BJPsych Open

BackgroundMany people with depression do not respond well to the first antidepressant prescribed. Treatment Resistant Depression (TRD) refers to depression which does not respond to multiple subsequent antidepressant treatments. Identifying TRD in routinely-collected health records is challenging due to limited response-related data. Previous studies have used definitions based on the number of antidepressant switches observed. However, these do not account for other features clinically indicati...

BackgroundThe negative impacts of the COVID-19 pandemic on bereavement experiences and grief outcomes are relatively well documented. However, less is known about the evolving support needs of people bereaved during this time, what support they used and, crucially, how this support helped (or hindered) their coping. Beyond the pandemic context, evidence of how bereavement support needs relate to the use and perceived helpfulness of different types of support is needed to inform bereavement servi...

BackgroundPsychomotor retardation is characterised by slowed motor and cognitive processes. Although associated with greater illness severity in depression, its relationship with treatment response is unclear. We examined whether psychomotor retardation is associated with treatment outcomes in depression. MethodsWe conducted a secondary analysis of individual participant data from nine randomised controlled trials of pharmacological, psychological and exercise-based treatments for unipolar depr...

BackgroundHealthcare workers experience disproportionately high rates of depression, anxiety, and post-traumatic stress compared with the general population. Within the NHS, work-related stress and mental health-related sickness absence has increased over the past decade, a trend intensified by COVID-19. Mental health support offers are patchy across the UK, and the evidence base around interventions is scarce. The Staff Mental Health Service (SMHS) provides rapid, confidential support for NHS s...

BackgroundWhile commonly accepted depressive subtypes reflect phenotypic differences, there has been minimal progress in identifying discrete pathophysiological pathways, biomarkers or differential therapeutic approaches which effectively guide clinical management. AimsTo test the biological validity and clinical utility of a circadian subtype of depression on the basis of clinical course, differential medication response (self-reported) and genetic risk profile. MethodsCross-sectional data we...

BackgroundChildhood maltreatment is a major risk factor for depression and may contribute to sex differences in depression prevalence. We examined sex-specific associations between childhood maltreatment and depression and estimated the proportion of depression cases attributable to specific maltreatment subtypes. MethodsWe analyzed baseline data from 159,045 participants (49.4% women; aged 19-72) in the German National Cohort (NAKO). Childhood maltreatment was assessed via the Childhood Trauma...

BackgroundThe COVID-19 pandemic, coupled with concurrent social instabilities, has raised concerns about the long-term impact on the population mental health. While existing studies have primarily focused on the acute phase, less is known about how anxiety and depression symptoms have evolved throughout prolonged societal disruption. This study aimed to identify distinct anxiety and depression symptom trajectories and to determine the individual, relational, and societal protective and risk fact...

BackgroundImproving access to high-quality community-based crisis care and reducing inpatient admissions are key policy objectives in England, yet evidence on who uses crisis-related services and potential inequalities in access remains limited. AimsTo examine socio-demographic patterns in the use of six crisis-related services in England: 1) Crisis phonelines; 2) Crisis cafes; 3) Crisis Resolution and Home Treatment teams (CRHTs); 4) Voluntary inpatient admissions; 5) Compulsory inpatient admi...

Individuals with psychiatric disorders have significantly higher mortality rates than the general population. Despite identifying risk factors, few attempts have been made to systematically use this information to stratify mortality risk. To address this gap, we developed and externally validated a risk prediction model using national healthcare and social register data from two countries. Nationwide register data were used to create a Swedish cohort (n=530,201) for model development and a Finni...

BackgroundPredictive models in mental health can identify service users at risk of high-intensity care, enabling proactive interventions. However, false positive predictions may lead to over-medicalisation, inequitable resource use, and stigma. Understanding the factors associated with false positives can improve model interpretation and real-world application. AimsTo evaluate a previously validated prediction model for high-intensity (top decile) service use and identify false positive (FP) vs...

BackgroundPoor patient retention and family engagement compromise the effectiveness of coordinated specialty care (CSC) for first-episode psychosis (FEP). This mixed methods study aimed to identify program-level characteristics (CSC fidelity and engagement strategies) associated with patient retention and family engagement in Massachusetts CSC programs. MethodsPrimary outcomes were rates of patient retention and family engagement ([≥]1 evidence-based family intervention session), based on CS...

BackgroundRecovery Colleges (RCs) support recovery through adult education, with preliminary evidence of positive effects on a range of outcomes. This study examined associations between RC enrolment and mental health service use at an index mental health provider, use of other National Health Service (NHS) hospital services for all causes, associated costs, and service user outcomes. MethodsOur retrospective matched cohort study used a controlled before-and-after design. We used linkage with e...

BackgroundExternal validations of existing risk models is an efficient step towards potential implementation, obviating the need to develop new models. However, validation in new clinical settings poses several challenges. ObjectiveTo externally validate the OxSATS tool using data from the Oxford Monitoring System for Self-harm in England. OxSATS is a validated tool to predict suicide after self-harm developed using Swedish population registers. MethodsWe selected episodes of self-harm (ICD-10...

BackgroundWorldwide, common mental disorders such as anxiety and depression are major contributors to disability. However, the role of diet as a risk factor for anxiety and depression remains underexplored. Therefore, we investigated the associations between food groups and major depressive disorder (MDD) and anxiety disorders, following a harmonized protocol to enable integration of studies. MethodsWe analysed data from 1,634 participants in the Netherlands Study of Depression and Anxiety to e...

BackgroundUp to one-third of medical inpatients experience clinically relevant mental distress, yet many remain untreated. Stepped and collaborative care (SCC) models may improve access to mental health care, but predictors of service uptake are unclear. We examined patient- and ward-level predictors of psychosomatic-psychiatric consultation (PPC). MethodsWe analyzed data from SomPsyNet, a stepped-wedge cluster randomized trial targeting SOMatic inpatients across three Swiss tertiary hospitals,...

BackgroundFood insecurity (FI) is associated with overall poorer mental health in childhood and adolescence and negatively impacts longer-term health. However, less is known about how differential exposure to FI may shape the development of different mental health symptoms over this period. MethodsWe used data from two population-based UK birth cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC; n=6,182; born 1991-1992) and Growing Up in Scotland (GUS; n=3,167; born 2004-2005)...

IntroductionUse of coercive measures in psychiatric hospitals is clinically and ethically challenging. Aiming to support prevention, we developed and evaluated machine learning models to predict both mechanical restraint and a broader composite outcome that includes related coercive measures. MethodsThe dataset comprised electronic health records (EHR) from adults ([≥]18 years) who had at least one admission to the Psychiatric Services in the Central Denmark Region between 2015 and 2021. For...

ObjectiveDespite recommendations that young people at clinical high risk (CHR) for psychosis receive stepped treatment, few programs have published details of their clinical models or outcomes. This study describes the preliminary effectiveness of a risk calculator-informed stepped care model used at the Yale PRIME Clinic, a specialized outpatient clinic for young people at CHR. MethodsSeventy-one individuals (ages 12-25) at CHR enrolled in Yales PRIME Clinic during the first four years of the ...

ObjectiveThis study aimed to identify characteristics that define population need groups with similar mental health service needs within prisons and describe the mix of services required to meet those needs. MethodsMixed methods were used, including three iterative, semi-structured focus groups, followed by an online survey, seeking information on the characteristics that define service needs, how these can identify groups of people who require mental health care in prisons and the services req...

BackgroundMental well-being encompasses positive psychological functioning, life satisfaction, and engagement with daily activities. It is influenced by multiple interrelated factors, including symptoms of stress, anxiety, depression, and psychological inflexibility. Network analysis provides a data-driven framework for examining the complex interconnections between these components and for identifying elements that may play a central role in the mental well-being system. The present study aimed...