BMJ mental health最新文献

{"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}

{"title":"Effect of home visiting support on maternal psychosocial needs and postnatal depression: emulating a target trial.","authors":"Kaori Baba, Zui C Narita, Syudo Yamasaki, Tomohiro Shinozaki, Junko Niimura, Naomi Nakajima, Satoshi Yamaguchi, Gemma Knowles, Jordan Devylder, Satsuki Ayaya, Shin-Ichiro Kumagaya, Daniel Stanyon, Nao Oikawa, Mariko Hosozawa, Miharu Nakanishi, Shuntaro Ando, Kiyoto Kasai, Mitsuhiro Miyashita, Mariko Hiraiwa-Hasegawa, Toshi A Furukawa, Vikram Patel, Susan M Sawyer, Atsushi Nishida","doi":"10.1136/bmjment-2026-302675","DOIUrl":"10.1136/bmjment-2026-302675","url":null,"abstract":"<p><strong>Background: </strong>Adolescent and young adult (AYA) mothers often experience unmet psychosocial needs, and those under 25 years of age are at increased risk of perinatal depression. Although home visiting programmes may be beneficial, no controlled trial has evaluated a programme co-designed with first-time AYA mothers and grounded in their lived experiences.</p><p><strong>Objective: </strong>We evaluated the effect of the co-designed Early Partnership programme on perceived fulfilment of psychosocial needs and postnatal depressive symptoms among first-time AYA mothers.</p><p><strong>Methods: </strong>We emulated a target trial using data from a pragmatic historically controlled study in four Tokyo municipalities. Participants were primiparous women aged 16-25 years. The intervention group included 151 participants and the control group included 158 participants. The intervention group received intensive tailored home visits by multi-professional family support workers from pregnancy to 12 months postnatally, and the historical control group received publicly funded health and social services.</p><p><strong>Findings: </strong>Retention at 12 months was high in both groups (intervention group, 82.1%; control group, 82.9%). For the primary outcome analysis, the intervention group had greater improvement in perceived fulfilment of psychosocial needs at 6 months postnatally (difference in mean changes 4.16, 95% CI 1.35 to 6.97, Cohen's <i>d</i> 0.40, 95% CI 0.13 to 0.67) and 12 months postnatally (difference in mean changes 3.93, 95% CI 0.63 to 7.23, Cohen's <i>d</i> 0.39, 95% CI 0.06 to 0.72) than the control group. Postnatal depressive symptoms were lower in the intervention group at 6 months postnatally (mean difference -1.54, 95% CI -2.70 to -0.38, Cohen's <i>d</i> -0.34, 95% CI -0.59 to -0.08) and 12 months postnatally (mean difference -1.55, 95% CI -2.74 to -0.36, Cohen's <i>d</i> -0.34, 95% CI -0.61 to -0.07). Well-being also improved at each time point, but estimates were imprecise.</p><p><strong>Conclusions: </strong>The Early Partnership programme, co-designed with young mothers and delivered by multi-professional teams, was acceptable and effective in improving perceived fulfilment of psychosocial needs and postnatal depressive symptoms.</p><p><strong>Clinical implications: </strong>These findings suggest that a person-centred and relationship-based home visiting model, delivered through a non-stigmatising design, may represent a plausible model of maternal care.</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/PMC13289090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280204","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":"Association of psychotropic medications with the use of coercive measures and recidivism during forensic psychiatric care: a Swedish nationwide register-based study.","authors":"Taalke Maria Sitter, Suvi Savinen, Peter Andiné, Anja Fernqvist, Hanna Edberg, Isabell Brikell, Brian M D'Onofrio, Tatja Hirvikoski, Ralf Kuja-Halkola, Agnieszka Szwajda, Seena Fazel, Thomas Nilsson, Zheng Chang","doi":"10.1136/bmjment-2026-302515","DOIUrl":"10.1136/bmjment-2026-302515","url":null,"abstract":"<p><strong>Background: </strong>Patients in forensic psychiatric care (FPC) are often treated with various psychotropic medications. However, evidence regarding their effectiveness in this setting is lacking.</p><p><strong>Objective: </strong>The study aimed to estimate how different psychotropic medications are associated with the use of coercive measures and recidivism during FPC.</p><p><strong>Methods: </strong>In this observational national register-based study, we included all patients newly registered as admitted to FPC in Sweden between January 2009 and August 2024. Exposures included major classes of psychotropic medication (typical antipsychotics, atypical antipsychotics, antidepressants, hypnotics and sedatives, antiepileptic medications, opioids, medications for addictive disorders and mood stabilisers), antipsychotic treatment strategies (no use, monotherapy, polypharmacy, long-acting injectables or clozapine) and specific antipsychotic agents. Outcomes were the use of coercive measures and recidivism into criminal behaviour. We performed a within-individual analysis using conditional generalised estimating equation models, where the risk of outcomes was compared between exposed and non-exposed time periods.</p><p><strong>Findings: </strong>In total, 2690 patients were included, of which 25.1% experienced at least one occasion of coercion and 27.1% at least one event of recidivism during FPC. Atypical antipsychotics were associated with a reduced risk of subsequent use of coercive measures (OR 0.70, 95% CI 0.55 to 0.89) and recidivism (OR 0.79, 95% CI 0.63 to 0.99). Medication for addictive disorders was associated with a reduced risk of coercive measures by 34% (OR 0.66, 95% CI 0.47 to 0.93). Among antipsychotic agents, clozapine was associated with the largest risk reduction in the use of coercive measures (OR 0.48, 95% CI 0.33 to 0.69) and recidivism (OR 0.49, 95% CI 0.33 to 0.74). There was no significant difference between long-acting injectable, oral monotherapy or polypharmacy.</p><p><strong>Conclusions: </strong>We observed that atypical antipsychotics, especially clozapine, were associated with a risk reduction for coercive measures and recidivism during FPC. Additionally, medications for addictive disorders were associated with a reduced risk of coercive measures.</p><p><strong>Clinical implications: </strong>Our results can help inform decision-making processes in this clinical setting regarding pharmacotherapy but should be interpreted as one of many aspects influencing treatment success in FPC.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273901","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":"Trends in antipsychotic drug utilisation and indication in the paediatric population: a nationwide cohort study in Sweden.","authors":"Karl-Hermann S Kamgang, Bjorn Pasternak, Johan Reutfors, Richeek Pradhan, Viktor Wintzell","doi":"10.1136/bmjment-2025-302455","DOIUrl":"10.1136/bmjment-2025-302455","url":null,"abstract":"<p><strong>Background: </strong>Data on antipsychotic use for the Swedish paediatric population is limited.</p><p><strong>Objective: </strong>We assessed the incidence, likely indication and extent of off-label antipsychotic use among children and adolescents in Sweden.</p><p><strong>Methods: </strong>In this nationwide register-based study, individuals younger than 18 years with at least one antipsychotic dispensing between 1 January 2008 and 31 December 2021 were identified. Yearly age-standardised and sex-standardised incidence per 1000 persons was estimated and temporal trends were assessed using Poisson log-linear regression. We also assessed the likely indication and the proportion of on-label and off-label use.</p><p><strong>Findings: </strong>Among 4 108 171 individuals who were children or adolescents at some point during the study period, 24 742 initiated antipsychotic treatment at least once, contributing 25 576 incident dispensings during the study period. Incidence increased from 0.48 to 1.28 per 1000 persons (risk ratio, RR per year 1.08, 95% CI 1.05 to 1.11; cumulative increase 180%), with a more pronounced rise in females (0.43 to 1.51 per 1000; RR 1.11, 95% CI 1.10 to 1.12; 284%) than males (0.53 to 1.06 per 1000; RR 1.06, 95% CI 1.05 to 1.07; 113%), driven by adolescents aged 12-17 years. The largest drug-specific increases were observed for quetiapine (0.04 to 0.33 per 1000; RR per year 1.18, 95% CI 1.17 to 1.19; cumulative increase 804%) and aripiprazole (0.03 to 0.36 per 1000; RR per year 1.16, 95% CI 1.14 to 1.18; cumulative increase 608%). A likely indication was identified in 64.3% (n=16 455) of incident dispensings, most commonly autism spectrum disorder (15.4%), attention-deficit hyperactivity disorder (10.9%) and anxiety disorders (9.6%). Among those with an identifiable indication, 81% were dispensed off label, mainly due to non-approved indications (64.8%) and most frequently among adolescent females.</p><p><strong>Conclusions: </strong>In the paediatric population in Sweden, incidence of antipsychotic use increased between 2008 and 2021, especially among adolescent females and most incident dispensing with an identifiable indication were off label, underscoring the need to evaluate the long-term effectiveness and safety of antipsychotics in children and adolescents.</p><p><strong>Clinical implications: </strong>These patterns highlight the need to evaluate the long-term effectiveness and safety of antipsychotics in children and adolescents.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267205","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":"Predictive analytics to direct clinical attention to complex patients with elevated suicide risk: enhancement of the Veterans Health Administration REACH VET model.","authors":"Alina Peluso, Jorge Ramirez Osorio, William H Kazanis, Amy Robinson, Susana B Martins, Hope Cook, Kelley Callaway, Noah Schaefferkoetter, John F McCarthy, Elizabeth M Oliva, Anuj Kapadia, Jodie A Trafton","doi":"10.1136/bmjment-2025-302338","DOIUrl":"10.1136/bmjment-2025-302338","url":null,"abstract":"<p><strong>Background: </strong>Suicide is a major public health concern, particularly among Veterans. The U.S. Department of Veterans Affairs Veterans Health Administration (VHA) employs the Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET) model to prioritise high-risk patients for targeted clinical attention.</p><p><strong>Objective: </strong>REACH VET 1.0 (RV 1.0) was developed on 2008-2011 data. To reflect changes in clinical practice and populations, VHA updated it to REACH VET 2.0 (RV 2.0). This study describes its development and validation.</p><p><strong>Methods: </strong>RV 2.0 used longitudinal data from 7,248,170 VHA patients (4,967 suicide deaths) in 2018-2019, with 650 time-varying demographic, clinical and area-level predictors derived from a 2-year lookback (2016-2019). An ensemble of Elastic-Net logistic regression models was trained on 2018 data and evaluated monthly at the population level in 2019, focusing on the top 0.1% intervention risk tier. Analyses assessed model discrimination, suicide detection, risk concentration, subgroup consistency (sex, age and race/ethnicity) and performance relative to RV 1.0 using the same percentile-based risk strata.</p><p><strong>Results: </strong>RV 2.0 outperformed RV 1.0 across all risk strata, with better discrimination (C-statistic 0.76 vs 0.69) and consistent performance across demographic subgroups. Within the top 0.1% of predicted risk, RV 2.0 identified more deaths, higher suicide rates and greater mortality risk concentration both when averaged across the 12 monthly 2019 test sets (5.6 vs 3.6; 83.6 vs 53.7 per 100,000 person-years; 21.0 vs 14.1) and when annualised for 2019 (67 vs 43; 2.7% vs 1.7%; 1,003 vs 644 per 100,000 person-years; 26.7 vs 17.1).</p><p><strong>Conclusions: </strong>RV 2.0 improves suicide risk stratification among Veterans, demonstrating better performance and consistent prediction across subgroups and highlighting the need for regular model updates and evaluation.</p><p><strong>Clinical implications: </strong>RV 2.0 enables targeted interventions and, since its national VHA implementation in June 2025, continues to support system-wide suicide prevention.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145557","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":"Infections and severe mental illness: a population-based matched cohort study.","authors":"Sharon L Cadogan, Georgia R Gore-Langton, Kathryn E Mansfield, John Tazare, Seena Fazel, Ian J Douglas, Caroline Morton, Naaheed Mukadam, Charlotte Warren-Gash","doi":"10.1136/bmjment-2026-302640","DOIUrl":"10.1136/bmjment-2026-302640","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether acute infections associated with short-term systemic inflammation influence the risk of severe mental illness (SMI).</p><p><strong>Objective: </strong>To investigate relationships between acute infections and incident SMI using electronic health records from the UK.</p><p><strong>Methods: </strong>Using data from the Clinical Practice Research Datalink Aurum (1 January 2007 to 15 June 2024), we conducted six matched cohort studies. Adults (≥18 years) with gastroenteritis (GE), lower respiratory tract infection (LRTI), skin and soft tissue infection (SSTI), urinary tract infection (UTI), sepsis and meningitis/encephalitis (positive control exposure) recorded in primary care were matched with up to five individuals without infection on age, sex and practice in calendar date order and followed for incident SMI (schizophrenia, bipolar disorder, other psychoses). We estimated HRs for SMI comparing those with and without each infection using Cox regression, stratified by match set, adjusting for potential confounders (deprivation, Charlson Comorbidity Index, alcohol, smoking, body mass index and ethnicity).</p><p><strong>Findings: </strong>Our six study cohorts ranged from 2 089 168 adults (391 773 with SSTI, 1 697 395 without) to 106 155 (17 860 with meningitis/encephalitis, 88 295 without). Median follow-up ranged from 4.1 years (IQR 1.9-6.9) in the sepsis cohort to 5.7 years (IQR 2.6-9.8) in the meningitis/encephalitis cohort. After adjustment, each infection was associated with increased SMI risk: SSTI, HR 1.16 (95% CI 1.08 to 1.24); LRTI, 1.28 (95% CI 1.20 to 1.38); UTI, 1.44 (95% CI 1.31 to 1.58); GE, 1.53 (95% CI 1.42 to 1.65); sepsis, 1.69 (95% CI 1.52 to 1.88); and meningitis/encephalitis, 3.36 (95% CI 2.61 to 4.32).</p><p><strong>Conclusion: </strong>Our findings suggest SMI risk is higher among adults with a range of acute infections compared with those without, with higher risks for the more severe infections meningitis/encephalitis and sepsis.</p><p><strong>Clinical implications: </strong>Providing timely infection treatment, targeted mental health support following severe infections, and where appropriate offering relevant vaccinations, may limit SMI risk.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044905","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":"Research priorities for oral health in people with severe mental ill-health.","authors":"Easter Joury, Ellie Heidari, Derek Tracy, Imad Barngkgei, David Shiers, Gordon Johnston, Kamaldeep Bhui","doi":"10.1136/bmjment-2026-302673","DOIUrl":"10.1136/bmjment-2026-302673","url":null,"abstract":"<p><strong>Background: </strong>People with mental disorders bear an excessive burden of oral diseases. This burden can exacerbate the personal, social and economic impacts of mental disorders. There is a need for transformational research to tackle this problem, which should start with co-setting research priorities with people with lived experience and key stakeholders.</p><p><strong>Objective: </strong>This national Priority Setting Partnership (PSP) aimed to identify the top 10 research priorities for oral health among people with mental disorders.</p><p><strong>Methods: </strong>Following the James Lind Alliance approach, this three-stage PSP engaged people with mental disorders, carers and staff of all levels and decision-makers from healthcare, social care and non-governmental organisations. In stage 1, questions for research were gathered via an online survey. Summary questions were then formed and checked against existing evidence. In stage 2, unanswered questions were compiled into an online shortlisting survey. In stage 3, a consensus workshop was held to determine the top 10 research priorities.</p><p><strong>Findings: </strong>From 1214 questions received in stage 1, 60 unanswered questions were formed. Based on 2377 shortlisting survey responses, the 25 top-ranked questions were taken to the consensus workshop, where the top 10 research priorities were determined by 27 participants. The most important research question was 'What are the best ways to integrate oral health within physical health checks and follow-up care for people with severe mental ill-health?' Other questions focused on the capability of primary care, mental health and dental teams in supporting oral health, integrated system-level models of dental care and financial incentives for professionals.</p><p><strong>Discussion: </strong>This PSP identified the top 10 research priorities for oral health among people with mental disorders, which would guide future research and funding aimed at reducing the stark inequalities in oral health between this group and the general population.</p><p><strong>Clinical implications: </strong>Addressing the priorities identified in this consultation through transformational research would lead to impactful changes in healthcare and public health practice and policy. This in turn would address the burden of oral diseases among people with mental disorders and contribute towards improving their mental and physical health and recovery.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044893","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":"Emulated trial of artificial intelligence use and subsequent depressive outcomes in a survey of US adults.","authors":"Roy H Perlis, Faith M Gunning, Ata Uslu, Mauricio Santillana, Matthew A Baum, James N Druckman, Katherine Ognyanova, David Lazer","doi":"10.1136/bmjment-2026-302609","DOIUrl":"10.1136/bmjment-2026-302609","url":null,"abstract":"<p><strong>Background: </strong>Generative artificial intelligence (AI) use has been suggested to have adverse mental health consequences but a causal relationship has not been examined.</p><p><strong>Objective: </strong>To simulate a randomised controlled trial of AI use in a work, school or personal context by applying target trial emulation to multiple waves of data from a nationally representative survey.</p><p><strong>Methods: </strong>We conducted a target trial emulation using non-probability survey data from three waves of a nationally representative survey conducted between 18 June 2024 and 8 January 2025. Participants aged ≥18 years reported generative AI use frequency at baseline. High-frequency use was defined as multiple times per week or more. The primary outcome was depressive symptom severity measured using the Patient Health Questionnaire 9-item (PHQ-9) at follow-up. Generalised causal forests assessed heterogeneity of treatment effects.</p><p><strong>Findings: </strong>Among 19 099 participants assessed at baseline, 2862 (15.0%) reported AI use at least multiple times per week. A subset of 3109 (16.3%) returned for follow-up. In the primary weighted analysis, high-frequency use was not significantly associated with change in PHQ-9 score at follow-up (mean difference -0.18, 95% CI -0.94 to 0.59; p=0.65). Multiple sensitivity analyses using alternate outcome definitions also did not identify significant causal effects. Generalised causal forests yielded no significant evidence of heterogeneity of effect (p=0.81).</p><p><strong>Conclusions: </strong>In an emulated randomised trial among US adults, generative AI use was not associated with subsequent depressive symptoms. This result does not support the premise that AI use causes greater depressive symptoms, although adverse outcomes among vulnerable individuals cannot be excluded.</p><p><strong>Clinical implications: </strong>AI use is unlikely to cause increased depressive symptoms among most US adults. Continued monitoring should clarify potential risks among vulnerable populations.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935958","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":"Mental health in university students: an umbrella review grading the evidence for psychosocial interventions.","authors":"Giulia Muriago, Andrea Chiccoli, Davide Papola, Beatrice Compri, Giulia Turrini, Michela Nose, Corrado Barbui","doi":"10.1136/bmjment-2025-302323","DOIUrl":"10.1136/bmjment-2025-302323","url":null,"abstract":"<p><strong>Question: </strong>Psychological distress is increasingly prevalent among university students, raising concerns about their mental health. This review aimed to assess the strength and credibility of evidence on the efficacy of psychosocial interventions for improving mental health in this population.</p><p><strong>Study selection and analysis: </strong>We conducted an umbrella review of systematic reviews (SRs) with meta-analyses of randomised controlled trials assessing psychosocial interventions among university students. Searches were performed in Medline, PubMed, Cochrane Central, PsycINFO, CINAHL, Epistemonikos and Campbell Collaboration from 1 January 2014 to 1 February 2026. Data on intervention type, comparator, outcome and study-level effect sizes were analysed using inverse-variance random-effects models with restricted maximum likelihood estimation of between-study heterogeneity (τ²). Strength of associations was evaluated according to umbrella review criteria, reporting quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Findings: </strong>A total of 34 SRs were identified. After excluding overlapping syntheses, 28 unique meta-analyses from 12 SRs were included. Mindfulness-based interventions versus inactive controls for distress (standardised mean difference (SMD) -0.40; 95% CI -0.53 to -0.28) showed highly suggestive evidence (class II; GRADE: low; AMSTAR: high). Seven associations provided suggestive evidence (Class III): mindfulness-based interventions versus inactive controls for anxiety (SMD -0.54; 95% CI -0.81 to -0.27) and depression (SMD -0.52; 95% CI -0.65 to -0.39); cognitive-based interventions versus inactive controls for anxiety (SMD -0.48; 95% CI -0.62 to -0.34) and depression (SMD -0.60; 95% CI -0.75 to -0.45); cognitive-based interventions versus active controls for well-being (SMD -0.30; 95% CI -0.42 to -0.18); positive psychology interventions versus inactive controls for distress (SMD -0.22; 95% CI -0.35 to -0.10); and multimodal interventions versus inactive controls for distress (SMD -0.85; 95% CI -1.32 to -0.87). The remaining associations were weak or non-significant, generally supported by low or very low certainty and mostly low or very low reporting quality.</p><p><strong>Conclusions: </strong>The most robust evidence emerged for mindfulness and cognitive-based interventions, with some support also for positive psychology approaches. These interventions appear to improve depression, anxiety, distress and well-being among university students, though further rigorous research is needed.</p><p><strong>Prospero registration number: </strong>CRD42023493618.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857837","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":"Cognition and future depression: associations with risk in those with and without a history of depression.","authors":"Angharad N de Cates, Angeline Lee, Laura Winchester, Klaus P Ebmeier, Paris Lalousis, Rachel Upthegrove, Susannah E Murphy, Catherine J Harmer, Thomas Nichols, Anya Topiwala","doi":"10.1136/bmjment-2025-302332","DOIUrl":"10.1136/bmjment-2025-302332","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairments are common in depression and often persist beyond mood resolution. However, the relationship between cognitive performance, its neurological underpinnings, and future depression risk is unclear, limiting strategies for primary and secondary prevention.</p><p><strong>Objective: </strong>Our objective was to determine whether cognition associates with subsequent depression, both relapse and first-episode occurrences.</p><p><strong>Methods: </strong>1862 UK Biobank participants with a history of International Classification of Diseases (ICD)-10-defined depression in remission (RD) (mean (SD) age: 52.7 (7.13) years) were age-matched and sex-matched to 1862 participants without depression history or current antidepressant use. Cognitive scores were compared between groups at the composite (z-score), domain and task levels. MRI-derived phenotypes assessed brain network structure and functional connectivity. Longitudinal associations with future depression were assessed using logistic regression models and a Cox proportional hazards model controlling for key confounders.</p><p><strong>Findings: </strong>Participants with RD had a higher risk of future depression (33%) than controls (13%), including when we accounted for temporal differences in longitudinal assessment (HR=3.16 (95% CI 2.71 to 3.67), global proportional hazard assumption p=0.07). Composite cognitive performance in controls was inversely associated with future depression risk (risk estimated marginal means: 0.25% at -1SD, 0.20% at mean, 0.15% at +1 SD). In RD, this relationship was reversed (0.74% at -1SD, 0.90% at mean, 1.10% at +1 SD). Executive functioning, processing speed and reasoning task scores all contributed. Higher grey matter in default mode network regions was associated with better concurrent cognitive performance across all participants, but not with future depression risk. Other MRI findings were limited.</p><p><strong>Conclusions: </strong>RD carried a threefold higher risk of future depression than controls. Cognitive performance was a risk marker for future depression in both groups but in opposing directions. Neuroimaging metrics provided little predictive value.</p><p><strong>Clinical implications: </strong>Personalised risk factor assessment for depression is likely to be dependent on depression history. Those without previous history of diagnosed depression are at higher risk of future depression when cognitive performance is lower at baseline. RD is a high-risk group for future depression, and those with relatively higher cognitive performance may be more likely to report future depressive symptoms.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846872","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}