Psychiatry Research

Background: Adolescents frequently consult online resources regarding sensitive health topics, including suicide. Although content analyses demonstrate that online platforms contain both suicide-preventive and pro-suicide material, they rarely incorporate subjective data from adolescents at elevated suicide risk. Aims: This exploratory study examined associations between reasons for seeking suicide-related information online and the digital media used to access such content among adolescents with suicidal ideation. Method: Over one year, 131 adolescents aged 13 to 18 with current or past suicidal ideation were recruited from the Emergency Department of an urban pediatric hospital to complete a cross-sectional survey. Participants reported whether they had sought suicide-related information online, the type of information sought, and the online locations used. Mixed-effects regression models examined associations between reasons for online searches and digital media used. Results: Of 131 enrolled adolescents, 113 completed the survey; 69 (61.1%) reported ever seeking suicide-related information online. Searches were more often intended to assist with acting on suicidal thoughts than to reduce suicidal thoughts (63.7% vs. 55.1%). Social media were used for help-seeking searches slightly more often than professional health organization websites (42.1% vs. 31.6%). Among adolescents who used social media for their searches, discussion forums were significantly more likely to be used when seeking information to act on suicidal thoughts (OR=7.0, p=.02). Conclusion: The majority of adolescents with suicidal ideation may seek out suicide-related content online, particularly to facilitate suicide planning. Social media may be used as frequently as professional mental health websites like 988 or The Trevor Project for suicide-related searches.

Background: Dissociative identity disorder (DID) is associated with frequent psychiatric comorbidity. Its complex and overlapping symptom profile can complicate recognition of both DID and co-occurring psychiatric conditions, contributing to diagnostic uncertainty. Evidence regarding psychiatric comorbidity is limited and prevalence estimates vary across studies. Aims: This meta-analysis aimed to examine the prevalence of psychiatric comorbidities in DID and factors associated with variation in prevalence estimates. Methods: Eligible studies were identified through PubMed, Scopus, Embase, PsycINFO, and MEDLINE from 1980 to 25 April 2026 (PROSPERO, no. CRD420261335819). Studies reporting psychiatric comorbidity in adults with DID were independently screened by two reviewers. Risk of bias was assessed. Random-effects meta-analyses using logit-transformed prevalence estimates were conducted. Meta-regressions examined moderators, whilst influence and sensitivity analyses assessed robustness. Certainty was evaluated using the GRADE approach. Results: Twenty-four studies (N = 858) contributed to the meta-analysis across 23 psychiatric comorbidities. Among individuals with DID, posttraumatic stress disorder had the highest pooled prevalence (87.44%, 95% CI 71.79-94.96), followed by major depressive disorder (62.64%, 95% CI 33.45-84.84), and borderline personality disorder (47.05%, 95% CI 34.21-60.32). Substantial heterogeneity was noted across most estimates. Meta-regressions identified significant associations with participant characteristics, recruitment, study quality, and diagnostic method. Risk of bias and certainty of evidence were heterogenous. Conclusions: Psychiatric comorbidity in DID is substantial and spans multiple diagnostic categories, although considerable heterogeneity and methodological variation limit confidence in prevalence estimates. Standardised diagnostic assessment, more representative sampling, and longitudinal research are needed to clarify the extent and clinical significance of comorbidity in DID.

Depression is one of the most prevalent mental health disorders globally. Social media content can reflect emotional states, offering real-time signals of depressive symptoms. This study aimed to develop a deep learning model to predict depression using Twitter/X data, and to characterize potential causes of depression using a large language model (LLM). Twitter/X posts from April 20, 2023, to July 24, 2024, were obtained using the key phrase ("I" or "me") and "diagnosed with depression". After data cleaning and GPT-4o labelling, 2,275 depressive Twitter users, and an additional 1,661 non-depressive users from tweets using the keyword "today", were identified. A deep learning RoBERTa model for predicting depression was built on tweets from both user groups, with an 80/20 training-testing split. GPT-4o models were subsequently employed to analyze depressive users posts to understand potential causes for depression. The RoBERTa model achieved strong performance in predicting depression among Twitter users from their tweets, with an accuracy of 0.822, an F1 score of 0.855, and an AUC of 0.809. Common reasons for depression identified by GPT-4o models included societal pressure, low self-esteem, cultural influences, and identity-related challenges. These findings highlight the potential of deep learning models in early screening of depression using social media data. Insights into potential reasons for depression may inform targeted prevention strategies, public health interventions, and improved mental health support for at-risk populations.

Objective This study aimed at analyzing changes in the prevalence of excessive internet use and to analyze its associations with mental and cognitive health problems among adolescents. Method We used repeated cross-sectional data from the School Health Promotion study, a population-based nationwide classroom survey in Finland. All adolescents in grades 8-11 were invited, with a total of 602,226 responses in 2017-2023. Excessive internet use was measured with the five-item Excessive Internet Use Scale covering core behavioral addiction symptoms. Depressive symptoms, generalized anxiety, and social anxiety were measured with validated questionnaires. Problems in cognitive functioning were assessed with one-item indicators. Analyses were done with Chi-square tests and logistic regression. Results From 2017 to 2023, the prevalence of excessive internet use increased, especially among girls. The increasing trend was significantly (p<0.001) steeper among girls, with the OR for time (in years) being 1.12 in grades 8-9 and 1.14 in grades 10-11, while among boys the corresponding ORs were 1.00 and 1.04, respectively. Excessive internet use associated with short sleep, depressive, generalized anxiety, and social anxiety symptoms (ORs between 1.73-2.42 in boys; 1.92-2.26 in girls; p<0.001) and with difficulties in tasks requiring reading, writing, and mathematics, and difficulties in concentrating (ORs 1.84-2.31 in boys; 1.83-1.98 in girls; p<0.001). Conclusion The prevalence of excessive internet use showed an increasing trend, especially among girls. The associations of excessive internet use with mental health symptoms and cognitive challenges were clear.

BackgroundPsychotic-like experiences (PLEs) have been shown to increase the risk for mental health problems in later life, especially psychosis. Following previously raised methodological concerns about the assessment of PLEs in adolescents, this study sought to differentiate subtypes of PLEs and to explore their trajectories. MethodsLongitudinally matched data of 671 German adolescents from three surveys over the time span of one year were analysed. Four trajectories were identified, including persisting, subsiding, and emerging highly indicative PLEs (HIPs), and non-highly indicative PLEs (non-HIPs), and longitudinally compared in terms of associated distress, psychopathology, and substance use. A differentiated never PLEs group was considered as a control. ResultsThe persisting HIPs group reported greater distress than the non-HIP group over time and was consistently associated with higher rates of internalising symptoms. The subsiding HIP group showed significant reductions in distress and internalising symptoms over time, but no significant changes regarding externalising symptoms and substance use. There was no difference in the extent of substance use between the groups. ConclusionsScreenings of PLEs should be mindful of different subtypes of PLEs that indicate a greater associated risk of poor mental health. PLE screening should not stop at whether PLEs are present but ask which ones.

Background: Childhood trauma is a well-established risk factor for adverse mental health outcomes, yet large-scale cross-national evidence from the Arab region remains limited. This study examined the prevalence of childhood trauma and its associations with multiple transdiagnostic outcomes across 17 Arab countries. Methods: A cross-sectional online survey was conducted between September and October 2025 among 6,181 adults from 17 Arab countries. Childhood trauma was assessed using the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Transdiagnostic mental health outcomes included depression, anxiety, posttraumatic stress symptoms (PTSS), maladaptive behavior, and social/functional impairment. Descriptive statistics, Pearson correlations, and multiple linear regression analyses were performed via IBM SPSS Statistics. Confirmatory factor analysis and structural equation modeling were conducted via R (Lavaan) to evaluate a second-order latent construct representing global childhood trauma. Results: Childhood trauma was widely reported across the sample, with physical neglect and emotional neglect emerging as the most frequently endorsed domains. All trauma domains were significantly associated with poorer mental health outcomes (p < .001). In regression analyses adjusted for demographic factors, emotional abuse emerged as the strongest predictor of depression ({beta} = .472, p < .001) and PTSS ({beta} =.439, p < .001). Structural equation modeling supported a second-order global trauma construct, which showed strong associations with depression ({beta} = .70), anxiety ({beta} = .64), PTSS ({beta} = .68), maladaptive behavior ({beta} = .68), and social impairment ({beta} = .67). This latent factor showed strong associations with all mental health outcomes, explaining substantial variance in depression (R2 = .52), anxiety (R2 = .43), and PTSS (R2 = .48). The structural model demonstrated borderline-to-acceptable fit (CFI = .899, TLI = .890, RMSEA = .058, SRMR = .085), supporting the hypothesized latent structure while indicating scope for further model refinement. Conclusions: Childhood trauma is highly prevalent across the Arab region and is strongly associated with multiple dimensions of psychological distress, highlighting the urgent need for trauma-informed prevention, screening, and early intervention programs in the Arab region.

BackgroundAtypical antipsychotics (AAPs) are increasingly prescribed for paediatric patients with autism spectrum disorder (ASD). However, pharmacovigilance data from Saudi Arabia remain scarce. The aim of this study is to detect and characterise signals associated with AAPs and assess gender- and age-related ADR reporting patterns. MethodsA retrospective cross-sectional study with disproportionality analysis was conducted on paediatric patients (0-19 years) using the Saudi Food and Drug Authority (SFDA) database (2021-2024). Disproportionality analyses were performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and Bayesian confidence propagation neural network (BCPNN). Age and gender were assessed using odds ratios (ORs), with Firth penalized logistic regression to confirm associations. ResultsOverall, 701 ADR reports were analysed. Most involved males (59.91%) and children aged 0-9 years (82.88%). Olanzapine had the highest proportion of serious reports (44.44%). At the system organ class (SOC) level, signals included nervous system disorders with risperidone (ROR 32.61 [16.62-64.00]; PRR 3.49 [2.22-5.47]; IC025 0.08); cardiac and general disorders with quetiapine; haematological, metabolic, and psychiatric disorders with olanzapine; and gastrointestinal disorders with aripiprazole. Gender-adjusted analyses indicated significant variation in selected ADR signals across age groups, while no significant differences were observed by gender. ConclusionsThis study highlights disproportionality signals associated with AAP use in paediatric patients. Age-related ADR variation supports consideration of age-specific ADR monitoring within current paediatric recommendations. While these findings do not establish causality, they generate hypotheses for further evaluation. Regional pharmacovigilance may complement international paediatric safety monitoring frameworks.

Background: A comprehensive overview of how premature mortality in severe mental illness varies by socioeconomic position and healthcare utilization is lacking. Methods: We followed all Norwegian residents aged 30-79 years on January 1, 2008, through December 31, 2023. Nationwide registry linkage provided data on mental illness in primary and specialist care, educational attainment, and cause of death. We estimated the mortality gap as excess life-years lost from age 30 for depression, bipolar disorder, and schizophrenia compared with the general population, stratified by sex, healthcare utilization, and educational attainment. All-cause, external-cause, and natural cause mortality were assessed using competing risks. Results: The cohort comprised 2,486,836 individuals, including 483,933 with depression, 40,125 with bipolar disorder, and 21,963 with schizophrenia. Among men, the mortality gap ranged from 1.50 year (95% CI 0.36-3.34) among those with depression, non-inpatient care utilization, and university education to 19.86 years (18.34-21.36) among those with schizophrenia, inpatient care utilization, and less than high school education. Among women, the corresponding range was no gap to 18.16 years (17.03-19.53). Mortality gaps were generally larger with lower educational attainment and inpatient care utilization and increased from depression to bipolar disorder to schizophrenia. This pattern was consistent across sexes, diagnoses, healthcare utilization levels, and educational attainment levels and was most pronounced for natural-cause mortality. Conclusions: Premature mortality among people with severe mental illness forms a continuum across socioeconomic disadvantage, healthcare utilization, and diagnosis. Combining these measures can identify subgroups with the greatest mortality burden and may help target preventive interventions.

Brief assessments reduce clinician and patient burden and increase utilization. Recently, five core depression symptoms (low mood, poor concentration, low self-worth, loss of interest, low energy) have been shown to be particularly sensitive to treatment effects in adults. How these core depressive symptom domains perform for screening or diagnostic purposes in youth is unknown. To address this question, we extracted five analogous symptom items from four widely used symptom assessment tools for children and adolescents (Child Behavior Checklist [CBCL], Youth Self Report [YSR], Parent General Behavior Inventory [P-GBI], and Adolescent General Behavior Inventory [A-GBI]) to create 5-item short forms. We evaluated their psychometric properties and diagnostic utility in a large (N=1185), racially diverse sample (48% Black youth) across community and academic outpatient mental health settings, with diagnoses established through LEAD consensus. All short forms correlated highly with full-length measures (r=.74-.92) and demonstrated comparable inter-item correlations (r =.19-.46). The short forms did not differ meaningfully from the full measures in correlations with psychiatric diagnoses, demographics, or diagnostic interviews. Area under the curve (AUC) values for identifying depression and any mood disorder diagnosis (determined by semi-structured diagnostic interviews) were fair to good (AUC=0.60-0.79), which were not worse than full measures, except for the P-GBI. The CBCL-5, YSR-5, P-GBI-5, and A-GBI-5 may be useful brief depression assessments in youth. How these five symptom domains perform as outcome measures in treatment deserves study.

Background: Autistic people experience substantially higher rates of mental health conditions and are overrepresented in mental health services. However, most interventions and service models have been developed for non-autistic people, and evidence is needed as to whether there are disparities in outcomes. This systematic review aimed to compare outcomes between autistic and non-autistic people receiving the same mental health interventions or services. Methods: We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420251021068). We searched academic databases (MEDLINE, Embase, PsycINFO, PubMed, CINAHL), a grey literature database (HMIC), a trial registry (ISRCTN), preprint servers (medRxiv and PsyArXiv), Google, and Google Scholar, to identify relevant papers published 01/01/1992-30/04/2026. We conducted backwards and forwards citation searching and contacted experts. Study quality was assessed using a modified Critical Appraisal Skills Programme Cohort Study Checklist and the Autism-Inclusive Research Assessment (AIRA). Data were synthesised narratively, with random effects meta-analyses where appropriate. Results: Thirty-nine studies were included, comprising 4787730 participants, assessing outcomes of psychological therapies (n = 17) and multi-component or service-level approaches (n = 22). Nearly half (46.2%) were UK-based, and under a quarter (23.1%) included people with intellectual disabilities. Ten studies (25.6%) were rated low quality, twenty-two (56.4%) medium quality, and seven (17.9%) high quality. AIRA ratings highlighted concerns about research inclusiveness for autistic people, including limited involvement of autistic people and lack of validated or adapted outcome measures. Findings varied by intervention: for some, multiple large, higher-quality studies showed less favourable outcomes for autistic people (e.g., less improvement in symptoms or functioning, or higher rates of restrictive practices or acute service use). For other interventions, comparable or mixed outcomes were found across studies, with interpretation often limited by small samples. Conclusions: Mental health treatment outcomes for autistic versus non-autistic people varied across interventions and outcome types. Where significant differences were observed, these usually showed poorer outcomes for autistic people, although they generally reflected smaller improvements rather than a lack of benefit. Action is needed to improve the accessibility and appropriateness of mental health care for autistic people, supported by more high-quality, co-produced research across a broader range of countries and service contexts.

Polygenic risk scores (PRS) are rapidly developing, enabling estimates of genetic risk for developing psychiatric disorders. Psychiatric PRS are also increasingly entering consumer and clinical settings. Yet, little is known about how adults with psychiatric disorders perceive their potential use. Here, we conducted semi-structured interviews with 29 adults with psychiatric disorders to examine their perspectives on hypothetically receiving psychiatric PRS for themselves and their current or future children. Key themes emerged around perceived utility, motivations and deterrents to genetic testing, interpretation of PRS, and anticipated responses to results. In particular, participants expressed hope that PRS could support self-understanding, inform better psychiatric care, and enable earlier recognition of difficulties for their children. Participants however raised multiple concerns, including those of privacy, stigma, discrimination, eugenics, and the risk of self-fulling prophecies. Together, these findings offer critical empirical evidence to inform guidance on the responsible use of psychiatric PRS in clinical and consumer settings.

Background: Adolescent mental health problems have risen alongside increasing sleep disruption and widespread social media use (SMU). However, the mechanisms linking these factors remain unclear. This study concurrently examined objectively measured sleep and SMU in relation to psychopathology to test whether SMU moderates the sleep-mental health association and to characterize day-to-day bidirectional relations among sleep, affect, mood, and SMU during the school year. Methods: Eighty-five adolescents (ages 12-18) completed 14 days of wrist actigraphy, smartphone-based ecological momentary assessments of mood and affect, and objective SMU duration tracking. Cross-sectional models tested whether SMU moderated associations between sleep and psychopathology, and multilevel daily models examined within-person lagged associations among sleep, SMU, and affect, controlling for age and sex. False discovery rate correction was applied. Results: Shorter average sleep duration and greater variability in sleep duration between weekdays and weekends were associated with higher psychopathology symptoms, primarily externalizing problems. SMU duration neither moderated nor directly predicted psychopathology or sleep. Within-person analyses showed that longer-than-usual sleep predicted more positive and less negative affect and lower next-day SMU, though these associations did not survive correction for multiple comparisons. Conclusions: Sleep disruption showed consistent associations with adolescent psychopathology, whereas the amount of time spent on social media did not. These findings suggest that duration-based measures of SMU may incompletely capture adolescents digital experiences and highlight the need for more granular, context-sensitive indicators of online behavior in understanding youth mental health.

Abstract Background: Glycosylated RNAs (GlycoRNAs) participate in immune recognition and intercellular communication, but their relationship with brain cell-type transcriptional signatures in major depressive disorder (MDD) remains unclear. We examined GlycoRNA-related transcriptional coupling with microglial and other cellular signatures in the dorsolateral prefrontal cortex (DLPFC). Method: Postmortem DLPFC transcriptomic data from 22 controls and 26 MDD patients (GSE102556) were analyzed. GlycoRNA-related pathway enrichment was quantified using gene set variation analysis (GSVA), whereas microglial, neuronal, astrocytic, and oligodendrocytic signatures were derived using single-sample gene set enrichment analysis (ssGSEA). Pearson correlations, linear regression, and generalized estimating equations (GEE) evaluated cell-type-specific associations and diagnostic interactions. Exploratory GEE results underwent false discovery rate (FDR) correction. Results: No differentially expressed genes survived FDR correction, and GlycoRNA-related and cell-type signatures did not differ significantly between groups. In controls, GlycoRNA enrichment was positively associated with the microglial signature (beta = 0.447, FDR-adjusted P = 0.006), with significantly weaker associations for neurons, astrocytes, and oligodendrocytes (all FDR-adjusted P < 0.05). The two-way GlycoRNA x is_microglia interaction was nominally significant (beta = 0.210, P = 0.048), confirming that GlycoRNA transcriptional coupling is substantially stronger for microglia than for the other three cell types combined. The microglial association was numerically attenuated in MDD (beta difference = -0.273, P = 0.167), but diagnostic interactions were nonsignificant. Conclusions: GlycoRNA pathway transcriptional enrichment exhibits preferential microglial association in control DLPFC. Its possible attenuation in MDD remains to be validated. keyword: Major depressive disorder; GlycoRNA; microglia; dorsolateral prefrontal cortex; generalized estimating equation; ssGSEA; bioinformatics

Objective: To evaluate the psychometric properties, factor structure, validity, and age- and sex-specific norms of the 21- and 10-item parent-report Child Mania Rating Scale (CMRS-P) in a nationally representative U.S. sample of youth aged 6-18 years. Method: Parents of 2,229 youth aged 6-18 years [weighted M(SD)=12.0(3.3) years; 45.9% female] completed the CMRS-P and related measures between July 2025 and March 2026. Data were weighted to represent U.S. demographics. A clinical comparison sample included parents of 522 youth seeking outpatient mental health services. Complete-case analyses evaluated reliability, factor structure, item response theory, measurement equivalence, retest stability, and convergent and discriminant validity. GAMLSS estimated age- and sex-specific norms. Results: Weighted mean scores were 8.5(SD=9.0) for CMRS-P-21 and 4.0(4.3) for CMRS-P-10. Internal consistency was high ({omega}=.97/.93), and forms correlated .95. A general severity factor explained most reliable variance ({omega}H=.94). Three items differed in response thresholds across samples, with an average impact below one point on expected total scores. Both forms correlated strongly with attention problems, suicidality, depression, externalizing symptoms, and emotion dysregulation (r=.51-.63 for CMRS-P-21) and negligibly with pubertal status. Reliable-change thresholds were 14.5 (CMRS-P-21) and 6.8 (CMRS-P-10) points. Weighted GAMLSS CMRS-P-21 95th percentiles declined with age in males (30-23) and increased in females (22-30), with wide bootstrap intervals at age extremes; the female trend was not replicated without weights. Conclusions: Findings support both CMRS-P forms for assessing youth manic symptoms. The first nationally representative U.S. norms provide age- and sex-adjusted benchmarks for interpreting scores and informing further clinical assessment.

Borderline personality disorder (BPD) has traditionally been viewed as one of the most chronic psychiatric disorders. Although longitudinal studies have demonstrated promising rates of symptomatic remission, recovery and other clinical outcome measures often remain comparatively low. Qualitative research offers an important perspective on how individuals with BPD may extend a more representative view of improvement and change. We collected narratives from 41 participants with a self-reported diagnosis of BPD and analyzed them using thematic analysis. Its national, virtual recruitment approach enabled a relatively large qualitative sample diverse in gender identity, age, U.S. geographic region, treatment history, and current clinical severity, extending the range of perspectives represented in prior work. Three central themes were identified. The first, Differing attitudes toward language, reflected participantsexperiences of recovery language as paradoxically both validating and stigmatizing. While individual language preferences varied, participants generally converged on a sharedunderstanding of what recovery meant to them. The second, Recovery as a dynamic and relational process, described recovery as nonlinear, effortful, and closely tied to interpersonal experiences. The third, Crossroads and uneven change over time, highlighted the role of personal agency, critical decision points in seeking treatment, and the persistence of internal distress even as behavioral symptoms improve. Findings from this study both replicate and extend existing qualitative research by discussing how individuals with BPD understand recovery in ways that may not be captured by traditional clinical outcome measures. These results emphasize the importance of incorporating lived-experience perspectives when defining recovery and setting treatment goals.

In Ethiopia, khat (Catha edulis) leaves, containing amphetamine-like alkaloids, are chewed for their psycho-stimulating effects. Khat use has been associated with psychosis. In a psychosis etiology framework, we investigated whether season, fluctuations of khat availability and khat use are associated with khat-induced psychotic experiences and whether trauma load moderates this association. In Southwestern Ethiopia, a cohort of 685 men aged 18-40 years were interviewed twice, during dry and after rainy season (low vs. high khat availability). Khat use was assessed by urine immunoassay and self-report. Trauma load and psychotic experiences were assessed by trained local interviewers. Khat use increased after the rainy season (p < 0.0001). Khat use and seasonality predicted khat-induced psychotic experiences. Main findings comprise increased odds of psychotic experiences among immunoassay-positive individuals with high trauma load. A potential additional interaction with recent trauma emerged. Findings support sensitization-related mechanisms but require replication in larger samples with longer follow-up.

Objective: The Genetic Risk for Serious Mental Illness and Development ("Paisa Kids") Study is establishing a longitudinal cohort of 3,000 youth enriched transdiagnostically for risk for serious mental illnesses (SMI; i.e., schizophrenia, bipolar disorder, and severe depression) from the Paisa region of Colombia. Its objective is to clarify the early clinical, neurobehavioral, genetic, and environmental profiles associated with later SMI and distinguish transdiagnostic from disorder-specific pathways. This paper describes the study infrastructure, recruitment streams, and baseline assessment battery, and characterizes the first two-thirds of the cohort. Method: Youth aged 6-15 years are being recruited. Youth recruited for high SMI risk either have a first or second degree adult relative with a SMI diagnosis or a psychiatric diagnosis themselves identified through electronic medical records (EMRs) associated with later SMI. Lower-risk youth have a relative without a SMI diagnosis. Baseline measures include psychiatric and developmental history, neurobehavioral functioning, environmental exposures, and genome-wide genotyping. Psychiatric EMRs provide longitudinal follow-up. Results: Among 2,384 participants enrolled thus far (mean age=11.2 years, 45.0% female), 2,211 were recruited for high SMI-risk and 173 for lower SMI-risk. Overall, 73.2% met criteria for a history of one or more psychiatric disorders. Logistic regression comparing rates of diagnoses and ACEs between recruitment streams showed elevated rates of depressive and anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and several ACEs among high versus lower SMI-risk youth. Conclusion: Integrating multidomain phenotyping, genomic data, and longitudinal EMR follow-up, the Paisa Kids cohort provides a unique resource for investigating pathways of risk and resilience to SMI.

Background: Self-harm is a frequent and challenging occurrence in adult inpatient psychiatric units. The use of restrictive practice to manage self-harm incidents continues to be widespread within mental health environments despite increasing national and organisational guidance to minimise its use. Aim: The aim of this project was to introduce and evaluate a continuous quality improvement programme to progressively reduce incidents of self-harm and the use of restrictive practice. The project was set in a female acute mental health inpatient unit. The project sought to embed improvements in an inpatient unit interventions, procedures, and culture and staff mindset, and move towards a sustained collaborative and positive therapeutic and communication-based approach. Methods: A retrospective service evaluation design was employed to assess differences in the number of incidents of self-harm, enhanced observation, seclusion, restraint and rapid tranquillisation in the period following the introduction of a continuous whole-systems multimodal interventional initiative in 2019. Pre- and post-initiation data were compared (2017/18 compared to 2019/2025) to evaluate improvement and whether this had been sustained. Data were analysed using descriptive statistics, including frequencies, percentages, and means. Results: Self-harm incidents reduced between 2017/18 and 2019, with a downward trend sustained between 2019 and 2025 (136 to 72 incidents respectively between 2019 and 2025; 47% reduction). A sustained reduction in the use of restrictive practice was shown in all domains pre- and post-initiation (2017/18 compared to 2025). Clinical implications: No one approach will successfully reduce self-harm and the use of restrictive practice. Approaches employed have to be multi-faceted, multi-interdisciplinary, collaborative, and blend together to deliver improvement. Sustained progress requires commitment to an iterative process of continuous collaboration, improvement and adaptation.

Humans often communicate meaningfully during existential transition, yet the structure of final communications before death remains poorly understood. Suicide notes provide rare behavioral records, but two questions remain unresolved: whether note-leavers represent the broader population of suicide decedents, and whether notes follow systematic narrative structures. We analyzed a nationwide police-investigated registry of 102,922 suicide deaths in South Korea from 2013 to 2020, including 38,044 notes. Note-leavers differed systematically from non-leavers across demographic, situational and behavioral characteristics, indicating that note production reflects a selective communicative act within the suicidal process. Modeling notes as sequential narratives, we identified consistent patterns across opening, middle and closing sections, organized around apology and shame, love and gratitude, and practical directives concerning post-mortem affairs. Emotional trajectories also varied by age and gender. These findings provide population-scale evidence that suicide notes are structured final communications shaped by social relationships and demographic context under extreme circumstances.

Objective: To identify speech features distinguishing adults with depression from healthy controls, evaluate whether these features track with depression severity during naturalistic treatment, and assess whether baseline speech features predict treatment response. Design: Cross-sectional group comparison (Objective A) followed by longitudinal evaluation in an independent sample (Objectives B and C). Candidate features surviving false discovery rate (FDR) correction in the cross-sectional analysis were carried forward to longitudinal and predictive analyses. Setting: A community mental health center in New York. Participants: Dataset I (cross-sectional): 82 adults with chart-diagnosed depressive disorders and 80 healthy controls (N=162), recruited via convenience sampling. Dataset II (longitudinal): 85 adults with depressive disorders followed for up to four timepoints over a mean of 10.4 weeks during naturalistic treatment; 63 with baseline PHQ-9 >=10 and at least one follow-up were included in prediction analyses. Recruitment occurred under protocols approved between 2020 and 2021. Interventions: None; participants received naturalistic clinical care. Outcome Measures: Cross-sectional: diagnostic group membership (depressive disorder vs. healthy control). Longitudinal: Patient Health Questionnaire-9 (PHQ-9) total score. Predictive: treatment response, defined as >=50% PHQ-9 reduction from baseline to last follow-up. Results: Across three speech tasks (journaling, picture description, phonemic fluency), 11 voice quality features, six shimmer variants and five harmonics-to-noise ratio (HNR) variants, survived FDR correction (all q<.05) in all tasks, with higher shimmer and lower HNR in the depressed group (largest adjusted effect beta=1.89, q<.001). In longitudinal analysis, one phonemic fluency voice quality feature was associated with PHQ-9 at FDR<.05 (maximum HNR beta=-1.43, SE=0.41, FDR=.006), with the remaining ten consistent in direction at FDR<.10; no speech x time interactions were significant. Sex moderated voice quality-depression associations in picture description and phonemic fluency. For treatment response prediction, phonemic fluency voice quality features achieved cross-validated AUC=0.727 [95% CI: 0.662, 0.792], comparable to clinical features alone (AUC=0.700-0.715); the combined model across all tasks and clinical features achieved AUC=0.730 [0.639, 0.820]. No pairwise AUC comparisons between predictor configurations reached significance after correction (all corrected p>.54). Conclusions: Voice quality features, particularly shimmer and HNR, were the most consistent speech correlates of depression across cross-sectional, longitudinal, and predictive analyses and across multiple speech tasks. These features are computationally simple to extract from brief recordings and showed preliminary predictive utility comparable to standard clinical variables. However, the modest sample sizes, chart-based diagnoses and heterogeneous treatment exposures preclude clinical application at this stage. Larger, prospectively designed studies with standardized recording protocols, structured diagnostic assessment, and recruitment at treatment initiation are needed before voice quality features can be recommended as clinical biomarkers.