BMJ Mental Health

ImportanceAI-enabled features may improve the effectiveness of routine mental health care, yet large-scale real-world evidence remains limited. ObjectiveTo evaluate whether access to AI-enabled continuous care features embedded within routine psychotherapy delivery is associated with improved treatment engagement and clinical outcomes under real-world conditions. DesignPreregistered cluster-level, matched, quasi-experimental study using a real-world rollout of AI-enabled continuous care featur...

BackgroundAdults with intellectual disabilities who display behaviours that challenge (BtC) are more prone to poor health. This study seeks to evidence the long-term health outcomes for this population. MethodsWe conducted a longitudinal cohort study of adults with intellectual disabilities aged 18+ years in England using data from Clinical Practice Research Datalink Aurum (01/2003-12/2023) linked to Hospital Episode Statistics and Office for National Statistics. Main outcome measures were Annu...

Digital therapeutics for mental health often face low patient engagement, which limits their clinical impact. Interventions that deliver treatment using a video game medium may improve engagement and therapeutic efficacy, but the putative emergence of gaming-related problems remains a concern among clinical stakeholders. We examined whether long-term engagement with Meliora, a video game therapeutic for adult major depressive disorder, was associated with changes in gaming-related problems in a ...

BackgroundAs digital communication becomes central to daily life, psychotherapy increasingly has access to patients electronic media data. While digital phenotyping has been widely studied, less is known about whether incorporating personal communication data, such as text messages, improves clinical outcomes in psychotherapy. ObjectiveTo determine whether integrating personalized text message data into psychotherapy improves depression, anxiety, health related quality of life, and therapeutic ...

BackgroundThe causes of neuropsychiatric symptoms in Parkinsons disease (PD) remain ill-defined. Disruptions in dopamine-dependent reward learning, a consequence of midbrain dopamine loss, potentially represent a mechanism that could underlie the neuropsychiatric symptoms of apathy, depression, and impulsivity, all of which have been proposed to reflect aberrant goal-directed behaviour. However no large-scale investigation that jointly considers these symptoms in PD has ever been undertaken. We ...

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...

ImportanceArtificial Intelligence (AI) voice applications have the potential to address the unmet treatment needs among patients with depression and anxiety, but their therapeutic utility is largely unknown. ObjectiveTo investigate the efficacy and mechanisms of an AI-driven voice-based coach, Lumen, delivering problem-solving treatment (PST) for patients with untreated, moderate depression and/or anxiety. DesignPhase 2, 3-arm randomized clinical trial. SettingA public university and affiliat...

ObjectivesTrauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric posttraumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12-week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD, and to explore preliminary changes in PTSD symptoms. DesignSingle-group feasibility trial. SettingSave the Children, Swede...

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,...

BackgroundCognitive deficits in anxiety disorders (ADs) contribute to clinical and socio-occupational dysfunction, necessitating targeted interventions. NoveltyIntegrated Cognitive Control Training (ICCT), a novel intervention, has demonstrated benefits in other disorders, however, remains unexplored in ADs. With its process-specific training and multi-pronged exercises for stimulation, metacognitive training and generalization, it has potential for enhancing cognitive functions in ADs. Object...

ObjectiveIn response to a clinical observation of an Anorexia Nervosa (AN) patient with family history of Parkinsons Disease (FHoPD), and evidence of similarities in dopamine function, personality, anxiety and weight loss symptoms between AN and PD, we completed a pilot study to estimate FHoPD in families of those with eating disorders (EDs). MethodWe ascertained FHoPD among ED patients and community participants, and estimated relative risks (RRs) for AN, Bulimia Nervosa (BN) and Binge Eating ...

ImportanceLarge language models (LLMs) have demonstrated diagnostic potential in several medical specialties, but their application to psychiatry - where diagnosis relies heavily on clinical judgment, narrative interpretation, and reasoning under uncertainty - remains insufficiently evaluated. ObjectiveTo evaluate diagnostic accuracy and clinician-judged reasoning quality of multiple large language models using psychiatric case vignettes. DesignMixed-methods evaluation study of diagnostic accu...

BackgroundLight plays a critical role in mental health, as the primary input to the circadian system, which regulates mood, energy, and the sleep-wake cycle. Altered light sensitivity is a potential mechanism in circadian-associated mental disorders. MethodsActigraphy-derived sleep, physical activity, and circadian rhythm correlates of the pupillary light reflex were explored in young people with emerging mental disorders. Participants were 27 healthy controls (Mean age=25.67 {+/-} 2.83, 52% fe...

The COVID-19 pandemic had substantial impact on healthcare systems across the globe, including psychiatric services. Use of electroconvulsive therapy (ECT), a lifesaving intervention for severe mental illness, was reported to have declined during the pandemic in several countries, but nationwide data remain scarce. Using nationwide data from the Danish National Patient Register, we examined all ECT treatments administered in Denmark from September 2019 to May 2025. Weekly treatment numbers were ...

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...

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...

PurposeTo address high levels of depression and anxiety among college students, innovative, feasible, and effective treatment approaches with high potential for dissemination in university counseling centers are needed. This pilot study aimed to develop a toolkit and training intervention to support implementation of nature-based physical activity into group therapy in a university counseling center, and to evaluate the feasibility, acceptability, and preliminary effectiveness of the interventio...

ObjectivesElectroconvulsive Therapy (ECT) is an effective treatment for bipolar disorder, particularly in severe acute cases or for illness resistant to pharmacotherapy. However, the risk of relapse following ECT is high, necessitating intervention to reduce this risk. Based on findings from ECT studies in unipolar depression and its well-known mood-stabilizing properties, it is likely that lithium treatment may reduce the risk of relapse of bipolar disorder following ECT. Therefore, we conduct...

IntroductionSevere mental illness is associated with high mortality rates and cardiovascular disease. Obesity and dysmetabolism associated with antipsychotic treatment comprise modifiable risk factors, which remain undertreated. Interventions such as antipsychotic-switching, lifestyle-interventions and weight-reducing medication have shown varying results indicating a need for a more individualized approach. The Meta-Care Trial aims to assess the effectiveness of a pragmatic, individualized, evi...

BackgroundIn 2020, Oregon became the first U.S. state to establish a regulated framework for adults to access psilocybin services using naturally-derived mushroom products. No studies have examined mental health outcomes among individuals receiving psilocybin in this context. AimsTo evaluate changes in self-reported symptoms of depression, anxiety, and well-being 30-days post-psilocybin session under the Oregon state-regulated model , and document session-related adverse events and doses consum...