Abstract Aims Lung cancer patients have a higher risk of suicide, but the long-term patterns and how they differ by treatment type have not been fully characterized. To investigate longitudinal suicide risk among lung cancer patients who underwent surgery compared to matched controls and to examine variations over time by treatment modality and patient characteristics. Methods We identified 37,215 individuals newly diagnosed with lung cancer between 2010 and 2017 who underwent lung resection within 1 year of diagnosis, along with 1:3 age- and sex-matched controls. Subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for suicide were estimated using a competing risk analysis. Results The cohort (mean age 64.0 years; 62.5% male) was followed for a mean of 7.6 years. There were 154 suicides among lung cancer patients (incidence rate 0.6 per 1,000 person-years). Suicide risk peaked during the first year after surgery (sHR 1.88, 95% CI 1.23–2.87) and declined in subsequent years. Patients who underwent surgery alone had a higher risk in the first year (sHR 1.66, 95% CI 1.02–2.69), which gradually decreased over time. In contrast, patients treated with adjuvant chemotherapy or radiotherapy experienced a substantially higher initial risk (e.g., sHR 7.00, 95% CI 3.00–16.37 for surgery + radiotherapy) and maintained a moderate increase in suicide risk even beyond 5 years. Subgroup analyses showed an especially elevated first-year suicide risk among younger adults aged 20–49 years, males, and never smokers. Conclusions Suicide risk for lung cancer patients is highest during the first postoperative year, particularly for those who receive multimodal therapy, or are younger adults, males, or never smokers. These findings emphasize the need to prioritize early, tailored psychosocial support in survivorship care to help mitigate long-term suicide risk.
AIMS:The relationship between retirement and mental health remains unclear, with mixed evidence likely driven by methodological challenges and heterogeneity across population subgroups. This study explores the relationship between retirement, time since retirement and mental health, focusing on differences between those living alone and cohabiting. METHODS:We used data from 10,698 participants (48,815 observations) in the Survey of Health, Ageing and Retirement in Europe, waves 1-8, spanning 20 countries and 16 years. Participants were included if they were employed at baseline and retired during follow-up. We applied a triangulated approach using (1) multilevel linear spline models to examine trajectories and (2) fixed-effects instrumental variable analyses (IV) using statutory retirement age as an instrument to establish causal effects. The outcome was depressive symptoms measured using the EURO-D scale (higher scores indicate more depressive symptoms). RESULTS:Multilevel spline models showed minimal change in depressive symptoms before retirement. At retirement, a small decline in EURO-D scores was indicated (-0.07 points per year [95% CI: -0.13 to -0.0003]), followed by an increase starting two years post-retirement (0.09 per year, 95% CI: 0.02 to 0.16). IV analyses showed that retirement was associated with fewer depressive symptoms (-0.26, 95% CI: -0.45 to -0.07). Individuals living alone reported higher depressive symptoms, but cohabitation status did not moderate the relationship between retirement and mental health. CONCLUSIONS:Retirement is associated with a short-term reduction in depressive symptoms, but the effect diminishes over time. While individuals living alone consistently report higher depressive symptoms, cohabitation status does not moderate the retirement-mental health relationship.
Abstract Aims Schizophrenia is a chronic psychiatric disorder associated with significantly elevated mortality. While antipsychotics are the cornerstone of treatment, their long-term effects on survival remain uncertain, particularly in non-Western populations. We aimed to assess the real-world association between antipsychotic treatment patterns and all-cause mortality among adults with schizophrenia in China. Methods This population-based cohort study included 435,816 adults from the Community Schizophrenia Registry System of Guangdong Province, China. Patients were classified into four groups: antipsychotic monotherapy, polytherapy, non-antipsychotic treatment and non-drug treatment. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for mortality. Results Over a median follow-up of 7.2 years, 73,527 deaths (16.9%) occurred. Antipsychotic polytherapy (57.6%) was the most common regimen, followed by monotherapy (27.6%). Compared with the non-drug group, mortality risks were significantly lower for polytherapy (aHR: 0.18; 95% CI: 0.18–0.19), monotherapy (aHR: 0.24; 95% CI: 0.24–0.25) and non-antipsychotic treatment (aHR: 0.22; 95% CI: 0.21–0.23). Both first- and second-generation antipsychotics showed comparable mortality benefits. While most polytherapy regimens performed similarly to or better than monotherapy, combinations like risperidone–sulpiride were associated with higher mortality. Subgroup analyses showed stronger benefits in women, younger individuals, rural residents and those with less severe illness. Conclusions Antipsychotic treatment is associated with significantly reduced mortality among patients with schizophrenia in China, with effects varying by patient characteristics and drug regimen.
Abstract Aims Adverse childhood experiences (ACEs) shape children’s socioemotional development, yet longitudinal evidence from low- and middle-income countries remains limited. This study examined how ACEs relate to internalizing, externalizing and prosocial behaviours from childhood to adolescence in a rural Pakistani cohort. Methods Data were drawn from the Bachpan Cohort, a longitudinal study including 1,791 observations across three waves: ages 4–5, 8–9 and 12–15 years. ACEs were assessed using an adapted ACE-International Questionnaire. Outcomes were measured using the Strengths and Difficulties Questionnaire. Network analysis, dose-response modelling and moderation analyses were employed. Results Emotional neglect was the most prevalent ACE (83.7%). Parental psychiatric issues, parental trauma exposure and emotional neglect were the most central ACE stressors. A dose-response relationship emerged: compared to children with no ACEs, those with four or more ACEs showed higher internalizing (incidence ratio [IR] = 4.24) and externalizing problems (IR = 3.42) and lower prosocial behaviour (IR = 0.90). Girls showed greater internalizing vulnerability; boys showed more externalizing problems. ACE effects on internalizing problems strengthened with age. Conclusions ACEs are strongly associated with internalizing, externalizing and prosocial outcomes from childhood to adolescence. Findings highlight the need for tiered, gender-sensitive and developmentally appropriate interventions in low-resource settings.
Abstract Campaigns to enhance public awareness and attitudes towards mental health problems have been a feature of mental health policy and practice for several decades. In Australia, Beyond Blue, an independent, not-for-profit organisation which was launched in 2000, marked a turning point in the national approach to improving population mental health. From the outset, it prioritised a systemic approach including national awareness campaigns, support for consumers and carers, early intervention, primary care reform and investment in research. Over the past 25 years, Australia has seen substantial improvements in mental health literacy, stigma and help-seeking. To explore Beyond Blue’s contribution, we drew on nationally representative surveys of mental health literacy, stigma and service use. Analyses of surveys from the mid-2000s showed that respondents in states with greater exposure to Beyond Blue had higher awareness, better recognition of depression and more accurate treatment beliefs. Later studies confirmed that engagement with Beyond Blue was associated with higher mental health literacy, including among young people. National surveys have also shown significant reductions in stigma towards people with depression, changes not observed in other countries. Longitudinal data suggest that engaging with Beyond Blue predicts lower stigma and greater help-seeking over time. National Surveys of Mental Health and Wellbeing have shown steady increases in professional help-seeking and perceived need for support since the late 1990s. While there are multiple reasons for this, recent national survey data link engagement with Beyond Blue to increased contact with health professionals and informal supports. Globally, Beyond Blue is unique in its long-term, multi-pronged approach to improving population mental health. Its sustained focus and demonstrated impact on mental health literacy, stigma and help-seeking for depression and anxiety remain largely unmatched among comparable national initiatives.
Abstract Aims Refugees bear the highest burden of mental health issues; however, they often underuse available mental health services. Interventions aimed at those with diagnosed conditions frequently do little to prevent the onset of disorders. Problem Management Plus for Immigrants (PMP-I) is a prevention intervention adapted from the World Health Organization’s Problem Management Plus (PMP). PMP-I includes psychoeducation, problem-solving, behavioural activation, social support and networking, and mind-body exercises. This pilot randomized controlled trial (RCT) aimed to evaluate the impact of PMP-I on mental, social and emotional well-being outcomes among Bhutanese refugees resettled in Massachusetts. Methods Bhutanese individuals aged 18 or older who had resettled in Massachusetts and scored ≤14 on the Patient Health Questionnaire-9 (PHQ-9) were randomly assigned to two groups: PMP-I (n = 58 families) and a talk programme with a community support services pamphlet (n = 58 families). Trained community interventionists delivered five sessions of PMP-I to intervention participants in their family settings. Primary outcomes included scores on measures of stress (Cohen Perceived Stress Scale-10), and anxiety and depression (Hopkins Symptoms Checklist-25), assessed at baseline, 6-week and 3-month post-intervention. Secondary outcomes included hair cortisol, coping, coping self-efficacy, social support, social network, family conflict resolution and family satisfaction. Linear mixed-effects models were used to analyse differences in changes in outcomes between the intervention and control groups, adjusting for baseline scores on the primary outcomes, as well as age, duration of residence, marital status and history of chronic diseases. Results All 232 participants recruited (116 families) were retained throughout the project. The intervention group evidenced a significantly greater decrease than the control group at both 6-week and 3-month post-intervention assessments on the primary outcomes of stress, anxiety, and depressive symptom scores. Similarly, the intervention group demonstrated significantly higher scores at both the 6-week and 3-month periods after the intervention compared to the control group on measures of coping, family conflict resolution, self-efficacy, family satisfaction and social networking with large effect sizes (Cohen’s d > 0.8, p < .01). Hair cortisol concentrations did not differ significantly between the intervention and control groups at either baseline or 3-month post-intervention. Conclusions The PMP-I improved the mental, social and emotional well-being of Bhutanese adults (PHQ-9 score ≤ 14) resettled in Massachusetts. Peer-delivered, family-centred PMP-I offers a significant public health benefit; however, a large-scale, RCT involving diverse refugee groups is necessary to replicate its success nationwide and beyond.
Abstract Aims Childhood maltreatment has been associated with increased risk of cognitive impairment in later life, but little is known about whether distinct joint trajectories of social isolation and depression across midlife predict this risk. Methods Using a prospective cohort design with documented childhood maltreatment and matched controls (N = 1196) followed from ages 0 to 11 into late midlife, we modelled joint trajectories of social isolation and depression (ages 29–47) using group-based trajectory modelling (GBTM) and examined their associations with cognitive impairment with no dementia (CIND) at age 59 through modified Poisson regression, controlling for risk factors related to neurodegenerative outcomes (i.e., hypertension, diabetes, obesity, limited physical activity, hearing impairment, smoking, excessive alcohol consumption and traumatic brain injury). Results GBTM identified four groups: ‘Not isolated or depressed’ (67.7%), ‘Moderately isolated’ (11.7%), ‘Moderately depressed’ (16.5%) and ‘Chronically isolated and depressed’ (4.1%). Using the ‘Not isolated or depressed’ group as the reference category, membership in the highest-risk trajectory (‘Chronically isolated and depressed’) was associated with a 41.5% higher risk of CIND, whereas the ‘Moderately isolated’ and ‘Moderately depressed’ groups did not differ significantly from the reference group. Black non-Hispanic participants and those with documented childhood maltreatment histories had 32.8% and 21.2% higher risk of CIND, respectively, and each additional year of education was associated with a 4.9% reduction in CIND risk. Conclusions Sustained co-occurring social isolation and depression from early to mid-adulthood predicted increased risk of CIND independent of established risk factors, highlighting prolonged social and emotional difficulties as modifiable targets for late midlife cognitive health.
Abstract Aims Research on the link between threat-related and deprivation-related adverse childhood experiences (ACEs) and the risk of gastrointestinal (GI) and liver diseases in later life remains limited. This study aims to evaluate the independent associations of threat-related and deprivation-related ACEs with the development of GI and liver disorders in middle-aged and older Chinese adults. Methods This prospective cohort study used data from the China Health and Retirement Longitudinal Study, which included participants aged 45 and older who had complete ACE data, two health assessments, and no pre-existing GI or liver conditions at baseline. Participants reported on five threat-related and deprivation-related ACEs before age 17. GI and liver diseases were classified based on self-reported physician diagnoses. Results The outcomes of GI and liver diseases are based on self-reported physician diagnosis and broad categories. Compared with no exposures, participants with two or more threat-related ACEs exhibited a higher risk of both chronic liver disease (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.04–1.52; P = 0.016) and GI disease (HR, 1.36; 95% CI, 1.20–1.55; P < 0.001); two or more deprivation-related ACEs showed stronger associations with GI disease (HR, 1.48; 95% CI, 1.28–1.70; P < 0.001); and no significant associations with liver disease risk across all exposure levels. Additionally, depressive symptoms accounted for 10.7% (P = 0.003) of the association between threat-related ACEs and liver disease risk and accounted for 12.7% (P < 0.001) of the association between threat-related ACEs and GI disease risk. Midlife loneliness accounted for 5.3% (P = 0.001) of the association between threat-related ACEs and incident GI diseases and for 3.7% (P = 0.004) of the association between deprivation-related ACEs and incident GI diseases. Conclusions Threat-related ACEs are directly associated with an increased risk of liver and GI diseases. A modest proportion of this observed relationship is partially mediated through depressive symptoms and loneliness in middle age.
AIMS:Unipolar mania (UM), defined by the occurrence of manic episodes without a history of depression, is a topic of debate within the classification of affective disorders. However, its epidemiological burden remains unclear. This systematic review and meta-analysis aimed to estimate the prevalence of UM among individuals with bipolar type I disorder (BD-I) while exploring potential sources of heterogeneity. METHODS:The study protocol was registered in Open Science Framework on 27 March 2025. Embase, MEDLINE and APA PsycInfo were searched. We included observational studies reporting data on UM prevalence rates in adults with BD-I. Pooled prevalence was estimated using the Freeman-Tukey double arcsine transformation, employing a restricted maximum likelihood random-effects model. Subgroup and meta-regression analyses were implemented to explore sources of heterogeneity. RESULTS:We included 26 studies, encompassing 35 independent samples and 17,716 individuals with BD-I. The pooled prevalence of UM was 21.1% (95% confidence interval: 15.5-27.4%). Although potential publication bias was detected (Egger's p = 0.010), the trim-and-fill method did not impute any missing studies. No differences were found between clinical and community-based studies (p = 0.966). However, prevalence estimates were influenced by both geographical area (p = 0.020) and study quality (p = 0.014). Rate differences across studies may also be attributable to variations in UM diagnostic definition. CONCLUSIONS:People with UM represent a significant subset of BD-I cases worldwide, warranting greater clinical awareness. The observed rate variability emphasizes the impact of sociocultural and methodological factors on UM diagnosis. Further research is necessary to refine diagnostic criteria and evaluate optimal treatment approaches for individuals with UM.
Abstract Aims Social inclusion is increasingly recognised as a key determinant of health and well-being, encompassing participation in social, economic, political and cultural life through access to resources, opportunities and relationships. Individuals with mental disorders are at increased risk of social exclusion, yet existing evidence often relies on broad population-level indicators that fail to capture the multidimensional nature of inclusion. This systematic review aimed to compare levels of social inclusion between these groups using validated psychometric instruments and to identify the dimensions in which disparities are most pronounced. Methods The review followed PRISMA guidelines. A two-step search strategy was conducted across PubMed, Embase, PsycINFO, Scopus, CINAHL and Web of Science. First, validated measures of social inclusion and related constructs were identified. Second, studies applying these instruments in individuals with and without mental disorders were retrieved. Eligible studies included adults with clinician-established or self-reported diagnosis of mental disorders and comparison groups from the general population. A random-effects meta-analysis was conducted to estimate standardised mean differences (SMDs) with 95% confidence intervals (CIs) between the two groups, while a thematic narrative synthesis explored domain-specific inequalities. Results Ten studies met inclusion criteria, and six were included in the meta-analysis, comprising 844 individuals with mental disorders and 1086 controls. Individuals with mental disorders reported significantly lower levels of social inclusion than the general population (SMD = −0.91; 95% CI: −1.25 to −0.56). The narrative synthesis identified inequalities across several interconnected domains. Individuals with mental disorders experienced weaker social relationships, lower perceived support, reduced community participation and fewer opportunities for meaningful engagement. Marked disadvantages were also observed in employment, income, education and housing, including financial hardship, insecure living conditions and neighbourhood dissatisfaction. Several studies highlighted discrepancies between objective indicators of participation and subjective experiences of inclusion, indicating that participation alone may not reflect a sense of belonging or access to valued social roles. Socioeconomic position, gender and ethnicity appeared to intensify exclusion across domains. Conclusions Individuals with mental disorders experience substantial inequalities in social inclusion across interconnected relational, community and socioeconomic domains. These disparities are shaped by broader structural conditions and compounded by intersecting forms of disadvantage, including socioeconomic position, gender and ethnicity. The findings highlight the need for multidimensional, intersectional and person-centred approaches that recognise both the cumulative nature of exclusion and individuals’ subjective experiences of inclusion. Policies and interventions should address the social determinants that constrain opportunities for meaningful inclusion. OSF: https://doi.org/10.17605/OSF.IO/USXWG.
AIMS:Childhood maltreatment and adolescent mental health problems are unequally distributed, with the highest burdens among marginalised groups including females and those experiencing socioeconomic disadvantage. However, little is known about how the psychological consequences of maltreatment vary across intersecting social positions (e.g., socioeconomically disadvantaged females). Prior quantitative work has largely focused on average differences across a limited number of groups, obscuring non-additive intersectional patterning. Because social realities are structured by overlapping systems of privilege and oppression (e.g., relating to gender, socioeconomic position, ethnicity, age, and place), we leveraged recent methodological advances to address this gap. Accordingly, this study aimed to (i) map inequalities in adolescent emotional problems and the effects of maltreatment across intersectional positions; and (ii) describe the extent to which inequalities in emotional problems reflect additive and non-additive (intersectional) effects. METHODS:Data were analysed from 19 590 students aged 11-16 years who participated in the OxWell 2023 Student Survey in England, United Kingdom. Within a random-coefficient Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), individuals were nested in 180 intersectional strata defined by combinations of social positions relating to gender, ethnicity, household poverty, school year group, and school-level deprivation (also entered as additive main effects). Emotional problems (Revised Child Depression and Anxiety Scale; RCADS-11) were regressed on maltreatment exposure (Short Childhood Maltreatment Questionnaire) as the primary effect of interest. Stratum-specific predicted emotional problems and maltreatment effects were estimated, and between-stratum variance was partitioned into additive and residual non-additive components. RESULTS:Maltreatment was associated with higher levels of emotional problems, with stratum-specific increases ranging from +3.20 to +6.14 scale points. Socioeconomically disadvantaged females and individuals who selected 'other' or 'prefer not to say' for gender showed the highest levels of emotional problems and among the strongest maltreatment effects. Between-stratum inequalities in emotional problems were largely accounted for by maltreatment exposure and the additive contributions of the included social positions. However, residual non-additive effects were also evident, particularly among individuals exposed to maltreatment, where 5.25% of between-stratum variance remained unaccounted for by additive effects (compared with 3.46% among those not exposed). CONCLUSIONS:In this large community sample of adolescents in England, the detrimental effects of maltreatment on emotional problems appear pervasive but not uniform across intersectional social positions. Applying an intersectional MAIHDA framework suggests that inequalities in adolescent emotional problems largely reflect additive social patterning, with additional non-additive contributions suggestive of intersectional dynamics that are more pronounced with maltreatment exposure. These findings motivate deeper investigation into the social-structural mechanisms that shape vulnerability and resilience in adolescence, and support the need for trauma-informed, equity-focused interventions and policy action to reduce unequal exposure to maltreatment and the contexts that amplify its harms.
Abstract Aims Migrants use less mental healthcare than non-migrants, but it is unclear how much this reflects differing needs and whether this gap has changed over time. We examined differences in mental healthcare use by migrant status between 2006 and 2022 while considering probable mental healthcare needs. Methods We used data from four cross-sectional surveys conducted in Stockholm County (2006, 2010, 2014 and 2021) in which self-reported need indicators, including psychological distress, were measured. Survey participants, 81,650 adults (18–64), were linked to administrative registries to estimate differences in mental healthcare use (both likelihood and frequency), within 6 months of survey response. Logistic regression and zero-truncated negative binomial regression were used, with survey weights and adjustments for sex, age, income, education, psychological distress (main need-indicator), general health status and long-term limiting illness. Results Non-Nordic migrants were more likely to report increased levels of psychological distress but were less likely to use services than non-migrants. The gap in mental healthcare use was initially marginal but increased with adjustment for mental healthcare needs, as well as over time (2006–2022). The odds ratios comparing the likelihood of mental healthcare use between European migrants with Swedish-born individuals decreased from 0.93 (95% confidence intervals: 0.77–1.11) in 2006/2007 to 0.48 (0.39–0.59) in 2021/2022, adjusting for sociodemographic factors and psychological distress. For non-European migrants, the corresponding odds ratios decreased from 0.72 (0.62–0.85) to 0.46 (0.39–0.54). Further adjustments for general health status and long-term limiting illness widened the gap even more. In 2021/2022, the gap was larger in secondary than in primary care and for online than in-office services. Nordic-born migrants had similar utilization patterns as Swedish-born individuals. Differences in the frequency of outpatient visits between migrants and Swedish-born individuals, conditional on having at least one visit, were marginal. For instance, the rate ratios comparing non-European migrants with Swedish-born individuals changed from 0.67 (0.48–0.93) in 2006/2007 to 0.90 (0.65–1.26) in 2021/2022. Conclusions Despite indicating greater needs, non-Nordic migrants faced persistent inequities in mental healthcare access, but differences in intensity/continuity of care were marginal among those who accessed services. Inequities in access grew over the study period and were largest during the COVID-19 pandemic, particularly in access to online mental healthcare services and specialized care. These findings should be interpreted cautiously given potential selection bias from declining survey participation and changes in distress scales.
Abstract Aims Pesticide self-poisoning accounts for 14–20% of global suicides, predominantly in agricultural regions where highly hazardous pesticides (HHPs) remain accessible. This poses a critical challenge in South Korea despite its advanced healthcare system. In response, South Korea implemented a phased ban on HHPs, including paraquat, beginning in November 2011. This study aimed to evaluate the long-term effect of this ban on pesticide suicide mortality. Methods We conducted an interrupted time series study using national mortality data from 2004 to 2023, with autoregressive integrated moving average errors to account for autocorrelation. Sensitivity analyses included alternative intervention timings, period definitions and outcome measures. The primary outcome was the monthly count of pesticide-related suicides. Results Among 268,869 suicide deaths recorded during the study period, 34,962 (13.0%) involved pesticide poisoning. The monthly pesticide suicide counts declined from a mean of 244 before the ban to 81 afterwards. The interrupted time series analysis revealed no immediate level change following the ban (−0.204; 95% confidence interval [CI]: −0.989 to 0.581; P = 0.61) but showed a significant acceleration in the decline during the first 36 months (initial slope change: −0.122; 95% CI: −0.163 to −0.082; P < 0.001). Counterfactual projections estimated 10,846 deaths averted (95% CI: −567 to 29,715), representing a 48% model-based reduction. These effects were robust across all sensitivity analyses. Structural breakpoint analysis identified an increase in gas poisoning suicides in August 2008, more than three years before the ban, indicating no evidence of method substitution. The demographic profiles of pesticide and gas poisoning suicides differed substantially. Conclusions The ban on HHPs in South Korea was associated with a sustained decline in pesticide suicide mortality over 12 years, with no evidence of method substitution. These findings support the means restriction through pesticide regulation as an effective suicide prevention strategy.
Abstract Aims Chronotype reflects individual variation in circadian rhythm (CR) (e.g., morningness versus eveningness). CR and chronotype have been associated with dementia pathology, and recent literature suggests that impaired sleep quality and CR disturbances may represent relevant causal factors for dementia. Current evidence is scarce and consists of just a small number of cross-sectional analyses and one longitudinal study. The aim of this study is to investigate the longitudinal association between chronotype and dementia risk in the older adult population, aged 60 years and older. Methods Linking data from the Lifelines Cohort Study and data from Vektis obtained by Statistics Netherlands led to a sample for analysis of n = 16,757 participants. Chronotype was measured with the Munich ChronoType Questionnaire (MCTQ) between 2011 and 2015. Chronotype was categorised into five categories: extremely early, slightly early, intermediate, slightly late, extremely late. Dementia incidence was based on having at least one dementia indicator from the Vektis dataset in the years 2018 until 2024. A discrete-time survival model was used to examine the association between chronotype and dementia. Age was specified as the underlying time scale in the discrete-time logistic survival analysis. Sex was included as a covariate. Interactions between age, sex, and educational attainment and chronotype were measured by including relevant interaction terms in the model. Results The median age in the sample was 65 years old, and 54% was female. In total, 7% got dementia during a mean follow-up period of 6.6 years. Most individuals had an intermediate chronotype (56%), with about 20% of the individuals having a slightly early and late chronotype, and only about 3% having an extremely early and late chronotype. Individuals with a slightly early (HR, 1.26 [95% CI: 1.08, 1.46]) and an extremely late chronotype (HR, 1.42 [95% CI: 1.00, 2.02]) had an elevated risk of dementia. There were no significant interactions. Conclusions Having a slightly early as well as an extremely late chronotype was associated with an elevated risk of dementia.
Abstract Aims Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels. Methods Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990–2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute’s APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010–2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data. Results In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17–78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58–23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015–2019 was approximately 60% lower than 2000–2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68–0.78) in the 1980 cohort to 0.90 (95% CI: 0.70–1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010–2019. Conclusions Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.
Abstract Aims The COVID-19 pandemic has exerted significant mental health impacts worldwide, with a major concern in the literature being its potential effect on suicide rates. Brazil, one of the countries most severely affected by the pandemic, still lacks clear evidence regarding the consequences of the crisis on self-inflicted deaths. This paper aims to estimate the impact of the COVID-19 pandemic on suicide rates in Brazil. Methods We employed an interrupted time series design with seasonal adjustments to estimate changes in suicide rates per 100,000 population. The analysis was based on deaths from all forms of self-inflicted injury, as classified by the International Classification of Diseases. We estimated trends for the total population, stratified by sex and administrative region. Results Suicide rates increased significantly before the pandemic (β₁ = 0.00148, p < 0.001). No significant change in trend was observed after the onset of the pandemic at the national level (β₃ = 0.00092, p > 0.05). Among men, both the pre-pandemic trend (β₁ = 0.00236, p < 0.001) and the post-pandemic increase (β₃ = 0.00155, p < 0.05) were significant. For women, the pre-pandemic trend was modest (β₁ = 0.00065, p < 0.001), and the post-pandemic slope was not significant (β₃ = 0.00033, p = 0.10). Regionally, the Central-West (β₃ = 0.00217, p < 0.01) and North (β₃ = 0.00186, p < 0.05) experienced significant post-pandemic increases, while the Southeast (β₃ = 0.00087, p > 0.05) and South (β₃ = −0.00034, p > 0.05) showed no significant changes. Seasonal effects revealed consistent mid-year declines across all groups and regions. Conclusions The COVID-19 pandemic did not produce a statistically significant shift in national suicide trends but coincided with the persistence of pre-existing upward patterns in specific demographic and regional contexts. These findings underscore the need for targeted and region-specific suicide prevention strategies.
AIMS:Homelessness is increasing and associated with poor mental health (MH). Few studies have examined how experiences of homelessness and sexual identity intersect to effect MH. We used an intersectional approach to examine MH inequalities related to sexual identity and past homelessness in a nationally representative private household sample, and whether associations were explained by discrimination. METHODS:Analysis of the 2007 and 2014 Adult Psychiatric Morbidity Surveys included 10,428 individuals aged 16-64 (58% female/3.8% non-heterosexual). The Clinical Interview Schedule-Revised (CIS-R) identified common mental disorders (CMDs). Self-harm, attempted suicide, alcohol dependence, substance use, sexual identity, discrimination/bullying, past homelessness and health behaviours were self-reported. Associations between sexual identity and homelessness were examined using multivariable Poisson regression. Prevalence ratios (PRs) for MH and health behaviours by intersectional sexual identity-past homelessness were examined using Poisson regression and adjusted for age, sex, area-level deprivation and further for discrimination/bullying. RESULTS:Bisexual (adjusted PR [aPR]: 2.52, 95% CI: 1.48-4.29) and gay/lesbian (aPR: 1.76, 0.97-3.19) individuals were more likely to report past homelessness than heterosexual peers. Sexual minority (SM) and heterosexual individuals with past homelessness had higher prevalence of all MH outcomes compared to heterosexual peers without homelessness, with associations strongest in the SM-homelessness group (e.g., CMD: aPR: 2.67 [2.37-3.01] for heterosexual-homeless, aPR: 4.11 [3.00-5.63] for SM-homeless, aPR: 1.82 [1.45-2.28] for SM-not homeless groups), and similarly for depression/self-harm/attempted suicide. Likewise, the SM-homeless group had highest prevalence for drug dependence (aPR, 7.38 [3.15-17.29]) compared to the heterosexual-homeless (aPR, 4.03 [3.00-5.42]) and SM-not homeless (aPR, 2.19 [1.27-3.79]) groups. Adjustment for discrimination and bullying substantially attenuated point estimates, with the greatest attenuation (30-50%) in the SM-homeless compared to the heterosexual-homeless groups. CONCLUSIONS:Individuals with past experiences of homelessness have significantly worse MH than heterosexuals without homelessness, with associations highest in the SM-homeless group. Considering experiencing homelessness and SM identity together identifies a group facing particular adversity, which is often lost when examined separately. Discrimination and bullying explained much of the worse MH in SM- and heterosexual-homeless groups, but especially the former. Investigation into the mechanisms leading to MH inequalities is needed, alongside policies and services to support this group.
Abstract Aims Intolerance of uncertainty (IU) – a dispositional inability to react effectively to uncertain situations – has been increasingly conceptualized as a transdiagnostic risk factor for internalizing problems such as generalized anxiety and depression. However, evidence for its temporal role in the development of these conditions remains limited, particularly in adolescents, a group at heightened risk for psychopathology. Methods A total of 5,291 adolescents (46.2% boys; M age = 14.40 ± 1.56, range = 10–18 years) completed self-report measures of IU, generalized anxiety and depressive symptoms at baseline, 6 months and 12 months. Linear and logistic regression analyses examined whether baseline IU predicted subsequent symptom severity and elevated (above-cut-off) symptom levels over time. Results Higher baseline IU significantly predicted increases in generalized anxiety and depressive symptoms, as well as higher odds of elevated generalized anxiety and depressive symptom levels at both 6- and 12-month follow-ups, even after adjusting for baseline symptom severity or baseline elevated symptom status. Baseline IU also predicted the new-onset and persistence of elevated symptoms across both intervals. Stratified analyses revealed developmental and sex differences: IU’s predictive effects were strongest in early adolescence for girls and in middle-to-late adolescence for boys. Conclusions IU emerged as a transdiagnostic longitudinal predictor of generalized anxiety and depressive symptoms in adolescents, supporting its value as an early screening marker of vulnerability. Interventions targeting IU may offer an effective strategy for reducing broad internalizing risk during this critical developmental period.
Abstract Aims Reducing stigma and discrimination towards people with mental ill-health is a key priority in Australian mental health policy. Population-based surveys conducted in Australia between 2003 and 2011 showed some improvement in stigmatising attitudes, but also a deterioration in attitudes about dangerousness and unpredictability, particularly in relation to schizophrenia. This study aimed to investigate whether stigmatising attitudes have changed since the 2011 national survey. Methods Two large, nationally representative samples of Australian adults were surveyed in 2011 (n = 1967) and 2024 (n = 1984). At each time point, participants were presented with vignettes of a person in the early stages of depression or schizophrenia and completed questionnaires about stigmatising attitudes towards the person in the vignette (Personal Stigma Scale) and willingness to interact with them (Social Distance Scale). Using weighted data, logistic regressions assessed change from 2011 to 2024 while controlling for sociodemographic characteristics. Results were considered significant at p < .01. Results There were significant reductions in endorsement of stigmatising attitudes towards depression and early schizophrenia. Notably, there were large reductions in beliefs about dangerousness (depression 22.5–4.8% and schizophrenia 37.1–18.1%). Conversely, the willingness to interact with a person with depression remained unchanged and had worsened for schizophrenia, with the odds of being unwilling to interact approximately doubling (11.0–26.9% unwilling to make friends and 18.8–33.2% unwilling to work closely with them). Conclusions The data show mixed findings regarding change in stigma in the Australian population. Despite negative beliefs diminishing over time, this has not translated into greater willingness to interact with people with depression or schizophrenia. Key action is needed on understanding the barriers to interacting with people with mental health conditions and reducing perceptions of unpredictability, particularly for schizophrenia, which remains more highly stigmatised.
Abstract Aims Prevention of child maltreatment – incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence – is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributable to childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributable to child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors. Methods We estimated burden attributable to child maltreatment by age and gender for Australia in 2021. Risk–outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributable fractions (PAFs) were calculated. Attributable mortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributable burden estimates using Monte Carlo simulation methods. Results Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2–6.9%) of all DALYs for women and 6.4% (95% UI, 6.0–6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributable to child maltreatment. Conclusions Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributable to child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.
