The physical environment of psychiatric in-patient facilities plays a significant role in patient well-being, treatment satisfaction and recovery. Despite growing evidence that architectural design influences clinical outcomes, systematic data on patient preferences regarding hospital structure remain scarce.

To identify structural and architectural requirements for psychiatric hospital design, from the patient perspective.

A cross-sectional, hybrid questionnaire survey incorporating closed- and open-ended questions was administered to former psychiatric in-patients from all wards of a tertiary care centre (University Psychiatric Clinics Basel, Switzerland) who had been treated before September 2023. The survey assessed patient-reported disturbances related to room conditions, preferences for structural and environmental design elements, importance ratings of specific architectural features (measured using Likert scales) and preferred treatment settings.

A total of 604 participants completed the survey (response rate 19.1%). Room-related disturbances were reported by 49% of respondents (n = 282), with key concerns including insufficient privacy, limited withdrawal opportunities and impaired sleep quality. Single-occupancy rooms were rated as very important (10/10) by 64% of respondents. Access to a surrounding park environment (74%) and direct outdoor access (75%) were among the most highly valued features. In-patient treatment was the preferred modality for 54.1% of respondents, followed by out-patient care (17.8%) and day clinics (15.9%).

Psychiatric patients strongly prioritise in-patient settings offering single-occupancy rooms, privacy and access to green spaces and outdoor areas. These findings underscore the importance of systematically incorporating patient perspectives into the architectural and structural planning of psychiatric facilities.

Prolonged grief disorder (PGD) is characterised by persistent yearning and intense emotional pain, and is often accompanied by identity disruption and social withdrawal. Research has identified various PGD risk factors; however, limited research has examined how relationship to the deceased relates to PGD risk.

This study introduces ‘simpatico’, a novel construct assessing a mourner’s perceived similarity and connection to the deceased as a risk factor for PGD. Grounded in the micro-sociological theory of bereavement, the study hypothesises that simpatico relationships heighten PGD risk because of the particular social deprivations their absence creates.

This cross-sectional study was conducted in Turkey via online surveys with 400 bereaved. Data were analysed using exploratory and confirmatory factor analyses, as well as correlation- and regression-based analyses.

A nine-item Simpatico Scale was validated within a Turkish bereaved adult sample (N = 400), demonstrating good internal consistency (Cronbach’s α = 0.90). Regression analyses revealed that elevated simpatico scores, particularly felt similarities with the deceased, were significantly associated with PGD symptom severity (β = 0.31, p < 0.001), even when controlling for demographic, cause of death, relationship to deceased and social support variables.

Results identify simpatico as a new, particularly influential, interpersonal risk factor for PGD. Further, according to the micro-sociological theory, results suggest that promotion of simpatico relationships among bereaved persons may compensate for the social deprivations resulting from simpatico relationship losses. In these ways, this study identifies mourners at risk and suggests promising ways to intervene to reduce mourners’ risk of PGD.

This longitudinal study examines the psychometric validity of the Subjective Traumatic Outlook (STO) questionnaire by evaluating its structural consistency and diagnostic performance in a conflict-affected context. The STO was used to measure trauma-related subjective distress at two time points following the terrorist attacks in Israel on 7 October 2023.

The primary aim of this study was to evaluate the STO as a concise and reliable assessment tool for populations affected by armed conflict.

A nationally representative sample of 4097 participants responded at T1, of whom 2005 completed the study at T2. Data were collected during the ongoing war in Israel. Participants completed the STO alongside validated measures of post-traumatic stress disorder (PTSD (PTSD Checklist for DSM-5) and International Trauma Questionnaire), depression, anxiety and adjustment disorder. Exploratory factor analyses were used to estimate one- to three-factor solutions using robust maximum likelihood estimation. Convergent validity was assessed through bivariate correlations with trauma- related measures. Receiver operating characteristic analyses were conducted to evaluate diagnostic utility for PTSD and complex PTSD per the ICD-11.

Exploratory factor analysis supported a stable two-factor structure across both waves. The STO demonstrated strong internal consistency and stable convergent validity over time. Receiver operating characteristic analyses indicated that the four-item version matched or slightly outperformed the five-item version, suggesting improved parsimony without loss of diagnostic accuracy.

The stable factor structure of the STO and its strong psychometric properties across both waves within a wartime context support its utility for large-scale screening and early detection of trauma-related distress.

Behavioural activation is effective for depression, but its effectiveness in treating adults with depression when delivered by lay workers remains unclear.

To examine the effectiveness of behavioural activation delivered by lay workers, compared with any control group, in reducing depressive symptoms in adults.

This systematic review searched six databases from inception to January 2025, for randomised controlled trials (RCTs) comparing behavioural activation and any control conditions for individuals with depression when delivered by lay workers. Additional searches were conducted in the international trial registries and reference lists (PROSPERO registration CRD42024625620). Risk of bias was assessed using the Cochrane Collaboration’s Risk-of-Bias 2 tool. Random effects meta-analysis was conducted using the Metafor package in R.

Of 9614 initial studies, six RCTs met the inclusion criteria and were included. A total of 1118 participants in the intervention groups and 1596 in the control groups. The findings demonstrated a small but statistically significant effect in reducing depressive symptoms in favour of the intervention group (standardised mean difference: −0.28, 95% CI −0.46 to −0.09; p = 0.0029). However, the risk of bias was high across all studies, with substantial heterogeneity (I2 = 76%).

Evidence from this review and meta-analysis suggests that behavioural activation, when delivered by trained lay workers, may offer an effective approach for reducing depressive symptoms in adults, particularly in settings with limited access to specialist mental healthcare professionals. However, high risk of bias and heterogeneity of the included studies means that these findings should be interpreted with caution.

Psychiatric in-patient populations are heterogeneous. Severe and enduring psychiatric illness (SEPI) and trauma, stressor-related and substance use (TSRS) presentations differ clinically, but their service demands and mortality within one system are poorly characterised.

To characterise in-patient service use and mortality across clinical trajectories in one National Health Service general adult psychiatry (GAP) service.

Longitudinal cohort study of 5204 in-patient episodes (2016–2024) aggregated to 2665 patients classified as SEPI (schizophrenia spectrum, bipolar disorder, severe unipolar depression) or TSRS, the latter subdivided into borderline personality disorder (BPD) and non-psychotic mood, stress-related and substance-use presentations. Analyses used person-years, standardised mortality ratios (SMRs), survival analysis and years of life lost.

SEPI comprised 28.9% of patients but 69.3% of bed utilisation, with longer, recurrent admissions. TSRS presentations were brief and crisis-driven; BPD had the highest admission frequency with short stays. Cumulative mortality was 53% higher in SEPI than TSRS (13.5 v. 8.8%), but after adjustment for age and illness duration mortality was similar across groups (SMR 4.87). TSRS deaths occurred at younger ages, particularly in BPD, whereas SEPI deaths reflected common physical illnesses occurring far earlier than in the general population. Most deaths (98.5%) occurred outside in-patient settings.

GAP services accommodate two trajectories with contrasting demands but similarly high mortality (SMR 4.87): enduring, medically managed illness with high cumulative resource use, and episodic brief crisis presentations. Recognising this is essential for service design, since current models combine structurally distinct demands within a single system.

Lithium is the gold standard treatment for bipolar disorder, but its mechanism of action is not fully understood. Emerging research suggests structural and functional alterations in the retina of people with bipolar disorder and depression, including a thinner retinal nerve fibre layer and ganglion cell layer. Retinal structure and function can be characterised using several noninvasive imaging techniques, from which numerous quantitative metrics can be derived. We aimed to complete a systematic review of the literature to establish which parameters have been evaluated in relation to lithium use and what insights they provide into its potential retinal effects.

Searches using the terms ‘Lithium’ AND ‘retina’ were carried out to identify peer reviewed studies assessing the impact of lithium on retinal structure or function. These included those with or without a control group comparison, pre- and post-lithium comparisons and observational studies. There were no exclusions based on the quantity or preparation of lithium administered, or the length of administration. Any studies where lithium was administered in combination with another intervention were excluded, unless it was directly compared to the other intervention without lithium. The main outcome of interest was optical coherence tomography (OCT) derived metrics, but any measure of structure or function was included.

Seven studies reporting structural outcomes, and 10 reporting functional outcomes, were identified.Structural outcomes were derived from optical coherence tomography (OCT) imaging studies which had multiple limitations. There was no evidence of statistically significant difference in the retinal nerve fibre layer (RNFL) between people with bipolar disorder taking lithium and healthy controls in two studies with larger numbers, indicating a protective effect on the retina. In four studies looking at differences in people with bipolar taking lithium and those taking valproate, two showed no signs of difference and two evidence of statistically thicker RNFL in the lithium group, also in line with a potential protective effect. For all other OCT derived metrics, the evidence was limited.

Studies reporting functional outcomes were highly heterogeneous with multiple limitations and no clear trends. The majority reported a statistically significant effect of lithium on at least one functional measure, derived from electrooculography, electroretinography, and dark adaptation threshold procedures.

Trends indicate that lithium is likely to have an effect on both the structure and function of the retina, but significant limitations in all included studies mean that better designed and adequately powered prospective studies are required for both structural and functional measures of the retina.

An increasing number of children and adolescents are prescribed second-generation antipsychotic medications, which may lead to cardiometabolic or other physical health impairments. It is unknown whether lifestyle interventions can prevent or manage these adverse effects.

To evaluate the effectiveness of lifestyle interventions for preventing or managing cardiometabolic risks and other adverse physical health outcomes in this population.

Four bibliographic databases were searched up to February 2024. Randomised controlled trials reporting a physical health outcome of children or adolescents (aged 6–17 years) taking antipsychotics and participating in a lifestyle intervention compared with treatment as usual (TAU) were eligible for inclusion. The Cochrane Risk of Bias 2 tool was used to assess risk of bias. Data were synthesised via a random-effects meta-analysis and narrative synthesis.

Four studies with a total of 370 participants were included. Most (75%) had a high risk of bias. Lifestyle interventions resulted in moderate but statistically non-significant reductions in participants’ body mass index (standard mean difference −0.70, 95% CI: −1.70 to 0.31) compared with TAU. Some studies reported improvements in other physical health outcomes favouring the intervention, although findings were inconsistent and varied across different measures. Reporting of secondary indicators of physical health, including participant or family health behaviours, was limited.

The effectiveness of lifestyle interventions for preventing or managing the cardiometabolic risk and other adverse physical health outcomes in this population is unclear due to the limited number of available trials, small samples and high risk of bias. Larger trials are needed.

A considerable proportion of individuals who die by suicide have no recorded psychiatric diagnosis, yet their psychosocial and clinical profiles remain poorly understood.

To examine whether conventional demographic, physical health, psychosocial and mental health characteristics distinguish suicide decedents with, versus without, psychiatric diagnoses in a population-based cohort.

This retrospective case–control study used UK Biobank baseline data linked with national mortality records. Suicide decedents were classified as having a recorded psychiatric diagnosis prior to death (PtD) or no recorded diagnosis (NPD). Group comparisons and logistic regression analyses examined associations between psychosocial variables and diagnostic status, including domain-specific multivariable models adjusted for age and gender.

Among suicide decedents, 44% had no recorded psychiatric diagnosis. There were no significant differences between groups in smoking-related variables, diabetes, hyperlipidaemia, body mass index, social support or social connectedness. Hypertension, as well as the use of immunosuppressants and anti-inflammatory agents, were more prevalent in the PtD group. PtD individuals exhibited higher levels of anxiety-related traits, neuroticism and healthcare utilisation. In multivariable analyses, several unadjusted comparisons were attenuated. Neuroticism, ‘suffering from nerves’, healthcare utilisation and lower risk-taking remained significantly associated with PtD status whereas mood-related variables, including depressed mood and anhedonia, were no longer statistically significant following adjustment.

Nearly half of suicide decedents had no recorded psychiatric diagnosis, and conventional psychosocial markers demonstrated limited discriminative value under current measurement conditions. These findings support a detection-gap framework and highlight the need for suicide prevention strategies extending beyond diagnosis-based approaches towards broader, population-level detection.

Although clinically framed as a public health concern, the meanings of suicide are fundamentally shaped by cultural narratives and visual representations.

To examine the evolution of sculptural representations of suicide from antiquity to the present, and to interpret these works through psychiatric and sociological lenses relevant to contemporary clinical and public health discourse.

A structured search across PubMed, Scopus and Web of Science (up to August 2025) was integrated with museum archives and art-historical catalogues. Selected sculptural works were analysed as interpretive case studies using iconographic, semiotic and contextual approaches. Interpretation focused on affective and relational processes such as psychological pain (psychache), shame, entrapment and social disconnection prioritising cultural formulation over retrospective diagnostic attribution in historical cases.

Sculptural representations frame suicide through shifting moral and social logics: from honour-bound self-death in antiquity and virtue-coded narratives in the early-modern period to interiority and estrangement in modernity. Contemporary public installations shift this focus towards visibility, urban space and prevention. These works externalise private suffering and structural conditions (e.g. isolation, stigma), actively shaping collective imaginaries of self-destruction.

Sculpture provides a unique medium for the translation of individual suffering and the collective meanings of suicide into public form. An interdisciplinary reading of these works supports culturally informed clinical reflection and contributes to ethically attentive public communication and prevention strategies.

People with severe mental illness experience significant physical health morbidity and are vulnerable to diagnostic overshadowing. This may be particularly relevant where reproductive health factors overlap with psychiatric symptoms. This case study describes an unrecognised pregnancy identified during admission for psychotic relapse in a woman with schizoaffective disorder and explores learning points for inpatient, community and antenatal care. The hypothesis underpinning this work is that routine pregnancy testing and proactive consideration of reproductive health in women of childbearing potential may reduce the risk of delayed pregnancy recognition and associated harm.

A 35-year-old woman with schizoaffective disorder was managed in the community on a Community Treatment Order with depot antipsychotic medication. She developed persecutory beliefs that her food was being poisoned, reported altered taste and smell, alongside nausea and vomiting, and gradually reduced her food intake, leading to weight loss and non-attendance for depot medication. Due to increasing self-neglect and psychotic relapse, she was recalled to hospital under the Mental Health Act. During admission, antipsychotic treatment was recommenced and partial insight returned. As part of routine physical health monitoring, she was noted to weigh under 50 kg. Medical review identified an unexplained abdominal mass, prompting urgent ultrasound, which demonstrated a previously unrecognised 27-week pregnancy.

Retrospective reflection suggested that first-trimester pregnancy symptoms may have interacted with psychotic experiences. Symptoms consistent with hyperosmia and hypergeusia, recognised features of early pregnancy, may have contributed to altered taste perception and heightened sensitivity to food. Nausea and vomiting associated with morning sickness may have further reinforced persecutory beliefs that food was being poisoned. This cluster of physical symptoms appeared to coincide with increasing fearfulness of professionals, medication non-concordance and subsequent psychotic relapse, highlighting the complex, bidirectional relationship between physical health symptoms and psychopathology. The pregnancy was identified incidentally rather than through routine screening, illustrating how pregnancy-related physiological changes may be misattributed to psychiatric illness in both community and inpatient settings.

This case illustrates the risk of diagnostic overshadowing at the interface of physical and mental health in severe mental illness. It highlights the importance of routine pregnancy testing for women of childbearing potential on admission and maintaining clinical curiosity when physical changes accompany psychiatric deterioration. In community settings, emerging physical symptoms, weight change or non-attendance should prompt consideration of pregnancy and clearer screening pathways. While individual circumstances vary, proactive physical health screening may support safer, more holistic psychiatric and antenatal care.

Mental health problems among children in England are rising, with significant wait times and barriers preventing many from accessing timely support. Watch Me Play! (WMP) is a caregiver–child interaction intervention designed to enhance child development and promote mental health resilience through child-led play.

To assess the feasibility of delivering WMP remotely to parents and carers of children aged 0–8 years referred to UK early years and children’s services.

A non-randomised, single-group feasibility design with a mixed-methods process evaluation aimed to recruit 40 families. The study evaluated recruitment, retention, adherence, fidelity and acceptability. Outcomes were collected at baseline and 3 months; we conducted qualitative interviews to examine barriers and facilitators, and we used health economic data estimated intervention costs.

WMP was well-regarded and acceptable to families and service providers. Recruitment involved seven sites and 21 families, with 67% retention at 3 months. Self-reported adherence was 80%. Facilitators included the simplicity of the approach and quick access to support. Barriers included limited staff capacity and practitioner perceptions of readiness in families with complex needs. Hybrid delivery (online and face-to-face sessions) was feasible and acceptable. The average intervention cost was £209 per family.

Findings indicate core feasibility parameters – including acceptability, fidelity, data-collection procedures and delivery across diverse contexts – were met. WMP is a low-cost intervention suited for early years services. Although a full-scale effectiveness trial is not yet warranted, a future randomised feasibility trial is recommended to investigate the acceptability of randomisation and recruitment across a broader range of services.

Studies have consistently found that up to 20% of people with anorexia nervosa experience a persistent illness, resulting in considerable psychosocial impairment, morbidity and mortality. This has been variously termed severe and enduring anorexia nervosa or longstanding anorexia nervosa (L-AN). Conflicting findings have hindered progress in distinguishing the nosological features of individuals with persistent illness.

This study aims to investigate the putative defining features of individuals reporting symptoms of L-AN, including consideration of their treatment trajectory.

This cross-sectional study, drawing from a mixed-methods design, utilised a sample of symptomatic individuals who reported experiencing eating disorder treatment (n = 208). Several qualitative and quantitative data strands (a–c) were embedded within a single, self-report questionnaire measuring eating disorder severity and treatment experiences. Between-group comparisons were used to compare those of shorter (<3 years) and longer (>7 years) duration of illness.

No between-group differences were found in measures of severity, including body mass index (kg/m2), eating disorder symptom scores, psychological distress or perceived health-related quality of life. However, those with L-AN had a significantly higher number of mental and physical health comorbidities, longer treatment delay, greater number of episodes of treatment and poorer subjective ratings of their treatment experiences.

Delineating L-AN by severity may be inappropriate; anorexia nervosa of any duration is a severe illness. This study suggests that treatments, or lack thereof, may have an inadvertent impact on duration of illness. Future focus needs to be on reconceptualising L-AN and its treatments. Treatment refinements informed by lived experience are proposed.

Antipsychotics are essential for managing certain mental disorders; however, little is known about regional disparities in their prescribing or how these patterns are shaped by ethnic density and health inequalities.

To analyse national, regional and local integrated care board trends in antipsychotic prescribing in England from April 2019 to March 2025, and to explore their associations with health inequalities and ethnic density.

A population-level observational study was conducted using the English primary care prescription data from OpenPrescribing. Linear regression was used to assess trends in first-generation (FGA), second-generation (SGA) and total antipsychotic prescribing. Generalised additive models examined associations between prescription rates and health inequalities and ethnic density at the local level.

Antipsychotic prescribing increased from 185.55 to 199.85 prescriptions per 1000 population between April 2019 and March 2025. SGA use increased significantly (168.48 to 186.27) whereas FGA use declined (17.08 to 13.58). Regional annual increases ranged from 3.85% (95% CI = 3.53%, 4.16%) in London to −0.21% (95% CI = −0.72%, 0.31%) in the South-West region, with greater variation at the local level, from 6.62% (95% CI = 5.71%, 7.53%) in North Central London to −2.05% (95% CI = −2.71%, −1.40%) in Shropshire, Telford and the Wrekin. Higher Pakistani ethnic density was associated with lower prescribing rates, whereas greater health inequalities were linked to increased prescribing.

Antipsychotic prescribing patterns have shifted in recent years, with notable regional disparities influenced by health inequalities and ethnic composition. Targeted interventions are needed to promote equitable access and address prescribing disparities in mental healthcare.

In the UK, clozapine is the only licensed treatment for treatment-resistant schizophrenia (TRS). However, it is underused because initiation is often limited by the need for in-patient admission, which is costly and unattractive to patients. Community clozapine services may address this.

To describe a targeted out-patient clinic (Treating Unmet Needs in Psychiatry (TUNE-UP)) for TRS management and assess its impact on community clozapine initiation rates.

We reviewed clozapine titrations of patients under four community mental health teams from September 2021 to January 2025, recording whether titration occurred as in- or out-patient. The TUNE-UP clozapine clinic operated for 12 months (September 2023 to September 2024). Initiation rates during the TUNE-UP period were compared with those when the service was unavailable, using Poisson regression. Clinical outcomes were assessed using scales including the Positive and Negative Syndrome Scale (PANSS).

Fifty-one individuals commenced clozapine during the study period. There was a significant increase in the rates of community initiation in the TUNE-UP period (11.0 per year) compared with those outside of this period (1.71 per year; incidence risk ratio 6.42 [95% CI 2.04–20.2, P = 0.0015]). Patients seen by TUNE-UP showed significant improvements in PANSS (n = 6, median improvement 21.5 [95% CI 7.0–33.0], P = 0.03).

A specialist service was associated with a significant increase in community clozapine initiations. This approach offers a strategy to improve TRS treatment in the community.

Exercise is increasingly utilised as a complementary therapy within eating disorder treatment because of the emerging evidence for the psychological and physical benefits of exercise in eating disorders. Despite this, there is currently limited guidance on assessment within exercise therapy and eating disorders.

This review aimed to (a) outline outcome assessments used in the exercise and eating disorder literature, including interventional and cross-sectional studies; and (b) provide an overview of the general impacts of exercise intervention trials in eating disorders.

A scoping review was employed with searches on databases PsycINFO, Medline and EMBASE, with terms related to eating disorders, exercise and health outcomes. Data extraction included study and intervention characteristics, assessments and outcome change.

Twenty-six intervention and cross-sectional studies were included, consisting of anorexia nervosa (n = 27%), binge eating disorder (n = 19%), bulimia nervosa (n = 4%) and mixed diagnostic populations (n = 50%). Body composition assessment was conducted with the greatest frequency of included studies (n = 26), followed by eating disorder psychopathology (n = 21), subjective physical activity level (n = 13) and exercise assessment (n = 11), including strength assessment (n = 6) and cardiorespiratory fitness testing (n = 6). No adverse events were reported in the included studies.

The results of this review outline that comprehensive assessment within exercise interventions and eating disorders, including strength and cardiorespiratory fitness exercise tests, are safe when conducted in appropriate contexts and may offer additional insight into patient health and function beyond current standard practice. The results of this review may guide future exercise professionals in eating disorder services on relevant assessment as part of exercise therapy.

In The Netherlands, it is unknown whether the number of youth suicide-related emergency department visits has changed over time. Also, insight is needed in the hospital costs for managing these patients, as a first step toward the economic evaluation of suicide prevention measures.

This study examines (a) changes in emergency department-recorded suicide attempts, suicidal ideation and non-suicidal self-injury in youth, including repeat emergency department visits; and (b) related hospital costs for these patients, from a health insurer perspective.

In this cross-sectional study, data from various sources was combined to identify all youth aged ≤27 years visiting a Dutch inner-city emergency department between 2016 and 2023 for a suicide attempt, suicidal ideation or non-suicidal self-injury. Hospital records were reviewed manually to determine inclusion. Ambiguities were discussed within an expert panel and descriptive analyses, Poisson regression and logistic regression analyses were performed. For a subset of 30 patients, invoiced costs were determined.

The number of suicide attempts increased by approximately 5% annually, peaking in 2022 (n = 172); there were significantly more female patients (71%), and the median age was 21 years. Cases of suicidal ideation showed a similar trend, whereas the number of recorded non-suicidal self-injuries reduced. A total of 28.5% of all patients (n = 281) had one or multiple repeat visits for the above reasons. Median suicide attempt-related costs per case were €930, range €385–€33 473.

Since 2016, an increasing number of youth visited the emergency department of a Dutch hospital after a suicide attempt, but this increase does not seem to continue after 2022. Hospital-invoiced costs differ substantially between patients.

National policy frameworks, including the UK Government’s Suicide Prevention Strategy (2023–2028), emphasise person-centred, relational approaches that prioritise therapeutic engagement, collaborative safety planning and a flexible understanding of psychosocial risk. Peer support and lived experience initiatives are increasingly recognised as vital components of suicide prevention and recovery support. Community-based suicide crisis (CBSC) support, which emphasises rapid access, person-centred care and lived experience integration, was established to provide immediate support without clinical criteria, barriers to access or waiting lists.

To examine outcomes of a CBSC intervention supporting individuals in suicidal crisis, with particular attention to differences in outcomes across National Health Service (NHS) and non-NHS/self-referral pathways.

A mixed-methods explanatory sequential design was adopted to provide a comprehensive assessment of service impact and client outcomes among individuals (n = 9801) referred through the NHS (n = 2929, 30%) or non-NHS/self-referrals (n = 6872, 70%) between 2019 and 2025.

A subanalysis of 1387 (14%) client interventions showed significant improvements across all mental health recovery domains (p < 0.05), particularly among older clients (aged ≥65 years). Fifty interviews with clients, carers, staff and referrers generated three themes around accessibility, rapid response, continuity of care and the value of lived experience in building trust, reducing stigma and helping with long-term recovery.

CBSC services would benefit from the expansion of NHS partnerships to extend regional reach, standardised monitoring and follow-up, and the strategic use of outcome data to strengthen advocacy and secure sustainable funding. Embedding this community-based model firmly within wider health systems has the potential to enhance its impact, ensure equitable access and inform broader systemic developments in suicide prevention.

The Maudsley 3-item visual analogue scale (M3VAS) was developed as a novel and intuitive patient-reported measure for depression, focusing on core symptoms and suicidality.

To evaluate the longitudinal validity of M3VAS for capturing symptom change over time.

Both M3VAS and the Patient Health Questionnaire (PHQ-9, as reference standard) were administered in an observational study (RHAPSODY, no. NCT04939818) at weeks 0, 2 and 4 to both depressed patients (n = 50) and matched controls (n = 24). We serially tested factor structure, internal consistency and convergence (correlation) over time, assessing responsiveness by both correlation of change in score and effect of time across scales (analysis of variance and effect size).

M3VAS exhibited strong factor loadings and high item interrelatedness (Cronbach’s alpha 0.78–0.83) at all time points. Total scores correlated strongly with PHQ-9 at each time point (r > 0.8, P < 0.001). Correlation of score change over the study period (r = 0.65, P < 0.001) also confirmed responsiveness. In the depressed group, an effect of time on score was seen for both M3VAS (F = 4.942, P = 0.010) and PHQ-9 (F = 12.505, P < 0.001), with standard response mean (Cohen’s d) of 0.58 and 0.74, respectively. No effect of time was seen in the control group.

Following previous cross-sectional validation against the Quick Inventory of Depressive Symptomatology–Self-report, this present study demonstrated appropriate longitudinal measurement properties for M3VAS as a measure of depression, including responsiveness. Evaluating the ability of M3VAS to discern responses with a variety of treatments is a key future goal.

Background/Rationale

The military coup in Myanmar in February 2021 caused widespread disruption to medical education. Many psychiatry trainees and trainers joined the Civil Disobedience Movement (CDM), resulting in the suspension of formal postgraduate psychiatry training nationwide and posing a serious threat to the future psychiatric workforce. In response, Myanmar CDM psychiatrists, supported by the psychiatrist diaspora, developed an alternative pathway to sustain postgraduate psychiatry training in a conflict setting.

Aims/Objectives

To restore postgraduate psychiatry training while maintaining academic standards, clinical competency, and professional integrity through an innovative, digitally enabled, and internationally supported training model.

Biweekly online Continuing Medical Education (CME) sessions commenced in March 2021. By September 2023, CDM psychiatrists collaborated with retired academics and diaspora psychiatrists from the United Kingdom, United States, and Australia to develop a formal curriculum. The programme was finalised in December 2023 and approved by the Federal Health Professional Council and Interim University Councils. An online Master of Medical Science (Psychiatry) programme was launched on 15 January 2024. The programme focused on clinical knowledge development through weekly Zoom lectures and Moodle-based learning, and clinical skills development through supervised practice, CME case discussions, and workplace-based assessments. Research training was deferred due to safety concerns.

Trainee engagement was monitored through assignment completion, participation in synchronous teaching, and completion of supervised clinical attachments. Ten trainees enrolled. Assignment completion reached 100%, participation in teaching was at least 75%, and clinical attachment completion exceeded 90%. Between April and May 2025, seven trainees completed final assessments, including multiple-choice examinations and virtual clinical examinations with live assessors and simulated patients. All seven trainees passed and were certified as qualified psychiatrists. A 360-degree evaluation demonstrated high satisfaction among trainees, supervisors, and assessors.

Despite severe disruption, Myanmar’s CDM psychiatrists successfully revitalised postgraduate psychiatry training using a decentralised, digitally enabled, and internationally supported model. This experience demonstrates that high-quality postgraduate psychiatry education can be sustained in fragile and conflict-affected settings and offers a scalable framework for global mental health workforce development.

Acknowledgements: We acknowledge all Civil Disobedience Movement (CDM) mental health professionals in Myanmar and the Myanmar psychiatrist diaspora worldwide for their collective leadership, academic contribution, and unwavering commitment to sustaining postgraduate psychiatry training under conflict conditions.