It is commonly assumed that single doctors are more focused on career progression than doctors in a relationship/ or having dependents. In this study, we tried to find out if it's true. We measured this among doctors in Psychiatry (from training – to consultants’ level) across Wales.

We designed an anonymized online survey and distributed it among Psychiatry doctors.

We categorized the relationship status as

1. a. Single

2. b. In a relationship – committed, engaged, married, living together

3. c. Separated, Divorced, Widowed

4. d. Others

1. 1. Why they were interested in Psychiatry

2. 2. Number of years taken to complete or intending to complete training.

3. 3. Having met the portfolio criteria for their level.

4. 4. Undertaking RCPsych Exams

5. 5. Having missed any opportunities related to career.

The survey included questions that measured the link between career progression/choices and relationship Status/responsibilities. We used the Likert Scale, yes or no questions, and free text boxes.

We received 66 responses and we divided them into three groups according to their relationship status which are the single group, relationship group, Divorced/ Separated/ Widowed group, and compared the results between them. We got some interesting results as follows.

• ◦ Single participants seem to be less limited in choosing the specialty, Exam Preparation, and overall career progression.

• ◦ A significant proportion of people in relationships felt limited in choosing the Specialty and workplace. Had less time for Exam preparation and have missed career opportunities.

• ◦ Females in Relationships were more restricted.

• ◦ The divorced / Separated / Widowed group did not feel limited, however, affected their exams, and have missed opportunities.

Single doctors seems to have overall better opportunities in career progression compared to people in relationship. However, our sample size was small especially in single group. A bigger study is needed to conclude the impact of relationship in career progression.

The COVID-19 pandemic has had profound consequences for population mental health. However, it is less clear for whom these effects are sustained.

To investigate the prevalence, incidence, prognosis and risk factors for symptoms of depression and anxiety in a UK cohort over three distinct periods in the pandemic in 2020.

An online survey was completed by a UK community cohort at three points (n = 3097 at baseline, n = 878 completed all surveys): April (baseline), July to September (time point 2) and November to December (time point 3). Participants completed validated measures of depression and anxiety on each occasion, and we prospectively explored the role of sociodemographic and psychological factors (loneliness, positive mood and perceived risk of and worry about COVID-19) as risk factors.

Depression (Patient Health Questionnaire-9 means: baseline, 7.69; time point 2, 5.53; time point 3, 6.06) and anxiety scores (Generalised Anxiety Disorder-7 means: baseline, 6.59; time point 2, 4.60; time point 3, 4.98) were considerably greater than pre-pandemic population norms at all time points. Women reported greater depression and anxiety symptoms than men. Younger age, history of mental health disorder, more COVID-19-related negative life events, greater loneliness and lower positive mood at baseline were all significant predictors of poorer mental health at time point 3.

The negative impact of the COVID-19 pandemic on mental health has persisted to some degree. Younger people and individuals with prior mental health disorders are at greatest risk. Easing of restrictions and resumption of social interaction could mitigate the risk factors of loneliness and positive mood.

Bipolar disorder is a chronic mental disorder related to cognitive deficits. Low serum vitamin D levels are significantly associated with compromised cognition in neuropsychiatric disorders. Although patients with bipolar disorder frequently exhibit hypovitaminosis D, the association between vitamin D and cognition in bipolar disorder, and their neuroaxonal integrity, is unclear.

To investigate the interaction effects between vitamin D and neurofilament light chain (NfL) levels on cognitive domains in bipolar disorder.

Serum vitamin D and NfL levels were determined in 100 euthymic patients with bipolar disorder in a cross-sectional study. Cognitive function was measured with the Brief Assessment of Cognition in Affective Disorders. We stratified by age groups and used general linear models to identify associations between vitamin D and NfL levels and their interaction effects on cognitive domains.

The mean vitamin D and NfL levels were 16.46 ng/nL and 11.10 pg/mL, respectively; 72% of patients were vitamin D deficient. In the older group, more frequent hospital admissions and lower physical activity were identified in the group with versus without vitamin D deficiency. The age-modified interaction effect of vitamin D and NfL was associated with composite neurocognitive scores and verbal fluency in both age groups, and with processing speed domain in the younger group.

We observed a high vitamin D deficiency prevalence in bipolar disorder. We identified the interaction of vitamin D and NfL on cognitive domains, and the effect was modified by age. Longitudinal or randomised controlled studies enrolling patients with various illness durations and mood statuses are required to validate our findings.

Although recent reports suggest that service users in West African psychiatric facilities are exposed to poor quality of care and human rights violations, evidence is lacking on the extent and profile of specific deficits in the services provided to persons with mental health conditions.

To evaluate the quality of care and respect of human rights in psychiatric facilities in four West African countries, The Gambia, Ghana, Liberia and Sierra Leone, using the World Health Organization QualityRights Toolkit.

Trained research workers collected information through observation, review of records and interviews with service users, caregivers and staff. Independent panels of assessors used the information to assign scores to the criteria, standards and themes of the QualityRights Toolkit.

The study revealed significant gaps in these facilities. The rights to an adequate standard of living and to enjoyment of the highest attainable standard of health were poorly promoted. Adherence to the right to exercise legal capacity and the right to personal liberty and security was almost absent. Severe shortcomings in the promotion of the right to live independently and be included in the community were reported.

Inadequate appreciation of service users’ rights, lack of basic approaches to protect them and the non-promotion of rights-based services in these facilities are major problems that need to be addressed. Although it recognises the resource constraints and need for more human and financial resources, the study also identifies critical areas and challenges that require significant changes at the facility level.

There is a need to investigate how adopting different strategies for treating obesity in different countries in the European Union affects the psychological well-being of patients.

The aim of this study was to perform a comparative evaluation of psychiatric symptoms (depression, anxiety and stress) in patients undergoing bariatric surgery versus patients receiving conservative treatment for morbid obesity in Poland and Germany.

A multicentre international prospective cohort study with 155 patients who underwent bariatric surgery and 409 patients who received conservative weight reduction treatment. Evaluation of the psychiatric symptoms was carried out for each patient at baseline and after 12 months of active treatment using a standardised Depression Anxiety Stress Scale questionnaire (DASS-21) questionnaire.

After 12 months of active treatment, the level of psychiatric symptoms (depression, anxiety and stress) significantly decreased in both groups of patients: surgically treated versus conservatively treated patients from Poland and also from Germany. The median change in level of psychiatric symptoms among patients from both countries was significantly higher among surgically treated patients compared with conservatively treated patients (Poland P < 0.0001; Germany P < 0.0001). Improvements in the patient's mental health as a consequence of treatment were dependent on the specific strategy for treating obesity adopted in the analysed countries, the percentage of total weight loss and on gender.

The use of bariatric surgery in both Poland and Germany compared with non-surgical treatment for obesity resulted in more measurable benefits in the form of a decrease in psychiatric symptoms (depression, anxiety and stress) and reduction in body weight.

Individuals with intellectual and developmental disability (IDD) can have a high prevalence of pain, which can be managed with prescription opioids. However, the prevalence of substance use disorder is also high in this population, raising concern about opioid-related adverse events.

To assess the risk of opioid-related adverse events following opioid initiation among adults with versus without IDD.

We conducted a population-based, propensity score matched cohort study on all adults starting prescription opioid therapy in Ontario, Canada, between January 2013 and December 2018. The outcomes of interest were opioid toxicity, new opioid use disorder (OUD) diagnosis and dose escalation (≥90 mg morphine or equivalent) in the year after opioid initiation. We used Cox proportional hazards models to assess the association between IDD diagnosis and each outcome.

The hazards of opioid toxicity and OUD were significantly higher in those with IDD compared with those without IDD in unmatched analyses (opioid toxicity hazard ratio 3.19, 95% CI 2.81–5.18; OUD hazard ratio 2.36, 95% CI 2.10–2.65), whereas the hazard of dose escalation was significantly lower (hazard ratio 0.76, 95% CI 0.66–0.88). Findings were no longer significant in propensity score matched models for opioid toxicity and dose escalation, whereas the hazard of OUD diagnosis was attenuated substantially in those with IDD (hazard ratio 0.79, 95% CI 0.68–0.91).

IDD diagnosis is not a driver of opioid-related harm. The increased risk we observed is likely driven by various risk factors often present in this population.

Assess and improve the educational supervision for the core psychiatry trainees (CT) in the west midlands.

The data were collected from core psychiatry trainees in West Midland (CT1 – 3) through a Microsoft form sent via the Faculty support team and data are collected (June 2021) from CT's perspective. It involved demographics and questions evaluating quantitative and qualitative overview of educational supervision. We used HEE guidelines and RCPsych recommendations. Similarly, we used a modified questionnaire to anonymise educational supervisors’ (ES) perspectives in the West Midlands School of psychiatry annual Education day conference (January 2022).

Trainees Perspective: 40% out of 123 trainees responded, of which 35% were CT1, 40% were CT2, and 25% were CT3. 59% said that CT in psychiatry was their first training job in the UK. In the quantitative overview, 25% of the trainees responded their 1st contact with their ES was more than six weeks after beginning their 1st post, and 29% expressed their 1st meeting more than six weeks following the start of their 1st post in the academic year. 67% met adequate standards in the quantity of educational supervision in an academic year. In qualitative overview, 19% didn't understand the role of ES, and 54% didn't know how to raise concerns about ES. The thematic analysis of the feedback suggested points of improvement as supervisions not being ‘tick-box’ exercises and accessibility of ES.

The trainer's perspective: 60% of attendees responded, 71.4% were ES. All the responding ES answered that they would arrange their 1st meeting six weeks before the start of the academic year. Almost all suggested the most common difficulty in educational supervision as availability of time, considering clinical workload for both ES and CTs. All respondents knew that the number of meetings would be as many as trainees wanted in an ideal/needful situation. From the thematic analysis of free text, almost all responded lack of time was a barrier in providing the supervision reflecting on their ability to engage with the trainees.

Suggested recommendations were to raise awareness among the trainees through workshops at induction to explain the aim and objective of educational supervision and to have a guided list of suggested topics to discuss in supervision. For trainers, further training about HEE & RCPsych guidance about Educational supervision would be helpful. Educational leads need to engage in job planning. A comparison between Trainees and trainers feedback through the GMC survey may help to compare with the national picture.

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 Royal College of Psychiatrists census (2019) highlighted that 10% of all consultant psychiatrist roles remain unfilled. This pattern is replicated elsewhere in the UK with 7.8% in Northern Ireland, 9.6% in Scotland and 12.7% in Wales. This increase in consultant vacant posts is indicative of the recruitment challenges to psychiatry. On the other hand, the 2017 New Zealand Medical Workforce survey report showed recruitment to psychiatry was up by 8.2% in 2018 compared to 2017. I conducted a qualitative comparison study to look at psychiatry trainee views regarding their training in a UK and New Zealand deanery at similar stages of their psychiatric training.

Questionnaires were distributed to current psychiatry trainees in the Capital and Coast District Health Board (CCDHB) based in Wellington, New Zealand and Birmingham and Solihull Mental Health Foundation Trust (BSMHFT), UK who were between years 1–3 of their psychiatry training. Qualitative information was collated from the questionnaires regarding various aspects of their training. Areas of focus were; pros and cons of psychiatry training, suggestions for improvements, supervision, access to annual leave and study leave, teaching, encouragement to attend courses and involvement in research.

Of the 33 current trainees working in CCDHB, 48% were immigrants from the UK, previously having worked in the NHS.

17% of BSMHFT trainees felt valued in their organisation, compared to 64% in New Zealand.

27% in New Zealand considered switching to another training programme, whereas none considered switching in the UK. Burn out was quoted as a problem in both New Zealand and the UK. 100% were able to take annual leave with ease in New Zealand, compared to 0% in BSMHFT.

This small study gives a closer insight into the views of trainees in New Zealand, a place often thought as being more attractive for doctors to work in. What this study shows is 2 key factors; there are shocking differences in the quality of trainee experiences between New Zealand and the UK, however New Zealand is not free from issues around trainee retention, although the study does show overall trainee satisfaction being greater in New Zealand. Feeling valued, supported and leading a life with better work-life balance appear to be key driving factors for UK graduates leaving the UK and there is more that could be done to make trainees in the UK feel more valued and prevent burn out.

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.

The COVID-19 pandemic highlighted a greater need for multidisciplinary input for psychiatric patients with complex physical comorbidities at Reaside Forensic Medium Secure clinic. It was also felt that junior doctors would benefit from support in managing complex physical health matters as well as issues arising whilst on-call in order to improve morale and support their educational needs. We aimed to add to existing services by offering junior doctors a regular discussion group (Physical Health Huddle) to support with complex cases, share different perspectives on patient treatment and open conversation regarding issues arising whilst on-call. We further hoped to improve communication, provide education for junior trainees with limited experience of forensic psychiatry and support their involvement in patient care and multi-disciplinary meetings.

Junior doctors were invited to a monthly informal Huddle (in person and online) and supported to propose patients for discussion. A proforma was supplied to assist. The junior doctor presented the summary and following discussion we explored various ideas on how to manage the patient's physical health. Feedback was provided to the patient teams afterwards and short before and after questionnaires were used to monitor effectiveness and collect feedback.

The result showed a significant increase in support felt and individual feedback highlighted the need to continue this effort. The Huddle therefore provided a safe reliable space to freely discuss concerns regarding the day-to day management or escalation of complex physical health issues on psychiatric wards as well as on-call.

The Huddle successfully created a sustainable, effective and interactive short learning session which has shown to be effective in engaging trainees in this vital area and help us meet our aim. This format further has the potential to be refined and rolled out to a wider audience in the future to improve learning throughout the trust regarding physical health matters.

In 2021, we completed a project entitled: ‘Stigma Towards Psychiatry: Correlating Personal Experience with Existing Literature’ – ‘International Congress Award Winning’. We aim to use the themes generated from this to inform recommendations to medical educators to reduce stigma in their curricula towards psychiatry.

Using previously identified themes, we generated a set of recommendations aimed at the pre-admission, pre-clinical and clinical phases of learning. Pre-admission themes include: misconceptions of the role of the psychiatrist and disinterested medical applicants. Pre-clinical themes include: dissociation of psychiatry from medicine and clinical role modelling. Our final category, clinical, includes: cross-speciality support for psychiatry, pathophysiology in de-stigmatisation of psychiatric disease, discrimination of the aspiring psychiatrist, psychiatric exposure in training not seeing conversion of students to psychiatrists and the role of unofficial mentors in continuing enthusiasm for the speciality. Division in this way gave us multiple opportunities to look for areas of potential intervention in influencing medical student's views on psychiatry. Further influencing our recommendations was the feedback from a group of consultant psychiatrists this project was presented to.

Addressing the themes driving stigma from the previous project saw us producing a list of recommendations targeted at each phase of medical school. (1) Pre-admission stage: selecting candidates who are more psychologically minded by recognition of A level psychology as a core subject; encouraging people with experience in mental health settings to apply for medical training (Srivastava et al, 2018); highlighting psychiatry as a medical career in the prospectus. (2) Pre-clinical stage: making students aware of their unconscious stigma towards psychiatry; clearer links made to psychiatry in early medical school to relevant biochemistry, anatomy, physiology and pharmacology (Mahli et al, 2003); tutor / doctor led psychiatry based extracurricular groups; highlighting mental health aspects of functional neurological disorders and disorders within rheumatology such as fibromyalgia. (3) Clinical stage: making clinicians aware of their unconscious stigma towards psychiatry; encouraging cross-speciality support for psychiatry; improving contact with psychiatrists on mental health placements (Archdall et al, 2013).

Stigma towards psychiatry extends from medical school and into clinical practice. It feels important that medical school curricula should be altered in order to change students’ experience of psychiatry within medical school. The recommendations target each stage the themes were identified within. Our local medical school has agreed to let us present this at their curriculum meeting which may pave the way for further refinement and implementation of our suggestions.