Tackling Scotland's drug-related deaths and improving outcomes from substance misuse treatments, including residential rehabilitation, is a national priority.

To analyse and report outcomes up to 4 years after attendance at a substance misuse residential rehabilitation programme (Lothians and Edinburgh Abstinence Programme).

In total, 145 participants were recruited to this longitudinal quantitative cohort study of an abstinence-based residential rehabilitation programme based on the therapeutic community model; 87 of these participants were followed up at 4 years. Outcomes are reported for seven subsections of the Addiction Severity Index-X (ASI-X), together with frequency of alcohol use, heroin use, injecting drug use and rates of abstinence from substances of misuse.

Significant improvement in most outcomes at 4 years compared with admission scores were found. Completing the programme was associated with greater rates of abstinence, reduced alcohol use and improvements in alcohol status score (Mann–Whitney U = 626, P = 0.013), work satisfaction score (U = 596, P = 0.016) and psychiatric status score (U = 562, P = 0.007) on the ASI-X, in comparison with non-completion. Abstinence rates improved from 12% at baseline to 48% at 4 years, with the rate for those completing the programme increasing from 14.5% to 60.7% (χ2(2, 87) = 9.738, P = 0.002). Remaining abstinent from substances at follow-up was associated with better outcomes in the medical (U = 540, P < 0.001), psychiatric (U = 273.5, P < 0.001) and alcohol (U = 322.5, P < 0.001) subsections of the ASI-X.

Attending this abstinence-based rehabilitation programme was associated with positive changes in psychological and social well-being and harm reduction from substance use at 4-year follow-up, with stability of change from years 1 to 4.

Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people.

The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK.

Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach.

Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. ‘Behind self-harm’ refers to factors associated with self-harm and suicide. ‘Functions of self-harm’ captures the meaning attributed to self-harm and suicide. ‘Recovery from self-harm’ encapsulates personal and professional help, and practical suggestions for the improvement of mental health services.

Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.

There are few data on the profile of those with serious mental illness (SMI) admitted to hospital for physical health reasons.

To compare outcomes for patients with and without an SMI admitted to hospital in England where the primary reason for admission was chronic obstructive pulmonary disease (COPD).

This was a retrospective, observational analysis of the English Hospital Episodes Statistics data-set for the period from 1 April 2018 to 31 March 2019, for patients aged 18–74 years with COPD as the dominant reason for admission. Patient with an SMI (psychosis spectrum disorder, bipolar disorder) were identified.

Data were available for 54 578 patients, of whom 2096 (3.8%) had an SMI. Patients with an SMI were younger, more likely to be female and more likely to live in deprived areas than those without an SMI. The burden of comorbidity was similar between the two groups. After adjusting for covariates, SMI was associated with significantly greater risk of length of stay than the median (odds ratio 1.24, 95% CI 1.12–1.37, P ≤ 0.001) and with 30-day emergency readmission (odds ratio 1.51, 95% confidence interval 1.34–1.69, P ≤ 0.001) but not with in-hospital mortality.

Clinicians should be aware of the potential for poorer outcomes in patients with an SMI even when the SMI is not the primary reason for admission. Collaborative working across mental and physical healthcare provision may facilitate improved outcomes for people with SMI.

Adolescence is a pivotal stage vulnerable to mental health problems such as anxiety and depression. Although self-acceptance and social comparison are known to affect adolescent mental health, their interactive and moderating roles are not fully understood.

To explore the role of self-acceptance, social comparison and attributional style in predicting these mental health outcomes among adolescents in clinical settings.

A cross-sectional study was conducted on a sample of 242 adolescents. Participants completed measures assessing self-acceptance, social comparison, attributional style and mental health outcomes (depression and anxiety). Mediation models and multi-group analysis were used to examine the relationships among these variables.

Our findings demonstrated a significant relationship between self-acceptance, social comparison, depression and anxiety (rs = 0.32–0.88). Specifically, lower self-acceptance and higher social comparison were associated with higher levels of depression and anxiety. Additionally, individuals with external attributional tendencies reported higher depression (Cohen's d = 0.61) and anxiety (d = 0.58) compared with those with internal tendencies. Mediation modelling showed that social comparison is a mediator between self-acceptance and depression (effect size −0.04, 95% CI −0.08 to −0.01) and anxiety (effect size −0.06, 95% CI −0.10 to −0.02). Crucially, multi-group analysis showed that the impact of social comparison on mental health outcomes varied significantly based on attributional style.

These findings underscore the importance of considering self-acceptance, social comparison and attributional style in understanding and addressing mental health challenges during adolescence. This could inform the development of targeted interventions to promote mental health and well-being among adolescents. However, further research is needed to confirm these findings in diverse populations and to explore the underlying mechanisms in greater detail.

Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues.

To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy.

Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data.

Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The ‘healthy/normative’ trajectory had the largest sample size for all health indicators (73–86%). A stable (moderate) ‘ill health’ trajectory was identified for all health indicators (7–17%), except anxiety. An ‘improving’ trajectory was found for PTSD and anxiety symptoms (5–14%). A minority of staff (4–15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the ‘healthy’ trajectory. Female biological sex was associated with higher odds of belonging to the ‘worsening’ depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the ‘worsening’ depressive symptoms trajectory.

Most iHAWs stayed healthy during their assignment; a stable ‘ill health’ trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the ‘healthy’ profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs’ ability to remain healthy under stress.

To assess the effectiveness of a new educational activity for mental health teams, which is intended to empower staff in the early recognition, escalation and management of acute medical problems.

Health Education England (HEE) has recently developed a teaching resource named ‘Bitesized Teaching’, which spans 24 physical health topics that are commonly encountered in mental health settings. It provides doctors an evidence based framework to deliver a concise 10–15 minute teaching session on each topic at a convenient time and place for everyone. I organised weekly ‘Bitesized Teaching’ sessions for staff at a long term community rehabilitation unit with complex psychiatric conditions. The topics selected for the 8 sessions were based off staff preferences and included; hypotension, deep vein thrombosis, hyperglycaemia and serotonin syndrome. The presentations covered the signs, symptoms, causes and basic ward level management that can be expected from nursing grades. An anonymous feedback form was distributed after the sessions to assess the effectiveness of this new teaching initiative.

Total number of completed feedback forms = 15 (3 HCAs, 9 nurses and 3 student nurses). 11/15 indicated an improvement in their knowledge and understanding of the topics. 10/15 felt confident in managing patients presenting with the conditions. 10/15 felt the teaching material was 'very relevant' to their roles. 11/15 were 'very likely' to recommend these sessions to a colleague. 12/15 described the sessions as 'very useful' and everyone would like the sessions to continue on a regular basis. Open responses shared similar positive sentiments.

The results were reassuring that the ‘Bitesized Teaching’ approach was received well by staff. There is scope to incorporate this into the weekly schedule of mental health teams more long term. It also offers junior doctors a great teaching opportunity and foster greater inter-professional working relationships.

Poor oral health is increasingly recognised as an important comorbidity in people with psychiatric illness. One risk factor is psychotropic-induced dry mouth.

To perform a systematic review of the severity of dry mouth due to psychotropic drugs in adults (CRD42021239725). Study quality was assessed using the Cochrane risk of bias tool.

We searched the following databases: PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science. We included randomised controlled trials (RCTs) measuring the severity of drug-induced hyposalivation and xerostomia.

Eighteen RCTs with 605 participants were included. Severity of drug-induced dry mouth was compared among eight drug classes and/or against placebo. All studies were published 20 to 40 years ago and included tricyclic antidepressants (TCAs), serotonin specific reuptake inhibitors (SSRIs) and other drug classes. Meta-analysis was not feasible owing to design heterogeneity. TCAs caused more severe dry mouth, both objectively and subjectively, than placebo or other drug classes. SSRIs were generally associated with less severe symptoms. However, there was no information on antipsychotics or more recently available antidepressants, and there was minimal information on mood stabilisers. Most studies were on healthy subjects, limiting the generalisability of findings. Only one study measured both objective and subjective dry mouth, which have different clinical implications.

Psychotropic-induced dry mouth is a poorly researched area, and well-designed RCTs of newer psychotropic drugs using standardised objective and subjective measures are indicated. Given the ongoing use of TCAs for treatment-resistant depression, prescribers need to remain vigilant for xerostomia.

Family involvement has been identified as a key aspect of clinical practice that may help to prevent suicide.

To investigate how families can be effectively involved in supporting a patient accessing crisis mental health services.

A multi-site ethnographic investigation was undertaken with two crisis resolution home treatment teams in England. Data included 27 observations of clinical practice and interviews with 6 patients, 4 family members, and 13 healthcare professionals. Data were analysed using framework analysis.

Three overarching themes described how families and carers are involved in mental healthcare. Families played a key role in keeping patients safe by reducing access to means of self-harm. They also provided useful contextual information to healthcare professionals delivering the service. However, delivering a home-based service can be challenging in the absence of a supportive family environment or because of practical problems such as the lack of suitable private spaces within the home. At an organisational level, service design and delivery can be adjusted to promote family involvement.

Findings from this study indicate that better communication and dissemination of safety and care plans, shared learning, signposting to carer groups and support for carers may facilitate better family involvement. Organisationally, offering flexible appointment times and alternative spaces for appointments may help improve services for patients.

As the next generation of doctors, medical students' perception of patients with personality disorder (PD) is critical. Yet a systematic review of the literature shows this has not been studied. The study aims to identify 1) the understanding and perception of medical students about PD and 2) factors that may relate to this knowledge and perception.

A focus group discussion (FGD) was conducted with eight medical students in their sixth year at Amoud University, Somaliland. We presented a case vignette of a patient with typical Borderline PD symptoms (which would meet DSM5 criteria for Borderline PD) and used Barts Explanatory Model Inventory (BEMI) to explore the issue. The FGD was recorded, transcribed, translated and thematically analysed.

The Medical students showed accurate knowledge regarding Borderline PD, recognising features of unstable mood, impulsiveness, and emptiness. Medical students showed binary perception, whether this patient was ‘crazy’ (waali) or not crazy. They perceived their community as a strong African Muslim population. Half the participants believed religious intervention would be helpful “I believe in Islam. So, to some degree it could be managed in certain religious centrs”. Importantly, medical students, when asked to divest of their professional identity, and to describe their personal views as members of the local population, then associated PD with craziness or madness.

The views of PD as craziness or ‘madness’ and the role of religious intervention have important implications for training and service development. The importance of a culturally sensitive training to medical students regarding PD in order to match cultural and religious views, and consideration of development of health services which are sensitive to religious practice is highlighted. We recommend including social and cultural implications in the training of medical students to better prepare them for the complexity of managing PD.

The recent World Health Organization (WHO) blueprint for dementia research and Lancet Commission on ending stigma and discrimination in mental health has identified a gap around dementia-related measures of stigma and discrimination that can be used in different cultural, language and regional contexts.

We aimed to characterise experiences of discrimination, and report initial psychometric properties of a new tool to capture these experiences, among a global sample of people living with dementia.

We analysed data from 704 people living with dementia who took part in a global survey from 33 different countries and territories. Psychometric properties were examined, including internal consistency and construct validity.

A total of 83% of participants reported discrimination in one or more areas of life, and this was similar across WHO Regions. The exploratory factor analysis factor loadings and scree plot supported a unidimensional structure for the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia). The instrument demonstrated excellent internal consistency, with most of the construct validity hypotheses being confirmed and qualitative responses demonstrating face validity.

Our analyses suggest that the DISCUS-Dementia performs well with a global sample of people living with dementia. This scale can be integrated into large-scale studies to understand factors associated with stigma and discrimination. It can also provide an opportunity for a structured discussion around stigma and discrimination experiences important to people living with dementia, as well as planning psychosocial services and initiatives to reduce stigma and discrimination.

A variety of psychosocial factors have been shown to affect the quality of life of families (FQoL).

This study aimed to assess the impact of mother's demographic characteristics, parental stress, illness perceptions about autism spectrum disorder (ASD), coping strategies, ASD severity and time since diagnosis on FQoL during the initial period following diagnosis (≤6 months).

Fifty-three mothers of children newly diagnosed with ASD completed the Beach Center Family Quality of Life Scale, the Autism Parenting Stress Index, the Brief Illness Perception Questionnaire and the Brief Coping Orientation to Problems Experienced Inventory. A descriptive analysis was conducted on the demographic characteristics of the family. Eta coefficients and Pearson's analysis were used to determine the associations between the variables and the FQoL dimensions. Hierarchical regression was used to determine whether variables explained a statistically significant family quality of life variance.

Pearson's analysis and eta coefficients indicated several correlations. Hierarchical regression analysis showed that higher parental stress related to core autism symptoms was associated with poorer FQoL (95% CI −0.08 to −0.02, P = 0.001), and higher perceived treatment control was associated with better FQoL (95% CI 0.04–0.16, P = 0.001). In addition, stronger perceived personal control was associated with higher physical/material well-being (95% CI 0.01–0.16, P = 0.022) and higher disability-related support (95% CI 0.30–0.61, P = 0.001). Higher family monthly income was associated with better FQoL (95% CI 0.08–0.027, P = 0.000), whereas marital status (divorced mother) was correlated with poorer FQoL (95% CI −0.68 to −0.16, P = 0.002).

Interventions should emphasise managing the disorder's characteristics and implementing psychoeducational and supportive programmes for parents, immediately after the diagnosis, to enhance FQoL.

A previous study identified students taking Bangladeshi university entrance tests as a vulnerable group at a higher risk of suicidal behaviours before the COVID-19 pandemic. However, the impact of the pandemic on the magnitude of these behaviours among this population remains unexplored.

This study aimed to investigate the prevalence of suicidal ideation and associated factors among Bangladeshi university entrance test takers following the pandemic. In addition, an approach based on Geographic Information System (GIS) data was used to visualise the distribution of suicidal ideation across the country.

A cross-sectional approach was used to collect data among participants taking the entrance test at Jahangirnagar University in September 2022. Using SPSS, data were analysed with chi-squared tests and binary regression, and ArcGIS was used to map the results across the nation.

The study revealed a prevalence of 14.4% for past-year suicidal ideation, with 7.4% and 7.2% reporting suicide plans and attempts, respectively. Notably, repeat test-takers exhibited a higher prevalence of suicidal behaviours. Significant risk factors for suicidal ideation included urban residence, smoking, drug use, COVID-19 infection and deaths among close relations, depression, anxiety and burnout. The GIS-based distribution indicated significant variation in the prevalence of suicidal ideation across different districts, with higher rates observed in economically and infrastructurally deprived areas.

Urgent measures are needed to address the high prevalence of suicidal behaviours among students taking university entrance tests students in Bangladesh, particularly in light of the COVID-19 pandemic. Enhanced mental health support, targeted prevention efforts and improved resources in economically disadvantaged regions are crucial to safeguard the well-being of these students.

Depression is a major cause of disability worldwide. Recent data suggest that, in industrialised countries, the prevalence of depression peaks in middle age. Identifying factors predictive of future depressive episodes is crucial for developing prevention strategies for this age group.

We aimed to identify future depression in middle-aged adults with no previous psychiatric history.

To predict a diagnosis of depression 1 year or more following a comprehensive baseline assessment, we used a data-driven, machine-learning methodology. Our data-set was the UK Biobank of middle-aged participants (N = 245 036) with no psychiatric history.

Overall, 2.18% of the study population developed a depressive episode at least 1 year following baseline. Basing predictions on a single mental health questionnaire led to an area under the curve of the receiver operating characteristic of 0.66, and a predictive model leveraging the combined results of 100 UK Biobank questionnaires and measurements improved this to 0.79. Our findings were robust to demographic variations (place of birth, gender) and variations in methods of depression assessment. Thus, machine-learning-based models best predict diagnoses of depression when allowing the inclusion of multiple features.

Machine-learning approaches show potential for being beneficial for the identification of clinically relevant predictors of depression. Specifically, we can identify, with moderate success, people with no recorded psychiatric history as at risk for depression by using a relatively small number of features. More work is required to improve these models and evaluate their cost-effectiveness before integrating them into the clinical workflow.

There is growing evidence of a beneficial effect of social group processes on well-being and mental health.

To investigate the role of group membership continuity in reducing mental ill-health among young people who were already vulnerable pre-pandemic, and to understand the social and psychological mechanisms of the benefits of group memberships for vulnerable young people.

This study takes a cross-sectional design, using survey data from a sample of 105 young people aged 16–35 years, collected approximately 1 year after the global COVID-19 outbreak (January to July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences) and the mediation of these associations by hope and social connectedness (in-person and online). To correct for multiple testing, the Benjamini–Hochberg procedure was implemented for all analyses. Indirect effects were assessed with coverage of 99% confidence intervals.

Multiple prior group memberships were associated with preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms.

The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as means of helping to prevent exacerbation of symptoms and promote recovery of mental health problems, particularly during significant life events.

The effect of long working hours on mental health has drawn great social attention in recent years.

We investigated how work–family conflict mediates the associations between long working hours and sleep disturbance and burnout.

We included 19 159 individuals from a nationally representative sample of workers in South Korea. We decomposed the total effect into a direct effect (long working hours → sleep disturbance or burnout) and an indirect effect (long working hours → work–family conflict → sleep disturbance or burnout). Logistic mediation models were used.

Long working hours were associated with increased risks of work–family conflict, sleep disturbance and burnout. The longer the working hours, the stronger the direct and indirect effects. The odds ratios of the direct effects of long working hours on sleep disturbance were 1.64 (95% CI 1.39–1.95) for 49–54 h/week and 1.66 (95% CI 1.37–2.01) for ≥55 h/week; those of the indirect effects were 1.16 (95% CI 1.12–1.21) for 49–54 h/week and 1.27 (95% CI 1.21–1.33) for ≥ 55 h/week. Similarly, odds ratios of the direct effects of long working hours on burnout were 1.18 (95% CI 1.05–1.33) for 49–54 h/week and 1.20 (95% CI 1.04–1.37) for ≥55 h/week; those of the indirect effects were 1.11 (95% CI 1.09–1.15) for 49–54 h/week and 1.20 (95% CI 1.16–1.24) for ≥55 h/week.

Our results suggest that work–family conflict mediates the associations between long working hours and sleep disturbance and burnout. Longitudinal studies should be followed to confirm the causal relationship.