BMJ mental health最新文献

{"title":"Reduced risk of cause-specific hospitalisations and all-cause hospitalisation/mortality during treatment with attention-deficit/hyperactivity disorder medications in the course of bipolar disorder: a Swedish registry-based within-subject cohort study.","authors":"Cagatay Ermis,Antti Tanskanen,Olivier Corbeil,Johannes Lieslehto,Eduard Vieta,Christoph U Correll,Ellenor Mittendorfer-Rutz,Jari Tiihonen,Heidi Taipale","doi":"10.1136/bmjment-2025-302159","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302159","url":null,"abstract":"BACKGROUNDComorbid attention-deficit/hyperactivity disorder (ADHD) increases the burden in bipolar disorder (BD). Concerns about the risk/benefit balance of ADHD treatment have been raised.OBJECTIVEThis study aimed to investigate the association between hospital admissions and add-on ADHD medications to antipsychotics and/or mood-stabilisers (APs/MSs) compared with AP/MS alone in BD.METHODSIndividuals with BD prescribed ADHD medications in Sweden during 2006-2021 were identified from national registers of inpatient care, specialised outpatient care, sickness absence and disability pension. ADHD treatment was defined as stimulants (mostly methylphenidate and lisdexamfetamine, rarely amphetamine, dexamphetamine) and non-stimulants (atomoxetine, modafinil). Add-on ADHD treatment to concomitant AP/MS was compared with treatment periods with AP/MS without ADHD treatment, using within-individual models where individuals acted as their own control. Adjusted HRs (aHRs) and CIs (95% CIs) were calculated for the primary outcome of psychiatric hospitalisation, and for the secondary outcomes: substance-use-related, somatic or mania-related hospitalisations, and all-cause hospitalisation/mortality.RESULTSAltogether, 17 971 individuals (mean age=32.0±11.6 years, males=37.6%, ADHD=88.9%, follow-up=8.9±4.4 years) with BD who used any ADHD treatment were included. compared with the use of AP/MS alone, add-on stimulant use was related to a lower risk of psychiatric hospitalisations (aHR=0.89, 95% CI 0.85 to 0.93), substance-related hospitalisations (aHR=0.75, 95% CI 0.70 to 0.81) and all-cause hospitalisations/mortality (aHR=0.90, 95% CI 0.87 to 0.93), but was not associated with increased risk for somatic (aHR=1.00, 95% CI 0.90 to 1.12) or mania-related hospitalisations (aHR=0.93, 95% CI 0.72 to 1.20). Of commonly used specific ADHD medications, add-on lisdexamfetamine (aHR=0.81, 95% CI 0.75 to 0.87) and methylphenidate (aHR=0.92, 95% CI 0.88 to 0.97) were associated with decreased risk of psychiatric hospitalisations while add-on atomoxetine was not. Findings on substance-use-related hospitalisations were significant only for stimulants, specifically lisdexamfetamine (aHR=0.70, 95% CI 0.61 to 0.79) and methylphenidate (aHR=0.80, 95% CI 0.74 to 0.86).CONCLUSIONSAmong individuals with BD who received ADHD medications, add-on lisdexamfetamine and methylphenidate were associated with lower risks of psychiatric and substance-use-related hospital admissions, compared with AP/MS use alone. No significant association was found between ADHD medication use and mania-related hospitalisations or somatic admissions when these medications were used together with AP/MS. Larger samples are needed to reach adequate statistical power and conclusive findings on atomoxetine, dexamfetamine and modafinil.CLINICAL IMPLICATIONSThe findings of this study suggested that the treatment of comorbid ADHD could be considered after adequate mood-stabilisation in patients with BD.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483327","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":"Sex differences in familial risk and genetic components of suicide attempts: a register-based cohort study in Sweden.","authors":"Thuy-Dung Nguyen,Tong Gong,Kejia Hu,Ralf Kuja-Halkola,Karen Borges,Agnieszka Butwicka,Isabell Brikell,James J Crowley,Zheng Chang,Brian M D'Onofrio,Henrik Larsson,Paul Lichtenstein,Christian Rück,Cynthia Bulik,Fang Fang,Patrick Sullivan,Yi Lu","doi":"10.1136/bmjment-2025-302082","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302082","url":null,"abstract":"BACKGROUNDSuicidal behaviour shows notable sex differences, and understanding whether genetic factors contribute to these differences is critical for identifying at-risk individuals and prevention.OBJECTIVEWe aim to investigate the genetic contribution to suicide attempts and examine whether genetics account for sex differences in incidence.METHODSThis population-based cohort study includes 3.1 million individuals born 1963-1998 and followed through Swedish National Registers, including hospitals and specialist outpatient diagnoses and cause of death data. Suicide attempts were identified using ICD codes, indicating intentional self-harm, self-harm using lethal methods or leading to hospitalisation, or resulting in death. Familial aggregation, coaggregation, pedigree heritability and genetic correlations were estimated using genealogical data. For sex-specific analyses, we examined mother-daughter, female sibling, father-son and male sibling pairs, separately.FINDINGSSuicide attempts were more common among females than males (3.3% vs 2.6%). In both sexes, risk aggregated within families (ORs ranged 1.6-3.4 across relative types) and was higher in first-degree than second-degree relatives. Familial aggregation was stronger in females than in males, and in same-sex first degree relatives compared with cross-sex pairs. Pedigree heritability was 41.9% (95% CI 36.0 to 48.4%) and did not differ significantly by sex (female 51.4% (95% CI 40.1% to 58.6%), male 45.1% (95% CI 32.3% to 52.5%), Bootstrap p value 0.40). Suicide attempt showed moderate to high pedigree genetic correlations with psychiatric disorders, strongest with substance use disorders (SUD, rg=0.85 (95% CI 0.83 to 0.96)), with no significant sex differences. The genetic correlation between female and male suicide attempts was high (0.85 (95% CI 0.80 to 0.99)), suggesting a substantial genetic overlap.CONCLUSIONSSuicide attempt has a moderate heritable component that largely overlaps between females and males and with other psychiatric disorders, particularly SUD. Stronger familial aggregation in females and in same-sex pairs highlights the potential role of sex-specific environmental or social factors. Future research should focus on non-genetic contributors and their potential interaction with genetic factors to better understand and address sex disparities in suicidal behaviour CLINICAL IMPLICATIONS: Genetic risk for suicide attempt is substantial but does not fully explain sex differences in incidence. Clinicians should, therefore, consider non-genetic, including sex-specific environmental and social factors, alongside family history and psychiatric comorbidity when assessing suicidal risk.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383498","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":"Levels of evidence supporting American, European and international guidelines in psychiatry, 2014-2024: a systematic review with quantitative synthesis.","authors":"Troels Boldt Rømer,Signe N Andersson,Michael Eriksen Benros","doi":"10.1136/bmjment-2025-302194","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302194","url":null,"abstract":"QUESTIONTo what extent are psychiatry guidelines supported by high-level evidence?STUDY SELECTION AND ANALYSISGuidelines from the American Psychiatric Association, European Psychiatric Association, WHO and World Federation of Societies for Biological Psychiatry (2014-2024) were selected. Recommendations were graded by guideline authors' levels of evidence (LOE) appraisal (standardised to the Grading of Recommendations, Assessment, Development and Evaluations framework (high, moderate, low, very low)) and by the highest-level study referenced (meta-analysis, randomised controlled trial (RCT), observational study, expert opinion, etc.).FINDINGS24 guidelines, containing 545 recommendations, were included. Of 82 guidelines screened, 29 (35%) had not been updated in a decade. 63 (11.6%) recommendations were rated by guideline authors as based on high LOE. The proportion was the highest for pharmacotherapies (41/281 (14.6%)) and the lowest for somatic assessment (0/13 (0%)). The proportion of high LOE recommendations varied between publishers (European Psychiatric Association: 20 %, WHO: 1.6 %). For high LOE recommendations, only those concerning pharmacotherapies cited meta-analyses based on double-blind studies using adequate controls. A large proportion (n=241 (44.2%)) of recommendations cited either a meta-analysis of RCTs (n=155 (28.4%)) or ≥two RCTs (n=86 (15.8 %)). There were few recommendations primarily addressing self-harm (n=2), autism (n=3), attention-deficit/hyperactivity disorder (n=3), prevention (n=3), patient involvement (n=3) or discontinuation (n=6).CONCLUSIONSClinical guidelines in psychiatry frequently cite RCTs, but the evidence is often downgraded by guideline authors, highlighting the need for better quality trials. LOE varies across areas, with pharmacotherapies supported by the highest quality evidence. Organisations should commit to a timely update of guidelines covering all areas of psychiatry.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383222","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":"Effects of smartphone cognitive behavioural therapy on social functioning in non-depressive and subthreshold depressive adults: a secondary analysis of the RESiLIENT trial.","authors":"Aran Tajika,Rie Toyomoto,Masatsugu Sakata,Yan Luo,Tatsuo Akechi,Masaru Horikoshi,Kosuke Inoue,Hisashi Noma,Pim Cuijpers,Toshi A Furukawa","doi":"10.1136/bmjment-2025-302303","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302303","url":null,"abstract":"BACKGROUNDDepression is a leading cause of global disability, and subthreshold cases contribute substantially to the burden. Cognitive behavioural therapy (CBT) is effective for depressive symptoms, but its impact on social functioning in subthreshold depression remains unclear.OBJECTIVEThis study evaluated the effects of smartphone-based CBT on social functioning and personal health records among individuals with subthreshold depression and examined whether a personalised and optimised therapy (POT) algorithm enhanced these outcomes.METHODSWe performed a secondary analysis of the RESiLIENT trial (n=5361). Participants were stratified by baseline Patient Health Questionnaire-9 (PHQ-9) scores (0-4 and 5-14) and randomised to nine CBT app groups or a self-check group. Outcomes included social functioning and health records. A mixed-effects model for repeated measures was used to analyse the outcomes. The POT algorithm selected CBT skills tailored to individual characteristics.FINDINGSDepressive symptoms improved in both PHQ-9 groups compared with those of the self-check group, but gains in social functioning were modest, observed mainly in the PHQ-9 score ≤4 group. No consistent benefits were seen for health behaviours, job resignation, sick leave or healthcare costs. However, in a simulated randomised comparison using 10-fold cross-validated datasets, the POT algorithm had potentially beneficial effects for productivity (standardised mean difference (SMD)=0.16, 95% CI 0.03 to 0.29) and social adjustment (SMD=-0.13, 95% CI -0.26 to 0.00).CONCLUSIONSSmartphone CBT effectively reduced depressive symptoms but showed limited impact on social functioning and healthcare costs. Personalised optimisation may modestly improve productivity and adjustment, suggesting its promise for enhancing social outcomes.CLINICAL IMPLICATIONSPersonalised tailoring of CBT skills may strengthen the effects of digital interventions on social functioning.TRIAL REGISTRATION NUMBERUMIN000047124.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350631","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":"Are all risks equal? Understanding the differential mechanism linking early environmental risk and obesity via the interplay of mental health and lifestyle factors.","authors":"Hongyi Sun,Janet Kiri,Valerie Brandt,Dennis Golm","doi":"10.1136/bmjment-2025-302211","DOIUrl":"https://doi.org/10.1136/bmjment-2025-302211","url":null,"abstract":"BACKGROUNDThe mechanisms linking early environmental risk (EER) and obesity via the interplay of mental health and lifestyle factors in the early life stage remain unclear.OBJECTIVETo examine whether EER was associated with later mental health, lifestyle factors and obesity and to identify the mediating roles of mental health and lifestyle in these relationships.METHODUsing data from the Millennium Cohort Study (valid n=5401), we longitudinally assessed the relationship between EER (prenatal risks, neonatal risks, low socioeconomic status, maternal psychological problems and harsh parenting; 9 months to age 3 years), mental health problems in childhood (internalising and externalising problems; age 7 years), lifestyle factors in early adolescence (diet, exercise, smoking and drinking; age 11 years) and obesity in late adolescence (age 14-17 years). Structural equation modelling was used to test proposed pathways.FINDINGSThe proposed model showed an acceptable fit (Comparative Fit Index=0.926, Tucker-Lewis Index=0.875, root mean square error of approximation=0.034, standardised root mean square residual=0.046). EER was significantly associated with later mental health problems, lifestyle factors (ie, diet, exercise, smoking) and obesity. Higher EER was modestly associated with higher obesity risk via the interplay of externalising problems and drinking (β=0.01, p=0.036). The sex-stratified model results indicated differences between males and females.CONCLUSIONBy highlighting the importance of EER and the mediating role of lifestyle factors in mental health and later obesity risk, our findings provide evidence of shared risk mechanisms linking mental and physical health.CLINICAL IMPLICATIONSThese findings suggest that integrating mental health assessment (especially externalising symptoms) with routine screening for adolescent alcohol use and other risk factors could inform more targeted obesity prevention in clinical and public health settings.","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346446","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":"How can we make interventions more 'acceptable' in mental health?","authors":"Thomas Kabir","doi":"10.1136/bmjment-2025-302337","DOIUrl":"10.1136/bmjment-2025-302337","url":null,"abstract":"<p><p>Are we properly assessing the acceptability of mental health interventions from a service user's point of view? A treatment can be efficacious and effective but still not acceptable to a service user. For example, someone with psychosis may find a treatment that improves symptoms but causes significant weight gain and sedation unacceptable. Despite significant progress being made in developing safe and effective interventions for mental health problems, a notable proportion of people remain in need. The reasons for this are complex. Part of the problem could be an inadequate focus on how 'acceptable' interventions really are to service users given their views and specific circumstances.Treatment acceptability has been a rather poorly defined concept. This has led to researchers using several methods to assess their own ideas about what service user acceptability is. This can include methods such as using recruitment and withdrawal data. But such data may not be true markers of acceptability to a service user.Current approaches to assessing acceptability need improvement. Existing acceptability questionnaire measures are not widely used and are often developed for specialist settings. Crucially, very few have had any stated involvement of people with mental health conditions in their development. This approach risks not listening to service users' voices fully.Developing better ways of understanding and assessing service users' views of treatment acceptability in mental health could have many benefits-including empowering individual service users to identify interventions that they can and cannot accept. It is time to better understand what 'acceptable' really means in mental health.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319151","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":"Psychiatric admission in female survivors of childhood and young adult cancer: a whole population retrospective study.","authors":"W Hamish B Wallace, Tom W Kelsey, David S Morrison, Katie Fm Marwick, Richard Anderson","doi":"10.1136/bmjment-2025-301683","DOIUrl":"10.1136/bmjment-2025-301683","url":null,"abstract":"<p><strong>Background: </strong>The last 40 years have seen a substantial improvement in overall survival from cancer in children and young people. There is limited information on psychiatric wellbeing in female survivors of cancer at a young age.</p><p><strong>Objective: </strong>In this 40-year population-based linkage study, we set out to determine the incidence of first psychiatric admission compared with a non-exposed age-matched control.</p><p><strong>Methods: </strong>Scottish cancer registry records from 1981 to 2012 were linked to psychiatric admissions, maternity and death records from January 1981 to September 2018 using the unique personal Community Health Index number allocated to each person in Scotland. For each exposed subject, three age and deprivation matched controls from the population were selected. The primary exposed group was all females with a cancer diagnosis at age <25 years and no previous pregnancy and no psychiatric admission before cancer diagnosis. The main outcome measure is admission to a psychiatric hospital with a mental health diagnosis.</p><p><strong>Findings: </strong>Female cancer survivors had a significantly lower cumulative incidence of first psychiatric admissions than matched controls over the 38 years of follow-up for the cohort (p<0.05). The relative risk of a first psychiatric admission at 25 years from cancer diagnosis was 0.72 (0.56-0.89).</p><p><strong>Conclusion: </strong>Overall, we have shown that young cancer survivors are less likely than age-matched controls to have a psychiatric admission after cancer diagnosis. In particular, psychiatric admissions for mood disorders, neuroses, personality disorders and substance use are significantly less likely in the cancer survivors.</p><p><strong>Clinical implications: </strong>The experience of cancer treatment and survival in young females may reduce the risk of psychiatric admission in later life.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313151","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":"Cannabis use, cognitive function and dementia risk in older adults: observational and genetic analyses.","authors":"Saba Ishrat, Daniel F Levey, Joel Gelernter, Klaus P Ebmeier, Anya Topiwala","doi":"10.1136/bmjment-2025-302290","DOIUrl":"10.1136/bmjment-2025-302290","url":null,"abstract":"<p><strong>Background: </strong>The cognitive effects of cannabis use in older adults remain unclear, despite increasing use for medical and recreational purposes in this age group.</p><p><strong>Objective: </strong>To investigate associations between cannabis use, cognitive performance and dementia risk in older individuals, using large population cohorts and Mendelian randomisation (MR) to explore potential causal relationships.</p><p><strong>Methods: </strong>Observational analyses were conducted using the UK Biobank (UKB) and the US Million Veteran Program (MVP). In UKB, cross-sectional and longitudinal cognitive performance across five domains was compared between lifetime cannabis users (up to 18 975 participants) and non-users (up to 60 598 participants). In MVP, cannabis use disorder (CanUD; n=12 222) was examined in relation to incident all-cause dementia using Cox proportional hazards models. MR analyses assessed potential bidirectional causal relationships between cannabis use, cognitive function and dementia.</p><p><strong>Findings: </strong>At baseline, cannabis users performed modestly better on tests of numeric memory (beta=0.07, 95% CI 0.06 to 0.09, p<0.001) and fluid intelligence (beta=0.12, 95% CI 0.10 to 0.13, p<0.001), but no significant differences were observed in longitudinal cognitive change. In MVP, CanUD was not significantly associated with dementia risk (HR=1.11, 95% CI 0.97 to 1.26, p=0.12). MR analyses provided no evidence of a causal relationship between cannabis use and either cognitive performance or dementia risk.</p><p><strong>Conclusions: </strong>Cannabis use was not linked to longitudinal cognitive decline or dementia risk. Within the limits of these cohorts, we found no evidence that cannabis use contributes substantially to cognitive ageing or dementia risk in older adults. Further research with detailed exposure assessment and longer follow-up is warranted to confirm these findings.</p><p><strong>Clinical implications: </strong>Cannabis use in older adults does not appear linked to faster cognitive decline or higher dementia risk. Occasional or prior use may not substantially affect cognitive ageing, though safety at higher doses or prolonged use remains uncertain. Clinicians should inquire about cannabis history and consider cognitive screening in routine care.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313034","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":"Automating thematic review of prevention of future deaths reports: concordance study of a child-suicide analysis using large language models.","authors":"Sam Osian, Arpan Dutta, Sahil Bhandari, Iain E Buchan, Dan W Joyce","doi":"10.1136/bmjment-2025-302212","DOIUrl":"10.1136/bmjment-2025-302212","url":null,"abstract":"<p><strong>Background: </strong>Prevention of future deaths (PFD) reports issued by coroners in England and Wales identify systemic safety hazards but are difficult to analyse at scale. Reports are not machine-readable, lack consistent metadata and cannot be reliably searched or exported, meaning prior national reviews have relied on labour-intensive manual screening and coding.</p><p><strong>Objective: </strong>To evaluate whether a fully automated, vision-enabled large language model (LLM) pipeline (PFD Toolkit) can replicate and extend the Office for National Statistics (ONS) thematic review of child-suicide PFD reports, and to assess concordance with blinded clinical adjudication.</p><p><strong>Methods: </strong>All PFD reports published between July 2013 and November 2023 (n=4730) were scraped from judiciary.uk and processed using PFD Toolkit, which combines optical character recognition with LLM-powered screening and thematic coding. Reports were classified for child suicide (≤18 years), addressee categories and 23 coroner-concern subthemes mirroring the ONS coding frame. Agreement was evaluated against a blinded clinical reference standard: three psychiatrists independently adjudicated a stratified sample of 146 reports (73 Toolkit-positive cases and 73 decoys), with disagreements resolved by consensus. Inter-rater reliability and index-reference agreement were quantified using kappa statistics.</p><p><strong>Findings: </strong>The Toolkit identified 73 child-suicide PFD reports between July 2013 and November 2023, compared with 37 identified in the ONS review. 62 cases fell within the ONS analytical window, and 11 pre-dated the introduction of suicide-related tags on the PFD archive. Pre-consensus inter-rater reliability among clinicians was substantial to almost perfect (Fleiss' κ=0.75, 95% CI 0.65 to 0.84). Post-consensus agreement between the Toolkit and the clinical reference standard was substantial to almost perfect (Cohen's κ=0.93, 95% CI 0.77 to 1.00; raw agreement 97%). End-to-end screening, coding and tabulation of all reports completed in 5 min 29 s on a consumer-grade laptop.</p><p><strong>Conclusions: </strong>A national thematic review of child-suicide PFD reports can be fully automated with high concordance to expert judgement, dramatically reducing time and labour while recovering previously missed cases.</p><p><strong>Clinical implications: </strong>Automated analysis of PFD reports enables rapid, reproducible surveillance of recurring system failures, supporting more timely public health intelligence, policy responses and learning from coronial data.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313051","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":"Digital peer support interventions for people with mental health conditions in outpatient settings: a systematic review and meta-analysis.","authors":"Sarah Croke, Natasha Tyler, Chloe-Nicole Low, Evgenia Gkintoni, Ioannis Angelakis, Ozlem Eylem-Van Bergeijk, Alexander Hodkinson, Brian Mcmillan, Maria Panagioti","doi":"10.1136/bmjment-2025-302275","DOIUrl":"10.1136/bmjment-2025-302275","url":null,"abstract":"<p><p><b>Background</b>Mental health conditions are a major global challenge with rising demand for accessible, effective, scalable treatments. Digital peer support interventions are a promising way to extend support beyond clinical settings, but their effectiveness requires comprehensive evaluation.<b>Objective</b>To evaluate the effectiveness of digital peer support interventions in improving clinical symptoms, functioning, and treatment engagement among individuals with mental health conditions in outpatient settings.</p><p><strong>Study selection and analysis: </strong>We conducted a systematic review and random-effects meta-analysis of controlled interventional studies. Five databases (MEDLINE, CENTRAL, Embase, PsycINFO) were searched up to January 2025. Studies evaluated digital peer support via online platforms, mobile apps or digital communities for people aged ≥16 years with mental health conditions. Outcomes included clinical symptoms (depression, anxiety), functioning (quality of life, social functioning) and treatment engagement. Risk of bias was assessed using Cochrane Risk of Bias 2.0 for randomised controlled trials and ROBINS-I for non-randomised studies. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).</p><p><strong>Findings: </strong>29 studies including 5825 participants were included. Digital peer support was associated with small-to-moderate improvements in symptoms of depression (standardised mean difference (SMD) -0.28; 95% CI -0.42 to -0.14) and anxiety (SMD -0.47; 95% CI -0.68 to -0.27). Functional outcomes improved modestly: social functioning (SMD 0.18; 95% CI 0.07 to 0.29), quality of life (SMD 0.14; 95% CI 0.02 to 0.26), patient activation (SMD 0.39; 95% CI 0.23 to 0.55) and personal recovery (SMD 0.23; 95% CI 0.11 to 0.35). No significant effects were observed for treatment engagement or satisfaction. Preliminary evidence suggested sustained benefits for depression, anxiety and social functioning.</p><p><strong>Conclusions and clinical implications: </strong>Digital peer support offers modest improvements in symptoms and functioning for individuals with mental health conditions and may be considered as an adjunct to usual care to enhance engagement and provide accessible support between clinical contacts. Key priorities include establishing optimal intervention models, clarifying longer-term benefits, and ensuring these approaches can be delivered safely and sustainably within routine outpatient services.</p><p><strong>Prospero registration number: </strong>CRD42023445194.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313144","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}