Countries worldwide are experiencing a third wave of the coronavirus disease 2019 (COVID-19) pandemic. Government-imposed restrictive measures continue with undetermined effects on physical and mental health.

To compare child and adolescent mental health services (CAMHS) referrals over 11 months (January–November) in 2020, 2019 and 2018 and examine any impact the different phases of the COVID-19 restrictions might have on referral rates.

Monthly CAMHS Health Service Executive data were examined, covering a catchment population of 260 560 or 12.7% of all youth (age group 0–18 years) in Ireland. The total number of urgent and routine referrals, appointments offered, rates of non-attendances and discharge outcome are presented.

There was a significant drop in referrals in 2020, compared with prior years (χ2 = 10.3, d.f. = 2, P = 0.006). Referrals in 2020 dropped from March to May by 11% and from June to August by 10.3%. From September, both routine and urgent referrals increased by 50% compared with previous years (2018/2019), with the highest increase in November 2020 (180%). Clinic activity also increased from September, with double the number of out-patient appointments offered, compared with previous years (χ2 = 5171.72, d.f. = 3, P < 0.001) and lower (6.6%) rates of non-attendance (χ2 = 868.35, d.f. = 3, P < 0.001).

In 2020, following an initial decline, referrals to CAMHS increased consistently from September. Such unprecedented increase in referrals places further strain on services that are already underresourced and underfunded, with the likelihood of increased waiting lists post COVID-19. It is envisaged that once the pandemic is over, resources will be even more constrained, and CAMHS will be urgently in need of additional ring-fenced funding.

Human trafficking is a grave human rights violation and a major public health concern. Survivors present with high rates of mental health problems including post-traumatic stress disorder (PTSD). Studies of effective treatments for PTSD in survivors of human trafficking are lacking. Narrative exposure therapy (NET) is an effective PTSD treatment for multiple, prolonged and complex trauma, but its efficacy has not been rigorously tested in survivors of human trafficking.

To test the feasibility and acceptability of a randomised controlled trial (RCT) offering NET as a treatment for PTSD in trafficking survivors with a history of multiple traumatic events, as well as providing preliminary evidence regarding its efficacy (trial registration: ISRCTN95136302).

A single-blind RCT compared NET with a wait-list control in survivors of trafficking with PTSD (n = 25). In the NET arm of the study, participants attended a mean of 17 sessions.

NET was well tolerated by participants. There were significant reductions in PTSD, depression and anxiety symptoms post-treatment in the NET group but no significant change in the wait-list group.

The results indicate that NET is a promising and acceptable treatment for trafficking survivors. Psychological therapy in an RCT design can be safely delivered to this vulnerable group, although modifications are required to ensure their holistic needs are properly addressed.

The Trauma History Questionnaire (THQ) is one of the most widely used traumatic event inventories, but its lack of validation makes it unsuitable for the millions of homeless people with severe mental illness in India, who are particularly vulnerable to trauma exposure.

To translate and culturally adapt the THQ for use in a population of homeless people with severe mental illness in Tamil Nadu, India.

We used Herdman et al's model of cultural equivalence to conduct an in-depth qualitative assessment of the cultural validity of the THQ. Following several translations, conceptual, item, semantic and operational equivalence of the THQ was assessed through four focus groups with user-survivors (n = 20) and two focus groups with mental health professionals (n = 11).

Several adaptations, including the addition of 18 items about relationships, homelessness and mental illness, were necessary to improve cultural validity. Three items, such as rape, were removed for reasons of irrelevance or cultural insensitivity. Items like ‘adultery’ and ‘mental illness’ were reworded to ‘extramarital affair’ and ‘mental health problem’, respectively, to capture the cultural nuances of the Tamil language. Findings revealed a divergence in views on tool acceptability between user-survivors, who felt empowered to voice their experiences, and mental health professionals, who were concerned for patient well-being. Providing a sense of pride and autonomy, user-survivors preferred self-administration, whereas mental health professionals preferred rater administration.

Culture significantly affects what types of events are considered traumatic, highlighting the importance of cultural validation of instruments for use in novel populations and settings.

Suicide is an important, understudied public health problem in Bangladesh, where risk factors for suicide have not been investigated by case–control psychological autopsy study.

To identify the major risk factors for suicide in Dhaka, Bangladesh.

We designed a matched case–control psychological autopsy study. We conducted a semi-structured interview with the next-of-kin of 100 individuals who died by suicide and 100 living controls, matched for age, gender and area of residence. The study was conducted from July 2019 to July 2020.

The odds ratios for the risk factors were 15.33 (95% CI, 4.76–49.30) for the presence of a psychiatric disorder, 17.75 (95% CI, 6.48–48.59) for life events, 65.28 (95% CI, 0.75–5644.48) for previous attempts and 12 (95% CI, 1.56–92.29) for sexual abuse.

The presence of a psychiatric disorder, immediate life events, previous suicidal attempts and sexual abuse were found as significant risk factors for suicide in Dhaka, Bangladesh.

Self-harm and eating disorders are often comorbid in clinical samples but their co-occurrence in the general population is unclear. Given that only a small proportion of individuals who self-harm or have disordered eating present to clinical services, and that both self-harm and eating disorders are associated with substantial morbidity and mortality, we aimed to study these behaviours at a population level.

We assessed the co-occurrence of self-harm and disordered eating behaviours in 3384 females and 2326 males from a UK population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants reported on their self-harm and disordered eating behaviours (fasting, purging, binge-eating and excessive exercise) in the last year via questionnaire at 16 and 24 years. At each age we assessed how many individuals who self-harm also reported disordered eating, and how many individuals with disordered eating also reported self-harm.

We found high comorbidity of self-harm and disordered eating. Almost two-thirds of 16-year-old females, and two-in-five 24-year-old males who self-harmed also reported some form of disordered eating. Young people with disordered eating reported higher levels of self-harm at both ages compared to those without disordered eating.

As self-harm and disordered eating commonly co-occur in young people in the general population, it is important to screen for both sets of difficulties to provide appropriate treatment.

Regional planning may help to ensure that the specific measures implemented as part of a national suicide prevention strategy are aligned with the varying needs of local services and communities; however, there are concerns that the reliability of local programme development may be limited in practice.

The potential impacts of independent regional planning on the effectiveness of suicide prevention programmes in the Australian state of New South Wales were quantified using a system dynamics model of mental health services provision and suicidal behaviour in each of the state's ten Primary Health Network (PHN) catchments.

Reductions in projected suicide mortality over the period 2021–2031 were calculated for scenarios in which combinations of four and five suicide prevention and mental health services interventions (selected from 13 possible interventions) are implemented separately in each PHN catchment. State-level impacts were estimated by summing reductions in projected suicide mortality for each intervention combination across PHN catchments.

The most effective state-level combinations of four and five interventions prevent, respectively, 20.3% and 22.9% of 10 312 suicides projected under a business-as-usual scenario (i.e. no new policies or programmes, constant services capacity growth). Projected numbers of suicides under the optimal intervention scenarios for each PHN are up to 6% lower than corresponding numbers of suicides projected for the optimal state-level intervention combinations.

Regional suicide prevention planning may contribute to significant reductions in suicide mortality where local health authorities are provided with the necessary resources and tools to support reliable, evidence-based decision-making.

The Patient Health Questionnaire-9 (PHQ-9) is a widely used measure of depression in primary care. It was, however, originally designed as a diagnostic screening tool, and not for measuring change in response to antidepressant treatment. Although the Quick Inventory of Depressive Symptomology (QIDS-SR-16) has been extensively validated for outcome measurement, it is poorly adopted in UK primary care, and, although free for clinicians, has licensing restrictions for healthcare organisation use.

We aimed to develop a modified version of the PHQ-9, the Maudsley Modified PHQ-9 (MM-PHQ-9), for tracking symptom changes in primary care. We tested the measure's validity, reliability and factor structure.

A sample of 121 participants was recruited across three studies, and comprised 78 participants with major depressive disorder and 43 controls. MM-PHQ-9 scores were compared with the QIDS-SR-16 and Clinical Global Impressions improvement scale, for concurrent validity. Internal consistency of the scale was assessed, and principal component analysis was conducted to determine the items’ factor structure.

The MM-PHQ-9 demonstrated good concurrent validity with the QIDS-SR-16, and excellent internal consistency. Sensitivity to change over a 14-week period was d = 0.41 compared with d = 0.61 on the QIDS-SR-16. Concurrent validity between the paper and mobile app versions of the MM-PHQ-9 was r = 0.67.

These results indicate that the MM-PHQ-9 is a valid and reliable measure of depressive symptoms in paper and mobile app format, although further validation is required. The measure was sensitive to change, demonstrating suitability for use in routine outcome assessment.

SARS-CoV-2 has rapidly spread worldwide, threatening public health and financial and social life.

The current study's aim was to determine the prevalence of psychological distress and post-traumatic stress symptoms in the Greek population during the first COVID-19 lockdown, and to detect potential correlates.

An anonymous online survey was conducted between 10 April and 4 May 2020, to collect information regarding people's psychological functioning and COVID-19-related perceptions.

A total of 1443 individuals completed the survey; 293 (20%) reported clinically significant anxiety symptoms, 188 (12.9%) reported clinically significant depressive symptoms and 506 (36.4%) suffered from definite post-traumatic stress disorder. Anxiety symptoms were independently associated with female gender (β = 1.281, 95% CI 0.808–1.755, P < 0.001), educational level (β = −1.570, 95% CI −2.546 to −0.595, P = 0.002), perceived severity (β = −1.745, 95% CI −3.146 to −0.344, P = 0.015) and COVID-19-related worry (β = 7.633, 95% CI 6.206–9.060, P < 0.001). Depressive symptoms were strongly correlated with educational level (β = −1.298, 95% CI −2.220 to −0.377, P = 0.006), perceived severity (β = −1.331, 95% CI −2.579 to −0.082, P = 0.037) and COVID-19-related worry (β = 4.102, 95% CI 2.769–5.436, P < 0.001). Finally, post-traumatic stress symptoms were linked to female gender (β = 6.451, 95% CI 4.602–8.299, P < 0.001), educational level (β = −5.737, 95% CI −9.479 to −1.996, P = 0.003), psychiatric history (β = −4.028, 95% CI −6.274 to −1.782, P < 0.001) and COVID-19-related worry (β = 23.865, 95% CI 18.201–29.530, P < 0.001).

A significant percentage of the population reported clinically important anxiety, depressive and post-traumatic stress symptoms. Women, less-educated individuals and people with a psychiatric history appeared more vulnerable to the pandemic's psychological impact.

To examine the relationship between depression, anxiety and wellbeing in doctors.

The relationship between doctor wellbeing and mental health diagnoses is not well evidenced in the literature. There is a lack of comparable measurement of wellbeing in doctors within the National Health Service, meaning the effectiveness of wellbeing interventions is unknown.

A cross-sectional survey containing the PHQ9, GAD7 and WEMWBS questionnaires to measure depression, anxiety and wellbeing respectively, was advertised online nationally. The relationships between the total scores were explored using Spearman's rho correlation coefficients and Chi square tests. Thematic analysis of semi-structured interviews offered further insights.

Sixty-seven doctors returned completed questionnaires. 29.9% had PHQ9 scores >5 and 41.8% had GAD7 scores >5. Therefore, over a quarter of the participants had a score that would suggest a management plan was needed for depression, and a third for anxiety. Moderate negative correlation between the total WEMWBS scores and the total PHQ , rs= –0.775, p = 0.00, N = 67 and GAD7 scores rs= –0.724, , p = 0.00, N = 67 was seen. Statistically significant differences between those with low wellbeing scores (WEMWBS < 40) and normal wellbeing scores (WEMWBS ≥ 40) in relation to the need for a management plan for depression (PHQ9 > 10) X2 (1, N = 67) = 12.395, p = 0.00 and anxiety (GAD7>10) X2 (1, N = 67) = 5.611, p = 0.018 were seen. The main themes identified from the interviews (n = 10) were the importance of social support outside of work, cynicism about an NHS plan check-in and a tendancy to neglect wellbeing until it has dipped.

There is a moderate negative correlation between anxiety, depression and wellbeing, but they are not opposites and separate measures for wellbeing should be used. It is clinically useful to note that only those with a WEMWBS score of <45 had a PHQ9 score suggesting the need for treatment of depression.

The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown.

To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA.

Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18–75 years) with a first PES contact in 2010–2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period.

We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission.

We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.

Risk of death from suicide in Huntington's disease is notably elevated relative to that in the general population, although the incidence within HD populations has not been precisely defined. Robust incidence estimates of suicidal behavior can serve as references for HD therapeutic research and post-marketing surveillance to help evaluate the suicidality risk of novel therapeutics.

To estimate the incidence rate of completed suicide and suicide attempt in the global, prospective HD cohort study Enroll-HD that records these events per protocol.

A total of 20 912 participants were available for analysis (HD gene-expansion carriers (HDGECs) n = 15 924; non-HDGECs n = 4988) representing a collective observation period of 53 390 participant-years. Each observed event was subject to clinical review and evaluation. We generated incidence rates (events per 100 000 person-years) for suicides and suicide attempts using all available data, as well as by year of study and geographical region. Proportionate mortality statistics for suicide and respective 95% confidence intervals were also generated.

The overall incidence rate of suicide in HDGECs was 72 per 100 000 person-years, and 8 per 100 000 person-years in non-HDGECs. Proportionate mortality attributable to suicide in HDGECs was 4.6%. For suicide attempts, the global overall incidence rate observed in HDGECs was 306–375 per 100 000 person-years, and 23–38 per 100 000 person-years in non-HDGECs.

The incidence estimates calculated here can be used as a reference to help evaluate drug safety and may also be useful in assessing progress in clinical care for HDGECs once therapeutic interventions become widely available.

Religious and traditional healers remain the main providers of mental healthcare in much of Africa. Collaboration between biomedical and traditional treatment modalities is an underutilised approach, with potential to scale up mental healthcare.

To report the process and feasibility of establishing a collaboration between religious healers and psychiatrists in Addis Ababa, Ethiopia. To gain insight into the collaboration through studies of patient demographics, help-seeking patterns, nature of illness and receptivity of the project.

This case study describes the process and challenges in establishing a collaborative psychiatric clinic for patients who are simultaneously receiving treatment with holy water, including an examination of basic clinical records of 1888 patients over a 7-year period.

The collaboration is feasible and has been successfully implemented for 8 years. A majority (54%) of the clinic's patients were seeing biomedical services for the first time. Patients were brought in largely by families (54%); 26% were referred directly by priest healers. Most patients had severe mental illness, including schizophrenia (40%), substance misuse (24%) and mood disorders (30%). A vast majority (92.2%) of patients reported comfort in receiving treatment with holy water and prayers simultaneously with medication, and 73.6% believed their illness was caused by evil spirit possession.

A cross-system collaborative model is a feasible and potentially valuable model to address biomedical resource limitations. Provider collaboration and mutual learning are ultimately beneficial to patients with severe mental illness. Open-minded acceptance of cultural benefits and strengths of traditional healing is a prerequisite. Further study on outcomes and implementation are warranted.

The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined.

First, to interrogate the relationship between the subjective experience of irritability and mood, and that with its behavioural indicators. Second, to determine how these relationships vary with age and over time.

This study examined data from a previous clinical trial of adolescents and young adults (N = 82) with bipolar disorder, who received a psychological intervention over 18 months. Participants completed a battery of questionnaires, which included assessments of irritability. Analyses of covariance were conducted to examine the interaction between mood symptoms, subjective measures of irritability, behavioural measures of irritability and age over time.

Subjective irritability scores differed significantly over time when controlling for manic, but not depressive, symptom scores. Further, subjective irritability significantly differed when controlling for behavioural measures of irritability (temper outbursts and argumentativeness). There were significant interactions between scores of depressive symptoms, temper outbursts and subjective irritability with age, wherein younger participants showed no correlation between depressive symptoms and temper outbursts. In addition, younger participants showed lower correlations between subjective irritability and both depressive and temper outburst scores, than older participants.

Subjective irritability is linked to mood morbidity and behavioural outbursts, and these relationships are contingent on age. Our novel findings suggest that subjective irritability should be assessed in greater detail in patients with mood disorders.

The aim of this audit is to assess communication between the general and psychiatric hospital. This audit was prompted after a number of patients were transferred to Udston Hospital, a community hospital with two older adult acute mental health wards, with no written communication. This led to several significant issues including medication errors, ambiguity regarding patient escalation plans and uncertainty regarding what had been discussed with families.

Over the course of one month eight patients were identified who had been transferred from the acute site to Udston Hospital. Three were new admissions to Udston, four were returning after treatment for physical illness, and one returned following assessment in ED. Data were collected by examining paper and electronic notes, and analysed using Excel. The results of this audit were discussed at the local clinical governance meeting. A 2nd cycle was performed. Eight transfers were identified. Four were returning after an assessment in ED, two were new admissions to Udston and two were returning after treatment for physical illness.

Initial audit found that 38% of patients were transferred with their medical notes, 50% were transferred with no written documentation whatsoever, and none of the patients were transferred with a transfer letter. The second cycle found that 88% of patients had a transfer or discharge letter. 12% of patients came with no written documentation.

The initial audit found significant deficiencies in communication. Highlighting the need for all patients to have a transfer letter at a local management meeting seems to have led to an improvement. However, differences between the samples in the 1st and 2nd audit cycle could be distorting the results. Further audits would be useful given the small sample size and due to the differences between the sample populations.

It is essential to investigate the experiences behind why adolescents start and continue to self-harm in order to develop targeted treatment and prevent future self-harming behaviours.

The aims of this study are to understand the motivations for initiating and repeating nonfatal self-harm, the different methods used between first-time and repeated self-harm and the reasons that adolescents do not seek help from health services.

Adolescents with repeated nonfatal self-harm experiences were recruited to participate in individual, semi-structured qualitative interviews. The interviews were analysed with interpretative phenomenological analysis.

We found that nonfatal self-harm among adolescents occurred comparatively early and was often triggered by specific reasons. However, the subsequent nonfatal self-harm could be causeless, with repeated self-harm becoming a maladaptive coping strategy to handle daily pressure and negative emotions. The choice of tools used was related to the ease of accessibility, the life-threatening risk and the size of the scars. Adolescents often concealed their scars on purpose, which made early identification insufficient. Peer influence, such as online chat groups encouraging self-harm by discussing and sharing self-harm pictures, could also lead to increased self-harm. The results also included participants’ opinions on how to stop nonfatal self-harm and their dissatisfaction with the current healthcare services.

The current study provides important implications both for early identification and interventions for adolescents who engage in repeated nonfatal self-harm, and for individualising treatment planning that benefits them. It is also worthwhile to further investigate how peer influence and social media may affect self-harm in adolescents.

Throughout the coronavirus disease 2019 (COVID-19) pandemic, health and social care workers have faced unprecedented professional demands, all of which are likely to have placed considerable strain on their psychological well-being.

To measure the national prevalence of mental health symptoms within healthcare staff, and identify individual and organisational predictors of well-being.

The COVID-19 Staff Wellbeing Survey is a longitudinal online survey of psychological well-being among health and social care staff in Northern Ireland. The survey included four time points separated by 3-month intervals; time 1 (November 2020; n = 3834) and time 2 (February 2021; n = 2898) results are presented here. At time 2, 84% of respondents had received at least one dose of a COVID-19 vaccine. The survey included four validated psychological well-being questionnaires (depression, anxiety, post-traumatic stress and insomnia), as well as demographic and organisational measures.

At time 1 and 2, a high proportion of staff reported moderate-to-severe symptoms of depression (30–36%), anxiety (26–27%), post-traumatic stress (30–32%) and insomnia (27–28%); overall, significance tests and effect size data suggested psychological well-being was generally stable between November 2020 and February 2021 for health and social care staff. Multiple linear regression models indicated that perceptions of less effective communication within their organisation predicted greater levels of anxiety, depression, post-traumatic stress and insomnia.

This study highlights the need to offer psychological support to all health and social care staff, and to communicate with staff regularly, frequently and clearly regarding COVID-19 to help protect staff psychological well-being.

In total numbers, Germany has faced the largest number of refugees and asylum seekers (RAS) in Europe in the past decade. Although a considerable proportion have experienced traumatic and stressful life events, there is no systematic review to date examining the prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms in RAS in Germany.

To calculate the prevalence of depressive symptoms and PTSD symptoms in the general population of RAS living in Germany after the year 2000 and explore the impact of study- and participant-related characteristics on prevalence estimates.

We systematically searched PubMed, CINAHL, PsycINFO, PSYNDEX, Academic Search Complete, Science Direct and Web of Science from January 2000 to May 2020 to identify articles reporting prevalence of depressive symptoms and PTSD in RAS in Germany (PROSPERO registration number: CRD42020182796).

In total, 31 different surveys met inclusion criteria with 20 surveys reporting prevalence estimates of depressive symptoms and 25 surveys symptoms of PTSD. Based on screening tools, the pooled prevalence estimate of PTSD symptoms was 29.9% (95% CI 20.8–38.7%) and of depressive symptoms 39.8% (95% CI 29.8–50.1%). Heterogeneity was large within and between subgroups. In multivariate meta-regressions on depressive symptoms, heterogeneity was largely explained by survey period, length of field period and study quality.

Prevalence rates of depressive symptoms and PTSD symptoms in RAS are notably large. They exceed the prevalence in the general German population. As a result of high heterogeneity, however, pooled prevalence rates should be interpreted with caution.

Choice of suicide method can strongly influence the outcome of suicidal behaviour, and is an important aspect of the process and planning involved in a suicide attempt. Yet, the reasons why individuals consider, choose or discard particular methods are not well understood.

This is the first study to explore method choices among people with a history of suicidal behaviour and individuals who have experienced, but not enacted, suicidal thoughts.

Via an online survey, we gathered open-ended data about choice of methods in relation to suicidal thoughts and behaviours, including reasons for and against specific means of harm.

A total of 712 respondents had attempted suicide, and a further 686 experienced suicidal thoughts (but not acted on them). Self-poisoning was the most commonly contemplated and used method of suicide, but most respondents had considered multiple methods. Method choices when contemplating suicide included a broader range of means than those used in actual attempts, and more unusual methods, particularly if perceived to be lethal, ‘easy’, quick, accessible and/or painless. Methods used in suicide attempts were, above all, described as having been accessible at the time, and were more commonly said to have been chosen impulsively. Key deterrents against the use of specific methods were the presence of and impact on other people, especially loved ones, and fears of injury and survival.

Exploration of method choices can offer novel insights into the transition from suicidal ideation to behaviour. Results underscore the need for preventative measures to restrict access to means and delay impulsive behaviour.