The British Journal of Psychiatry

BackgroundSexual minority (SM) individuals have worse mental health than heterosexual peers. However, there is no total population-based and national-level evidence on differences in risk of self-harm and suicide by sexual orientation. This study provides the first national population-based estimates in England and Wales. MethodsUsing 2021 Census data linked with hospital records and death registrations, we analysed sexual orientation (SO) differences in: (i) at least one hospital inpatient adm...

BackgroundRecovery Colleges (RCs) support recovery through adult education, with preliminary evidence of positive effects on a range of outcomes. This study examined associations between RC enrolment and mental health service use at an index mental health provider, use of other National Health Service (NHS) hospital services for all causes, associated costs, and service user outcomes. MethodsOur retrospective matched cohort study used a controlled before-and-after design. We used linkage with e...

BackgroundHealthcare workers experience disproportionately high rates of depression, anxiety, and post-traumatic stress compared with the general population. Within the NHS, work-related stress and mental health-related sickness absence has increased over the past decade, a trend intensified by COVID-19. Mental health support offers are patchy across the UK, and the evidence base around interventions is scarce. The Staff Mental Health Service (SMHS) provides rapid, confidential support for NHS s...

BackgroundExternal validations of existing risk models is an efficient step towards potential implementation, obviating the need to develop new models. However, validation in new clinical settings poses several challenges. ObjectiveTo externally validate the OxSATS tool using data from the Oxford Monitoring System for Self-harm in England. OxSATS is a validated tool to predict suicide after self-harm developed using Swedish population registers. MethodsWe selected episodes of self-harm (ICD-10...

BackgroundImproving access to high-quality community-based crisis care and reducing inpatient admissions are key policy objectives in England, yet evidence on who uses crisis-related services and potential inequalities in access remains limited. AimsTo examine socio-demographic patterns in the use of six crisis-related services in England: 1) Crisis phonelines; 2) Crisis cafes; 3) Crisis Resolution and Home Treatment teams (CRHTs); 4) Voluntary inpatient admissions; 5) Compulsory inpatient admi...

BackgroundParental genetics matters for childrens behavioural difficulties, but the extent to which this is due to direct genetic transmission versus environmentally mediated indirect genetic effects remains unclear. MethodsWe studied eight European birth cohorts with over 33,000 family-based trio samples. We analysed polygenic scores (PGSs) for 13 mental health and neurodevelopmental conditions and their composite indices (PC1 and mean) representing general neuropsychiatric liabilities, as wel...

BackgroundFood insecurity (FI) is associated with overall poorer mental health in childhood and adolescence and negatively impacts longer-term health. However, less is known about how differential exposure to FI may shape the development of different mental health symptoms over this period. MethodsWe used data from two population-based UK birth cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC; n=6,182; born 1991-1992) and Growing Up in Scotland (GUS; n=3,167; born 2004-2005)...

BackgroundPredictive models in mental health can identify service users at risk of high-intensity care, enabling proactive interventions. However, false positive predictions may lead to over-medicalisation, inequitable resource use, and stigma. Understanding the factors associated with false positives can improve model interpretation and real-world application. AimsTo evaluate a previously validated prediction model for high-intensity (top decile) service use and identify false positive (FP) vs...

Individuals with psychiatric disorders have significantly higher mortality rates than the general population. Despite identifying risk factors, few attempts have been made to systematically use this information to stratify mortality risk. To address this gap, we developed and externally validated a risk prediction model using national healthcare and social register data from two countries. Nationwide register data were used to create a Swedish cohort (n=530,201) for model development and a Finni...

BackgroundUp to one-third of medical inpatients experience clinically relevant mental distress, yet many remain untreated. Stepped and collaborative care (SCC) models may improve access to mental health care, but predictors of service uptake are unclear. We examined patient- and ward-level predictors of psychosomatic-psychiatric consultation (PPC). MethodsWe analyzed data from SomPsyNet, a stepped-wedge cluster randomized trial targeting SOMatic inpatients across three Swiss tertiary hospitals,...

BackgroundThe COVID-19 pandemic, coupled with concurrent social instabilities, has raised concerns about the long-term impact on the population mental health. While existing studies have primarily focused on the acute phase, less is known about how anxiety and depression symptoms have evolved throughout prolonged societal disruption. This study aimed to identify distinct anxiety and depression symptom trajectories and to determine the individual, relational, and societal protective and risk fact...

BackgroundAntipsychotic medications are recommended for managing schizophrenia spectrum disorders, yet their long-term effects on functional recovery remain unclear. Existing evidence is conflicting, often derived from between-subject comparisons vulnerable to confounding by indication. MethodsWe conducted a nationwide register-based cohort study of 65,630 individuals with incident schizophrenia spectrum disorders in Denmark (1998-2023). We modelled antipsychotic exposure against productive en...

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

BackgroundForensic psychiatric services are expanding in many countries, and discharging patients from secure hospitals relies on accurate estimates of risk of adverse outcomes. Novel evidence-based tools for estimating one key risk, violent reoffending, have been developed in recent years. We aimed to externally validate one new tool, FoVOx, in forensic psychiatric patients sentenced to treatment, and to develop an updated model (FoVOx2), incorporating additional clinical predictors. MethodsUs...

Background and HypothesisClozapine is the only antipsychotic with protective effects against suicide in schizophrenia (SCZ). Newer third-generation antipsychotics (TGA) have better tolerability and modulate serotonin, dopamine, and N-methyl-d-aspartate neurotransmission pathways implicated in suicide. We aimed to investigate the effects of TGAs on suicide in SCZ. MethodsWe searched seven databases up to December 2023 for SCZ studies that reported suicide data. The primary outcome was suicide de...

ImportanceAs the percentage of young people in the United States identifying as transgender and gender diverse increases, more youth face identity-linked social and structural stigma and discrimination. Little is known about the impact of stigma on psychotic-like experiences in gender diverse youth. ObjectiveTo assess the impact of bullying victimization and state-level policies on psychotic-like experiences among gender diverse youth. DesignIn this prospective cohort study, cross-sectional an...

ImportancePrenatal cannabis exposure is increasing in prevalence, yet its associations with early brain development--particularly how the timing and frequency of exposure across gestation relate to neonatal brain structure--remain insufficiently understood. Clarifying these associations is essential for informing early risk identification and guiding perinatal care. ObjectiveTo examine associations between patterns of maternal prenatal cannabis exposure, including exposure presence, gestational...

BackgroundWhile growing evidence implicates sleep-wake and circadian rhythm disturbances (SCRDs) in the onset and course of mood and psychotic disorders, longitudinal studies using objective measures are limited. This clinical cohort study examined whether actigraphy-derived SCRDs (sleep duration, timing, and efficiency) predicted transition to (i) any full-threshold mental disorders; and then specifically: (ii) full-threshold bipolar or psychotic disorders or (iii) other full-threshold (i.e. de...

BackgroundAntipsychotics are central to relapse prevention in schizophrenia, but longer-term use is associated with adverse effects that often prompt dose reduction or discontinuation. Although relapse risk increases after discontinuation, the nature of relapse remains unclear. Specifically, it is uncertain whether relapse reflects re-emergence of underlying illness or pharmacological withdrawal. MethodsWe analysed longitudinal symptom data (Positive and Negative Syndrome Scale; PANSS) from 417...

Violent victimisation affects 1-4% of populations annually and constitutes a major risk factor for psychiatric morbidity and suicidal behaviours. However, the aetiological mechanisms underlying vulnerability to severe victimisation remain poorly understood. We examined genetic and environmental contributions to victimisation risk across development using nationwide family data from 4,458,368 individuals born in Sweden (1973-2004) and Finland (1970-2003). Violent victimisation was identified thro...