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.

Promoting bystander interventions is a core strategy to prevent suicides in public places, but little is known about how people with lived experience perceive this intervention.

To explore people’s experiences of receiving an intervention during a suicide attempt on the railways.

Interviews were conducted with 28 people with experience of receiving a bystander intervention during a suicide attempt on the railways. Interview data were triangulated with an online ethnography exploring posts made on forums and similar platforms openly discussing suicide.

Using reflexive thematic analysis, five themes were generated: (a) ‘I’m a good actor… we all carry a mask’: concealing feelings and intentions; (b) ‘It kind of draws your attention away but it doesn’t almost shine a spotlight’: interventions should be gentle and not draw more attention; (c) ‘People that were getting in my way were just making me want to try harder’: interventions can trigger difficult feelings in the moment; (d) ‘I did feel different, I felt better’: the power of small talk; and (e) ‘You feel like a human being and you feel like they actually care’: wanting to feel cared for.

Findings suggested that some people actively avoid receiving an intervention by concealing how they are feeling in that moment. Interventions that are gentle and do not draw attention may be preferable, such as making small talk and simple gestures such as smiling or being near the individual. Conversely, more intrusive or aggressive interventions may be triggering and exacerbate suicidality.

The treatment of eating disorders by the National Health Service in England and Wales adheres to the National Institute for Health and Care Excellence (NICE) guidelines, which were informed by an experimental evidence base.

As the presentation and treatment of eating disorders have been shown to vary on the basis of age, we aimed to review the representation of older people in the evidence base for the NICE guidelines.

The evidence base was reviewed by identification of participant ages and the recruitment methods used in the experimental literature. The use of clinician referral was of particular interest, owing to the age-dependent risk of eating disorders being misdiagnosed in older adults.

The results highlighted low participant ages across the evidence base, most notably in anorexia nervosa samples. In accordance with the age data, a high frequency of clinician referral was used to recruit participants, with the highest rate identified in anorexia nervosa samples.

NICE guidance fails to consider the economic, social, political and health contexts around onset or chronological development of an eating disorder, with no reference to comorbidities which are commonly reported with older people or how this might affect diagnosis, formulation and treatment recommendations. Research is urgently required to inform clinical recommendations for older adults.

Survivors of the 1988 Halabja chemical attack have experienced severe, chronic trauma, yet limited research has examined the long-term psychological and biological consequences of chemical warfare exposure more than three decades later.

To examine long-term post-traumatic stress disorder (PTSD) symptoms, depression/anxiety symptoms, somatic symptoms and perceived stress among survivors of the Halabja chemical attack, and to investigate the associations of trauma exposure, sociodemographic factors and hair cortisol concentrations (HCCs) with psychological symptom severity and symptom profiles.

A total of 209 survivors of the Halabja chemical attack participated in structured interviews using culturally adapted and field-tested instruments, including the Post-Traumatic Stress Disorder Checklist for DSM-5, Hopkins Symptom Checklist-25, the Patient Health Questionnaire-13, the Perceived Stress Scale-14 and an adapted War and Adversity Exposure Checklist-26. Hair cortisol and cortisone concentrations were assessed as biomarkers of chronic stress. Data were analysed using correlations, independent-samples t-tests, multiple linear regression analyses, multinomial logistic regression and latent profile analysis (LPA).

Survivors demonstrated a substantial long-term psychological symptom burden. Overall, 87.6% of participants exceeded the cut-off for probable PTSD symptoms, and 75.1% exceeded the cut-off for elevated depression/anxiety symptoms. Most participants (81.8%) reported exposure to 11 or more lifetime traumatic events. Men reported significantly greater cumulative trauma exposure, whereas women reported significantly greater somatic symptom severity. Higher educational attainment and employment were consistently associated with lower psychological symptom severity across multiple outcomes. HCCs were not significantly associated with PTSD symptoms or latent symptom-profile membership after adjustment for trauma exposure and psychosocial variables. The LPA identified four symptom-severity classes characterised by differing levels of PTSD and depression/anxiety symptoms. Greater cumulative trauma exposure and lower social support were associated with membership in more severe symptom classes.

Survivors of the Halabja chemical attack continue to experience substantial psychological distress more than three decades after exposure. Long-term symptom severity appears to be more strongly associated with cumulative trauma exposure and psychosocial adversity than with HCCs. The findings highlight substantial heterogeneity in symptom presentation and support the need for long-term, culturally sensitive and trauma-informed mental health interventions for survivors of chemical warfare and mass violence.

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.

International evidence suggests that Early Intervention for Psychosis (EIP) services are both effective and cost-effective. Such evidence, however, comes almost exclusively from high-income countries.

Our aim was to estimate the cost-effectiveness of EIP services in a Latin American setting.

We compared EIP services against community mental health teams (CMHT) from the Chilean health system perspective. We developed a six-state Markov model to estimate the costs, benefits (measured as quality-adjusted life-years (QALYs)) and incremental cost-effectiveness ratio (ICER) for a 10-year time horizon. The model was populated with data from a Chilean EIP cohort, published literature and expert opinion. We characterised uncertainty through probabilistic sensitivity analysis and calculated the value of information to reduce such uncertainty.

In the base case analysis, EIP was cost-effective compared with CMHT, with an ICER of 5 550 044 Chilean pesos per QALY (USD 13 742 adjusted for purchasing power parity). Uncertainty analysis revealed an 80% probability of EIP services being the most cost-effective option at a willingness-to-pay threshold of one gross domestic product per capita (USD 15 923). Sensitivity analysis showed that the results were sensitive to parameters such as intervention effectiveness and cost, suggesting that a new trial might be worthwhile to reduce uncertainty.

This model suggests that implementing EIP services in Chile may cost more, but it is likely to be cost-effective. Nonetheless, more evidence about affordability, equity and broader perspectives is needed to improve the economic case of implementing EIP services in less-resourced settings, such as in Latin America.

Substance use disorder (SUD) is frequently associated with cognitive impairment that negatively affects treatment adherence and clinical outcomes. Neuropsychological assessments provide detailed information but are often impractical in clinical settings, underscoring the value of brief but sensitive tools such as the Montreal Cognitive Assessment (MoCA).

This study aimed to evaluate the utility of MoCA in detecting cognitive impairment in SUD, examining cognitive recovery following sustained abstinence, exploring gender differences in cognitive progression and determining whether baseline cognitive performance predicts treatment dropout.

Ninety-five SUD patients and 57 healthy controls completed MoCA at baseline and were reassessed after 6 months.

At baseline, 72.60% of individuals demonstrated cognitive impairment compared with controls, with deficits evident in both global cognition and visuospatial/executive, attention, memory and language domains. Following 6 months of abstinence, deterioration rates decreased to 50%, indicating substantial but not complete recovery, because the improvement in overall cognition was moderate. Male patients showed significantly greater cognitive gains than female patients, particularly in visuospatial/executive and digit span performance. Patients impaired at baseline reported more severe alcohol use and earlier onset of cannabis use disorder. Patients with cocaine use disorder showed the poorest recovery and the highest rate of treatment dropout. Lower baseline language and fluency scores were strongly associated with treatment discontinuation. Language deficits, together with cocaine use disorder, predicted 69% of dropout cases.

Findings indicate MoCA as a practical screening tool for early detection of cognitive impairment, longitudinal monitoring and personalised treatment planning in SUD.

Bipolar disorder in youths is associated with metabolic dysregulation, impaired inhibitory control and limbic network connectivity changes.

To investigate whether limbic network connectivity is associated with appetite hormones and inhibitory control in youths with bipolar disorder.

The current study included 68 youths with bipolar disorder and 57 age- and gender-matched controls. They completed clinical assessments, the go/no-go (GNG) task, fasting appetite hormone (leptin, adiponectin, insulin and ghrelin) tests and resting-state functional magnetic resonance imaging. Region of interest (ROI)-to-ROI functional connectivity was analysed across 17 limbic ROIs. Cluster-level inferences were derived by using threshold-free cluster enhancement with family-wise error correction (p < 0.05). Furthermore, associations with appetite hormones and GNG task parameters were investigated.

Compared with the control individuals, youths with bipolar disorder exhibited elevated leptin (p = 0.005) and insulin levels (p < 0.001), poorer performance on the GNG task and hyperconnectivity within the limbic network, identifying a significant cluster comprising the right anterior parahippocampal gyrus (aPHG)–right thalamus and right aPHG–hypothalamus edges (cluster-level family-wise error-corrected p = 0.045). No significant correlations were observed between limbic hyperconnectivity, appetite hormone levels and GNG task performance.

Current cross-sectional cohort indicates that youths with bipolar disorder exhibit concurrent alterations in appetite hormones, inhibitory control and limbic connectivity. These findings provide a characterisation of youth bipolar disorder across multiple indices, although longitudinal studies are necessary to understand how these features relate to long-term clinical trajectories.

The re-audit aimed to assess compliance with previously implemented recommendations regarding alcohol assessment, intervention, documentation, and signposting for people with gambling disorder presenting to the Southern Gambling Service (SGS), and to evaluate improvements in practice since the initial audit.

The re-audit included all referrals received by the Southern Gambling Service (SGS) between 1 March 2025 and 30 September 2025 who completed an initial assessment.

Baseline data were analysed to stratify patients’ alcohol use risk based on their extended Alcohol Use Disorder Identification Test (AUDIT-C) and Estimated Weekly Alcohol Consumption (EWAC), collected via a digital pre-assessment tool, with escalation to a full AUDIT where indicated. Clinical assessment letters and formulations were reviewed to assess documented compliance with National Institute for Health and Care Excellence (CG115) guidance, Department of Health and Social Care guidance, and Royal College of Physicians regarding appropriate management according to their risk brackets. Outcomes included: completion of full AUDIT for those meeting criteria; delivery and documentation of brief interventions for hazardous or harmful drinking; provision of advice on avoiding abrupt reduction for those scoring ≥20; delivery and documentation of formulations on alcohol use and signposting to specialist alcohol services where appropriate.

A total of 301 referrals were received during the audit period, of which 124 referrals (41.2%) were accepted and assessed. AUDIT-C and EWAC were completed for 100% of assessed patients. Fifty-five patients (44.4%) met criteria for escalation and completed a full AUDIT. Of these, 27 patients (49.1%) scored 8 or above, indicating hazardous or harmful drinking, and 10 patients (18.2%) scored 20 or above, suggesting possible alcohol dependence. Among patients scoring ≥8, 18 (66.7%) received a documented brief intervention and 20 (74%) had an alcohol-related formulation recorded. Of those scoring ≥20, seven (70%) received documented advice on avoiding abrupt alcohol reduction and eight (80%) had a formulation addressing alcohol use. Signposting to specialist alcohol services was documented for 7 of 10 (70%) patients who met criteria.

The re-audit demonstrates substantial improvements across all areas compared with the initial audit. Full AUDIT completion improved from 0% to 100%, delivery of brief interventions from 7% → 67%, advice on safe alcohol reduction from (0% → 70%) and signposting for patients improved substantially. Maintaining current standards with improvement in documentation consistency, staff education and reinforcement of intervention thresholds can help improve these gains.

Many people presenting to emergency departments after self-harm do not receive adequate care, even in well-resourced health systems.

To identify patterns of health care service use across two periods: (a) during and (b) up to 1 year after an index emergency department self-harm presentation.

A retrospective population-based cohort study including 4668 individuals aged ≥9 years who presented to the Royal Melbourne Hospital emergency department for self-harm between January 2012 and December 2019. Linked administrative data captured >1.3 million records across primary care, pharmacy, specialist mental and physical health services and emergency departments. Sequential pattern mining identified longitudinal service-use clusters. Multinomial regression explored associations with demographic, clinical, psychosocial and presentation characteristics. Cox proportional hazards models assessed associations between clusters and all-cause and suicide mortality.

Emergency department self-harm presentations triggered short-term increases in multi-sector contacts. However, most (68.7%) reverted to the same service-use cluster observed prior to their index presentation. Suicide risk was highest within 1 year, particularly among those in the specialist mental health services cluster (4.5% of the cohort).

A small subgroup engage intensively with specialist mental health services yet remain at high suicide risk, while one in ten remain disengaged altogether, suggesting that an acute presentation of self-harm often fails to alter patients’ care trajectories long-term. Policy alignment with national recommendations for integrated, community-based care could improve sustained, evidence-based support beyond acute crises.

Shared decision-making is essential to patient-centred care, but remains underutilised in psychiatry, particularly when deciding whether to continue, reduce or stop antipsychotic medication after remission from first-episode psychosis (FEP). Existing decision aids do not fully address recovery goals such as autonomy, identity and social reintegration.

To co-develop a patient decision aid (PDA) prototype that supports individuals in making the decision to continue, reduce or stop antipsychotics following remission from FEP.

We used a patient-centred design process informed by International Patient Decision Aid Standards (IPDAS), User Centered Design (UCD-11) and the CHIME framework. A multidisciplinary steering group – including individuals with lived experience, clinicians, and researchers – co-developed the PDA. Iterative feedback was collected from an external advisory group of patient partners, caregivers and healthcare providers (n = 7). Acceptability was evaluated with structured questionnaires.

The final prototype, structured into five sections (decision overview, personal values, risks and benefits, planning and real-life experiences), demonstrated strong acceptability across stakeholders. Ratings improved with each iteration, with version 3 receiving near-perfect scores on clarity, usefulness and balance. Users described the tool as relatable and empowering. The inclusion of real-life stories and visual decision exercises were particularly valued. However, some clinicians expressed concerns about time constraints and workflow integration.

This recovery-oriented PDA prototype offers a practical, evidence-based resource to facilitate shared decision-making with respect to continuing, reducing or stopping antipsychotics after FEP. Although early feedback is promising, pilot testing is needed to evaluate its impact on decision quality, satisfaction and treatment outcomes.

Perinatal mental health problems are increasingly recognised, and specialist services are more widely available for support and treatment. However, little is known about how women use these services. This study examined the use of health and support services associated with perinatal anxiety, and possible inequities.

To determine the health service use and healthcare experiences of women with perinatal anxiety, and to examine regional differences and inequalities.

A prospective longitudinal follow-up of women recruited from 17 hospital trusts. Participants (N = 722) completed anxiety measures 6 weeks postpartum, and health service use and experience measures 6 months postpartum.

Anxiety 6 weeks postpartum was associated with more GP (incidence risk ratio (IRR) 1.02, 95% CI 1.01–1.03) and health visitor (IRR 1.01, 95% CI 1.01–1.02) visits for the mother but not for the infant. Effects were moderated by ethnicity for GP visits (IRR 1.03, 95% CI 1.00–1.06) and by level of education for health visitor visits (IRR 1.02, 95% CI 1.01–1.03). Anxiety was associated with lower satisfaction with GP care for the baby, health visitor care and poorer overall healthcare experiences. Women with anxiety were more likely to attend specialist mental health (odds ratio 1.09, 95% CI 1.06–1.12) or other support services (odds ratio 1.04, 95% CI 1.01–1.06). However, 29.2% of those referred to mental health services and 30.8% referred to other support services did not attend.

Perinatal anxiety increases health service use for mothers but not for infants. Anxiety also negatively impacts satisfaction with healthcare. Findings can inform strategies to improve access and experience of care.

Adults with mental illness have higher smoking prevalence and face greater financial burdens from smoking compared with the general population.

This study explores how individuals’ psychological distress and smoking status are jointly associated with household expenditure patterns in Australia.

Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey over three waves. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10) and the mental health domain of Medical Outcomes Study Short-Form General Health Survey (SF-36 MHD). Household expenditure categories included alcohol, clothing, education, fuel, general insurance, medicines, health practitioners, groceries, meals eaten out, internet, utilities, public transport and rent. Regression models using the generalised estimating equation technique compared expenditure data, controlling for age, gender, household composition, socioeconomic position, education level and wave of data collection.

Smokers and ex-smokers showed significant differences in expenditure across K10 psychological distress levels. At low and moderate distress levels, smokers spent more on alcohol and rent and less on insurance, health practitioners, meals out and medicines. At high distress levels, only education expenditure was significantly lower for smokers. Across SF-36 MHD tertiles, smokers spent less on education, insurance and medicine, but more on alcohol, especially at lower and moderate distress levels.

Smoking cessation for those with moderate psychological distress may be associated with a reallocation of spending, benefiting both households and their local communities. Targeted interventions addressing smoking cessation and mental health are crucial for reducing financial and health inequities.

Background: Armed conflict severely disrupts the continuity of psychiatric care, particularly for patients dependent on long-term psychotropic medication. During the recent Gaza war, widespread displacement of patients and medical personnel and destruction of the health service infrastructure created unprecedented barriers to treatment continuity. Mental health professionals were compelled to develop innovative, context-specific solutions to prevent clinical deterioration and safeguard patient stability.

Aims were to identify the main challenges affecting psychotropic medication adherence among war-affected patients in Gaza and to describe adaptive strategies that supported treatment continuity under crisis conditions.

This study was conducted between October 2023 and January 2024 within five community mental health centres and two psychiatric hospitals in Gaza. This was a mixed-methods study, that used triangulated data from semi-structured interviews with clinicians, focus group discussions with multi-disciplinary teams, clinical records and medication tracking data. Thematic analysis of interviews and focus groups was used to identify recurring patterns of non-adherence, contributing factors, and responsive interventions. Themes were identified and refined through iterative discussions to ensure they reflected clinical observations across sites. Descriptive statistics were used to describe reasons for medication interruption as recorded in clinical records.

Medication discontinuation was due to drug shortages (45%), forced displacement (33%), and restricted mobility caused by security risks (22%). Thematic analysis identified several adaptive strategies: decentralised medication distribution through NGO partnerships, telepsychiatry follow-ups, substitution with pharmacological equivalents, and family engagement in adherence monitoring. Clinicians reported that these strategies reduced relapse rates and preserved treatment stability in most high-risk cases.

Maintaining psychotropic medication adherence during armed conflict is both a clinical and ethical imperative. The Gaza experience demonstrates that flexible, community-driven, and ethically grounded models of care can sustain treatment continuity in extreme humanitarian settings. Strengthening emergency medication supply chains and integrating psychosocial support into humanitarian response frameworks are essential to protect psychiatric outcomes in conflict-affected populations.

The effectiveness of Community Treatment Orders (CTO) and the variability with which they are used remains the subject of ongoing debate.

To examine the associations between discharge from psychiatric in-patient care on to a CTO in New South Wales (NSW), Australia, and hospital admissions and bed-days in the following 12 months.

Retrospective matched case-control study using linked administrative health data from NSW between 1 January 2017 and 31 December 2023. Cases were individuals discharged on to a CTO after their first psychiatric hospital admission during the study period. We attempted to match controls 2:1 on age, gender and hospital discharge within 6 months of each other. Data were from the NSW Mental Health Ambulatory and Admitted Patient Data Collections.

There were 5506 individuals discharged on to CTOs and 9761 matched controls. Discharge on to a CTO did not affect the odds of hospital readmissions in the following 12 months (adjusted odds ratio (ORadj) = 1.06, 95% CI 0.97–1.14) though was associated with significantly greater bed-days (log βadj = 0.12, 95% CI 0.08–0.17, p < 0.0001). Individuals with a principal diagnosis of non-affective psychosis who were discharged on to a CTO had significantly lower odds of hospital readmissions in the following 12 months (ORadj = 0.67, 95% CI 0.59–0.77).

Discharge on to a CTO did not significantly affect hospital readmissions across the full sample, but did significantly lower the odds for individuals with non-affective psychosis. This suggests that targeted use of CTOs in specific populations (e.g., non-affective psychosis) warrants greater consideration, as the benefit of their use otherwise – especially from a human rights point of view – is unclear.

Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).

The aim of this study is to design and create a virtual coach powered by artificial intelligence (AI) to support young people aged 14–17 who are receiving a brief talking therapy for complex emotional needs (CEN).

Creating an AI-driven virtual coach to use in-between the sessions offers a potential solution to enhance engagement, accessibility and outcome without replacing the human therapist.

We planned three work packages over a 10-month period starting from July 2025.

Work package 1 focused on understanding the needs and preferences of the AI coach’s intended users and those who will be influential in its adoption and sustainment, including young people aged 14–17 with CEN, their parents/carers and youth mental health clinicians. Semi-structured qualitative interviews and focus groups were carried out, transcribed verbatim and analysed thematically using a framework approach.

Work package 2 focused on design and creation of an initial prototype of the AI coach based on the findings of work package one. A code design workshop was planned where the participants advisory group worked with the research team to agree on how the AI coach should be structured and operate to support the brief psychological intervention.

The objective of work package 3 is to refine the prototype AI coach in preparation for future research. Participants who took part in work package 1 will be invited to interact with the prototype AI coach for the purpose of providing feedback. A bespoke feedback form will be designed to encourage participants to critique all relevant aspects of the prototype. This feedback will be used to produce a refined version which participants will again be invited to review. The refined prototype will also undergo technical and clinical review including for equitable performance across demographic groups.

Participants viewed the virtual coach as a feasible and acceptable adjunct to traditional care. Based on the themes from work package 1, an initial prototype of the AI coach based is created. We aim to further refine the prototype AI coach in preparation for future research.

We believe an AI-powered virtual coach can improve accessibility, engagement and outcome for adolescents receiving brief interventions. Based on the findings, the research team will work further to agree plans for future research mostly to evaluate clinical outcomes and address ethical considerations in AI-driven mental health support.