BACKGROUND:Little is known about self-harm in children involved in family justice proceedings, particularly in private family courts in England and Wales. AIMS:To examine records of self-harm in children involved in private and public law proceedings using population-level linked data. METHOD:A retrospective e-cohort study of children aged under 18 years, using linked health and family justice (Cafcass Cymru) data (2011-2018). Family court involvement was recorded from age 0 to 17 years. Incidence of self-harm was recorded from age 10 to 17 years to fit with the standard definition of self-harm. Annual incidence of self-harm over time across general practitioner (GP), emergency department and hospital admissions for individual children in private and public law proceedings were compared with a non-court cohort using Poisson regression. Self-harm following court proceedings was compared with an age- and gender-matched non-court cohort using Cox regression. RESULTS:Adjusted self-harm rates were higher in court-involved children than the non-court cohort (incident rate ratios (IRRs) (95% CI), private: GP 1.8 (1.6-2.1); emergency department 1.4 (1.2-1.7); admissions 1.8 (1.5-2.1); public: GP 4.6 (4.1-5.3); emergency department 5.0 (4.3-5.8); admissions 5.0 (4.3-5.8)). Compared with matched comparison children, risk of self-harm was higher following private (adjusted hazard ratios 2.0 (1.7-2.2)) and public court proceedings (hazard ratio 2.3 (2.7-3.8)). Hazard ratios were greater for those from less deprived areas and those with no history of self-harm. CONCLUSIONS:The elevated risk of self-harm in children involved in public law proceedings is well recognised. Our study highlights risk in children in private family justice proceedings. Elevated risk among those from less deprived areas and those with no history of self-harm may reflect circumstances associated with family justice involvement, resulting in rates comparable to children with other pre-existing vulnerabilities. Contact with family justice is an opportunity to offer preventative support.

Background:Ethnic disparities in healthcare access and outcomes have been widely reported across different settings. In this scoping review, we aimed to explore whether adults from minority racial and ethnic backgrounds face higher risks of death after presenting with injuries to emergency healthcare services in high-income countries. Methods:We searched five electronic databases [Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane, Scopus and PsycInfo® (American Psychological Association, Washington, DC, USA)] for peer-reviewed studies published between January 2010 and March 2024. We included studies that compared mortality outcomes by race or ethnicity in emergency healthcare settings such as ambulance services, trauma centres and hospital emergency departments in high-income countries. Results:Out of the 1873 articles identified, 32 met the inclusion criteria. Of these, 20 reported higher risk of mortality for ethnic minority patients compared to White patients following injury. Most studies were conducted in the USA with limited representation from other high-income countries such as Canada and Israel. This strong emphasis on USA-based research limits how well the findings apply to other countries with different healthcare systems. A major issue identified across the studies was the inconsistency in how race and ethnicity were recorded and reported. This lack of standardisation makes it difficult to compare results across studies and may hide the true extent of disparities. Future work:To better understand and address ethnic disparities in trauma care, future research should adopt consistent and inclusive ethnicity coding to improve data quality and comparability across studies. Studies should be conducted in a wider range of high-income countries and include pre-hospital settings, where disparities may first appear. This will help build a more globally relevant evidence base. Researchers should also take an intersectional approach, examining how ethnicity combines with other social determinants to influence outcomes. In addition to mortality, future studies using longitudinal and mixed-methods designs should explore long-term recovery and access to rehabilitation to gauge the full impact of these health disparities. Limitations:The review focused solely on mortality outcomes, limiting insight into broader health outcomes such as long-term recovery, quality of life or patient experiences. It also did not explore how ethnicity interacts with other social factors such as gender, income, disability or immigration status. These gaps obscure the full extent of inequalities in emergency care. Conclusion:This review adds to the growing evidence that ethnic minority patients in high-income countries could be at a higher risk of injury-related deaths. However, inconsistent ethnicity coding and a USA-centric evidence base limit the generalisability of findings. To create fairer and more effective emergency care systems, future research must improve data quality, broaden its geographic scope and consider the complex social factors that shape health outcomes. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.

BACKGROUND:Academic pressure could increase the risk of adolescent depression and self-harm. However, there are few longitudinal studies of this association, and those that exist have limitations. We aimed to investigate associations between perceived levels of academic pressure and subsequent depressive symptoms and self-harm from adolescence to early adulthood. Our hypothesis was that higher levels of academic pressure would be associated with higher levels of depressive symptoms and self-harm. METHODS:In this longitudinal study, we used data from the Avon Longitudinal Study of Parents and Children (Avon, UK) that includes adolescents born in 1991-92. Our primary exposure of interest was academic pressure measured at age 15 years, using items from a school experiences questionnaire (total scores 0-9). Outcomes were depressive symptoms assessed with the Short Mood and Feelings Questionnaire at five timepoints between age 16 years and 22 years (total scores 0-26), and a self-harm questionnaire at four timepoints between age 16 years and 24 years. Analyses were linear (depressive symptoms) and logistic (self-harm in the previous year) multilevel models in samples with multiply imputed data, before and after adjustments. FINDINGS:We included 4714 adolescents (2725 [57·8%] female, 1989 [42·2%] male). In fully adjusted models, a 1-point increase in academic pressure at age 15 years was associated with a 0·43 (95% CI 0·36-0·51) point increase in depressive symptoms. This association was largest when depressive symptoms were assessed at age 16 years (0·53, 0·42-0·64), but remained at age 22 years (0·35, 0·23-0·47). For self-harm, in fully adjusted models, each 1-point increase in academic pressure was associated with an 8% higher odds of self-harm (adjusted odds ratio 1·08, 1·01-1·16), with no differences over time. INTERPRETATION:Our findings support the hypothesis that academic pressure is a potential modifiable risk factor for adolescent depressive symptoms, and possibly self-harm. Interventions to reduce academic pressure could be developed and evaluated. FUNDING:Sir Henry Dale Fellowship, Wellcome Trust, and Royal Society.

Background:Routinely collected health data, such as that held by United Kingdom (UK) national health services (NHS), has important research uses. However, its use requires public trust and transparency. Access by commercial/industrial organisations is especially sensitive for the public, as is mental health (MH) data. Although existing MH data science guidelines emphasise patient/public involvement (PPI), they do not cover commercial uses specifically. Objectives:To develop patient- and public-led guidelines for the commercial and industrial use of MH data for research. Though UK-focused, their principles may apply internationally. Methods:A PPI Lived Experience Advisory Group (LEAG) was created within DATAMIND, a UK data hub for MH informatics. Initial discussion yielded a requirement for definitions and explanations of concepts relating to MH data research, developed iteratively. Subsequently, the LEAG developed guidelines via a qualitative quasi-Delphi approach. The agreed scope excluded data provided for research with informed consent, data processing arrangements (e.g. companies hosting electronic systems on the instruction of health services), and compliance with legal minimum requirements. The scope included the use of routinely collected MH data for research by commercial/industrial organisations without explicit consent, and aspects of industry-led MH data collection conducted with consent. Results:Alongside the primer in MH data research concepts, the LEAG provide best-practice guidelines relating to commercial/industrial research use of MH data, for organisations controlling MH data (such as NHS bodies) and for commercial applicants seeking access. Core principles include transparency, patient rights, meaningful PPI, stringent governance, and statistical disclosure control. The guidelines recommend a risk-benefit approach to assessing data access applications, within limits that include avoiding the export of unconsented patient-level data outside NHS-controlled secure data environments, and not providing commercial applicants with access to unconsented free-text MH data. Further recommendations for NHS executive and regulatory bodies relate to public choice and transparency, clarity of guidance to research-active NHS organisations, and support for de-identification. Conclusions:MH data research requires patient/public involvement and understanding. These guidelines reflect the views of people with personal or family experience of mental ill health. We hope they are useful to the MH research community and increase public transparency and trust.

AIM:This study investigated the influence of depression status on lipid lowering therapy (LLT) prescribing and achievement of guideline targets for low density lipoprotein cholesterol (LDL-C) levels in patients after first documentation of a high risk of developing atherosclerotic cardiovascular disease (ASCVD). Associations with sex, socioeconomic status and location of residence on these relationships were also explored. METHODS:A retrospective observational cohort study (2010-2019) using individual-level linked, anonymised, routinely collected electronic health record data sources. Patients with/without depression and documentation of a high global QRISK risk score (HQR) were included. Outcome variables were LLT prescription within 6 months of HQR documentation and recording of LDL-C level within European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) targets and achievement of >40% reduction in LDL-C according to National Institute for Health and Care Excellence guidance within 1 year of HQR. Logistic regression analysis explored the association between depression and outcome variables adjusting for sex, age group, deprivation, location of residence and other risk factors. RESULTS:QRISK was documented in 284 859 (12.8%) patients. In the 103 340 HQR patients, depression (identified pre-HQR or post-HQR documentation) was associated with a higher likelihood of LLT prescription (pre-OR 1.15, 95% CI 1.08 to 1.23; post-OR 1.39, 95% CI 1.19 to 1.64). Depression was not associated with achievement of LDL-C control as per EAS/ESC guidelines (<2.6 mmol/L; pre-OR 1.10, 95% CI 1.00 to 1.23; post-OR 1.00, 95% CI 0.79 to 1.28). Depression pre-HQR was associated with achievement of a >40% reduction in LDL-C (pre-OR 1.16, 95% CI 1.02 to 1.32; post-OR 0.94, 95% CI 0.70 to 1.25) CONCLUSION: Only a small proportion of patients had a documented QRISK score in their record. While high ASCVD risk patients with depression were more likely to be prescribed LLT, this was not necessarily associated with better LDL-C control.

LGBTQ+ young people are disproportionately affected by self-harm and suicide and are active social media users, yet little is known about their suicide-related online experiences. We analysed data from a quota-sampled survey of Australian social media users aged 15–25 (N = 885; LGBTQ+ n = 249). Compared with their non-LGBTQ+ peers, LGBTQ+ youth had over fourfold higher odds of exposure to self-harm and suicide-related content, and elevated odds of creating such content and seeking help on social media. More LGBTQ+ youth reported worsened mood and self-harm following exposure. These findings suggest that engagement-driven algorithms may create a feedback loop in which help-seeking amplifies harmful exposure. Enforceable platform accountability frameworks that reduce harmful exposure without limiting support pathways are needed.

Objective The COVID-19 pandemic brought global disruption, increased mortality, and concern about mental health impacts. Although children and young people (CYP) generally experienced less severe physical symptoms, public health measures such as school closures and restricted social interactions likely had adverse effects. Concerns were raised that risks of suicide and self-harm could increase during and after the pandemic. This review examined the extent to which these concerns were reflected in published evidence. Design A systematic search of databases was conducted for quantitative observational studies reporting suicide deaths, self-harm (including non-suicidal self-injury and suicide attempts), or suicidal ideation in individuals aged 24 years and under. Studies published between 1 January 2020 and 30 June 2022 were included. Quality was assessed using National Institutes of Health tools. Due to methodological heterogeneity, findings were synthesised narratively. Results Eighty-seven studies met inclusion criteria: 23 reported on suicide, 53 on self-harm, and 27 on suicidal ideation. Two were not peer-reviewed; all were observational. Most were conducted in healthcare settings and presented pre- and post-pandemic data. Half were rated low quality. Suicide data, largely from high-income countries, showed little or no overall change, though some studies reported increases among males. Moderate- or high-quality studies of self-harm indicated increases, especially from late 2020 into 2021/2022, and more pronounced among females. Increases in suicidal ideation were also reported, mainly in cohort or healthcare-based studies, though most were low quality. Conclusions The pandemic appeared to have minimal immediate impact on suicide rates in CYP. There was limited evidence from low- and middle-income countries, ethnic minorities, low-income households, and marginalised groups. Evidence of increased self-harm, particularly among females, highlights the need for age- and gender-specific policies, care pathways, and prevention strategies that are adaptable during future public health crises and ensure timely access to effective support. PROSPERO registration number: CRD42020183326 22 nd October 2020

BACKGROUND:Poor school attendance adversely affects youth behaviour and health trajectories. We reviewed and synthesised the evidence from randomised controlled trials (RCTs) on interventions to improve school attendance. METHODS:This systematic review and meta-analysis updates the Education Endowment Foundation (EEF) 2022 review on attendance interventions. We synthesised RCT data to inform recommendations. We searched ERIC (via EBSCOhost), PsycINFO, Web of Science and Google Scholar for publications 1 January 2020-16 October 2024 to identify attendance interventions delivered to students, parents/guardians or school staff. We also extracted and analysed RCTs identified in the EEF review. Two reviewers independently extracted data from published articles and assessed risk of bias and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation, GRADE assessment). We synthesised and meta-analysed data per our protocol (PROSPERO: CRD42024610037). RESULTS:We screened 9366 titles and abstracts and included 61 articles (2000-2024): 43 articles published 2020-2024 plus 18 articles from the previous review (2000-2020), reporting 57 trials of 54 interventions. Pooled mean difference and 95% CIs for days of school attended was 0.63 (-0.34 to 1.61), I2=64.0%, low certainty, for mentoring interventions and 0.43 (0.10 to 0.76), I2=91.9%, moderate certainty, for parental engagement interventions. Other intervention areas including targeted approaches, behavioural programmes and social-emotional interventions had smaller, heterogeneous evidence bases. Risk of bias was moderate-to-low in most trials. CONCLUSION:A large range of interventions exist to address the diverse causes of school absence. Parental engagement demonstrated a small positive effect on attendance, particularly among younger age groups. Most trials were from the USA; implementation and evaluation in other countries will inform effectiveness.

Background: Parental problems, low income and area-level deprivation are known predictors of children entering public care, but it is unclear how much this is due to relationships between these factors. Objective: This study explores these interrelationships and asks how area-level deprivation and household-level low income interact with parental risk factors to influence the likelihood of care entry. Methods: Administrative data from health services, education and children's social care were linked, creating a population-level dataset of households in Wales, UK, with children aged 3-17 (n = 221,312). Multilevel binary logistic regression models were used to identify the effects on the odds of care entry of adult risk factors (types of substance misuse, mental ill health, learning disability and neurodivegence), with and without adjustment for area-level deprivation and household low income. Further models examined interaction effects. Results: Models suggest the effect on care entry of both area-level deprivation and low income is partly due to higher levels of the adult risk factors in deprived areas and in households with low income. There is no evidence of risk factors having a differential effect on the likelihood of care by area deprivation. Depression, anxiety and self-harm had a greater effect on the odds of care in households that did not have a low income. Conclusions: These findings provide new evidence unpicking the association between families struggling financially and children entering care. Findings highlight the need for policies combating child poverty and to support families living in poverty to prevent entry of children into care.

[This corrects the article DOI: 10.1371/journal.pgph.0000282.].

The COVID-19 pandemic revealed essential weaknesses in mental health systems and intensified existing inequities, highlighting the need for a comprehensive assessment of policy responses and strategies for future resilience. Guided by four questions relating to system adaptations, approaches to inequities, financing strategies, and evidence gaps, we synthesised evidence from a structured literature search (2020-24), expert consultation, and lived experience. We found that public health systems embedded infodemic management, expanded digital services, and mobilised community workforces, but responses varied in equity and effectiveness. Although gender, age, socioeconomic, and racial disparities worsened during the COVID-19 pandemic, social protection, gender-sensitive policies, school-based services, and culturally adapted interventions showed promise. High-income countries buffered shocks with welfare measures while low-income and middle-income countries faced sharp fiscal constraints. Few studies evaluated cost-effectiveness or equity impacts of psychosocial interventions. Building resilient, equitable mental health systems requires integrated policies spanning communication, digital and community care, gender-responsive and youth-responsive strategies, and sustainable financing, alongside investment in longitudinal and cross-national research.

PURPOSE:Mental health (MH) and mental well-being (WB) are related but distinct, potentially shaped by shared or unique factors. Understanding how influences like bullying, body image, and peer support affect each can guide more targeted interventions. METHODS:The School Health Research Network includes 176,603 pupils from 196 secondary schools in Wales (94% coverage of all schools). Biannual pupil health survey data were used to explore the relationship between MH (i.e., Strengths and Difficulties Questionnaire Total Difficulties) and WB (i.e., Short Warwick-Edinburgh Mental Wellbeing Scale) using structural equation modeling. Explanatory variables hypothesized to influence MH or WB were grouped into demographic, behavioral, and social domains. Any 11-to 16-year-old pupils with a pair of MH and WB scores in the 2019 or 2021 survey (N = 176,603) were included. RESULTS:Explanatory variables from each domain were adversely associated with MH and WB. Difficulties sleeping had the strongest adverse effect on WB (β = 0.18, 95% confidence interval = 0.13-0.23, p < .001) and MH (β = 0.21, 95% confidence interval = 0.16-0.26, p < .001). The strength of this association did not differ significantly between the two outcomes. There was no evidence of an effect of school on MH or WB indicating that the individual-level effects may not directly be influenced by schools. DISCUSSION:Key modifiable explanatory variables, for example, academic pressure, body image, and lack of support from friends and teachers could serve as targets for interventions for MH and WB. Further development with schools, families, and health and social care services across Wales could support a more coordinated approach to improving adolescent MH and WB.

Background:Many features of social media platforms can influence safety in relation to self-harm/suicide-related content. In 2019, platforms including Meta updated their policies regarding self-harm/suicide content. This included community guidelines, content restrictions, and signposting. The impact of these safety measures has yet to be fully evaluated. Objective:This study aimed to better understand the perspectives of social media users on safety measures related to self-harm/suicide content, including perspectives of those with a history of self-harm. Methods:This was a cross-sectional mixed methods study. Participants were recruited through convenience sampling. Quantitative data were collected using a fixed-response cross-sectional survey (5294 respondents aged 16-84 years, largely women/girls or nonbinary). Questions related to the experience of self-harm and suicide content, the change policy in 2019, and specific features of platforms. Qualitative data were collected via semistructured interviews (17 participants aged 16-56 years) with interview guides broadly following the topic areas of the survey. Interviews were analyzed using thematic analysis. Results:Half of the survey respondents (49.8%, 95% CI 47.8%-51.8%; 2476/4970) stated the current restrictions made social media feel safer, 34.9% (95% CI 32.6%-37.2%; 1736/4981) reported that this changed what they saw on social media, and just 9.9% (95% CI 7.5%-13.0%; 492/4479) stated that this changed what they posted. Furthermore, 64.3% (95% CI 62.6%-65.9%; 3212/4997) stated that they would be "very likely" to click on a post marked with a generic content warning, with 15.1% (95% CI 12.6%-17.9%; 753/4998) being "very likely" to click on a post with a self-harm specific content warning. Of the respondents who had content removed due to mental health or self-harm content, ~90% indicated that this was harmful or very harmful to them at the time, particularly where content was removed because of visible scars (extremely harmful 58.3%, 95% CI 54.3%-62.3%; 599/1027; harmful 31.3%, 95% CI 26.3%-36.7%; 321/1027). Thematic analysis of in-depth interviews revealed 13 subthemes organized into 7 overarching thematic areas. Participants described the experience of social media platforms before and after the policy changes, with opinions divided on whether existing safety features were effective. Participants described the distress caused by inappropriate censoring of images, for example, where healed self-harm scars were visible. Suggestions were made for how platforms can continue to improve, including age verification procedures for young people, tailored signposting, and increased control over content. Conclusions:To our knowledge, this is the first study to explore the 2019 change in platform policies with respect to self-harm/suicide-related content from the perspectives of those with a history of self-harm. This research adds to the evidence of the risks and unintended consequences of imposing untested blanket restrictions in online settings. Full evaluation of these restrictions is essential to allow platforms to continue to improve, encouraging a safe space for supportive communities while mitigating potential harm.

The COVID-19 pandemic revealed essential weaknesses in mental health systems and intensified existing inequities, highlighting the need for a comprehensive assessment of policy responses and strategies for future resilience. Guided by four questions relating to system adaptations, approaches to inequities, financing strategies, and evidence gaps, we synthesised evidence from a structured literature search (2020-24), expert consultation, and lived experience. We found that public health systems embedded infodemic management, expanded digital services, and mobilised community workforces, but responses varied in equity and effectiveness. Although gender, age, socioeconomic, and racial disparities worsened during the COVID-19 pandemic, social protection, gender-sensitive policies, school-based services, and culturally adapted interventions showed promise. High-income countries buffered shocks with welfare measures while low-income and middle-income countries faced sharp fiscal constraints. Few studies evaluated costeffectiveness or equity impacts of psychosocial interventions. Building resilient, equitable mental health systems requires integrated policies spanning communication, digital and community care, gender-responsive and youthresponsive strategies, and sustainable financing, alongside investment in longitudinal and cross-national research.

BACKGROUND:Mental health conditions account for 18% of years lived with disability worldwide. 1-in-6 adults are affected in England, with most mental health conditions beginning in childhood and adolescence. Mental distress and ill health are unequally distributed in the UK, with strong associations with wider determinants of health, and higher prevalence among systemically disadvantaged groups. Currently, there is a lack of evidence to inform effective and timely policymaking for primary prevention in the UK. METHODS:In recognition of these challenges, a national Population Mental Health (PMH) Consortium was established, as part of Population Health Improvement UK (PHIUK). PHIUK is a national research network which works to transform health and reduce inequalities through change at the population level. Our aim is to establish an interdisciplinary PMH Consortium, focussing on upstream determinants and the prevention of risks and onset of mental health conditions through interdisciplinary stakeholder engagement, to create new opportunities for population-based improvement of mental health in the UK.The PMH Consortium brings together leading interdisciplinary representation in population mental health, spanning from sciences to the arts, across the UK. Membership includes six academic institutions, third sector organisations, lived experience expertise, and strong links with national bodies to ensure integrated cross-national and regional policy impact. The PMH Consortium comprises four cross-cutting platforms (Partners in policy, implementation, and lived experience; Data, linkages, and causal inference; Narrowing inequalities; Training and capacity building) and three challenge areas (Children and young people's mental health; Prevention of suicide and self-harm; Multiple long-term conditions) which are highly integrated and interdependent. The work will be underpinned by a Theory of Change across an initial four-year life cycle. CONCLUSION:This paper describes the aim, objectives, and approach of the PMH Consortium, as well as anticipated challenges and strengths. The goal of the PMH Consortium is to develop a model for population mental health research and policy translation that is both scalable and sustainable. It is critical to ensure continued impact and viability beyond the initial four years, contributing to the prevention of mental health conditions in the UK, with personal, economic, social, and health benefits.

Purpose There is evidence that academic pressure has been rising among adolescents in the UK. While this may be a modifiable risk factor for mental health problems, there are few validated measures of academic pressure and all have limitations. Methods With secondary-school students, we co-produced a student-reported measure of academic pressure, the 7-item Academic Pressure Questionnaire (APQ). This was included in the baseline survey of students aged 12-13 within the Positive Choices trial, a whole-school intervention to promote sexual health in English secondary schools. We ran factor analyses and assessed internal consistency, associations with sex and depressive symptoms, and variation in academic pressure between schools. Results We extracted one factor (Cronbach's alpha 0.76). Female students had higher APQ scores than males (mean difference = 2.18, 95% CI: 1.88 to 2.49). Higher APQ scores were associated with more depressive symptoms (coefficient = 0.51, 95% CI: 0.48 to 0.55) and associations were larger in female than male students (p value for interaction <0.001). School-level factors explained 2.6% of variation in APQ scores after adjusting for individual-level factors (ICC = 0.026, 95% CI: 0.01 to 0.06). Conclusion The APQ is a valid and reliable tool to investigate academic pressure in secondary-school adolescents.

Objectives:A minority of people make high use of emergency ambulance services. Some UK ambulance services have deployed multidisciplinary case management for these patients. This approach extends usual (within-service) care provision to include input from other agencies such as social care. We aimed to evaluate the effectiveness of case management compared with usual care. Methods:Natural experiment retrospective cohort study with patients from 4 UK ambulance services. We accessed anonymized electronic health records for patient cohorts identified by ambulance services. We compared patient-level outcomes based on mortality and emergency health contacts within 6 months of patient eligibility for case management. Cohorts were compared using logistic regression models, adjusting for ambulance service, patient characteristics, and service use in the 6 months before patients became eligible. Results:We found no differences between case management (intervention; n = 550) and usual care (control; n = 633) cohorts for our primary outcome, defined as death or any emergency health contact within 6 months. Nearly all patients recorded at least 1 such contact: 526 of 550 (95.6%) in the intervention cohort, compared with 601 of 633 (94.9%) in the control (adjusted odds ratio 1.159; 95% CI, 0.595-2.255). Mortality at 6 months was high: 58 of 550 (10.5%) in the intervention cohort and 89 of 633 (14.1%) in the control cohort. Conclusion:We found no evidence for the clinical effectiveness of multidisciplinary case management over within-service usual care. Study patients had a high risk of death within 6 months of eligibility for case management, and almost all made at least 1 recorded emergency health contact in that period.

BACKGROUND:Harmful alcohol use is a major modifiable risk factor for self-harm. We aimed to examine associations between minimum unit pricing for alcohol, introduced in Scotland in 2018, and rates of hospital-admitted self-harm. METHODS:Data were obtained from Public Health Scotland and English Hospital Episode Statistics. Interrupted time series (ITS) analysis compared pre- and post-intervention self-harm admission rates per 100 000 population, including controlled comparisons with England. RESULTS:The before-after slope reduction in Scotland corresponded to -5.6 (95% CI -7.5 to -3.7) admissions per quarter, per 100 000 population, over the intervention period. Using controlled ITS, a greater slope reduction was observed in Scotland relative to England: -3.5, CI -6.4 to -0.6. No differences in slope change were observed when examining only pre-pandemic study quarters. Findings were consistent with a possible postintervention rate reduction in the two most deprived population quintiles, while no between-nation slope difference was observed in the three least deprived quintiles. CONCLUSIONS:Findings were consistent with possible postintervention reductions in hospital-admitted self-harm in Scotland compared to England, with reductions concentrated in more deprived populations. Population-level alcohol pricing policies may contribute to reducing self-harm frequency, although causal interpretation is limited by the observational, quasi-experimental study design and differing between-nation pre-intervention trajectories.

Background People with severe mental disorders, including schizophrenia, experience worse physical health and shorter life expectancy. While socio-demographic factors are well established contributors to these disparities, less is known about how environmental exposures differ between individuals with severe mental disorders and the general population. Objective To explore socio-demographic and environmental differences between the general population and individuals with schizophrenia and/or other psychotic disorders (OPD). Methods Anonymised general practice records (2016--2019) for individuals resident in Wales were accessed within the Secure Anonymised Information Linkage (SAIL) Databank. This anonymised health data were linked to small-area level air pollution data for 2016 (PM10, PM2.5, NOx) for individuals who remained at the same residential address during the study period. Individuals with a first relevant diagnosis were identified; age, sex, urban/rural residence, deprivation, and air pollution exposures were compared with the general population. Results Overall, 0.1% (1,784) of the SAIL population had a first recorded diagnosis of schizophrenia/OPD. Of these, 52.7% (941) were male and 47.3% (843) were female. The psychiatric cohort had a higher mean age at study entry than the general population (46.9 vs 42.3 years). The distribution of diagnoses in urban (72.3%) and rural (27.7%) areas closely matched the total population (urban 70.5%, rural 29.5%). Mean air pollutant levels (PM10, PM2.5, NOx) in 2016 were similar between the psychiatric cohort and the general population. A clear socioeconomic gradient was observed: 29.1% of cases resided in the most deprived quintile compared with 15.0% in the least deprived quintile. Conclusions Area-level deprivation was associated with higher prevalence of schizophrenia/OPD, whereas no clear differences were observed by urbanicity or air pollution exposure. Linked population-scale health and environmental data provide valuable evidence which could inform service planning and targeted public health interventions.