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Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression. 常见靶向启发式重复经颅磁刺激治疗抑郁症的疗效比较。
BMJ mental health Pub Date : 2025-05-19 DOI: 10.1136/bmjment-2025-301598
Katrin Sakreida,Nicholas T Trapp,Sarah Kreuzer,Ulrike Rubin,Dieter Schnabel,Jana Hovančáková,Alexander T Sack,Irene Neuner,Thomas Frodl,Timm B Poeppl
{"title":"Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression.","authors":"Katrin Sakreida,Nicholas T Trapp,Sarah Kreuzer,Ulrike Rubin,Dieter Schnabel,Jana Hovančáková,Alexander T Sack,Irene Neuner,Thomas Frodl,Timm B Poeppl","doi":"10.1136/bmjment-2025-301598","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301598","url":null,"abstract":"BACKGROUNDRepetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective non-pharmacological, non-invasive intervention for depression. However, the optimal strategy for localising the DLPFC treatment site on the patient's scalp is heavily disputed. Routine strategies were previously incrementally refined and compared in terms of anatomical accuracy, but little is known about their impact on clinical outcomes.OBJECTIVETo assess the impact of three common scalp-based heuristics for magnetic coil positioning on the treatment outcome of rTMS.METHODSThis retrospective analysis of real-world clinical data involved patients suffering from a major depressive episode (n=94) who received a 4-week course of excitatory rTMS to the left DLPFC. The treatment target (ie, coil position) was either determined at an absolute distance anterior to the motor hotspot ('6 cm rule') or defined in reference to the EEG electrode position F3 using a traditional ('Beam F3') or optimised ('Beam F3 Adjusted') approach.FINDINGSThere was no statistically significant difference between the '6 cm rule' and the 'Beam F3' method nor between the 'Beam F3' and the 'Beam F3 Adjusted' method in head-to-head comparisons of averaged per cent change of scores on depression rating scales (all p>0.605) and response rate (all p>0.475).CONCLUSIONSEnhancing targeting precision via scalp-based heuristics does not affect treatment outcomes.CLINICAL IMPLICATIONSThere is no need for clinicians to switch from their familiar to an 'advanced' approach among these common targeting heuristics.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097762","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}
引用次数: 0
Ending nuclear weapons, before they end us. 在核武器终结我们之前终结它们。
IF 4.9
BMJ mental health Pub Date : 2025-05-15 DOI: 10.1136/bmjment-2025-301772
Chris Zielinski
{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjment-2025-301772","DOIUrl":"10.1136/bmjment-2025-301772","url":null,"abstract":"","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082562","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}
引用次数: 0
Common mental disorders in young adults: temporal trends in primary care episodes and self-reported symptoms. 年轻人常见精神障碍:初级保健发作和自我报告症状的时间趋势
BMJ mental health Pub Date : 2025-05-13 DOI: 10.1136/bmjment-2024-301457
Jennifer Dykxhoorn,Francesca Solmi,Kate Walters,Shamini Gnani,Antonio Lazzarino,Judi Kidger,James B Kirkbride,David P J Osborn
{"title":"Common mental disorders in young adults: temporal trends in primary care episodes and self-reported symptoms.","authors":"Jennifer Dykxhoorn,Francesca Solmi,Kate Walters,Shamini Gnani,Antonio Lazzarino,Judi Kidger,James B Kirkbride,David P J Osborn","doi":"10.1136/bmjment-2024-301457","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301457","url":null,"abstract":"BACKGROUNDRates of common mental disorders (CMDs) including anxiety, depression and stress, treated in primary care have increased among young adults, but it is unclear if this reflects more help-seeking and/or an increase in symptoms, and if there are differences across sociodemographic groups.OBJECTIVEThis study examined trends in primary care-recorded CMD and self-reported psychological distress symptoms in young adults over time.METHODSWe used data from participants born between 1980 and 2003 in two datasets: UK primary care records and longitudinal cohort data. Participants were followed from age 16 to age 39 (maximum) or the end of the follow-up (2019-2020). Annual incidence rates of recorded CMD overall and by sociodemographic group were calculated for 2009-2019, using incidence rate ratios to explore changes. We calculated annual self-reported psychological distress symptoms from cohort data, calculating ratios to explore changes over time.FINDINGSBetween 2009 and 2019, recorded CMD increased by 9.90%, while average psychological distress symptoms rose by 19.33%. The sharpest increases for both recorded CMD and average psychological distress symptoms were observed in older adolescents (ages 16-19) and those born after 1995. Recorded CMD increased more in males (20.61%) than in females (7.65%), despite similar symptom increases. Recorded CMD increased the most in the least deprived areas (16.34%) compared with the most deprived areas (3.55%), despite comparable rises in psychological distress symptoms.CONCLUSIONSBoth recorded CMD and psychological distress symptoms in young adults increased between 2009 and 2019, which may indicate that the rising primary care-recorded CMD reflects increased symptom burden.IMPLICATIONSDifferences between recorded CMD and psychological distress symptoms across sociodemographic groups highlight potential misalignment in mental healthcare with underlying population need, indicating that the most affected groups may not be those receiving the most care.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945341","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}
引用次数: 0
Effects of anaemia development during pregnancy on maternal psychological health. 妊娠期贫血对产妇心理健康的影响。
BMJ mental health Pub Date : 2025-05-13 DOI: 10.1136/bmjment-2024-301465
Dong Wook Kwak,Seokyung Kim,Su Young Lee,Hee Jin Park,You Jung Han,Moon Young Kim,Jin Hoon Chung,Ji Hyae Lim,Hyun Mee Ryu
{"title":"Effects of anaemia development during pregnancy on maternal psychological health.","authors":"Dong Wook Kwak,Seokyung Kim,Su Young Lee,Hee Jin Park,You Jung Han,Moon Young Kim,Jin Hoon Chung,Ji Hyae Lim,Hyun Mee Ryu","doi":"10.1136/bmjment-2024-301465","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301465","url":null,"abstract":"BACKGROUNDAnaemia during pregnancy is associated with maternal depressive symptoms during pregnancy and the postpartum period. However, the effect of anaemia development during pregnancy on maternal psychological health in non-anaemic women remains unclear.OBJECTIVETo investigate the effect of anaemia development during pregnancy on maternal psychological health during pregnancy and the postpartum period.METHODSThis study includes a secondary analysis of data collected prospectively from the Korean Pregnancy Outcome Study. Depression and anxiety were evaluated in each trimester and 4-6 weeks postpartum. The Hospital Anxiety and Depression Scale was used for anxiety and the Edinburgh Postnatal Depression Scale for depression.FINDINGSAmong 3310 women with normal haemoglobin concentrations in the first trimester, 270 (8.1%) developed anaemia in the third trimester. Depression during the first trimester and anxiety during the second trimester were significantly more frequent among patients who later developed anaemia in the third trimester than among those who did not. Even after adjusting for confounding factors, anaemia development during pregnancy was significantly associated with increased risks of depression during the first trimester (aOR, 1.45; 95% CI, 1.07 to 1.96; p=0.017) and anxiety during the second trimester (aOR, 1.57; 95% CI, 1.04 to 2.38; p=0.033), respectively.CONCLUSIONS AND CLINICAL IMPLICATIONSAmong women who were non-anaemic in the first trimester and developed anaemia by the third trimester, higher risks of maternal depression and anxiety were observed during the first and second trimester, respectively. It suggests that a decrease in haemoglobin concentrations during pregnancy negatively impacts on maternal psychological health.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945295","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}
引用次数: 0
Reasoning language models for more transparent prediction of suicide risk. 推理语言模型更透明地预测自杀风险。
BMJ mental health Pub Date : 2025-05-11 DOI: 10.1136/bmjment-2025-301654
Thomas H McCoy,Roy H Perlis
{"title":"Reasoning language models for more transparent prediction of suicide risk.","authors":"Thomas H McCoy,Roy H Perlis","doi":"10.1136/bmjment-2025-301654","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301654","url":null,"abstract":"BACKGROUNDWe previously demonstrated that a large language model could estimate suicide risk using hospital discharge notes.OBJECTIVEWith the emergence of reasoning models that can be run on consumer-grade hardware, we investigated whether these models can approximate the performance of much larger and costlier models.METHODSFrom 458 053 adults hospitalised at one of two academic medical centres between 4 January 2005 and 2 January 2014, we identified 1995 who died by suicide or accident, and matched them with 5 control individuals. We used Llama-DeepSeek-R1 8B to generate predictions of risk. Beyond discrimination and calibration, we examined the aspects of model reasoning-that is, the topics in the chain of thought-associated with correct or incorrect predictions.FINDINGSThe cohort included 1995 individuals who died by suicide or accidental death and 9975 individuals matched 5:1, totalling 11 954 discharges and 58 933 person-years of follow-up. In Fine and Grey regression, hazard as estimated by the Llama3-distilled model was significantly associated with observed risk (unadjusted HR 4.65 (3.58-6.04)). The corresponding c-statistic was 0.64 (0.63-0.65), modestly poorer than the GPT4o model (0.67 (0.66-0.68)). In chain-of-thought reasoning, topics including Substance Abuse, Surgical Procedure, and Age-related Comorbidities were associated with correct predictions, while Fall-related Injury was associated with incorrect prediction.CONCLUSIONSApplication of a reasoning model using local, consumer-grade hardware only modestly diminished performance in stratifying suicide risk.CLINICAL IMPLICATIONSSmaller models can yield more secure, scalable and transparent risk prediction.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932731","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}
引用次数: 0
Identification of circadian-sensitive brain structure and its role in cognitive impairment and dementia. 对昼夜节律敏感的大脑结构及其在认知障碍和痴呆中的作用的鉴定。
BMJ mental health Pub Date : 2025-05-11 DOI: 10.1136/bmjment-2024-301142
Siwen Luo,Yimeng Wang,Mengchao He,Qiaorui Wen,Shengfeng Wang,Jia Cao,Qing Chen
{"title":"Identification of circadian-sensitive brain structure and its role in cognitive impairment and dementia.","authors":"Siwen Luo,Yimeng Wang,Mengchao He,Qiaorui Wen,Shengfeng Wang,Jia Cao,Qing Chen","doi":"10.1136/bmjment-2024-301142","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301142","url":null,"abstract":"BACKGROUNDCircadian disruption has been suggested to induce cognitive impairment and dementia. It remains unknown which brain structures are involved in the pathology.OBJECTIVETo investigate which specific brain structure alterations are associated with dementia and cognitive impairment induced by circadian disruption.METHODSCircadian disruption was represented by two accelerometer-derived circadian variables, composite phase deviations (CPD) and relative amplitude (RA), separately reflecting circadian disruption in timing and amplitude. The outcomes include brain structures (139 imaging-derived phenotypes), cognitive test performances (seven cognitive tests) and dementia (all-cause dementia, Alzheimer's disease, vascular dementia (AD/VD) and non-AD/VD dementia). Association analysis was used to explore the relationships between circadian disruption and brain structure alterations, cognitive test performances and dementia. Mediation analysis was conducted to investigate which brain structure alterations mediated the cognitive impairment and dementia caused by circadian disruption.FINDINGSA total of 88 461 participants (57% female, 62.0±7.8-year old) were included. CPD and RA correlated with substantially different brain structures. All CPD-related brain structures were located in the cerebrum, whereas most RA-related brain structures were located in the cerebellum. Furthermore, only the CPD-related brain structures, including the hippocampus and thalamus, exhibited significant mediation effects accounting for up to 8.6% of the risk for dementia and 13.5% of the risk for cognitive impairment.CONCLUSIONSCircadian disruption is associated with brain structural alterations involving dementia and cognitive impairments.CLINICAL IMPLICATIONSThese results provide a novel insight into the mechanism underlying circadian disruption-induced neurological disorder and may propose potential preventive strategy.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932733","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}
引用次数: 0
Trends and socioeconomic inequalities in acute mental health service use in Canada, 2004-2019: a nationally representative retrospective cohort study. 2004-2019年加拿大急性精神卫生服务使用的趋势和社会经济不平等:一项具有全国代表性的回顾性队列研究
BMJ mental health Pub Date : 2025-05-02 DOI: 10.1136/bmjment-2025-301600
Jasleen Arneja,Brice Batomen,Marie-Josee Fleury,Arijit Nandi
{"title":"Trends and socioeconomic inequalities in acute mental health service use in Canada, 2004-2019: a nationally representative retrospective cohort study.","authors":"Jasleen Arneja,Brice Batomen,Marie-Josee Fleury,Arijit Nandi","doi":"10.1136/bmjment-2025-301600","DOIUrl":"https://doi.org/10.1136/bmjment-2025-301600","url":null,"abstract":"BACKGROUNDAcute mental health service use (AMHSU), that is, hospitalisations and emergency department (ED) visits for mental health, have been rising in the Canadian province of Ontario and globally; however, national-level estimates are not available. We examine trends and socioeconomic inequalities in AMHSU in the Canadian adult population between 2004 and 2019.METHODSUsing the Canadian Community Health Survey linked to tax and health administrative datasets, we reported prevalence rates of AMHSU using negative binomial regression models. Income-based absolute inequalities in AMHSU were reported using the Slope Index of Inequality.RESULTSOver the study period, hospitalisations for mood disorders decreased from 144.8 (95% CI: 116.0-173.7) to 67.5 (95% CI: 54.5-80.4) per 100 000, while those for substance-related disorders (SRD) increased. Rates of ED visits increased for all conditions, with the largest increase for anxiety disorders, from 252.3 (95% CI: 210.9-293.6) to 434.1 (95% CI: 382.2-486.1) per 100 000. Females had higher rates of hospitalisations and ED visits for all conditions except SRD. We found pronounced income-based inequalities in both hospitalisations and ED visits for mental health, comparing those at the top versus bottom of the income distribution. Absolute inequalities for hospitalisations widened for SRD, from -93.6 (95% CI: -131.1 to -56.1) to -135.2 (95% CI: -203.4 to -67.1) per 100 000, and decreased for mood disorders, from -309.5 (95% CI: -443.8 to -175.3) to -126.0 (95% CI: -182.0 to -69.9) per 100 000. Additionally, absolute inequalities increased for ED visits across all mental health conditions.CONCLUSIONInterventions aimed at improving access to preventive services could mitigate observed inequalities in AMHSU.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903090","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}
引用次数: 0
Preventing suicide with Safe Alternatives for Teens and Youths (SAFETY): a randomised feasibility trial. 用安全的替代方法预防青少年自杀(SAFETY):一项随机可行性试验。
BMJ mental health Pub Date : 2025-04-29 DOI: 10.1136/bmjment-2025-301575
Moa Karemyr, Martin Bellander, Moa Pontén, Anna Ohlis, Oskar Flygare, Ylva Walldén, Ralf Kuja-Halkola, Gergö Hadlaczky, David Mataix-Cols, Joan Rosenbaum Asarnow, Clara Hellner, Jennifer L Hughes, Johan Bjureberg
{"title":"Preventing suicide with Safe Alternatives for Teens and Youths (SAFETY): a randomised feasibility trial.","authors":"Moa Karemyr, Martin Bellander, Moa Pontén, Anna Ohlis, Oskar Flygare, Ylva Walldén, Ralf Kuja-Halkola, Gergö Hadlaczky, David Mataix-Cols, Joan Rosenbaum Asarnow, Clara Hellner, Jennifer L Hughes, Johan Bjureberg","doi":"10.1136/bmjment-2025-301575","DOIUrl":"10.1136/bmjment-2025-301575","url":null,"abstract":"<p><strong>Background: </strong>Suicide attempts are common in youth and have potentially lethal outcomes. Effective treatments targeting suicide attempts are scarce.</p><p><strong>Objective: </strong>To assess the feasibility and preliminary efficacy of a family-based cognitive behavioural treatment relative to an active control for youth with suicidal behaviour.</p><p><strong>Methods: </strong>30 youths (93% female; mean (SD) age=14.6 (1.5) years) residing in Sweden with recent suicidal behaviour (last 3 months) and at least one available parent were randomised to 12 weeks of the family-based cognitive behavioural treatment Safe Alternatives for Teens and Youths (SAFETY) or supportive therapy, an active control treatment. Primary endpoint was 3-month post-treatment. Feasibility outcomes included treatment and assessment compliance, adverse events, treatment credibility and treatment satisfaction. Secondary outcomes included suicide attempt, non-suicidal self-injury, anxiety, depression, quality of life and emotion dysregulation.</p><p><strong>Findings: </strong>Both treatments showed high compliance, satisfaction, credibility and session completion, with few adverse events and dropouts as well as low attrition (7% at primary endpoint). At the primary endpoint, two (14%) participants in SAFETY and four (27%) in supportive therapy had attempted suicide. Non-suicidal self-injury was reduced by 95% (incidence rate ratio=0.05 (95% CI 0.01 to 0.20)) in SAFETY and 69% (incidence rate ratio=0.31 (0.11 to 0.83)) in supportive therapy. Participation in SAFETY, but not in supportive therapy, was associated with moderate-to-large within-group improvements in anxiety and depression (Cohen's d=0.85 [0.33 to 1.40]), quality of life (d<i>=</i>1.01 [0.48 to 1.56]) and emotion dysregulation (d=1.22 [0.45 to 2.03]).</p><p><strong>Conclusions: </strong>The results suggest that SAFETY is feasible and promising for youth with suicidal behaviour.</p><p><strong>Clinical implications: </strong>A large randomised controlled trial is warranted to further examine the efficacy of SAFETY.</p><p><strong>Trial registration number: </strong>NCT05537623.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054257","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}
引用次数: 0
Impact of the COVID-19 pandemic on antidepressant prescribing with a focus on people with learning disability and autism: an interrupted time series analysis in England using OpenSAFELY-TPP. COVID-19大流行对抗抑郁药处方的影响,重点是学习障碍和自闭症患者:使用opensafety - tpp在英格兰进行的中断时间序列分析。
BMJ mental health Pub Date : 2025-04-28 DOI: 10.1136/bmjment-2024-301378
Christine Cunningham, Orla Macdonald, Andrea Schaffer, Andrew Brown, Milan Wiedemann, Rose Higgins, Chris Bates, John Parry, Louis Fisher, Helen Curtis, Amir Mehrkar, Liam C Hart, William Hulme, Victoria Speed, Tom Ward, Richard Croker, Christopher Wood, Alex Walker, Colm Andrews, Ben Butler-Cole, David Evans, Peter Inglesby, Iain Dillingham, Simon Davy, Lucy Bridges, Thomas O'Dwyer, Steve Maude, Rebecca Smith, Amelia Green, Ben Goldacre, Brian MacKenna, Sebastian Bacon
{"title":"Impact of the COVID-19 pandemic on antidepressant prescribing with a focus on people with learning disability and autism: an interrupted time series analysis in England using OpenSAFELY-TPP.","authors":"Christine Cunningham, Orla Macdonald, Andrea Schaffer, Andrew Brown, Milan Wiedemann, Rose Higgins, Chris Bates, John Parry, Louis Fisher, Helen Curtis, Amir Mehrkar, Liam C Hart, William Hulme, Victoria Speed, Tom Ward, Richard Croker, Christopher Wood, Alex Walker, Colm Andrews, Ben Butler-Cole, David Evans, Peter Inglesby, Iain Dillingham, Simon Davy, Lucy Bridges, Thomas O'Dwyer, Steve Maude, Rebecca Smith, Amelia Green, Ben Goldacre, Brian MacKenna, Sebastian Bacon","doi":"10.1136/bmjment-2024-301378","DOIUrl":"10.1136/bmjment-2024-301378","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 restrictions led to increased reports of depressive symptoms in the general population and impacted health and social care services. We explored whether these changes affected antidepressant prescribing trends in the general population and those with learning disability or autism.</p><p><strong>Methods: </strong>With the approval of NHS England, we used >24 million patients' primary care data from the OpenSAFELY-TPP platform. We used interrupted time series analysis to quantify trends in those prescribed and newly prescribed an antidepressant across key demographic and clinical subgroups, comparing pre-COVID-19 (January 2018-February 2020), COVID-19 restrictions (March 2020-February 2021) and recovery (March 2021-December 2022) periods.</p><p><strong>Results: </strong>Prior to COVID-19 restrictions, antidepressant prescribing was increasing in the general population and in those with learning disability or autism. We did not find evidence that the pandemic was associated with a change in antidepressant prescribing trend in the general population (relative risk (RR) 1.00 (95% CI 0.97 to 1.02)), in those with autism (RR 0.99 (95% CI 0.97 to 1.01)) or in those with learning disability (RR 0.98 (95% CI 0.96 to 1.00)).New prescribing post restrictions was 13% and 12% below expected had COVID-19 not happened in both the general population and those with autism (RR 0.87 (95% CI 0.83 to 0.93), RR 0.88 (95% CI 0.83 to 0.92)), but not learning disability (RR 0.96 (95% CI 0.87 to 1.05)).</p><p><strong>Conclusions and implications: </strong>In this England study, we did not see an impact of COVID-19 on overall antidepressant prescribing, although unique trends were noted, such as trends in new antidepressant prescriptions which increased in care homes over the pandemic and decreased in the general population and those with autism since recovery.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065376","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}
引用次数: 0
"I am not a priority": ethnic minority experiences of navigating mental health support and the need for culturally sensitive services during and beyond the pandemic. “我不是优先考虑的对象”:少数民族在大流行期间和之后获得心理健康支持的经历以及对文化敏感服务的需求。
BMJ mental health Pub Date : 2025-04-24 DOI: 10.1136/bmjment-2024-301481
Evgenia Stepanova,Sarah Croke,Ge Yu,Oládayò Bífárìn,Maria Panagioti,Yu Fu
{"title":"\"I am not a priority\": ethnic minority experiences of navigating mental health support and the need for culturally sensitive services during and beyond the pandemic.","authors":"Evgenia Stepanova,Sarah Croke,Ge Yu,Oládayò Bífárìn,Maria Panagioti,Yu Fu","doi":"10.1136/bmjment-2024-301481","DOIUrl":"https://doi.org/10.1136/bmjment-2024-301481","url":null,"abstract":"BACKGROUNDExisting health inequalities and the lack of timely and appropriate support have long been a reality for many ethnic minority individuals living with mental health conditions, even before the pandemic. Limited access to services and the absence of culturally or religiously embedded care have led to increased severity of mental health problems.OBJECTIVETo explore the complexity of interactions between ethnic minorities and mental health services and their experiences of seeking and receiving mental health support throughout the pandemic.METHODSSemi-structured interviews with purposive and snowball sampling of ethnic minorities aged over 18 (n=32) across North East and North West in England were analysed using a framework approach.FINDINGSFive themes were generated. Cultural stigma attached to mental health could lead to fear and reluctance to seek support. Individuals struggled to engage with non-culturally sensitive health services. Instead, they indicated a strong preference for wider community support, which continued through the pandemic despite interrupted health services. A collaboration between mental health services and ethnic minority communities was advocated to shape services to cultural contexts and improve patient-centred service delivery.CONCLUSIONSEthnic minorities with mental health face significant challenges and disparities in seeking and engaging in mental health services. They often seek support from multicultural community settings even though the support is not specifically targeted at addressing mental health issues. Understanding cultural beliefs, religious influences and family and community structures are necessary components of culturally appropriate care.CLINICAL IMPLICATIONSCulturally sensitive mental health services need to be integrated into existing systems through initiating collaborations with ethnic minority communities that tailor services to meet the needs of diverse populations, improving overall engagement and experiences.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885259","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}
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