BMJ mental health最新文献

{"title":"Genetic investigation of non-affective psychosis and depression as causal risk factors for dementia.","authors":"Valentina Escott-Price,Emily Simmonds,Michael J Owen,Michael O'Donovan","doi":"10.1136/bmjment-2025-302424","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302424","url":null,"abstract":"BACKGROUNDMajor psychiatric disorders are associated with increased risk of dementia but establishing whether psychiatric disorders causally increase dementia risk is challenging because dementia pathology can precede clinical diagnosis by decades. Prodromal psychiatric symptoms may arise long before cognitive decline, leaving open the possibility of reverse causation.OBJECTIVEWe aimed to determine whether non-affective psychosis or depression credibly causally influence dementia risk using a design robust to reverse causation. We tested whether people with psychiatric disorders who later develop dementia show reduced genetic liability to Alzheimer's disease (AD) compared with dementia cases without such history.METHODSWe compared AD genetic liability, measured by polygenic risk scores (PRS) among dementia cases (N=7936) with and without prior non-affective psychosis (N=56) or depression (N=937) in the UK Biobank. We examined whether schizophrenia or major depressive disorder (MDD) PRS correlates with dementia liability to assess whether shared trait liability contributes to the association.FINDINGSDementia cases with prior non-affective psychosis or depression had lower AD genetic liability than those without a psychiatric history (psychosis: B=-0.29, 95% CI (-0.54 to -0.05), p=0.036; depression: B=-0.12, 95% CI (-0.18 to -0.05), p=0.0004), which is inconsistent with the hypothesis that the association between psychiatric disorders in dementia is explained by prodromal dementia effects. After excluding people with psychiatric diagnoses, neither schizophrenia nor MDD liability showed the negative correlations with AD liability in people with dementia expected if trait liability to those disorders per se contributed to dementia risk. Our findings instead are consistent with exposure to the disorders themselves as being associated with dementia.CONCLUSIONSOur findings are consistent with the hypothesis that psychiatric disorders are associated with increased vulnerability to dementia.CLINICAL IMPLICATIONSIdentification of potentially modifiable mechanisms for the association and optimal management of non-affective psychosis and depression may help reduce long-term dementia risk and inform prevention strategies.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313580","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":"Leveraging simulation to provide a practical framework for estimating the novel scope of risk of large language models in healthcare.","authors":"Mark Kalinich,James Luccarelli,John Santa Maria,Frank Moss,John Torous","doi":"10.1136/bmjment-2026-302626","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302626","url":null,"abstract":"BACKGROUNDLarge language models (LLMs) are rapidly entering clinical and consumer use, yet their probabilistic outputs have delivered a variety of unsafe user responses. Difficulties in quantifying and mitigating risks posed by LLMs threaten to stall regulatory evaluation and clinical deployment of LLM-based software as a medical device (LLM-SaMD). Practical approaches are needed to extend existing medical-device regulations to LLM-SaMDs.OBJECTIVETo demonstrate how simulation can extend existing medical-device risk management frameworks for addressing LLM-SaMD-specific risks.METHODSWe implement a simulation-based methodology for estimating LLM-SaMD risk. Fourteen open-source models were evaluated on three safety-classification tasks: suicidal-ideation, therapy-request and therapy-like interaction detection. Synthetic datasets were generated by Gemini 2.5 Pro and evaluated by psychiatrists. Model false-negative rates informed estimates of P1, the likelihood that a hazard progresses to a hazardous situation, and P2, the likelihood that that situation results in harm.FINDINGSLLM success at generating synthetic datasets varied by task, with strong performance for neutral and non-therapeutic content but frequent errors in suicidal-ideation and therapy-like interactions. Performance generally improved with model size. Estimated P1 values ranged from 1.1×10⁻⁸ to 1.6×10⁻⁴ and P2 from 4.9×10⁻⁵ to 5.1×10⁻³, spanning four orders of magnitude.CONCLUSIONSBy linking model failure modes to structured pathways to harm, simulation can extend existing medical-device risk frameworks to help address the probabilistic and context-dependent risks of LLM-SaMDs.CLINICAL IMPLICATIONSSimulation-based risk estimation offers a practical way to characterise the risk landscape for specific LLM-SaMD, patient population and clinical context combinations.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313577","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":"Depressive symptoms in chronic kidney disease: the hidden role of uremic toxins.","authors":"Hélène Levassort,Sophie Liabeuf,Julie Boucquemont,Gaye Hafez,Solene M Laville,Celine Lange,Luc Frimat,Christian Combe,Denis Fouque,Maurice Laville,Christian Jacquelinet,Yves-Edouard Herpe,Lucile Montalescot,Islam Amine Larabi,Natalia Alencar de Pinho,Ziad A Massy,Jean-Claude Alvarez,Marion Pépin, ","doi":"10.1136/bmjment-2026-302537","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302537","url":null,"abstract":"BACKGROUNDDepression is closely linked to neuroinflammation, and in chronic kidney disease, the accumulation of uremic toxins (UTs) may promote neuroinflammatory processes through the activation of inflammatory pathways.OBJECTIVEThe objective of this longitudinal study was to evaluate the association between UTs and depressive symptoms in a large, well-characterised cohort of non-dialysed adults with chronic kidney disease, a population in which this relationship had not yet been investigated.METHODSThe Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort comprised 3033 CKD stage 2-5 patients with 5 years of follow-up. Changes over time in depressive symptoms were assessed on the Center for Epidemiologic Studies Depression (CESD) scale. Mixed models were used to examine associations between the change in the CESD score and baseline levels of the UTs phenylacetylglutamine (PAG), indoxyl sulphate (IS), indole-3-acetic acid (IAA), p-cresyl sulphate, kynurenine, kynurenic acid and trimethylamine N-oxide.FINDINGS2165 patients were included (median age: 68 years; mean estimated glomerular filtration rate (eGFR): 35 mL/min/1.73 m²; median baseline CESD score: 7; mean follow-up time: 4.0 years). After adjustment for confounders, the CESD score was found to have increased by 0.11 (0.04 to 0.18) points per year. A doubling in PAG level was associated with an additional increase of 0.06 (0.01 to 0.18) points per year in the CESD. A doubling in IS and IAA levels was associated with a higher mean CESD score (0.20 (0.01 to 0.39) for IS and 0.28 (0.05 to 0.50) for IAA) but not with the score's change over time.CONCLUSIONPAG was significantly associated with changes in CESD score over time. Higher IS and IAA levels were linked to higher mean scores. Further studies are needed to confirm these results and to determine whether lowering serum UT levels would help to manage depressive symptoms in patients with CKD.CLINICAL IMPLICATIONSFurther research is needed to clarify the role of UTs; a better understanding could uncover novel metabolic pathways and inform new therapeutic strategies to complement the management of depressive symptoms.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313582","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":"Unmasking microaggressions: Experiences of women in clinical and academic psychiatry and the need for systemic reform.","authors":"Margaret Isioma Ojeahere,Anna Rebeka Szczegielniak,Helena Niu,Chonnakarn Jatchavala,Bita Vahdani,Saida Heshmati,Ruta Karaliuniene,Ozge Kilic,Chandrima Naskar,Mahsa Nahidi,Nafisatu Hayatudeen,Marwa Nofal,Florence Jaguga,María Gracia Martínez Guardado,Frances Nkechi Adiukwu,Estephania Hidalgo,Gbonjubola Abiri,Fahimeh Saeed,Laura Orsolini,Mariana Pinto da Costa,Nagina Khan","doi":"10.1136/bmjment-2025-302360","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302360","url":null,"abstract":"Microaggressions constitute a pervasive and insidious form of discrimination, frequently manifesting as subtle, unconscious and unintentional actions that disproportionately affect individuals based on gender, race, ethnicity, religion, age, sexual orientation, culture or disability. Although such phenomena are observed across a wide range of contexts, the present perspective article focuses specifically on women working as providers of healthcare services in psychiatry.For these professionals, microaggressions commonly take the form of implicit biases, dismissive attitudes and unequal treatment, all of which contribute to a professional environment in which their contributions are systematically undervalued. These behaviours are reinforced by cultural norms and entrenched systemic practices, which serve to normalise discrimination, impede career progression and contribute to psychological distress. Addressing such stereotypes and discriminatory practices at both micro and macro levels is therefore essential.This article draws on both the existing literature and collective personal experiences, arguing that the complexity of microaggressions in psychiatry necessitates a multidimensional analytical approach. By incorporating the perspectives of 21 women psychiatrists and psychologists from 15 countries across six continents, this perspective identifies recurring challenges related to service delivery and career progression. Cross-regional analysis reveals persistent patterns, including commentary on physical appearance, dismissal of professional contributions, violations of personal boundaries and forms of structural marginalisation. These findings extend the academic understanding of microaggressions in psychiatry and underscore the need for systemic reform and cultural transformation.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"187 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313578","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":"Building evidence on digital psychotherapies for adults living with depression: a systematic scoping review of populations, interventions and design features of ongoing and planned randomised controlled trials.","authors":"Etienne Karl Duranté,Christopher James Veal,Blandine Thibout,Victoire Maçon-Dauxerre,Philippe Ravaud,Astrid Chevance","doi":"10.1136/bmjment-2026-302575","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302575","url":null,"abstract":"BACKGROUNDDigital psychotherapies may offer scalable options for depression, but most randomised controlled trials (RCTs) are at moderate or high risk of bias. Mapping the methodologies, populations, interventions and outcomes of completed, ongoing and terminated/withdrawn RCTs of digital psychotherapies for depression could help anticipate future evidence gaps and redundancies.STUDY SELECTION AND ANALYSISWe conducted a systematic scoping review of RCTs registered in the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, European Union Clinical Trials Register and European Union Clinical Trials Information System between 2018 and 2025. Eligible RCTs evaluated digital psychotherapies for adults with depressive disorders, bipolar depression or depressive symptoms. Extracted data encompass methodological features, population characteristics, settings, description of intervention, control, funders, registration timing and reporting practices.FINDINGSAmong the 681 RCTs, 51.8% were completed, 34.1% published their results, 78.1% were prospectively registered and 8.5% were industry funded. Multicentre RCTs accounted for 23.1%, with 42.9% being planned in the USA, Germany or Canada and 25.1% recruiting in low- or middle-income countries. Inclusion relied on self-reported symptoms only for 61.5% and suicidal ideation was an exclusion criterion in 61.8%. The most frequent type of digital psychotherapy was cognitive-behavioural therapy for 64.6%. Human support was a component of the intervention in 44.2%. Chatbots were assessed by 4.6%. Waitlist control was used in 21%, with 49.3% of RCTs being open-label. The most frequent primary outcome was the Patient Health Questionnaire-9 for 35.7%.CONCLUSIONStrengthening future evidence on digital psychotherapies requires timely dissemination of results, use of active controls, diversifying assessed psychotherapies and studying efficacy in populations with limited access to psychotherapy.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304834","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":"ADHD medication discontinuation and non-adherence: a Norwegian population-based register study.","authors":"Miguel Garcia-Argibay,Tore Hofstad,Ingvar Bjelland,Samuele Cortese,Arnstein Mykletun","doi":"10.1136/bmjment-2026-302649","DOIUrl":"https://doi.org/10.1136/bmjment-2026-302649","url":null,"abstract":"BACKGROUNDPoor persistence and adherence to attention-deficit/hyperactivity disorder (ADHD) medication is a significant barrier to effective long-term care, particularly during adolescence, yet age-specific and sex-specific trajectories remain poorly characterised.OBJECTIVETo characterise medication initiation, discontinuation and long-term adherence patterns for children and adolescents diagnosed with ADHD in a real-world setting.METHODSA nationwide retrospective cohort study, including 8961 children and adolescents (aged <18 years) with a new ADHD diagnosis in child and adolescent mental health services between 1 January 2010 and 31 December 2012, with follow-up until 31 December 2021. Main outcomes were medication initiation rates; time to first medication discontinuation, analysed using Kaplan-Meier estimates and restricted mean survival time at 1 year and longitudinal adherence, measured by the proportion of days covered over 9 years.FINDINGSOf the 8961 individuals in the cohort (mean age at diagnosis, 12 years; 69% male), 6661 (74.3%) initiated medication, with a median time from diagnosis to initiation of 106 days (IQR 17-231); 55% initiated within 90 days. Discontinuation increased significantly with age; adolescents aged 15-17 years remained on treatment for 31.9 fewer days (95% CI -40.8 to -23.1; p<0.001) in the first year compared with children aged 5-11 years. Females also discontinued significantly earlier than males (difference -13.2 days; 95% CI -19.8 to -6.5; p<0.001). Longitudinal analysis confirmed that older age at initiation and female sex were associated with a significantly steeper decline in medication coverage over time.CONCLUSIONSDiscontinuation and low adherence to ADHD medication were common and increased substantially through adolescence, with females at higher risk of early cessation.CLINICAL IMPLICATIONSLate adolescence warrants closer clinical monitoring and shared decision-making to support appropriate treatment continuation or well-informed discontinuation, particularly for older adolescents and females. Integrating structured transition planning and attention to sex-specific barriers may help reduce avoidable non-adherence during this high-risk period.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148299177","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":"Unheard voices: the overlooked mental health toll of climate change in vulnerable communities.","authors":"Kristina Zeljic,Nambinina Rasolomalala,Julia E Michalek,Samuel Solomon,Hervé Rasamison,Satry Ramaroson,Kristin Hadfield,Isabelle Mareschal","doi":"10.1136/bmjment-2025-302344","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302344","url":null,"abstract":"Climate change has an increasing physical and mental health toll on young people globally. In this Perspective, we suggest that the extent of mental health impacts is likely to be underestimated in the low- and middle-income countries which are most vulnerable to the effects of climate change. We highlight a strong global inverse relationship between internet connectivity and climate vulnerability, which poses significant challenges for understanding climate change's worldwide mental health impacts and for developing effective mitigation strategies. Inclusive methodologies that enable engagement with offline but climate-vulnerable communities are therefore needed. Such locally grounded mental health research is essential to ensure that climate policies are informed by the lived experiences of populations on the frontlines of the crisis, many of whom remain digitally disconnected and excluded from much current research.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148299176","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":"Metabolomic ageing across mental and behavioural disorders.","authors":"Julian Mutz, Lachlan Gilchrist, Andrea G Allegrini, Sandra Sanchez Roige, Cathryn M Lewis","doi":"10.1136/bmjment-2025-302181","DOIUrl":"10.1136/bmjment-2025-302181","url":null,"abstract":"<p><strong>Background: </strong>Individuals with mental disorders face excess morbidity and premature mortality. Accelerated ageing has been proposed as a contributing mechanism but population-scale evidence across diverse diagnoses is limited.</p><p><strong>Objective: </strong>To examine whether metabolomic ageing differs across mental disorders and whether associations vary by sex, age group and genetic liability.</p><p><strong>Methods: </strong>Using plasma metabolomic profiles from UK Biobank participants, we applied a metabolomic ageing clock (MileAge) to estimate disorder-specific differences between metabolite-predicted and chronological age. Mental disorders were ascertained from health records and self-reported physician diagnoses. We analysed nine diagnostic groups and 45 individual disorders and assessed sex and age group differences and associations with polygenic scores.</p><p><strong>Findings: </strong>Among 225 212 participants (54% female; mean age 56.97), 38 524 had a diagnosis preceding baseline. Substance use, psychotic, affective and neurotic disorders were associated with a metabolite-predicted age older than chronological age, largest for psychosis (β=0.556, 95% CI 0.250 to 0.861, p<0.001). Obsessive-compulsive and eating disorders were associated with a metabolite-predicted age younger than chronological age. Several associations were stronger in males and in individuals aged <65 years. Higher genetic liability to depression, autism and attention-deficit/hyperactivity disorder predicted an older metabolomic age (β range=0.020 to 0.047), whereas polygenic scores for psychosis and tobacco use disorder predicted a younger metabolomic age (β range=-0.023 to -0.040). For obsessive-compulsive disorder and anorexia nervosa, clinical and genetic associations indicated younger metabolomic ageing.</p><p><strong>Conclusions: </strong>Metabolomic ageing in mental disorders is heterogeneous. While many disorders are associated with an older biological age, some are linked to a younger biological age. Divergence between genetic liability and clinical phenotypes suggests that non-genetic factors shape biological ageing differences.</p><p><strong>Clinical implications: </strong>Biological age should not be assumed to uniformly exceed chronological age across mental disorders. Sex and age-specific approaches could improve understanding of biological ageing processes in psychiatry.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303957","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>Correction</i>: Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations.","authors":"","doi":"10.1136/bmjment-2019-300136corr1","DOIUrl":"10.1136/bmjment-2019-300136corr1","url":null,"abstract":"","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284946","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":"Mood instability and mental health service use in autism and attention-deficit/hyperactivity disorder: a natural language processing analysis of CRIS electronic healthcare records from 21 906 children and adolescents.","authors":"Asilay Seker, Seungyoung Kim, Susie Chandler, Craig Colling, Rashmi Patel, Edmund Sonuga-Barke, Johnny Downs","doi":"10.1136/bmjment-2026-302488","DOIUrl":"10.1136/bmjment-2026-302488","url":null,"abstract":"<p><strong>Background: </strong>Children and young people (CYP) with neurodevelopmental diagnoses such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have high child and adolescent mental health service (CAMHS) needs. Mood instability is a common and impairing emotion dysregulation-related symptom linked to increased adult psychiatric service use; however, its role in CAMHS trajectories remains unclear. We aimed to examine whether baseline mood instability was significantly associated with time to discharge and annual CAMHS use in CYP with ASD and/or ADHD.</p><p><strong>Methods: </strong>We applied natural language processing (NLP) to extract mentions of mood instability within 3 months of ASD or ADHD index diagnosis from electronic health records of 21 906 CYP referred to CAMHS between 2008 and 2022. We used accelerated failure time models and negative binomial regression to assess associations between baseline mood instability and time to discharge and annual CAMHS use, adjusting for clinical and sociodemographic confounders.</p><p><strong>Findings: </strong>Mood instability was associated with increased annual CAMHS use across ASD (adjusted incidence rate ratio (aIRR) 1.24, 95% CI 1.08 to 1.42), ADHD (aIRR 1.47, 95% CI 1.30 to 1.67) and ASD+ADHD (aIRR 1.27, 95% CI 1.12 to 1.44) groups. While mood instability had no significant effect on discharge timelines in autistic children with or without ADHD, it was linked to reduced time to discharge in the ADHD group (aTR 0.76, 95% CI 0.69 to 0.84). Associations were most pronounced in those not receiving ADHD medication in the ADHD group (aIRR 1.67, 95% CI 1.47 to 1.89; aTR 0.70, 95% CI 0.61 to 0.79).</p><p><strong>Conclusions: </strong>Mood instability was significantly associated with elevated CAMHS use in CYP with neurodevelopmental conditions, with differential effect across diagnostic groups. This may reflect both variations in clinical expression of mood instability and configuration of neurodevelopmental CAMHS provision.</p><p><strong>Clinicalimplications: </strong>These findings suggest the importance of assessing emotion dysregulation in care planning and pathway allocation in neurodevelopmental CAMHS. NLP offers a time- and cost-efficient approach to surface and structure clinical data from electronic CAMHS records for scalable clinical research on complex constructs such as mood instability.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284902","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}