Epidemiology and Psychiatric Sciences

Objective. To estimate lifetime and 12 month mental health contact gaps among Peruvian adults with survey-defined mental disorders, and to describe inequalities in contact, perceived need for care, and mental health service use. Methods. We analyzed the information for adults of the 2022 Peruvian National Mental Health Survey, a cross-sectional household survey. The primary outcome was the survey-weighted proportion of adults with a 12 month mental disorder who reported no contact with an included source of mental health-related care during that period; the lifetime contact gap was descriptive. Perceived need was assessed using two derived 12 month perceived-need measures based on direct ENSM variables and service contact routing items. Analyses incorporated weights, strata, and clusters. Adjusted prevalence ratios were estimated using survey weighted Poisson models. Results. The dataset contained information on 13,840 individuals; 13,833 had complete survey-design information. Contact gap denominators were 3,927 for lifetime disorders and 1,649 for 12-month disorders. The lifetime and 12-month contact gaps were 61.0% (95% CI 58.4-63.7) and 84.5% (95% CI 81.5-87.6), respectively. Rural estimates exceeded urban estimates in both periods; after adjustment, poverty and rural residence were associated with the lifetime gap, and extreme poverty with the 12-month gap. Among individuals meeting survey-based criteria for one or more 12-month mental disorders, 37.3% (95% CI 33.4-41.4) reported self-perceived need, whereas 25.6% (95% CI 21.8-29.8) reported that need had been identified by others. Annual psychological and psychiatric service use was 3.7% and 1.1%, respectively. Conclusions. Mental health contact gaps were high, particularly for one or more 12-month mental disorders, and were associated with social and territorial variables. These contact measures do not establish adequate, continuous, or effective treatment, which needs to be addressed to understand the impact of the Peruvian mental health reform.

Objectives: To assess whether higher state-level community-based U.S. Immigration and Customs Enforcement (ICE) arrest rates are associated with adverse mental health outcomes among Hispanic and non-Hispanic adults in the United States. Design: Retrospective analysis using individual-level data from the 2023 and 2024 Behavioral Risk Factor Surveillance System (BRFSS) linked to monthly state-level ICE arrest records from the Deportation Data Project. Two-way fixed effects models assessed associations between mental health outcomes and ICE arrests, net of secular trends, state-specific time invariant factors, and individual covariates. Setting/participants: The sample included 534,099 US adults aged 18 years or older residing in all 50 states and the District of Columbia surveyed between September 2023 and December 2024. Analyses exploited within-state month-to-month variation in enforcement intensity with state and year-month fixed effects. Outcome measures: Number of poor mental health days in the past 30 days; any poor mental health days (binary); mental health status (3-level categorical); frequent mental distress ([&ge;]14 poor mental health days); and a composite indicator combining depressive disorder diagnosis with frequent mental distress. Results: Among 534,099 respondents (approximately 10% Hispanic), higher ICE arrest rates were significantly associated with worse mental health among Hispanic adults, including 0.19 additional poor mental health days per month (p < 0.05), a 2.2% higher likelihood of reporting any poor mental health days (p < 0.01), and a 2.4% increase in composite mental health problems (p < 0.01). Associations were concentrated among Hispanic women and those with a high school diploma or less. Among non-Hispanic adults, estimates were small and precisely centered around zero across outcomes. Similar findings obtained in difference-in-differences event study models, models including lagged exposures, and models with leave-one-out state exclusions. Conclusion: Higher community-based immigration enforcement was associated with worse mental health outcomes among Hispanic adults but not among non-Hispanic adults. Contemporary enforcement strategies may have broader psychological spillover effects within Hispanic communities, and mental health may be an underrecognized social cost of interior immigration enforcement.

One-to-one peer support is widely used in mental health services, but the components associated with better outcomes remain unclear. We systematically reviewed randomised controlled trials and conducted additive component network meta-analyses to identify which components of one-to-one peer support worker interventions were associated with outcomes for adults using mental health services. CINAHL Ultimate, Embase, MEDLINE, PsycINFO, CENTRAL, ClinicalTrials.gov and ISRCTN were searched, supplemented by citation tracking, previous reviews and expert consultation. Interventions were coded for seven components: Training and development, Maintaining peer support worker wellbeing, Relationship-building, Social support, Emotional support, Practical support and Cultural adaptation. The review followed PRISMA-NMA reporting guidance and was registered with PROSPERO (CRD42022355291). Thirty-six trials randomised 6,645 participants across nine countries. Only quality of life and recovery yielded estimable component effects at one or more follow-up points. For quality of life, Practical support had a positive incremental estimate at 3 months (standardised mean difference 0.52, 95% confidence interval 0.17 to 0.87); no component showed clear evidence of benefit at 6 months; and at 12 months Social support had a positive estimate (1.57, 0.12 to 3.01), whereas Maintaining peer support worker wellbeing had a negative estimate (-1.66, -3.05 to -0.28). These estimates were not consistent across follow-up points. For recovery, Relationship-building had positive estimates at 6 months (0.90, 0.03 to 1.78) and 12 months (0.50, 0.29 to 0.72). Networks were sparse and often disconnected, and additivity could not be tested in disconnected networks. Current trials do not permit definitive prioritisation of peer-support components. Relationship-building was the most consistent candidate component, but all findings remain provisional. Future trials should prospectively specify, manipulate and measure component delivery.

Oregon (OR) and Colorado (CO) were the first states to enact regulations for provision of psilocybin with support of licensed "facilitators." As more states and countries adopt similar policies, informed public policy decisions require that client characteristics and rationale for using psilocybin, psilocybin dosing practices, mental health outcomes, and adverse events are understood. We performed a retrospective observational study of responses for 2363 individuals receiving psilocybin at OR and CO regulated service centers. Clients and facilitators entered data before and after receiving psilocybin, including the Mystical Experience Questionnaire-30 (MEQ-30), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and World Health Organization Well-Being Index-5 (WHO-5). Preexisting mental health issues were common (66%) in participants. Psilocybin doses ranged from 1-95 mg, with a mean total of 28*8 mg. We observed improvements of 49% in PHQ-9 scores, 51% in GAD-7 scores, and 22% in WHO-5 scores at two-weeks after dosing. MEQ-30 scores were dose-dependent. Changes in PHQ-9 and GAD-7 scores were not different for psilocybin doses [&le;]30 mg and >30 mg, and only weakly correlated with MEQ-30 scores. There were 94 mild adverse events during and after dosing, five more serious events not clearly related to treatment, and evidence of possible risk of increased suicidality. Study limitations include open label administration, self-reporting, loss of participants for follow-up, and a short 2-week post-dosing end-point. We conclude that psilocybin services, delivered within these regulated frameworks, is associated with improvements in mental health in real world populations, however, more robust monitoring is needed to ensure safety.

Relatively little is known regarding suicide among older adults in nursing homes. The aim of this study was to compare the incidence of suicide among older nursing home residents (NHR) with community-dwelling older people (CDP) using newly available, national, individual-level register data, and to assess differences with regard to socio-demographic characteristics. We obtained data on all older adults aged 65+ who were living in Austria at the end of October 2018 (n=1,665,450), including 155,020 NHR. Death by suicide was followed until the end of 2023. A total of 114 and 2,136 suicides were observed among NHR and CDP; corresponding to cumulative incidences of 14 and 27 per 100,000, respectively. Among NHR, suicide incidence was higher among males (28.0, 95% CI=22.1, 35.5), those aged 65-74 years (20.2, 95% CI=13.3, 30.6), with tertiary education (23.3, 95% CI=10.6, 50.6), divorced (25.0, 95% CI=16.2, 38.5), and residing in urban nursing homes (22.0, 95% CI=17.0, 28.4). Compared to CDP, more suicides in NHR occurred by poisoning and but few by firearms. In conclusion, we found that suicide incidence was lower among older NHR compared to CDP. More research on and preventive efforts against suicide among older NHR are needed.

Purpose: Suicide mortality is underestimated due to misclassification under undetermined and accidental deaths. This study examined national trends in suicide and related external causes of death in Portugal from 2002 to 2023, by sex and age group, assessing potential shifts suggesting masked suicide and quantifying the relationship between undetermined, suicide, and accident death rates through ratio indices. Methods: Using official mortality data from Portugal's Statistics Institute (INE) for 2002-2023, we calculated age-standardised (SDR) and age-specific death rates (ASDR) for suicide (X60-X84), undetermined intent deaths (Y10-Y34), and unintentional deaths (V01-X59), disaggregated by sex and four age groups (15-24, 25-44, 45-64, 65+). We estimated undetermined-to-suicide (UnD:Suic) and undetermined-to-accidents (UnD:Accs) rate ratios for SDRs and ASDRs. Trends were analysed using joinpoint regression (APC/AAPC) and structural breakpoint analysis (Chow test, BIC). Results: Suicide SDRs declined across the period for males (AAPC: -2.25%) and females (AAPC: -1.32%), with the sharpest reductions among males aged 25-44 (AAPC: -2.56%) and females aged 65+ (AAPC: -2.44%). Deaths of undetermined intent rose steeply from 2002 to 2005-2006 and declined thereafter. Unintentional deaths declined in most age groups, except females aged 65+ (AAPC: +1.41%). Both ratio series peaked around 2005-2009, declined progressively through the 2010s, and reached their lowest values in 2021-2022. Age-specific analyses revealed a significant and sustained increase in both ratios among females aged 45-64. Structural breakpoints clustered around 2004, 2013-2015, and 2019-2020. Conclusion: Suicide mortality declined in Portugal from 2002 to 2023, but divergent trends in undetermined and accidental deaths across sex and age subgroups highlight ongoing misclassification. Age- and sex-specific ratio analyses identify the population subgroups where misclassification is most concentrated, providing a foundation for future imputation-based estimates of probable suicide burden.

Background: Mobile outreach initiatives have emerged to address persistent barriers to care for people experiencing homelessness, substance use, and mental illness. Although these models show promise, less is known about how and under what conditions they enable engagement and coordinated care. This study explains how, why, and under what circumstances a mobile, cross sector outreach model enables access to care for marginalized populations. Methods: We conducted a realist evaluation of Supportive Outreach Services (S.O.S.), a mobile, cross sector outreach program in Grey County, Ontario. Data included 31 semi structured interviews with outreach providers, partner organizations, system leaders, and clients, supplemented by document review and stakeholder feedback. Using retroductive reasoning and constant comparison, we developed and refined context mechanism outcome configurations to construct an explanatory program theory. Results: Five interconnected realist explanations account for how the model enables access to care. Trust built through repeated, non judgmental encounters supports engagement; proximity reduces barriers to participation; accessible support enables timely help seeking; cross sector relationships enable adaptive coordination; and visible results build legitimacy that sustains participation and resources. Together, these explanations provide a linked explanatory account of how mobile outreach reduces friction between marginalized populations and fragmented services while identifying the structural conditions that constrain its effectiveness. Conclusions: The effectiveness of mobile outreach depends less on the services delivered than on its capacity to reduce friction, sustain relationships, and adapt care across organizational boundaries. The resulting program theory offers transferable explanations for designing coordinated community based services while highlighting the structural conditions required for durable change.

Purpose: Involuntary psychiatric hospitalization under court orders requires careful balancing of legal obligations and clinical needs. Identifying factors that influence the length of these hospital stays helps clarify the relationship between legal frameworks and psychiatric treatment. This study aims to describe the socio-demographic, clinical, and legal profiles of individuals hospitalized under court warrants and to identify factors independently associated with the duration of forensic hospitalization. Methods: A retrospective study was conducted on 119 patients discharged between 2018 and 2023. Data were collected from medical and legal records, including socio-demographic details, psychiatric diagnoses, offense types, hospital stay lengths, and legal proceedings. Results: Most patients were men (91.6%) diagnosed with schizophrenia or schizoaffective disorder (97.5%), with high rates of comorbid substance use disorder (79.0%) and unemployment (85.7%). The median hospital stay was 19.0 months, representing 40% of the maximum statutory sentence. Patients with low-severity offenses served a larger share of their maximum sentence (47%) than those with high-severity offenses (24%). Time to first discretionary leave was the strongest predictor of total stay duration in univariable analysis. Conclusion: The finding that patients with minor offenses have longer hospital stays than those with serious offenses confirms that clinical factors, rather than offense severity, primarily influence discharge decisions. These findings support moving toward personalized, clinically focused, and family-inclusive forensic discharge planning while maintaining public safety.

Background: Concerns about "AI psychosis" have swirled in the media since ChatGPT's release, but few systematic analyses exist. We therefore conducted an electronic health record (EHR) analysis to identify the frequency, clinical characteristics, and quality of AI interactions in patients experiencing psychosis treated in a medical center. Methods: AI keywords (e.g., ChatGPT, AI) were used to search Vanderbilt University Medical Center's EHR from 12/1/2022-4/1/2026. Records were discarded if they were not AI-related or if the primary diagnosis did not include psychosis. Three raters read notes to determine if a patient was experiencing AI psychosis and classified the interactions using 4 a-priori categories (Catalyst, Amplifier, Co-Author, Object) formulated to explain how AI-related negative outcomes emerge. Findings: 73 patients met our criteria. 28 patients were rated as experiencing AI psychosis, 17 had neutral interactions, and 28 expressed delusional content related to AI without documented evidence of conversational AI use. ChatGPT was the matching keyword for 53.6% patients experiencing AI psychosis. The majority of AI psychosis cases were documented after ChatGPT's "4o" model was released in May 2024. Notably, the AI Psychosis group had significantly more patients experiencing a first psychotic episode (60.7%) compared to the other two groups. Amplifier was the most common (64.3%) qualitative rating in the AI Psychosis group. Interpretation: "AI psychosis" is an infrequent but real phenomenon observed in clinical practice. Most affected patients were experiencing their first psychotic episode and presented with AI psychosis following the release of the more sycophantic GPT-4o. Among the affected patients, AI most often exacerbated an existing condition by reinforcing distorted ideas.

Although romantic partners tend to resemble each other on many characteristics, the geographical processes underlying partner similarities remain poorly understood. Using Finnish nationwide registry data from cohabiting or married partners (N = 1,500,204 couples; partnerships were formed between 1990-2023), we examined regional differences in partner similarity in mental disorders, educational attainment, and adolescent school performance. We also analysed geographical variation in partner similarity within three major cities. Accounting for local demographic composition of potential partners attenuated the partner similarity from r=0.43 to r=0.34 for highest obtained educational attainment, but increased partner similarity in any mental disorders from r=.40 to r=.42. In urban municipalities partners were more similar in educational attainment, but less in mental disorders, compared to more rural regions. We found no clear within-city variation in partner similarity. These findings highlight the role regional demographic composition plays in partnership formation and suggest different partnering dynamics depending on societal organization.

Introduction: Self-rated health is an important patient-centred measure of health. The relationship between cannabis use and self-rated health has been previously studied, although with methodologic concerns which we aimed to address in this investigation. Methods: Propensity score weighted analyses of the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were conducted. The primary exposure was self-reported cannabis use in the 30 days prior to survey response. The primary outcome was self-rated health measured on a five-level ordinal scale. Secondary outcomes included the number of days in the past months with: i) poor physical health, ii) poor mental health, and iii) activity limitations related to poor health. A weighted proportional odds regression model was used for the primary analysis and weighted zero-inflated negative binomial regression models were used for each secondary analysis. Results: Among 22,055 adults aged 20-59 responding to the NHANES cannabis questionnaire, 14.4% endorsed use in the past 30 days. After reweighting the sample to balance cannabis users and non-users across sociodemographic, medical, and lifestyle characteristics, there was no statistically significant association between recent cannabis use and higher levels of self-rated health (OR 0.90, 95% CI 0.80-1.01). Cannabis use was associated with poor mental health and activity limitations in the past month, but not poor physical health. Conclusions: Recent cannabis use was not associated with self-rated health but was associated with poor mental health and activity limitations in the past month. Cannabis users at risk of poor mental health should be connected with clinicians to help guide therapy.

Objective: To examine if food insecurity moderates the relationship between rurality and mental health outcomes (suicide mortality, poor mental health days, frequent mental distress) and to assess if these effects vary across U.S. Census divisions. Methods: This county-level (n=2,397) cross-sectional study used OLS and spatial error regression to analyze public data from sources including the County Health Rankings and USDA. We modeled suicide mortality, poor mental health days, and frequent mental distress as functions of the Index of Relative Rurality (IRR) and food insecurity, controlling for median income and provider rates. The suicide model was also tested across nine U.S. Census divisions. Results: Baseline models revealed a paradox: rurality was a direct risk factor for suicide (B=0.400) but protective for poor mental health days (B=-0.224). The national multivariable model revealed a significant, positive rurality-food insecurity interaction for suicide mortality (B=0.861), indicating a synergistic risk. This interaction was not significant for general mental distress, which was more strongly predicted by income and food insecurity. Regional analysis confirmed the suicide interaction was potent in five divisions, including the Pacific (B=3.048) and Mountain (B=1.712) , but absent in others (e.g., South Atlantic). Conclusions: The drivers of suicide are distinct from those of general mental distress and are geographically heterogeneous. The interaction of rurality and food insecurity creates a compounded risk for suicide. Suicide prevention must be regionally-tailored and address structural inequalities, such as food insecurity, alongside clinical care.

Introduction: Group interpersonal psychotherapy (IPT-G) can expand access to depression care, but assessment conditions may influence outcomes. This pilot cluster-randomized trial was designed to refine outcome-measurement procedures and generate preliminary effect estimates to inform a larger trial. We evaluated a six-week model, examining associations between follow-up assessment conditions and depressive symptoms. Methods: In Mayuge, Uganda, female participants aged [&ge;]13 years with Patient Health Questionnaire-9 (PHQ-9) scores [&ge;]10 were randomized by village to IPT-G or enhanced treatment as usual. Primary outcome was the PHQ-9 score. Assessments occurred at baseline, two weeks and three months post-treatment. During early two-week follow-up, therapy facilitators remained visible near interview locations while mobilizing participants; thereafter, they left before subsequent interviews. At three months, interviews were conducted independently and participants were randomly assigned to receive a prompt emphasizing confidentiality, accurate reporting and that incentives were not contingent on responses. We examined associations between these two conditions and PHQ-9 scores. Results: Of 292 randomized participants, 263 provided three-month data. Mean PHQ-9 scores were lower in intervention than control participants at two weeks (1.73 versus 15.14; mean difference [MD] -13.41, 95% confidence interval [CI] -16.10 to -10.71) and three months (3.19 versus 10.97; MD -7.78, 95% CI -9.66 to -5.90; both p<0.001). Among intervention participants, prior assessment without facilitators and receipt of the confidentiality and honest-reporting prompt were jointly associated with 4.41-point higher PHQ-9 scores versus the reference condition (95% CI 2.37 to 6.45; p<0.001). In exploratory sensitivity analysis, an intervention subgroup exposed to both conditions had lower three-month PHQ-9 scores than controls (MD -5.19, 95% CI -7.39 to -2.99; p<0.001). Conclusions: Six-week IPT-G was associated with significant symptom reductions, but follow-up procedures influenced the apparent benefit, highlighting the need for independent outcome assessment in community-delivered psychological intervention trials. Trial registration: Pan African Clinical Trials Registry, PACTR202606549854263; retrospectively registered.

Background:Previous self-harm elevates the risk of repeat self-harm and suicide, but the prognostic value of events and clinician observations around the index event is unclear. We evaluated established and exploratory risk factors for suicide and repeat self-harm among patients presenting to emergency psychiatric units after a suicide attempt or nonsuicidal self-injury (NSSI). Methods: Multicentre cohort study in Sweden (n = 804). Outcomes were suicide and repeat self-harm at 1-year and 5-year follow-up, ascertained through linked national registers. Established risk factors included psychiatric diagnoses, prior suicidal behaviour, and sociodemographic characteristics; exploratory factors comprised past-week self-reported symptom changes and clinician observations. LASSO-regularised Cox regression models were fitted for established (n=21) and exploratory (n=11) risk factors. Results: During five-year follow-up, 285 (35%) individuals had a new episode of self-harm and 41 (5%) died by suicide. No risk factors reached statistical significance for suicide, although male sex was retained after regularisation (1-year hazard ratio [HR] = 3.57 [95% CI 0-8.33]; 5-year HR = 2.5 [0.03-4.55]). Three established risk factors were significantly associated with repeat self-harm: psychiatric inpatient care in the three months before the index event (1-year HR = 1.85 [1.3-2.6]; 5-year HR = 1.72 [1.23-2.65]), previous suicide attempt (1-year HR = 2.01 [0.79-2.4]; 5-year HR = 2.19 [1.27-2.6]), and borderline personality disorder (1-year HR = 1.82 [1.13-3]; 5-year HR = 1.67 [0.14-2.75]). Among exploratory risk factors, clinician-observed hopelessness (1-year HR = 1.72 [1.1-2.3]; 5-year HR = 1.51 [1.03-1.91]) and personality disorder features (1-year HR = 1.48 [0.96-2.05]; 5-year HR = 1.47 [1.04-1.95]) were associated with repeat self-harm. Conclusions: Risk factor profiles for repeat self-harm were consistent at 1 and 5 years. Beyond established risk factors, clinician-observed hopelessness and personality disorder features emerged as markers of risk, suggesting that qualitative clinician assessments may yield prognostic information not available from medical records alone.

Background Older adults evaluated by consultation-liaison psychiatry services (CLPS) often present with complex psychiatric and medical comorbidity, frequent psychotropic exposure and a high prevalence of frailty. However, the relative contribution of these factors to clinical outcomes remains unclear. Methods We conducted a multicentre prospective cohort study including 465 consecutive patients aged more than 65 years evaluated by CLPS in 10 general hospitals in Spain between January and July 2024. Psychiatric history, postconsultation psychiatric diagnoses, psychotropic use, age group (65-74 vs older than 75 years) and frailty assessed using the Clinical Frailty Scale were recorded. Outcomes included falls, institutionalisation, access to mental health follow-up and mortality at 1 and 3 months after discharge. Results The mean (SD) age was 77.4 (7.8) years and 55.9% were women. Psychiatric history was present in 68.8% of patients and 55.8% received a new psychiatric diagnosis, most commonly delirium. Psychotropic use was frequent (71.6%), particularly antidepressants (49.0%) and benzodiazepines (42.6%). Psychotropic polypharmacy was associated with falls. Frailty was prevalent (60.2%) and independently associated with early mortality, whereas age was the main predictor of mortality between 1 and 3 months. Older age was also associated with a lower likelihood of specialised mental health follow-up. Conclusions Among older adults evaluated by CLPS, frailty and medical comorbidity appear to outweigh psychiatric variables in predicting outcomes. Integrating comprehensive geriatric assessment and medication review into CLPS may improve care for this population.

Introduction: Blackpool, England's most deprived local authority, has the highest drug-related death rate in the country. People in police custody with problem substance use are a key Core20PLUS5 inclusion-health group, yet referral from the police into structured drug and alcohol treatment is fragmented and relies heavily on self-report. We evaluated the current police-to-treatment route in Blackpool and designed an evidence-informed unified pathway. Materials and Methods: A mixed-methods service evaluation and pathway-design project was conducted during a six-month General Practice / Public Health rotation. Routinely collected referral data from Horizon (the local specialist drug and alcohol service) covering the 47-month period from December 2019 to October 2023 were analysed. Findings were triangulated with national policy, the Project ADDER and Liaison and Diversion evaluations, and the international evidence on police-led pre-arrest diversion. Results: Of 5,900 total referrals into Horizon over 47 months, only 269 (4.56%) originated from the police. Police referrals accounted for fewer than 5% of monthly referrals in 30 of 47 months, for 5 to 9.9% in 16 months, and for >/= 10% in only one month (10.8%, December 2022). Blackpool recorded 76 drug-misuse deaths in 2019-21 (19.4 per 100,000, approximately four times the England rate). A six-step unified pathway is proposed: Initiate Referral (opt-out, from ADDER Police and Liaison and Diversion); Initial Assessment; Tailored Treatment Plan; Continuous Support; Collaboration and Monitoring; and Evaluation and Adjustment. Conclusions: Police contact is markedly under-used as a gateway to treatment despite Blackpool having the highest drug-related mortality in England. An opt-out, multi-agency pathway anchored in Core20PLUS5 has the potential to narrow the treatment gap, reduce re-offending, and address the structural health inequalities that drive premature mortality.

Background Individuals with severe mental illness (SMI), including schizophrenia spectrum disorders (SSD) and bipolar disorder (BD), have been shown to have an elevated risk of violent perpetration. However, no population-wide study has systematically examined how this risk varies across psychiatric comorbidity patterns and specific violent crime types. Methods Using the first nationwide Norwegian registry linkage comprising mental health and crime data, we included 3,612,215 individuals aged 15-79 years living in Norway on Jan 1, 2008, and followed them until Dec 31, 2022. We estimated absolute and relative risks (RRs) of violent offending overall and by specific violent crimes among individuals with SSD and BD. To capture clinically relevant comorbidity patterns, we included substance use disorders (SUD), common personality disorders (PD), and hyperkinetic disorders (ADHD). RR models were adjusted first for sex and age, and subsequently for co-occurring mental disorders. Findings At the population level, individuals with SMI accounted for a minority of violent offenders (SSD: 8.7%; BD: 4.6%), whereas SUD was present among a substantially larger proportion (36.8%). Absolute risk of violent offending increased markedly with psychiatric comorbidity, from e.g., 5.0% among individuals with SSD alone to 43.9% for SSD combined with SUD and PD. Compared with the remaining general population, the RR of violent offending for SSD decreased from 6.58 (95% CI 6.4-6.8, adjusted for sex and age), to 2.0 (2.0-2.1) after further adjustment for other mental disorders. Similar attenuation patterns were observed across specific violent crime types, although varying in magnitude. In contrast to SMI, elevated risks associated with SUD remained substantial after full adjustment across most crime categories. Interpretation The association between SMI and violent offending is strongly influenced by psychiatric comorbidity, particularly SUD, and varies across crime types. Our findings underscore the importance of identifying and treating co-occurring mental disorders and substance use, both in the clinical management of SMI and in population-level violence prevention strategies.

Importance: The impact of COVID-19 containment policies (e.g., physical distancing, school closures) on population anxiety has been debated and difficult to resolve. Objective: To estimate the joint effects of state-level COVID-19 containment policies on anxiety symptoms during the early pandemic. Design: Retrospective analysis of a prospective cohort with cross-sectional outcome assessment. Setting: All of Us Research Program, a U.S. national research cohort. Participants: 40,610 adult participants who completed the All of Us COPE survey in July 2020. Exposures: Seven state-level COVID-19 containment policies (school closures, workplace closures, cancellation of public events, restrictions on gatherings, public transport closures, stay-at-home requirements, and restrictions on internal movement) measured from March 22 to May 23, 2020, via the Oxford COVID-19 Government Response Tracker (OxCGRT). Main outcomes and measures: The primary outcome was anxiety symptoms (GAD-7) in July 2020. Using quantile g-computation, we classified policies as anxiety-increasing or anxiety-decreasing by the sign of their training-set contributions, then re-estimated joint effects in a holdout testing set. Results: Among participants (64% female; mean age: 57.8 years), 13.3% (n=5398) reported moderate-to-severe anxiety (GAD-7 score 10-21) in July 2020. The joint effect of all seven containment policies was not significant ({beta} = 1.88, 95% CI: -0.51 to 4.28, p = 0.12). An anxiety-increasing joint effect from 4 policies (school, workplace, public events, internal movement; {beta} = 2.98, 95% CI: 0.30 to 5.66, p = 0.03) and an anxiety-decreasing joint effect from 3 policies (gatherings, public transport, stay-at-home; {beta} = -1.10, 95% CI: -1.75 to -0.44, p = 0.002) reached significance. Effects were largest in adults 18-44 (anxiety-increasing {beta} = 8.93, 95% CI: 1.50 to 16.37, p = 0.02; anxiety-decreasing {beta} = -2.81, 95% CI: -4.98 to -0.64, p = 0.01), with no significant effects in adults 45 and older. Conclusions and Relevance: Modeling seven containment policies jointly showed no net anxiety effect, a result that masked opposing-direction effects. Partitioning by effect direction revealed significant joint effects exceeding single-policy estimates, with young-adult point estimates above the 4-point GAD-7 minimal clinically important difference (MCID) though lower CI bounds fell below it. These findings may inform the use of containment policies in future pandemics, given their differing association with population anxiety

Introduction: In 2020, Oregon became the first US state to legalize state-regulated psilocybin services. This study aims to examine: 1) the clinical and demographic characteristics, 2) psilocybin use motivations, and 3) differences in preparedness among patients seeking care in a Oregon- based pilot consult service specializing in psilocybin risk reduction. Methods: This retrospective chart review abstracted sociodemographics, trauma history, and medical and psychiatric risks of patients (November 2023 - September 2025). The Psychedelic Preparedness Scale (PPS), a validated self-report questionnaire, measured preparedness. Two sample t-tests examined associations of PPS scores by insurance, consult motivations, and prior psychedelic use. Results: Patients (N=29) had a mean age of 47.14 years (SD=15.9), were majority female (55.2%); White (82.8%); and privately insured (62.1%). Patients mostly sought psilocybin to address only a psychiatric concern (75.9%); 27.6% anticipated naturalistic (non-state regulated) use. Most patients were deemed low risk for adverse events. Prevalence of prior challenging psychedelic experiences (CPE) was 17.2%; 58.6% reported lifetime psilocybin use. 86.2% endorsed >1 form of lifetime trauma. Of PPS completers (N=23, 79%), mean score was 91.3 (SD = 23.99). Scores did not significantly differ by insurance; consultation motivation; CPE; prior psilocybin or psychedelic use. Conclusion: Patients utilizing a novel consultation service demonstrate a high prevalence of trauma, prior psilocybin use, and baseline preparedness. While preliminary, this is among the first descriptions of patients seeking medical and psychiatric consultation when considering psilocybin and highlight the potential role of healthcare systems in providing evidence-based patient education and risk reduction as interest in psychedelics grows.

Background: Suicide is the second leading cause of death in US adolescents aged 10-24. Method use strongly influences lethality and design of prevention strategies, but recent trends remain unclear. We therefore aimed to investigate trends in suicide mortality rates by method, age group, and sex. Methods: This cross-sectional study used suicide mortality data from the National Center for Health Statistics for a quarter-century period, between 1999 and 2024. All individuals aged 10-24 years at the time of death, with suicide as the underlying cause, were included. We estimated suicide mortality rates (i.e., the number of suicide deaths per 100,000 people) and annual percent change by method (firearm, asphyxiation, poisoning, other), age group (10-14, 15-19, 20-24), and sex. Changing trend time points were determined using Joinpoint regression models Results: From 1999 to 2024, 159,241 suicide deaths occurred among individuals aged 10-24. While suicide rates declined across all age groups between 2017 and 2024, the male-to-female gap narrowed by 18.9%. Among 10-14-year-olds, declining rates among males masked a consistent increase in female suicide rates since 2011. Although asphyxiation-related suicides decreased across all groups since 2018, firearm suicide rates increased for females in the 10-14 and 20-24 age groups. Albeit not as common as firearms or asphyxiation, poisoning suicide rates increased in the 15-19 and 20-24 age groups. Since 1999, suicide rates by other less common methods (e.g., jumping) showed significant increases, for both sexes, especially among individuals aged 20-24. Suicide rates were consistently highest in the 20-24 age group across all study years. Conclusion: The decrease in suicide mortality rates among individuals aged 10-24 was largely driven by declines in males and reductions in asphyxiation-related suicides. However, increasing female suicide rates in the 10-14 age group, as well as increasing rates of death by less common means, warrant close attention. While suicide prevention efforts like structural interventions and means restriction have shown effectiveness among male adolescents, priority should now be given to adapting these approaches for female adolescents, particularly those aged 10-14.