Healthcare professional (HCP) students are at high risk of mental health problems, but stigma and fear of career repercussions often deter them from seeking help. Mental Health First Aid (MHFA) is a globally disseminated course teaching the public to identify and respond to people experiencing mental health problems. MHFA training may address some of the challenges faced by HCP students, by improving mental health knowledge and by enhancing well-being and peer support.

To systematically review the available literature regarding the impact of MHFA training on HCP students’ mental health literacy, confidence and intentions to provide help, stigma, peer support and self-care.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews ID: CRD42024589509), five databases were searched. Primary studies evaluating the above outcome measures in HCP students were included. Two authors independently screened references and extracted data. Quality was assessed using the Modified Medical Education Research Study Quality Instrument and Cochrane Risk of Bias tools. A narrative synthesis was performed.

Of 2367 records screened, 26 met inclusion criteria. Confidence in supporting others and mental health literacy showed the most consistent improvements following MHFA training, whereas evidence for changes in stigma was mixed. Peer support, self-care and student well-being were infrequently examined, although qualitative data suggested that MHFA had improved openness to help-seeking.

MHFA shows promise in enhancing mental health literacy, confidence and intentions, and in reducing stigma, particularly when supplemented with experiential learning. HCP students may benefit from tailoring of such courses to their specific needs, fostering a culture of peer support, enhancing well-being and introducing basic concepts in mental health.

Mental health challenges are common in autistic individuals but there is limited research, particularly among preschool children.

To ascertain the nature and occurrence of mental health challenges in autistic preschool children, as well as their association with autistic traits and cognitive and adaptive functioning.

We conducted a secondary analysis of data collected from children attending Autism Specific Early Learning and Care Centres across six states in Australia. The primary outcome of mental health challenges was assessed using the Child Behaviour Checklist (CBCL). The severity of autism and autistic traits, such as social communication differences and repetitive behaviours, alongside cognitive and adaptive functioning, were used as exposure variables. Multivariable linear regression analyses examined the associations among mental health challenges, autistic traits, cognitive level and adaptive functioning, and adjusted for key sociodemographic covariates.

Among 760 children, about 76% scored above the clinical range of CBCL total problem scores. Mental health difficulties were significantly associated with greater severity of autistic traits, social communication differences and repetitive behaviours, and lower verbal developmental functioning and adaptive functioning. Additionally, sociodemographic determinants, such as children who were older, female or with an autistic sibling, were associated with higher risk of mental health difficulties, whereas culturally and linguistically diverse status, higher parental education and family income were protective against mental health challenges.

Our findings provide useful insights into the high prevalence of mental health difficulties among autistic preschool children, highlighting the significant association with autistic traits, cognitive and adaptive functioning levels and sociodemographic risk factors.

Existing research demonstrates that insomnia is common, with significant negative impacts on health and quality of life. Cognitive–behavioural therapy for insomnia (CBT-I), the first-line treatment, is highly cost-effective. However, healthcare records have not been used in the UK to establish real-world insomnia prevalence, inequalities or unmet need.

This study’s aim was to establish the above in North Central London.

Data were extracted from primary care records across three London boroughs for 765 035 patients. Prevalence was determined by identifying those with a recent code for insomnia, insomnia treatment or sleeping tablet prescription.

Insomnia prevalence was 4.3%. Prevalence increased steadily with age, and was highest for women (4.9%), those of Bangladeshi ethnicity (7.3%) and those in the most deprived quintile (5.2%). Prevalence was significantly higher in patients with comorbidities (including chronic obstructive pulmonary disease (17.5%), severe mental illness (16.6%) and depression (14.1%)). Only 1.7% of people with insomnia had been referred for CBT-I.

Findings suggested that insomnia is at least as common as illnesses receiving high levels of focus and resourcing in the UK, and that prevalence estimates were probably underestimates. Variation in prevalence by demographic factors and deprivation may represent health inequalities. Insomnia was particularly common among patients with certain comorbidities and of advancing age, indicating that those groups should be actively screened. Concerningly, referral rates for CBT-I were extremely low. This has important implications regarding population health management, commissioning and training. Prevalence and unmet need are likely to be high in many other areas and should be investigated locally.

The national recruitment process for higher psychiatry training in the UK includes a self-assessment section that recognises applicants’ experience and achievements outside of their usual work. Evidence is uploaded by applicants then reviewed by verifiers using a standardised scoring system. The total awarded score ultimately influences applicants’ priority ranking when training offers are allocated. The aim of this study is to identify trends in self-assessment scoring inaccuracies and explore the reasons for these. This will inform future improvements to the self-assessment process and scoring guidance.

Anonymised data was provided by the National Psychiatry Recruitment Office for all applicants to higher psychiatry training in February and August 2025. Counts were summarised overall and by group using descriptive statistics. Thematic analysis was conducted to explore reasons for scoring adjustments and appeals across the ten assessed domains. Coding was cross-checked by a second researcher to enhance validity.

There were 1,025 applicants across the two recruitment rounds, with 76% having completed core psychiatry training or being in their final year of training. Fifty-nine per cent of applicants were non-UK graduates. The findings highlighted frequent errors in both applicants’ evidence submissions and in verifiers’ reviews. Common applicant error themes included submitting inappropriate, excessive, or incomplete evidence, misunderstanding current guidance, and incorrect domain allocation. Upheld appeals highlighted several instances of incorrect verifier scoring due to misinterpretation of submitted evidence and verification guidance. This resulted in frequent misalignment between candidates’ self-assessments and verifiers’ scoring, with 16% of applicants appealing their scores. Most scoring errors were identified in domains 6 (Clinical Governance, Audit and Quality Improvement as a postgraduate), 8 (Teaching), and 10 (Presentations and Poster Presentations). Scoring errors disproportionately affected applicants with non-UK qualifications and those submitting evidence obtained abroad as documents often did not conform to UK formats, contributing to scoring misalignment.

These findings highlight several challenges in translating applicants’ achievements into standardised scores in the current Higher Psychiatry Training recruitment process. Frequent scoring errors by both applicants and verifiers indicate that the current guidance may lack sufficient clarity, particularly regarding evidence requirements, domain boundaries and scoring thresholds. There is a need to develop the applicant and verifier guidance to include clearer definitions, descriptions, and examples to reduce error rates and improve equity and consistency in portfolio scoring.

Evidence shows that advance care planning has the potential to reduce involuntary admissions and empower service users. The perinatal period is a time of heightened risk of relapse of mental illness, and, in this context, many perinatal mental health services routinely offer pre-birth mental health care planning meetings.

We aimed to explore the experience of perinatal mental health service users and their partners following a pre-birth planning meeting and the writing of a perinatal care plan that included advance care plans for birth, postpartum and in case of crisis.

We interviewed pregnant perinatal mental health service users and their partners at two large, urban maternity hospitals in Dublin, Ireland. We used thematic analysis to identify key themes relevant to their experiences of pre-birth planning meetings and written perinatal mental health care plans.

Ten service users and three partners were interviewed. We identified five themes: theme 1, Hoping for change; theme 2, A wish to be heard; theme 3, Individualised care; theme 4, Security of ‘a plan in place’ and theme 5, Role of the support network.

Women and their partners value pre-birth planning meetings and these should routinely be offered within services, with consideration as to the size and timing of the meeting, and who is in attendance. These findings are relevant to general adult and liaison psychiatrists who should also incorporate advance care planning into routine practice.

Although most couples share a bed, current interventions rarely consider dyadic sleep patterns.

We investigated whether bedtime alignment between partners affects longitudinal sleep outcomes in older couples, with particular attention to gender differences.

Based on the temporal relationship between partners’ bedtimes and the earlier sleeper’s sleep onset latency, 859 couples (1718 individuals) aged ≥60 years were classified into 5 mutually exclusive bedtime alignment groups. Pittsburgh Sleep Quality Index (PSQI) scores, sleep onset latency and sleep efficiency were compared using analysis of variance and multivariate analysis of covariance. Both cross-sectional and 8-year longitudinal trajectory analyses were conducted.

Bedtime alignment significantly affected sleep outcomes (P < 0.001, Pillai’s Trace = 0.37, F24, 3352 = 14.04, P < 0.001, η2P = 0.09). Couples with synchronised bedtimes demonstrated excellent sleep quality, whereas those with bedtime differences less than the earlier sleeper’s sleep onset latency exhibited the worst. The earlier sleepers in such couples experienced longer sleep onset latencies (53.4 ± 46.8 min) and greater sleep quality impairment (PSQI = 7.9 ± 4.1). The 8-year trajectory analysis revealed gender-specific vulnerability: only women in misaligned groups experienced progressive sleep deterioration over time (5.84 ± 8.42 min/year increase in sleep onset latency, P < 0.001; 1.27 ± 1.93%/year decrease in sleep efficiency, P < 0.001), whereas men maintained stable sleep parameters regardless of alignment.

Bedtime alignment represents a modifiable determinant of sleep health in older couples, with synchronised bedtimes providing optimal outcomes and partial sleep onset overlap creating disruption. This particularly benefits women, who show progressive deterioration with misalignment. These findings support the development of gender-informed, couple-based interventions for sleep disorders.

Cognitive function is a significant predictor of daily functioning in the population, yet the extent to which common mental health symptoms account for this relationship remains unclear.

This study aimed to examine the relationship between cognition, mental health and functioning across two cohorts.

Participants were recruited from an online population cohort, HealthWise Wales (N = 3679), and a psychiatric cohort, the National Centre for Mental Health (NCMH, N = 1036), to complete a cognitive battery and the World Health Organization Disability Assessment Schedule (WHODAS). We assessed the associations between cognitive performance and the WHODAS, as well as two measures of life functioning: current employment and cohabitation with a partner. We examined the role of current mood, psychiatric and neurodevelopmental history and lifestyle factors using linear and logistic regression.

Higher cognitive performance was associated with fewer functional difficulties on the WHODAS (HealthWise Wales: B = −0.12, 95% CI (−0.15,−0.09), P < 0.001; NCMH: B = −0.1, 95% CI (−0.13,−0.08), P < 0.001), being in employment or education (HealthWise Wales: odds ratio 1.22, 95% CI (1.11,1.34), P < 0.001; NCMH: odds ratio 1.31, 95% CI (1.19,1.46), P < 0.001) and living with a partner (HealthWise Wales only: odds ratio 1.19, 95% CI (1.06,1.32), P = 0.003). Higher levels of depression and anxiety symptoms were consistently associated with reduced functioning across all analyses. The relationship between cognition and functioning remained significant but attenuated after accounting for these symptoms.

Cognitive function was associated with functioning in both clinical and population-derived samples. Current symptoms of depression and anxiety play a key role in this relationship. Both cognitive function and common mental health problems may be potential intervention targets to alleviate daily difficulties.

Ethnic minority children and adolescents are consistently under-represented in UK mental health services. Accurate ethnicity recording is essential for monitoring equity of access and informing service improvement. A baseline clinical audit conducted in 2020 across East Lancashire Child and Adolescent Mental Health Services (CAMHS) identified incomplete ethnicity recording and significant under-representation of Asian service users relative to the local population.

This re-audit reassessed the original audit standards by evaluating ethnicity recording completeness and whether the ethnic composition of CAMHS service users reflected the local under-18 population. It tested the hypotheses that ethnicity recording completeness would improve following the 2020 audit and that service use would reflect local population demographics.

A re-audit was conducted using electronic health records for all open CAMHS cases (n=1626) across East Lancashire Child and Adolescent Services as of 6 May 2025. Analyses were undertaken at locality level (Blackburn with Darwen; Burnley and Pendle; Hyndburn, Ribble Valley and Rossendale). Descriptive statistics were used to assess ethnicity recording completeness. Population-based access rates per 1,000 children were calculated using 2011 Census under-18 population denominators, and observed and expected numbers of Asian CAMHS service users were compared using chi-square goodness-of-fit tests.

Ethnicity recording completeness improved overall between 2020 and 2025, increasing from approximately 78% at baseline to 88% at re-audit, with improvement seen in most localities. Despite this, Asian children and adolescents remained significantly under-represented among CAMHS service users. Access rates for Asian children were consistently lower than those for non-Asian children across all localities (approximately 2–5 vs 12–18 per 1,000 children, respectively), and observed numbers were significantly lower than expected based on population proportions (χ² goodness-of-fit, p < 0.001).

This re-audit demonstrates measurable improvement in ethnicity recording completeness within East Lancashire CAMHS since the 2020 baseline audit, indicating partial completion of the audit cycle. However, improved data quality has not translated into equitable access to CAMHS, with Asian children remaining under-represented and access rates persistently lower than expected.

Subjective perspectives on aetiological factors in atypical depression have not been previously explored from the viewpoint of those with lived experience.

This study aimed to explore individuals’ subjective experiences and explanations of atypical depression, and to examine whether perceived gender-specific influences might contribute to the observed gender disparity in atypical depression prevalence.

Semi-structured, one-to-one interviews were conducted online with 16 individuals. Data were analysed using thematic analysis, employing an inductive approach and interpreted within a constructionist framework. Data coding was conducted using NVivo.

Key themes centred on the prevalence of comorbid conditions and how they affected atypical depression presentation; how trauma was seen as both a causal factor and catalyst; the subjective impact of gender identity and roles; how environmental factors seemed to affect atypical depression onset and presentation; the difficulties experienced with atypical depression symptom variability in daily life; and reported coping behaviours.

These findings highlight how individuals with atypical depression believed onset to be linked to experiences of trauma and comorbidity, in addition to ongoing influences of varied environmental factors. The variability of atypical depression symptoms in both the short and long term appears to be a core challenge in this subgroup. The gender disparity of atypical depression is also explored through the lens of lived experience and gender identity. Future research would benefit from exploring further these potential contributing factors, to provide a better understanding of their complex influences on atypical depression onset and maintenance.

This study investigates the relationships between family burden, perceived social support, quality of life and happiness among mothers of individuals with intellectual and developmental disabilities (IDDs).

This study aimed to examine the relationship between family burden and maternal happiness, and to investigate the serial mediating roles of perceived social support and family quality of life in mothers of children with IDDs.

The study sample comprised 250 mothers of children with IDDs. Data were collected using validated instruments: The Multidimensional Scale of Perceived Social Support, a family burden scale, the Beach Center Family Quality of Life Scale and the Oxford Happiness Questionnaire Short Form. Descriptive statistics, correlation analyses and structural equation modelling were conducted with software SPSS 26.0 and JASP 0.16.4.

Perceived social support and family quality of life were positively associated with happiness and negatively associated with caregiving burden; structural equation modelling indicated that their sequential mediation fully explained the link between family burden and happiness.

The findings underscore the critical role of social support and family quality of life in mitigating the negative impact of caregiving burden on maternal happiness.

Post-traumatic stress disorder (PTSD) symptoms can fluctuate substantially over short periods, yet routine screening typically relies on infrequent self-report. Wearable sensors provide continuous behavioural and physiological signals that may help identify periods of elevated risk.

This study aimed to evaluate whether combining wearable sensor features with daily self-report data could identify short-term PTSD symptom increases among recently discharged veterans.

Seventy-four veterans wore commercial activity trackers and completed brief daily questionnaires over 87 days. For each participant, we defined an individual baseline by using the first 14 days of PTSD scores. Wearable variables were transformed into baseline-referenced deviation features to capture departures from personal norms. Missing data were addressed with multiple imputation by chained equations. Candidate predictors were prioritised with least absolute shrinkage and selection operator regression, and a set of machine-learning classifiers was evaluated. Primary performance was assessed by using the area under the precision–recall curve (PR AUC).

Across feature set sizes (k = 1–25), performance peaked at k = 17. At this iteration, LightGBM achieved the strongest discrimination (PR AUC 0.86 (s.d. 0.07); area under the receiver-operating characteristic curve 0.89 (s.d. 0.04)) with a precision of 0.67 (s.d. 0.08), recall of 0.64 (s.d. 0.08) and F1 of 0.65 (s.d. 0.07). Key predictors reflected a multimodal profile, combining self-reported affect and perceived stress with wearable indicators of sleep continuity, activity variability and autonomic regulation.

Baseline-referenced wearable features combined with daily self-report may help identify near-term PTSD symptom increases among recently discharged veterans with elevated PTSD symptoms and problematic cannabis use. Future work should validate performance in broader PTSD populations, including samples without problematic cannabis use.

Adolescent depression often presents with somatic complaints, and its clinical manifestation is strongly shaped by cultural context. In non-western districts, psychological distress is frequently expressed through physical symptoms; a tendency that, combined with mental health stigma and culturally influenced health beliefs, complicates accurate detection, diagnosis and treatment. Standardised diagnostic tools developed in Western populations may overlook culturally specific symptom patterns, contributing to under-recognition and inadequate care. Despite the global impact of adolescent depression, cross-cultural symptom-level studies remain limited, hindering the development of culturally responsive mental health strategies.

This study aims to compare somatic-depressive symptom networks in Chinese and Rwandan adolescents using symptom-level network analysis, to identify culturally distinct central and bridge symptoms, and to assess structural differences between symptom networks across groups.

A cross-sectional sample of 3830 adolescents (China: n = 2017, mean age 15.35 ± 1.56; Rwanda: n = 1813, mean age 15.80 ± 1.90) completed culturally adapted versions of the Patient Health Questionnaires for somatic symptoms (PHQ-15) and depression (PHQ-9). Gaussian Graphical Models were estimated in R to construct symptom networks. Centrality measures (expected influence and bridge expected influence) were used to identify influential symptoms within each group. Network Comparison Tests were conducted to examine differences in global strength and network structure, and bootstrapping was employed to assess network stability.

Depressive symptoms were more prevalent among Rwandan adolescents (54.6%) than among Chinese adolescents (29.2%), whereas somatic symptoms were more commonly reported by Chinese participants (71.0% v. 64.0%). Low energy and sleep problems emerged as key bridge symptoms in both groups. Cultural differences were observed in central symptoms: psychomotor impairment and chest pain were central symptoms in Rwanda, whereas dizziness and headaches were central in China. Network structure differed significantly between groups (S = 0.99, p < 0.05), with culturally specific symptom connections.

The findings revealed distinct central and bridge symptoms in Chinese and Rwandan adolescents, reflecting culturally patterned architectures of symptom expression and distress reporting. These results highlight the need for culturally adapted screening tools and symptom-level interventions that target culture-specific symptoms to improve adolescent mental health care globally.

The first year after diagnosis and the last year of life are critical periods for people with dementia.

To (a) identify subgroups within a large sample of people with dementia, characterised by healthcare use in the year after diagnosis and the last year of life; (b) describe the biopsychosocial characteristics associated with these subgroups; and (c) explore moves between subgroups over time.

A retrospective cohort of people diagnosed with dementia in London, UK, was assembled using linked clinical and administrative data-sets. We used latent class analysis to identify subgroups based on hospital and specialist mental healthcare service use in the year following diagnosis and the year before death. We used multinomial logistic regression to describe biopsychosocial characteristics and class membership, and latent transition analysis to explore moves between subgroups.

Among 8623 people with dementia, we identified 3 subgroups of healthcare use in the year after diagnosis: ‘low use’ (49%), ‘hospital use’ (34%) and ‘mental healthcare use’ (17%). In the last year of life, four subgroups were identified: ‘low use’ (32%), ‘moderate hospital use’ (43%), ‘high hospital use’ (9%) and ‘community healthcare use’ (17%). Biopsychosocial factors, including age, ethnicity, and cognitive and physical problems, associated with subgroups differed for the time periods. Male gender, mixed dementia and vascular dementia diagnoses were associated with a higher risk of unplanned hospital use. Transition probabilities indicated unstable patterns of healthcare use after diagnosis and before death.

Distinct subgroups and healthcare patterns in two care periods can facilitate proactive, needs-based service provision while potentially reducing emergency hospital use.

Clinically relevant anxiety can be detected in patients with amyotrophic lateral sclerosis (ALS), but its prevalence and determinants have not yet been fully assessed.

This study aimed at assessing the prevalence and clinical underpinnings of anxiety in ALS.

Non-demented ALS patients (N = 433) and healthy controls (N = 313) were administered the State- and Trait-Anxiety Inventory – Form Y (STAI-Y1 for state-anxiety and STAI-Y2 for trait-anxiety) and the Beck Depression Inventory (BDI). Patients were further assessed for cognition (Edinburgh Cognitive and Behavioural ALS Screen), behaviour (Frontal Behavioural Inventory) and motor status (disease duration, ALS Functional Rating Scale-Revised and progression rate). The prevalence of clinically significant state- and trait-anxiety were estimated by applying age-stratified cut-offs to STAI-Y1/-Y2 t-scores. Linear and logistic regressions were run to test the determinants of STAI-Y1/-Y2 scores.

STAI-Y1 and -Y2 scores above cut-off were detected in 18.2 and 13.9% of patients, respectively – with proportions being higher in cases versus controls (ps < 0.001). BDI, but neither cognitive/behavioural nor motor variables, was identified as a significant predictor of STAI-Y1/-Y2 scores (ps < 0.003). The cognitive–affective subscale of BDI was the sole predictor of scores above cut-off on both STAI-Y1 and STAI-Y2 (ps < 0.001).

Clinically significant levels of state- and trait-anxiety occur in ∼18 and ∼14% of non-demented ALS patients, respectively, mostly driven by cognitive and affective facets of depression, and are independent of motor and cognitive/behavioural features.

Women with first-episode psychosis (FEP) may experience distinct clinical, reproductive and social challenges, yet their experiences of psychosis care remain underexplored. Greater understanding of women’s perspectives is needed to inform gender-responsive service provision.

To explore how women make sense of their experience of psychosis care, to identify areas where gender-specific needs were unmet and to highlight priorities for improving care for women experiencing FEP.

This qualitative study employed semi-structured interviews with women who had experienced FEP and received care through early intervention in psychosis and adult community mental health services (N = 15). Data were analysed using reflexive thematic analysis.

Four overarching themes were identified: (a) violations of personhood and bodily integrity; (b) invisible menstrual and reproductive health in mental healthcare; (c) women-specific barriers to accessing and sustaining care; and (d) moving towards better care for women with FEP. Women described feeling unsafe in mixed-gender in-patient settings, experiencing unmet reproductive and menstrual health needs and navigating caregiving responsibilities that complicated engagement with care. Findings informed a framework of recommendations for improving gender-responsive psychosis care.

This study provides one of the first in-depth qualitative examinations of women’s experiences of FEP care. Women described how their experiences were shaped by issues of safety, autonomy, reproductive health and gendered expectations that remain insufficiently recognised within current service models. These findings highlight persistent gaps in sex- and gender-responsive psychosis care, and support the development of services that more effectively address women’s safety, reproductive health and caregiving needs.

Increasing rates of involuntary treatment in the UK and persisting ethnic disparities in detentions have led to the reform of the Mental Health Act (MHA) in 2025. The MHA bill introduces several new measures including the offer of Advance Choice Documents (ACDs) to people who wish to make them. ACDs are written statements of a person’s wishes and preferences for treatment and care, made when a person is well and has the capacity to do so. Systematic reviews show that ACDs can reduce detention rates by up to 25%. The South London and Maudsley NHS Foundation Trust (SLaM) rolled out ACDs as part of routine care, ahead of the MHA 2025. This study describes the implementation of ACDs as part of routine care at SLaM.

SLaM recruited independent senior mental health professionals (ACD facilitators) to lead the creation, use and review of ACDs. The facilitators underwent training and utilised resources previously developed through previous research. The resources included an ACD template, an ACD manual and role description for facilitators, simulation training and Recovery College courses. A clinical lead and clinical supervisor were also employed to provide oversight for the implementation project. Data on implementation were collected through case note reviews, and interviews with service users and staff. Analyses on how ACDs were created and used when people experienced crises were conducted.

At the time of abstract submission, 77 ACDs have been created with service users at SLaM. The implementation of ACDs has been aided by service user-led initiatives such as the Patient Carer Race Equality Framework, staff training, and Recovery College courses which enabled people to create ACDs with high fidelity to the evidenced interventions. Staff and service users report that the ACD creation process is a holistic experience that is empowering and beneficial for improving therapeutic alliance between service users and mental health professionals. The main barrier cited by staff was a lack of time due to large caseloads.Service users expressed scepticism about their ACDs being accessed and honoured during times of crisis.

Implementing evidence-based interventions in healthcare settings is complex. SLaM has replicated the implementation of ACDs with high fidelity to the intervention trials that reported reductions in Mental Health Act detentions and greater autonomy for service users. Our results show that multiple strategies are needed to accelerate the reach and adoption of ACDs in other Trusts.