BJPsych Open

Using data from the Attitudes to Mental Illness (AMI) survey, we previously reported positive change in mental health stigma in England between 2008-2019. However, following the conclusion of the Time to Change campaign in 2021, 2023 data revealed a deterioration in several stigma-related attitudes. This report presents AMI survey 2024 results, examining changes over the past year. Regression analyses assessed stigma-related knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes toward the Mentally Ill scale (CAMI)) and behavioural intent (Reported and Intended Behaviour Scale (RIBS-IB)), along with willingness to interact based on vignettes of depression and schizophrenia. The proportion of respondents achieving 2023-level MAKS and CAMI scores declined significantly (by 3.5%, p=0.028; and 7.0%, p<0.001), while RIBS-IB scores showed a non-significant decrease. Vignette responses remained stable, but there are signs of increasing desire for social distance. This report explores potential drivers of these trends.

BackgroundWe investigated the extent to which positive changes in stigma outcomes reported over the course of Time to Change were sustained by 2023, two years after the programmes end in 2021. MethodsWe used regression analyses to evaluate trends in outcomes. Measures were of stigma-related knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes to the Mentally Ill scale (CAMI)), and desire for social distance (Reported and Intended Behaviour Scale (RIBS)). We also examined willingness to interact with people based on vignettes of depression and schizophrenia, and attitudes towards workplace discrimination against people with these conditions, using data from the British Social Attitudes Survey (BSAS) 2015 for comparison. FindingsReported in standard deviation units (95% confidence intervals (CI)), attitudes towards mental illness improved between 2008 and 2023 (SD=0.24, 95% CI=0.16 to 0.31), but following an increase of 9.9% between 2008-19, scores decreased by 3.3% (p=0.015). After improvements to 2019, 2023 MAKS and RIBS scores no longer differed from 2009 scores, indicating decreases since 2019 in stigma-related knowledge (MAKS scores declined 7.8% since 2019, p<0.001) and willingness to interact (RIBS scores declined by 10.2% since 2019, p<0.001). Conversely, comparison with BSAS 2015 data indicated that in 2023 respondents were more willing to interact with people with depression ({beta}=-2.69, p<0.001) and schizophrenia ({beta}=-2.70, p<0.001); and more likely to agree that people with either condition are just as likely to be promoted, and to disagree that their medical history should influence this. This change was most pronounced for schizophrenia (OR=2.52, 95% CI=2.02 to 3.14). ConclusionsThe lasting positive changes reflect support for non-discrimination and willingness to interact with someone after a sense of familiarity is evoked. Besides the end of Time to Change, interpretations for declines in other outcomes include the impacts of the covid-19 pandemic; economic stress; and reduced access to healthcare.

BackgroundPeople with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimuli, and employ safety behaviours which are often in excess of health guidelines and at the expense of other life priorities. The natural course of severe COVID anxiety is not known. MethodsThis prospective cohort study followed 285 people with severe COVID anxiety in United Kingdom over 18-months. Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety. ResultsMost participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease; p<0.001), but a quarter of people (23.7%, 95% CI 17.8 to 30.1) continued to worry about COVID every day. Increasing age, being from an ethnic background which conferred greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms predicted significantly slower improvements in severe COVID anxiety adjusting for other clinical and demographic factors. ConclusionsFor most people severe COVID anxiety significantly improves with time. However established interventions treating depression or health anxiety, and targeting older people and people from at-risk minority groups who appear to recover at slower rates, might be clinically indicated in future pandemics. HighlightsO_LIMost people with severe COVID anxiety reported large improvements in symptoms 18-months later. C_LIO_LILevels of co-occurring poor mental health and social functioning also improved for most people. C_LIO_LIMore than 1 in 10 continued to have severe COVID anxiety symptoms 18 months later. C_LIO_LIAge, ethnic background, and high levels of health anxiety and depression predict slower improvements. C_LIO_LIPeople with these risk characteristics could be considered for targeted support. C_LI

ImportanceMultiple data sources suggest that COVID-19 is having adverse effects on mental health. But it is vital to understand what is causing this: worries over potential adversities due to the pandemic, or the toll of experiencing adverse events. ObjectiveTo explore the time-varying longitudinal relationship between (i) worries about adversity, and (ii) experience of adversity, and both anxiety and depression and test the moderating role of socio-economic position. DesignLongitudinal cohort study SettingCommunity study ParticipantsA well-stratified sample of UK adults recruited into the UCL COVID -19 Social Study (a panel study collecting data weekly during the Covid-19 pandemic) via a combination of convenience and targeted recruitment. The sample was weighted to population proportions of gender, age, ethnicity, education and geographical location. ExposuresWorries or experiences of adversities during the COVID-19 pandemic OutcomesAnxiety (GAD-7) and depression (PHQ-9) ResultsData were analysed from 41,909 UK adults (weighted data: 51% female, aged 18-99) followed up across 6 weeks (178,430 observations). Using fixed effects regression was used to explore within-person variation over time, cumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression. Number of worries were associated more with anxiety than depression, but number of experiences were equally related to anxiety and depression. Individuals of lower socio-economic position were more negatively affected psychologically by adverse experiences. Conclusions & relevanceMeasures over the first few weeks of lockdown in the UK appear to have been insufficient at reassuring people given we are still seeing clear associations with poor mental health both for cumulative worries and also for a range of specific worries relating to finance, access to essentials, personal safety and COVID-19. Interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies. Key pointsO_ST_ABSQuestionC_ST_ABSHow do worries over potential adversities due to the COVID-19 pandemic, or the toll of experiencing adverse events affect mental health? FindingsCumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression during COVID-19, especially amongst individuals of lower socio-economic position. MeaningDuring a pandemic, interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies.

BackgroundThere is a growing global awareness of the psychological consequences of long Covid, supported by emerging empirical evidence. However, the mergence and long-term trajectories of psychological symptoms following the infection are still unclear. AimsTo examine when psychological symptoms first emerge following the infection with SARS-CoV-2, and the long-term trajectories of psychological symptoms comparing long and short Covid groups. MethodsWe analysed longitudinal data from the UCL Covid-19 Social Study (March 2020-November 2021). We included data from adults living in England who reported contracting SARS-CoV-2 by November 2021 (N=3,115). Of these, 15.9% reported having had long Covid (N=495). They were matched to participants who had short Covid using propensity score matching on a variety of demographic, socioeconomic and health covariates (N=962, n=13,325) and data were further analysed using growth curve modelling. ResultsDepressive and anxiety symptoms increased immediately following the onset of infection in both long and short Covid groups. But the long Covid group had substantially greater initial increases in depressive symptoms and heightened levels over 22 months follow-up. Initial increases in anxiety were not significantly different between groups, but only the short Covid group experienced an improvement in anxiety over follow-up, leading to widening differences between groups. ConclusionsThe findings shed light on the psychobiological pathways involved in the development of psychological symptoms relating to long Covid. The results highlight the need for monitoring of mental health and provision of adequate support to be interwoven with diagnosis and treatment of the physical consequences of long Covid.

The SARS-CoV-2 (COVID-19) pandemic has been associated with worsening mental health. Longitudinal studies have monitored changes in mental health from pre-pandemic levels, identifying critical points for mental health as COVID-19 restrictions evolve. Here we highlight changes in depression and anxiety in the UK from pre-pandemic across four pandemic occasions: April and June 2020, January, and July 2021 - corresponding to changes in COVID-19 restrictions. Data were from >5,000 27-29-year-olds from the Avon Longitudinal Study of Parents and Children (ALSPAC). We found that anxiety almost doubled throughout the pandemic compared to pre-pandemic levels and remained high until July 2021 when COVID-19 restrictions were fully lifted. Depression was lower than pre-pandemic levels in April 2020 but increased as the pandemic evolved until July 2021. Women, those with existing mental/physical health conditions and those with economic hardship were most at risk of sustained poorer mental health across the pandemic. Our results highlight the importance of longitudinal studies for tracking mental health during the COVID-19 pandemic and across virus suppression policy changes.

BackgroundCognitive function is a significant predictor of health and mortality in the population. Common mental health problems, such as depression and anxiety, are associated with both cognitive impairments and increased functional impairment. This study aimed to examine the relationship between cognition, mental health and functioning across two cohorts. MethodsParticipants were recruited from an online population cohort, HealthWise Wales (N=3,679), and a psychiatric cohort, the National Centre for Mental Health (NCMH, N=1,036), to complete a cognitive battery and the World Health Organisation 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, education and health/lifestyle factors using linear and logistic regression. ResultsHigher 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: OR=1.22, 95%CI[1.11,1.34], P<0.001; NCMH: OR=1.31, 95%CI[1.19,1.46], P<0.001) and living with a partner (HealthWise Wales only: OR=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. ConclusionsCognitive function was associated with functioning in both samples. This association may be partially explained by current symptoms of depression and anxiety. Both cognitive function and common mental health problems may be potential intervention targets to alleviate daily difficulties.

BackgroundAnxiety and somatic symptoms were common during the coronavirus pandemic. People who were highly anxious about COVID-19 may have been at a higher risk of developing new somatic symptoms which persisted after the pandemic. Here we examine changes in somatic symptoms before and after the pandemic among people who had severe COVID anxiety, and identify factors associated with these changes. DesignUK adults who met the threshold for severe COVID anxiety were recruited online during the coronavirus pandemic, and were asked to rate their somatic symptoms post-pandemic, and retrospectively before the pandemic with the PHQ-15. Data on demographic and clinical factors were also collected. MethodsDescriptive statistics and multiple linear regression were used to characterise the sample of 197 people who provided complete data, and to examine factors associated with changes in somatic symptoms. ResultsMean PHQ-15 score increased significantly from 7.97 before the pandemic to 11.34 afterwards (t= 9.043, p<0.001). Despite this, there were gradual corresponding declines in levels of COVID anxiety and other co-occurring mental health symptoms after the pandemic ended. Multiple linear regression models identified that greater generalised anxiety symptoms and living with someone vulnerable to COVID were the strongest predictors of increased somatic symptoms during the pandemic. ConclusionsPeople with severe COVID anxiety reported high rates of somatic symptoms before the pandemic, which then increased significantly after the pandemic. There appears to be a complex interaction between COVID anxiety, pandemic experience, and somatic symptoms which warrants further investigation, and could inform targeted intervention in the future. What is already known on this subject?O_LIA host of demographic and psychological factors, such as generalised and health anxiety, contribute to the reporting of somatic symptoms. C_LIO_LIRecent evidence suggests that individuals with COVID-19 specific anxiety are more likely to report somatic symptoms, and that this association was present after controlling for other demographic and psychological factors. C_LIO_LIPeople who lived with someone vulnerable to COVID-19 during the pandemic reported higher rates of pandemic related stress and mental health symptoms. C_LI What does this study add?O_LIIndividuals with severe levels of COVID anxiety show a higher somatic symptom count compared to the general population. C_LIO_LIChest pain, dizziness and palpitations were the somatic symptoms which were most frequently reported to have increased over the pandemic by people who had severe levels of COVID anxiety. C_LIO_LIThe combination of severe COVID anxiety and living with someone vulnerable to COVID appears to have contributed to a higher risk of worsening somatic symptoms during the pandemic. C_LI

BackgroundRemote measurement technologies (RMT), such as smartphones and wearables, allow data collection from an individual in real-time during their day-to-day life, from which their mood, physiology, behaviour, and environment can be inferred. As such, RMT could monitor and detect changes relevant to depression for objective screening, symptom management, relapse-prevention, and personalised interventions. Whilst RMT for depression in young people has been previously reviewed, technological capability and digital mental health literature steeply increase each year but with limited scrutiny of the realist and ethical considerations likely to impact the benefits, implementation, and overall potential of RMT in the real-world. MethodsA realist review of RMT for depression in young people aged 14 - 24 years was conducted in collaboration with two young, lived experience co-researchers from The McPin Foundation Young Peoples Network (YPN) and in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) for quality and publication. Iterative searches across 10 electronic databases and 7 sources of grey literature, fine-tuning of selection-criteria, data extraction and evidence synthesis with insights from the wider YPN members allowed gradual refinement of an initial framework into a realist intervention theory. ResultsOf 6118 records identified, 104 were included in evidence synthesis. What does and does not work? Smartphones were most preferred, with both passive and active data collection for a holistic approach but a balance between data quality, intrusiveness, and data privacy. From the evidence currently available, depression was best detected by changes in sleep, mobility, smartphone use, social communication, and self- or- parent-reported mood. This had some uses in screening, self-monitoring, and feedback to the healthcare professional but not in relapse-prevention and personalised interventions, where significantly more research is required. How and why? The impact of RMT as an intervention itself on depression outcomes remained unclear but self-monitoring and feedback improved emotional self-awareness, therapeutic relationship, and help-seeking behaviours. For whom? With limited standardisation and investigation of the impact of depression on adherence rates, there may be an overestimation of how much young people are likely to use RMT in the real-world. However, they were most likely to benefit those interested in and motivated by the data-driven nature, who have lower depression severity, no co-morbidities where self-monitoring could cause harm, and the presence of changeable behaviours. In what contexts? RMT facilitated monitoring during transition to university, known to be associated with worsening depression in young people; however, there were significant challenges in health care and school settings. Adaptability was important, such that RMT were culturally compelling and accurate for the local context. Overall, there were many gaps in the evidence and common methodological issues across the literature. ConclusionsFrom the evidence base and lived experience insights, realist and ethical considerations were highlighted, as well as the remaining gaps in evidence and methodological issues common across the literature. For RMT to be the scalable solution for depression in young people rather than a case of overplayed potential, several important recommendations for future research and practice were made.

Background: Various explanations have been proposed for increasing trends in diagnosed depression in the UK, including increases in the proportion of the population that experience symptoms, changes in the threshold for seeking treatment and changes in clinical recognition or coding practices. Identifying trends over time for the relationship between the experiences of psychological distress and receiving a diagnosis can help explain wider trends in the incidence of clinical depression, such as whether the threshold for seeking treatment and receiving a diagnosis of depression has changed. Aims: This study aims to examine trends in the incidence of diagnosed depression, and relationships between psychological distress and recent depression diagnosis among UK adults between 2011 and 2022. We also assess whether the difference in psychological distress between adults with and without a recent depression diagnosis has changed over time and examine these relationships across subgroups (sex, ethnicity, age, cohort, education and financial stress). Methods: Data were from 66,360 adults (341,764 observations) aged 16 or older from the UK Household Longitudinal Study (UKHLS) across nine fieldwork periods spanning 2011-2022. Psychological distress was reported with the GHQ-12 used as a continuous variable and as a binary variable indicating caseness. Recent depression diagnoses were self-reported. Analyses we run for the overall population and stratified by different sociodemographic characteristics. Results: Incidence of diagnosed depression has not increased over time in the overall sample, but there was a notable increase in some sub-groups, most clearly seen for women aged 16 to 24. There has been a clear increase in the number of cases of psychological distress, but who have not received a recent diagnosis of depression. The level of psychological distress experienced by adults recently diagnosed with depression has slightly increased over time, whilst the difference in psychological distress experienced by adults with and without a recent depression diagnosis remained stable. Subgroup analyses show differences in the distress experienced by those with and without a recent diagnosis based on sex, age, cohort, ethnicity, education and financial situation: temporal trends were mostly similar across groups. Conclusions: Stable trends in (a) the distress experienced by adults recently diagnosed with depression, and (b) the difference in psychological distress experienced by adults with a recent depression diagnosis compared to adults without suggests little support for the hypothesis that depression is being diagnosed at lower levels of psychological distress. Instead, our findings suggest there may be a growing population who are not receiving clinical support for high levels of distress.

ObjectivesDuring the COVID-19 pandemic, NHS staff support services aimed to support healthcare workers (HCWs) wellbeing, alongside informal support from colleagues and managers. However, bullying, harassment, and discrimination against HCWs from ethnic minority and migrant groups, along with low wellbeing support uptake, suggest disparities in workplace support. This study aimed to address the following research questions: 1) How does support programme use vary by ethnicity and migration status? 2) How does the perception of support from managers and colleagues vary by ethnicity and migration status? MethodsThis study analysed NHS CHECK survey data which examined the mental health and occupational outcomes (including support use) of HCWs during the COVID-19 pandemic across 18 Trusts in England. Data from 9,769 participants who completed the baseline survey (launched April 2020) and the six-month follow-up was analysed using descriptive statistics and binary logistic regression. ResultsHCWs from White Other (AOR 0.79; CI 0.64-0.99) and Asian ethnic groups (AOR 0.65; CI 0.57-0.74) were less likely to feel supported by their colleagues than White British HCWs. Similarly, those born outside of the UK and EU were less likely to feel supported by their colleagues than UK-born HCWs (AOR 0.70; CI 0.52-0.94). No variations in support programme use or support from managers were found across ethnicity or migration status. ConclusionsThe study suggests equitable formal support but identified critical disparities in perceived collegial support for HCWs during the COVID-19 pandemic. Improving workplace wellbeing should address the underlying social and structural factors that influence peer support and belonging. O_LIWhat is already known on this topic - Healthcare workers (HCWs) in the UK from ethnic minority and migrant groups are more likely than White British HCWs to experience abuse and discrimination from other staff. Therefore, they may be less likely to use workplace support, and feel less supported by their colleagues or manager. However, this has not been examined. C_LIO_LIWhat this study adds - The study indicates that formal support mechanisms for HCWs during the COVID-19 pandemic were generally equitable. However, it highlights significant disparities in perceived collegial support, with HCWs from some ethnic minority groups and HCWs born outside of the UK reporting lower levels of peer support compared to White British HCWs. C_LIO_LIHow this study might affect research, practice or policy - These findings suggest that while structured support systems may be in place, the day-to-day experiences of workplace camaraderie and informal support vary considerably, underscoring the need for targeted interventions to foster a more inclusive and supportive work environment. C_LI

ObjectivesTo examine trends in psychological distress in Australia between 2001 to 2017-18, including analysis by age, sex, and location. Design, setting and participantsSecondary analysis of six successive national health surveys of representative samples of the working age population (18-64 years). Main outcome measuresPrevalence of psychological distress at very-high symptom level (defined by a Kessler Psychological Distress Scale [K10] score of 30 or more) and combined high/very-high level (K10 score of 22 or more). ResultsThe latest survey showed 5.1% of Australians reporting very-high level distress and 14.8% combined high/very-high level - both the largest rates recorded this century. The greatest increase from 2001 to 2017-18 was in women aged 55-64 with very-high distress significantly increasing from 3.5% (95% CI: 2.5-4.5%) to 7.2% (5.9-8.5%), and; high/very-high distress from 12.4% (10.5-14.2%) to 18.7% (16.7-20.7%). Men aged 25-34 had very-high distress increase from 2.1% (1.4-2.8) to 4.0% (2.9-5.1%); and combined high/very-high distress remained stable at 10.6% (9.1-12.1%) to 11.5% (9.7-13.3%). In 2017-18, greatest distress was in women aged 18-24 years (very-high 8.0% (5.9-10.2%); high/very-high 22.1% (18.8-25.3%)). Overall, distress was significantly more prevalent in inner regional Australia than elsewhere (very-high level 4.8% (4.4-5.1%); high/very-high 14.4% (13.8-15%)). ConclusionsAustralias annual mental health expenditure over this period has doubled, yet population level psychological distress has increased. A whole of government approach and targeted strategies focusing on groups with the poorest mental health such as older working aged women, younger people, particularly women, and those outside of major cities are indicated. Box"The known" Previous examinations of national health surveys had suggested that population mental health was stable as measured by psychological distress. "The new" Examining six consecutive national surveys we provide evidence that mental health has significantly deteriorated between 2001 and 2018. The latest survey showed 5.1% of Australians reporting very-high distress and 14.8% combined high/very-high distress, which are the largest rates reported this century. "The implications" Whole of government approach and targeted strategies focusing on groups with the poorest mental health such as older working aged women, younger people particularly women, and those outside of major cities are indicated.

There is an urgent need for services to address the social and economic adversities which contribute to the aetiology and outcomes of mental health problems. However, the implementation of interventions to do so is inconsistent, and entrenched cycles of poor mental health and social exclusion persist. We conducted a service evaluation survey of 28 staff working across community and inpatient teams, enhanced by a series of in-depth case studies, in the largest NHS mental health trust in the UK to explore how social and economic needs are currently assessed and addressed. We found that assessment for social and economic needs varied across different domains; for example, family relationships were more consistently assessed than domains such as education and income. A range of support is available and provided by a patchwork of teams, including Community Mental Health Teams, other NHS teams, Local Authority staff, and many third sector organisations. However, what support is available is severely restricted and respondents highlighted a lack of adequate support in every domain we considered - employment, education and training, social participation and connectedness, family relationships, community support, social security, debt, income, housing, and trauma and victimisation, as well as additional domains including healthy eating, sex and relationships, and activities of daily living. Nevertheless, our case studies illustrate examples of approaches to addressing social and economic needs to improve outcomes for people with mental health problems.

BackgroundTo investigate factors associated with anxiety, depression, and self-reported general health during "lockdown" due to COVID-19 in the UK. MethodsOnline cross-sectional survey of a nationally-representative sample of 2240 participants living in the UK aged 18 years or over (data collected 6-7 May 2020). Participants were recruited from YouGovs online research panel. OutcomesIn this sample, 21{middle dot}9% (n=458, 95% CI [20{middle dot}1% to 23{middle dot}7%]) reported probable anxiety (scored three or over on the GAD-2); while 23{middle dot}5% (n=494, 95% CI [21{middle dot}7% to 25{middle dot}3]) reported probable depression (scored three or over on the PHQ-2). Poorer mental health was associated with greater financial hardship during the lockdown, thinking that you would lose contact with friends or family if you followed Government measures, more conflict with household members during the lockdown, less sense of community with people in your neighbourhood, and lower perceived effectiveness of Government measures. Females and those who were younger were likely to report higher levels of anxiety and depression. The majority of participants reported their general health as "good" (as measured by the first item of the SF-36). Poorer self-reported general health was associated with psychological distress, greater worry about COVID-19 and markers of inequality. InterpretationRates of self-reported anxiety and depression in the UK during the lockdown were greater than population norms. Reducing financial hardship, promoting social connectedness, and increasing solidarity with neighbours and household members may help ease rifts within the community which are associated with distress, thereby improving mental health. Reducing inequality may also improve general health. RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSO_LIQuarantine is associated with adverse psychological outcomes. C_LIO_LIPsychological distress during quarantine is associated with greater financial loss, greater perceived susceptibility to and severity of the illness, and greater frustration and boredom during quarantine. C_LIO_LIMeasures put in place to prevent the spread of COVID-19 have highlighted existing inequalities in society, disproportionally affecting younger people, those in lower-income households, and Black and minority ethnic groups. C_LIO_LIResearch in the UK and other countries indicates that rates of anxiety and depression during restrictions of movement such as "lockdown" measures are higher than population norms. C_LI Added value of this studyO_LIIn this study, 22% of the sample reported anxiety, while 24% reported depression. Normative data indicate that these rates are usually approximately 5% and 7% respectively. C_LIO_LIFactors associated with psychological distress included greater financial hardship, poorer social connectedness, greater conflict within the household and the wider neighbourhood, being female and of younger age. C_LIO_LISelf-reported general health in the sample was "good" on average. Factors associated with poorer self-reported general health included markers of inequality and greater worry about COVID-19. C_LI Implications of all the available evidenceO_LIDecreasing the financial impact of measures put in place to prevent the spread of COVID-19 may help improve mental health. C_LIO_LIInterventions promoting social connectedness in isolated young people and measures that increase household and neighbourhood solidarity may help improve mental health. C_LI

BackgroundRelationship breakdowns or conflict are frequent precipitants for self-harm thoughts and behaviours, but the majority who experience these stressful life events do not think about or engage in self-harm. Understanding factors that attenuate or exacerbate this risk is therefore needed. The aim of this paper is to investigate whether relationship breakdowns, loss, and conflict lead to more frequent self-harm thoughts and behaviours. We also examine whether coping styles and neuroticism, posited by diathesis-stress models of suicide risk to interact with these events, attenuate or exacerbate the risk for self-harm thoughts and behaviours from these events. MethodsThis study utilised data collected during the COVID-19 pandemic, which acted as a natural experiment by leading to a greater prevalence of relationship breakdowns than usual. Data from 21,581 adults who participated in the UCL COVID-19 Social Study between 28 February 2021 and 4 April 2022 were utilised. Poisson regression models which controlled for socio-demographics and a diagnosed mental health condition were used to examine the impact of four predictor variables (separation or divorce, family problem, an other relationship breakdown [e.g., friend or colleague], and the death of a close relative or friend) with the number of times self-harm thoughts and behaviours were reported over the study period. Interactions between these events and coping styles (problem-focused, emotion-focused, socially supported, and avoidant coping) were also examined. ResultsVariables representing relationship breakdowns, loss, and conflict were associated with an increased frequency of self-harm thoughts (incidence rate ratio [RRR] range: 1.04 to 1.77) and behaviours (RRR range: 1.48 to 1.96). The use of more avoidant coping strategies (e.g., substance use, denial) increased the risk for both outcomes but unexpectedly attenuated associations between predictor variables and self-harm thoughts. Socially supported coping increased the likelihood of both outcomes, but not in sensitivity analyses which excluding venting from the scale. Problem-focused coping strategies (e.g., active planning) attenuated the impact of separation or divorce and having had a family problem on the frequency of self-harm behaviours. ConclusionsFindings underscore the importance of interpersonal loss and conflict for the frequency of thinking about and engaging in self-harm and suggest that the magnitude of these associations may depend on different coping styles.

BackgroundA family history of mental illness, particularly parental depression, is a risk factor for mental health difficulties in young people, with this heightened risk extending into adulthood. Evidence suggests low rates of formal mental health support in children/adolescents with depressed parents, but it is unknown whether this pattern persists into adulthood and applies to informal support. AimsWe examined the prevalence of formal and informal mental health support accessed by young adults with recurrently depressed parents. We identified factors associated with access to different support, reported satisfaction with support and identified potential facilitators/barriers to access. MethodsA mixed-method study comprising 144 young adults (mean age=23 years, range=18-28 years) who completed psychiatric assessments and reported on their use of mental health support. Regression analyses explored predictors for support. A focus group examined facilitators and barriers. ResultsYoung adults accessed a range of formal (29%) and informal (56%) support. Among those with psychiatric disorder, nearly half had not accessed formal support and one-fifth had not accessed any support. Predictors of support included psychiatric disorder, severity indicators (e.g. self-harm/suicidal thoughts, impairment), and demographic factors (e.g. education, gender). Predictors varied by type of support. Most participants reported satisfaction with support. Facilitators included role models, public mental health discussions, and practitioner training. Barriers included identifying difficulties, stigma, service limitations, and family/friends experiences. ConclusionsYoung adults at high risk of mental disorders accessed various mental health support. However, many did not access/receive support when needed. Further work is required to improve access to tailored support.

Background Little is known about the provision of diagnoses to young people with mental health disorders. We investigated diagnosis provision by NHS mental health services, focusing on 17-year-olds in South London between 2009-2024, and compared with estimated disorder prevalence. Methods To examine diagnosis provision in the population, we extracted diagnosis data from records of the NHS mental healthcare provider serving South London, using the Maudsley Biomedical Research Centre Clinical Record Interactive Search application; we then compared these data with the corresponding population size, obtained from the Office for National Statistics. To assess diagnosis provision in those with mental health disorders, we compared diagnosis data with the number of young people estimated to have met criteria for a disorder, derived from epidemiological interview data collected in the Environmental Risk (E-Risk) Longitudinal Twin Study and weighted according to characteristics of 17-year-old South Londoners. To assess diagnosis provision in those with mental health disorders within health services, we compared diagnosis data with the number estimated to have met criteria for a disorder and used any health service for their mental health, again derived from weighted E-Risk Study data. Findings Of 17-year-olds from South London in 2009-2024, 4.0% (n=8,958/223,404) had a diagnosis in mental health records during the previous year. This diagnosis provision covered <1 in 16 of those estimated to have had a mental health disorder, and <1 in 4 of those estimated to have also used health services. Diagnosis provision was lower in girls than boys and in young people with Black/Asian/Mixed/Other ethnicity than those with White ethnicity, in those estimated to have had a mental health disorder and used health services. Interpretation These findings demonstrate gaps and biases in mental health diagnosis provision for young people, including within health services, and reveal the imperative need to strengthen young people's mental healthcare.

Background: Young people impacted by adverse childhood experiences (ACEs) are often underrepresented in mental health research. Aims: This paper aims to advance inclusive research on ACEs by 1) describing co-designed recruitment and engagement methods in a national project on ACEs (Attune), 2) characterising a highly marginalised cohort of young people using identity descriptors co-designed with participants, and 3) reporting associations between ACEs, identity characteristics and mental health outcomes. Methods: A trauma-aware approach to engage under-represented young people was co-developed with a national youth advisory group, lived experience researchers, and trusted community partners. Our co-created purposive sampling strategy recruited 74 young people, aged 10 to 24 years, across England, seeking representation by age, sex, gender identity, sexual orientation, ethnicity, neurodivergence, and geographic location. Participants completed validated self-report measures of ACEs, life events, and mental health. Descriptive, correlational and regression analyses examined cohort characteristics and associations between ACEs, identity characteristics, and mental health measures. Results: The final cohort included participants identifying as non-White British (39.5%), non-binary/other gender (25%), and neurodivergent (30%). Half of participants reported exposure to at least one ACE. Analyses identified patterns consistent with prior literature. In addition, ACEs and barriers related to being neurodivergent were associated with increased depression and anxiety symptom severity. Non-binary gender identity was associated with anxiety. We did not observe associations of ACEs or mental health measures, with sex or ethnicity. Conclusions: Under-represented groups can be reached via co-created engagement methods informed by lived experience. We identified important associations between ACEs, identities, and mental health outcomes.

BackgroundThe prevalence of mental health problems among young adults has rapidly increased over the past decade. The argument that reductions in stigma lead to less under-reporting over time is often presented as a potential explanation. As a first step towards understanding how stigma influence self-reporting in this age group, we examine the extent to which parents attitudes are related to young peoples self-reported mental health. MethodsWe leveraged the household design of the 2014 Health Survey for England to test whether mothers (complete-case n = 630) and fathers (n = 428) prejudice and tolerance towards people with mental illness is associated with the self-reporting of any specific mental disorder and non-specific psychological distress (GHQ-12) in participants aged 13-24. Associations were tested in random-intercept Poisson models (nesting participants in households) adjusting for parents sociodemographics and mental health, and participants own sociodemographics. ResultsMothers were on average less prejudiced (81.2 versus 74.1 out of 100) but as tolerant (72.0 versus 70.0 out of 100) as fathers. In fully-adjusted models: 1) those with a less prejudiced (PR for a one-unit increase = 1.036, 95%CI 1.007-1.066) and more tolerant (PR = 1.038, 95%CI 1.011-1.066) mother had a higher probability of reporting a mental disorder; 2) those with a less prejudiced (PR = 1.034, 95%CI 1.006-1.062) father had a higher probability of reporting a mental disorder; 3) those with a more tolerant father also had a higher probability of reporting a high level of psychological distress (PR = 1.024, 95%CI 1.008-1.041). ConclusionParents attitudes were associated with their childrens mental health, more so with specific mental disorders compared with non-specific psychological distress. New data collection efforts are needed to understand changes in parental attitudes over time and its relationship with self-reporting among young people.

Staff in the National Health Service (NHS) have been placed under considerable strain during the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. Moreover, the research that does exist typically includes only clinical staff, despite a large proportion of patient-facing NHS workers being in non-clinical roles. We interviewed forty-eight clinical and non-clinical healthcare workers from eighteen NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking. This could involve providing all staff with regular reminders about support options, in a variety of formats (e.g. email, posters, mentioned in meetings), and easily remembered single points of access, delivered by a mix of in-house and externally-provided services, to cater for those more and less concerned about stigma and confidentiality. In addition, managers at all levels should be trained and supported to feel confident to speak about mental health with staff, with formal peer support facilitated by building in time for this during working hours. As others have pointed out, this will require long-term strategic planning to address workforce shortages.