BMJ mental health最新文献

{"title":"Sex differences in internalising and externalising symptom patterns, pathway and persistence in adolescents receiving psychiatric care: a 2-year follow-up of the MILESTONE European cohort.","authors":"Miriam D'Addazio,Silvia Leone,Anna Caterina Leucci,Marta Magno,Anna Rita Atti,Stefano Calza,Martina Carnevale,Elisa Caselani,Laura Iozzino,Federica Marcolini,Donato Martella,Samuele Cortese,Gwendolyn Dieleman,Tomislav Franić,Athanasios Maras,Fiona McNicholas,Diane Purper-Ouakil,Paramala Santosh,Ulrike M E Schulze,Cathy Street,Swaran Preet Singh,Sabine Tremmery,Helena Tuomainen,Larissa van Bodegom,Dieter Wolke,Stefano Vicari,Giovanni de Girolamo, ","doi":"10.1136/bmjment-2025-302260","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302260","url":null,"abstract":"BACKGROUNDSex differences in adolescent mental disorders are well documented, but less is known about how these differences evolve during the transition to adulthood, particularly during the shift from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS), a critical period marked by vulnerability to discontinuity of care.OBJECTIVETo examine sex-specific differences in psychiatric symptom profiles and clinical trajectories during the CAMHS-AMHS transition using data from the European MILESTONE project, a 2-year longitudinal study.METHODSA cohort of 1004 adolescents (aged 17-19) in CAMHS was assessed at baseline (T1), 9 months (T2), 15 months (T3) and 24 months (T4). Measures included the Child Behavior Checklist/Adult Behavior Checklist, Health of the Nation Outcome Scales for Children and Adolescents, and the Specific Level of Functioning Scale. Multilevel modelling included sex, diagnosis and time point as covariates, testing three-way interactions for differential trajectories.FINDINGSMales showed higher symptom severity and impairment across measures, particularly in anxiety/somatic/trauma, eating disorder/obsessive-compulsive disorder (ED/OCD) and schizophrenia. Females exhibited better functioning. Significant sex differences emerged in internalising symptoms (eg, anxiety/somatic/trauma, autism spectrum disorder (ASD)), externalising symptoms (eg, attention deficit hyperactivity disorder (ADHD)), overall psychopathology (eg, ADHD, personality disorder/conduct disorder/substance use disorder) and functioning (eg, ED/OCD, schizophrenia spectrum disorder).CONCLUSIONSSex-related differences in symptom severity, diagnosis and functioning persist across the CAMHS-AMHS transition, with males generally more impaired and females showing better adaptive outcomes.CLINICAL IMPLICATIONSIdentifying sex-specific trajectories can enhance personalised transitional care, reduce misdiagnosis and guide targeted interventions-especially for under-recognised presentations such as ADHD/ASD in females and ED in males.TRIAL REGISTRATION NUMBERISRCTN83240263.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539251","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":"Weight loss prior to diagnosis of first-episode psychosis predicts subsequent weight gain: a retrospective cohort study of the UK Clinical Practice Research Datalink (CPRD) primary care database.","authors":"Brian O'Mahony,Richard I G Holt,Emanuele F Osimo,Karla V B Hitchins,Brian O'Donoghue,Benjamin I Perry","doi":"10.1136/bmjment-2026-302720","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302720","url":null,"abstract":"BACKGROUNDPost-psychosis weight gain is commonly rapid, yet prediagnosis weight changes are under-researched. The untreated phase of first-episode psychosis (FEP) can be characterised by behaviour which could lead to weight loss, triggering physiological adaptations which prime the body to regain weight.OBJECTIVEWe aimed to investigate the prevalence and extent of weight loss prior to diagnosis of FEP, and to investigate its impact on subsequent weight gain.METHODSWe used Clinical Practice Research Datalink primary care data, supplemented with linked hospital episode statistics, ethnicity and deprivation data to estimate pre-FEP weight loss prevalence. We then used multiple linear regression to assess its association with subsequent weight change, while adjusting for relevant confounders.FINDINGSPrimary analysis included 369 individuals with adequate data. 53% of individuals experienced weight loss before FEP. Using percentage weight change as an outcome, individuals with pre-FEP weight loss gained weight post-FEP at over twice the rate of those without prior loss (8.93% (95% CI 6.90% to 10.96%) bodyweight per year vs 4.07% per year (95% CI 1.90% to 6.24%); p=0.005). Each 1% of pre-FEP weight loss predicted 0.41% (95% CI 0.23% to 0.59%) additional annual weight gain (p=0.004), most pronounced within 6 months and independent of antipsychotic treatment selection. Using kilogram per year as an outcome, average gain (6.49 kg (95% CI 5.28 kg to 7.70 kg)) exceeded average prior loss (4.83 kg (95% CI 4.00 kg to 5.66 kg)) by 1 year. Findings were robust across sensitivity analyses.CONCLUSIONSPre-FEP weight loss is common and predicts rapid post-diagnosis gain. While all patients were expected to gain weight, those with pre-FEP weight loss gained double the weight of those who had not lost weight.CLINICAL IMPLICATIONSClinicians treating individuals with FEP should enquire about weight loss in the pretreatment period, which predicts extra weight gain in the initial period following diagnosis. This could inform early intervention to avoid consequences of short-term weight gain.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"235 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462461","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":"Systematically developed, comprehensive atlas of unique evidence-based psychological interventions for severe mental disorders.","authors":"Giuliano Tomei,Chrysanthi Blithikioti,Camilla Cadorin,Lorena Pizzocri,Fabrizio Visconti,Marcella Lucente,Irene Gómez-Gómez,Ioana Alina Cristea","doi":"10.1136/bmjment-2026-302555","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302555","url":null,"abstract":"BACKGROUNDThe existent classifications of the distinct evidence-based psychological interventions (EBPs) are broad, not systematically developed or restricted to one mental disorder.OBJECTIVETo identify the unique EBPs and their variations evaluated for six severe mental disorders (schizophrenia and psychosis, bipolar disorders, bulimia nervosa, anorexia nervosa, one type of substance use and borderline personality).STUDY SELECTION AND ANALYSISWe established a large cohort of EBPs by selecting all randomised controlled trials (RCTs) from six recent and large network meta-analyses for severe mental disorders in adults. Pairs of researchers independently selected all psychological intervention arms and assigned them to macro-families based on labels and theoretical background. Subsequently, within each macro-family, groups of identical arms, that is, referencing the same manual or protocol, were consolidated as distinct psychological interventions. Adaptations related to content, structure, delivery or culture were also described.FINDINGSFrom 260 RCTs, 422 psychological intervention arms were grouped in 45 macro-families and reduced to 266 distinct interventions (63% of total arms) across disorders. Intervention variability, that is, the proportion of unique psychological interventions out of the total number of arms, was lowest for the substance use disorder selected-stimulant use disorder (47/104, 45%) and bulimia nervosa (25/45, 55.5%). Variability was high for bipolar disorders (48/59, 81%), anorexia nervosa (20/29, 69%), schizophrenia/psychosis (86/123, 70%) and borderline personality disorder (40/62, 64.5%). 79 of the 266 distinct interventions (29%) contained adaptations (12% multiple adaptations) and 75/266 (28%) had openly available manuals or protocols.CONCLUSIONS AND CLINICAL IMPLICATIONSMapping EBPs across macro-families and distinct interventions could inform evidence synthesis and identification of active ingredients, guide mechanisms of change exploration and support prioritising interventions for research and dissemination.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"362 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451663","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":"Suicide among older adults in Ireland: a national case series of coronial data, 2015-2020.","authors":"M Isabela Troya,Paul Corcoran,Anne M Doherty,Katerina Kavalidou,Caoimhe Lonergan,Faraz Mughal,Ella Arensman,Michael J Norton, ","doi":"10.1136/bmjment-2026-302665","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302665","url":null,"abstract":"BACKGROUNDOlder adults have the highest suicide rates globally, yet contemporary national evidence on suicide in later-life remains limited in Ireland.OBJECTIVETo examine the rates, sociodemographic and clinical factors of older adults who die by suicide in Ireland.METHODSRetrospective analysis of coronial files of older adults aged ≥60 years who died by suicide in Ireland during 2015-2020, with adults aged 18-59 years as a comparison group. Crude suicide rates per 100 000 were calculated. Differences in sociodemographic and clinical variables were tested using χ2 or Fisher's exact tests. ORs with 95% CIs compared suicide methods between age groups. Poisson regression models estimated changes in suicide rates. A Lived Experience group contributed to interpretation.FINDINGSBetween 2015 and 2020, 654 older adults died by suicide. The average suicide rate for older adults was 12.0 per 100 000 compared with 17.5 per 100 000 among adults aged 18-59. However, marked within-group variation existed, with older single males having the highest suicide rate overall (38.1 per 100 000). Among older adults, males aged 60-69 years had the highest rate (21.8 per 100 000). Suicide risk increased during summer, especially among older adults. Rates declined in 2020 in older males. Among individuals who died by suicide, older adults were more likely to be married, live alone and in agricultural and managerial socioeconomic groups compared with adults aged 18-59. Among suicide deaths, older adults were more likely to have physical health conditions, recent acute pain, loneliness and seen their general practitioner (GP). Within the suicide cohort, financial concerns and interpersonal difficulties were more commonly experienced by younger adults. Method profiles differed by age, with drowning and firearm-related suicides higher among older adults.CONCLUSIONSOlder adults who died by suicide in Ireland had distinct sociodemographic and clinical profiles compared with younger adults. While mental health symptoms were common across age groups, later-life suicide was more frequently characterised by physical health conditions, loneliness and recent healthcare contact.CLINICAL IMPLICATIONSFindings highlight the need for sex-specific and age-specific suicide prevention strategies that address systemic factors, including improved GP training and strengthened community-based services. Increased contact with healthcare services highlights opportunities for intervention.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440920","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":"Ability to detect depression in ethnic minority groups: a UK Biobank cohort study.","authors":"Amy Ronaldson,Mel Ramasawmy,Paramjit S Gill,Rose Rickford,Hannah Frith,Andrea Martinez,Madiha Sajid,Khaula Ali,Lydia Poole","doi":"10.1136/bmjment-2026-302493","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302493","url":null,"abstract":"BACKGROUNDEvidence on ethnic differences in depression in the UK is mixed, and the suitability of current screening tools is under question.OBJECTIVETo examine ethnic differences in depression identification, symptom reporting and phenotypes among middle-aged and older adults in the UK.METHODSWe assessed lifetime depression in 502 140 UK Biobank participants using an established algorithm. Depression symptoms were assessed using the Composite International Diagnostic Interview-Short Form data from the 2022 mental health follow-up. Latent class analysis (LCA) identified depression phenotypes. Logistic regression models adjusted for age, sex, deprivation and physical health assessed ethnic differences in depression identification, symptom reporting and phenotype membership.FINDINGSOverall, 23.7% of participants met study criteria for a lifetime history of depression. Compared with White participants, depression identification was significantly lower in all ethnic minority groups except the mixed group. Black, other Asian and South Asian participants were less likely to report core depression symptoms (prolonged sadness or loss of interest). LCA produced four phenotypes: major depression, somatic depression, non-somatic depression and subthreshold depression. Black (adjusted OR (aOR) 1.70, 95% CI 1.32 to 2.20), other Asian (aOR 1.73, 95% CI 1.21 to 2.46) and South Asian (aOR 1.63, 95% CI 1.26 to 2.10) participants were more likely than White participants to belong to the somatic depression phenotype.CONCLUSIONSLower rates of depression identification among ethnic minority groups may reflect limitations in how depression is defined, perceived and detected within these populations.CLINICAL IMPLICATIONSDepression may present more somatically in some ethnic minority groups. Clinicians may need to adopt more culturally informed assessment approaches to ensure accurate detection and appropriate support.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432721","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 frequency of haematological testing in patients initiating clozapine in the USA.","authors":"Katsiaryna Bykov,Mufaddal Mahesri,Krista F Huybrechts,Lauren V Moran,Catherine S Hwang,Junyi Wang,Joyce Lii,Gita A Toyserkani,Esther H Zhou,Cynthia LaCivita,Gerald J Dal Pan,Aaron S Kesselheim,Ameet Sarpatwari","doi":"10.1136/bmjment-2026-302578","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302578","url":null,"abstract":"BACKGROUNDUntil June 2025, individuals initiating clozapine in the USA were required to undergo routine haematological testing in accordance with the Clozapine Risk Evaluation and Mitigation Strategy (REMS) programme. Although the Clozapine REMS programme was eliminated in June 2025, clinical and prescribing recommendations on testing remained intact. Little is known, however, about adherence to testing requirements in practice.OBJECTIVEThe aim of this study was to assess the prevalence and frequency of haematological testing in patients on clozapine.METHODSA cohort study using three US health insurance claims databases (1 January 2000-31 March 2022) assessed (1) proportion of individuals with at least one haematological test (white blood cell count with differential) prior to clozapine initiation and (2) frequency of testing (number of tests per 30 days of follow-up) during months 0-6, 7-12 and 13-24 of clozapine therapy. Tests were identified based on billing codes; patients hospitalised during the assessment period were assumed to have received testing.FINDINGSA total of 62 003 clozapine initiations (mean (SD) age, 36 (15) years; 57% male) were identified, of which 71% were preceded by testing within 60 prior days. The mean (SD) testing rate while on therapy was 2.2 (1.8) tests per patient for each 30-day period during the first 6 months of treatment, 2.0 (1.8) tests per 30 days during months 7-12 and 1.5 (1.4) tests per 30 days during months 13-24.CONCLUSIONSIn this study of individuals initiating clozapine in the USA, haematological testing was completed at a lower-than-expected rate prior to clozapine initiation and during the first 6 months of treatment but was in accordance with testing requirements thereafter.CLINICAL IMPLICATIONSAlthough clozapine drug labelling recommends routine haematological testing, especially during the first 6 months of treatment, such testing may not consistently occur. Reasons for less-than-recommended testing frequency should be further investigated.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415804","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":"Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study.","authors":"Isabell Brikell,Aske Astrup,Theresa Wimberley,Masako Araki,Zheng Chang,Ditte Demontis,Zihan Dong,Stephen V Faraone,Le Gao,Malcolm B Gillies,Jan Haavik,Catharina Hartman,Henrik Larsson,Kenneth K C Man,Sallie-Anne Pearson,Harold Snieder,Melissa Vos,Ian C K Wong,Honghui Yao,Andrew Sc Yuen,Yanli Zhang-James,Yiling Zhou,Helga Zoega,Anders Engeland,Søren Dalsgaard,Kari Klungsøyr","doi":"10.1136/bmjment-2025-302469","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302469","url":null,"abstract":"BACKGROUNDEarly discontinuation of attention-deficit/hyperactivity disorder (ADHD) medication is common and linked to worse outcomes. Identifying clinical predictors could aid personalised treatment yet evidence is inconsistent across ages and countries/regions.OBJECTIVEInvestigate psychiatric and neurological comorbidity as predictors of early ADHD medication discontinuation in new ADHD medication users across age groups, sex and countries/regions.METHODSUsing health records from eight countries/regions, we identified 1 000 411 (44% female) new ADHD medication users (2011-2020). Discontinuation was defined as a ≥180 day gap between dispensations. We examined 23 indicators of psychiatric or neurological comorbidity, severity and psychotropic medication use. Associations were estimated using Cox regression, pooled with random-effects meta-analyses and stratified by age-at-initiation and sex.FINDINGSDiscontinuation rates varied widely (children 19%-61%, adolescents 37%-68%, young adults 52-67%, adults 38%-68%). In pooled analyses, earlier discontinuation in children was predicted by intellectual disability, autism and use of psychotropic medications (HR range 1.32-1.51), while conduct/oppositional defiant disorder (CD/ODD) was protective (HR 0.83, 95% CI 0.73 to 0.94). In adolescents, no indicators remained statistically significant after multiple-testing control. In young adults, CD/ODD (HR 1.42, 95% CI 1.30 to 1.55), and in adults, schizophrenia (HR 1.25, 95% CI 1.09 to 1.44) and tic disorders (HR 1.27, 95% CI 1.11 to 1.46) predicted earlier discontinuation. Statistical heterogeneity was substantial, largely driven by US estimates. In meta-analyses excluding the USA, additional associations emerged. For example, in children, OCD and anxiety disorders predicted earlier discontinuation, while eating disorders and antidepressants/anxiolytics were protective in adults. Associations with schizophrenia, tic disorders and CD/ODD were no longer significant. Country-specific analyses showed similar association patterns, except in the USA, Hong Kong and the UK. Sex differences were limited.CONCLUSIONSChildren with neuropsychiatric comorbidity and related comedication are more likely to discontinue ADHD medication early, whereas few consistent predictors were seen from adolescence onwards. Marked cross-country variation, particularly in the USA, points to system-level influences on treatment patterns.CLINICAL IMPLICATIONSImproving ADHD medication persistence will require consideration of healthcare context and age-specific strategies, including close monitoring for children with complex neuropsychiatric profiles, and consideration of broader factors in adolescents and adults, where clinical predictors were limited.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372801","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":"Factors associated with infection-related hospitalisations in severe mental illness: a retrospective cohort study.","authors":"Amy Ronaldson,Sarah Markham,Alex Dregan,Temi Lampejo,Jayati Das-Munshi,Matthew Broadbent,Claire Henderson,Robert Stewart,Ioannis Bakolis","doi":"10.1136/bmjment-2026-302636","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302636","url":null,"abstract":"BACKGROUNDPeople with severe mental illness (SMI) have a higher risk of infection-related hospitalisations than the general population, yet the reasons why remain poorly understood.OBJECTIVEWe aimed to identify factors associated with infection-related hospitalisations and to explore how these factors cluster together within the patient population.METHODSWe conducted a retrospective cohort study using linked electronic health records from a large secondary mental health service in South London. Individuals with an SMI diagnosis between 1 January 2007 and 31 December 2019 were included. Cox regression models examined associations between a wide range of sociodemographic, health-related, clinical and treatment and service-use factors and time to first infection-related hospitalisation. Significant factors were then used in a hierarchical cluster analysis to identify distinct patterns.FINDINGSIn 19 995 individuals with SMI, several factors associated with infection-related hospitalisations emerged, with the strongest being number of general hospital admissions for ambulatory care sensitive conditions (HR=2.31, 95% CI 2.08 to 2.56), clozapine prescribing (HR=1.67, 95% CI 1.45 to 1.92) and severe problems with physical illness/disability (HR=1.36, 95% CI 1.31 to 1.42). Two distinct patterns emerged: one characterised by older age, dementia and poor physical health; the other by younger age with complex psychiatric needs and use of alcohol and other substances. CONCLUSIONS1: This study identified several factors associated with infection-related hospitalisations and highlighted how these factors tend to group together among people with SMI.CLINICAL IMPLICATIONSThese findings indicate potential areas where tailored prevention and monitoring strategies may be warranted to help reduce the likelihood of infection-related hospitalisation in people with SMI alongside broader measures such as prioritisation for pneumococcal and influenza vaccination.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365610","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":"Risk of unnatural death following self-harm in South Africa: development and validation of multivariable prognostic models.","authors":"Veronika Whitesell Skrivankova,Roxanne Pelteret,Stephan Rabie,Mpho Tlali,Naomi Folb,Eliane Rohner,Chido Chinogurei,Yann Ruffieux,Soraya Seedat,Mary-Ann Davies,Gary Maartens,John Joska,Andreas D Haas","doi":"10.1136/bmjment-2025-302473","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302473","url":null,"abstract":"BACKGROUNDRecurrent self-harm is common and is associated with an increased risk of unnatural death including suicide and fatal accidents. We developed and validated prognostic models to stratify individuals by risk of unnatural death after healthcare presentation for non-fatal self-harm to support clinical decision-making and targeted prevention when capacity to deliver evidence-based intervention is limited.METHODSWe used insurance claims and vital registration data from 6846 South African medical insurance beneficiaries aged ≥10 years who were discharged alive after healthcare presentation for self-harm during 2011-2021 to develop and validate models predicting unnatural death after non-fatal self-harm. We fitted competing-risk regression models to predict unnatural death within 1-3 years after presentation and discharge. Variable selection was guided by the least absolute shrinkage and selection operator. We used bootstrapping for internal validation and estimated optimism-corrected concordance indices (C-index), calibration intercepts and slopes, and for risk stratification the proportions of unnatural deaths captured across predicted-risk groups. Final models included age, sex, encounter characteristics, prior psychotropic medication use and selected prior mental disorder diagnoses.RESULTSThe final models achieved optimism-corrected C-indices of 0.74 at presentation and 0.75-0.76 at discharge and identified 86-88% of observed unnatural deaths within 2 years among the 40% of individuals with the highest predicted risk. Models showed little evidence of systematic miscalibration (optimism-corrected calibration intercepts -0.02 to -0.01), but some overfitting (optimism-corrected calibration slopes 0.84-0.92). Using the model with the highest optimism-corrected C-index, the simplified discharge model, the observed 2-year risk of unnatural death was 0.15% (95% CI 0.06% to 0.32%) among the 60% of individuals with the lowest predicted risk, comparable to the risk among 1 249 760 individuals without a self-harm history (0.14%, (95% CI 0.14% to 0.15%)).CONCLUSIONSThe prediction models effectively rank individuals accessing private sector care in South Africa by their probability of unnatural death following healthcare presentation for non-fatal self-harm.CLINICAL IMPLICATIONSThe models are intended to support clinical decision-making and guide the prioritisation of individuals with predicted high risk for targeted interventions, supporting more efficient allocation of mental health care capacity, which is often limited in low- and middle-income settings.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"436 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148322560","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":"Risk of subsequent self-harm, suicide attempts and suicide following a first hospital-treated self-harm episode among young people: a population-based cohort study.","authors":"Thuy-Dung Nguyen,Moa Karemyr,Ralf Kuja-Halkola,Brian M D'Onofrio,Zheng Chang,Isabell Brikell,Paul Lichtenstein,Henrik Larsson,Patrick Sullivan,Yi Lu,Johan Bjureberg","doi":"10.1136/bmjment-2026-302569","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302569","url":null,"abstract":"BACKGROUNDSelf-harm in young people is associated with elevated risks for subsequent self-harm, suicide attempts and suicide, particularly during the first year. Yet the trajectory across sex, age and self-harm methods remains poorly understood.OBJECTIVETo estimate risk for subsequent self-harm, suicide attempts and suicide following a first hospital-treated self-harm event in young people.METHODSThis study included 77 647 individuals (57.0% female) whose first hospital-treated (ie, within inpatient or outpatient specialised healthcare) self-harm episode occurred between ages 10-24 years during 1973-2019. We estimated cumulative incidence and incidence rate for subsequent self-harm, suicide attempts and suicide at 1 month, 3 months and 1 year following the initial episode.FINDINGSWithin 1 year, the cumulative incidence was 17.3% (95% CI 17.0 to17.5) for subsequent self-harm, 8.3% (8.1 to 8.5) for suicide attempt and 0.3% (0.2 to 0.3) for suicide. The highest risks occurred in the first month: 8.4% (8.2 to 8.6) for self-harm, 2.9% (2.8 to 3.0) for suicide attempt and 0.04% (0.03 to 0.05) for suicide. In the first month, the incidence rate of self-harm was 2.97 per 1000 person-days (2.90 to 3.05), falling to 0.55 (0.54 to 0.56) over the year. The suicide attempt rate declined from 0.98 (0.94 to 1.02) to 0.24 (0.24 to 0.25) and the suicide rate from 0.013 (0.009 to 0.019) to 0.007 (0.006 to 0.008). Males exhibited the highest suicide risk and females the highest attempts risk. First-month self-harm risk was greatest among males and children aged 10-12.CONCLUSIONSThe month following a self-harm episode is marked by an elevated risk of subsequent self-harm, suicide attempts and suicide, yet risk remains elevated over the full year.CLINICAL IMPLICATIONSThese findings underscore the need for both acute and sustained prevention efforts. Special attention should be given to males and children aged 10-12 presenting with self-harm of ambiguous intent, as their risk of repetition may otherwise go unrecognised.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148322557","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}