An increasing number of children and adolescents are prescribed second-generation antipsychotic medications, which may lead to cardiometabolic or other physical health impairments. It is unknown whether lifestyle interventions can prevent or manage these adverse effects.

To evaluate the effectiveness of lifestyle interventions for preventing or managing cardiometabolic risks and other adverse physical health outcomes in this population.

Four bibliographic databases were searched up to February 2024. Randomised controlled trials reporting a physical health outcome of children or adolescents (aged 6–17 years) taking antipsychotics and participating in a lifestyle intervention compared with treatment as usual (TAU) were eligible for inclusion. The Cochrane Risk of Bias 2 tool was used to assess risk of bias. Data were synthesised via a random-effects meta-analysis and narrative synthesis.

Four studies with a total of 370 participants were included. Most (75%) had a high risk of bias. Lifestyle interventions resulted in moderate but statistically non-significant reductions in participants’ body mass index (standard mean difference −0.70, 95% CI: −1.70 to 0.31) compared with TAU. Some studies reported improvements in other physical health outcomes favouring the intervention, although findings were inconsistent and varied across different measures. Reporting of secondary indicators of physical health, including participant or family health behaviours, was limited.

The effectiveness of lifestyle interventions for preventing or managing the cardiometabolic risk and other adverse physical health outcomes in this population is unclear due to the limited number of available trials, small samples and high risk of bias. Larger trials are needed.

Studies have consistently found that up to 20% of people with anorexia nervosa experience a persistent illness, resulting in considerable psychosocial impairment, morbidity and mortality. This has been variously termed severe and enduring anorexia nervosa or longstanding anorexia nervosa (L-AN). Conflicting findings have hindered progress in distinguishing the nosological features of individuals with persistent illness.

This study aims to investigate the putative defining features of individuals reporting symptoms of L-AN, including consideration of their treatment trajectory.

This cross-sectional study, drawing from a mixed-methods design, utilised a sample of symptomatic individuals who reported experiencing eating disorder treatment (n = 208). Several qualitative and quantitative data strands (a–c) were embedded within a single, self-report questionnaire measuring eating disorder severity and treatment experiences. Between-group comparisons were used to compare those of shorter (<3 years) and longer (>7 years) duration of illness.

No between-group differences were found in measures of severity, including body mass index (kg/m2), eating disorder symptom scores, psychological distress or perceived health-related quality of life. However, those with L-AN had a significantly higher number of mental and physical health comorbidities, longer treatment delay, greater number of episodes of treatment and poorer subjective ratings of their treatment experiences.

Delineating L-AN by severity may be inappropriate; anorexia nervosa of any duration is a severe illness. This study suggests that treatments, or lack thereof, may have an inadvertent impact on duration of illness. Future focus needs to be on reconceptualising L-AN and its treatments. Treatment refinements informed by lived experience are proposed.

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.

Research on gender-based violence has shown the influence of Dark Tetrad personality traits (i.e. Machiavellianism, narcissism, psychopathy and sadism) on the development and perpetuation of sexist attitudes and cognitions that justify or condone harmful behaviours.

This study explored the potential mediating role of empathy in the relationship between the Dark Tetrad personality traits and support for vindictive rape, as a form of revenge for the perceived violation of traditional sexual norms.

A sample of 1548 adult individuals from the general community (67.3% female, age range 18–83 years) completed the Dark Triad Dirty Dozen, the Short Sadistic Impulse Scale, the Basic Empathy Scale and the Vindictive Rape Attitude Questionnaire.

The results showed that empathy partially mediated the relationship between sadism and attitudes supportive of vindictive rape, while a full mediation of empathy was found in the association between Machiavellianism, psychopathy and attitudes supportive of vindictive rape. Conversely, no significant association between empathy or vindictive rape and narcissism was observed.

Empathy plays an important role in mitigating the effects of Dark Tetrad personality traits on support for vindictive rape. Given the global prevalence of violence against women, these findings are discussed in the context of a social climate that may reinforce the perpetuation of gender inequalities and sex-based stereotypes that are at the root of the acceptance of violence.

Dissociative identity disorder (DID) manifests with distinct trauma-avoidant and trauma-related identity states. Overtly conscious trauma-related knowledge processing is identity state-dependent. Previous research on covertly subconscious knowledge processing in DID lacks subject-specific trauma-related stimuli.

Our controlled functional magnetic resonance imaging (fMRI) study explored neural and behavioural differences of overt and covert knowledge processing of individualised self-relevant words in DID.

Behavioural data were gathered while 56 participants underwent task-based fMRI: 14 with DID, 14 DID simulators and a paired control group of 14 healthy controls and 14 participants with post-traumatic stress disorder. Individuals with DID and simulators participated in a trauma-avoidant and a trauma-related identity state. Reaction times and brain activation following overtly and covertly presented individualised words were statistically analysed.

Behavioural analyses showed a main effect of consciousness (P < 0.001). Post hoc between-group pairwise comparisons revealed slower reaction times for individuals with DID compared with simulating (P < 0.05) and paired controls (P < 0.05). Neural data analyses showed increased brain activation in frontal and parietal regions within the diagnosed DID group, especially during overt processing. Between-group comparisons mostly showed less pronounced activation in frontal, occipital and temporal areas.

The present study showed increased cognitive control during overt self-relevant knowledge processing in the trauma-avoidant identity state of DID, in line with previous research. The slower reaction times and increased frontoparietal activation shown in individuals with diagnosed DID, as compared with both control groups, support the notion of cognitive avoidance of trauma-related information in DID and further reinforce the authenticity of DID experiences.

The COVID-19 pandemic disrupted daily social interactions, potentially affecting mental health. Understanding the risk of depressive and anxiety symptoms is essential for guiding mental health strategies during future crises.

To explore how social networks influenced mental health outcomes during the pandemic and how these relationships changed over time.

Data from the Omtanke2020 study, a prospective cohort study of Swedish adults, were analysed using structural equation modelling (N = 10 918). Surveys at baseline and follow-up at 6 and 12 months assessed social networks, including structural components (e.g. relationship status, frequency of social contact) and perceived components (e.g. emotional support from family, feeling safe at home). Cross-lagged panel modelling was used to observe changes over time in the associations between social network indicators and depressive and anxiety symptoms.

Stronger perceived social support – specifically closeness to family, perceived warmth or love from others and increased societal cohesion – were negatively correlated with depressive and anxiety symptoms across all time points (β coefficients = −0.14 to −0.23, all P < 0.001). Social network variables consistently predicted mental health outcomes, with effect sizes remaining relatively stable over time (β coefficient = −0.17 at baseline, β coefficient = −0.21 at 1-year follow-up).

This study highlights the protective role of the social network – namely perceived social support – in combatting depressive and anxiety symptoms during the COVID-19 pandemic. Interventions that strengthen close interpersonal ties and community cohesion may help mitigate mental health impacts during future public health crises.

Students, due to their specific academic and psychosocial conditions, are at higher risk of suicide compared with the general population, and suicide is one of the leading causes of death among students worldwide.

To investigate the prevalence of suicidal ideation and suicide attempts among Iranian university students.

A systematic search was conducted in international and national databases, including Scopus, Web of Science, PsycINFO, PubMed and Magiran, up to February 2025. Title and abstract screening was performed by a single reviewer. Two reviewers independently undertook full-text screening (study selection) and data extraction. Data were analysed using Stata 16. The heterogeneity of studies was tested with Cochran’s Q and quantified with the I2 statistic. To explore the sources of heterogeneity, we performed sensitivity analyses and meta-regression. The protocol was registered in the International Registration of Systematic Reviews (no. CRD42023471340).

We included 28 studies in this research. The pooled prevalence of suicidal ideation, 12-month suicide attempts and lifetime suicide attempts among Iranian students was 17% (95% CI: 13–21%), 3% (95% CI: 2–4%) and 8% (95% CI: 6–10%), respectively, with substantial heterogeneity (I2 = 94.85, 91.16 and 93.46%, respectively).

This study highlights the high prevalence of suicidal ideation and suicide attempts among Iranian university students, underscoring the need for effective preventive strategies and further research.

Memory deficits are among the key risk factors in mental health problems, and are associated with dysfunctional cognitive factors.

The present study explored the relations between dysfunctional attitudes, rumination and mind-wandering, and emotional and non-emotional memory, respectively, aiming to inform the mechanism underlying the negative association of these cognitive factors with memory.

A total of 123 undergraduate university students completed self-report measurements, including Dysfunctional Attitude Scale Form A, Rumination Responses Scale, Mind Wandering Frequency Scale and the Center for Epidemiological Studies Depression Scale. Additionally, they were invited to participate in an experiment consisting of two tasks (n = 111 completed the task for emotional memory and n = 110 for non-emotional memory). Pearson correlation analysis and a linear regression model examined the relationship between cognitive factors and memory performance.

Based on correlational analyses, rumination, dysfunctional attitudes and depression are negatively correlated with the accuracy of negative emotional face memory (emotional memory, all P<0.05). The regression models suggest that dysfunctional attitude significantly predicts the accuracy of negative face memory (β = –0.205, P = 0.037). Digit memory accuracy (non-emotional memory) was associated with rumination and mind-wandering (all P<0.05), in which rumination was the significant predictor of accuracy (β = –0.231, P = 0.021).

The study indicated that dysfunctional attitudes are related mostly to negative emotional memories, and that rumination is mostly associated with non-emotional memories. Dysfunctional attitude and rumination represent potential treatment targets for emotional and non-emotional memory deficits, respectively, related to psychopathology.

Crime has significant impact on older victims. High rates of anxiety and depression may be associated with crimes.

This paper aims to evaluate the cost-effectiveness of a victim improvement package (VIP) for the reduction of continued symptoms of depression or anxiety in older victims of community crime, from the societal perspective, in a three-step, parallel-group, single-blind randomised controlled trial.

Participants (N = 131) were randomised to receive either the VIP intervention in addition to treatment as usual (TAU) (n = 65), or to TAU alone (n = 66). Service resource use was collected using the Client Service Receipt Inventory and health-related quality-of-life data via the EQ-5D-5L instrument at 3 months post-crime (baseline), 6 months post-crime (post-intervention) and 9 months post-crime (follow-up).

The mean cost of the VIP intervention was estimated at £1330 per participant in the intervention arm. The mean difference in costs between the VIP and TAU arms over the 6-month trial duration was −£881 (95% CI: −£5947 to £4186). The mean difference in quality-adjusted life-years (QALYs) was −0.011 (95% CI: −0.042 to 0.020).

The addition of VIP to TAU for older victims of community crime generated a lower mean point estimate for costs, and failed to improve quality of life compared with TAU alone. While this places VIP in the south-west quadrant of the cost-effectiveness plane, the magnitude and significance of the QALY difference do not justify declaring VIP cost-effective or TAU not cost-effective. Future research is needed to identify the most cost-effective intervention.

The new psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) is a manualised dementia care intervention.

To evaluate whether goal-setting plus NIDUS-Family is more effective than the control condition (goal-setting and routine care) in supporting dyads’ (family carers and care recipients with dementia) attainment of personalised goals; and to determine participant-perceived goal relevance over 24 months.

We randomised dyads from community settings (2:1): to NIDUS-Family, a manualised psychological intervention tailored to goals that dyads set by selecting modules, delivered in 6–8 video call/telephone sessions over 6 months then 2–3 follow-ups monthly for 6 months; or to control. Outcomes were goal attainment scaling (GAS) (primary) at 18 and 24 months, functioning, quality of life, time until care home admission or death, carer anxiety and depression. Primary analysis, a mixed-effects model, accounted for randomisation group, study site, time, intervention arm facilitator and repeated measurements.

In the period 2020–2021, 204 participants were randomised to intervention and 98 to control; 164 (54.3%) and 141 (46.7%) dyads completed 18- and 24-month outcomes, respectively.

In the primary analysis, including 277 participants contributing 6-, 12-, 18- or 24-month outcomes, adjusted GAS mean differences (intervention–control) at 18 and 24 months were 11.78 (95% CI 6.64, 16.93) and 8.67 (95% CI 3.31, 14.02), respectively. Secondary outcome comparisons were not significant. The hazard ratio for dying or care home admission was 0.80 (95% CI 0.45, 1.42; intervention versus control), and 0.87 (95% CI 0.41, 1.82) and 0.59 (95% CI 0.26, 1.33) for death and care home admission, respectively. Among baseline GAS goals, carers considered 436 (78.0%) relevant at 18 months and 383 (78.5%) at 24 months.

NIDUS-Family improved attainment of GAS goals over 2 years.

ISRCTN11425138.

Mental health literacy (MHL) is the ability to recognise mental disorders; have knowledge of professional help available, effective self-help and prevention strategies; and have the skills to support others. MHL is linked to better help-seeking behaviours and better management of mental illness. Mental illness prevalence is increasing in Malawi. Assessing MHL in communities crucially helps identify knowledge gaps, informing the development of evidence-based interventions.

This study assessed the MHL levels of young adults (16–30 years old) in rural and urban communities in Malawi.

A cross-sectional national survey was administered to 682 people across 13 districts in Malawi, using a self-reporting Mental Health Literacy questionnaire (MHLq) that assessed knowledge of mental health problems, erroneous beliefs/stereotypes, first aid skills, help-seeking behaviour and self-help strategies.

Most respondents were either unemployed (36%) or enrolled in school (43%). A total of 73% completed primary or secondary education, and 48% knew someone with a mental illness, but only 14% of this group could specify the illness. The mean MHL score was 111.8 (s.d. 13.9). Individuals with primary and secondary school qualifications had significantly lower scores in factor 2 (erroneous beliefs/stereotypes) and factor 3 (first aid skills and assistance-seeking behaviour) of the MHLq than those with higher education.

This research highlights persisting mental health misconceptions, limited knowledge about specific mental illnesses and low help-seeking behaviour among young adult Malawians. Higher education is linked to a better understanding of mental health. Prioritising community education on causes, signs, treatments and prognosis of mental illness is crucial for increased MHL.

Many studies have observed a link between mortality and mental illness, although the contribution of violence exposure to mortality in people with mental illness remains under-researched.

To examine the association of violence exposure, such as being physically assaulted, with general and cause-specific mortality in a population using mental health services.

We assembled a cohort study using electronic health records from a mental health and substance use treatment provider in south-east London. Records were linked to acute medical admission and emergency department presentation data, as well as to a national mortality register with death certificates for deaths registered in England and Wales. Cox regressions estimated the associations of binary and cumulative violence exposure, as indicated by assault admission and presentation to emergency departments for violence-related reasons. Mortality was adjusted for sociodemographic and clinical potential confounders.

The hazard ratio for assault admission with all-cause mortality was 2.14 (95% CI: 1.93–2.36) following covariate adjustment. Adjusted associations were also found with mortality from the following causes: internal (natural) (hazard ratio 1.72, 95% CI: 1.50–1.98), external (hazard ratio 1.94, 95% CI: 1.51–2.48), suicide (hazard ratio 2.20, 95% CI: 1.38–3.52), respiratory (hazard ratio 2.01, 95% CI: 1.41–2.85), circulatory (hazard ratio 1.71, 95% CI: 1.27–2.28), diabetes-related (hazard ratio 2.86, 95% CI: 1.20–6.86) and alcohol-related (hazard ratio 1.56, 95% CI: 1.10–2.22). Results for cumulative assault were consistent with these in both direction and magnitude. There was evidence for an association of weapon-related assault admission with all-cause mortality (hazard ratio 1.58, 95% CI: 1.14–2.18).

People with mental illness, who are exposed to assault, experience greater mortality than those who are not exposed. Excess mortality attributable to violence exposure in people with mental illness was related to deaths from natural and external causes.

Understanding the neuroanatomical correlates of treatment response in schizophrenia is crucial for improving clinical stratification and clarifying underlying pathophysiological mechanisms.

To examine subcortical volumetric differences across clinically defined schizophrenia treatment-response subgroups.

T1-weighted structural magnetic resonance imaging data were analysed from 109 participants, including 79 individuals with schizophrenia and 30 healthy controls. Patients were categorised into three distinct treatment response groups: ultra-treatment-resistant (UTR; n = 22), clozapine-responsive (n = 28) and first-line antipsychotic responsive (FLR; n = 29). Group differences were examined across 33 regions of interest, including subcortical, ventricular and hippocampal subfield regions.

The UTR group had higher antipsychotic dosages and exhibited greater symptom severity than other patient groups. Across all schizophrenia subgroups, hippocampal and amygdala volumes were smaller relative to controls. Treatment-resistant patients (UTR and clozapine-responsive) also showed reduced nucleus accumbens volumes, whereas FLR patients demonstrated larger pallidal volumes. In addition, the UTR subgroup exhibited enlarged lateral ventricles. Hippocampal subfield analyses revealed widespread reductions in treatment-resistant patients, most prominently in the CA4/dentate gyrus, subiculum and stratum, whereas FLR patients showed more focal reductions in the CA4/dentate gyrus and left subiculum.

These results suggest that smaller hippocampal and amygdala volumes represent a shared neuroanatomical signature of schizophrenia, whereas reduced accumbens and enlarged pallidal volumes may differentiate treatment-resistant and treatment-responsive profiles, respectively. The findings underscore the heterogeneity of schizophrenia and highlight the need for longitudinal research to disentangle illness-related pathology from medication effects.

Electroconvulsive therapy (ECT) is highly effective for major depressive disorder (MDD), but about 50% of patients relapse within 1 year. A comprehensive review of all potential relapse-prevention strategies is lacking.

This systematic review aimed to identify, summarise and critically evaluate the available evidence on pharmacological, neuromodulatory, psychological and combination strategies to prevent relapse following successful ECT for MDD.

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: no. CRD42023392575). We searched PubMed, Embase, PsychInfo and Cochrane Library up to March 2025. Eligible studies included adults (>18 years) with unipolar MDD who responded to acute ECT and were followed for ≥3 months. We included randomised controlled trials (RCTs), cohort studies and case series (over ten cases). Risk of bias and quality were assessed and a narrative synthesis conducted.

A total of 28 studies (N = 11 119) were included. Lithium (alone or with antidepressants) was most consistently associated with reduced relapse in 10 studies. Continuation ECT (C-ECT), particularly when combined with pharmacotherapy, also reduced relapse in several RCTs. Evidence for psychotherapy (e.g. cognitive–behavioural therapy) is limited (two studies), warranting further studies. No studies on repetitive transcranial magnetic stimulation or ketamine were found. Study quality varied, with some being underpowered or having used inconsistent definitions of relapse.

Pharmacotherapy with lithium and, separately, C-ECT combined with medication, showed the strongest evidence for relapse prevention following ECT. The evidence base is limited by heterogeneity, small sample sizes and few studies on novel or psychological strategies. More robust clinical studies are needed to identify optimal long-term strategies.

People who gamble experience elevated rates of suicidal thoughts and behaviours. Longitudinal studies have been scarce, and none has focused on those who regularly gamble in the UK.

To examine the relationship between specific products and locations of gambling activity (and their combinations) and risk of subsequent suicidal thoughts.

We analysed a UK longitudinal survey of 3927 adults (18 years old or over) who regularly bet on sports. Data were collected online between June and November 2020. Latent class analysis was used to identify groups of people with similar gambling profiles on the basis of 13 types of gambling activity. Weighted group characteristics are presented. Regression modelling was used to test associations between gambling groups and suicidal thoughts, adjusting for baseline characteristics.

Five distinct groups were identified. One group (5.6% of the sample) reported multiple types of both in-person and online gambling. This group was the most likely to use electronic gambling machines. After adjustment for baseline suicidal thoughts, this group had significantly higher odds of subsequent suicidal thoughts (adjusted odds ratio 3.42; 95% CI: 1.18–9.89) than other groups.

Although many profiles of gambling activity present suicide risk, some types present greater risk. National Institute for Health and Care Excellence guidelines recommend enquiry in primary care settings about gambling behaviours. Our findings suggest that clinicians should consider asking questions on mode (online or in-person) and product (especially electronic gambling machines) to identify those at heightened risk of suicidal ideation. Gambling should also be considered routinely in psychosocial assessments across clinical settings and incorporated into suicide prevention campaigns.

Autism spectrum disorder (ASD) and obsessive–compulsive disorder (OCD) may coexist in children and adolescents and present with several overlapping features.

We aimed to assess the prevalence of ASD traits and diagnosis in children and adolescents with OCD, explore the correlation between OCD severity and ASD traits/diagnosis, and examine the impact of ASD traits/diagnosis on global functioning in this population.

Electronic searches were carried out on Pubmed, Embase and PsycINFO, using selected keywords and specified inclusion and exclusion criteria. Meta-analysis was performed with R Version 4.3.1.

Of 1410 studies initially identified, 29 reported on the prevalence of ASD traits or diagnosis. Pooled mean prevalence rate was 8.0% (95% CI 5.0–13%). ASD questionnaire scores were higher in OCD versus control groups (standardised mean difference: 1.23; 95% CI 0.76–1.69). There was limited significant correlation between ASD questionnaire scores and OCD questionnaire scores, and no significant differences in these scores were demonstrated between OCD samples and samples diagnosed with comorbid OCD and ASD (mean difference −0.41; 95% CI −1.23 to 0.40). Functional impairment appeared elevated with ASD traits/diagnosis in OCD, but meta-analysis feasibility was limited.

This review indicates higher ASD traits and diagnosis in children and adolescents with OCD compared with the general population. Limited data and methodological constraints in trials limit generalisability, warranting further research.

Trauma, a psychological phenomenon, can contribute to several mental health disorders such as acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). Understanding the impacts of childhood adversities on mental disorders is essential, since early trauma can profoundly shape an individual’s reaction to subsequent trauma.

To study the association between childhood adversities and full-threshold and subthreshold PTSD onset, either directly or through the intermediary role of ASD.

Data were collected longitudinally from healthcare workers aged 18 years and above, working at Saint George Hospital University Medical Center, at three distinct time points: 9–15 days (wave 1), 21–27 days (wave 2) and 6–7 months (wave 3) following the Beirut port blast on 4 August 2020.

Childhood adversities, encompassing physical, emotional and sexual abuse, were collected. ASD and PTSD were assessed, respectively, using the Acute Stress Disorder Scale and the PTSD Checklist for DSM-5. Odds ratios, both unadjusted and adjusted, with 95% confidence intervals, were calculated to study the associations.

Emotional abuse was found to be a significant predictor of ASD at wave 2 (21–27 days), and both full-threshold and subthreshold PTSD at wave 3 (6–7 months) post-blast. Individuals with negative ASD status at waves 1 and 2 who experienced emotional abuse in childhood showed approximately double the rates of subthreshold PTSD.

Childhood emotional abuse was a strong predictor of both ASD and PTSD. Screening for past childhood adversities is important, even in individuals without ASD, as they remain more vulnerable to later PTSD.