frequently evaluate mental health and psychosocial support interventions to achieve one or more of these objectives. Distinguishing between RCTs focused on mental health promotion, prevention or treatment remains conceptually and methodologically challenging. No standardized tool exists to position RCTs along a promotion-to-treatment continuum in mental health. We aimed to develop and validate the VErona-LUgano Tool (VELUT) for distinguishing RCTs along the promotion-to-treatment continuum.

An interdisciplinary tool development group (TDG) was established. The Population, Intervention, Comparison and Outcome framework was used to define key constructs. Items in the tool were devised, categorized and reduced through qualitative and quantitative methods. Finally, we performed a preliminary validation of the VELUT applying item response theory (IRT) using data from 180 RCTs.

The TDG generated 33 items for the initial version of the VELUT, reduced to 16 through review, cognitive interviews and psychometric analysis. Analyses of 180 RCTs using the 16-item tool showed high internal consistency (α = 0.94) and unidimensionality. Following item reduction and IRT, a final 8-item version was retained, and IRT models confirmed strong item discrimination for the 8 items and high scale reliability (marginal reliability >0.90 across most of the range of the scale), good response distribution, item performance and alignment with the Institute of Medicine (IOM) promotion-to-treatment continuum.

The VELUT addresses methodological gaps in global mental health research by helping to position RCTs of MHPSS interventions along the IOM promotion-to-treatment continuum.