Recent paradigm shifts suggest that psychopathology manifests through dynamic interactions between individual symptoms.

To investigate the longitudinal relationships between symptoms in a transdiagnostic sample of patients with psychiatric disorders.

A two-wave, cross-lagged panel network model of 15 nodes representing symptoms of depression, (social) anxiety and attenuated psychotic symptoms was estimated, using baseline and 1-year follow-up data of 222 individuals with psychiatric disorders. Centrality indices were calculated to determine important predictors and outcomes.

Our results demonstrated that the strongest relationships in the network were between (a) more suicidal ideation predicting more negative self-view, and (b) autoregressive relationships of social anxiety symptoms positively reinforcing themselves. Negative self-view was the most predictable node in the network as it had the highest ‘in-expected influence’ centrality, and may be an important transdiagnostic outcome symptom.

The results give insight into longitudinal interactions between symptoms, which interact in ways that do not adhere to broader diagnostic categories. Our results suggest that self-view can also be a transdiagnostic outcome of psychopathology rather than just a predictor, as is normally posited, and may especially have an important relationship with suicidal ideation. Overall, our study demonstrates the dynamic complexity of psychopathology, and further supports the importance of investigating symptom interactions of different psychopathological dimensions over time and across disorders.

There is increasing evidence that assessing outcomes in terms of capability provides information beyond that of health-related quality of life (HRQoL) for outcome evaluation in mental health research and clinical practice.

To assess similarities and differences in the measurement properties of the ICECAP-A capability measure and Oxford Capabilities Questionnaire for Mental Health (OxCAP-MH) in people with schizophrenia experiencing depression, and compare these measurement properties with those of (a) the EuroQol EQ-5D-5L and EuroQol Visual Analogue Scale (EQ-VAS) and (b) mental health-specific (disease-specific) measures.

Using data for 100 patients from the UK, measurement properties were compared using correlation analyses, Bland–Altman plots and exploratory factor analysis. Responsiveness was assessed by defining groups who worsened, improved or remained unchanged, based on whether there was a clinically meaningful change in the instrument scores between baseline and 9-month follow-up assessments.

The two capability instruments had stronger convergent validity with each other (Spearman's rho = 0.677) than with the HRQoL (rho = 0.354–0.431) or the mental health-specific (rho = 0.481–0.718) instruments. The OxCAP-MH tended to have stronger correlations with mental health-specific instruments than the ICECAP-A, whereas the ICECAP-A had slightly stronger correlation with the EQ-VAS. Change scores on the capability instruments correlated weakly with change scores on the HRQoL scales (rho = 0.131–0.269), but moderately with those on mental health-specific instruments for the ICECAP-A (rho = 0.355–0.451) and moderately/strongly on the OxCAP-MH (rho = 0.437–0.557).

Assessing outcomes in terms of capabilities for people with schizophrenia and depression provided more relevant, mental health-specific information than the EQ-5D-5L or the EQ-VAS. The ICECAP-A and the OxCAP-MH demonstrated similar psychometric properties, but the OxCAP-MH was more correlated with disease-specific instruments.

Previous research has highlighted the need to promote help-seeking by men with mental health problems.

To investigate barbers’ views about offering mental health support for men in barbershops, with a specific focus on the psychosocial impacts of the COVID-19 pandemic.

We used a sequential mixed-methods qualitative design with online data collection. In Phase 1, 30 barbers in Southern England completed surveys exploring perceptions of their clients’ mental health during the COVID-19 pandemic, experiences of informal supportive roles and scope for providing formal mental health support in barbershops. Phase 2 involved member validation interviews and explored practice implications with three Phase 1 respondents.

Thematic analysis identified three overarching themes: ‘more than a haircut’ (describing how the physical and relational contexts of barbershops can offer a supportive environment for clients); ‘impacts of COVID-19’ (describing stressors related to the pandemic and implications for clients’ mental health and barber–client relationships); and ‘formal mental health strategies’ (describing opportunities for, and potential barriers to, formalising mental health support in barbershops).

Barbers were aware of their clients’ worsening mental health during the COVID-19 pandemic. Barbershops were generally considered to be a suitable setting in which to promote good mental health, monitor for signs of mental ill health and provide information about local mental health services. Future work is needed to co-produce and evaluate formal mental health promotion and prevention strategies in barbershops. Particular attention should be given to service innovations that preserve the credibility and trust that are fundamental to the barbershop experience for many males.

Despite the abundant research on COVID-19-related mental health problems, little attention has been paid to acute depression occurring concurrently with the infection as a neuropsychiatric manifestation. This is important because depression is known to adversely affect help-seeking. Decreased help-seeking is likely to be aggravated by the isolation measures demanded as part of fighting the pandemic, given the disruption of social support networks.

To study the effects of acute depression associated with COVID-19 infection on help-seeking behaviour.

We present a case report and personal account of a patient psychiatrist who developed a first onset of acute depression as part of COVID-19 infection.

Despite being a mental health expert the patient lacked insight into his mood change and its negative effect on help-seeking behaviour, resulting in reliance on a family caregiver to raise the alarm.

For those experiencing this complex interaction between COVID-19 infection and the brain, social support will be needed to ensure timely presentation to the healthcare system. Greater attention to behavioural change as part of COVID-19 infection is needed to optimise treatment outcome.

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2015 and MDcpg2020) provide evidence-based and consensus-based recommendations for managing mood disorders.

We examined Australian real-world prescribing habits to determine whether management in clinical practice aligned with MDcpg2015 recommendations.

A retrospective analysis of a cohort of patients ≥16 years old who had been dispensed a Pharmaceutical Benefits Scheme (PBS)-listed antidepressant between July 2013 and June 2019 was conducted using Australian Commonwealth Department of Human Services PBS 10% sample data.

Between July 2013 and June 2019, 239 944 patients in Australia commenced antidepressant treatment. Of these, 22% (52 694 patients) received a second treatment (a new class of treatment after a period of discontinuation or additional antipsychotic therapy) and 6% (15 741 patients) received a third treatment. Patients were initially prescribed primarily selective serotonin reuptake inhibitors (SSRIs; 52% of prescriptions) or tricyclic antidepressants (TCAs; 25%), even though TCAs are not recommended for first-line treatment. Fewer than one-quarter of patients were prescribed serotonin–noradrenaline reuptake inhibitors (13%) or other agents (10%). General practitioners (GPs) were more likely to initiate TCAs than psychiatrists (22% v. 7%).

Once initiated, the overall median time patients remained on treatment was 4.5 months; this was highest with SSRIs (5.8 months) and lowest with TCAs (0.9 months).

First-line prescribing broadly follows guidelines. GP and psychiatrist prescribing patterns differ, perhaps reflecting different patient groups and the need to tailor treatment to individuals. Future guidelines should aim to capture the different presentations and complexity of depression.

According to more recent approaches on problematic internet use (PIU), using the internet can be seen as a way of compensating for psychosocial malaise. Taking semiotic cultural psychology theory as its theoretical framework, this study examines the role of affect-laden assumptions concerning the world, known as latent dimensions of sense (LDSs), in promoting (or not) adaptive responses, including internet use as a maladaptive strategy against problems and difficulties.

To test a theoretical model in which PIU is predicted by LDSs through the mediation of high levels of psychosocial malaise.

We measured PIU (using the Generalized Problematic Internet Use Scale 2), LDSs (View of Context questionnaire), negative affect (Positive and Negative Affect Schedule), social anxiety (Interaction Anxiousness Scale) and loneliness (Italian Loneliness Scale) in 764 Italian adolescents (mean age 15.05 years, s.d. = 1.152 years). LDSs were detected using a multiple correspondence analysis; after confirmatory composite analysis, partial least squares structural equation modelling with higher-order components was performed to test the mediation model.

The results show a relationship between LDSs corresponding to an extreme negative evaluation of the sociocultural context, experienced as absolutely unreliable, and PIU through the mediation of psychosocial malaise (95% CI 0.101– 0.171; P = 0.000).

Overall, the findings suggest that PIU might be a way of compensating for unpleasant states in a context perceived in an extremely negative and homogenising way, i.e. as totally lacking resources and trustworthy people.

Childhood adversity may lead to mental and somatic complications throughout life. General practitioners are equipped to identify and manage adverse events in households. The relationship between adversities and psychiatric symptoms has not been studied in primary care.

We investigated the relationship of common adversities in families with respect to subsequent development of psychosocial and psychiatric problems in young children.

We analysed data from seven general practices, including participants between 0 and 9 years of age. Adversity was defined as having a household member who was diagnosed with cancer, psychiatric disease or social problems. We compared these patients with controls matched for gender, age and general practice. The primary outcome was any new episode defined with a psychological and psychiatric label. Secondarily, the encounter rates at the general practices after adversity were analysed.

Participants in both groups were followed for an average of 12 years, whereby patients with an adversity were more likely to develop psychiatric morbidities compared with matched references (odds ratio 1.38, 95% CI 1.12–1.68, P = 0.002), also revealing higher encounter rates at general practices. We found no statistically significant association between adversities in the family and increased psychosocial symptoms.

The short- and long-term consequences of exposure to negative events in childhood are of great public health importance. Our data suggest screening more proactively for consequences of commonly occurring adversities in families, as they are a risk factor for subsequent psychiatric symptoms. Enhanced consultation frequency at general practitioners following adversities should be differentiated in more detail.

Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors.

We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery?

Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed.

Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth.

We recommend that people who respond to survivors’ psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.

It is essential to conduct randomised controlled trials of psychological interventions on acute psychiatric wards to build a robust evidence base for clinical practice.

This paper aims to share strategies from three different in-patient trials that successfully recruited and retained participants, to disseminate good practice for the conduct of future trials in this challenging and complex clinical setting.

We present strategies from three in-patient trials of psychological interventions: TULIPS (Talk, Understand, Listen for Inpatient Settings), amBITION (Brief Talking Therapies on Wards) and INSITE (Inpatient Suicide Intervention and Therapy Evaluation). All studies recruited participants from acute in-patient wards, initiated therapy within the in-patient setting and followed up on participants post-discharge.

We summarise our recommendations for good practice in the form of ten top tips for success, based on our collective experience of conducting trials on psychiatric wards. Key themes relate to the importance of relationships between the research team and clinical staff; good stakeholder involvement and getting early buy-in from the team; and adapting to the particular demands of the clinical setting.

Sharing good practice recommendations can help reduce research waste arising from poor recruitment and/or retention in future in-patient clinical trials.

Factors associated with single suicide attempts (SSA) and multiple suicide attempts (MSA) may differ.

The study aimed to assess the factors associated with MSA in adolescents with a history of suicide attempts during the past 12 months in Argentina.

National cross-sectional data from the Global School-based Student Health Survey in Argentina in 2018 were analysed. Students who reported having a history of suicide attempts in the past 12 months were included in the final sample (n = 8507). Students with MSA were compared with students with an SSA through multiple logistic regression.

In a subsample of adolescents attending school (mean age 14.8 years, s.d. = 1.3), 59.4% had an SSA and 40.6% had MSA in the past 12 months. In the final adjusted logistic regression model, compared with participants with SSA, both male and female students with MSA more frequently had no close friends, reported feeling more lonely and had more anxiety-induced sleep disturbances. Furthermore, among female participants, having been physically attacked, having participated in physical fights, low parental support, current tobacco use and lifetime amphetamine use were associated with MSA. Among male students, multiple sexual partners were associated with MSA. Furthermore, among both boys and girls, compared with participants without psychosocial distress, participants with one, two, three or more psychosocial distress factors had higher odds of MSA. Compared with students with one or two social or environmental risk factors, students with seven or eight social or environmental risk factors had higher odds of MSA; compared with students who had zero or one health risk behaviours, students with six or more health risk behaviours had higher odds of MSA.

Psychosocial distress (anxiety-induced sleep disturbance, having no close friends and loneliness) increased the odds of MSA among both sexes. The odds of MSA were increased by interpersonal violence, low parental support and substance use among girls, and by having multiple sexual partners among boys. This suggests the potential relevance of these variables in identifying multiple suicide attempters among adolescents attending school in Argentina.

The COVID-19 pandemic has affected all our lives, not only through the infection itself but also through the measures taken to control the spread of the virus (e.g. lockdown).

Here, we investigated how the COVID-19 pandemic and unprecedented lockdown affected the mental health of young adults in England and Wales.

We compared the mental health symptoms of up to 4773 twins in their mid-20s in 2018 prior to the COVID-19 pandemic (T1) and during four-wave longitudinal data collection during the pandemic in April, July and October 2020, and in March 2021 (T2–T5) using phenotypic and genetic longitudinal designs.

The average changes in mental health were small to medium and mainly occurred from T1 to T2 (average Cohen d = 0.14). Despite the expectation of catastrophic effects of the pandemic on mental health, we did not observe trends in worsening mental health during the pandemic (T3–T5). Young people with pre-existing mental health problems were disproportionately affected at the beginning of the pandemic, but their increased problems largely subsided as the pandemic persisted. Twin analyses indicated that the aetiology of individual differences in mental health symptoms did not change during the lockdown (average heritability 33%); the average genetic correlation between T1 and T2–T5 was 0.95, indicating that genetic effects before the pandemic were substantially correlated with genetic effects up to a year later.

We conclude that on average the mental health of young adults in England and Wales has been remarkably resilient to the effects of the pandemic and associated lockdown.

Early-life interpersonal stress, particularly childhood maltreatment, is associated with neurobiological abnormalities. However, few studies have investigated the neural effects of peer victimisation.

This study examines common and specific associations between childhood maltreatment, peer victimisation and brain structural alterations in youths.

Grey matter volume (GMV) and cortical thickness data were collected from 105 age- and gender-matched youths (age range: 17–21 years). Region-of-interest and whole-brain analyses were conducted.

For the region-of-interest analyses, the childhood maltreatment group had smaller GMV than controls in left inferior frontal gyrus, bilateral anterior insula, postcentral and lingual regions, which were associated with greater emotional abuse, along with smaller insular GMV than the peer victimisation group, who had smaller left lingual and postcentral GMV than controls. At the whole-brain level, both childhood maltreatment and peer victimisation groups had smaller GMV than controls in a cluster comprising left post/precentral, inferior frontal gyrus, insula, superior parietal and supramarginal gyri. The peer victimisation group alone had increased cortical thickness in a cluster comprising left superior frontal, anterior cingulate and medial orbitofrontal gyri, which was related to greater cyberbullying.

Early-life interpersonal stress is associated with common structural alterations of the inferior frontal-limbic, sensory and lingual regions involved in cognitive control, emotion and sensory processing. The findings of childhood-maltreatment-related reduced anterior insular GMV and peer-victimisation-related increased cortical thickness in the left medial prefrontal-anterior cingulate cluster underscore the distinctive negative effects of childhood maltreatment and peer victimisation, and suggest that peer victimisation, particularly cyberbullying, could be as detrimental as childhood maltreatment.

Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown.

We aim to identify psychosocial factors associated with bipolar disorder AAO.

Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure.

We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = −0.2855), regular cannabis use in the year before onset (β = −0.2765), death of a close family friend or relative in the 6 months before onset (β = −0.2435), family history of suicide (β = −0.1385), schizotypal personality traits (β = −0.1055) and irritable temperament (β = −0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575).

The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD.

To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention.

The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4–6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress.

Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers.

A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

Patients with alcohol use disorder (AUD) are at high risk for suicide attempts. Mental health problems along with AUD-related factors may contribute to this increased risk. Studies have shown sex differences in rates and correlates of suicide attempts.

The purpose of the study was to examine mental-health-related and AUD-related factors associated with suicide attempt separately in female and male AUD patients.

We collected information about lifetime suicide attempt and mental-health- and AUD-related factors for AUD in-patients (n = 114; 32 females) receiving rehabilitative treatment.

The prevalence of lifetime suicide attempt was 27%, and the rate was similar in both sexes. Among females, current depressive symptoms and current post-traumatic stress disorder diagnosis were associated with suicide attempt. In male AUD patients, among the mental-health-related factors, lifetime major depression, panic disorder, social phobia, childhood sexual abuse and antisocial personality disorder were associated with suicide attempt. In addition, AUD-related factors including longer duration of drinking, history of delirium tremens, greater severity of AUD and lower levels of prolactin were associated with suicide attempt in males.

Our results indicate that suicide attempts in female AUD patients were more mental-health-related, whereas those in males were also related to the severity of AUD. This suggests that a suicide prevention programme for AUD patients would benefit from a sex-based understanding of the risk factors.