Mental disorders are a leading cause of disease burden in 10–24-year-olds. In Australia, fragmentation within and across health, mental health and human services sectors contributes to gaps in service provision and increased disease burden. Comprehensive methodologies are needed to identify service gaps and inefficiencies to shape policy, optimise resource allocation and improve outcomes for young people.

To describe the design and methodology of a population-based data linkage study involving evaluation of health, mental health and human service use among young people in Victoria and identify subgroups experiencing unmet mental health needs.

The primary cohort comprises young people aged 12–25 years in the period between January 2018 and December 2025. For comparative purposes, children aged 5–11 years and adults aged 26–53 years are also included. We describe data sources, linkage methodology and planned analyses. Traditional statistical methods alongside contemporary machine learning and natural language processing techniques will be used.

The study will provide a comprehensive examination of the clinical characteristics of young people, their service use behaviour and typical pathways through care that cannot be gleaned from examining datasets in isolation. Ongoing consultation and engagement with young people and key stakeholders will inform interpretation, dissemination and translation of findings.

By integrating data across multiple service sectors, this study will generate novel evidence regarding pathways through care and unmet mental health needs among Victorian young people. Findings will inform mental health service reform and support improvements in healthcare delivery, service integration and outcomes for young people.

People with intellectual disabilities experience higher rates of mental disorders, contributing to restrictive practices and premature mortality. Prevalence data are essential to understanding the patterns of disease, and for the development of tailored interventions.

To systematically examine the burden and pattern of mental disorders in people with intellectual disabilities across the lifespan.

We searched six databases (inception to 17 October 2024), and conducted a manual search up to 15 December 2024, for systematic reviews on the prevalence of mental disorders in people with intellectual disabilities with or without neurodevelopmental conditions. We conducted a narrative synthesis of prevalence rates, including those stratified by intellectual disability level, sex, age and autism, where available, and compared these with published prevalence rates in people without intellectual disabilities (International Prospective Register of Systematic Reviews, no. CRD42024610611).

We included 26 systematic reviews: 7 meta-analyses and 19 narrative reviews. Compared with the general population, the prevalence of schizophrenia (3.55–4.80%), anxiety (5.4–5.5%) and obsessive–compulsive disorders (2.4%) appeared higher, whereas that of mood (6–7%), personality and post-traumatic stress disorders appeared lower. Study quality was moderate to critically low. For syndromic intellectual disabilities we noted high anxiety rates in fragile-X, Williams and 22q11.2 deletion syndromes, and in those with co-occurring autism. We found gaps on dementia, bipolar, substance use and eating disorders, and limited data stratified by intellectual disability level, sex and age.

This umbrella review confirms the high prevalence of mental disorders among people with intellectual disabilities, and highlights limited evidence for several conditions and population subgroups, including for minoritised ethnic groups. Standardised, high-quality epidemiological research is needed to shape clinical care and public mental health policy.

Obstructive sleep apnoea (OSA) is a common sleep disorder linked to significant psychological issues, particularly depression and anxiety. The relationship between OSA and these mental health conditions is complex and has not been thoroughly studied in the Omani population.

This study aimed to assess the prevalence of depression and anxiety in patients diagnosed with OSA at Almasarra Hospital (AMH) in Oman and to identify related socio-demographic and clinical factors.

This cross-sectional study involved 108 patients diagnosed with OSA, with data collected during routine follow-ups at AMH. Structured questionnaires were used to gather demographic information and responses to the Hospital Anxiety and Depression Scale (HADS). Statistical analyses included descriptive statistics, Pearson correlation, and regression models to identify predictors of depression and anxiety.

The study found that 22.2% of participants exhibited depressive symptoms, while 17.6% showed anxiety symptoms. A significant positive correlation was found between anxiety and depression scores (r=0.680, p<0.01). Regression analysis revealed that higher BMI and employment status were significant predictors of both depression and anxiety (p<0.05). The mean age of participants was 38.35 years, with a notable prevalence of overweight/obesity (mean BMI=32.31). While sleep severity indices showed only marginal associations, psychosocial factors appeared to have a greater impact.

A significant proportion of Omani patients with OSA experience symptoms of depression and anxiety, which are interconnected and influenced by lifestyle factors. Incorporating mental health assessments into routine OSA management may enhance patient outcomes and overall quality of life.

Concurrent psychiatric care in medical in-patients is associated with adverse hospital stay outcomes, but data from low- and middle-income countries is limited.

We aimed to investigate the association between psychiatric diagnosis–medication concordance and discharge disposition outcomes in acute medical in-patients.

This was a retrospective cross-sectional analysis of 16 868 adults presenting to the Department of Internal Medicine at Aga Khan University Hospital, Karachi, Pakistan (2018–2022) with specified acute care conditions. Patients were classified into four groups based on presence of a psychiatric diagnosis and/or psychiatric medication use: neither, medication without diagnosis, diagnosis without medication and both. Primary adverse outcomes were in-hospital mortality and leaving against medical advice. Multinomial logistic regression was used, adjusting for age, gender, Charlson Comorbidity Index score, medication burden and individual acute medical conditions.

A total of 2527 (15.0%) patients had a documented psychiatric diagnosis; however, 6279 (37.2%) received at least one psychiatric medication. Referencing patients with neither exposure, those receiving psychiatric medications without a documented diagnosis had the highest adjusted odds of mortality (adjusted odds ratio (aOR) 1.95, 95% CI 1.74–2.19, p < 0.001) and higher odds of leaving against medical advice (aOR 1.21, 95% CI 1.06–1.39, p = 0.006). Patients with a documented diagnosis but no psychiatric medications had higher odds of leaving against medical advice (aOR 1.28, 95% CI 1.04–1.57, p = 0.022) without a significant increase in mortality (aOR 1.21, 95% CI 0.98–1.49, p = 0.076). Patients with both a diagnosis and psychiatric medication usage showed no significant change in either outcome.

Diagnosis–treatment concordance may be associated with in-patient prognosis in acute care conditions.

Adults with intellectual disabilities who display behaviours that challenge (BtC) are more prone to poor health.

This study seeks to evidence the long-term health outcomes for those who display BtC.

We conducted a longitudinal cohort study of adults with intellectual disabilities aged ≥18 years in England, using data from the Clinical Practice Research Datalink Aurum (January 2003 to December 2023) linked to Hospital Episode Statistics and Office for National Statistics. Main outcome measures were annual health checks, general practitioner referrals, emergency visits, out-patient attendance, in-patient admissions and mortality.

Among 83 166 adults with intellectual disabilities (mean age 38.6 years), 18.5% had a record of BtC, with similar sociodemographic distributions to those without BtC, but higher rates of physical and mental health comorbidities and uptake of annual health checks. A total of 72.5% of participants with BtC were receiving psychotropic medication(s). Adults with BtC had higher rates of mental health out-patient attendance (odds ratio: 1.42, 95% CI 1.33–1.52) and in-patient admissions (incidence rate ratio (IRR): 1.19, 95% CI 1.09–1.29), but consistently lower rates of physical health out-patient attendance (IRR = 0.81, 95% CI 0.78–0.84) and in-patient admissions (IRR = 0.77, 95% CI 0.74–0.79), after adjusting for demographic and clinical characteristics. BtC were not associated with mortality after adjustment for comorbidities (hazard ratio: 0.97, 95% CI 0.93–1.00).

This longitudinal study not only corroborated the markedly elevated burden of physical and mental health comorbidities among individuals displaying BtC, but also indicated that repeated efforts to improve health outcomes have yielded minimal measurable benefit over time. The apparent absence of progress is likely underpinned by a combination of insufficiently effective or poorly tailored interventions and wider systemic constraints that limit the capacity of services to respond to the complex needs of this population.

Mental health issues in Arab countries, including Oman, have been traditionally stigmatized, leading to increased non-adherence to prescribed medications. This study aims to explore gender differences in medication adherence among patients with mental illness in Oman, highlighting the impact of social factors on treatment compliance.

A cross-sectional study was conducted at Al Masarra Hospital in Muscat between October 2020 and May 2021. Using convenience sampling, 302 participants aged 18 and older, receiving follow-up care for documented mental health disorders, were recruited. The Medication Adherence Rating Scale (MARS) was employed to assess adherence levels and collect demographic data.

The study included 302 participants, predominantly aged 26–45 years (59.61%). Male patients had a mean medication adherence score of 5.75 (SD=2.550), compared to 5.67 (SD=2.347) for females. An independent samples t-test revealed a statistically significant difference, with a t-value of−2.027 (p=0.044), suggesting that gender influenced adherence rates. ANCOVA showed that marital status (F(1, 295)=5.321, p=0.021) and patient insight (F(1, 295)=7.456, p=0.007) significantly predicted adherence, whereas no significant effect of gender was observed.

This study highlights the complexity of medication adherence in mental health care, emphasizing the need for tailored interventions that consider gender dynamics and social support systems. By addressing these factors, mental health services can improve adherence rates and overall patient outcomes in Oman.

In England, 354 000 people were homeless on a given night in 2024. It has long been recognised that the physical and mental health of people who are homeless is poorer than for those who are stably housed. There are few peer-reviewed studies to inform health- and social care around depression or anxiety for people who are homeless in this setting.

To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe the distribution of symptoms across sociodemographic, health-related characteristics and indicators of social vulnerability.

We surveyed 311 adults between August and December 2021. We measured anxiety and depression symptoms using the four-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of sociodemographic, social vulnerability and health-related characteristics, and tested for associations with the Kruskal–Wallis test.

The median PHQ-4 score was 7 out of 12, with 38% having scores warranting clinical attention. While PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and marijuana use. The most common barrier to accessing healthcare related to transportation (60%).

People who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support further coordination between health- and social care sectors.

Many autistic adolescents receive in-patient psychiatric care from services that are ill-equipped to meet neurodivergent needs. However, the outcomes for autistic adolescents accessing in-patient care remain poorly understood.

To document the demographics and clinical outcomes of autistic adolescents referred to in-patient psychiatric services over a 5-year period and compare these with those of their allistic peers accessing the same services.

We conducted a retrospective cohort study involving all adolescents (aged 12–17 years inclusive) referred for in-patient psychiatric care through the Thames Valley Provider Collaborative between 1 April 2019 and 31 March 2024. Clinical characteristics and outcomes of referrals for autistic and allistic adolescents were collected and summarised from routine service data. Inferential statistics (including t-tests and chi-squared tests) were used to compare characteristics between the autistic and allistic groups.

Autistic adolescents were more likely than their allistic peers to be referred in an emergency (24.6 v. 16.6%) and for risk management (53.7 v. 33.5%). Autistic adolescents without an eating disorder had longer average length of stay than their peers (146.1 v. 97.5 days) and were more likely to be discharged to more secure settings following admission (12.9 v. 7.7%). Emerging evidence from routine outcome measures suggests less positive progress during in-patient care and greater impairment among autistic adolescents at both admission and discharge.

There are important differences in outcomes from psychiatric in-patient admissions between autistic and allistic adolescents. Greater work is needed to understand these differences and the factors influencing treatment success for autistic adolescents.

Forensic mental health services need a reliable and repeatable outcome measure to assess the progression of self-rated recovery during the forensic journey. The Questionnaire about the Process of Recovery (QPR) was developed in individuals with psychosis, and has been used to assess recovery in people with severe mental illness; however, its psychometric properties have not been studied in a forensic psychiatric cohort.

This study aimed to assess the psychometric properties of the QPR in a sample of individuals who currently access, or formerly accessed, high-security psychiatric care, including internal consistency, test–retest reliability, factor structure and criterion validity.

Psychometric analysis was undertaken in a sample of 146 current or former high-security patients. Confirmatory and exploratory factor analysis examined the latent test structure. Non-parametric comparisons of QPR score indices tested for differences according to individuals’ current setting (high-, medium- or low-security or open wards; community) as evidence of criterion validity.

A unique two-factor structure related to self-actualisation/empowerment and growth/insight fit forensic patients’ QPR responses. Internal consistency and test–retest reliability were adequate for QPR all-item scores for the original and shortened scales, as well as for the new forensic factor scores. QPR score indices differentiated patients by current setting (eta2 = 0.03–0.04), although only the forensic factor related to growth/insight was significant in corrected post hoc comparisons.

The original QPR is recommended for use to assess recovery progress in a forensic psychiatric sample. Forensic patients’ scores may be best represented using the unique two-factor structure identified.

In-patient mental health rehabilitation services provide specialist care to adults with complex psychosis. In England, there are more than 350 such services, half provided by the National Health Service (NHS) and half by the independent sector.

To investigate whether NHS and independent sector in-patient mental health rehabilitation services differ.

We recruited a random sample of NHS and independent sector services across England. We collected cross-sectional data regarding service and patient characteristics through interviews with patients, clinicians and managers, and from healthcare record reviews.

We recruited 411 patients from 48 NHS services and 172 patients from 20 independent sector services. Service characteristics, including standardised quality scores, were similar. Most patients had a diagnosis of schizophrenia (NHS n = 237, 57.7%; independent sector n = 99, 57.6%) or schizoaffective disorder (NHS n = 88, 21.4%; independent sector n = 32, 18.6%). More than half had at least one comorbid condition, but more independent sector patients had at least two (NHS 131 of 411, 31.9%; independent sector 80 of 172, 46.5%; P = 0.001). Current admissions were twice as long for independent sector patients (NHS mean 1.2 years [s.d. 1.5]; independent sector mean 2.4 years [s.d. 2.8]). Standardised ratings of patients’ quality of life, autonomy, time use, satisfaction with care, social and everyday functioning, and challenging behaviours were similar. However, independent sector patients had more needs (NHS mean 6.5 [s.d. 3.2]; independent sector mean 7.9 [s.d. 3.9]; P < 0.001) and more had a history of fire setting (NHS 32, 7.9%; independent sector 28, 17.2%; P = 0.001).

Both NHS and independent sector in-patient rehabilitation services support people with complex psychosis, but independent sector patients may have more complex conditions, which could explain their longer admissions.

Emotional disorders are increasingly prevalent among medical students, significantly affecting their well-being and academic performance due to high levels of academic pressure. This study aims to assess emotional distress at Oman Medical College, addressing a gap in understanding mental health within this demographic and underscoring the need for targeted interventions.

Conducted from April to May 2025, this descriptive cross-sectional study utilized standardized surveys to evaluate emotional distress among medical students at the National University of Science and Technology in Oman. Data were collected through an online questionnaire from a convenience sample of 400 students, employing the General Health Questionnaire (GHQ-12) for mental health assessment. Statistical analysis was performed using SPSS to determine significance.

Of the 400 students invited, 336 completed the survey, yielding a response rate of 84%. The average age of participants was 21.6 years, with the majority identifying as female (89.6%) and Omani nationals (78.2%). Emotional distress was reported by 73% of respondents, with exam-related stress identified as a key contributing factor. Notably,students who received strong parental support exhibited significantly lower levels of emotional distress (p <0.05).

This study reveals a high prevalence of emotional distress among medical students in Oman, closely linked to academic stressors and mitigated by familial support. These findings highlight the urgent need for tailored mental health programmes and resilience-building interventions within medical education in Oman.

Relapse following discharge from inpatient rehabilitation remains a major challenge in substance use disorder (SUD) care and is associated with significant clinical, social, and legal consequences. While relapse rates are well described, far less is known about the timing of relapse, particularly within mandated treatment systems where patients are referred through legal (Court) or regulatory pathways (General Persecution) and experience structured supervision and monitoring. Identifying periods of heightened vulnerability following discharge is critical for optimising aftercare strategies and allocating resources effectively. This study aimed to characterise the timing and distribution of relapse events following discharge from inpatient SUD rehabilitation in Qatar and to identify critical post-discharge periods for targeted preventive intervention within mandated treatment pathways. We hypothesised that relapse risk would be highest during the early post-discharge period.

A retrospective cohort study was conducted including 72 patients discharged from an inpatient SUD rehabilitation programmeoperating under a mandated treatment framework. All patients entered a structured aftercare pathway with routine follow-up and urine drug screening. Relapse was defined as a documented positive urine drug screen for illicit substances during follow-up. Time-to-relapse was measured from the date of discharge and tracked over a 26-week post-discharge period. Patients who did not relapse during follow-up were censored at their last negative drug screen. Kaplan–Meier survival analysis was used to estimate relapse-free survival and to describe the temporal distribution of relapse events across the follow-up period.

During the 26-week follow-up, 40.3% of patients (n=29) experienced relapse. The median time-to-relapse was 28 days, indicating that half of all relapse events occurred within the first four weeks following discharge. Relapse timing ranged from 7 to 182 days, demonstrating substantial inter-individual variability in post-discharge recovery stability. Kaplan–Meier survival curves showed the steepest decline in relapse-free survival during the first month after discharge, identifying this period as the highest-risk phase for recurrence. Beyond the initial four weeks, the hazard of relapse declined progressively over time, with fewer new relapse events observed in later follow-up.

This time-to-event analysis demonstrates that the first four weeks following discharge constitute a critical vulnerability window for relapse among patients undergoing mandated inpatient SUD rehabilitation. Findings support prioritising intensive early aftercare, enhanced monitoring, and rapid-response interventions during the immediate post-discharge phase. Targeting this high-risk period within mandated treatment pathways may reduce early relapse and improve longer term recovery outcomes.

Treatment-resistant depression (TRD) poses a significant clinical challenge, with limited evidence guiding long-term pharmacological strategies. Esketamine, a glutamatergic modulator, has demonstrated short-term efficacy in TRD, but data on its extended use in real-world settings remains scarce.

This study aimed to evaluate the long-term effectiveness and side-effects of intranasal esketamine in adults with TRD over more than 100 treatment sessions.

We conducted a retrospective, single-arm, pre–post study of 20 patients with TRD at a psychiatric out-patient clinic in the United Arab Emirates. All participants received ≥100 sessions of intranasal esketamine alongside oral antidepressants. Depression and anxiety symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) scales. Side-effects were monitored through blood pressure, sedation, dissociation, urinary symptoms and psychiatric symptoms.

After an average of 129 esketamine sessions (mean duration 2.5 years), PHQ-9 and GAD-7 scores significantly decreased (P < 0.001). A total of 85% of patients improved in depressive severity, with 25% achieving remission; 65% improved in anxiety severity, and 20% reached remission. Esketamine was generally well tolerated; side-effects were mild and transient, with no serious adverse events. However, urinary symptoms suggestive of cystitis occurred in 20% of patients, highlighting the need for ongoing monitoring in long-term treatment.

Intranasal esketamine demonstrated sustained effectiveness and an acceptable side-effect profile in a real-world TRD cohort with extensive psychiatric comorbidity. These findings support its long-term use in complex clinical populations, and underscore the need for further prospective, multi-site studies.

Pre-existing cardiovascular disease (CVD) affects 1–4% of pregnancies in the USA and is associated with maternal morbidity. High-risk pregnancies with increased medical supervision are associated with poor postpartum mental health, although the prevalence in those with CVD is unclear.

This scoping review aimed to synthesise estimates of post-pregnancy mental health outcomes among people with pre-existing CVD.

Cochrane Library, Ovid Medline, Ovid EMBASE, Scopus, Google Scholar and Web of Science Core Collection were searched to identify relevant published literature, using controlled vocabulary and keywords for post-pregnancy mental health and CVD in pregnancy. The search was not limited by publication type, year or study design. Studies that included an assessment of post-pregnancy depression, anxiety or post-traumatic stress disorder (PTSD) symptoms after a pregnancy complicated by pre-existing CVD were included.

Of the 1591 studies screened, 7 met the inclusion criteria. In patients with pre-existing CVD, 4 studies assessed depressive symptoms and found a prevalence of 10.4–32.2%; 2 studies assessed anxiety symptoms and found a prevalence of 22.0–28.5%; and 1 study assessed PTSD and found a prevalence of 26.4% for mild symptoms and 18.2% for moderate symptoms.

The prevalence of post-pregnancy depression, anxiety and PTSD symptoms among people with pre-existing CVD may be similar to, or higher than, estimates from the general population. However, there was high heterogeneity in the included studies. More research is needed to determine if there is an increased risk of postpartum mental health disorders for pregnant people with pre-existing CVD.

Globally, suicide is more prevalent in older adults compared with any other age group. Although some research has identified risk and protective factors for suicidal behaviour in older adults, further research is needed to provide an up-to-date overview to inform service delivery.

This study protocol describes mixed-methods research that will examine and identify factors associated with self-harm and suicide in older adults (aged 60 years and older) living in Ireland.

Four stages will be conducted. First, data from the National Self-Harm Registry of Ireland (NSHRI), will be used to examine recent hospital self-harm presentations of older adults, including during the COVID-19 pandemic. Second, a case-series study will examine the adverse life events and psychosocial factors experienced by older adults before dying by suicide, using data from closed coronial files, through the Irish Probable Suicide Deaths Study (IPSDS). Third, risk of suicide following hospital-presenting self-harm will be examined among older adults via data linkage of the NSHRI and IPSDS. Finally, using semi-structured interviews, the service needs of older adults with suicidal behaviour will be explored from the perspectives of older adults, carers and healthcare practitioners.

A comprehensive understanding of adverse events and psychosocial factors associated with the suicidal behaviour of older adults is needed to inform service provision. This proposed research is aligned with (inter)national priorities, mental health promotion and suicide reduction policies. It aims to address gaps in mental healthcare interventions for older adults at risk of suicide.

By 2021, we found that 88 Recovery Colleges were operating in England. Recovery Colleges adhere to shared principles including adult education and co-production, but are also heterogeneous, varying in the populations they serve, their sources of funding and access to resources. Previous research has not explored the organisational factors that influence the set-up of Recovery Colleges, nor the factors which facilitate or pose challenges to their sustainable operation.

To identify how Recovery Colleges vary in their operation and to ascertain how organisational factors facilitate or hinder the set-up, running and sustainability of English Recovery Colleges.

Semi-structured interviews with 31 Recovery College managers across England were analysed using framework analysis.

Four themes were identified: Recovery College pioneers; Adapting to the local context; Degree of autonomy within the National Health Service; and Ongoing organisational work. Colleges were commonly established by key individuals from diverse backgrounds, leveraging their organisational positions and lived experience to facilitate implementation. Colleges were adapted to fit local contexts, shaped by factors including existing services, regional demographics and community resources. Colleges varied in their relations with key funders, with some operating comparatively autonomously and others tied closely to their ‘parent’ organisations. Sustaining college operations involved ongoing organisational work to respond to changing pressures.

Recovery Colleges exhibit consistent values and aims oriented around supporting recovery through education and co-production but are diverse in their operation. These colleges are highly complex interventions, and their sustainability requires organisational agility to manage competing pressures.