Limited studies have conducted a comprehensive investigation on the impact of China’s birth policy change on the mental health among women of childbearing age. This study aimed to explore the potential impact of China’s Universal two-child policy on depressive symptoms among women of childbearing age, based on national-representative, longitudinal survey data.

Data we employed in this study were derived from the China Family Panel Study (CFPS) for the waves of 2012, 2014, 2016, 2018 and 2020. We included 7481 currently married females (17079 for pooled sample) aged 20–40 years. Depressive symptoms were assessed using the Kessler 6 Rating Scale (K6) and the Center for Epidemiologic Studies Depression Scale (CES-D). All scores were standardized for analysis. We employ the difference-in-difference model to investigate the association between the implementation of the Universal Two-child Policy (UTP) and women’s depressive symptoms.

Women in the exposed group, after implementing UTP, had a standardized score of depressive symptoms 0.10 higher (95% CI: 0.03–0.16, p = 0.007) than during the pre-intervention period after controlling for multiple covariates. They also faced a higher risk of having moderate or severe depressive symptoms (OR = 1.45, 95% CI: 1.12–1.87, p = 0.004). The stratified analysis revealed that the negative impact of UTP on mental health was pronounced among women with advanced age, low education, medium family income, only male offspring before UTP, and no new birth after UTP.

We observed that the implementation of the UTP was associated with increased depressive symptoms among married women of childbearing age in China, with significant heterogeneity across different sociodemographic groups. Greater attention should be paid to the complex psychological conditions of women of childbearing age when adjusting fertility policies, which is crucial to prevent women from suffering poor mental health and to advance high-quality development in population health.

Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.

We used Taiwan’s National Health Insurance Research Database (2000–2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).

Over a mean follow-up of 8 years, PTSD was associated with excess all-cause mortality (AHR = 1.32, 95% CI 1.24–1.41) driven by markedly increased unnatural deaths (AHR = 5.93, 5.13–6.85), especially suicide (AHR = 10.36, 8.41–12.76) and accidental deaths (AHR = 2.18, 1.67–2.86). Natural-cause mortality showed no consistent increase (AHR = 0.91, 0.85–0.98). In sibling analyses, excess risks persisted for all-cause (AHR = 2.48, 2.04–3.01), unnatural deaths (AHR = 4.76, 3.58–6.34) and suicide mortality (AHR = 7.90, 5.21–11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.

PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.

Assessing depression symptoms in people with a chronic illness is challenging due to possible bias from overlapping somatic symptoms associated with both depression and chronic illnesses. Previous studies, however, have found that people with a chronic illness do not report more somatic symptoms on depression measures than people without a chronic illness with similar levels of mood and cognitive symptoms. The reason for this surprising finding is unknown. Our primary objective was to evaluate differences in mean sum scores of Patient Health Questionnaire-8 (PHQ-8) somatic symptom items (sleep disturbances, fatigue, appetite changes) in people with a chronic illness when the items were administered outside the context of a depression questionnaire versus as part of the PHQ-8. Secondary objectives were to evaluate individual somatic item scores. We hypothesised that people who completed somatic items outside of a depression assessment would have significantly higher scores than those who completed items as part of a depression assessment.

We conducted a randomised controlled experiment within the Scleroderma Patient-centred Intervention Network (SPIN) Cohort, a multinational cohort of people with systemic sclerosis. SPIN Cohort participants were randomly allocated to complete the PHQ-8 with somatic items (sleep disturbances, fatigue, appetite changes) presented separately from psychological items and without any indication that they were part of a depression questionnaire (Reordered Items arm) or in standard format (Standard PHQ-8 arm). Participants were automatically randomised when they logged into the SPIN Cohort platform to complete routine research assessments. The primary outcome was the mean sum score of PHQ-8 somatic items. Secondary outcomes were the mean scores of individual somatic items. Differences were assessed using between-groups t-tests.

In total, 851 participants were included (N = 428 in Reordered Items arm, N = 423 in Standard PHQ-8 arm). Mean (SD) PHQ-8 score was 6.0 (5.3) for all participants. We found no statistically significant differences in PHQ-8 somatic item sum scores (0.05 points; 95% confidence interval [CI]: −0.29 to 0.38) or in mean scores for item 3 (sleep disturbances; 0.04 points; 95% CI: −0.09 to 0.19), item 4 (fatigue; 0.03 points; 95% CI: −0.11 to 0.16) and item 5 (appetite changes; −0.03 points; 95% CI: −0.15 to 0.10).

We did not find evidence that responses to PHQ-8 somatic items were influenced by whether participants were aware they were responding to items about depression. This finding supports the validity of self-reported questionnaires for depression symptom assessment in people with chronic medical conditions.

Off-label use of antipsychotics, often at low doses, is increasing. Exploring the link between individual antipsychotic treatment patterns, including low-dose continuous use, and cardiometabolic health is crucial to prevent long-term morbidity and mortality. The current retrospective study examined the prevalence of cardiometabolic medicine use among antipsychotic-users, and its association with their past antipsychotic treatment patterns.

Using a 10% sample of the Australian national medicine dispensing claims data from 2022, we identified individuals aged 15–64 years with ≥2 antipsychotic dispensings (antipsychotic-users) and non-users. We extracted their past 5-year antipsychotic treatment patterns (dose, duration and use of multiple agents). Using Poisson regression and accounting for age and sex, we calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for cardiometabolic medicine use (anti-diabetics, antihypertensives, lipid modifiers, anti-thrombotics) among antipsychotic-users versus non-users. We applied unsupervised hierarchical clustering analysis to identify common antipsychotic-cardiometabolic co-dispensing.

Use of any cardiometabolic medicine was more prevalent among antipsychotic-users (35.8%, n = 28,345) than non-users (26%, n = 1,106,610) yielding an aPR of 1.30 (CI 1.28–1.33). aPRs for the use of anti-diabetics, lipid modifiers and antihypertensives were the highest among the younger age groups between 20 and 49 years and among women. Clustering analysis revealed increased co-dispensing of antipsychotics and anti-diabetics including sulfonylureas, statins, platelet aggregation inhibitors and beta blockers. The prevalence of cardiometabolic medicine use was associated with higher antipsychotic doses (23–54%), treatment duration (12–37%) and use of multiple agents (51%) compared with non-users. However, the prevalence of cardiometabolic medicine use for continuous (≥1 year) low-dose use of aripiprazole, asenapine, brexpiprazole, chlorpromazine, lurasidone, olanzapine, periciazine and quetiapine was also elevated (13–43%).

Use of cardiometabolic medicines is increased among people on long-term antipsychotic treatment. These results highlight the need for active monitoring for cardiometabolic adverse effects, with antipsychotic cessation where possible, or timely interventions to limit morbidity.

Reducing stigma and discrimination has been a priority in many national mental health policies for decades. Focusing efforts requires us to understand where this has the greatest impact on people with mental health problems. In 2024, we conducted a nationally representative survey that aimed to assess the burden of discrimination (as a product of frequency and impacts of experiences). Secondary aims were to quantify the types of discrimination experienced in different life domains and the sociodemographic and mental health problem characteristics of those experiencing higher burden.

Online surveys were completed by 6032 members of the general Australian community aged 18 years and over. The survey was carried out by the survey company The Social Research Centre, using their Life in Australia™ probability-based panel. Those who reported a mental health problem or scored high on the Kessler 6 measure of psychological distress (n = 2613) were asked about the past 12-month frequency and impact of their experiences of discrimination in a broad range of settings, including family, friends, workplaces and health services. The data were initially analysed using percent frequencies and 95% confidence intervals. A burden score was calculated for each domain, incorporating frequency and impact among those who reported discrimination experiences.

Overall, discrimination in social life was the most common (43.6% [95% CI 41.2, 45.9]), followed by discrimination from family (41.4% [95% CI 39.1, 43.7]) or in making or keeping friends (41.0% [95% CI 38.7, 43.3]). However, the highest burden was from discrimination in finding or keeping a job, in dating/intimate relationships, in housing (including renting or public housing) and in obtaining welfare benefits or disability pensions. The most common type of discrimination experience in the workplace and among friends, family and partners was of people lacking understanding of the impact of the person’s mental health problem. People aged 35–64 years were more likely than those aged 18–34 years to report higher burden in multiple domains; people with depression or attention-deficit/hyperactivity disorder also reported burden in more domains than people with anxiety or severe mental health conditions. Overall, 67.7% (95% CI 65.5, 69.9) agreed that stigma and discrimination was worse than the mental health problem itself.

Our study suggests that reducing the frequency and impact of discrimination in workplaces, welfare benefits and housing should be key targets for policy and practice. Improving the capacity of people in workplaces and intimate partners, families and friendship groups to better understand the impacts of mental health problems on individuals should also be a priority.

Generalized anxiety disorder (GAD) is characterized by persistent worry and physical symptoms, with prevalence estimates ranging from 0.8% to 8%. Researchers utilize various tools, such as standardized diagnostic interviews and self-report questionnaires, to estimate GAD prevalence in population-level studies. However, the diagnostic accuracy of these tools varies greatly. This scoping review aimed to identify the tools used for GAD prevalence estimation and assess the extent to which diagnostic tool accuracy is reported.

A systematic search was conducted in MEDLINE, Embase and PsycINFO using MeSH terms and keywords related to GAD prevalence. No date restrictions were applied. Studies were eligible if they used nationally or regionally representative samples and defined GAD based on DSM-5, ICD-11 or older case definitions. Studies focusing solely on specific sub-groups were excluded. Data extraction included study characteristics, diagnostic tools and reporting of test accuracy.

A total of 537 studies were initially identified, with 48 meeting inclusion criteria, published between 1994 and 2024. Most studies were conducted in Europe (43.75%) and employed cross-sectional designs (92%). Structured diagnostic interviews were the most commonly used tool (77.08%), although self-report questionnaires gained popularity after 2005. Among the included studies, 62.5% reported test accuracy, often addressing validity and reliability.

Despite the widespread use of diagnostic tools in prevalence studies, test accuracy is not consistently reported, which may impact the reliability of prevalence estimates. The variability in agreement between self-report questionnaires and structured diagnostic interviews highlights the need for transparent reporting of test characteristics to improve the validity of GAD prevalence assessments across populations.

To synthesize the available experimental study evidence to estimate the effects of ketamine on suicide ideation (SI) in high-risk individuals.

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Double-blind randomized controlled trials and open-label studies investigating the safety and effectiveness of ketamine on SI published up to October 2025 were identified. Data were pooled using random-effects meta-analysis. The main outcome was standardized mean difference on SI in high-risk individuals. Secondary outcomes were the percentage of adverse events and the moderator effects.

We identified 21 studies with a total of 927 participants meeting our inclusion criteria. The pooled effect size for the reduction of SI after ketamine treatment was significant and clinically meaningful (large effect size of −1.40, 95% confidence interval: −2.15 to −0.66, P < 0.001, low–quality evidence). Dissociation (38.8%, P = 0.014), nausea (31.6%, P < 0.001), dizziness (24.7%, P = 0.003), headache (22.0%, P = 0.011) and anxiety (15.8%, P < 0.001) were the frequently reported adverse events. Moderator analyses indicated that the effect was higher in younger individuals and those with severe SI.

Our findings highlight the effectiveness of ketamine in reducing SI in high-risk individuals, especially younger individuals and those with severe ideation. Nonetheless, additional research is required to better understand optimal dosing regimens and the potential long-term effects of ketamine treatment.

While breast cancer is rare in men, its incidence is rising, prompting more research into the mental health impacts of the disease in male patients. Anxiety, depression and sleep disorders are well-documented in women with breast cancer, but the effects on men are not as well understood, underscoring a need for gender-specific analysis.

This retrospective cohort study used data from the Health Insurance Review & Assessment Service from 2009 to 2017, examining patients diagnosed with ductal carcinoma in situ or invasive breast cancer. A propensity score matching at a 5:1 ratio resulted in a sample size of 280 men and 1,400 women for analysis. The study assessed the cumulative incidence of anxiety, depression and sleep disorders, along with potential risk factors for these conditions.

Out of 75,936 breast cancer patients, 0.4% (281) were men. Women exhibited a significantly higher incidence of mental health conditions compared to men (p = 0.017), particularly in terms of anxiety. However, there were no significant gender differences in the incidence of depression or sleep disorders. Women demonstrated a higher risk of developing anxiety disorders (hazard ratio: 1.498, 95% CI: 1.057–2.123, p = 0.023). After adjusting for confounders, gender differences in depression and sleep disorders were not statistically significant.

Women with breast cancer experience higher rates of anxiety disorders, while depression and sleep disorders show no gender disparity. These findings suggest that mental health care approaches should be adapted to better support men with breast cancer and address their unique mental health needs.

The mental health risk factors for primary healthcare workers (PHWs) following the Coronavirus Disease 2019 pandemic and the differences by urbanicity remain unclear. In this study, we aimed to identify key factors of anxiety and depression among PHWs in urban and rural settings in China.

This cross-sectional study was conducted in all 31 provinces in mainland China, between 1 May and 31 October 2022. A total of 3,769 PHWs, including family physicians, nurses, public health professionals, pharmacists, and other medical staff, were recruited from 44 urban community health service centers and 27 rural township hospitals. The Bayesian Additive Regression Tree model was employed to identify risk factors of anxiety and depression.

Among 3,769 PHWs, 1,006 (26.7%) worked in urban areas and 2,763 (73.3%) in rural areas. Occupational satisfaction significantly influenced anxiety in both urban and rural practitioners. For urban PHWs, living with family (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.28–0.62) and self-rated health (fair: OR: 0.31, 95% CI: 0.23–0.42; good: OR: 0.13, 95% CI: 0.09–0.20) were key factors of anxiety. For rural PHWs, after-work exercise (rarely: OR: 0.28, 95% CI: 0.11–0.76; frequently: OR: 0.15, 95% CI: 0.05–0.44) played a critical role. Depression was associated with after-work exercise, self-rated health, and occupational satisfaction for all PHWs. Additionally, living with family (OR: 0.51, 95% CI: 0.34–0.75) and organizational support satisfaction (satisfied: OR: 0.28, 95% CI: 0.19–0.42) were significant for urban practitioners.

Risk factors such as occupational satisfaction, health, and family relations significantly influence PHW mental health in China, with notable differences by urbanicity. Tailored mental health interventions are recommended to address urban–rural disparities.

Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders.

We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years.

In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15–1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99–1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15–2.09, fully adjusted model). The results further demonstrated an exposure–response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants.

Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.

Although often associated with ageing, disability is becoming increasingly prevalent among young adults. While disability can pose a substantial psychological burden for young adults on critical pathways to establish the foundations for their future, the mental health risks faced by this population remain underexplored.

This study aimed to (1) assess the association between disability – including its presence, severity and type – and the risk of depressive and anxiety disorders, and (2) examine whether this association varies across sociodemographic factors, health behaviours and comorbidities in a young adult population.

We conducted a population-based cohort study using linked data from the National Disability Registry and the National Health Insurance Database of South Korea. A total of 6,058,290 individuals aged 20–39 years who underwent health check-ups between 2009 and 2012 were followed through 2022. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for depressive and anxiety disorders.

Individuals with disabilities had significantly higher risks of depressive (aHR: 1.58, 95% CI: 1.55–1.60) and anxiety disorders (aHR: 1.50, 95% CI: 1.42–1.59). Increased risks were consistently observed across various disability types with the highest risk observed for mental health-related disabilities in depression (aHR: 4.98, 95% CI 4.62–5.37) and epilepsy-related disabilities in anxiety disorders (aHR: 12.05, 95% CI 8.73–16.63). Subgroup analyses revealed stronger associations among individuals in their 20s, low-income groups, non-smokers and those abstaining from alcohol, compared to their respective counterparts.

Young adults with disabilities, a population that has been relatively overlooked in policy discussions, warrant greater policy attention in relation to their mental health.

Loneliness is a global public health concern that has been widely associated with a variety of mental health impairments. Two dimensions of loneliness have been differentiated, that is, social loneliness (the perceived absence or inadequacy of a broader social network) and emotional loneliness (the perceived absence of a close, intimate relationship or emotional support from a significant person). The present study aimed to test the hypothesis that both dimensions of loneliness are differentially associated with mental health outcomes.

Altogether, 3275 individuals (aged 45.2 ± 15.7 years, 47.9% men), enrolled from the general population, were assessed at two waves spanning 6 to 7 months. Social and emotional loneliness were quantified using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was assessed with the six-item Lubben Social Network Scale, depressive symptoms with the Patient Health Questionnaire-9, generalised anxiety with the Generalised Anxiety Disorder-7, social anxiety with the Social Interaction Anxiety Scale, and paranoid ideation with the Revised Green et al. Paranoid Thoughts Scale. The data were analysed using a cross-lagged panel network model. Covariates included age, gender, education, employment status, place of residence, monthly income, the history of psychiatric treatment and substance use.

Both dimensions of loneliness were bidirectionally associated and were found to have the highest overall weight of outcoming network connections. Emotional loneliness was bidirectionally and positively associated with all measures of mental health. In turn, social loneliness predicted higher levels of social anxiety but was not associated with other mental health outcomes. It was bidirectionally associated with social isolation.

The findings imply the relevance of differentiating social and emotional dimensions of loneliness in the assessment of its underlying mechanisms and consequences for mental health. Emotional loneliness might show a greater importance in the development of psychopathological symptoms compared to its social dimension.

Although extensive research has been conducted on the impact of the COVID-19 pandemic on global mental health, a systematic synthesis of the cross-time dynamics of suicidal ideation (SI) remains lacking. This study aims to systematically synthesise the global aggregated prevalence of SI before and after the pandemic, investigate the potential association between pandemic exposure and the SI risk through meta-regression analysis of longitudinal studies, and explore key moderating factors.

A systematic search was conducted in Web of Science, PubMed, PsycINFO and ProQuest databases up to August 2025. Observational studies were included if they employed cross-sectional or longitudinal designs and reported the prevalence of SI before and after the pandemic across global regions.

The analysis included 354 cross-sectional studies (N = 8,247,875) and 27 longitudinal studies. In cross-sectional studies, the pooled prevalence of SI was 13.20% [95% CI 12.06%–14.42%]. Pre-pandemic prevalence was 12.52% [95% CI 8.46%–18.14%], and post-pandemic prevalence was 13.24% [95% CI 12.07%–14.50%], with no significant difference. Meta-regression analysis identified three moderators. Specifically, larger sample sizes (n) were associated with lower prevalence (β = −0.232, P < 0.0001); higher study quality predicted lower prevalence (β = −0.278, P < 0.001); and studies on adults reported significantly lower prevalence than adolescents (β = −0.366, P < 0.05). Conversely, time progression during the pandemic, development level, geographical area, gender and measurement method did not show significant independent effects. Interaction analyses also found no significant moderating effect of economic development level or geographical area on the temporal trend of SI prevalence. Longitudinal analysis found no significant increase in prevalence from the pre-pandemic to the post-pandemic period (P = 0.101). However, a small but significant increase occurred between early and late stages within the pandemic (β = 0.265, P = 0.021). Subgroup analyses showed no significant moderation of these temporal changes.

The COVID-19 pandemic’s impact on SI was dynamic. While no significant prevalence change was found between pre- and post-pandemic periods, a significant increase occurred as the crisis progressed. This deteriorating trend was more pronounced in adolescents, identifying them as a key vulnerable group. Methodologically, findings were moderated by the measurement instrument, study quality and sample size, with evidence suggesting potential small-study effects. These findings underscore the need for robust mental health surveillance and targeted interventions for at-risk populations during prolonged public health crises.

The protocol was registered on PROSPERO (CRD42024603151).

Having a child with a psychiatric diagnosis is associated with parents’ greater risk of subsequent mental disorders but no immediate change in their annual labour market metrics. This discrepancy could be explained by shorter absences from work. We examined first-time psychiatric sickness absences in parents whose children have psychiatric diagnoses.

Using several linked nationwide Finnish registers, in this cohort study we examined time to first psychiatric sickness absence in parents whose children were born in 2001–2012 (early-childhood-onset diagnoses) or 2005–2016 (late-childhood-onset diagnoses). Exposure was having a child with a psychiatric diagnosis. Follow-up started when the parent’s eldest turned 1 (early-childhood-onset diagnoses) or 5 (late-childhood-onset diagnoses) and ended at psychiatric sickness absence, emigration, 68th birthday, death, or 31 December 2020, whichever occurred first.

The 2001–2012 and 2005–2016 cohorts included 357 135 and 397 874 parents followed for 3.31 and 3.70 million person-years. Having a diagnosed child was associated with greater risk of psychiatric sickness absence in all except men whose children had substance use or psychotic disorder diagnoses. Time-varying analyses showed the greatest associations for women (HR: 4.92; 95% CI: 3.97–6.10) and men (HR: 2.48; 95% CI: 1.61–3.80) within 6 months of a child’s eating disorder diagnosis.

Parents of children with psychiatric diagnoses may be at a greater risk of a psychiatric sickness absence. Associations differed by child’s diagnosis, parent’s gender and time since diagnosis.

Efforts to reduce restrictive practices (RPs) in mental health care are growing internationally. Yet, inconsistent definitions and perspectives often challenge the consistent implementation and evaluation of reduction strategies. This study explored which scenarios different mental health stakeholders classify as RPs, examined the contextual factors influencing these classifications and compared classification patterns across clinicians, researchers, service users and family caregivers.

An international cross-sectional survey was conducted using a multilingual online questionnaire hosted on the Qualtrics platform. A total of 851 stakeholders participated, including clinicians (n = 517), service users (n = 80), family caregivers (n = 89) and researchers (n = 165). Participants were presented with 44 potential RP case scenarios and asked to rate whether each scenario should be classified as an RP using a four-point Likert scale (Definitely yes, Probably yes, Probably no, Definitely no). The scenarios were organized into 22 paired comparisons, each sharing the same core context but differing in specific details. Paired comparisons were analyzed one pair at a time, allowing us to identify classification patterns between the scenarios and isolate the effects of particular contextual factors using ordered logistic regression. Interaction analyses were then conducted to assess how classification patterns varied across stakeholder groups.

Substantial discrepancies exist both within and between stakeholder groups regarding whether a given action should be considered an RP or not. Physically visible actions were often identified as RPs across all groups, while less visible forms often went unrecognized. Contextual differences, such as the healthcare professional’s intention, duration of the action, methods used, presence or absence of consent, door-locking status, and the severity of anticipated harm to be prevented influenced whether a given action was classified as an RP. Service users classified more scenarios as RPs than other groups; however, their decisions were more context-sensitive, shifting notably even with minor changes in scenario details. Among the 22 paired scenarios compared, 13 (59.09%) showed significant differences (p < 0.01) within at least one stakeholder group and eight demonstrated differences between groups.

Mental health stakeholders’ interpretations of RPs were often shaped not only by the inherent coercive nature of actions but also by the context in which they occurred and the professional role of the assessors. This underscores the need for harmonized definitions and classification frameworks for RPs, co-designed with diverse stakeholders. Addressing less visible forms of RPs in policy and clinical practice is also essential.

In England, psychological therapies provided in primary care are recommended as first-line treatment for people living with mild-to-moderate dementia experiencing depression or anxiety. It is known that people living with dementia experience more barriers to accessing therapy than people without dementia, but such inequalities in terms of rates of access to primary care services are yet to be characterised.

In this retrospective, observational study of linked electronic healthcare records, the national database of the National Health Service (NHS) Talking Therapies for anxiety and depression programme was used to compare pathways to accessing therapy between 6623 people living with dementia and 4 825 489 without dementia between 2012 and 2019. Outcomes included access to an assessment, to therapy and reasons for discharge. Primary analyses used a propensity-score matched cohort to compare outcomes. Exact matching was used for the NHS service entity.

The prevalence of dementia in the study cohort was lower than the prevalence of dementia in a representative population, based on an estimation of prevalence in people with mild-to-moderate age over 35 (0.23% in our study vs 3.82% in previous research). Compared to people without dementia, people living with dementia were less likely to access an assessment (odds ratio [OR] = 0.60; 95% confidence interval [CI]: 0.55–0.65), to subsequently receive therapy (OR = 0.67; 95% CI: 0.61–0.73) and more likely to be discharged because services were deemed not suitable before having an assessment (relative rate ratio [RRR] = 4.90; 95% CI: 4.20–5.72) and starting therapy (RRR = 2.74; 95% CI: 2.24–3.35). Female gender, social deprivation, Asian ethnicity and less common dementia subtypes (such as frontotemporal dementia) were also associated with poorer access rates and a higher likelihood of services being deemed not suitable. Involvement of care partners in the referral process was associated with better access rates.

Pathways to accessing primary care psychological therapy services must be made more accessible for people living with dementia. Better access could be achieved by increasing referrer awareness and training for staff within services to promote access for people living with dementia (especially for groups under-represented in services), better understanding how to involve care partners in the process, as well as when specialist support might be more suited in secondary care. More granularity in the medical coding of rarer dementia diagnoses in electronic health records would also allow for better statistically powered research for these groups.

While depressive symptoms are common during menopausal transition, the relationship between the two remains unclear. Therefore, this study aimed to examine the longitudinal changes in depressive symptoms among middle-aged Korean women and identify those with elevated and worsening symptoms during this period.

A total of 1,178 participants who underwent comprehensive health examinations at Kangbuk Samsung Hospital in Korea were followed for a median of 10.8 years (IQR, 9.2–11.6; maximum, 12.7), including all women who reached natural menopause during follow-up, with only data prior to HRT initiation included. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and menopausal stages were classified according to the STRAW + 10 criteria and final menstrual period (FMP). Linear mixed-effects models and group-based trajectory modelling (GBTM) were applied to evaluate longitudinal changes in depressive symptoms and to identify distinct trajectories in the severity and stability of depressive symptoms.

The age-adjusted prevalence of CES-D ≥ 16 was 11.0%, 11.5%, 11.2% and 12.4%, with corresponding mean scores of 6.7, 6.6, 6.9 and 7.1 across stages. After adjusting for time-varying age and covariates, menopausal stage transitions were not significantly associated with higher levels of depressive symptoms, whether analysed as continuous or binary variables. For binary CES-D (≥16), the estimated coefficients (95% CI) were 0.10 (–0.20 to 0.41) for early transition, 0.09 (–0.21 to 0.39) for late transition and 0.26 (–0.09 to 0.61) for post-menopause. Similarly, time relative to the FMP (–11 to +9 years) showed no significant association with depressive symptoms. GBTM identified three distinct trajectories: most participants (75.5%) maintained consistently low depressive symptoms throughout the transition, whereas 5.8% showed worsening symptoms. Poor sleep quality (OR 5.83, 95% CI 3.25 to 10.45) and moderate-to-severe vasomotor symptoms (OR 2.95, 95% CI 1.30 to 6.70) were significantly associated with the worsening trajectory. Suicidal ideation was higher in this group (45.4% at baseline, increasing to 70.5% at follow-up).

Most women maintained low depressive symptoms during the menopausal transition; however, a subset experienced worsening symptoms linked to menopause-related physical symptoms. Medical visits for menopause-related symptoms may provide opportunities for screening depressive symptoms in higher-risk women, though the screening effectiveness requires further evaluation.

To investigate the association of midlife and late-life undiagnosed mood symptoms, especially their comorbidity, with long-term dementia risk among multi-regional and ethnic adults.

The prospective study used data from the UK Biobank (N = 142,670; mean follow-up 11.0 years) and three Asian studies (N = 1,610; mean follow-up 4.4 years). Undiagnosed mood symptoms (manic symptoms, depressive symptoms and comorbidity of depressive and manic symptoms) and diagnosed mood disorders (depression, mania and bipolar disorders) were classified. Plasma levels of 168 metabolites were measured. The association between undiagnosed mood symptoms and 12-year dementia (including subtypes) risk and domain-specific cognitive function was examined. The contribution of metabolites in explaining the association between symptom comorbidity and dementia risk was estimated.

Undiagnosed mood symptoms were prevalent (11.4% in the UK cohort and 31.2% in Asian cohorts) among 1,462 (1.0%) and 74 (19.4%) participants who developed dementia. Comorbidity of undiagnosed mood symptoms was associated with higher dementia risk (sub-distribution hazard ratios = 9.46; 95% confidence interval = 4.07–21.97), especially Alzheimer’s disease, and with worse reasoning ability, poorer numeric memory and metabolic dysfunction. Glucose and total Esterified Cholesterol explained 9.1% of the association between symptom comorbidity and dementia, with most of the contribution being from glucose (6.8%).

Comorbidity of undiagnosed mood symptoms was associated with a higher cumulative risk of dementia in the long term. Glucose metabolism could be implicated in the development of mood disorders and dementia. The distinctive pathophysiological mechanism between psychiatric and neurodegenerative disorders warrants further exploration.

Depression among middle-aged and older adults is a critical public health priority. Clarifying the dynamic evolution of depression is essential for establishing prevention and intervention strategies; however, relevant research is limited. The aim of this study was to elucidate the transition patterns underlying different depressive symptoms (DS) states.

Data from the China Health and Retirement Longitudinal Study were utilised in this study, which included participants aged ≥45 years with multiple DS assessments via the Center for Epidemiological Studies Depression Scale. Multi-state Markov models were employed to estimate transition probabilities and intensities between DS states, the total length of stay and mean sojourn time in each state and the hazard ratios (HRs) of factors.

Among 19,991 participants (average follow-up: 7.3 years), the 10-year cumulative probabilities of transition from non-DS to depressive states increased by 19.4% in males and 31.8% in females. Mild DS was the most unstable state, with the highest transition intensities (males: 1.029; females: 0.970) and shortest sojourn time (males: 0.959 years; females: 1.022 years). Sex and age strongly influenced depressive state transitions. Compared to participants without chronic disease, those with ≥3 chronic diseases had a higher risk of developing mild DS (HR = 1.685, 95% Confidence Interval [CI]: 1.530–1.856) and transitioning to death from both the non-DS (HR = 2.905, 95% CI: 2.293–3.681) and severe-DS (HR = 3.429, 95% CI: 1.290–9.112) states, but a lower likelihood of recovery from mild DS (HR = 0.821, 95% CI: 0.749–0.900) and severe DS (HR = 0.730, 95% CI: 0.630–0.847). Compared to no participation in social activities, frequent participation was associated with a lower risk of progression to the mild-DS state (HR = 0.851, 95% CI: 0.785–0.920) and a greater likelihood of recovery from severe DS (HR = 1.169, 95% CI: 1.034–1.322). Being underweight was associated with an increased risk of mild-DS onset (HR = 1.338, 95% CI: 1.129–1.587) and transitioning to death from both the non-DS and mild-DS states, compared with individuals of normal weight.

Our study revealed a continuous population shift towards depressive states and identified the mild-DS state as a critical intervention state owing to its instability. In addition to sex and age, modifiable factors, including chronic disease conditions, social activity participation and weight status, significantly influenced DS-state transitions, offering actionable insights for precision prevention strategies.