BMJ mental health最新文献

{"title":"Building consensus on the core clinical competencies and outcomes related to effective child and adolescent mental health services (CAMHS) crisis team provision: findings from a Delphi study.","authors":"Clau Nader, Lucy Tindall, Kapil Sayal, Josephine Holland, Catherine Elizabeth Hewitt, Paul A Tiffin","doi":"10.1136/bmjment-2026-302719","DOIUrl":"10.1136/bmjment-2026-302719","url":null,"abstract":"<p><strong>Background: </strong>Young peoples' mental health is worsening, increasing demands on Child and Adolescent Mental Health Services (CAMHS) crisis teams. However, evidence is lacking regarding the effectiveness of such services. To pave the way for service developments and robust evaluation, it is crucial to establish a consensus on the core competencies for CAMHS crisis clinicians and the most desirable outcomes from their input.</p><p><strong>Objective: </strong>To elicit and establish consensus among experts, including those with relevant lived experience, regarding the most important staff competencies and outcomes in this service context.</p><p><strong>Methods: </strong>A three-round Delphi study was conducted with young people (aged 18-25 years with relevant lived experience of CAMHS crisis team input), parents/carers and mental health clinicians/academics. The study aimed to establish consensus (≥70% agreement) on which core staff competencies and outcomes were perceived as 'essential'/'very important' in relation to CAMHS crisis services.</p><p><strong>Findings: </strong>Of 69 initial participants, 43 (62%, mainly young people) completed all three rounds. A broad consensus was reached, with over 90% of proposed items meeting the consensus threshold. The strongest agreement was found for competencies in the <i>therapeutic alliance</i> domain, particularly <i>cultural competency</i> (93%) and <i>validation</i> (91%). For the <i>case formulation</i> domain, a <i>holistic mental state examination</i> (91%) was highly prioritised. Key outcomes with high consensus included <i>improved communication with support networks</i> (91%), <i>better understanding of the young person</i> (88%), <i>feeling validated</i> (88%) and <i>reduced involuntary inpatient admissions</i> (88%). The findings were integrated into a Theory of Change-based logic model illustrating how these skills and knowledge could lead to the desired outcomes.</p><p><strong>Conclusions: </strong>Our results demonstrate a clear stakeholder consensus prioritising relational, validating and personalised approaches to assessment and intervention over an emphasis on administrative or diagnostic processes in CAMHS crisis care. The findings also highlight a desire to move from a perception of a paternalistic risk management style to collaborative, community-based support.</p><p><strong>Clinical implications: </strong>These findings underscore the need for crisis team clinicians to be trained and supported to deliver care that is relationship-based, trauma-informed and culturally responsive. These should potentially translate into better outcomes for young people, their families and the crisis team workforce itself.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714783","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":"BLACK-ARTS: a qualitative study exploring the insights of black young people with psychiatric disorders and the uses of creative arts therapies to improve mental well-being.","authors":"Briana Applewhite, Susanne Birnkammer, Valerie Hartland, Oliver Campbell, Cara Horsley, Rose Meghen-Prudhoe, Jamie Crane, Melanie Berry, Ilina Singh, Joshua E J Buckman, Morten Kringelbach","doi":"10.1136/bmjment-2026-302491","DOIUrl":"10.1136/bmjment-2026-302491","url":null,"abstract":"<p><strong>Background: </strong>Black people experience persistent inequalities in mental health outcomes, access and care quality compared with their white counterparts. These disparities are compounded by structural racism and a lack of culturally competent care within National Health Service (NHS) services. Creative arts therapies (CATs), including music, art, dance and drama therapy, may offer culturally relevant, non-verbal approaches to mental health support for this population.</p><p><strong>Objective: </strong>To explore how black young people with mental health challenges and NHS clinicians perceive the usefulness and cultural relevance of CATs and to examine their potential as culturally competent interventions for improving mental well-being.</p><p><strong>Methods: </strong>A qualitative, multicentre study was conducted across five NHS Trusts in England. 20 black service users (aged 16-24) and 15 clinicians participated in 10 online focus groups (45-60 min each). Transcripts were analysed thematically using Braun and Clarke's six-step thematic analysis method constructed with NVivo V.12 software. Coding was led by the first author, with regular discussions with a second researcher to refine interpretations and develop themes.</p><p><strong>Findings: </strong>Five overarching themes were identified: (1) creative arts as vehicles for emotional healing, identity and agency, (2) challenges and barriers to CAT implementation, (3) disconnection and mistrust within clinical encounters, (4) discovering therapeutic potential through creative experience and (5) creative expression as a bridge between culture and care. Participants viewed CATs as emotionally regulating, accessible and aligned with black cultural identity though limited by underfunding, stigma and insufficient cultural competence within the NHS.</p><p><strong>Conclusions: </strong>CATs may provide a culturally congruent and emotionally accessible approach to mental healthcare for black youth. Embedding culturally competent, creative modalities within NHS pathways could enhance engagement, trust and equity in service outcomes.</p><p><strong>Clinical implications: </strong>CATs should be integrated early in NHS pathways (eg, Child and Adolescent Mental Health Services, Talking Therapies) to improve engagement among black youth who may be hesitant to engage in verbally dominant therapies. However, scaled implementation requires meaningful coproduction with black communities, cultural competence training for multidisciplinary teams and recognition within NHS and National Institute for Health and Care Excellence frameworks.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708684","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":"Correction: Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations.","authors":"","doi":"10.1136/bmjment-2019-300136corr2","DOIUrl":"10.1136/bmjment-2019-300136corr2","url":null,"abstract":"","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674569","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":"Lithium for the prevention of suicide in US veterans: a target trial emulation.","authors":"Alejandro G Szmulewicz, Hanna Gerlovin, Nick Rezaee, William Robb, Gonzalo Martínez-Alés, Howard Liu, Robert M Bossarte, Eric G Smith, Ira Katz, Ryan Ferguson, Ronald C Kessler, Miguel A Hernan","doi":"10.1136/bmjment-2026-302694","DOIUrl":"10.1136/bmjment-2026-302694","url":null,"abstract":"<p><strong>Background: </strong>Lithium has long been considered to reduce suicidal behaviour in patients with affective disorders, but evidence from large real-world populations remains limited.</p><p><strong>Objective: </strong>To estimate the effects of lithium initiation and continuation on suicide deaths and non-lethal suicidal behaviours among adults with bipolar disorder or major depressive disorder.</p><p><strong>Methods: </strong>We emulated two target trials using electronic health records and administrative claims from US veterans between January 2010 and December 2022. The first trial benchmarked results against the CSP-590 randomised trial by estimating the 1-year risk of suicide-related events (non-fatal suicide attempts, hospitalisations to prevent suicide or suicide deaths) among patients with a recent suicide attempt initiating lithium versus not initiating lithium. The second trial extended follow-up to 10 years to estimate risks of suicide deaths and non-lethal suicidal behaviours separately, including subgroup analyses by age and diagnosis. An additional analysis removed the requirement of a prior suicide attempt.</p><p><strong>Findings: </strong>In the benchmarking analysis, the 1-year risk ratio for suicide-related events comparing lithium initiation with no initiation was 1.06 (95% CI 1.01 to 1.12), consistent with findings from the CSP-590 trial. In the extended analysis, the 10-year per-protocol risk ratio for suicide death was 1.00 (95% CI 0.86 to 1.15) and for non-lethal suicidal behaviours was 0.96 (95% CI 0.90 to 1.02). Results were similar among individuals with and without a prior suicide attempt.</p><p><strong>Conclusion: </strong>When added to ongoing pharmacological treatment for patients with affective disorders, lithium may not substantially reduce suicide risk highlighting the need for additional suicide prevention strategies in this population. Limitations include lack of information on adherence, dosage or blood levels of lithium which may have obscured existing differences.</p><p><strong>Clinical implications: </strong>Our findings suggest that adding lithium therapy to the ongoing treatment regimens of patients with affective disorders for the sole purpose of reducing suicide may not be well-tolerated or meaningfully reduce suicide risk.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686799","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":"Reappraising lithium, triiodothyronine and second-generation antipsychotic augmentation treatment for major depression: a systematic review and meta-analysis with bias-adjustment analyses.","authors":"Tien-Wei Hsu, Chih-Wei Hsu, Trevor Thompson, Andre F Carvalho, Brendon Stubbs, Ping-Tao Tseng, Fu-Chi Yang, Chia-Ling Yu, Yu-Kang Tu, Chih-Sung Liang","doi":"10.1136/bmjment-2026-302656","DOIUrl":"10.1136/bmjment-2026-302656","url":null,"abstract":"<p><strong>Background: </strong>Pharmacological augmentation is commonly used for patients with major depressive disorder (MDD) who respond inadequately to antidepressant treatment. However, the robustness of evidence supporting lithium, second-generation antipsychotics (SGAs), and triiodothyronine (T3) augmentation for MDD remains uncertain.</p><p><strong>Objective: </strong>To reappraise the efficacy and robustness of evidence for pharmacological augmentation strategies for MDD, focusing on lithium, SGAs, and T3.</p><p><strong>Study selection and analysis: </strong>We systematically searched five electronic databases and included placebo-controlled RCTs in adults with MDD who received augmentation with lithium, SGAs, or T3. The primary outcome was response rate (defined as ≥50% depressive symptom reduction). Random-effects meta-analysis and trial sequential analysis (TSA) were conducted. We also performed publication-bias-adjustment analyses, including PET-PEESE and selection models. Subgroup analyses were conducted for individual SGAs.: To reappraise the efficacy and robustness of evidence for pharmacological augmentation strategies for MDD, focusing on lithium, SGAs, and T3.</p><p><strong>Findings: </strong>Fifty-six RCTs were included (n=13616). SGA augmentation was associated with a higher response than placebo (k=45; reported as OR with 95% CI: 1.53; 1.42-1.65; I²=0%), and the evidence was supported by TSA. Conversely, while lithium showed benefit in conventional meta-analysis (k=17; OR 2.06; 1.30-3.27; I²=11.5%), this effect was not supported by TSA (accrued information size reached 8% of the required information size; 1.99, TSA-adjusted 95% CI 0.02-189.11) and became statistically non-significant in the PET-PEESE-adjusted and selection models. Additionally, T3 augmentation was not associated with significantly higher response than controls (k = 6; 1.19; 0.53-2.70). Among individual SGAs, only aripiprazole, quetiapine, brexpiprazole, and cariprazine demonstrated TSA-supported efficacy, whereas evidence for other SGAs was limited or inconclusive.</p><p><strong>Conclusion: </strong>The certainty and robustness of evidence for lithium and T3 augmentation remained limited. Evidence for T3 was sparse and did not show a significant advantage over control, while interpretation of the lithium findings is further constrained by the fact that most trials were conducted before treatment-resistant depression was more operationally defined in contemporary research. SGAs with TSA-supported benefits (aripiprazole, quetiapine, brexpiprazole and cariprazine) may be prioritised, pending individual patient considerations.</p><p><strong>Study registration: </strong>https://osf.io/27gp9.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633001","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":"Prediction models for highly scalable technology-assisted differential diagnostics of autism spectrum disorder.","authors":"Irene Sophia Plank, Jana C Koehler, Jonathan Eckelmann, Afton M Bierlich, Richard Musil, Nikolaos Koutsouleris, Christine M Falter-Wagner","doi":"10.1136/bmjment-2025-302451","DOIUrl":"10.1136/bmjment-2025-302451","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing autism spectrum disorder (ASD) in adulthood is time-consuming and markedly complicated by the requirement to distinguish between ASD and differential diagnoses also associated with social interaction difficulties, such as borderline personality disorder (BPD)-a distinction for which currently no valid screening or diagnostic tool exists. While technology-assisted diagnostics (TAD) has emerged, existing algorithms have focused on classifying between ASD and no diagnosis, not fully addressing clinical reality.</p><p><strong>Objective: </strong>Therefore, we assessed the feasibility of TAD for differential diagnostics by classifying between ASD and BPD in this proof-of-concept study.</p><p><strong>Methods: </strong>We collected a rich multimodal dataset of reciprocal interactions, specifically dyadic conversations (n=120 interaction partners). From this data, we extracted more than 800 features, allowing us to capture the core area of defining symptoms for both conditions: social interactions. These features include speech patterns, facial expressions, movement quantity and interpersonal synchrony. We used these features to train and stack linear support vector machines to classify between ASD-involved, BPD-involved and comparison interaction partners.</p><p><strong>Findings: </strong>Base models capturing facial expressions during speaking and listening, speech patterns, synchronisation of facial expressions and movement quantity all performed above chance when differentiating between ASD-involved and BPD-involved interaction partners. Stacking all base models containing conceptually related features further increased accuracy, with our algorithm achieving nearly 82% of balanced accuracy, solely based on 20 min of conversation.</p><p><strong>Conclusions: </strong>Our proof-of-concept study shows the immense potential of TAD for differential diagnostics: data collection only requires microphones and webcams while feature-extraction is automated, making this approach highly objective, scalable and user-friendly.</p><p><strong>Clinical implications: </strong>Our TAD algorithm shows the potential of multimodal, behavioural data for differential diagnostics. On the basis of clinical validation such an algorithm has the potential to streamline differential diagnoses of ASD in the future, enabling faster and more accurate diagnostic assessment and ultimately reducing patient distress by shortening the wait for an appropriate treatment plan.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632998","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":"Impact of problematic Khat use on mental health in Ethiopia's Somali Regional State: a population study.","authors":"Nasir Warfa, Roxanne C Keynejad, Elyas Abdullahi, Chris Willott, Ramadan Budel, Mahamed A Wali, Abdifetah A Shiek, Selamu Medhin, Mussie Abdosh Hassen, Abdulahi Hussen, Ahmed M Abdinasir, Abdikarim Mohamed M Abdi, Abdilahi E Mumin, Mohamud Salaad Mohamud, Solomon Teferra, Mustafa Al'Absi, Fadumo Osman, Iain Marshall, Charlotte Hanlon","doi":"10.1136/bmjment-2025-302388","DOIUrl":"10.1136/bmjment-2025-302388","url":null,"abstract":"<p><strong>Background: </strong>Tackling the global burden of mental health conditions and substance misuse is an international priority. In recent years, strategic work has begun to develop mental health services in Ethiopia and strengthen human rights protection for people with mental health conditions. To inform mental health service planning in the Somali region of Ethiopia, the extent of mental health conditions and substance misuse requires quantification.</p><p><strong>Objective: </strong>We aimed to investigate associations between problematic <i>khat</i> use and mental health conditions in Ethiopia's Somali Regional State (SRS).</p><p><strong>Method: </strong>We carried out a quantitative household survey of 844 randomly selected residences in two cities in Ethiopia's SRS: the regional capital, Jigjiga (55.1%, n=465), and third largest city, Kabridahar (44.9%, n=379). We used the culturally validated Problematic Khat Use Screening Test and Mini International Neuropsychiatric Inventory to assess the prevalence and factors associated with mental health conditions and problematic <i>khat</i> use.</p><p><strong>Findings: </strong>Out of 844 participants, 18.6% (n=156) met criteria for major depression, 11.1% (n=92) met criteria for post-traumatic stress disorder (PTSD) and 5.7% (n=48) expressed suicidal ideation. The combined prevalence of these mental health conditions was 21.8% (n=186). Men reported more aggregated mental health conditions than women (30.6%, n=97 vs 16.9%, n=89). Adjusted regression analyses showed that people with problematic <i>khat</i> use had more than twice the prevalence of major depression (prevalence ratio (PR) 2.5, 95% CI 1.7 to 3.5), recurrent depression (PR 2.8, CI 1.8 to 4.4), suicidal ideation (PR 2.4 CI 1.9 to 5.3), PTSD (PR 3.1, CI 1.9 to 5.3) and any mental health condition (PR 2.4, CI 1.7 to 3.4) compared with people without problematic <i>khat</i> use.</p><p><strong>Conclusion: </strong>This study provides the first data regarding population mental health needs and harms associated with problematic <i>khat</i> use in the SRS, to inform the design, development and prioritisation of mental health services and substance regulation and policy.</p><p><strong>Clinical implications: </strong>Associations between problematic <i>khat</i> use and a range of poor mental health outcomes demonstrate the importance of targeted services for this population. Further research is needed to explore causal pathways underlying these associations.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610327","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":"Impact of 15 years of social, political and economic shocks on population mental health in the UK: a longitudinal, Bayesian quasi-experimental analysis.","authors":"Annie Jeffery, Connor Gascoigne, Ioannis Rotous, Xuewen Yu, Sara Geneletti, Gianluca Baio, Marta Blangiardo, James B Kirkbride","doi":"10.1136/bmjment-2026-302688","DOIUrl":"10.1136/bmjment-2026-302688","url":null,"abstract":"<p><strong>Background: </strong>Mental health in the UK has worsened over the last 15 years, a period marked by major systemic shocks.</p><p><strong>Objective: </strong>We investigated annual changes in population-level psychological distress and the impact of five systemic shocks: the referendum on European Union membership (Brexit), two COVID-19 lockdowns, Russia's invasion of Ukraine and the UK Government's 2022 'mini-budget'.</p><p><strong>Methods: </strong>We used longitudinal survey data from the UK Household Longitudinal Study, including 87 857 between years 2009 and 2024. We used Bayesian time series models to evaluate annual changes in psychological distress and the association with each shock, including subgroup analyses by age group, sex, ethnicity, deprivation quintile and employment status.</p><p><strong>Outcomes: </strong>We found evidence of increasing psychological distress from 2009 to 2023 (+1.085 point increase in 12-item General Health Questionnaire scores; credible interval (CrI) 0.987 to 1.184). In interrupted time series models, we observed increased psychological distress immediately after the Brexit referendum (+0.117, CrI 0.029 to 0.205) and the first COVID-19 lockdown (+0.649; CrI 0.531 to 0.767), with more insidious monthly increases in psychological distress after the Russian invasion of Ukraine (+0.010, CrI 0.004 to 0.023) and the 2022 mini-budget (+0.015, CrI 0.005 to 0.034). We found considerable sociodemographic variation by age, sex, ethnicity, deprivation and employment status.</p><p><strong>Conclusions: </strong>We found that some systemic shocks had detrimental effects on population mental health in the UK, being most pronounced for the Brexit referendum and first COVID-19 lockdown.</p><p><strong>Clinical implications: </strong>Our results demonstrate that population mental health can change in response to systemic shocks. This should inform the design of responsive clinical and public mental health provision.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586167","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":"Symptom co-fluctuations with suicidal ideation over time: a dynamic time warp analysis.","authors":"A J C van der Slot, C Boonmann, M Eikelenboom, M W M Gijzen, A A L Kok, D De Beurs, B W J H Penninx, E J Giltay","doi":"10.1136/bmjment-2026-302563","DOIUrl":"10.1136/bmjment-2026-302563","url":null,"abstract":"<p><strong>Background: </strong>Suicidal ideation (SI) is a major global concern, yet its dynamic interplay with other symptoms remains poorly understood.</p><p><strong>Objective: </strong>To identify symptoms that co-fluctuate with or temporally precede SI to better understand symptom dynamics.</p><p><strong>Methods: </strong>Longitudinal data from three Dutch psychiatric cohorts with lifetime internalising disorders (16 waves from April 2020 until February 2022) were collected during the COVID-19 pandemic. We analysed depressive, happiness, anxiety, loneliness, worry symptoms and COVID-19-specific items only in those participants with SI fluctuations. Dynamic time warping (DTW) quantified within-person similarity between symptom trajectories and SI and results were aggregated at the group level.</p><p><strong>Findings: </strong>307 participants (mean age 44.8 years; 61.6% female) showed increasing SI over time (p<0.001). In the undirected analysis, SI aligned with four depressive symptoms (ie, sad mood, low self-esteem, low interest and reduced happiness), two anxiety-related symptoms (ie, fear of losing control, faintness) and overwhelming worrying, whereas the interpersonal symptoms feeling abandoned and feeling lonely did not survive false discovery rate (FDR) corrections. In directed analysis, while sad mood, hypersomnia, numbness and worrying about projects initially demonstrated temporal precedence, no directed lead-lag relationships survived FDR correction.</p><p><strong>Conclusion: </strong>SI is embedded in a broad symptom network beyond depression. These results underscore the value of time-sensitive, idiographic monitoring using tools like DTW to capture the person-specific temporal pathways through which SI emerges and intensifies.</p><p><strong>Clinical implications: </strong>This study suggests a core group of affective, cognitive and distress-related symptoms that could serve as informative signals for evaluating changes in SI and may represent actionable targets for intervention.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581230","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":"Life-course patterning of MLTC clusters and their patient-centred burden in depression: a population-based study using real-world data.","authors":"Alex Dregan,Thomas Canning,Marc Delord,Mozhdeh Shiranirad,Emilia Holland,Jakub Dylag,Michael Boniface,Mariam Molokhia,David Armstrong,Matthew Hotopf,Robin Poole,Frances S Mair,Nisreen A Alwan,Simon Ds Fraser","doi":"10.1136/bmjment-2026-302705","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302705","url":null,"abstract":"BACKGROUNDUnderstanding how multiple long-term conditions (MLTCs) develop and cluster across the life-course remains a key public health priority. Evidence on how these patterns relate to patient-centred outcomes among patients with mental health disorders remains limited.OBJECTIVETo evaluate patient-centred outcomes in patients with a history of depression and MLTC.METHODSA retrospective matched cohort study design was implemented in the Clinical Practice Research Datalink, a UK primary care database. Patients aged ≥10 years with a first recorded diagnosis of depression between 1 January 2003 and 31 December 2023 were matched (1:1) to a comparator without a depression history on age, sex and practice. MLTC was defined using 256 long-term conditions. Clusters of MLTC were derived for each life decade via multiple correspondence analysis and k-means clustering. Patient-centred burden was assessed across eight patient-prioritised 'work themes': symptoms, emotions, investigation and monitoring, health service and administration, learning and adapting, medication, finance and accumulation and complexity. Poisson and logistic regression models assessed associations between decade-specific MLTC clusters and burden indicators.FINDINGSAmong 1 962 757 patients with incident depression, 1 563 065 (78%) presented with MLTC over a mean follow-up of 14 years (SD=6), compared with 987 138 (50%) of comparators (mean follow-up=10, SD=7). Patients with depression history had a higher median number of LTCs (5 (IQR 3-9) vs 4 (3-8)). Clusters of MLTCs varied by life decade: atopic triad and liver clusters predominated in early life, metabolic and cardiovascular (CVD) clusters in midlife and musculoskeletal (MSK) and respiratory in later life. The burden patterning varied between cases and their comparators, who showed lower overall burden and distinct early-life patterns. The strongest prognostic cluster for increased burden in patients with depression changed across life. In early life, the metabolic cluster had the highest risk (incidence rate ratio=1.02 (95% CI 1.01 to 1.03)), followed by respiratory and CVD during midlife and MSK/functional in later life.CONCLUSIONSMLTC in patients with depression is common, shows dynamic temporal patterning and leads to high patient-centred burden from adolescence onwards.CLINICAL IMPLICATIONSThe study identified specific burdensome clusters of MLTC at each life decade which could inform MLTC prevention for patients with depression.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539088","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}