Sleep problems associated with poor mental health and academic outcomes may have been exacerbated by the COVID-19 pandemic.

To describe sleep in undergraduate students during the COVID-19 pandemic.

This longitudinal analysis included data from 9523 students over 4 years (2018–2022), associated with different pandemic phases. Students completed a biannual survey assessing risk factors, mental health symptoms and lifestyle, using validated measures. Sleep was assessed with the Sleep Condition Indicator (SCI-8). Propensity weights and multivariable log-binomial regressions were used to compare sleep in four successive first-year cohorts. Linear mixed-effects models were used to examine changes in sleep over academic semesters and years.

There was an overall decrease in average SCI-8 scores, indicating worsening sleep across academic years (average change −0.42 per year; P-trend < 0.001), and an increase in probable insomnia at university entry (range 18.1–29.7%; P-trend < 0.001) before and up to the peak of the pandemic. Sleep improved somewhat in autumn 2021, when restrictions loosened. Students commonly reported daytime sleep problems, including mood, energy, relationships (36–48%) and concentration, productivity, and daytime sleepiness (54–66%). There was a consistent pattern of worsening sleep over the academic year. Probable insomnia was associated with increased cannabis use and passive screen time, and reduced recreation and exercise.

Sleep difficulties are common and persistent in students, were amplified by the pandemic and worsen over the academic year. Given the importance of sleep for well-being and academic success, a preventive focus on sleep hygiene, healthy lifestyle and low-intensity sleep interventions seems justified.

This study aimed to determine the prevalence of problematic mobile phone use and its association with the chronotypes among the doctors of a medical college hospital in Puducherry, India. It also aimed to assess the feasibility of the University of Rochester Modified CAGE Questionnaire as a brief screening tool for problematic mobile phone use.

This cross-sectional study was conducted at a tertiary care teaching hospital in South India. After obtaining the Institutional ethics committee approval, doctors including consultants, higher trainees, core-trainees, and junior doctors working in various departments were approached and requested to participate in the study. Those who agreed were provided with the participant information sheet and written informed consent was obtained. Part-A of the questionnaire contained requests for personal and professional details and part B had the following questionnaires to assess problematic mobile phone use, chronotypes, phantom ringing and vibration and, sleep quality.

• • Problematic use of mobile phone scale (PUMP)

• • Reduced Morningness Eveningness Questionnaire (r MEQ)

• • Questionnaire for Phantom ringing and Phantom vibration

• • The Pittsburgh Sleep Quality Index (PSQI)

• • University of Rochester Modified CAGE Questionnaire

• • Data were analysed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). Nonparametric tests were used as the data were skewed. The data were summarized by frequencies and percentages for categorical variables and median and interquartile range for continuous variables. The chi-square test was used to find the association between two categorical variables. Kruskal Wallis test was used to compare the chronotype with the continuous variables such as CAGE total, PUMP, and PSQ score. Correlation between different continuous variables was studied by using Spearman rank correlations. Kappa statistics were used to evaluate the concordance between PUMP and the University of Rochester Modified CAGE questionnaire.

Neither type (NT) was the most common chronotype (41.5%), followed by morning type (38%) and evening type (20%). Eight (5.6%) doctors had problematic mobile phone use, and 38(26.8%) had poor sleep quality. Evening chronotype (p-value- 0.002), being a female (p-value- 0.014), working in a clinical department (p-value 0.017) and experiencing phantom ringing (p-value- 0.001) had significant association with higher PUMP score. Even though females had a higher median PUMP score, problematic mobile phone use was more among males. University of Rochester Modified CAGE Questionnaire had a sensitivity of 81.73% (73–88.6%), and a specificity of 28.95% (15.4–45.9%).

Doctors should be aware of their mobile phone usage. This study has reiterated the predilection evening chronotype has for behavioral addictions and doctors of evening type should be extra cautious.

There has been a significant change in the way we see patients during psychiatric consultations, this has led to challenges we face in delivering safe and effective care to patients under our care. “Telepsychiatry” has been used in literature from countries like Australia and India, there is very little around coming from the UK but there appears to be many ongoing research making the rounds. It is interesting to know that the existing literature on remote/virtual consultations during the COVID-19 pandemic are on the rise. The idea of this study was conceived during outpatient clinics after making an observation that many patients were likely to miss their appointments when they had telephone appointments compared to video consultations. This prompted a study to know if this is more likely to be observed in other outpatient clinics. The purpose of this study was to establish if virtual/remote consulting has affected patient attendance rate and whether this is also affected by the type of virtual consultation.

The data were collected using the “2020 stats sheets” for inpatient appointments between North Fife consultants from January to October 2020. This was registered with the NHS Fife clinical effectiveness team in January 2021.

The results were categorized for the purpose of this survey as January – March (Pre-lockdown) and April – October (lockdown). It is important to note that some face-to-face appointments occurred during lockdown because there were emergency assessments and drug monitoring appointments scheduled.

The results of this survey showed that there was a clear reduction in clinic appointments made during lockdown compared to pre-lockdown and slight observable improvement in attendance rates during the lockdown. There was no statistical significance seen using t-test comparing attendance rates between video and telephone consultations including new patient virtual consultations.

The large sample size over this period suggests that the results are reliable and valid, we can therefore say virtual/telephone consultation does not affect attendance. It should be noted that the attendance rate may be a good indicator but we should also consider patient/clinician satisfaction, communication quality/effectiveness and other factors which could influence patient's compliance to outpatient follow-up. It is important to acknowledge the lack of a control group and the COVID-19 pandemic were major cofounding factors. Mental health services should continue the use of virtual consultation post-pandemic and possibly integrate it with in person consultations (hybrid), this may help with attendance rate of patients with difficulty attending face-to-face appointments.

To evaluate compliance within a Community Mental Health Team (CMHT) to the NICE guidelines for the management of depression.

Reducing the prevalence of depression continues to be a major public health challenge.

Given the complexity and recurrent nature of the condition, the NICE guideline CG90 is an invaluable resource to aid the effective management of depression. Here we present an audit of adherence to this guideline within a CMHT.

A retrospective electronic casenote review of all patients diagnosed with depression between January 2016 and October 2019 under the care of a Birmingham CMHT (n = 35), assessing key performance areas including: quality of assessment and coordinated care, risk assessment, choice of pharmacological and psychological treatment using the stepped care model and appropriate crisis resolution planning.

Key results include:

• The majority of patients were Caucasian (63%). Ages ranged from 27 to 69 (mean age 48 years old).

• Severity of disorder was typically moderate (46%) or severe (48%). Of those with a diagnosis of severe depression, 41% had associated psychotic symptoms.

• Psychiatric comorbidity was high (49%), of which generalised anxiety disorder was the most common (59%).

• Referrals were typically from primary care (77%). Approximately half (51%) had reported suicidal thoughts according to the referral.

• A quarter of patients (26%) were seen by CMHT within 8 weeks of referral; 20% of referrals however waited over 12 months before being assessed.

• Risk assessments were out of date for 71% of patients.

• 100% of patients had a crisis plan noted within their most recent clinic letter; however, none of these met the required standards.

Over half of patients (60%) had been referred to psychology services; of these, 38% had either completed or were in ongoing treatment at the time of review.

CMHTs manage the care of individuals with depression who have high levels of active symptoms and disability, psychiatric comorbidity, care requirements, and complex treatment plans. Pharmacological management was broadly in line with guidelines, and rates of referral to psychology were satisfactory. Risk assessment and crisis planning are clear areas in need of urgent attention in order to comply with guidelines and ensure patient safety.

One of the effective interventions in reducing stress and burnout and increasing the job satisfaction and relationship of doctors is participation in Balint groups. The purpose of this study is to design, implement and evaluate the use of Balint groups in improving doctor-patient relationships among first-year psychiatry residents at the University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran.

This study was a pretest-posttest study conducted in 2022. First-year psychiatry residents at USWR were invited to join a Balint group through the Department of Psychiatry, and then they were called to attend an interview. During the interview, the inclusion and exclusion criteria for the study were reviewed. The requirements for participating in an online Balint group, including having a strong internet connection and the ability to work and communicate properly with the group, as well as ethical considerations such as the ability to keep confidential information within the group were examined.

12 group meetings were held for 6 months. The group leader had previously led various Balint groups for medical staff. Due to the COVID-19 pandemic, the sessions were held online on Skype.

The participants completed the demographic information questionnaire, the Jefferson Scale of Physician Empathy, and the patient communication questionnaire before and after participating in the Balint group. Next, data analysis was done using SPSS software version 25.

The average (standard deviation) age of the participants in the study was 30.70 (±4.54) years. Ten Participants included both male and female first-year psychiatry residents, eight of which were females, and eight were married. They all worked at the university. 70% had a high interest and 30% had an average interest in their field. Intra-group comparisons using the paired t-test showed that the the participants’ scores in the following areas significantly increased after the intervention: verbal communication skills (t=−6.26, P < 0.001), non-verbal communication skills (t=−9.76, P < 0.001) and total communication skills (t = −5.72, P <0.001). Also the results showed a significant increase in the scores of the Jefferson Scale of Physician Empathy after the intervention (t =−10.67, P < 0.001).

The results of the present study showed that participating in Balint group work can have a significant effect on the communication skills and the level of empathy among psychiatry residents. The results of this study are in line with Parker and Leggett's study (2012) and confirm the effectiveness of the Balint group work . Also, the results of this study are consistent with the studies of Airagnes et al. (2014) and Gajree (2021) and show that adding the Balint group work to the Iranian psychiatry residency curriculum can be useful.

Balint group work, psychiatry residency, doctor-patient relationship, empathy.

Bedside teaching is one of the most important modalities in medical education. Sir William Osler stated, “Medicine is learned by the bedside and not in the classroom”. Despite this, the use of bedside teaching in the undergraduate curriculum has been declining, potentially due to changes in course design, increasing clinical workloads and reducing inpatient numbers. In my role as a Clinical Teaching Fellow (CTF), I have aimed to maximise bedside teaching and promote it as the primary approach for student learning.

As a CTF, I deliver teaching to students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. Weekly teaching is provided to groups of 2-4 students, with around 50% of sessions delivered ‘at the bedside’.

Within psychiatry, there is a vast range of potential bedside teaching topics. Given the length of time required to conduct a full psychiatric history and mental state examination (MSE), teaching sessions instead focus on one specific component of the patient interview, for example, assessing perceptual abnormalities or delusions, conducting a substance use history or exploring social circumstances and the functional impact of illness. This approach allows for more focussed feedback and teaching. Session structure is based upon Cox's model of bedside teaching, which I have modified slightly for the psychiatry setting.

Student feedback has been collected via an anonymous electronic end-of-block questionnaire.

Qualitative feedback reveals that students in NHS Lanarkshire value bedside teaching, with one student describing it as “informative, comprehensive and relevant for upcoming exams and clinical practice”.

There are a number of potential barriers to consider when delivering bedside teaching in psychiatry. These include issues identifying suitable patients who can provide informed consent to participate and the ethical concerns regarding exploring difficult subjects such as suicide risk assessment with patients for purely educational purposes.

These issues can be overcome; in inpatient units, there is usually a small cohort of patients who are able to consent and engage in student teaching, and difficult subjects can alternatively be addressed during role-play or simulation sessions.

Despite its challenges, bedside teaching can be an enjoyable and rewarding approach in undergraduate medical education, with feedback revealing it is positively received in NHS Lanarkshire. By utilising Cox's model and focussing on specific aspects of MSE and history-taking, bedside teaching is more accessible and an invaluable tool for psychiatric teaching. Clinicians and educators are encouraged to keep the patient at the centre of student learning.

Fruit and vegetable intake may improve sleep.

To assess the relationship between fruit and vegetable intake and sleep quality in a longitudinal study.

We analysed longitudinal data from two consecutive population surveys of adults in Agincourt, South Africa (2014–2015 and 2018–2019).

In total, 331 of 2975 participants without poor sleep quality in Wave 1 (11.1%) had incident poor sleep quality in Wave 2, and 270 of 3546 participants who had poor sleep quality in Wave 1 (7.6%) had poor sleep quality in both Waves 1 and 2 (persistent poor sleep quality). The prevalence of poor sleep quality at baseline was 17.2%. In the fully adjusted model for people without poor sleep quality at baseline, higher fruit and vegetable consumption (≥5 servings/day) was positively associated with incident poor sleep quality among men (AOR = 1.43, 95% CI 1.51–2.01) but not among women (AOR = 1.09, 95% CI 0.78–1.46). Two or more servings of fruits were positively associated with incident poor sleep quality among men (AOR = 3.35, 95% CI 1.96–5.72) and among women (AOR = 1.84, 95% CI 1.15–2.94). No models among men and women showed a significant association between vegetable intake and incident poor sleep quality or between fruit and vegetable intake, vegetable intake and persistent poor sleep quality. Fruit intake (one serving) was positively associated with persistent poor sleep quality among men (AOR = 1.76, 95% CI 1.00–3.08) but not among women (AOR = 1.42, 95% CI 0.93–2.18).

Higher fruit and vegetable intake was independently associated with poorer sleep quality among men but not women, and higher fruit but not vegetable intake was associated with poorer sleep quality among both men and women.

A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency.

We aimed to investigate the interrater reliability of the HoNOSI.

Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes.

Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7).

There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems.

To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary.

Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary.

The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary.

Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.

Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.

To investigate the clinical and cost-effectiveness of IST models.

We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.

We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable.

The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

Physiological brain function depends on tight glucose regulation, including transport and phosphorylation, the first step in its metabolism. Impaired glucose regulation is increasingly implicated in the pathophysiology of Alzheimer's disease (AD). Glucose hypometabolism in AD may be at least partly due to impaired glucose transport at the blood-brain barrier (BBB). Glucose transporters (GLUTs) are an integral component of the BBB. There is evidence of a significant reduction in vascular and non-vascular forms of GLUT1 and GLUT3 in AD brains compared to age-matched controls. Glucose transport, as well as phosphorylation, appears to be a rate limiting step for glucose metabolism in the brain. We have reviewed the literature on glucose transport abnormalities in AD and the effect such abnormalities have on the brain.

Published literature between 1st January 1946 and 1st November 2019 was identified using EMBASE and MEDLINE databases and titles and abstracts were scanned. Human studies (autopsy and imaging) and data from animal models were included while reviews, letters and cellular or molecular studies were excluded from the search.

Autopsy studies in AD patients show significant reductions in GLUT3 in areas of the brain closely associated with AD pathology. Patients with AD and diabetes showed greater reductions of GLUT1 and GLUT3. A longitudinal study showed significant reductions in GLUT3 levels which correlated with greater amyloid-β (Aβ) and neurofibrillary tangle pathological burden in participants with AD pathology at post-mortem but without evidence of cognitive dysfunction in their lifetime. Some studies showed increased GLUT1, with others showing reduced GLUT1, levels in AD brain. A newly recognised GLUT12 appears to be increased in AD. Animal studies showed similar results with GLUT1 and GLUT3 knockout animal models exhibiting AD pathology, while overexpression of GLUT1 or treatment with metformin decreased Aβ toxicity in a Drosophila model of AD. GLUT2 levels were increased in both human AD brain and in an animal model of AD. Imaging studies using fluorodeoxyglucose [18F]FDG with positron emission tomography (FDG-PET) in AD subjects show reductions in glucose transport and glucose metabolism in areas most affected in AD. A small randomised control trial showed anti-diabetic medications improved the glucose transport in AD subjects.

GLUTs play a significant role in AD pathology with evidence suggesting that GLUT3 reductions may precede the onset of clinical symptoms, while GLUT2 and GLUT12 may have a compensatory role. Repurposing anti-diabetic drugs shows promising results in both animal and human studies of AD.

The Dynamic Appraisal of Situational Aggression (DASA) is one of a few instruments designed for the prediction of violence specifically for inpatient populations. It is important that risk assessment tools demonstrate clinical utility, and that barriers to successful implementation are addressed. If successful, the tool should not only predict risk, but lead to the utilisation of interventions intended to manage and reduce risk. The aim of this study is to learn more about the acceptability of the tool (adherence), it's outputs (nursing interventions), and the outcomes (inpatient aggression and violence). Understanding more about the relationship and processes between an intervention and its outcomes is a key step in intervention evaluation.

Data were collected over a three-month period within a medium secure forensic hospital. A total of 43 patients were included for analysis.

Categories of nursing intervention were coded and content analysis of electronic health records analysed. Incidents of aggression/violence to others was recorded as aggression to patient and aggression to staff. Data were gathered on the completion of the DASA score for all patients for each 24-hour period. A DASA score of 2–3 for moderate risk and ≥4 for high risk was used. The change in DASA score (before and after intervention) and frequency of incidents was calculated for each intervention implemented.

The average adherence of the DASA tool was 58.82% (Range 1.09% - 90.02%). The most frequent intervention following a moderate and high DASA score was that no interventions were provided. The second most frequent outcome following a high score was a focussed discussion with the patient, the use of increased monitoring and the use of seclusion. For those patients that recorded a high score on the DASA tool, eight of those scores were followed by an incident of aggression (n = 8 / 50%). There was no statistically significant difference between the change in DASA scores between interventions implemented, for both high and moderate scores.

The ultimate goal of risk assessment is the management and prevention of risk. Thus, if a high score does not result in strategies for intervention, it renders the assessment process worthless. A recommendation for future clinical practice would be the systematic recording of interventions and risk management strategies when in receipt of a high score on the DASA. Greater operationalisation of risk management strategies and their ability to reduce aggression is needed to enhance risk assessment research and clinical practice.

Young people's mental health and well-being is an important concern in the UK. Provision of education and support to schools has been highlighted as an area for improvement; however, evidence-based programmes are scarce and costly.

To provide an acceptable education programme to improve pupils' confidence and knowledge of mental health and well-being. It covered the mental and emotional well-being outcomes set by the Scottish Government in their schools' curriculum.

Lessons were designed by A.P. and delivered by volunteer doctors and medical students, and supervised by a psychiatrist. Outcomes were measured using questionnaires before and after lessons with optional comments.

PsychEd was piloted in 2016 in six schools to pupils between the ages of 11 and 18. There was a statistically significant improvement in pupil confidence and knowledge after the lessons (P < 0.001). Of the pupils 84% felt that having lessons on mental health was useful. Qualitative feedback was also collected and coded into positive, constructive and negative comments. In total, 72% of pupil comments were positive.

PsychEd showed promising results. Future areas of development include reaching a greater number of local authority schools, longer training for volunteers and provision of teaching materials to teachers for their own use.

None.

Deep brain stimulation (DBS) has been proposed to improve symptoms of obsessive–compulsive disorder (OCD) but is not yet an established therapy.

To identify relevant guidelines and assess their recommendations for the use of DBS in OCD.

Medline, Embase, American Psychiatric Association PsycInfo and Scopus were searched, as were websites of relevant societies and guideline development organisations. The review was based on the PRISMA recommendations, and the search strategy was verified by a medical librarian. The protocol was developed and registered with PROSPERO (CRD42022353715). The guidelines were assessed for quality using the AGREE II instrument.

Nine guidelines were identified. Three guidelines scored >80% on AGREE II. ‘Scope and Purpose’ and ‘Editorial Independence’ were the highest scoring domains, but ‘Applicability’ scores were low. Eight guidelines recommended that DBS is used after all other treatment options have failed to alleviate OCD symptoms. One guideline did not recommend DBS beyond a research setting. Only one guideline performed a cost-effectiveness analysis; the other eight did not provide details on safe or effective DBS protocols.

Despite a very limited evidence base, eight of the nine identified guidelines supported the use of DBS for OCD as a last line of therapy; however, multiple aspects of DBS provision were not addressed.

Looked after children (LAC) are one of the most vulnerable groups in our society. Often, after experiences of neglect and abuse, they are more likely to experience poor mental health, attachment difficulties and problems in educational progress. This review aims to explore literature published over the past decade which addresses the mental health needs and management of LAC within CAMHS in the UK.

A literature review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 structure. Selection criteria was used. The total number of papers identified after this initial search was thirty-six across the database.

Literature titles and abstracts were then screened to exclude papers with an irrelevant focus. Full-texts of the remaining twenty-two papers were then assessed for relevant and conclusive information. The total number of full papers included in the research was thirteen.

To analyse the literature identified, a framework of three themes has been highlighted. These include:

• • the mental health needs of LAC,

• • factors relevant to the assessment of LAC in mental health services

• • considerations associated with the management of LAC with mental health conditions.

Mental health needs of LAC included numerous emotional, behavioural and social problems. These were largely focused around substance misuse, emotional disorders and poor relationships with peers.

The main themes which have come out of research in relation to the treatment of LAC include:

• • the importance of supporting healthy social relationships with primary care-givers, peers and teachers

• • maximising the informal support of family, friends and pets

• • the provision of early, holistic and flexible mental health services, rather than disjointed agencies

The literature published over the past decade has indicated the great number of adverse outcomes amongst LAC and has made useful suggestions for the assessment and treatment of these children within a CAMHS setting.

Through targeted support into residential placements, offering intensive and direct psychological input at an early stage and continuing even after they have been adopted, as well as, working alongside schools to promote peer interaction could significantly reduce the adverse outcomes of LAC.

Additionally, by referring patients along with their carers for psycho-education can be extremely beneficial. Alongside this, the young people ought to be directed to support groups with other LAC to meet peers who are in similar situations as themselves.

To compare the Emergency Department (ED) referrals to psychiatry in a suburban versus an urban setting over a one-month to evaluate mental health presentations characteristics across two locations.

This study was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre over one month; - one based in an inner-city setting, the other based in a suburban area outside the city. The anonymised data were collected from both hospital's electronic patient records and analysed. The authors collected data on gender, age, employment, housing, the clinical problem at presentation, time of assessment and admissions. Descriptive data and hypothesis testing were performed where appropriate using Statistical Package for Social Sciences SPSS® version 26.

The total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29 years, compared with 28/104 (27%) of suburban presenters (P-value 0.0134). A higher number of presenters were aged over 60 years in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) (P-value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting (P < 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period, 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted to the inner-city centre and 13/104 (12.5%) patients admitted to the suburban centre (P-value 0.002).

A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs. The variance in capabilities of liaison psychiatry (LP) and ED services means the local population's needs may not always be adequately catered for within a typical LP setting, which in the Irish context is predominantly driven by medical and nursing staff. This study highlights many patients attend the ED who may be better assessed directly by the community as per our National Emergency Program policies. This prompts consideration of expanding both ED and community services to comprise a more integrated, multidisciplinary-resourced, 24/7 care model.

Modern psychometric methods make it possible to eliminate nonperforming items and reduce measurement error. Application of these methods to existing outcome measures can reduce variability in scores, and may increase treatment effect sizes in depression treatment trials.

We aim to determine whether using confirmatory factor analysis techniques can provide better estimates of the true effects of treatments, by conducting secondary analyses of individual patient data from randomised trials of antidepressant therapies.

We will access individual patient data from antidepressant treatment trials through Clinicalstudydatarequest.com and Vivli.org, specifically targeting studies that used the Hamilton Rating Scale for Depression (HRSD) as the outcome measure. Exploratory and confirmatory factor analytic approaches will be used to determine pre-treatment (baseline) and post-treatment models of depression, in terms of the number of factors and weighted scores of each item. Differences in the derived factor scores between baseline and outcome measurements will yield an effect size for factor-informed depression change. The difference between the factor-informed effect size and each original trial effect size, calculated with total HRSD-17 scores, will be determined, and the differences modelled with meta-analytic approaches. Risk differences for proportions of patients who achieved remission will also be evaluated. Furthermore, measurement invariance methods will be used to assess potential gender differences.

Our approach will determine whether adopting advanced psychometric analyses can improve precision and better estimate effect sizes in antidepressant treatment trials. The proposed methods could have implications for future trials and other types of studies that use patient-reported outcome measures.