Parental substance use (PSU) is associated with increased psychiatric risk among offspring, but evidence from Sub-Saharan Africa remains limited.

To examine cross-sectional associations between PSU and Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) algorithm-defined adolescent psychiatric symptom profiles in Lagos, Nigeria, and assess whether family dysfunction statistically attenuates these associations.

Data came from the Lagos Schools Emotional and Behavioural Health Survey, a school-based sample of 9437 adolescents aged 11–17 years. PSU was categorised as neither parent, only father, only mother or both parents using substances, defined as adolescent-reported at least weekly parental alcohol consumption or tobacco use over the past 12 months. Psychiatric symptom profiles were identified using structured MINI-KID self-report algorithms administered with trained research-assistant support. Logistic regression estimated adjusted odds ratios (aORs). Family dysfunction, defined as domestic violence or high family conflict, was examined using cross-sectional statistical attenuation models.

PSU was reported by 20.0% of adolescents: 17.3% father-only, 1.3% mother-only and 1.4% both parents. Associations followed a graded pattern. Dual-parent PSU was associated with increased odds of symptoms meeting algorithm thresholds for substance use disorder (aOR = 5.84, 95% CI 3.42–9.97), alcohol use disorder (aOR = 4.98, 95% CI 3.09–8.03) and major depressive disorder (aOR = 2.81, 95% CI 1.94–4.07). Family dysfunction partially attenuated selected associations.

PSU was associated with elevated adolescent psychiatric symptom profiles in a graded fashion. Findings are cross-sectional and do not establish causality. Outcomes represent self-reported symptoms meeting MINI-KID algorithm thresholds, not clinician-confirmed diagnoses.

Paranoia is a transdiagnostic symptom and is associated with cognitive and social impairments. Attentional bias toward threat is thought to maintain paranoia.

Despite many studies, attentional biases in paranoia have not been systematically summarised, which was the aim of the current work.

We conducted a systematic review and meta-analysis, identifying 10 964 studies, of which 35 met inclusion criteria for review and 15 for meta-analysis.

Findings showed a significant negative attentional bias (average standardised effect size 0.26; 95% CI 0.01–0.52; p = 0.046). Preliminary indications suggested bias was strongest for paranoia-related stimuli (average effect size 0.30; 95% CI 0.03–0.57; p = 0.027) and stronger for words than faces (average effect size 0.41; 95% CI 0.05–0.77; p = 0.027), but more data is needed to confirm these effects. Limitations were primarily statistical and included likely underestimation of the overall effect size of the association between negative attentional bias and paranoia and a lack of sufficient studies to robustly examine moderators.

Summarising this literature provides a rationale for existing and new interventions for paranoia that target biased attentional mechanisms.

AWARE (Approaches for Wellbeing and Mental Health Literacy: Research in Education) is a three-arm, parallel-group, cluster randomised controlled trial. It assessed the effectiveness of two interventions – the Youth Aware of Mental Health (YAM) programme and Mental Health and High School Curriculum Guide – in addressing emotional well-being, compared with usual practice, among year 9 students in England.

To evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools.

Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – at 3–6 months after the start of intervention, and at 9–12 months post-intervention. Quality of life was measured with the Child Health Utility Index. Intervention delivery costs were calculated with data provided by the delivery teams. Service use costs were calculated with a short version of the Client Service Receipt Inventory, with unit costs obtained from publicly available sources.

For both interventions, difference in outcomes (change in quality-adjusted life-years over time) between the intervention group and control group were close to zero, with the largest change being an improvement of 0.0055 quality-adjusted life-years at the second follow-up for students in schools randomised to YAM. Changes in costs were likewise small.

At first follow-up, neither intervention is likely to be considered cost-effective. At second follow-up, YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio of around £23 000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20 000 to £30 000) as used by the National Institute for Health and Care Excellence.

People who are agitated, confused or distressed seldom receive holistic care within acute general hospitals. Unmet needs relating to conditions such as mental illnesses, learning disabilities or dementia can contribute to patient behaviours which staff find challenging to manage (e.g. self-harm). Enhanced observation, involving one-to-one care and monitoring, is a restrictive intervention often used to manage these presentations. The characteristics and outcomes of high-quality enhanced observation in this setting remain ill-defined, compromising quality and safety.

To understand what constitutes high-quality, safe enhanced observation in an acute general hospital for patients presenting with agitated, confused or distressed behaviours.

A systematic review was performed, involving searches of five bibliographic databases, hand-searching, and forward and backward citation searching. Data describing the characteristics of high-quality, safe enhanced observation practice were eligible and included in a framework-based synthesis. Quality and safety outcomes were summarised thematically. Studies were appraised for quality, and data interpretation was shaped by lived experience experts.

Fifty studies were included. Enhanced observation practice was influenced by individual staff members (e.g. attitudes), teams (e.g. teamwork fluency) and wider organisational factors (e.g. leadership, organisational culture). The quality and safety problems identified included self-harm, aggression and staff neglect of caring responsibilities during enhanced observation.

Findings on the characteristics and outcomes of high-quality, safe enhanced observation provision should inform the development of evidence-based guidance to support improved, standardised practice in acute general hospitals. Evidence gaps with respect to patient experiences of enhanced observation and trauma-informed approaches to its delivery warrant urgent attention.

Lithium is a highly effective mood stabiliser but has a narrow therapeutic index. Inadequate monitoring increases the risk of toxicity, renal impairment and thyroiddys function. Consequently, NICE and local shared-care guidelines mandate structured baseline assessment and regular biochemical monitoring for all patients prescribed lithium.

This quality improvement (QI) project aimed to systematically evaluate adherence to NICE and local guideline standards for lithium monitoring within the inpatient rehabilitation service at the Royal Edinburgh Hospital (REH). The project sought to identify specific gaps in baseline and ongoing monitoring, assess the timeliness and completeness of required investigations. A further objective was to use these findings to inform targeted, sustainable interventions to improve compliance with monitoring standards, enhance patient safety and reduce the risk of preventable lithium-related adverse events within this high-risk population.

A retrospective review was undertaken of all inpatients prescribed lithium across five rehabilitation wards at REH between July 2023 and July 2025. Ten patients met inclusion criteria. Data were extracted from electronic health records, the electronic prescribing system, laboratory results and Lothian Quality Improvement, Safety, Teaching, Supervision, Audit and Evaluation (QISTSAE) adverse event reports. Collected variables included patient demographics, lithium initiation, duration of treatment, the completion and timeliness of required monitoring investigations. Compliance was assessed against NICE guidance and local shared-care protocols.

Significant gaps in lithium monitoring were identified across the cohort. Urine albumin–creatinine ratio (uACR) testing, recommended for early detection of lithium-associated renal damage, was consistently absent in all patients reviewed. Serum calcium and thyroid function tests were missed in approximately 60% of cases. In addition, timeliness of monitoring was suboptimal, with several patients having overdue lithium levels, renal function tests or thyroid investigations. Renal function was not consistently rechecked following elevated lithium levels despite explicit guideline recommendations and over 10%of the results recorded supratherapeutic lithium concentrations during the review period, representing a clear safety concern.

Lithium monitoring within the inpatient rehabilitation setting was inconsistent and frequently failed to meet guideline standards exposing patients to avoidable risk. uACR testing, calcium monitoring and thyroid surveillance represented particular areas of deficit. These findings highlight the need for system-level interventions to support safer lithium prescribing.

Planned next steps include expansion of the project to other inpatient and outpatient services, development of standardised lithium initiation and monitoring order sets in collaboration with laboratory services, targeted educational interventions for multidisciplinary teams to improve awareness, compliance and patient safety.

Haiti is experiencing a severe humanitarian crisis characterised by political instability and economic and security hardship. These adversities contribute to significant mental health challenges, which are also exacerbated by poor access to psychological support due to a shortage of specialised professionals. Problem Management Plus (PM+), a scalable and low-intensity intervention developed by the World Health Organization, is based on a task-sharing approach to address the treatment gap by training non-specialist helpers to provide psychosocial support.

This study aimed to explore the implementation process of PM+ in Haiti, focusing on the barriers and facilitators that influenced its delivery. Specifically, the study focused on understanding the contextual factors affecting intervention accessibility, participant experiences and potential adaptations to enhance its effect.

A qualitative study was conducted across three Haitian cities, where trained helpers delivered PM+. Data were collected through the PSYCHLOPS tool with end-users and via cognitive interviews with stakeholders. Thematic analysis was conducted incorporating Lund’s social determinants of mental health model and Bronfenbrenner’s ecological systems theory to interpret findings.

Sixteen end-users and five stakeholders participated in the study. Key barriers to implementation and its success mainly included economic constraints and safety concerns. Facilitating factors included strong community engagement, adaptive implementation strategies (such as flexible scheduling, remote supervision and culturally responsive adjustments), alongside strong organisational support. End-users described substantial difficulties in managing everyday problems and emotional distress, as reported during pre-intervention qualitative assessments.

PM+ appeared feasible in the Haitian context from an implementation perspective; however, its implementability depends on cultural adaptations, economic considerations and sustained support for facilitators. Addressing systemic barriers and integrating task-sharing interventions within existing health structures could enhance the long-term impact.

Known influences on tic severity include medical, biological and contextual factors.

We aimed to further understanding of contextual factors by exploring if tic severity is influenced by calendar month.

This study used data from the Calgary Child Tic Registry. Children are extensively clinically phenotyped at their first visit and followed prospectively until adulthood. We evaluated the mean Yale Global Tic Severity Scale-Revised (YGTSS-R) total tic severity score based on the calendar month. Multivariable linear regression models were fit to assess the individual months adjusted for age, gender, comorbidity and tic treatment variables.

The study included 370 participants, with 549 assessments of tic severity performed. In the univariable analysis based on calendar month, August had the lowest tic severity, with a mean YGTSS-R total tic severity score of 15.68 (95% CI 13.41–17.95). This was significantly lower than the month with the highest tic severity, February, with a mean score of 20.41 (95% CI 18.19–22.63). In multivariable models adjusted for age, gender, comorbidity and treatment for tics, the omnibus test for whether month contributes to a better fit were not significant (YGTSS-R total tic score P-value: 0.495). The only significant predictors of increased tic severity were treatment for tics (P < 0.0001), diagnosis of depression (P = 0.003) and diagnosis of obsessive–compulsive disorder (P = 0.02).

While our univariate analysis of tic severity by calendar month supported significantly lower tic severity in August compared with February, this association was no longer statistically significant when controlling for other variables known to impact tic severity.

Task-sharing with non-specialist providers offers a promising solution to the mental health workforce shortage in low-resource settings. Supervision is essential to ensure treatment quality, but is often constrained by limited specialist availability.

This study evaluated the costs of developing PEERS, a smartphone app that can facilitate registering and scheduling supervision sessions, collecting patient outcomes, rating therapy quality and assessing supervision quality among community-based non-specialist providers delivering behavioural activation for depression.

The PEERS digital application was developed between June 2021 and September 2022 for use in Madhya Pradesh and Goa, India. Development involved contributions from researchers, clinicians, technology experts and end users. Activity-based costing was used to systematically document the inputs and expenditures involved in developing the PEERS app and its accompanying training materials from a health systems perspective. Key cost components included human resources, leadership, IT support and infrastructure.

Total development costs were US＄130 027, with the costs of information technology accounting for the largest share (81%; US＄105 110). Human resource contributions accounted for 17% (US＄22 523), which included oversight and contributions from international research collaborators. Additional costs included overhead and infrastructure (US＄2393).

Digital tools are increasingly being used to expand access to and support the delivery of mental health interventions in low-resource settings, yet few studies report on the development costs. By estimating the costs and resources required for developing a digital app for peer supervision, this study can inform efforts to facilitate broader implementation and adaptation of the app for use in other settings.

Patients admitted to Older Adult Psychiatric Wards often have significant comorbidities putting them at increased risk of clinical deterioration. As MDT morale in managing these patients varied greatly, this project aimed to improve confidence and knowledge in recognising physical deterioration, escalating concerns and initiating Immediate Life Support (ILS).

A pre-intervention questionnaire was distributed to MDT, including nurses, healthcare assistants, student nurses and allied health professionals. The questionnaire assessed knowledge and confidence in recognising clinical deterioration, escalation pathways, contacting emergency services, situation-background-assessment-recommendation (SBAR), and initiating ILS. The questionnaires used a mixture of close-ended questions, Likert scale, predefined option selection and open-ended short-answer questions, to explore perceived challenges. An interactive teaching session was delivered, focusing on acute clinical signs, NEWS chart, escalation pathways, practical ILS skills and SBAR. A confluent patient scenario was paired with questions to encourage participants’ engagement and learning. A post-teaching questionnaire with the same format as the pre-teaching questionnaire was completed to reassess confidence, awareness, and perceived impact on patient safety.

16 staff-members completed the pre-intervention questionnaire and 13 completing post-intervention. Pre-intervention, 19% of staff rated themselves as confident (Likert score 4–5) in recognising physical deterioration, 25% in escalation of concerns and 20% in initiating ILS. Anxiety of “getting it wrong” was reported by over 70% of respondents being cited as a barrier to escalation. 38% felt current escalation and management processes were clear.

Pre-intervention, 69% reported knowledge of local escalation policies, ILS processes and paramedic handover. Post-intervention this had grown to 100%.

There was substantial improvement in confidence across all domains post-intervention.On recognising physical deterioration, 92% of respondents rated themselves as confident or very confident. On escalation and calling emergency services and on initiating ILS, confidence increased to 92% and 83% respectively. Confidence in delivering a comprehensive handover improved from 25% pre-intervention to 92% post.

Post-intervention, 100% agreed or strongly agreed that the intervention would improve patient safety on the ward. Across every domain there was growth in mean confidence scores (mean increase of a factor of 1.46).

Team knowledge and confidence in managing and escalating the acutely unwell patient was significantly improved following targeted ward-based teaching. Following staff feedback requesting visual prompts, a second PDSA cycle is planned to introduce informative posters around the ward to reinforce key learning points.

Around 10% of people living with dementia (PLWD) will experience a deterioration in their condition that will require urgent (‘crisis’) community support or an in-patient psychiatric admission. We have previously shown that people at high risk of a crisis event can be identified at the point of diagnosis. How the idea that someone is at increased risk of experiencing a crisis event in their care is best communicated is not known. Here, we describe the analysis of interviews with clinicians and PLWD, to understand their perspective and the co-production of tools designed to support risk communication.

To explore multistakeholder perspectives (healthcare professionals, carers, PLWD; n = 12) on the communication of risk of future in-patient psychiatric admission or enhanced ‘crisis’ community care and develop tools to support communication.

This pilot study used an experience-based, co-design approach. Reflexive thematic analysis was used to analyse transcripts, leading to co-development of draft educational materials.

We identified five themes that inform how risk should be communicated. Participants underlined the importance of timing, setting and follow-up appointments. Digital tools were considered essential, but they were not seen as a substitute to face-to-face appointments. Individual preferences varied, highlighting the need for patient-centred communication. The findings led to the co-development of clinician guidelines and educational materials.

Risk communication in dementia is complex and must be personalised to be most effective. Our findings may have relevance for the communication of other areas of risk in dementia beyond risk of care crises.

Anxiety is the most prevalent mental health condition, causing significant distress, disability and cost.

This pilot study assessed the feasibility and acceptability of an eight-week self-directed online exercise intervention, supported by wearable activity monitors (WAMs), for mid-life and later-life adults with clinically significant anxiety, and provided preliminary estimates of effectiveness.

The Exercise Therapy to Reduce Anxiety (ExTRA) project recruited 21 participants aged 40–77 years with Depression, Anxiety and Stress Scales (DASS-21) anxiety scores >7. The ExTRA online platform integrated with the WAMs, and provided information about anxiety, exercise programmes and strategies to help meet national physical activity guidelines, overcome barriers and set goals.

ExTRA was feasible, with a 63% recruitment rate and 100% retention rate. Overall, evaluation questionnaire responses demonstrated high acceptability. At week 8, WAM average steps/day increased by 1358 (p = 0.036, Hedge’s g = −0.47), and fairly/very active minutes (3/6 metabolic equivalents) increased by 81.2 min/week (p = 0.024, g = −0.51), with moderate effect sizes. There was no statistically significant change on the self-report Global Physical Activity Questionnaire. The DASS-21 anxiety score reduction of 2.3 (p = 0.060, g = 0.42) from baseline to week 8 approached statistical significance. DASS-21 stress and depression scores were significantly reduced by 3.9 (p = 0.013, g = 0.57) and 3.7 (p = 0.02, g = 0.53), respectively, from baseline to week 8. There was no significant change in self-efficacy or dementia risk.

The ExTRA intervention is feasible and acceptable, with positive signals for increasing objectively measured physical activity and improving mental health. Findings support and inform the design of randomised controlled trials to assess efficacy of this potentially automated and scalable intervention.

Afghan refugees experience high levels of cumulative trauma and psychosocial adversity, yet attachment-related trauma has rarely been examined at the narrative level. Narrative attachment assessments may capture culturally embedded expressions of distress beyond post-traumatic stress disorder (PTSD)-focused symptom models.

This study examined narrative attachment-related trauma markers in Afghan refugees receiving out-patient psychological treatment. It investigated whether trauma marker frequency differed between resolved and unresolved attachment representations and whether it was associated with psychological symptom severity.

In an exploratory cross-sectional study, 40 Afghan refugees (mean age = 25.4 years; 75% male) receiving out-patient psychological treatment completed the Adult Attachment Projective Picture System, a narrative-based attachment interview. Trauma markers were identified and quantified within the narratives. Associations with attachment representations (resolved versus unresolved) and psychological symptom severity were examined in a subsample with available self-report data (n = 27).

Participants with unresolved attachment representations showed higher trauma marker frequencies than those with resolved representations. Trauma marker frequency was positively associated with depressive symptoms and overall psychological distress (Spearman’s effect size estimate (r) = 0.40–0.51; 95% bias-corrected and accelerated (BCa) confidence intervals excluding zero) but not with PTSD symptom severity.

Trauma markers captured clinically relevant distress in Afghan refugees beyond PTSD-specific symptomatology, particularly depressive symptoms and general psychological burden. Narrative, attachment-based approaches may be especially valuable in clinical encounters in which distress is conveyed implicitly, relationally, or in culturally contextualised ways rather than through explicit symptom reporting. Culturally sensitive applications of such methods, supported by well-trained interpreters, are essential for clinical understanding and meaningful clinical engagement.

Suicidal ideation following trauma exposure is frequently associated with depressive and post-traumatic stress disorder (PTSD) symptoms; however, the interactive effects of depression and distinct PTSD symptom clusters on suicidal ideation remain poorly understood.

To examine whether specific PTSD symptom clusters – namely intrusion, avoidance and hyperarousal – moderate the association between depressive symptoms and suicidal ideation, and whether these effects vary across different trauma types.

Medical records of 127 psychiatric out-patients with a history of at least one traumatic event were analysed. All participants had completed the Hamilton Rating Scale for Depression, the Impact of Event Scale-Revised, and the suicidal ideation item of the Beck Depression Inventory II. Trauma types were categorised into early versus late, single versus multiple, and interpersonal versus non-interpersonal.

Hierarchical regression analyses identified a significant moderating effect of avoidance symptoms on the relationship between depression and suicidal ideation (β = 0.19, P = 0.012), whereas intrusion and hyperarousal symptoms did not show such effects. Specifically, higher levels of avoidance were associated with a stronger positive relationship between depression and suicidal ideation. This moderating effect was observed only among individuals with late (β = 0.28, P = 0.002), single (β = 0.29, P = 0.002) or non-interpersonal trauma (β = 0.34, P = 0.018); it was not evident among those with early, multiple or interpersonal trauma.

These findings underscore the relevance of targeting avoidance symptoms to mitigate suicidal ideation, particularly in individuals with late-onset, single-incident or non-interpersonal trauma exposure. Exposure-based therapeutic interventions may offer particular benefit for reducing suicidal ideation among trauma-exposed individuals with depressive symptoms.

To investigate (1) the prevalence of anxiety and depression, (2) the association between physical activity (PA) and these mental health outcomes, and (3) the mediating role of social support in this relationship among college students, while controlling for gender and age.

Nationwide cross-sectional online survey (March 2024–May 2025) of 1,069 college students recruited through student-union mailing lists in China (92.7% response rate, mean age=21 years, 68.2% female). PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and categorized into low, moderate and high levels; continuous MET-min/week scores were also used. Anxiety and depression were measured by the Zung Self-Rating Anxiety Scale (SAS) and Depression Scale (SDS), reported as binary outcomes (SAS≥50, SDS≥53) and standard scores. Social support was evaluated using the Social Support Rating Scale (SSRS). Analyses included binary logistic regression and mediation analysis using PROCESS Model 4 with 5,000 bootstrap samples, controlling for gender and age.

Overall, 34.0% of participants screened positive for anxiety (10.5% moderate, 5.5% severe) and 43.5% for depression (9.4% moderate, 1.0% severe). Logistic regression showed that compared to high PA, low PA was associated with significantly higher risks of anxiety (OR=2.21, 95% CI:1.58–3.09) and depression (OR=2.91, 95% CI:2.10–4.01). Higher social support was associated with lower risks of both anxiety (OR=0.95) and depression (OR=0.96). Mediation analysis revealed that social support partially mediated the PA-mental health relationship: for anxiety, total standardized effect of PA β=−0.127 (p<0.001), indirect effect through social support β=−0.044, 95% CI [−0.062,−0.028] (34.2% mediated); for depression, total effect β=−0.173 (p<0.001), indirect effect β=−0.053, 95% CI [−0.073,−0.035] (30.5% mediated). Gender and age were not significant covariates in the mediation pathways.

This study identifies social support as a significant partial mediator in the PA-mental health relationship among college students.The mediating effect is proportionally larger for anxiety, although the association of social support is stronger for depression.These findings suggest that interventions should integrate PA promotion with social support enhancement to maximize mental health benefits.

The COVID-19 pandemic caused by the SARS-CoV-2 virus was the biggest global health emergency in the past century. The impact of the pandemic on society, and demand for health services, especially mental health services is not fully understood.

We describe the change in activity in a single UK NHS mental health trust during and following the pandemic.

We conducted a retrospective service evaluation using a population-based referral rates and clinical activity for mental health disorders in Cambridgeshire over the period 1 January 2017 to 31 December 2023. We divided the time period into pre-pandemic period, during the pandemic, and post-pandemic months. A negative binomial regression model was fitted to the monthly rates to yield incidence rate ratios. Subgroup analyses were performed by age, gender, ethnicity, and level of deprivation.

There was a steep decline in both referrals and clinical contacts during the lockdowns with a subsequent and steep increase in these measures during the immediate post-pandemic period. Increased numbers of referrals and contacts have been sustained well into the post-pandemic period.

In a single county-wide mental health service in the UK, the prolonged and sustained increase in both referrals and activity post-pandemic was not matched by equal increase in resource to meet demand. Our findings may be useful to effectively plan mental health services before, during and after any future pandemics.

The primary effect parameter in depression trials is usually a measure of depressive symptoms, e.g. the Hamilton Depression Rating Scale (HDRS). Such measures have been criticised for not covering patient-relevant domains, such as quality of life, and hence not accurately reflecting patient-experienced efficacy.

To investigate the relation between clinician-rated depressive symptoms and patient-reported quality of life measured by the Quality-of-Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF).

We included data from six acute-phase trials (n = 918) comparing mirtazapine to another antidepressant (amitriptyline, fluoxetine, paroxetine or venlafaxine) where both HDRS and Q-LES-Q-SF had been administered. No study included a placebo arm. Correlations between instruments (scales, subscales and items) were assessed after six weeks. Q-LES-Q-SF outcomes for participants who were in HDRS-defined remission were contrasted to those from participants with more severe depressive symptoms.

Q-LES-Q-SF ratings correlated strongly with HDRS-17 (r = −0.73, p < 0.0001) and HDRS-6 (r = −0.72, p < 0.0001), but somewhat weaker to HDRS-11 (r = −0.64, p < 0.0001). Depressed mood (r = −0.66, p < 0.0001) and work and activities (r = −0.65, p < 0.0001) showed the strongest item-level correlations to Q-LES-Q-SF. Participants in HDRS-remission had average Q-LES-Q-SF scores on the lower end of those reported by healthy controls, whereas patients with mild depressive symptoms (or worse) had average life-quality scores corresponding to severe impairment.

HDRS and Q-LES-Q-SF showed considerable agreement in depressed study participants treated with antidepressants, suggesting that HDRS meaningfully reflects patient-reported improvement.