BMJ mental healthPub Date : 2025-06-09DOI: 10.1136/bmjment-2025-301615
Louise Jane Hussey, Evangelos Kontopantelis, Nav Kapur, Richard Williams, Pearl Mok, Darren M Ashcroft, Shruti Garg, Carolyn Chew Graham, Karina Lovell, Roger Thomas Webb
{"title":"Self-harm incidence among children and young people 2019-2023: time series analysis of electronic health records in Greater Manchester, England.","authors":"Louise Jane Hussey, Evangelos Kontopantelis, Nav Kapur, Richard Williams, Pearl Mok, Darren M Ashcroft, Shruti Garg, Carolyn Chew Graham, Karina Lovell, Roger Thomas Webb","doi":"10.1136/bmjment-2025-301615","DOIUrl":"10.1136/bmjment-2025-301615","url":null,"abstract":"<p><strong>Background: </strong>The mental health of children and adolescents has declined in recent years. Self-harm is frequently an expression of this psychological distress.</p><p><strong>Objectives: </strong>To examine trends in self-harm incidence among 10-24-year olds between January 2019-December 2023.</p><p><strong>Methods: </strong>We conducted time-series analyses of all incident episodes of self-harm among 10-24-year olds using the Greater Manchester Care Record. The observation period was split into four phases: pre-pandemic (1/2019-2/2020); pandemic phase 1 (3/2020-6/2021); pandemic phase 2 (7/2021-12/2022) and post-pandemic (1/2023-12/2023). Rate ratios by sex, age, ethnicity and Indices of Multiple Deprivation were modelled using negative binomial regression.</p><p><strong>Findings: </strong>Self-harm incidence rates decreased significantly in the post-pandemic phase, compared with the pre-pandemic period (male-incident rate ratios (IRR) 0.72; 95% CI 0.62 to 0.84, female IRR 0.85; 95% CI 0.74 to 0.99). In females, this followed increased rates, rising by 18% in pandemic phase 2 (IRR 1.18; 95% CI 1.04 to 1.34). In males, rates decreased throughout the study period. Incidence rates were lowest for 10-12 year olds. However, the greatest increase was observed in this age group, with rates in pandemic phase 2 being almost two times that seen pre-pandemic for females (IRR 1.91; 95% CI 1.47 to 2.48). The change in rates among females was also most marked in the least deprived neighbourhoods, rising by more than 50% (IRR 1.54; 95% CI 1.21 to 1.95) in pandemic phase 2.</p><p><strong>Conclusions: </strong>Our results indicate a decrease in self-harm incidence during 2023. Analysis by age group showed the greatest increase in rates in 10-12-year olds. Further research is needed to confirm these findings and to identify the mechanisms driving these trends.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259509","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}
BMJ mental healthPub Date : 2025-06-08DOI: 10.1136/bmjment-2025-301701
Kaisla Komulainen, Ripsa Niemi, Mai Gutvilig, Natalie C Momen, Petri Böckerman, Marko Elovainio, Oleguer Plana-Ripoll, Christian Hakulinen
{"title":"Association of a child's mental disorder with parental income and employment: analysis of nationwide register-based cohorts in Finland and Denmark.","authors":"Kaisla Komulainen, Ripsa Niemi, Mai Gutvilig, Natalie C Momen, Petri Böckerman, Marko Elovainio, Oleguer Plana-Ripoll, Christian Hakulinen","doi":"10.1136/bmjment-2025-301701","DOIUrl":"10.1136/bmjment-2025-301701","url":null,"abstract":"<p><strong>Background: </strong>The onset of a severe physical illness of a child has been associated with earnings and employment losses among parents, but less is known in the context of children's mental disorders.</p><p><strong>Objectives: </strong>We estimated parental income and employment trajectories associated with a child's mental disorder diagnosis in nationwide register-based cohorts from Finland and Denmark.</p><p><strong>Methods: </strong>All parents whose child was diagnosed with a mental disorder (F00-F99 in ICD-10) at ages 1-25 in Finland and in Denmark during 1994-2019 were matched 1:1 to parents with a child without a mental disorder on psychiatric and sociodemographic characteristics. Generalised estimating equations were used to estimate the associations of a child's mental disorder with parental annual income and employment outcomes from 5 years before to 5 years after the child's diagnosis.</p><p><strong>Findings: </strong>In 1994-2019, over one million parents in Finland and Denmark had at least one child diagnosed with a mental disorder at age 1-25. Parents exposed to a child's mental disorder had consistently lower income and were more often unemployed compared with the matched unexposed parents, already 5 years before the child's diagnosis. These differences became slightly larger over time, especially in analyses on strata involving parents whose child was diagnosed at a younger age. However, there was no consistent evidence of a change in parental annual income or employment around the time of their child's diagnosis.</p><p><strong>Conclusions: </strong>Our analysis shows that even in countries with strong welfare systems, a younger child's mental disorder may contribute to widening socioeconomic inequity among families. However, the inequity in children's mental health appears to primarily exist prior to, rather than in response to, a child's mental disorder.</p><p><strong>Clinical implications: </strong>Clinical and policy efforts should prioritise addressing pre-existing socioeconomic vulnerabilities for effective primary prevention of children's mental disorders.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259506","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}
BMJ mental healthPub Date : 2025-06-05DOI: 10.1136/bmjment-2025-301669
Edward Penington, Ryan Williams, Apostolos Tsiachristas
{"title":"Risk of bias in routine mental health outcome data: the case of Health of the Nation Outcome Scales.","authors":"Edward Penington, Ryan Williams, Apostolos Tsiachristas","doi":"10.1136/bmjment-2025-301669","DOIUrl":"10.1136/bmjment-2025-301669","url":null,"abstract":"<p><strong>Background: </strong>Routine outcome data in secondary mental health services have significant potential for service planning, evaluation and research. Expanding the collection and use of these data is an ongoing priority in the National Health Service (NHS), but inconsistent use threatens their validity and utility. If recording is more likely among certain patient groups or at specific stages of treatment, measured outcomes may be biased and unreliable.</p><p><strong>Objective: </strong>The objective is to assess the scale, determinants and implications of incomplete routine outcome measurement in a secondary mental health provider, using the example of the widely collected Health of the Nation Outcome Scores (HoNOS).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using routine HoNOS assessments and episodes of care for patients receiving secondary mental healthcare from an NHS Trust in Southeast England between 2016 and 2022 (n=30 341). Associations among demographic, clinical and service factors, and rates and timings of HoNOS assessments were explored with logistic regressions. Relationships between total HoNOS scores and related mental health outcomes (costs, relapse and improvement between assessments) were estimated after adjusting for the likelihood of assessment.</p><p><strong>Findings: </strong>66% of patients (n=22 288) had a recorded HoNOS assessment. Of the distinct episodes of care for these patients (n=65 439), 43% (n=28 170) were linked to any assessment, 25% (n=16 131) were linked to an initial baseline assessment, while 4.7% (n=3 094) were linked to multiple HoNOS assessments, allowing for evaluation of clinical progress. Likelihood and timing of assessment were significantly associated with a range of factors, including service type, diagnosis, ethnicity, age and gender. After adjusting for observed factors determining the likelihood of assessment, the strength of association between HoNOS scores and overall costs was significantly reduced.</p><p><strong>Conclusion: </strong>Most of the activity observed in this study cannot be evaluated with HoNOS. HoNOS assessments are highly unlikely to be missing at random. Without approaches to correct for substantial gaps in routine outcome data, evaluations based on these may be systematically biased, limiting their usefulness for service-level decision-making.</p><p><strong>Clinical implications: </strong>Routine outcome collection must increase significantly to successfully implement proposed strategies for outcome assessment in community mental healthcare without inconsistent records undermining the use of resulting data.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236096","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}
BMJ mental healthPub Date : 2025-06-05DOI: 10.1136/bmjment-2024-301424
Marie-Maude Geoffray, Marie-Joelle Oreve, Lucie Jurek, Sandrine Sonie, Carmen Schroder, Veronique Delvenne, Sabine Manificat, Sandrine Touzet, Jay Agathe, Flavia Mengarelli, Gallifet Natacha, Nicolas Petit, Mario Speranza, Stéphane Bahrami, Laetitia Bouveret, Sara Linda Dochez, Pauline Auphan, Amelie Zelmar, Bruno Falissard, Sophie Carlier, Mikail Nourredine, Angélique Denis, Olivia Febvey-Combes
{"title":"Early Start Denver Model effectiveness in young autistic children: a large multicentric randomised controlled trial in two European countries.","authors":"Marie-Maude Geoffray, Marie-Joelle Oreve, Lucie Jurek, Sandrine Sonie, Carmen Schroder, Veronique Delvenne, Sabine Manificat, Sandrine Touzet, Jay Agathe, Flavia Mengarelli, Gallifet Natacha, Nicolas Petit, Mario Speranza, Stéphane Bahrami, Laetitia Bouveret, Sara Linda Dochez, Pauline Auphan, Amelie Zelmar, Bruno Falissard, Sophie Carlier, Mikail Nourredine, Angélique Denis, Olivia Febvey-Combes","doi":"10.1136/bmjment-2024-301424","DOIUrl":"10.1136/bmjment-2024-301424","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding early interventions based on the Naturalistic Developmental Behavioral Interventions framework, such as the Early Start Denver Model (ESDM), suggests efficacy for autistic children. However, the effectiveness of ESDM across diverse cultural contexts remains under-researched.</p><p><strong>Objective: </strong>To assess the effectiveness of ESDM compared with treatment as usual (TAU) on overall development in young children with autism spectrum disorder (ASD).</p><p><strong>Method: </strong>This parallel, randomised controlled trial, using a modified Zelen design, was conducted in five Child and Adolescent Mental Health Services in France and Belgium. A total of 180 children aged 19-36 months, who met autism criteria and were referred by community professionals, were randomly assigned to either receive 12-hour weekly ESDM+TAU or TAU alone. The primary outcome was the change in developmental quotient (DQ) on the Mullen Scale of Early Learning, assessed blindly from baseline to 24 months post randomisation.</p><p><strong>Findings: </strong>From September 2015 to March 2019, 180 children were randomly assigned to either ESDM+TAU (n=61, girls=21.7%) or TAU alone (n=119, girls=15.4%). Three children dropped out immediately after randomisation. Compared with TAU alone, children in the ESDM+TAU group did not significantly improve global DQ (endpoint mean difference 3.82 (95% CI -1.25 to 8.89), p=0.14).</p><p><strong>Conclusions and clinical implications: </strong>Our findings suggest that ESDM+TAU cannot be universally recommended for young children with ASD. Further research is required to evaluate the long-term effectiveness of ESDM and identify subgroups that may benefit more, thereby guiding optimal implementation strategies.</p><p><strong>Trial registration number: </strong>NCT02608333.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236095","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}
BMJ mental healthPub Date : 2025-06-03DOI: 10.1136/bmjment-2025-301592
Miguel Garcia-Argibay, Valerie Brandt, Hongyi Sun, Marco Solmi, Paul Lichtenstein, Henrik Larsson, Samuele Cortese
{"title":"General disease factor: evidence of a unifying dimension across mental and physical illness in children and adolescents.","authors":"Miguel Garcia-Argibay, Valerie Brandt, Hongyi Sun, Marco Solmi, Paul Lichtenstein, Henrik Larsson, Samuele Cortese","doi":"10.1136/bmjment-2025-301592","DOIUrl":"10.1136/bmjment-2025-301592","url":null,"abstract":"<p><strong>Background: </strong>Understanding the relationship between mental and physical health conditions is crucial for developing comprehensive healthcare strategies. The putative existence of a general disease factor (<i>d-factor</i>) that underlies the vulnerability to both physical and mental conditions could have important implications for our approach to health assessment and treatment.</p><p><strong>Objective: </strong>To investigate the presence and characteristics of a general <i>d-factor</i> in children and adolescents.</p><p><strong>Methods: </strong>This Swedish registry-based cross-sectional study included children and adolescents born between 1996 and 2003 with follow-up until 2013. We extracted data on 25 mental and physical health conditions according to the ICD-10 system. To determine the optimal dimensional structure of these conditions, several competing measurement models were tested, including correlated factors, one factor, various bifactor specifications and bifactor exploratory structural equation modelling (ESEM).</p><p><strong>Findings: </strong>The study cohort included 776 667 individuals (mean age 13.96 years, IQR=11.96-16.04; 51% male). The bifactor ESEM model, including a general <i>d-factor</i> and specific mental and physical health factors, provided the best fit to the data compared to alternative models (Comparative Fit Index=0.971, Tucker-Lewis Index=0.962, root mean square error of approximation=0.007 (0.007-0.007)). The <i>d-factor</i> accounted for substantial variance (ω<sub>h</sub>=0.582, explained common variance (ECV)=0.498), while specific mental (ω<sub>hs</sub>=0.377, ECV=0.373) and physical (ω<sub>hs</sub>=0.423; ECV=0.130) factors also indicated additional significant unique contributions.</p><p><strong>Conclusions: </strong>This study provided evidence for a multidimensional structure of health in children and adolescents, characterised by a general <i>d-factor</i> underlying both mental and physical conditions, alongside distinct domain-specific factors. These findings have important implications for clinical practice, providing evidence that suggests the need for more integrated approaches to health assessment and treatment that consider the interconnectedness of mental and physical health.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217693","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}
BMJ mental healthPub Date : 2025-05-26DOI: 10.1136/bmjment-2024-301528
Yusen Zhai, Laurence M Boitet, John Soldner, Jennifer D Lockman, Xue Du
{"title":"Trends in clinically significant anxiety, depression, suicidal ideation and service utilisation among US medical students, 2018-2023.","authors":"Yusen Zhai, Laurence M Boitet, John Soldner, Jennifer D Lockman, Xue Du","doi":"10.1136/bmjment-2024-301528","DOIUrl":"10.1136/bmjment-2024-301528","url":null,"abstract":"<p><p><b>Background</b> Medical students experience disproportionately high rates of anxiety and depression, and treatment gaps may exist. To date, little is known about how these mental health outcomes have changed over time.<b>Objective</b> To examine recent trends in clinically significant anxiety, depression, suicidal ideation, and counselling service utilisation among US medical students.<b>Methods</b> We analysed five waves of the Healthy Minds Study throughout the academic years between 2018 and 2023. The analytic sample comprised 5313 students enrolled in MD programmes from diverse US universities. Study outcomes included clinically significant anxiety, depression, past-year suicidal ideation, and current counselling use. Weighted prevalences were calculated, and sample-weighted multivariable logistic regression, adjusted for age, sex, race/ethnicity, international status, and socioeconomic status, estimated temporal trends.<b>Findings</b> Between 2018 and 2023, the prevalence of anxiety increased by 12.3 percentage points from 21.6% to 33.9%, depression increased by 13.1 percentage points from 14.0% to 27.1%. and counselling service utilisation increased by 17.2 percentage points from 6.7% to 23.9%. These upward trends remained statistically significant even after adjustment for participants' demographic differences. Suicidal ideation prevalence remained relatively stable over the same period.<b>Conclusions</b> The prevalence of anxiety and depression among US medical students have increased since 2018, paralleled by more but still insufficient counselling utilisation, suggesting a persistent treatment gap. Suicidal ideation remains concerning among this population with higher acquired capability for suicide over their lifespan.<b>Clinical implications</b> Medical schools should transform temporary support initiatives into enduring institutional strategies and foster school climates that enhance protective factors to promote medical students' well-being.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163983","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":"Effectiveness of combining psychological prevention interventions with interventions that address the social determinants of mental health in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Eleonora Prina, Beatrice Bano, Rakesh Singh, Emiliano Albanese, Daniela Trujillo, Maria Cecilia Dedios Sanguineti, Katherine Sorsdahl, Nagendra Luitel, Emily Garman, Marianna Purgato, Corrado Barbui, Mark Jordans, Crick Lund","doi":"10.1136/bmjment-2025-301573","DOIUrl":"10.1136/bmjment-2025-301573","url":null,"abstract":"<p><strong>Question: </strong>Task-shared preventive psychological interventions combined with interventions addressing social determinants of mental health may prevent common mental health conditions (CMHCs), particularly in low- and middle-income countries (LMICs). However, an evidence synthesis of their combination has not yet been investigated. We aimed to systematically assess the effectiveness of these combined interventions in LMICs.</p><p><strong>Study selection and analysis: </strong>We searched Epistemonikos, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, GIM, ClinicalTrials.gov and WHO ICTRP until 2 September 2024. Two reviewers independently abstracted the data and evaluated the risk of bias of included studies using the Cochrane Risk of Bias 2 tool. We performed random-effects meta-analyses to assess the primary outcome, which was the incidence of CMHCs, and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The protocol was registered in PROSPERO (CRD42023451072).</p><p><strong>Findings: </strong>Of the 21 780 records identified from electronic sources, we included 31 randomised controlled trials from 21 LMICs involving 35 885 participants. Combined interventions were effective in reducing the incidence of depression and post-traumatic stress disorders at postintervention compared with control conditions for adults (risk ratio (RR) 0.82, 95% CI 0.73 to 0.93) and children (RR 0.70, 95% CI 0.49 to 0.99). At 7-24 months, we only found beneficial effects of combined interventions for depressive symptoms in children (standardised mean difference -0.41, 95% CI -0.63 to -0.18). No data were available on the incidence of anxiety.</p><p><strong>Conclusions: </strong>Combined task-shared interventions are effective in mostly short-term prevention of CMHCs in LMICs. Combining strategies targeting social determinants with psychological prevention approaches offers a potential opportunity to reduce the global mental health burden. Future research should focus on key intervention components and head-to-head comparisons between different interventions and between their components.</p><p><strong>Prospero registration number: </strong>CRD42023451072.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163944","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":"Pragmatic randomised controlled trial of two brief community practice-based interventions for self-harm and suicidal ideation.","authors":"Joanna Lockwood,Tom Goodwin,Katie Freeman,Caroline Harroe","doi":"10.1136/bmjment-2025-301601","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301601","url":null,"abstract":"BACKGROUNDImproving preventative interventions for self-harm and suicide-related behaviour is a mental health policy priority. Existing evidence-based interventions can be lengthy, resource-heavy, difficult to access, and are not always acceptable or effective. Extending support through brief and remotely delivered interventions outside of traditional clinical services brings potential to expand access to timely and effective support.OBJECTIVEThe primary objective is to assess the effectiveness of two brief (6 week) interventions (Integrative Therapy and Stabilisation) in reducing self-harm frequency.METHODSWe evaluated data from a practice-based randomised controlled trial of hybrid Integrative Therapy and Stabilisation utilising a no-treatment control group to determine the effectiveness of each intervention targeting frequency of self-harm (primary outcome), suicidal ideation and depressive symptoms (secondary outcomes). Participants, 82 help-seeking adults with current self-harm behaviour aged 18-59 years (mean age=30.57, SD=12.5), received either Stabilisation (n=25) or Integrative Psychotherapy (n=25) or were assigned to a control waitlist (n=32). Six 1-hour sessions were delivered via video call in a 1:1 format. Outcome measures were completed at baseline and immediately postintervention.FINDINGSIn comparison to waitlist controls, those receiving Stabilisation had greater reductions preintervention to postintervention in self-harm frequency, suicidal ideation and depressive symptoms. Those receiving Integrative Psychotherapy had greater reductions in self-harm frequency and suicidal ideation, but not depression symptoms, compared with waitlist.CONCLUSIONSInterventions delivered in a service setting show promise in improving outcomes for self-harm and suicidal ideation, and to a lesser extent depression symptoms, over a 6-week period. Further evaluation and replication, including in longitudinal studies and fully randomised controlled trials, would be needed to build on these preliminary findings and extend beyond the current setting.CLINICAL IMPLICATIONSShort, remotely delivered interventions outside of traditional clinical settings may offer an effective and timely treatment option.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114106","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":"Physical long-term conditions and the effectiveness of England's NHS Talking Therapies programme for working-age adults: findings from a South London borough.","authors":"Amy Ronaldson,Matthew Broadbent,Brendon Stubbs,Lisa Harber-Aschan,Nicusor Sima,David Armstrong,Ioannis Bakolis,Stephani Hatch,Matthew Hotopf,Alex Dregan","doi":"10.1136/bmjment-2025-301632","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301632","url":null,"abstract":"OBJECTIVETo assess the effectiveness of NHS Talking Therapies (NHSTT) service for working-age adults with mild to moderate depression or anxiety and to evaluate the impact of multiple physical long-term conditions (LTCs) on treatment outcomes.METHODWe have linked routinely collected data from the NHSTT services in South London (UK) with primary care data for aged 18-64 years who had accessed the services between August 2008 and March 2021. The main outcome measures were NHSTT service key performance indicators of 'recovery' and 'reliable improvement'. Multiple and specific physical LTCs represented the exposure of interest. Cox proportional hazard models were used to assess associations between physical LTC exposures and outcomes.FINDINGSAmong 35 814 adults (mean age=37, 67% women) attending the NHSTT, physical LTCs were associated with moderately lower 'recovery' rate (adjusted HR (aHR)=0.91, 95% CI 0.88 to 0.95) relative to no LTCs. A dose-response relationship was also observed: the likelihood of 'recovery' decreased with the number of physical LTCs (one condition: aHR=0.95, 95% CI 0.91 to 0.98; two conditions: aHR=0.88, 95% CI 0.83 to 0.93; three conditions: aHR=0.82, 95% CI 0.75 to 0.91; four or more conditions: aHR=0.72, 95% CI 0.61 to 0.85).CONCLUSIONAmong working-age adults, the effectiveness of NHSTT services varied with the number and type of physical LTCs. These findings highlight the need for tailored interventions for patients with multiple physical LTCs to improve treatment outcomes.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097763","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}
BMJ mental healthPub Date : 2025-05-19DOI: 10.1136/bmjment-2024-301331
Tiffany Junchen Tao,Kayley D Estes,E Alison Holman,Farshid Vahedifard,Roxane Cohen Silver
{"title":"Understanding climate change anxiety and anticipatory climate disaster stress: A survey of residents in a high-risk California county during wildfire season.","authors":"Tiffany Junchen Tao,Kayley D Estes,E Alison Holman,Farshid Vahedifard,Roxane Cohen Silver","doi":"10.1136/bmjment-2024-301331","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301331","url":null,"abstract":"BACKGROUNDWith the increasing prevalence of climate-related disasters, psychological responses, including climate change anxiety and anticipatory climate disaster stress, have received heightened attention.OBJECTIVEWe investigate the correlates of climate change anxiety and anticipatory climate disaster stress, as well as the nature of these psychological responses.METHODSAt the start of the annual fire season (June to August 2023), we recruited a county-representative sample of n=813 residents of Lake County, in Northern California, to complete an anonymous online survey. Multiple regression analyses identified correlates of climate change anxiety and anticipatory climate disaster stress and explored how anxiety and stress were associated with disaster preparedness.FINDINGSClimate change anxiety, assessed via its cognitive-emotional impairment (odds ratio (OR)loss/injury=1.68; ORmedia=2.37) and functional impairment (ORloss/injury=1.68; ORmedia=2.63) subfactors, and anticipatory climate disaster stress (bloss/injury=0.15, bmedia=0.26) were associated with previous wildfire-induced loss/injury and media exposure to wildfire-related content. Anticipatory climate disaster stress was also associated with the frequency of being in an evacuation zone (b=0.05). Both the cognitive-emotional impairment subfactor of climate change anxiety (incidence rate ratio (IRR)=1.23) and anticipatory climate disaster stress (IRR=1.14) were associated with preparing an emergency kit and power outage supplies; anticipatory climate disaster stress was associated with evacuation intentions should an actual fire occur (b=0.12).CONCLUSIONSPrior experiences with climate disasters could explain people's psychological responses to climate change. These responses could be temporally appropriate and functionally adaptive, given the immediacy of a potential fire.CLINICAL IMPLICATIONSClimate change anxiety and anticipatory climate disaster stress should not be oversimplified as typical clinical symptoms because their presence might motivate adaptive self-protective behaviours in the face of an upcoming disaster.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097764","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}