Compared with well-studied internal adaptive systems, there remains a lack of comprehensive exploration of external correlated factors of resilience, as well as the way in which each ingredient of resilience is influenced.

This study aims to explore the dimensional associations among resilience and several factors, including parenting rearing style, childhood trauma and negative life events.

A series of social demographic variables, parental rearing patterns, childhood trauma, negative life events and resilience were assessed. Multiple linear regression analysis was used to explore correlated factors of resilience, with all the above factors included in the model. Network analysis was conducted to identify the central factor and key associations, and to visualise complex interactions among resilience, parenting rearing style, childhood trauma and negative life events.

This cross-sectional study was conducted among 4302 freshmen (2388 females, 55.5%; mean 18.59; s.d. = 0.95) from three colleges between October and December 2020. Three key associations were discovered: ‘learning pressure and emotional control’ (r = −0.195, P < 0.05), ‘emotional neglect and family support’ (r = −0.129, P < 0.05) and ‘maternal care family support’ (r = 0.193, P < 0.05). ‘Emotional abuse’ (bridge expected influence, −0.588) was the core node of the estimated network.

This study found that learning pressure, emotional neglect and maternal care emerged as the most critical external correlates of resilience. Emotional abuse occupies the most central position in the external correlated network of resilience. Future longitudinal research should clarify the temporal impacts of these associations, and the key factors, in the dynamic resilience system.

The true incidence of treatment-resistant schizophrenia (TRS) remains uncertain, largely because earlier studies relied on heterogeneous definitions and retrospective assessments. The Treatment Response and Resistance in Psychosis (TRRIP) consensus established standardised diagnostic criteria, but these have rarely been applied prospectively.

To estimate the incidence of TRS prospectively by using operationalised TRRIP criteria within a large community-based trial, and to examine whether baseline demographic or clinical variables predict its emergence.

We applied TRRIP criteria to 1334 participants with chronic schizophrenia enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. TRS was defined as persistent symptoms and functional impairment following two adequate antipsychotic trials, each meeting TRRIP thresholds for duration, dose and adherence. Incidence was estimated with bootstrap resampling, and logistic regression examined associations between baseline variables and TRS onset.

Of 1334 participants, 782 (58.6%) met TRRIP absolute symptom thresholds at baseline; 77 (9.8%) fulfilled full criteria for TRS during follow-up. The incidence rate was 5.68 per 100 person-years (95% CI 4.51–7.02) overall and 9.20 per 100 person-years (95% CI 7.43–11.39) among above-threshold participants. Higher baseline Positive and Negative Syndrome Scale positive and negative subscale scores and greater global illness severity were associated with TRS, although predictive performance was poor.

This first prospective application of TRRIP criteria to a randomised trial data-set provides robust estimates of TRS incidence. Routine clinical and demographic variables have limited predictive value, supporting the need for longitudinal, biologically informed studies that use TRRIP-aligned frameworks.

People diagnosed with schizophrenia can have functional impairments in multiple domains. Cognitive impairment is central to schizophrenia and has substantial prognostic value compared with other symptoms of schizophrenia. However, no study has previously investigated directed relationships in a complex system of cognitive, sociodemographic, clinical and quality of life (QOL) variables in people diagnosed with schizophrenia.

To identify the complex relationships of components of cognition with other cognitive components, as well as with clinical and QOL variables.

This study included data from 1450 participants in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The present study reconstructed a Bayesian network from this data using cognition, clinical, sociodemographic and QOL variables.

Processing speed was centrally associated with all other cognitive domains. Cognitive domains were conditionally independent of positive symptoms but moderately associated with negative symptoms (β = −0.25; P < 0.001). The positive symptoms subscale was independent of QOL, conditioning on third variables. Negative symptoms were moderately associated with QOL (β = −0.33; P < 0.001), and processing speed had a weak association with QOL (β = −0.12; P < 0.001). Processing speed was a central variable in the network.

Intervening with respect to processing speed may be the most beneficial way of improving other cognitive functions. More research is needed on directed networks that include social cognition and global levels of functioning.

Supporting voice hearers to explore and make meaning of their voice-hearing experiences can be helpful, but many mental health workers lack confidence or do not feel they have the skills required to do this. Although more is needed, some resources and training are available to assist workers in this area. To date, there are no suitable measures to evaluate the impact of these resources and training. Therefore, Supporting Voice Hearers Measure (SVHM) was developed. SVHM is a 23-item scale designed to evaluate mental health workers’ beliefs, attitudes, confidence and behaviours related to working with voice hearers.

To describe the development and testing of the SVHM.

Measurement properties explored included rating scale validity, unidimensionality, reliability, construct validity and person-fit statistics. Additionally, evaluations of concurrent validity, responsiveness and time taken to complete SVHM were completed.

A total of 548 completions of SVHM were included in the analysis. One item was interfering with measurement precision and was subsequently removed. The resultant 22-item measure demonstrated generally good measurement properties according to the quality criteria set. It demonstrated good concurrent reliability with confidence in working with voice hearers (r = 0.49, p < 0.001), strong responsiveness and evidence of feasibility, with a median time for completion of 3 min 39 s.

These results suggest that SVHM is a promising measure of mental health workers’ beliefs, attitudes, confidence and behaviours related to working with voice hearers. Future research should explore how changes in mental health workers’ beliefs, attitudes, confidence and behaviours impact the experiences and outcomes achieved by the voice hearers they are working with.

Mental health problems have long-lasting impacts and often begin in adolescence, yet young people face multiple barriers to accessing care and support, including a fragmented system, limited awareness of services and stigma. Afloat was developed to guide users to suitable support.

This study aimed to (a) co-develop a mobile app to support young people’s access to mental healthcare and support; and (b) evaluate its acceptability, potential impact on service use, mental health outcomes and economic implications.

Afloat was co-developed with young people to provide information on available support, and included personal stories from peers and links to care resources. A pilot evaluation involved 105 participants aged 16–25 years from London, UK. Participants completed surveys at baseline and 3 months to assess changes in mental health, service use, stigma and self-identification of mental health issues. App usage was monitored through analytics. A budget-impact analysis estimated financial implications of Afloat implementation.

Participants reported high acceptability and satisfaction. After 3 months, there was an increase in the likelihood of help-seeking and a reduction in mental health symptoms. The increase in actual service use was significant only among those with mild-to-moderate symptoms. Budget-impact analysis indicated potentially increased costs from additional service use.

Afloat shows preliminary promise as a tool associated with increased help-seeking and improved mental health. Long-term benefits of timely intervention may offset short-term costs from increased service use, although this requires formal evaluation. Further research is required to assess long-term outcomes and economic implications.

The effective implementation of evidence-based interventions is heavily dependent on matching interventions correctly to patients’ clinical needs, which, in turn, relies on the way the patients’ clinical needs are understood. Although previous research indicates a high degree of variability in assessment approaches, it remains unclear how clinicians determine clinical ‘caseness’ in routine practice. The aim of this study was to examine how clinicians make judgements about the nature of patients’ presentations when making care-related decisions in acute scenarios.

Semi-structured focus groups were undertaken with clinicians whose primary roles included assessments and decision-making in acute psychiatric scenarios. Participants were presented with a real-life vignette of a complex yet common presentation and asked to discuss their approaches to the assessment, conceptualisation and understanding a range of patient experiences illustrated in the vignette (with a particular focus on how the participant understands these experiences from perspective of phenomenology, psychopathology, causation and diagnosis). The interviews were recorded, transcribed and anonymised and the transcripts were subject to thematic analysis.

The results reported were based on an analysis of data from 4 focus groups involving a total of n=21 participants.

1. The thematic analysis of the way clinicians reached judgements about clinical ‘caseness’ identified four main themes:

2. Specific terminology to convey the relative clinical significance of patient experiences (e.g. ‘intrusive thoughts’ versus ‘voices’ or ‘hallucinations’).

3. Informal rules to reach a judgement about the clinical significance of signs and symptoms (e.g. rules based on the patient’s demeanour to determine whether or not to accept a patient’s self-report at face value).

4. Judgements about the typicality of the self-report.

5. Judgements based on causal assumptions about patients’ presentations (e.g. ‘drug-induced’ or ‘personality disorder voices’).

The findings of this study indicate that in routine mental health practice clinicians reach judgements about the clinical significance of patients’ presentation by using a range of assumptions that are outwith conventional guidance for assessing mental health morbidity. If these findings are supported by the results of other studies, then consideration should be given to (i) developing and implementing agreed approaches to determining clinical caseness in routine practice and (ii) ensuring that implementation research includes an evaluation of the impact of caseness-related judgements on the effectiveness of interventions in routine care.

Two functional genetic polymorphisms, ADH1B rs1229984 and ALDH2 rs671, play key roles in ethanol metabolism and are especially prevalent in East Asian populations. The rs1229984 variant accelerates the conversion of ethanol to acetaldehyde, whereas rs671 reduces enzymatic activity for converting acetaldehyde into acetic acid. These variants affect alcohol use disorder risk and have been implicated in various systemic conditions.

To investigate the broader associations of ADH1B rs1229984 and ALDH2 rs671 with habitual alcohol use in large, unselected populations.

We analysed data from 146 374 Taiwanese adults (aged 20–90 years) enrolled in the Taiwan Biobank.

Both variants showed clear associations with habitual alcohol use. The ADH1B rs1229984 CC genotype was associated with a higher prevalence of drinking, indicating a substantial contribution to alcohol-related behaviour. The ALDH2 rs671 A allele was linked to markedly reduced drinking, reflecting known intolerance among carriers rather than implying a uniformly larger effect than ADH1B. Beyond alcohol use, rs671 showed a protective association with gout, whereas rs1229984 was not significantly associated with chronic diseases after correction.

In this large population sample, both ADH1B rs1229984 and ALDH2 rs671 demonstrate meaningful, genotype-dependent effects on habitual alcohol use. Their combined effects underscore the importance of evaluating gene–gene interactions rather than attributing disproportionate influence to a single locus.

Psychiatry is a rewarding career, but many medical students have limited exposure to the specialty. Extracurricular enrichment programmes aim to provide early exposure to psychiatry, promote positive attitudes and encourage early career interest.

To systematically review literature on extracurricular psychiatry enrichment programmes for undergraduate medical students.

The review was registered with PROSPERO (CRD420251025990) and followed PRISMA guidelines. Four databases were searched using pre-determined search strings. Records were screened and data extracted independently by two authors. Quality was appraised using the Mixed Methods Appraisal Tool. A narrative synthesis summarised and consolidated findings.

Of 731 articles screened, 65 full reports were assessed for eligibility and 27 were included. These studies were conducted across 10 countries, most commonly the USA and UK. Programme duration and format varied from single-day events (n = 2) to longitudinal mentoring schemes spanning medical school (n = 5). Summer schools were most common (n = 10). Other schemes included mentoring, elective courses, special study modules, student-led clinics and film/media-based activities. Student feedback was positive, particularly for mentoring and film/media initiatives. Most studies reported improved attitudes towards psychiatry and mental illness, with several reporting statistically significant improvements using validated tools. Of 18 studies assessing career intentions, 16 reported increased interest in a career in psychiatry, and six studies reported higher subsequent match rates into psychiatry specialty training.

The available literature on voluntary extracurricular enrichment programmes suggests that they may provide positive student experiences and are associated with improved attitudes and early interest in psychiatry through meaningful learning opportunities. However, the evidence base is limited as most studies were small, self-selected samples with short-term follow-up and predominantly self-reported outcomes.

There is limited research exploring healthcare workers’ (HCWs) attitudes toward individuals with mental illness within mental health settings in the Arabian Gulf countries. Given their central role in patient care, understanding HCWs’ perceptions is vital for improving mental health services. Oman’s universal healthcare system provides free access, and psychiatric care is delivered through a tiered referral structure from primary to tertiary facilities.

This study aimed to (1) assess HCWs’ attitudes toward people with mental illness (PWMI) in a tertiary psychiatric hospital in Oman and (2) evaluate the reliability and construct validity of the Community Attitudes toward the Mentally Ill (CAMI) scale in this context.

A cross-sectional survey was conducted from March to August 2020 among HCWs at a tertiary psychiatric hospital. 315 HCWs of various nationalities completed the survey (response rate=55%). The survey included socio-demographic data and the CAMI scale, which measures attitudes across four subscales: Authoritarianism, Benevolence, Social Restrictiveness, and Community Mental Health Ideology. Data analysis included t-tests, ANOVA, regression, and Confirmatory Factor Analysis (CFA) using SPSS and AMOS software.

Presently used 30-item CAMI scale showed an acceptable internal consistency (Cronbach’s alpha: 0.62–0.91) and acceptable model fit in CFA. Authoritarian and socially restrictive attitudes were more prevalent among Omani nationals, HCWs with longer psychiatric tenure, and workers with personal histories of mental illness. In contrast, benevolence and positive community mental health attitudes were linked to Omani nationality, psychiatric experience, working by desire, and personal mental health experiences. Furthermore, male participants exhibited lower stigma levels than females.

Findings highlight the role of culture, work experience, and personal history of mental illness in shaping HCWs’ attitudes toward PWMI. The validated CAMI scale supports future research and targeted intervention development. Culturally sensitive education programmes are essential to reduce stigma levels and encourage inclusive mental healthcare in Oman.

Long-term segregation (LTS) is used in mental health hospitals in England to manage individuals perceived to pose a sustained risk of harm to others. Increasing evidence indicates that LTS causes significant psychological and physical harm and may breach international human rights standards. The HOPE(S) programme (2022–2025) was introduced nationally to reduce, and ultimately end, the use of LTS for autistic people, individuals with learning disabilities and children and young people.

To explore the experiences of LTS from different perspectives and to examine its impact through a human rights lens.

Qualitative data were collected from 73 participants, including people with lived experience of LTS, family members, HOPE(S) practitioners, clinical staff, commissioners and regulators. Reflexive thematic analysis was conducted as part of a wider, mixed-methods evaluation of the HOPE(S) programme.

LTS was described by most participants as harmful, dehumanising and lacking in therapeutic value. Four interrelated themes emerged: (a) dehumanisation and erosion of personhood; (b) safeguarding and systemic failure; (c) psychological and relational harm; and (d) loss of hope and systemic inertia. These experiences reflected breaches of the Convention on the Rights of Persons with Disabilities, and of the Convention on the Rights of the Child.

LTS is not a therapeutic intervention and is associated with profound psychological harm and human rights violations. Systemic reform and implementation of rights-based, trauma-informed alternatives, such as the HOPE(S) model, are urgently required to safeguard well-being and dignity in mental healthcare.

The increasing demand for adolescent eating disorder services during and following the COVID-19 pandemic necessitated alternative treatment approaches. Traditional in-patient and daycare settings faced challenges, including resource limitations and geographical accessibility.

To describe and evaluate the outcomes of the Hospital at Home (H@H) service, an innovative, virtual, intensive treatment programme designed to prevent in-patient admissions or shorten length of in-patient stay.

A prospective cohort of 71 consecutive admissions from October 2021 to December 2024 was established. Data included percentage median body mass index (%mBMI), Eating Disorders Examination Questionnaire (EDE-Q), Children’s Global Assessment Scale (CGAS) and any readmissions for in-patient treatment within the following 6 months. Qualitative feedback was also sought from staff and a sample of patients and family members.

Of the 71 admissions to H@H, only 9 (13%) required hospitalisation. Mean %mBMI increased significantly, from 82.4% (s.d. 8.17) on admission to 90.07% (s.d. 9.44) on discharge (p < 0.001, 95% CI 5.67 to 9.61). Global EDE-Q score improved significantly, from 3.75 (s.d. 1.32) on admission to 2.62 (s.d. 1.45) on discharge (p < 0.001, 95% CI −1.47 to −0.78). Average CGAS improved significantly, from 38.7 (s.d. 7.4) on admission to 51.8 (s.d. 14.2) on discharge (p < 0.001, 95% CI 10.06 to 16.11). Families and patients reported high satisfaction with the virtual care model.

This innovative model prevented hospital admissions, demonstrating clinical benefits and high user satisfaction. Expansion and further research are recommended to explore the long-term clinical outcomes and cost-effectiveness.

Psychological factors play a critical role in rehabilitation after sports injury and may delay return to sport (RTS) despite physical recovery. However, the most prevalent psychological sequelae and the comparative effectiveness of rehabilitation strategies are not consistently integrated into clinical pathways. This study aims to identify common psychological outcomes following sports trauma and determine which evidence-based psychological interventions are most strongly associated with improved rehabilitation and RTS outcomes. We hypothesised that (1) functional psychological symptoms would be more prevalent than formal psychiatric diagnoses and (2) cognitive-behavioural approaches would show the strongest association with positive recovery outcomes.

A structured review of peer-reviewed literature published between 2014 and 2025 was conducted. PubMed and Google Scholar were searched using predefined keywords related to sports injury, psychological outcomes, and rehabilitation interventions. Studies were included if they assessed psychological symptoms, return-to-sport outcomes, or intervention effectiveness in injured athletes. Findings were synthesised narratively, with intervention effects grouped by therapeutic modality.

Functional psychological sequelae were common following sports injury, particularly fear of reinjury (50%), reduced confidence (45%), and sleep disturbance or hyperarousal (40%). These were more frequent than formally diagnosed psychiatric disorders such as PTSD (25%) or major depressive disorder (35%). Anxiety symptoms were the strongest psychological predictor of delayed RTS, while reduced confidence was consistently associated with poorer rehabilitation outcomes. Depressive symptoms were most evident during prolonged inactivity and career-ending injuries, where loss of athletic identity (25%) was prominent.

Among psychological interventions, cognitive behavioural therapy (CBT) demonstrated the highest reported effectiveness in reducing psychological symptoms and supporting RTS (28.6%, 95% CI [20.6–36.6]). Graded exposure showed the next greatest effect (23.2%, 95% CI [13.2–33.2]), followed by psychological skills training (17.9%, 95% CI [8.9–26.9]). Stress-management interventions improved adherence to physical rehabilitation, whereas arousal imagery techniques were linked to increased pre-RTS anxiety in some athletes.

Functional psychological symptoms are more prevalent than formal psychiatric diagnoses after sports injury, supporting our first hypothesis, while cognitive-behavioural interventions show the strongest association with improved psychological outcomes and RTS readiness, supporting our second. Routine psychological screening and targeted CBT-based support may enhance rehabilitation. A biopsychosocial approach incorporating ongoing psychological assessment, pre-injury profiling tools (e.g. Sport Mental Health Assessment Tool-1; Athletic Coping Skills Inventory-28) and a 4Ps framework supports tailored, preventative rehabilitation and promotes resilient RTS. Screening and data extraction by a single reviewer increases risk of selection bias.

Effective implementation of novel digital technologies to improve health outcomes requires an in-depth understanding of end-users’ perspectives and experiences.

We sought the perspectives of people with schizophrenia and schizophrenia-related disorders (SSD) on the acceptability of a novel short text message-delivered intervention targeting metabolic health, called Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART).

Twenty-nine participants with SSD and either at risk of type 2 diabetes (T2D) or with T2D, were recruited from 3 mental health sites in Brisbane, Australia. They were provided, for 12 weeks, with SMART text messages that embedded psychoeducation and behaviour change techniques to facilitate lifestyle behaviours crucial for metabolic health. Interviews explored participants’ experiences of SMART, barriers to its use and suggestions for improvement. The qualitative data were collected by three mental health researchers and analysed using thematic analysis.

Three themes were generated: acceptability and user experience, feasibility and implementation considerations, and mechanisms supporting change. SMART was found to be highly accessible and engaging, and participants reported positive lifestyle changes, including healthier eating, increased physical activity, weight loss and smoking cessation. The messages reinforced learning and supported participants’ readiness for change.

SMART is a world-first digital intervention aimed at improving metabolic health and diabetes self-management in individuals with SSD. High levels of acceptability of SMART highlight its strong potential as a digital innovation that can support its users in protecting their metabolic health while limiting the detrimental side effects of antipsychotic medications.

Parents of adolescents facing suicidality play a crucial protective role, but often feel overwhelmed. The Partners in Parenting Plus – Suicide Prevention (PiP-SP+) programme is a co-designed, coach-supported, online parenting programme aimed to empower parents within their carer role to manage their adolescent’s suicide risk.

To evaluate PiP-SP+’s acceptability, feasibility, validity and short-term effects.

Fifteen parents of adolescents aged 12–18 years, concerned about their adolescent’s suicidality, participated in an open-label, non-randomised uncontrolled trial. Parents (n = 11) completed semi-structured interviews, exploring the programme’s acceptability, feasibility and validity. Thirteen parents completed quantitative assessments of parental self-efficacy to respond to adolescent suicidality and non-suicidal self-injury, protective parenting behaviours, carer burden, parental distress, mental health support quality, family functioning, and adolescent anxiety and depressive symptoms at baseline and 120 days post baseline. Finally, nine adolescents of the participating parents self-reported anxiety symptoms, depressive symptoms and perceptions of parental support at baseline and 120 days post baseline.

PiP-SP+ was an acceptable, feasible and valid intervention for parents. Significant baseline-to-post-intervention improvements were observed in parents’ self-efficacy to respond to adolescent suicidality and non-suicidal self-injury, protective parenting behaviours, carer burden, parental distress and mental health support quality. No significant differences were reported in family functioning. Adolescents perceived increased parental support; both parents and adolescents reported reductions in adolescent anxiety symptoms. Although parents reported a significant decrease in adolescent depressive symptoms, adolescents did not.

Findings support the value of undertaking an appropriately powered, randomised controlled trial to confirm these pilot findings.