BMJ mental health最新文献

{"title":"Digital sleep phenotype and wrist actigraphy in individuals at clinical high risk for psychosis and people with schizophrenia spectrum disorders: a systematic review and meta-analysis.","authors":"Rosario Aronica, Edoardo Giuseppe Ostinelli, Charlotte Austin, Dominic Oliver, Philip McGuire, Paolo Brambilla, John Torous, Andrea Cipriani","doi":"10.1136/bmjment-2024-301337","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301337","url":null,"abstract":"<p><strong>Aim: </strong>To identify sleep abnormalities in individuals at clinical high risk for psychosis (CHR-P) or with schizophrenia spectrum disorders (SSDs) compared with healthy controls (HCs) using wrist actigraphy, and to assess potential differences in the direction of effect with self-reported assessments of sleep.</p><p><strong>Methods: </strong>We conducted a systematic review of observational studies, with the search last updated on 29 April 2024. Primary outcome was total sleep time (TST), with secondary outcomes including time in bed (TIB), sleep latency, sleep efficiency, wake after sleep onset, nighttime awakenings and self-reported sleep quality. Random-effects pairwise meta-analyses were used to summarise the effects of each outcome.</p><p><strong>Results: </strong>Nineteen studies were included, with 18 contributing to the meta-analyses (202 CHR-P, 584 SSD, 582 HC). TST results were inconclusive for CHR-P (MD -4.88 min (95% CI -20.57 to 10.81)), while SSD participants showed an increase in TST compared with HC (MD 106.13 min (86.02 to 124.24)). Factors such as antipsychotic medications (pseudo-R²=88.14%), age (38.89%) and gender (26.29%) partially explained the heterogeneity between subgroups. Additionally, CHR-P individuals exhibited reduced sleep efficiency (MD -2.04% (-3.55 to 0.53)), whereas SSD participants had increased TIB (MD 121.58 min (88.16 to 155.00)) and sleep latency (MD 13.05 min (2.11 to 24.00)). The risk-of-bias assessment ranged from <i>some concerns</i> to <i>high risk</i>.</p><p><strong>Conclusions: </strong>Our analyses identified sleep abnormalities in CHR-P and SSD compared with placebo. However, observed heterogeneity and potential biases across studies may limit the interpretability of findings. These limitations underscore the need for standardised guidelines and more precise participant stratification.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional experiences on use of the mental health act in ethnically diverse populations: a photovoice study.","authors":"Kamaldeep Bhui, Roisin Mooney, Doreen Joseph, Rose McCabe, Karen Newbigging, Paul McCrone, Raghu Raghavan, Frank Keating, Nusrat Husain","doi":"10.1136/bmjment-2024-301406","DOIUrl":"10.1136/bmjment-2024-301406","url":null,"abstract":"<p><strong>Background: </strong>There are long-standing ethnic and racial inequalities in experiences and outcomes of severe mental illness, including compulsory admission and treatment (CAT).</p><p><strong>Aims: </strong>To gather professional experiences about (1) remedies for ethnic inequalities in the use of the Mental Health Act ((MHA) 1983 and 2007) and (2) recommendations for improving care experiences and for reducing ethnic inequalities.</p><p><strong>Method: </strong>We undertook a participatory research process using photovoice to gather experience data. Photographs were assembled and narrated by 17 professionals from a variety of disciplines. We undertook a thematic analysis.</p><p><strong>Results: </strong>Ineffective communications between inpatient and community services, insufficient staff capacity, a lack of continuity of care and language and cultural constraints meant MHA assessments were lacking information, leading to elevated perceptions of risk. Practitioners felt helpless at times of staff shortages and often felt CAT could have been prevented. They felt voiceless and powerless and unable to challenge stereotypes and poor practice, especially if they were from a similar demographic (ethnicity) as a patient. Interdisciplinary disagreements and mistrust led to more risk-aversive practices. The legislation created an inflexible, risk-averse and defensive process in care. Police involvement added to concerns about criminalisation and stigma. There were more risk-averse practices when team members and families disagreed on care plans. More rehabilitation and recovery-orientated care are needed. Legislative compliance in a crisis conflicted with supportive and recovery-orientated care.</p><p><strong>Conclusion: </strong>Clear standards are needed, including specific protocols for MHA assessment, police interactions, alternatives to admission, early intervention and continuity of care.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will things feel better in the morning? A time-of-day analysis of mental health and wellbeing from nearly 1 million observations.","authors":"Feifei Bu, Jessica K Bone, Daisy Fancourt","doi":"10.1136/bmjment-2024-301418","DOIUrl":"10.1136/bmjment-2024-301418","url":null,"abstract":"<p><strong>Background: </strong>Mood is known to change over seasons of the year, days of the week, and even over the course of the day (diurnally). But although broader mental health and well-being also vary over months and weeks, it is unclear whether there are diurnal changes in how people experience and report their mental health.</p><p><strong>Objective: </strong>To assess time-of-day association with depression, anxiety, well-being and loneliness.</p><p><strong>Methods: </strong>The study analysed data from 49 218 adults drawn from the University College London COVID-19 Social Study, which gathered detailed repeated measurements from the same participants across time over a 2-year period (March 2020-March 2022, 18.5 observation per person). Data were analysed using linear mixed-effects models.</p><p><strong>Findings: </strong>There is a clear time-of-day pattern in self-reported mental health and well-being, with people generally waking up feeling best and feeling worst around midnight. There is also an association with day of the week and season, with particularly strong evidence for better mental health and well-being in the summer. Time-of-day patterns are moderated by day, with more variation in mental health and individual well-being during weekends compared with weekdays. Loneliness is relatively more stable.</p><p><strong>Conclusions: </strong>Generally, things do seem better in the morning. Hedonic and eudemonic well-being have the most variation, and social well-being is most stable.</p><p><strong>Clinical implications: </strong>Our findings indicate the importance of considering time, day and season in research design, analyses, intervention delivery, and the planning and provision of public health services.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study exploring the feasibility and acceptability of computerised adaptive testing to assess and monitor children and young people's mental health in primary care settings in the UK.","authors":"William Lan, Joanna Anderson, Jan Stochl, Peter B Jones, Tamsin Ford, Anne-Marie Burn","doi":"10.1136/bmjment-2024-301381","DOIUrl":"10.1136/bmjment-2024-301381","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of mental health disorders among adolescents highlights the importance of early identification and intervention. Artemis-A is a web-based application of computerised adaptive testing (CAT), originally developed for secondary schools, to quickly and efficiently assess students' mental health. Due to its speed, reliability and accessibility, it may be a valuable tool for healthcare practitioners (HCPs) working with children and young people (CYP) in primary, community and potentially secondary care settings in the future.</p><p><strong>Objective: </strong>To explore whether Artemis-A would be a useful, feasible and acceptable tool for HCPs working in primary and community care settings to identify CYP's mental health difficulties.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 20 HCPs: 5 general practitioners, 5 Child and Adolescent Mental Health Services (CAMHS) staff, 5 school nurses and 5 community paediatricians. Data were analysed using the Framework approach.</p><p><strong>Findings: </strong>HCPs reported that Artemis-A has the potential to enhance mental health assessment and aid overburdened services by providing a quick, patient-centred assessment and monitoring mechanism. Benefits of the app include facilitating earlier intervention and appropriate referrals. However, some concerns emerged about safety netting and the way Artemis-A presents its information. Responsibilities for ensuring care continuity also require careful clarification.</p><p><strong>Conclusions: </strong>With proper protocols and integration, Artemis-A could prove valuable in supporting HCPs to promptly detect mental health issues in CYP. Further research into optimal implementation is warranted.</p><p><strong>Clinical implications: </strong>If paired with effective evidence-based interventions, the implementation of Artemis-A could help manage escalating demands in CAMHS.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally important change on the Columbia Impairment Scale and Strengths and Difficulties Questionnaire in youths seeking mental healthcare.","authors":"Karolin R Krause, Alina Lee, Di Shan, Katherine Tombeau Cost, Lisa D Hawke, Amy H Cheung, Kristin Cleverley, Claire de Oliveira, Meaghen Quinlan-Davidson, Myla E Moretti, Jo L Henderson, Clement Ma, Peter Szatmari","doi":"10.1136/bmjment-2024-301425","DOIUrl":"10.1136/bmjment-2024-301425","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based mental health requires patient-relevant outcome data, but many indicators lack clinical meaning and fail to consider youth perceptions. The minimally important change (MIC) indicator designates change as meaningful to patients, yet is rarely reported in youth mental health trials.</p><p><strong>Objective: </strong>This study aimed to establish MIC thresholds for two patient-reported outcome measures (PROMs), the Columbia Impairment Scale (CIS) and the Strengths and Difficulties Questionnaire (SDQ), using different estimation methods.</p><p><strong>Methods: </strong>A sample of 247 youths (14-17 years) completed the CIS and SDQ at baseline and at 6 months in a youth mental health and substance use trial. At 6 months, youths also reported perceived change. Three anchor-based (mean change, receiver operating characteristic analysis, predictive modelling) and three distribution-based methods (0.5 SD, measurement error, smallest detectable change) were compared.</p><p><strong>Findings: </strong>Different methods yielded varying MIC thresholds. Predictive modelling provided the most precise anchor-based MIC: -2.6 points (95% CI -3.6, -1.6) for the CIS and -1.7 points (95% CI -2.2, -1.2) for the SDQ, indicating that score improvements of 12% for the CIS and 8% for the SDQ may be perceived as 'important' by youths. However, correlations between change score and anchor were below 0.5 for both measures, indicating suboptimal anchor credibility. Stronger correlations between the anchor and T2 PROM scores compared with T1 scores suggest the presence of recall bias. All MIC estimates were smaller than the smallest detectable change.</p><p><strong>Conclusions: </strong>Predictive modelling offers the most precise MIC, but limited anchor credibility suggests careful anchor calibration is necessary.</p><p><strong>Clinical implications: </strong>Clinicians may consider the MIC CI as indicative of meaningful change when discussing treatment impact with patients.</p><p><strong>Trial registration number: </strong>NCT02836080.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial.","authors":"Han-I Wang,Simon Gilbody,Elizabeth Littlewood,Kalpita Baird,David Ekers,Dean McMillan,Della Bailey,Carolyn Chew-Graham,Peter Coventry,Caroline Fairhurst,Catherine Hewitt,Steve Parrott","doi":"10.1136/bmjment-2024-301270","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301270","url":null,"abstract":"BACKGROUNDDepression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.OBJECTIVEThis study aimed to assess the cost-utility of BA versus usual care for older adults with depression and MLTCs during COVID-19 restrictions.METHODSA randomised controlled trial recruited and randomised individuals aged 65 and over with depressive symptoms and MLTC (n=435) to either the BA intervention or usual care. Costs were measured from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were measured using the EQ-5D-3L at baseline, and 1, 3 and 12 months postrandomisation. Incremental cost-effectiveness ratios were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.FINDINGSPrimary analysis indicated that BA generated a small cost-saving (£62.34 per older adult; 95% CI: -£120.44 to £239.70) while QALY improvements remained unchanged (0.007; 95% CI -0.036 to 0.022) compared with usual care. The probability of BA being the preferred option is 0.71. Sensitivity analyses supported the primary analysis findings, confirming their robustness.CONCLUSIONS AND CLINICAL IMPLICATIONSCompared with usual care, BA demonstrated a slight cost reduction while maintaining QALY improvement. The findings provide promise for BA interventions for older people with depression and MLTCs facing isolation.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines.","authors":"Argyris Stringaris,Charlotte Burman,Raphaelle Delpech,Rudolph Uher,Dayna Bhudia,Despoina Miliou,Ioannis-Marios Rokas,Marinos Kyriakopoulos,Lucy Foulkes,Carmen Moreno,Samuele Cortese,Glyn Lewis,Georgina Krebs","doi":"10.1136/bmjment-2024-301162","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301162","url":null,"abstract":"OBJECTIVESShould a young person receive psychotherapy or medication for their depression and on what evidence do we base this decision? In this paper, we test the factors across modalities that may influence comparability between medication and psychotherapy trials.METHODSWe included 92 randomised controlled trials (RCTs) of psychotherapy and medication for child and adolescent depression (mean age 4-18 years). Using meta-analyses, we compared (a) participant characteristics and (b) trial characteristics in medication and psychotherapy trials. Lastly, we examined whether psychotherapy controls are well-matched to active conditions.RESULTSParticipants in medication RCTs had higher depression severity and were more frequently male compared with psychotherapy RCTs. There was a dramatic difference in the within-subject improvement due to placebo (SMD=-1.9 (95% CI: -2.1 to -1.7)) vs. psychotherapy controls (SMD=-0.6 (95% CI: -0.9 to -0.3)). Within psychotherapy RCTs, control conditions were less intensive on average than active conditions.CONCLUSIONSMedication and psychotherapy RCTs differ on fundamental participant and methodological characteristics, thereby raising questions about their comparability. Psychotherapy controls often involve little therapist contact and are easy-to-beat comparators. These findings cast doubt on the confidence with which psychotherapy is recommended for youth depression and highlight the pressing need to improve the evidence base.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"107 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multigenerational family coaggregation study of obsessive-compulsive disorder and cardiometabolic disorders.","authors":"Anna Holmberg,Josep Pol-Fuster,Ralf Kuja-Halkola,Henrik Larsson,Paul Lichtenstein,Zheng Chang,Brian M D'Onofrio,Isabell Brikell,Anna Sidorchuk,Kayoko Isomura,James J Crowley,Lina Martinsson,Christian Rück,David Mataix-Cols,Lorena Fernández de la Cruz","doi":"10.1136/bmjment-2024-301323","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301323","url":null,"abstract":"BACKGROUNDObsessive-compulsive disorder (OCD) is associated with an increased risk of morbidity and mortality due to cardiometabolic disorders. Whether this association is driven by familial factors is unknown. This population-based family study explored the familial co-aggregation of OCD and cardiometabolic disorders.METHODSWe identified 6 049 717 individuals born in Sweden between 1950 and 2008, including 50 212 individuals with OCD, and followed them up to 2020. These individuals were linked to their mothers, fathers, full siblings, maternal and paternal half siblings, aunts, uncles and cousins. We estimated the risk of cardiovascular diseases (CVD) and metabolic disorders (including obesity, type 2 diabetes and hyperlipidaemia), comparing the relatives of probands with and without OCD. Cox proportional hazards regression models, incorporating time-varying exposures, estimated HRs.RESULTSOCD was associated with an increased risk of CVD (HR 1.47; 95% CI 1.43 to 1.51), obesity (HR 1.69; 95% CI 1.63 to 1.74), type 2 diabetes (HR 2.01; 95% CI 1.90 to 2.12) and hyperlipidaemia (HR 1.42; 95% CI 1.33 to 1.52). The relatives of probands with OCD exhibited small increased risks of CVD (HRs from 1.01 to 1.11) and obesity (HRs from 1.03 to 1.20). Slightly increased risks for type 2 diabetes were observed in mothers (HR 1.11; 95% CI 1.07 to 1.15) and full siblings (HR 1.12; 95% CI 1.05 to 1.20), while for hyperlipidaemia it was only observed in mothers (HR 1.06; 95% CI 1.02 to 1.10).CONCLUSIONSOur results do not support a major contribution of familial factors to the association between OCD and cardiometabolic disorders, suggesting a more prominent role of unique environmental factors.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and patient characteristics associated with cardiovascular disease risk factor screening in UK primary care for people with severe mental illness: an electronic healthcare record study.","authors":"Naomi Launders, Caroline Anne Jackson, Joseph F Hayes, Ann John, Robert Stewart, Matthew H Iveson, Elvira Bramon, Bruce Guthrie, Stewart William Mercer, David P J Osborn","doi":"10.1136/bmjment-2024-301409","DOIUrl":"10.1136/bmjment-2024-301409","url":null,"abstract":"<p><strong>Background: </strong>People with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD), and initiatives for CVD risk factor screening in the UK have not reduced disparities.</p><p><strong>Objectives: </strong>To describe the annual screening prevalence for CVD risk factors in people with SMI from April 2000 to March 2018, and to identify factors associated with receiving no screening and regular screening.</p><p><strong>Methods: </strong>We identified adults with a diagnosis of SMI (schizophrenia, bipolar disorder or 'other psychosis') from UK primary care records in Clinical Practice Research Datalink. We calculated the annual prevalence of screening for blood pressure, cholesterol, glucose, body mass index, alcohol consumption and smoking status using multinomial logistic regression to identify factors associated with receiving no screening and complete screening.</p><p><strong>Results: </strong>Of 216 136 patients with SMI, 55% received screening for all six CVD risk factors at least once during follow-up and 35% received all six within a 1-month period. Our findings suggest that patient characteristics and financial incentivisation influence screening prevalence of individual CVD risk factors, the likelihood of receiving screening for all six CVD risk factors annually and risk of receiving no screening.</p><p><strong>Conclusions: </strong>The low proportion of people with SMI receiving regular comprehensive CVD risk factor screening is concerning. Screening needs to be embedded as part of broad physical health checks to ensure the health needs of people with SMI are being met. If we are to improve cardiovascular health, interventions are needed where risk of receiving no screening or not receiving regular screening is highest.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eco-anxiety, climate change and the 'bottom billion': a plea for better understanding.","authors":"Colin David Butler","doi":"10.1136/bmjment-2024-301380","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301380","url":null,"abstract":"Climate change poses enormous, rapidly increasing risks to human well-being that remain poorly appreciated. The growing understanding of this threat has generated a phenomenon often called 'eco-anxiety'. Eco-anxiety (and its synonyms) is best documented in the Global North, mostly among people who are better educated and whose reasons for concern are both altruistic and self-interested. However, the populations who are most vulnerable to climate change are disproportionately poor and live in the Global South, where evidence for eco-anxiety (or climate) anxiety is limited, especially among those who have been called the 'bottom billion', approximately the global population's poorest decile. Here, I postulate reasons for this research gap as both ethical and practical. Additionally, the bottom billion experience many disadvantages, some of which plausibly lower their recognition of anthropogenic climate change. These disadvantages include nutritional and health factors that can reduce learning capacity, even if access to formal education exists. Many in this population have limited or no electronic access to information. Furthermore, the relationship between the stresses faced by such populations and climate change is often indirect, potentially also disguising recognition of the role of climate change. The world is characterised by many distressing forms of inequality, one of which is the effective 'invisibilisation' of the bottom billion. This group faces many challenges; some of these may exceed climate change as rational causes for anxiety. However, it is here argued that policy makers should act on their behalf, irrespective of evidence that they experience eco-anxiety.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}