Epidemiology and Psychiatric Sciences

BackgroundMental health disparities persist as a significant public health concern in the United States, with certain populations experiencing disproportionate burdens of mental illness and barriers to care. This systematic review aims to synthesize current evidence on mental health disparities across various demographic groups and identify key factors contributing to these inequities. MethodsWe conducted a comprehensive search of peer-reviewed literature published between 2010 and 2024 using PubMed, PsycINFO, and Scopus databases. Studies examining mental health outcomes, access to care, and treatment efficacy across racial/ethnic, socioeconomic, gender, sexual orientation, and geographic groups in the US were included. Two independent reviewers screened articles, extracted data, and assessed study quality. ResultsOf 2,345 initially identified studies, 127 met inclusion criteria. Consistent disparities were observed across multiple domains, with racial/ethnic minorities, low-income individuals, LGBTQ+ populations, and rural residents experiencing higher rates of mental health disorders, lower access to quality care, and poorer treatment outcomes. Key contributing factors included systemic racism, socioeconomic barriers, stigma, lack of culturally competent care, and inadequate insurance coverage. ConclusionThis review highlights persistent and multifaceted mental health disparities in the US. Addressing these inequities requires comprehensive policy interventions, increased funding for community-based mental health services, improved cultural competence in healthcare delivery, and targeted research to develop effective, culturally-tailored interventions for underserved populations.

IntroductionMental health disorders are highly prevalent globally with access to appropriate care oftentimes problematic. The Emergency Medical Services (EMS) have been suggested as a potential solution to improve access, however, it is unclear whether these services provide the most appropriate response with respect to the needs of patients experiencing a mental health emergency. MethodsA multi-method study was conducted to assess the current burden and potential risks associated with the transportation of patients experiencing a mental health emergency by EMS. Part 1 utilised a cross-sectional study of routinely collected clinical data for the period January 2018 to December 2019. Part 2 employed a systematic risk identification methodology focused on identifying the hazards associated with the transportation of this patient cohort, to identify key action plans towards mitigating their occurrence. ResultsPatients experiencing a mental health emergency were transported at an average rate of 11.96 per 1000 transports. Approximately 7% were administered prehospital sedation, with Ketamine administered as the most common sedative. Altogether, 50 potential hazards were identified involving the transportation of patients experiencing a mental health emergency. The Patient Assessment subprocess contained the most potential hazards/failure points (n=13). Risks categorized as occasional (n=33) and moderate (n=16) made up the majority. ConclusionThe burden of mental health emergencies on EMS is considerable, with the potential for several significant risks. Despite this, there was unequal focus on the development of care pathways and clinical guidance for this patient cohort compared with the more "traditional" case types serviced by EMS. Consequently, we identified several strategic-level action plans to mitigate these hazards and improve the delivery of care for these patients in the community.

BackgroundNon-medical use of prescription psychotropic medications (NMUPM) among adolescents and young adults in low- and middle-income countries (LMICs) is an emerging public health concern. Such practices are associated with psychiatric comorbidities, increased risk behaviors, and long-term dependence. Limited access to mental health services, weak regulatory enforcement, and the widespread availability of prescription drugs contribute to NMUPM. Despite anecdotal reports, comprehensive epidemiological synthesis across LMICs is scarce. ObjectiveTo systematically review the prevalence, patterns, psychiatric correlates, and health-system drivers of NMUPM among young people (aged 10-35 years) in LMICs and provide a pooled estimate of prevalence through meta-analysis. MethodsWe conducted a systematic review following the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycInfo, LILACS, AJOL, WHO GIM, Google Scholar, and regional LMIC repositories were searched for studies published between 2000 and 2026 reporting NMUPM among adolescents and young people. Inclusion criteria comprised cross-sectional surveys, community or school-based studies, and national or regional surveillance reports. Data were extracted on sample size, prevalence, commonly misused drugs, sources of medication, and motivations. A random-effects generalized linear mixed model (GLMM) with logit transformation was used to estimate pooled prevalence, and heterogeneity was assessed using I{superscript 2} statistics. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) checklist. ResultsA total of 13 studies were included in the systematic review, with 10 studies (N = 6,728 participants) suitable for quantitative meta-analysis. The pooled prevalence of NMUPM among young people in LMICs was 18.4% (95% CI: 12.1-26.2%), with substantial heterogeneity (I{superscript 2} > 90%). Benzodiazepines and tramadol were the most commonly misused drugs. Primary drivers included prior experience with medications, ease of access through pharmacies or peers, and limited awareness of potential harms. NMUPM was associated with psychiatric symptoms, risky behaviors, and early progression to substance use disorders. ConclusionNon-medical use of psychotropic medications is prevalent among adolescents and young adults in LMICs, posing significant psychiatric and public health challenges. Interventions are urgently needed to strengthen regulatory enforcement, improve public awareness, enhance mental health service accessibility, and promote safe medication practices. Future research should focus on longitudinal studies to clarify causal pathways and test behavioral interventions to reduce NMUPM.

BackgroundThe COVID-19 pandemic has accelerated the adoption of telehealth services in mental healthcare. This systematic review aims to evaluate the effectiveness of telehealth interventions for mental health conditions compared to traditional face-to-face treatment. MethodsWe searched major electronic databases (PubMed, PsycINFO, CINAHL, and Cochrane Library) for randomized controlled trials published between 2010 and 2023. Studies comparing telehealth interventions to face-to-face treatment for adults with mental health disorders were included. Two independent reviewers assessed study quality and extracted data. Meta-analyses were conducted where appropriate. ResultsThirty-five studies met the inclusion criteria, encompassing 4,827 participants across various mental health conditions. Telehealth interventions demonstrated non-inferiority to face-to-face treatment for depression (standardized mean difference [SMD] = -0.03, 95% CI [-0.15, 0.09]) and anxiety disorders (SMD = -0.06, 95% CI [-0.19, 0.07]). For post-traumatic stress disorder, telehealth showed a small but significant advantage (SMD = -0.21, 95% CI [-0.37, -0.05]). Patient satisfaction and therapeutic alliance were comparable between telehealth and face-to-face interventions. However, dropout rates were slightly higher in telehealth conditions (risk ratio = 1.27, 95% CI [1.11, 1.46]). ConclusionThis review suggests that telehealth interventions are generally as effective as face-to-face treatment for common mental health disorders. While promising, these findings should be interpreted cautiously due to heterogeneity in study designs and interventions. Future research should focus on long-term outcomes, cost-effectiveness, and strategies to improve engagement in telehealth settings.

SummaryO_ST_ABSBackgroundC_ST_ABSThe aim of this systematic review was to synthesise evidence on the effectiveness and cost-effectiveness of interventions to support the recovery of people living with psychosis and their families in low-income and middle-income countries (LMICs). MethodsWe searched nine databases for articles published from January 2001 to January 2024 without language restrictions. Studies were eligible if they enrolled people living with psychosis or family members, and tested a psychoeducational, psychological, social, economic or service intervention or delivery or implementation strategy aimed at improving outcomes of people with psychosis. Eligible studies were required to compare outcomes with an alternative condition, using any prospective evaluation study design in a LMIC setting. We extracted summary data from published papers and appraised risk of bias using the Effective Public Health Practice Project tool. We prioritised the reporting of recovery-orientated outcomes including social inclusion, personal recovery, reduced stigma and discrimination and human rights protections. We conceptualised the person living with psychosis in their context (individual, family, organisation and community) based on the socio-ecological model of disability and highlighted studies intervening and measuring outcomes across multiple socio-ecological levels. Protocol registration: PROSPERO (CRD42022330298). FindingsA total of 310 individual studies including data from 34,435 participants in 37 countries were included. Aggregate data from a further five meta-analyses, comprising data from 130 individual studies were also included. The majority of studies (77%) were conducted in upper middle-income countries. There was a dominance of studies evaluating impacts of interventions on individual-level mental health and functioning and a paucity of studies measuring the recovery-orientated outcomes prioritised by people living with psychosis. There were modest effects for comprehensive interventions involving family, psychosocial rehabilitation and care close to home provided by trained specialists however their scalability in resource-limited settings is unclear. Over half the studies were considered to have a high risk of bias. InterpretationThere is a need for studies that evaluate scalable interventions supporting recovery with comprehensive and contextualised outcome measures and for greater investment in strengthening capacity to conduct rigorous psychosis research across LMICs. FundingNone. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSRecent World Health Organization (WHO) guidance on human rights-based, recovery-orientated community mental health care featured markedly few case studies of good practice for people with psychosis in low-income and middle-income countries (LMICs). Systematic reviews of interventions for psychosis in LMICs have been narrow in focus and reporting outcomes, and limited to English language publications. Added value of this studyThis systematic review is the most comprehensive synthesis to date of psychosis interventions in LMICs. Inclusion is not restricted by publication language. We highlight studies reporting recovery-oriented outcomes prioritised by people living with psychosis and impacts of interventions across levels of the socio-ecological model of disability. While being particularly relevant to LMICs, our findings also contribute a useful perspective for high income settings. Implications of all the available evidenceMost interventions were targeted at the individual and focused on mental health and functioning outcomes, with few evaluations of impact on social inclusion and other valued outcomes. There is some evidence in support of specialist-delivered comprehensive interventions involving family, psychosocial rehabilitation and care close to home, but effect sizes were small-to-modest, and many intervention types and delivery agents have not been adequately tested, especially in LICs and rural settings. There is a clear need to develop comprehensive and contextualised measures for recovery-orientated outcomes and to invest in strengthening capacity to conduct rigorous research on interventions for psychosis in LMICs.

BackgroundThe design and delivery of safe and effective mental healthcare requires data on local needs and priorities. The aim of this scoping review is to provide background information on the prevalence of mental health conditions and local stakeholder experiences of mental healthcare in Zambia. MethodsWe searched electronic databases of published (Medline, PsycINFO, Embase, African Index Medicus) and unpublished (University of Zambia repository) literature to retrieve relevant epidemiological and qualitative articles from database inception to January 9th, 2024. Qualitative studies were synthesised using thematic synthesis and key themes were triangulated with experiences of local stakeholders. ResultsEleven epidemiological papers were identified. These reported on the prevalence of mental distress in the general population (16.9%); depressive symptoms in adolescents (29.7%); problematic alcohol consumption in the general population (dependence, 7.4%; binge, 11.6%; and unhealthy consumption, 15.3%) and in adolescents (45.1%); suicidal ideation (7.8%) and behaviour (8.5%) in the general population and in adolescents (31.3% and 39.6%, respectively); suicide attempts in the general population (2.3%). Synthesis of 10 qualitative articles identified interrelated themes relating to barriers to access and provision of mental healthcare. Mental health stigma is perceived to be pervasive across all sectors of society and partly attributed to the language used in the previous Mental Health Act and the national psychiatric hospital. Structural stigma is perceived to drive the low priority of mental health in Zambia in policy, funding, advocacy and research. Reported consequences include low availability of safe and effective mental healthcare, particularly at community level, resulting in a cycle of coercive hospital admission, discharge, relapse and readmission. This is perceived to place significant social, emotional and economic stress on patients and their families. Carer burnout and the lack of visible recovery perpetuates the stigma that people with mental illness have little value to society. ConclusionsFindings from this review indicate the need for a multisectoral approach to tackle structural stigma, increase national advocacy for mental health, and facilitate the provision of safe and effective community-based mental healthcare in Zambia. While epidemiological data is limited, the current evidence indicates that adolescents are a high priority group for early intervention.

BackgroundPsychiatric hospital admissions in the Western Cape are increasing, driven by poverty and substance use. AimTo assess the trend of psychiatric admissions from 2015-2022 and factors associated with repeat psychiatric admissions and linkage to ambulatory services post-discharge. SettingPublic hospitals in the Western Cape, South Africa MethodsUsing electronic data from the Provincial Health Data Centre, a consolidated routine service database, all psychiatric hospital admissions in the Western Cape were analyzed, stratified by hospital level. Mixed effects logistic regression was used to determine factors associated with successful linkage to ambulatory services within 30 days following hospital discharge, and repeat psychiatric admission within 30 and 90 days. ResultsPsychiatric hospital admissions, particularly at the district/acute level, were increasing prior to 2020 and an increasing proportion were substance related. 40% of admissions at the district level had not been seen at a primary health care facility in the year prior to admission. Males and those with substance use disorders were less likely to be successfully linked to outpatient services post-discharge. Successful linkage was most protective against readmission within 90 days with an adjusted odds ratio of 0.76 (95%CI 0.73-0.79) and 0.45 (95%CI 0.42-0.49) at district/acute and specialized hospitals respectively. ConclusionImproving linkage to ambulatory services for mental health patients post-discharge is likely to avert hospital readmissions. ContributionThis research highlights how often mental health patients requiring admissions are not seen at the primary health care level and quantifies the risk for readmission of not following up psychiatric admissions post-discharge.

BackgroundBrazil is home to 50 million children and adolescents, whose mental health needs require context-sensitive research. Although scientific output is growing in the country, publications are scattered and often inaccessible. MethodsThis systematic review compiles prevalence estimates, assessment instruments, and interventions for child and adolescent mental health in Brazil (PROSPERO registration: CRD42023491393). We searched international (PubMed, Web of Science, PsycINFO, Google Scholar) and national (Scielo, Lilacs, Brazilian Digital Library of Theses and Dissertations) databases up to July 2024. Reference lists, reviews, and experts were consulted. Extraction followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Cochrane manuals. ResultsThis review appraises 734 studies on 2,576 prevalence estimates, 908 studies on 912 instruments, and 192 studies on 173 intervention trials. Point prevalence of any mental disorder ranged from 10.8% (age 12) to 19.9% (ages 7 to 14), although a nationally-representative study is lacking. There is a rise of self-harm notifications, reaching 133.1 in 2019 (per 100,000 aged 10-19). Indigenous youth face suicide rates of 11 (age 10 to 14), far exceeding national averages (0.652). There is severe violence exposure (21% of adolescents reported domestic physical violence in the previous month), disproportionately impacting Black youth and heightening risks for depression and substance use. Reliable instruments exist for assessing psychopathology, yet most lack psychometric and cross-cultural validation. Interventions remain under-implemented; the largest trials adapted international substance-use prevention programs, showing null effects. High-quality studies are mainly funded by public investment. DiscussionThis compilation provides accessible data for professionals, facilitating translation of science to practice. Brazilian sociocultural challenges impact youth mental health, with public health priorities including violence, systemic racism, and indigenous youth suicide. National research must develop culturally-sensitive resources for mental health, including scalable interventions focused on social minorities. FundingThe Stavros Niarchos Foundation.

AimsThe COVID-19 pandemic and associated lockdown may have psychiatric consequences and increase the number of psychiatric emergency consultations. This study aimed to compare the number and characteristics of emergency psychiatric consultations during the four first weeks of the lockdown in three psychiatric emergency services from Paris and its suburbs, and to compare them to the same period in 2019. MethodsThree psychiatric centers in Paris and its suburbs took part in the study. We compared the number of total psychiatric emergency consultations during the 4 first weeks of the lockdown in France to the corresponding 4 weeks in 2019. We also compared the number of consultations during these 4-week time periods in 2020 and 2019 across different diagnostic categories. ResultsIn the 4 first weeks of the lockdown in France, 553 emergency psychiatry consultations were carried out, compared to 1224 consultations during the corresponding period of 2019, representing a 54.8 % decrease. This decrease was evident across all psychiatric disorders, including anxiety (number of consultations in 2020 representing 36.1 % of 2019), mood (41.1 %), and psychotic disorders (57.3 %). The number of suicide attempts also decreased (number of suicide attempts in 2020 representing 42.6 % of 2019). In comparison to 2019, the proportion of total consultations for anxiety disorders also decreased (16.6 % vs. 20.8 %), whilst the proportion of total consultations increased for psychotic disorders (31.1 % vs. 24.1 %). ConclusionsThe total number of psychiatric emergency consultations during lockdown dramatically decreased. The psychological consequences of lockdown may be delayed, indicating that psychiatric services should be prepared for a secondary increase in emergency presentations.

ObjectiveTo standardize the implementation dates of various cannabis liberalization policies and determine whether previous research by Anderson et al. [D.M. Anderson, D.I. Rees, J.J. Sabia, American Journal of Public Health 104, 2369-2376] on medical marijuana access and population-level suicidality is robust to additional years of data and further cannabis liberalization in the form of recreational marijuana access. DesignA state-level longitudinal (panel) analysis. Suicide mortality rates from the National Center for Health Statistics and mental health morbidity rates from the National Survey on Drug Use and Health were employed with the procedures outlined by Anderson et al., using weighted ordinary least squares for three different specifications with various combinations of control variables as a sensitivity analysis to test for robustness. SettingAll 50 states and Washington, DC for the period 1990-2020. ParticipantsUSA population. InterventionsCannabis liberalization policies in the form of recreational and medical access. Primary and Secondary Outcome MeasuresState-level population mental health outcomes in the form of suicide mortality among various age groups for males and females defined by the International Classification of Diseases, Ninth and Tenth Revisions; past-month and -year marijuana use, mental illness, serious mental illness, major depression, and suicidal ideation defined by the Substance Abuse and Mental Health Services Administration. ResultsMedical marijuana access was associated with a 3.3% reduction (95% CI -5.0% to -1.7%) in suicide rates for males, which was mediated by a 5.4% reduction (95% CI -8.0% to -2.7%) among males in the 30 to 39 age group. No other mental health outcomes were consistently affected by cannabis liberalization. ConclusionsAdverse mental health outcomes do not follow cannabis liberalization at the state level, confirming the findings of Anderson et al. In addition, there is evidence that medical marijuana access reduces suicide rates for young-adult males. Strengths and limitations of this studyO_LICannabis liberalization policies, which vary greatly throughout the literature, are explicitly defined and corrected from previous studies. C_LIO_LISAMHSA suppresses state-level geographical information for individual-level responses in the NSDUH, so the analysis relied on population averages for a small number of age groups published in the NSDUH State Prevalence Estimates, which did not allow us to evaluate gender differences for mental health outcomes. C_LIO_LIThe reliability of suicide and NSDUH data to estimate true population rates is highly debated. C_LIO_LIPopulation-level analyses of longitudinal data can be evaluated with multiple accepted methods from the medical literature and it is not clear whether weighted ordinary least squares is the most appropriate approach for this type of analysis. C_LI Funding statementThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Competing interests statementReason Foundation is a 501(c)(3) nonprofit organization completely supported by voluntary contributions from individuals, foundations, corporations, and the sale of its publications. Reason Foundations general support includes contributions from marijuana manufacturers, which account for less than one percent of its annual budget. Data sharing statementMost data relevant to the study are publicly available and included as supplementary information. Mortality rates calculated from death counts of less than 10 deaths for any region are suppressed and may require special permissions for access.

BackgroundMental disorders are common in people living with HIV (PLWH) but often remain untreated. We aimed to explore the gap in access to treatment (treatment gap) for mental disorders in adults followed-up in antiretroviral therapy (ART) programs in South Africa and disparities in access to mental health services. MethodsWe conducted a cohort study using ART program data and linked pharmacy and hospitalization data to estimate the 12-month prevalence of treatment for mental disorders (pharmacological or inpatient) and to examine factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from January 1, 2012 to December 31, 2017 at one private care, two pubic primary care, and one public tertiary care ART programs in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programs. We calculated adjusted rate ratios (aRR) for factors associated with the rate of treatment of mental disorders using Poisson regression. Results182,285 ART patients were followed-up over 405,153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% CI 19.5%-52.9%) for patients followed-up in private care, 96.5% (95% CI 95.0%-97.5%) for patients followed-up in public primary care, and 65.0% (95% CI 36.5%-85.1%) for patients followed-up in public tertiary-care ART programs. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02 95% CI 0.01-0.03), and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary-care programs than in the private-sector ART program. InterpretationThere is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health service between patients receiving ART in the public vs. the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain largely untreated.

ObjectiveAcute agitation in psychiatric settings presents significant clinical and safety challenges. Pharmacological management is often necessary when de-escalation strategies fail, but optimal medication regimens remain unclear. This study evaluates the safety, efficacy, and adverse event profiles of commonly used intramuscular (IM) pharmacologic regimens for acute agitation in a multicenter cohort. MethodsWe conducted a retrospective cohort study using de-identified data extracted from the HCA Healthcare corporate database. Adult psychiatric patients who received PRN intramuscular medications for acute agitation were included. Patients were stratified into four treatment groups based on administered medication: (1) haloperidol monotherapy, (2) haloperidol + lorazepam, (3) haloperidol + diphenhydramine, and (4) haloperidol + lorazepam + diphenhydramine. Outcomes assessed included frequency of PRN use, benztropine administration, and incidence of hypotensive and hypoxic episodes. Generalized linear modeling was used for statistical analysis. ResultsThe combination regimen of haloperidol + lorazepam + diphenhydramine (Group 4) was associated with significantly higher odds of receiving multiple PRN administrations compared to haloperidol alone (Group 1). However, this regimen, along with the diphenhydramine-inclusive group (Group 3), was linked to a significantly lower likelihood of requiring benztropine, suggesting a reduction in extrapyramidal symptom burden. No statistically significant group differences were observed in hypotensive or hypoxic episodes. ConclusionTriple-agent regimens may be associated with increased treatment intensity but offer benefits in reducing extrapyramidal symptoms without increasing cardiovascular or respiratory risk. These findings support the thoughtful use of combination IM regimens, particularly those including diphenhydramine, in the management of acute agitation in psychiatric settings.

BackgroundThe prescription of psychotropic medication is rising in Europe along the last decade. Exploring consumption patterns in pre-pandemic times in Portugal, as well as relevant socio-demographic determinants, can help establish comparisons with worldwide patterns and support public health policies for mental health. MethodsDescriptive, non-comparative cohort study, comprising full nationwide drug prescription records in Portugal along antidepressant, antipsychotic, and anxiolytic classes. Statistical analysis of prescription and consumption patterns according to reference dosages and guided by several criteria, including active substance, demographics, geography, associated medical specialty, and incurred costs. ResultsAn increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, reasonably accompanied by an increase of 37M Eur in total expenditure (>20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, we further observed that 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. ConclusionNationwide patterns of psychotropic drug prescription in Portugal reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for the clinical practice and medical training. NoveltyTo our knowledge, first Portuguese psychopharmacoepidemiological study assessing: 1) economic correlates; 2) prescription patterns by medical specialty; 3) adherence rates and geographical determinants; 4) consumption patterns by active substance; and 5) systematic trends for the pre-pandemic period.

ObjectiveTo analyze the impacts of the COVID-19 pandemic on post-pandemic mental health, identifying the most prevalent symptoms, risk factors, and coping strategies. MethodsSystematic literature review conducted according to PRISMA guidelines, using open-access databases (Google Scholar and PubMed) with articles published between 2021 and 2025, in English or Portuguese, full-text available, and focused on human studies. Inclusion and exclusion criteria were applied rigorously, and data were extracted in a standardized manner for qualitative analysis of neuropsychiatric effects, psychosocial factors, and mental health coping strategies. ResultsA total of 26 studies were included. Depression and anxiety were the most prevalent symptoms (20-45%), while brief psychosis, acute mania, and post-COVID-19 encephalitis were less frequently reported. Risk factors included social isolation, unemployment, and comorbidities, with significant impact on children, adolescents, older adults, and healthcare professionals. Effective interventions included physical activity, psychological resilience programs, social support, and continuous clinical monitoring. ConclusionThe COVID-19 pandemic had significant physical, mental, and social health impacts, particularly among vulnerable groups. Integrated strategies promoting well-being, psychological support, and clinical follow-up are essential to mitigate adverse effects. Public and institutional policies should prioritize actions targeting at-risk populations, and future research should include longitudinal studies and quantitative meta-analysis to strengthen existing evidence.

BackgroundCommunity treatment orders (CTOs) are used to manage community-based care for individuals with severe mental health conditions who have been discharged from inpatient care. Evidence examining whether CTOs are successful at reducing rehospitalisation has been mixed. MethodsUsing deidentified electronic health records from 2009-21, we compared patients who had ever been placed on a CTO (n=836) and two other groups of patients who had never been placed on CTO: patients admitted under Section 3 of the Mental Health Act (n=1,182) and outpatients with severe mental health issues (n=7,651). We examined the association between CTOs and rehospitalisation using within-individual stratified multivariable Cox regression. ResultsPatients on CTO were more likely to be male, single, of Black or Mixed ethnicity, and have a severe mental illness diagnosis than patients in the comparison groups. Time spent on CTO was associated with a lower risk of hospitalisation compared to time spent off CTO for the same individual (HR 0.60; 95% CI 0.56-0.64). This decreased risk of hospitalisation remained when we restricted analysis to individuals with a single CTO episode (HR 0.05; 95% CI 0.02-0.11) and when we restricted follow-up time to a patients first CTO episode (HR 0.20; 95% CI 0.17-0.25). However, there was no difference in re-hospitalisations when we observed patients starting from the first CTO (HR 1.07; 95% CI 1.00-1.16). ConclusionsWe found that patients on CTO were at lower risk of hospitalisation, though this pattern was not observed when we excluded time prior to the first CTO. Further research should consider whether CTOs provide genuine clinical benefit.

This is a protocol for the project entitled "FDA and EMA clinical research guidelines: Assessment of trial design recommendations for pivotal psychiatric drug trials".

BackgroundEvidence-based information is essential to delivering effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a comprehensive analysis of scientific evidence on child and adolescent mental health in Greece. MethodsThis systematic review encompasses three research topics related to the mental health of children and adolescents in Greece: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality was ascertained using validated tools. This review was registered in protocols.io [68583]. OutcomesWe included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics were compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource on-line [https://camhi.gr/en/systematic-review-tables/]. InterpretationScientific evidence on child and adolescent mental health in Greece has been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policy making in Greece and may encourage similar assessments in other countries. FundingThe Stavros Niarchos Foundation.

BackgroundSuicide prevention has become a global public health priority, and Brief Contact Interventions (BCI) following suicide attempts (SA) are an important tool for preventing suicides. The VigilanS project was designed to generalize compounded BCIs at the entire population level., It involves resource cards, telephone calls, and mailings, following a predefined algorithm. It has been implemented progressively in France, on a region-by-region basis, since 2015. ObjectiveTo evaluate the effectiveness of VigilanS in reducing suicide attempts among patients aged 18 years and older, and to explore potential differences in effectiveness by sex, age, and geographical location. MethodsThe study used data from the French national hospitalization database, PMSI-MCO. It included all patients over age 18 who were admitted to general hospitals for suicide attempts, between 2012 and 2022. Time-to-event ("survival") analysis of a second SA after a first one was performed; patients whose first SA occurred before VigilanS implementation were compared with their after-VigilanS counterparts. Six regions, with implementation occurring between 2015 and 2017, are analyzed here. ResultsThe differences in distribution of time-to-new-SA among patients before and after VigilanS implementation were statistically significant in all six regions under scope (log-rank test: P<0.0001). The Cox regression analysis revealed that VigilanS was significantly associated with a reduced risk of reattempting suicide in all regions. Age consistently showed a negative association with reattempting suicide. ConclusionVigilanS is likely effective in reducing suicide attempts among patients aged 18 years and older in France. This suggests that implementing BCIs following SAs in general hospitals at a population-wide level can contribute to reducing suicide rates and provides real-world evidence (RWE).

BackgroundThe atypical antipsychotic clozapine is the gold standard for treating treatment-resistant schizophrenia; however, it is continuously underutilized in most parts of the world. A few systematic reviews addressing barriers to clozapine prescribing have previously been conducted, primarily focusing on clinical staffs attitudes and perceived barriers to prescribing. However, a preliminary literature search revealed that additional literature on the subject does exist, including literature on patient perspectives, without having been included in any of the former reviews. It is therefore difficult to conclude if the former synthesizes of the literature are representative of current evidence, and if the topic has been adequately investigated to inform clinical practice. A scoping review is warranted to map and synthesize a broader scope of primary studies on patients and/or clinicians perspectives on clozapine treatment to identify any gaps for future research. MethodsThe electronic databases Cochrane Library, CINAHL, Web of Science, Psychinfo, MEDLINE, and EMBASE were searched, supplied with searches of Google Scholar, The Networked Digital Library of Theses and Dissertations (NDLTD), and OpenGrey. Citation tracking of selected studies was furthermore undertaken. Two researchers independently screened and extracted the data. RegistrationPROSPERO does not offer registration of scoping reviews; however, the protocol was prospectively registered with the Open Science Framework and subsequently published as an article. ResultsOne hundred and forty-six studies were included. Most studies reported upon patients or clinicians perspectives on active clozapine treatment or on clinicians general perspectives on barriers to clozapine initiation. Three apparent gaps in research were identified: 1) clozapine eligible, yet clozapine-naive, outpatients attitudes towards clozapine commencement, 2) assessments of clinicians reasons for clozapine withholding and perceived facilitators of clozapine treatment in specific patient-cases, and 3) direct assessments of both patient and clinician perspectives on clozapine discontinuation, continuation and re-challenge in specific patient-cases. ConclusionsResearch regarding perspectives on clozapine treatment tends to repeat itself. Future studies addressing the identified gaps in evidence are warranted and could provide the insights needed to optimize clozapine utilization. Strengths and limitations of this studyO_LIThe prospective registration and publication of the review protocol has ensured transparency of the review process. C_LIO_LIThe search strategy has ensured a comprehensive search of the literature and multiple booster searches on Google Scholar have ensured a continued update on the scope of literature, the most recent one in January 2024. C_LIO_LIThe original literature search was conducted in June 2021. C_LIO_LIThe search was restricted to publications in the English language, which may have precluded the identification of some relevant insights and studies. C_LI

BackgroundEthnic inequalities in compulsory psychiatric hospital detentions are well-documented in the UK and internationally. It is unknown how UK COVID-19 lockdown measures, which led to restrictions in public movement, gatherings, in-person health service delivery, and changes to police powers, further impacted inequalities. AimsIn this study, we assessed whether national lockdown measures impacted ethnic inequalities in voluntary and compulsory psychiatric hospital admissions, during the COVID-19 pandemic. MethodsDaily counts of admissions and detentions to psychiatric hospitals were extracted from a large population-level sample of secondary mental health service users in southeast London. Changes during two COVID-19 lockdown periods, over 2020-2021, were compared with pre-pandemic periods (2016-2019) with the use of a regression discontinuity in time design to assess ethnic inequalities in voluntary/ compulsory mental health admissions. ResultsCompared to the pre-pandemic reference (2016-2019), after adjusting for seasonal and weekly trends, overall admissions to mental health units dropped during the first COVID-19 lockdown (Incidence Rate Ratio (IRR) 0.87 (95% CI: 0.75-1.00) but with more compulsory detentions (1.25 (1.05-1.54)). This was mostly due to higher compulsory detentions in the Black Caribbean group (1.54 (1.08-2.19)). During the second COVID-19 lockdown, whereas total daily admissions remained similar to the pre-pandemic reference (1.03 (0.92-1.15)), total new daily detentions was elevated (1.28 (1.11-1.49)), specifically in Black Caribbean (1.53 (1.14, 2.06)) and Black African (1.57 (1.06-2.34)) groups. ConclusionsCOVID-19 lockdown measures exacerbated pre-existing ethnic inequalities in compulsory psychiatric detention, particularly for those from Black Caribbean and Black African backgrounds. There is a need to address ethnic inequalities in compulsory psychiatric detentions and attend to exacerbations of pre-existing inequalities during health emergencies like the COVID-19 pandemic. This cannot be achieved without addressing systemic racism within criminal justice and healthcare systems and tackling inequalities in wider social and economic determinants of mental health. FundingHealth Foundation, NIHR, UKRI.