BMJ mental health最新文献

{"title":"External validation and refinement of the Psychosis Polyrisk Score to detect individuals at clinical high risk for psychosis.","authors":"Riccardo Stefanelli, Dominic Oliver, Stefano Damiani, Marika Orlandi, Umberto Provenzani, Elisa Bortolin, Margherita Rovida, Jean Addington, Luis Alameda, Celso Arango, Nicholas J Breitborde, Matthew Broome, Kristin S Cadenhead, Monica E Calkins, Ricardo E Carrion, Rolando I Castillo-Passi, Yu Hai Eric Chen, Jimmy Choi, Philippe Conus, Barbara A Cornblatt, Covadonga M Díaz-Caneja, Lauren M Ellman, Pablo A Gaspar, Carla Gerber, Louise Birkedal Glenthøj, Leslie E Horton, Christy Lm Hui, Joseph Kambeitz, Lana Kambeitz-Ilankovic, Matcheri S Keshavan, Minah Kim, Sung-Wan Kim, Nikolaos Koutsouleris, Jun Soo Kwon, Kerstin Langbein, Daniel Mamah, Daniel H Mathalon, Vijay A Mittal, Meredete Nordentoft, Godfrey D Pearlson, Nora Penzel, Jesus Perez, Diana O Perkins, Albert R Powers, Jack R Rogers, Fred W Sabb, Jason Schiffman, Jai Shah, Steven M Silverstein, Stefan Smesny, William S Stone, Gregory P Strauss, Judy L Thompson, Rachel Upthegrove, Swapna Verma, Jijun Wang, Daniel H Wolf, TianHong Zhang, Sylvain Bouix, Cheryl M Corcoran, Tina Kapur, Ofer Pasternak, Carrie Bearden, Rene S Kahn, John M Kane, Patrick D McGorry, Barnaby Nelson, Martha E Shenton, Scott W Woods, Paolo Fusar-Poli","doi":"10.1136/bmjment-2026-302838","DOIUrl":"10.1136/bmjment-2026-302838","url":null,"abstract":"<p><strong>Background: </strong>The Psychosis Polyrisk Score (PPS) was developed to characterise exposure to environmental and developmental risk factors for psychosis. In previous studies, the PPS showed promise particularly in discriminating between individuals at clinical high risk for psychosis (CHR-P) and community controls (CC).</p><p><strong>Objectives: </strong>This study aimed to (1) perform an external validation of the PPS model in a large independent sample and (2) refine the model using expanded predictor data.</p><p><strong>Methods: </strong>Participants were recruited through the AMP SCZ program: n=1642 CHR-P, n=519 CC. We performed a formal external validation of the PPS original model. The model was then refined incorporating expanded predictor data (perceived loneliness, neighbourhood quality) and increasing the granularity of existing predictors (ethnicity, childhood trauma, parental severe mental illness). Next, we evaluated the refined model through repeated nested cross-validation and compared it to the original model retrained in the new dataset. Discrimination (Harrell's C-index) and calibration (intercept and slope) were used to assess model performance.</p><p><strong>Findings: </strong>The externally validated PPS original model showed good discrimination (C=0.777, 95% CI 0.756 to 0.797) between CHR-P and CC and good calibration (intercept=0; slope=1.003) after recalibration. The refined PPS model exhibited higher internally cross-validated discrimination than the retrained original model (C=0.876, 95% CI 0.860 to 0.891 vs C=0.796, 95% CI 0.775 to 0.816), as well as good calibration performance (intercept=-0.008; slope=1.031).</p><p><strong>Conclusions: </strong>The PPS showed good generalisability to a large, independent sample, and performance improved after model refinement.</p><p><strong>Clinical implications: </strong>The PPS represents a potential scalable tool within stepped assessment frameworks for identifying individuals who warrant further CHR-P assessment.</p><p><strong>Trial registration number: </strong>NCT05905003.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076520","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":"Making medical AI benchmarks clinically interpretable: the case of mental health.","authors":"Ryan K McBain, Ellice Huang, Caroline Figueroa, Li Ang Zhang, Jonathan Cantor","doi":"10.1136/bmjment-2026-302921","DOIUrl":"10.1136/bmjment-2026-302921","url":null,"abstract":"<p><p>Medical artificial intelligence (AI) benchmarks are increasingly used to assess the readiness of large language models for health-related tasks, but aggregate performance scores can obscure clinically meaningful variation across domains. HealthBench, an open benchmark of 5000 multi-turn health conversations, represents a salient example: the score is difficult to interpret for decisions about specific clinical use cases, including those with mental health needs. Conversations involving suicidality, psychosis, eating disorders, trauma or relational dependence require recognising ambiguous disclosures, responding safely under uncertainty, avoiding reinforcement of harmful beliefs or over-reliance and knowing when to escalate to human-based crisis support. We propose that HealthBench and similar benchmarks report domain-specific results. To demonstrate feasibility and utility, we adopted OpenAI's classified dataset to identify 332 mental health conversations, validated against human review (sensitivity 0.980, specificity 1.000, positive predictive value 1.000, negative predictive value 0.980, F1 0.990, inter-rater agreement 99.0%). We analysed mental health domain performance separately from overall HealthBench performance using a stratified random sample of 500 conversations. Across deployments, mental health point estimates differed from overall estimates by -0.034 to +0.047. Mental health domain composition was also uneven: for example, postpartum depression represented 26.8% of mental health conversations compared with 4.5% for suicidal crisis, 0.9% for psychosis and 1.5% for eating disorders. The findings suggest benchmark averages can mask domain-specific insights relevant to clinical safety. We argue that interpretable medical AI evaluation requires transparent domain composition; subgroup and failure mode reporting; calibration against clinically meaningful anchors, including human expert performance; and reproducible versioned analyses as models, grader systems and deployment contexts evolve.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076476","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":"Regulatory reform and adult methylphenidate dispensing in France: a nationwide interrupted time-series study.","authors":"Chloé Saint-Dizier, Norman Therribout, Louise Carton, Romain Icick, Pauline Mercier, Clément Caron, Maxime Bubrovszky, Aghilès Hamroun, Michael Génin, Antoine Lamer","doi":"10.1136/bmjment-2026-302693","DOIUrl":"10.1136/bmjment-2026-302693","url":null,"abstract":"<p><strong>Background: </strong>France reports markedly lower adult attention-deficit/hyperactivity disorder (ADHD) medication use than other high-income countries despite similar prevalence. Methylphenidate is the predominant ADHD medication dispensed in France, accounting for the large majority of stimulant prescriptions in adults. Until recently, methylphenidate initiation was restricted to hospital specialists and largely excluded adult indications. Regulatory changes between 2021 and 2023 expanded adult access.</p><p><strong>Objective: </strong>Examine national trends in adult methylphenidate dispensing in France and quantify the impact of the November 2021 regulatory reform.</p><p><strong>Methods: </strong>Nationwide retrospective cohort study using the French National Health Data System (SNDS), including adults (≥18 years) with at least one community pharmacy dispensation of methylphenidate between January 2015 and December 2024. Weekly population-standardised dispensing rates were analysed using interrupted time-series models (quasi-Poisson) to estimate level and trend changes, stratified by sex and prescriber specialty. A secondary analysis examined incident treatment initiation to distinguish new users from individuals continuing pre-existing therapy.</p><p><strong>Findings: </strong>Between 2015 and 2024, a total of 195 393 adults received methylphenidate. Before the reform, weekly dispensing grew gradually (~0.2% per week). At reform implementation, an immediate 10.9% level increase occurred, followed by a sustained acceleration (~0.7% per week), largely driven by new treatment initiations. Similar patterns were seen in both sexes, though the immediate increase was greater for dispensing attributed to psychiatrists.</p><p><strong>Conclusions: </strong>The November 2021 reform was associated with a rapid and sustained expansion of adult methylphenidate use over the 3 years following the reform, primarily through increased treatment initiation, suggesting that prior regulatory constraints largely explained historically low treatment rates. Longer follow-up will be needed to assess whether this trajectory is maintained.</p><p><strong>Clinical implications: </strong>Regulatory changes expanding ADHD treatment access may produce rapid prescribing increases, requiring adequate specialist capacity and stimulant use monitoring.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984337","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":"Changes in incidence of hospital diagnoses of mental disorders among children and adolescents over the past 3 decades.","authors":"Pernille B Hansen, Andreas Moses Appel, Elisabeth Wreford Andersen, Soren Dalsgaard, Michael E Benros","doi":"10.1136/bmjment-2026-302658","DOIUrl":"10.1136/bmjment-2026-302658","url":null,"abstract":"<p><strong>Background: </strong>WHO considers mental disorders a significant disease burden among children and adolescents. However, there is a lack of population-based studies on the time trends of mental disorder diagnosis in this group.</p><p><strong>Objective: </strong>To investigate changes in the incidence of clinical diagnoses of mental disorders among all Danish children and adolescents in the past 3 decades.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included all Danish-born individuals from 1976. Follow-up started in 1994 until first diagnosis of a mental disorder, 18th birthday, emigration from Denmark, death or end of study on 30 June 2023. Sex-specific cumulative incidences of diagnosis by age 18 were calculated in 5-year birth cohorts from 1976-1980 to 2001-2005 using the Kaplan-Meier estimator. Poisson regression was used to estimate the age-specific and sex-specific incidence rates.</p><p><strong>Findings: </strong>From 1994 to 2023, a total of 193 354 children and adolescents received a mental disorder diagnosis. Over 3 decades the cumulative incidence of any mental disorder diagnosis before age 18 increased from 1.46% (95% CI 1.40% to 1.52%) to 14.56% (95% CI 14.36% to 14.76%) among females and from 1.22% (95% CI 1.16% to 1.27%) to 14.77% (95% CI 14.57% to 14.96%) among males. A lower mean age at first diagnosis accounted for an estimated 15-22% of the observed incidence in the most recent years.</p><p><strong>Conclusions: </strong>This study demonstrates a large increase in mental disorder diagnoses. Observed rates were in part accounted for by decreasing age at first diagnosis. While some of the remaining increase may reflect a true rise in the underlying prevalence of mental disorders, changes in diagnostic practice and greater awareness of mental disorders are probable contributors.</p><p><strong>Clinical implications: </strong>Estimates of specific diagnostic rates are essential for appropriate healthcare planning and resource allocation to accommodate the increasing number of mental disorder diagnoses among children and adolescents.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978974","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":"External validation, recalibration and updating of the OxSATS risk model for suicide after self-harm in England.","authors":"Tyra Lagerberg, Denis Yukhnenko, Maria D L A Vazquez-Montes, Thomas R Fanshawe, Seena Fazel","doi":"10.1136/bmjment-2026-302568","DOIUrl":"10.1136/bmjment-2026-302568","url":null,"abstract":"<p><strong>Background: </strong>External validations of existing risk models are efficient steps towards potential implementation, avoiding the need to develop new models. However, validation in new clinical settings poses several challenges.</p><p><strong>Objective: </strong>To 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.</p><p><strong>Methods: </strong>We selected episodes of self-harm (International Classification of Diseases, Tenth Revision codes X60-X84; Y10-Y34) by individuals who presented to a large regional hospital between 1 January 2000 and 31 December 2018, and were followed up until 31 December 2019. We applied the OxSATS tool to estimate each individual's suicide risk within 12 months after their index self-harm. We assessed model performance using discrimination (Harrell's concordance index (c-index)) and calibration measures (calibration plot and the observed-to-expected events ratio (O:E)). We assessed the effects of missing predictors on calibration and subsequently recalibrated the model.</p><p><strong>Findings: </strong>We identified 16 130 individuals who presented to hospital with self-harm, of whom 106 (0.7%) died by suicide in the 12-month follow-up period. The OxSATS model showed good discrimination in external validation (c-index 0.73, 95% CI 0.68 to 0.79). Recalibration was required because initial calibration reflected a lower outcome rate in the new data. After recalibration, calibration performance was excellent (O:E 1.00, 95% CI 0.77 to 1.25).</p><p><strong>Conclusions: </strong>Despite differences in clinical services and outcome ascertainment, suicide risk models can maintain good predictive performance in new settings. However, recalibration should be considered when applying prediction models in new settings, and the impact of missing predictors should be assessed using sensitivity analyses.</p><p><strong>Clinical implications: </strong>OxSATS may help clinicians assess suicide risk after self-harm by providing structured and transparent estimates as part of a comprehensive clinical assessment. Structured risk assessment tools may support identification of individuals who could benefit from additional risk management procedures, such as closer monitoring and follow-up or referral to specialist services, particularly in settings with limited access to such services.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957439","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":"<i>'</i>Weaving of perspectives<i>'</i>: lessons from co-production within an international mental-health science collaboration.","authors":"James Downs, Adeola Agunbiade, Mariana Bolivar, Maya Kaiser, Claire Friedrich, Tate Kambeu, Emma Kolaru, Gin S Malhi, Clara Martins De Barros, Richardson Mojica, Daniel Mumo, Tawanda Murepa, Kelvin Opiepie, Jennifer Potts, Martin Walker, Emily Wheeler, Lawrence A White, Simonne Wright","doi":"10.1136/bmjment-2026-302940","DOIUrl":"10.1136/bmjment-2026-302940","url":null,"abstract":"<p><p>Co-production is increasingly recognised as central to improving the quality, relevance and ethical integrity of mental health science, yet evidence is still needed on how lived experience involvement can be meaningfully embedded and sustained in complex research settings. Global Alliance for Living Evidence on Anxiety, Depression and Psychosis (GALENOS) is a Wellcome-funded collaboration conducting living systematic reviews and evidence triangulation, with people with lived experience contributing as Experiential Advisors and through a Global Lived Experience Advisory Board. This perspective uses GALENOS as a case example to reflect on what meaningful co-production practically requires especially in the context of large-scale, technical and international collaborations. It draws on a collective reflection designed and led by people with lived experience, developed through workshops and written contributions involving lived experience contributors, researchers and project-support staff. Discussions were organised around lived experience involvement, capacity development, diversity and representation and influence in strategic decision-making. Across these areas, contributors identified that experiential knowledge needs to become consequential, participation must be supported through care and flexibility, diversity must shape interpretation rather than representation alone and influence must be embedded in governance and decision-making. GALENOS shows that co-production is not a fixed method but an evolving relational practice requiring practical infrastructures for accessibility, accountability, continuity and ethical care.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957375","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":"ADHD medication use and risk of self-harm: a multinational self-controlled case series study.","authors":"Adrienne Y L Chan, Kebede Beyene, Sohee Park, Chin-Yao Shen, Andrew S C Yuen, Kirstie H T W Wong, Shiu Lun Au Yeung, Esther W Chan, David Coghill, Celine S L Chui, Sharon Cook, Stephen Crystal, Patrick Ip, Tatia M C Lee, Wallis C Y Lau, Xue Li, Terry Y S Lum, Hao Luo, Nirmala Rao, Andrew Tomlin, Li Wei, Yun K Wing, Amy H Y Chan, Edward Chia-Cheng Lai, Ju-Young Shin, Kenneth K C Man, Ian C K Wong","doi":"10.1136/bmjment-2026-302819","DOIUrl":"10.1136/bmjment-2026-302819","url":null,"abstract":"<p><strong>Background: </strong>Conflicting evidence from observational studies and randomised trials has created uncertainty about the association between attention-deficit/hyperactivity disorder (ADHD) medication use and self-harm.</p><p><strong>Objective: </strong>To assess the risk of incident self-harm associated with use of ADHD medication across multiple healthcare systems.</p><p><strong>Methods: </strong>We conducted a multinational self-controlled case series study using a common data modelling approach to assess the risk of self-harm among individuals treated with ADHD medication across population-based databases from Hong Kong, New Zealand, South Korea, Taiwan and the United Kingdom. We included individuals who initiated ADHD medication and had a record of self-harm between 2001-2020. Incidence rate ratios (IRRs) for self-harm were calculated using conditional Poisson regression, comparing three risk periods of ADHD medication exposure (ie, the 90 days before medication initiation, the first 90 days of medication use and the subsequent treatment period) to non-exposure periods. Adjusted IRRs and 95% CIs were estimated for various risk periods. Estimates from each site were pooled using a random-effects model.</p><p><strong>Findings: </strong>A total of 461 024 individuals with at least one prescription for ADHD medication were included, of whom 6847 had an incident self-harm event during the observation period. The risk was highest during the 90 days before medication initiation (pooled adjusted IRR: 2.58; 95% CI 2.12 to 3.13), followed by the first 90 days of medication use (pooled adjusted IRR: 1.78; 95% CI 1.23 to 2.57), and lowest in the subsequent treatment period (pooled adjusted IRR: 1.27; 95% CI 1.01 to 1.60). Results were consistent across included databases.</p><p><strong>Conclusions: </strong>While the use of ADHD medication was associated with self-harm, the highest risk occurred during the unexposed period immediately before starting treatment. The consistent findings across various health systems do not support ADHD medications as the main driver of self-harm. Instead, the increased risk observed prior to treatment may be related to untreated ADHD features.</p><p><strong>Clinical implications: </strong>Although our findings provide reassurance that ADHD medications do not appear to be the main driver of the increased self-harm risk, the persistently elevated risk highlights the need for ongoing clinical monitoring and counselling before and during treatment.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957347","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":"Factors underpinning international student mental well-being: a UK and China survey.","authors":"Jianyiwen Zhao, Rob Saunders, Phoebe Barnett, Siying Li, Yuqi Niu, Stephen Pilling, Peter Fonagy","doi":"10.1136/bmjment-2026-302624","DOIUrl":"10.1136/bmjment-2026-302624","url":null,"abstract":"<p><strong>Background: </strong>International students experience a high mental health burden and face barriers to accessing and sustaining support, yet domain-level stress frameworks provide limited guidance on which specific stressors should be prioritised.</p><p><strong>Objective: </strong>To prioritise item-level stressors associated with perceived stress and mental well-being among international students using machine-learning models, and to evaluate cross-site transportability via external testing between Chinese students in the UK and international students in China.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey of 481 students across two sites, Chinese students in the UK and international students in China. Item-level stressors, perceived stress (PSS 10) and mental well-being (Warwick-Edinburgh Mental Wellbeing Scale; WEMWBS) were assessed. Elastic net and random forest models were evaluated using nested cross-validation, and cross-site external testing was conducted by training in one site and testing in the other.</p><p><strong>Findings: </strong>Across the six models, random forest explained approximately 22%-35% of the variance in perceived stress and 25%-27% of the variance in mental well-being. Concerns about mental well-being, sleep difficulties, physical health and family or self-imposed academic expectations consistently ranked highly across sites. Social isolation and restricted social life were strongly associated with lower mental well-being. Context-specific stressors also emerged: in the UK setting, greater time-management pressure, low confidence in interacting with others and loneliness were more strongly associated with poorer outcomes, whereas in the Chinese setting, difficulties balancing study and personal life and not knowing where to seek help played a larger role. Cross-site validation indicated that a substantial portion of the item-level stressor signal generalised across settings.</p><p><strong>Conclusions: </strong>Item-level stressor profiles provide informative, partly generalisable evidence on stressors linked to international students' mental health. The identified high-impact stressors offer concrete, context-sensitive targets for prevention and intervention in university mental health services.</p><p><strong>Clinical implications: </strong>These findings can inform how university mental health services prioritise support and prevention by focusing on core stressors while adapting provision to locally salient challenges.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957401","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":"What systems must protect: relational care, uncertainty and recovery in early psychosis care.","authors":"Karen O' Connor, J V E Smith","doi":"10.1136/bmjment-2026-302981","DOIUrl":"10.1136/bmjment-2026-302981","url":null,"abstract":"<p><p>Early psychosis services, including early intervention in psychosis programmes (EIP), are built on principles of timely access, continuity and recovery-oriented, evidence-based care. While these elements are well described at a model level, less attention has been paid to the relational work required to deliver them effectively. In this perspective paper, we argue that EIP care is fundamentally relational, characterised by sustained engagement, tolerance of uncertainty and the nurturing of hope. We describe key features of this work. These include entering the person's world, holding multiple perspectives and navigating differing explanatory models of illness, as well as the role of stigma in shaping help-seeking and engagement. We also explore the emotional and organisational tensions inherent in relationally flexible care. These include risks relating to burnout, boundaries and resource allocation. Finally, we argue that protecting relational capacity within teams through adequate resourcing, supervision and manageable caseloads may itself represent a fidelity issue for EIP systems. As EIP services expand, maintaining 'relational fidelity' while allowing flexibility in delivery poses a critical challenge for systems and leaders. Relational fidelity refers to preserving the conditions that allow sustained, trusting engagement and continuity over time.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921949","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":"Differences in associations between long-acting injectable and oral antipsychotic prescribing and healthcare utilisation in people with intellectual disability: a self-controlled case series (LOID study).","authors":"Shek Ming Leung, Kyung Jin Lee, Yue Wei, Vincent K C Yan, Eunice Kehui Deng, Shoumitro Deb, David Castle, Caige Huang, Hei Hang Edmund Yiu, Simon Sai-Yu Lui, Vanessa W S Ng, Francisco Tsz Tsun Lai, Wai Ching Yan, Esther W Chan","doi":"10.1136/bmjment-2026-302830","DOIUrl":"10.1136/bmjment-2026-302830","url":null,"abstract":"<p><strong>Background: </strong>Literature guiding the use of long-acting injectable antipsychotics (LAIAs) versus oral antipsychotics (OAs) in people with intellectual disability (PWID) remains scarce.</p><p><strong>Objective: </strong>Examining the associations of LAIAs vs OAs with healthcare utilisation among PWID.</p><p><strong>Methods: </strong>This self-controlled case series study used electronic health records from Hong Kong. We included adults with intellectual disability prescribed both LAIAs and OAs at different periods in 2004-2023. We compared within-individual LAIA and OA periods, adjusting for age, calendar year, season, inpatient stay and concomitant psychotropic use, using conditional Poisson regression to estimate incidence rate ratios (IRRs) for all-cause emergency department (ED) visits; all-cause hospitalisations; hospitalisations for psychiatric disorders, schizophrenia/bipolar disorder, behaviour-related problems, somatic disorders and cardiovascular diseases (CVDs) and diagnosis records of extrapyramidal symptoms (EPS); falls and fractures. Subgroup analyses were conducted by diagnosis of schizophrenia or bipolar disorder.</p><p><strong>Findings: </strong>We identified 1675 PWID who had been prescribed both OAs and LAIAs at different periods during the study period. LAIA use was associated with lower risks of incident all-cause ED visits (adjusted IRR: 0.71, 95% CI 0.51 to 0.98), all-cause hospitalisations (0.91, 0.85-0.98); hospitalisations for psychiatric disorders (0.90, 0.81-0.99); for schizophrenia/bipolar disorder (0.86, 0.75-0.99) and EPS (0.34, 0.23-0.51), compared with OAs. In PWID with schizophrenia/bipolar disorder, LAIAs were associated with lower risks of all-cause hospitalisations, hospitalisations for psychiatric disorders, schizophrenia/bipolar disorder, behaviour-related problems and somatic disorders, and EPS, but a higher risk of hospitalisations for CVDs (with hypertensive disease being the most common), compared with OAs. In contrast, among PWID without such diagnoses, LAIA use was associated with higher risks of all-cause hospitalisations, hospitalisations for somatic disorders; a lower risk of incident all-cause ED visits and hospitalisations for CVDs, but no significant difference in hospitalisations for behaviour-related problems, compared with OAs.</p><p><strong>Conclusions: </strong>These findings are consistent with potential benefit of LAIAs among PWID with schizophrenia or bipolar disorder, while raising concern about off-label use in those without these diagnoses.</p><p><strong>Clinical implications: </strong>LAIAs may be considered in PWID with schizophrenia or bipolar disorder; off-label use in those without these diagnoses should be approached cautiously, and deprescribing may be considered where appropriate if these results are replicated.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914228","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}