Background National policy frameworks, including the UK Government’s Suicide Prevention Strategy (2023–2028), emphasise person-centred, relational approaches that prioritise therapeutic engagement, collaborative safety planning and a flexible understanding of psychosocial risk. Peer support and lived experience initiatives are increasingly recognised as vital components of suicide prevention and recovery support. Community-based suicide crisis (CBSC) support, which emphasises rapid access, person-centred care and lived experience integration, was established to provide immediate support without clinical criteria, barriers to access or waiting lists. Aims To examine outcomes of a CBSC intervention supporting individuals in suicidal crisis, with particular attention to differences in outcomes across National Health Service (NHS) and non-NHS/self-referral pathways. Method A mixed-methods explanatory sequential design was adopted to provide a comprehensive assessment of service impact and client outcomes among individuals (n = 9801) referred through the NHS (n = 2929, 30%) or non-NHS/self-referrals (n = 6872, 70%) between 2019 and 2025. Results A subanalysis of 1387 (14%) client interventions showed significant improvements across all mental health recovery domains (p < 0.05), particularly among older clients (aged ≥65 years). Fifty interviews with clients, carers, staff and referrers generated three themes around accessibility, rapid response, continuity of care and the value of lived experience in building trust, reducing stigma and helping with long-term recovery. Conclusions CBSC services would benefit from the expansion of NHS partnerships to extend regional reach, standardised monitoring and follow-up, and the strategic use of outcome data to strengthen advocacy and secure sustainable funding. Embedding this community-based model firmly within wider health systems has the potential to enhance its impact, ensure equitable access and inform broader systemic developments in suicide prevention.
Background Over 1.6 million refugees and asylum seekers from Myanmar reside in neighbouring countries. These populations face substantial mental health challenges, yet existing evidence remains fragmented, making a comprehensive review essential. Aims To synthesise evidence on common mental disorders among Myanmar refugees, examine associated factors and explore challenges across host countries and refugee subgroups. Method A systematic search of PubMed, PsycINFO, Web of Science, Embase, Scopus and grey literature was conducted through July 2025. Eligible studies reported on common mental disorders among Myanmar refugees of any age in regional host countries. Two reviewers independently screened studies and extracted data dually, assessed risk of bias with Joanna Briggs Institute checklists and synthesised findings narratively. Results Of 1614 records, 14 studies met inclusion criteria, covering >10 800 refugees in Bangladesh (n = 9), Thailand (n = 3) and Malaysia (n = 2). Reported prevalence was high for depression (30.0–89.0%), anxiety (39.3–41.8%) and post-traumatic stress disorder (3.7–61.2%). Risk factors associated with poorer mental health included potentially traumatic events, female gender, older age, family dependency, post-migration difficulties, lack of social support, food insecurity and pre-existing health conditions. Employment and income were identified as protective factors. Mental health challenges varied by country. Barriers to care included limited service access, lack of culturally appropriate interventions and stigma. Conclusions Myanmar refugees experience a high burden of mental disorders shaped by both potentially traumatic events and post-migration stressors. Effective interventions should be context-specific, focusing on person-centred care tailored to the refugee experience, improved living conditions, strengthened social support and enhanced economic opportunities.
This report details the case of a 72-year-old woman with a 5-year history of anorexia nervosa, whose presentation challenges the conventional presentation of anorexia nervosa. She was admitted under the Mental Health Act (MHA) of England and Wales because of escalating behavioural disturbance, including aggression and disinhibition, together with a long-standing pattern of restrictive eating and distorted body image. She presented with a markedly low body mass index, compulsive exercise and profound lack of insight, complicated by dilutional hyponatraemia, a less commonly reported but potentially life-threatening compensatory behaviour. Particularly noteworthy was the close temporal association between olanzapine discontinuation and the recurrence of severe weight loss and behavioural disturbance. Further complicating her assessment was the presence of encopresis and enuresis. Treatment involved multidisciplinary collaboration, thorough investigation to rule out age-related differentials, structured refeeding and cautious medication management, including olanzapine titration. This case highlights the diagnostic and therapeutic challenges of anorexia nervosa in older adults.
Background There have been limited studies investigating psychiatric outcomes of childhood trauma in individuals with intellectual disability or borderline intellectual functioning. Aims To investigate the associations of (a) intellectual disability or borderline intellectual functioning with childhood trauma up to age 11 years; and (b) childhood trauma with psychiatric diagnostic, prescribing and behavioural outcomes in adolescence and early adulthood among individuals with intellectual disability or borderline intellectual functioning. Method This was a prospective cohort study using data from the Avon Longitudinal Study of Parents and Children birth cohort with linked primary care data. Results Of 8661 participants, 310 had intellectual disability or borderline intellectual functioning and 107 had intellectual disability. We found increased odds of bullying (odds ratio = 1.84, 95% CI: 1.39–2.43) and sexual abuse (odds ratio = 2.11, 95% CI: 1.09–4.11) among individuals with intellectual disability or borderline intellectual functioning compared with those without. In the group with intellectual disability, the odds of bullying were attenuated (odds ratio = 1.66, 95% CI: 0.97–2.86), and estimates for sexual abuse were imprecise (odds ratio = 0.69, 95% CI: 0.09–5.09). Among those with intellectual disability or borderline intellectual functioning, we found increased odds of challenging behaviour (odds ratio = 2.62, 95% CI: 1.05–6.57), psychotropic prescribing (odds ratio = 2.73, 95% CI: 1.55–4.81), and suicidal and self-harm behaviours (odds ratio = 3.42, 95% CI: 1.15–10.20) in individuals who had experienced bullying, and increased odds of challenging behaviour (odds ratio = 3.31, 95% CI: 1.28–8.53) in individuals who had experienced emotional abuse compared with those who had experienced no trauma. Conclusions We provide evidence of increased odds of childhood bullying and sexual abuse among those with intellectual disability or borderline intellectual functioning. In this group, bullying is associated with increased odds of challenging behaviour, psychotropic prescribing, and suicidal and self-harm behaviours.
BACKGROUND:A considerable proportion of individuals who die by suicide have no recorded psychiatric diagnosis, yet their psychosocial and clinical profiles remain poorly understood. AIMS:To examine whether conventional demographic, physical health, psychosocial and mental health characteristics distinguish suicide decedents with, versus without, psychiatric diagnoses in a population-based cohort. METHOD:This retrospective case-control study used UK Biobank baseline data linked with national mortality records. Suicide decedents were classified as having a recorded psychiatric diagnosis prior to death (PtD) or no recorded diagnosis (NPD). Group comparisons and logistic regression analyses examined associations between psychosocial variables and diagnostic status, including domain-specific multivariable models adjusted for age and gender. RESULTS:Among suicide decedents, 44% had no recorded psychiatric diagnosis. There were no significant differences between groups in smoking-related variables, diabetes, hyperlipidaemia, body mass index, social support or social connectedness. Hypertension, as well as the use of immunosuppressants and anti-inflammatory agents, were more prevalent in the PtD group. PtD individuals exhibited higher levels of anxiety-related traits, neuroticism and healthcare utilisation. In multivariable analyses, several unadjusted comparisons were attenuated. Neuroticism, 'suffering from nerves', healthcare utilisation and lower risk-taking remained significantly associated with PtD status whereas mood-related variables, including depressed mood and anhedonia, were no longer statistically significant following adjustment. CONCLUSIONS:Nearly half of suicide decedents had no recorded psychiatric diagnosis, and conventional psychosocial markers demonstrated limited discriminative value under current measurement conditions. These findings support a detection-gap framework and highlight the need for suicide prevention strategies extending beyond diagnosis-based approaches towards broader, population-level detection.
Background Healthcare professional (HCP) students are at high risk of mental health problems, but stigma and fear of career repercussions often deter them from seeking help. Mental Health First Aid (MHFA) is a globally disseminated course teaching the public to identify and respond to people experiencing mental health problems. MHFA training may address some of the challenges faced by HCP students, by improving mental health knowledge and by enhancing well-being and peer support. Aims To systematically review the available literature regarding the impact of MHFA training on HCP students’ mental health literacy, confidence and intentions to provide help, stigma, peer support and self-care. Method Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews ID: CRD42024589509), five databases were searched. Primary studies evaluating the above outcome measures in HCP students were included. Two authors independently screened references and extracted data. Quality was assessed using the Modified Medical Education Research Study Quality Instrument and Cochrane Risk of Bias tools. A narrative synthesis was performed. Results Of 2367 records screened, 26 met inclusion criteria. Confidence in supporting others and mental health literacy showed the most consistent improvements following MHFA training, whereas evidence for changes in stigma was mixed. Peer support, self-care and student well-being were infrequently examined, although qualitative data suggested that MHFA had improved openness to help-seeking. Conclusions MHFA shows promise in enhancing mental health literacy, confidence and intentions, and in reducing stigma, particularly when supplemented with experiential learning. HCP students may benefit from tailoring of such courses to their specific needs, fostering a culture of peer support, enhancing well-being and introducing basic concepts in mental health.
BACKGROUND:Post-traumatic stress disorder (PTSD) symptoms can fluctuate substantially over short periods, yet routine screening typically relies on infrequent self-report. Wearable sensors provide continuous behavioural and physiological signals that may help identify periods of elevated risk. AIMS:This study aimed to evaluate whether combining wearable sensor features with daily self-report data could identify short-term PTSD symptom increases among recently discharged veterans. METHOD:Seventy-four veterans wore commercial activity trackers and completed brief daily questionnaires over 87 days. For each participant, we defined an individual baseline by using the first 14 days of PTSD scores. Wearable variables were transformed into baseline-referenced deviation features to capture departures from personal norms. Missing data were addressed with multiple imputation by chained equations. Candidate predictors were prioritised with least absolute shrinkage and selection operator regression, and a set of machine-learning classifiers was evaluated. Primary performance was assessed by using the area under the precision-recall curve (PR AUC). RESULTS:Across feature set sizes (k = 1-25), performance peaked at k = 17. At this iteration, LightGBM achieved the strongest discrimination (PR AUC 0.86 (s.d. 0.07); area under the receiver-operating characteristic curve 0.89 (s.d. 0.04)) with a precision of 0.67 (s.d. 0.08), recall of 0.64 (s.d. 0.08) and F1 of 0.65 (s.d. 0.07). Key predictors reflected a multimodal profile, combining self-reported affect and perceived stress with wearable indicators of sleep continuity, activity variability and autonomic regulation. CONCLUSIONS:Baseline-referenced wearable features combined with daily self-report may help identify near-term PTSD symptom increases among recently discharged veterans with elevated PTSD symptoms and problematic cannabis use. Future work should validate performance in broader PTSD populations, including samples without problematic cannabis use.
Background The physical environment of psychiatric in-patient facilities plays a significant role in patient well-being, treatment satisfaction and recovery. Despite growing evidence that architectural design influences clinical outcomes, systematic data on patient preferences regarding hospital structure remain scarce. Aims To identify structural and architectural requirements for psychiatric hospital design, from the patient perspective. Method A cross-sectional, hybrid questionnaire survey incorporating closed- and open-ended questions was administered to former psychiatric in-patients from all wards of a tertiary care centre (University Psychiatric Clinics Basel, Switzerland) who had been treated before September 2023. The survey assessed patient-reported disturbances related to room conditions, preferences for structural and environmental design elements, importance ratings of specific architectural features (measured using Likert scales) and preferred treatment settings. Results A total of 604 participants completed the survey (response rate 19.1%). Room-related disturbances were reported by 49% of respondents (n = 282), with key concerns including insufficient privacy, limited withdrawal opportunities and impaired sleep quality. Single-occupancy rooms were rated as very important (10/10) by 64% of respondents. Access to a surrounding park environment (74%) and direct outdoor access (75%) were among the most highly valued features. In-patient treatment was the preferred modality for 54.1% of respondents, followed by out-patient care (17.8%) and day clinics (15.9%). Conclusions Psychiatric patients strongly prioritise in-patient settings offering single-occupancy rooms, privacy and access to green spaces and outdoor areas. These findings underscore the importance of systematically incorporating patient perspectives into the architectural and structural planning of psychiatric facilities.
BACKGROUND:Women with first-episode psychosis (FEP) may experience distinct clinical, reproductive and social challenges, yet their experiences of psychosis care remain underexplored. Greater understanding of women's perspectives is needed to inform gender-responsive service provision. AIMS:To explore how women make sense of their experience of psychosis care, to identify areas where gender-specific needs were unmet and to highlight priorities for improving care for women experiencing FEP. METHOD:This qualitative study employed semi-structured interviews with women who had experienced FEP and received care through early intervention in psychosis and adult community mental health services (N = 15). Data were analysed using reflexive thematic analysis. RESULTS:Four overarching themes were identified: (a) violations of personhood and bodily integrity; (b) invisible menstrual and reproductive health in mental healthcare; (c) women-specific barriers to accessing and sustaining care; and (d) moving towards better care for women with FEP. Women described feeling unsafe in mixed-gender in-patient settings, experiencing unmet reproductive and menstrual health needs and navigating caregiving responsibilities that complicated engagement with care. Findings informed a framework of recommendations for improving gender-responsive psychosis care. CONCLUSIONS:This study provides one of the first in-depth qualitative examinations of women's experiences of FEP care. Women described how their experiences were shaped by issues of safety, autonomy, reproductive health and gendered expectations that remain insufficiently recognised within current service models. These findings highlight persistent gaps in sex- and gender-responsive psychosis care, and support the development of services that more effectively address women's safety, reproductive health and caregiving needs.
Background Peritraumatic dissociation and distress are among the most frequently studied early correlates of post-traumatic stress disorder (PTSD), yet their temporal role following large-scale disasters remains insufficiently understood. Aims This study examined the temporal relationship between peritraumatic dissociation, peritraumatic distress and PTSD symptoms across 3 waves spanning 2 years following the February 2023 Turkey earthquakes. Method Data were collected approximately 2 months (Time 1; N = 261), 1 year (Time 2; n = 182) and 2 years post-earthquake (Time 3; n = 131). PTSD symptoms, peritraumatic dissociation and peritraumatic distress were assessed using validated self-report instruments. Pearson correlation analyses and parallel-process latent growth curve models (LGMs) were used to examine temporal changes and longitudinal associations. Results Higher initial levels of peritraumatic dissociation (β = 0.40, p < 0.001) and distress (β = 0.46, p < 0.001) significantly predicted greater initial PTSD severity. However, neither peritraumatic dissociation nor distress predicted the slope of PTSD symptoms over time, and slope covariances were non-significant. All three variables declined substantially across waves (ηp2 = 0.75 to 0.79). Conclusions Peritraumatic reactions appear to function primarily as indicators of early PTSD severity rather than determinants of long-term symptom trajectories. These findings support multi-stage screening approaches that extend beyond early peritraumatic assessments to incorporate post-traumatic cognitive, social and environmental factors.
Background Discriminatory practices and barriers to care are increasingly recognised as a significant challenge for mental healthcare institutions. Yet, little research has considered what measures people with experience of using mental health services and mental healthcare service providers recommend to implement anti-discrimination within mental healthcare. Aims This study aims to explore the perspectives and recommendations of marginalised people with experience of using mental health services, mental healthcare service providers and psychosocial counsellors, to inform more equitable mental healthcare. Method Between May 2022 and June 2023, we conducted 17 semi-structured qualitative interviews and 2 focus groups with psychosocial counsellors, people with experience of using mental health services and mental healthcare service providers. Data analysis followed structuring qualitative content analysis, combined with participatory methods. Results Study participants recommended interpersonal, organisational and structural measures to address mental healthcare inequities. On an interpersonal level, they emphasised providers’ behaviour and attitudes toward discrimination. Organisationally, they called for a comprehensive intersectional care framework, fostering inclusive therapy environments, increasing staff diversity and implementing continuous anti-discrimination training. Structurally, they advocated for discrimination-critical therapy materials, revised curricula and removing barriers to medical education and healthcare. Conclusions The study yielded suggestions for anti-discriminatory, critical consciousness-based and inclusive practices on the interpersonal, organisational and structural levels of mental healthcare. It offers important insights for research devoted to implementing and evaluating such measures.
Background Task-sharing with non-specialist providers offers a promising solution to the mental health workforce shortage in low-resource settings. Supervision is essential to ensure treatment quality, but is often constrained by limited specialist availability. Aims This study evaluated the costs of developing PEERS, a smartphone app that can facilitate registering and scheduling supervision sessions, collecting patient outcomes, rating therapy quality and assessing supervision quality among community-based non-specialist providers delivering behavioural activation for depression. Method The PEERS digital application was developed between June 2021 and September 2022 for use in Madhya Pradesh and Goa, India. Development involved contributions from researchers, clinicians, technology experts and end users. Activity-based costing was used to systematically document the inputs and expenditures involved in developing the PEERS app and its accompanying training materials from a health systems perspective. Key cost components included human resources, leadership, IT support and infrastructure. Results Total development costs were US＄130 027, with the costs of information technology accounting for the largest share (81%; US＄105 110). Human resource contributions accounted for 17% (US＄22 523), which included oversight and contributions from international research collaborators. Additional costs included overhead and infrastructure (US＄2393). Conclusions Digital tools are increasingly being used to expand access to and support the delivery of mental health interventions in low-resource settings, yet few studies report on the development costs. By estimating the costs and resources required for developing a digital app for peer supervision, this study can inform efforts to facilitate broader implementation and adaptation of the app for use in other settings.
Background The integrated motivational–volitional (IMV) model of suicidal behaviour has received growing empirical support, yet few studies have tested its core pathways (defeat → entrapment → suicidal ideation → suicide attempts) in clinical psychiatric adolescent populations. Evidence on volitional moderators influencing the transition from ideation to action remains limited. Aims This study aimed to (a) test the core pathways of the IMV model and (b) examine whether volitional moderators differentiate between adolescents with suicidal ideation and those who have attempted suicide. Method In this cross-sectional study, 203 Danish adolescents aged 13–19 years were recruited from an out-patient child and adolescent psychiatry department, including patients in treatment or referred for initial assessment. Participants completed validated measures assessing IMV constructs. Path analysis tested the core pathways and multinomial logistic regression examined associations between volitional moderators and group membership (no suicidal behaviour, suicidal ideation only and suicide attempt), with Wald tests comparing effects across outcomes. Results Findings supported the core IMV pathway, with the entrapment–ideation pathway being weakest. Volitional moderators were more strongly associated with suicide attempts than suicidal ideation, with significant differences confirmed by Wald tests. A dose–response pattern showed increasing likelihood of suicide attempts with greater exposure to volitional moderators; effect sizes differed significantly between ideation (odds ratio 2.21) and attempts (odds ratio 3.94). Conclusions Results support the IMV model and highlight the role of volitional moderators in differentiating between suicidal ideation and attempts. These findings support a shift towards theory-informed psychosocial assessment in clinical adolescent populations.
Background Clozapine reduces overall mortality and suicide risk in schizophrenia, but the specific causes and clinical contexts of death among clozapine-treated patients remain less well characterised. Aims We aimed to characterise causes of death in clozapine-treated patients within a defined UK catchment area over 17 years (2009–2025); compare features across predefined mortality clusters (suicide, expected, unexpected); compare unexpected death cases with a clozapine-treated comparison cohort alive in 2019 and examine temporal mortality patterns. Method We conducted a retrospective, descriptive cohort study of all deaths among clozapine-treated patients within a UK mental health National Health Service Trust between 1 January 2009 and 31 December 2025. Deaths were classified into suicide, expected and non-intentional unexpected, using a previously established framework. Variables were compared across clusters and between unexpected death cases and a clozapine-treated comparison cohort alive in 2019. Results Of 87 deaths, 11 (12.6%) were suicides, 29 (33.3%) were expected and 47 (54.0%) were non-intentional unexpected. Malignancy was the most common cause (21/87, 24.1%), followed by cardiovascular (13/87, 14.9%) and respiratory or infective causes (9/87, 10.3%). Age differed across clusters (p = 0.005), with suicides at younger ages. Compared with the 2019 cohort, patients who died unexpectedly were older (55.0 v. 48.6 years, p = 0.006) and more likely to smoke (75.0 v. 34.6%, p < 0.001). Annual mortality peaked in 2021 and was not fully explained by direct COVID-19 deaths. Conclusions Mortality in clozapine-treated patients arises across diverse clinical contexts, with more than half classified as non-intentional unexpected. Findings support sustained physical health monitoring, closer attention to smoking and other modifiable risks, and continuity of care.
Background Afghan refugees experience high levels of cumulative trauma and psychosocial adversity, yet attachment-related trauma has rarely been examined at the narrative level. Narrative attachment assessments may capture culturally embedded expressions of distress beyond post-traumatic stress disorder (PTSD)-focused symptom models. Aims This study examined narrative attachment-related trauma markers in Afghan refugees receiving out-patient psychological treatment. It investigated whether trauma marker frequency differed between resolved and unresolved attachment representations and whether it was associated with psychological symptom severity. Method In an exploratory cross-sectional study, 40 Afghan refugees (mean age = 25.4 years; 75% male) receiving out-patient psychological treatment completed the Adult Attachment Projective Picture System, a narrative-based attachment interview. Trauma markers were identified and quantified within the narratives. Associations with attachment representations (resolved versus unresolved) and psychological symptom severity were examined in a subsample with available self-report data (n = 27). Results Participants with unresolved attachment representations showed higher trauma marker frequencies than those with resolved representations. Trauma marker frequency was positively associated with depressive symptoms and overall psychological distress (Spearman’s effect size estimate (r) = 0.40–0.51; 95% bias-corrected and accelerated (BCa) confidence intervals excluding zero) but not with PTSD symptom severity. Conclusions Trauma markers captured clinically relevant distress in Afghan refugees beyond PTSD-specific symptomatology, particularly depressive symptoms and general psychological burden. Narrative, attachment-based approaches may be especially valuable in clinical encounters in which distress is conveyed implicitly, relationally, or in culturally contextualised ways rather than through explicit symptom reporting. Culturally sensitive applications of such methods, supported by well-trained interpreters, are essential for clinical understanding and meaningful clinical engagement.
BACKGROUND:Questions have been raised whether the patient organisations assessments of coercion - often critical - captures the breadth of patient experiences of coercion. Existing systematic reviews have not captured the full scope of reported experiences, necessitating a more comprehensive approach. AIMS:To identify the existing body of qualitative studies reporting patients' experiences of coercion; map study distribution over time, regions, and type of coercion; and synthesise broad categories of reported experiences. METHOD:The review protocol was preregistered (PROSPERO identifier CRD42021248744). We searched 12 databases (MEDLINE, Embase, APA PsycINFO, CINAHL, Web of Science, Sociological Abstracts, Scopus, ASSIA, Norart, SveMed+, OpenGrey.eu and Google Scholar) for qualitative studies published from 1 January 1991 to 3 June 2025. Peer-reviewed studies and approved doctoral theses were included. We used EPPI-Reviewer for screening, data extraction and coding. Study quality was assessed with a modified Critical Appraisal Skills Programme tool. RESULTS:We included 291 studies, 18 of them from low-and middle-income countries. The most studied coercive practices were involuntary admissions, coercive measures and community treatment orders. Quality concerns included limited author reflexivity and lack of involvement of experts by experience. At least one negative experience was reported in 279 of the studies, while mixed and positive experiences appeared in 166 and 167, respectively. CONCLUSIONS:A large body of qualitative research reporting patient experiences of coercion exists, with a near-universal presence of negative experiences. Improved patient involvement in research, and more studies from low-and middle-income countries and on involuntary medication are needed.
BACKGROUND:Individuals with schizophrenia have shown distinct cancer incidence patterns. AIMS:We aimed to assess whether their cancer-related mortality differs from the general population overall, by gender and by specific cancer types. METHOD:We systematically searched Scopus, Web of Science, PsycINFO, PubMed and Embase, up to December 2025. Each record was independently screened by two reviewers, and data were independently extracted by two investigators. Two authors assessed the quality of the included articles with the Newcastle-Ottawa Scale. Analyses were conducted using Stata version 16; between-study heterogeneity was evaluated with Cochran's Q-statistic and the I2-statistic, and potential sources of heterogeneity were further examined through exploratory meta-regression. RESULTS:Meta-analysis of cohort studies showed that individuals with schizophrenia had a 55% higher risk of cancer-related death than the general population (standardised mortality ratio (SMR) 1.55; 95% CI 1.16-2.07). In gender-stratified analyses, SMRs for all cancers combined were 1.37 (95% CI 1.01-1.87) in men and 1.43 (95% CI 1.15-1.79) in women. Site-specific SMRs were 1.77 (95% CI 1.17-2.68) for breast, 2.40 (95% CI 2.35-2.45) for respiratory, 1.54 (95% CI 1.35-1.76) for gastrointestinal, 2.32 (95% CI 0.72-7.45) for haematologic, 4.43 (95% CI 0.71-27.62) for skin and soft tissue, 3.03 (95% CI 1.96-4.69) for urogenital and 1.01 (95% CI: 0.36-2.83) for other cancers, although precision varied considerably across cancer sites. CONCLUSIONS:Schizophrenia was associated with substantially elevated cancer-related mortality compared with the general population. These findings underscore the need for earlier cancer detection and guideline-concordant, integrated physical and mental healthcare for this high-risk group.
BACKGROUND:Post-migration stressors can exacerbate post-traumatic stress disorder (PTSD) and reduce treatment effectiveness among refugees. Evidence for integrated care models in high-income settings remains limited. AIMS:To compare treatment as usual (TAU) with an add-on integrated care intervention for unemployed refugees with PTSD. METHOD:We conducted a two-arm, parallel-group superiority trial with 1:1 randomisation to TAU or TAU with an add-on integrated care intervention, delivered at a specialised out-patient clinic in Denmark (ClinicalTrials.gov NCT04244864). TAU included sessions with a psychologist and physician over 8-12 months. The integrated care intervention also included structured collaboration with employment services. The primary outcome was functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS) interview. Secondary outcomes included symptoms, quality of life and post-migration stressors. Analyses followed the intention-to-treat principle, using analysis of covariance and linear regression with multiple imputations. RESULTS:The study included 195 patients in treatment from 2020 to 2025. No difference was observed in WHODAS score between groups pre- to post-treatment (mean difference 0.30, 95% CI -2.40 to 3.00; P = 0.825). Similarly, no differences were found for secondary or exploratory outcomes, and overall change was limited. However, the integrated care group had a lower rate of early dropout (P = 0.042) and higher level of treatment satisfaction (P = 0.035). CONCLUSIONS:Integrated care was feasible but not superior to TAU in improving outcomes for refugees with longstanding symptoms and unemployment. Future research should examine how the timing and intensity of integrated care interventions influence outcomes, including earlier implementation and adequate support for refugees with longstanding and complex needs.
Aims: Prolonged waiting times for ADHD assessment in child and adolescent mental health services (CAMHS) present a significant challenge. While outsourcing can address immediate waiting list pressures, it may simply shift the bottleneck back to the core CAMHS service. This service evaluation aimed to examine the effectiveness and cost implications of the in-house waiting list model in West Galway CAMHS, with a view to informing management decisions on developing and appropriately resourcing the team for sustainable long-term service delivery. Methods: This service evaluation reviewed CAMHS patients from West Galway who were awaiting ADHD assessment between January 2025 and January 2026. A random sample of 30 patients managed via the in-house waiting list initiative was compared with 28 patients managed through an outsourced model. Outcomes assessed included time to assessment, discharge to GP (without transfer to core CAMHS), diagnosis rate, and subsequent need for CAMHS follow-up. Data were analysed using simple descriptive comparisons to explore differences in service outcomes between the two models. Results: Direct comparison of time to assessment was limited by differences in team structure and staffing: the in-house waiting list team was newly established and consultant-led, while the outsourced model comprised a well-established external agency with longstanding experience in the UK. Notably, 70% of patients in the in-house team were discharged back to their GP without transfer to core CAMHS, compared with 0% in the outsourced group. Consequently, only 30% of in-house patients required ongoing CAMHS follow-up, versus 100% in the outsourced model. Diagnosis rates are currently being further analysed to examine the detection of comorbidities. These preliminary findings suggest that while outsourcing addresses immediate assessment capacity, the in-house model may offer opportunities for developing a sustainable, consultant-led service with longer-term oversight, provided adequate resourcing. Conclusion: This service evaluation highlights that a well-structured in-house waiting list team has the potential to improve downstream flow to the core CAMHS service, reducing the secondary bottleneck and minimising repetition of work through clear, consultant-led care plans. Effectiveness is dependent on having the right staffing skill set and staff-to-patient ratio, as limitations in these areas impact throughput, consistency, and the ability to meet service expectations across teams. These findings suggest that appropriately resourced, consultant-led in-house services could provide sustainable improvements in assessment and care delivery, supporting the case for expanding the service.
Aims: Challenging behaviours in individuals with intellectual disability and autism spectrum disorder are complex, multifactorial phenomena that often result in significant distress for patients, families, and caregivers. They are associated with poor quality of life, increased use of mental health services, and heightened risk of trauma for carers. Pharmacological management has traditionally favoured antipsychotics, with limited evidence supporting the use of antidepressants. Methods: We report the case of a 26-year-old woman with moderate learning disability and autism spectrum disorder who exhibited severe challenging behaviours, including self-harm, aggression and property damage. These behaviours persisted despite trials of benzodiazepines, analgesia, and multidisciplinary behavioural interventions. Antipsychotics were avoided due to comorbid pituitary tumour. Following a clinical review that identified anxiety as a perpetuating factor, trazodone was introduced and titrated to 50 mg three times daily. Results: Initiation of trazodone has resulted in marked reduction in the frequency and severity of challenging behaviours, improved identification of triggers, and enhanced engagement in structured ward activities. Residual incidents are shorter, less severe, and easily redirected, with fewer requiring physical intervention. The patient demonstrated improved participation in therapeutic activities, and staff reported greater confidence in managing residual behaviours. Conclusion: This case highlights the potential role of trazodone, an antidepressant, in managing challenging behaviours in individuals with intellectual disability and autism spectrum disorder. It underscores the importance of individualized treatment approaches and contributes to the limited evidence base supporting alternative psychotropic strategies beyond antipsychotics. Further studies are needed to assess antidepressant efficacy in managing challenging behaviours.
