BJPsych Open最新文献

Background: Perinatal depression and/or anxiety (depression-anxiety) have been associated with developmental disruptions. Less attention has been paid to preconception mental health, which could also contribute to adverse outcomes.

Aims: To examine whether preconception mental health is associated with developmental vulnerability in children who were either exposed or unexposed to prenatal depression.

Method: A population-based, retrospective cohort including 130 631 births to 108 340 pregnant people from British Columbia (Canada) between 1 January 2001 and 31 December 2012, with child development data in the form of the Early Development Instrument (EDI). Logistic regression using cluster-robust standard errors was used to compare the odds of vulnerability on EDI domains.

Results: Children born to pregnant people in all groups with depression-anxiety preconception history were more likely to be considered vulnerable on all developmental domains, except for communication skills and general knowledge, than those without prenatal depression and no preconception depression-anxiety. After adjusting for confounders, effect size was largest for children born to a person with prenatal depression who had persistent depression-anxiety before they conceived on the domains of physical health and well-being (adjusted odds ratio 1.73 [95% CI: 1.56-1.92]). Children born to people with prenatal depression but no preconception depression-anxiety were probably more vulnerable on social competence and emotional maturity domains than those without prenatal depression and no preconception depression-anxiety.

Conclusions: Preconception mental health is associated with child development, even after accounting for depression in pregnancy. We hypothesise that it is picking up on different experiences of mental illness through the life course and represents slightly different fetal exposures.

Background: Psychotropic medication use has been shown to be associated with decreased bone mineral density (BMD) and quality, and increased fracture risk. Less is known about psychotropic use and associated bone loss over time.

Aims: To determine the association between psychotropic medication use and bone loss in men.

Method: Data from 940 men (aged ≥20 years) participating in the Geelong Osteoporosis Study were used in this longitudinal study. BMD (g/cm²) at the spine and hip were measured with dual-energy X-ray absorptiometry at baseline, and 5 and 15 years post-baseline. Body mass index (BMI) was calculated, lifestyle factors and medication use was self-reported, and socioeconomic status was determined. Mood and anxiety disorders were identified through a clinical interview. Multivariable linear regression was used to determine the associations.

Results: Over the study period (median 13.2 years), psychotropic use was associated with change in BMD at the spine (unadjusted mean difference -0.063 g/cm², 95% CI -0.096 to -0.031, p < 0.001) and hip (-0.038 g/cm², 95% CI -0.059 to -0.017, p < 0.001). BMI was identified as an effect modifier. Psychotropic use was associated with spine and hip bone loss at the 25th (adjusted mean difference -0.077g/cm² (95% CI -0.122 to -0.033); and -0.058 g/cm² (95% CI -0.084 to -0.032), respectively) and 50th percentile (adjusted mean difference -0.053 g/cm² (95% CI -0.089 to -0.018) and -0.038 g/cm² (95% CI -0.059 to -0.017), respectively), but not the 75th percentile of BMI (p = 0.121 and p = 0.106, respectively).

Conclusions: Psychotropic use was associated with bone loss in non-obese men, highlighting the need for regular monitoring and preventive strategies to protect bone health.

Background: Despite young British Bangladeshis experiencing a higher prevalence of mental health problems than the White British population, they are comparatively underrepresented in mental health research and fewer access services.

Aims: This study aimed to identify priorities and preferences for mental health support among young British Bangladeshis, as well as strategies to enhance the cultural appropriateness and accessibility of services.

Method: A qualitative study was conducted in London and Leicester, with participants recruited through voluntary and community organisations. In-depth interviews were held with young people with lived experience of mental health problems (n = 12), their family members (n = 7) and Bangladeshi community workers from voluntary sector organisations (n = 7). Data were analysed using thematic framework analysis.

Results: Participants' priorities for mental health support included reducing stigma, raising awareness, and addressing intergenerational and identity-related stressors. Preferences centred on culturally and linguistically appropriate care delivered by therapists familiar with Bangladeshi values in trusted community settings. Suggested strategies for improving existing services included enhancing access by providing support in trusted community spaces, building trust through the involvement of culturally aware professionals, and involving families and community leaders to reduce stigma and promote open discussion around youth mental health.

Conclusions: This study identifies a need for culturally tailored, linguistically accessible and community-rooted mental health support for British Bangladeshi youth. Representatives from these communities should be actively involved in the development of future programmes and policies, ensuring that support is both relevant and sustainable.

Background: The effectiveness of Community Treatment Orders (CTO) and the variability with which they are used remains the subject of ongoing debate.

Aims: To examine the associations between discharge from psychiatric in-patient care on to a CTO in New South Wales (NSW), Australia, and hospital admissions and bed-days in the following 12 months.

Method: Retrospective matched case-control study using linked administrative health data from NSW between 1 January 2017 and 31 December 2023. Cases were individuals discharged on to a CTO after their first psychiatric hospital admission during the study period. We attempted to match controls 2:1 on age, gender and hospital discharge within 6 months of each other. Data were from the NSW Mental Health Ambulatory and Admitted Patient Data Collections.

Results: There were 5506 individuals discharged on to CTOs and 9761 matched controls. Discharge on to a CTO did not affect the odds of hospital readmissions in the following 12 months (adjusted odds ratio (OR_adj) = 1.06, 95% CI 0.97-1.14) though was associated with significantly greater bed-days (log β_adj = 0.12, 95% CI 0.08-0.17, p < 0.0001). Individuals with a principal diagnosis of non-affective psychosis who were discharged on to a CTO had significantly lower odds of hospital readmissions in the following 12 months (OR_adj = 0.67, 95% CI 0.59-0.77).

Conclusions: Discharge on to a CTO did not significantly affect hospital readmissions across the full sample, but did significantly lower the odds for individuals with non-affective psychosis. This suggests that targeted use of CTOs in specific populations (e.g., non-affective psychosis) warrants greater consideration, as the benefit of their use otherwise - especially from a human rights point of view - is unclear.

Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).

Background: Non-suicidal self-injury (NSSI) is a major clinical and public health issue in adolescence. Although psychological factors such as depression, anxiety and emotion dysregulation have been widely examined, less is known about how pain perception and autonomic reactivity interact with these variables in NSSI.

Aims: This study aimed to compare pressure pain threshold (PPT), autonomic responses and psychological characteristics between adolescents with NSSI and healthy controls, and to explore associations between pain perception, psychopathology, emotion regulation and NSSI functions.

Method: Sixty-eight adolescents (34 with NSSI, 34 controls) participated. PPT was assessed using a pressure algometer. Depressive symptoms, anxiety symptoms and emotion regulation difficulties were measured, and NSSI functions were evaluated using a standardised tool. Systolic (SBP)/diastolic blood pressure and heart rate were recorded before and after pain stimulation. Correlational analyses and mixed (repeated measures) analyses of variance were performed.

Results: The NSSI group showed a significantly higher PPT than controls (mean difference 1.43 kg/cm²; 95% CI: 0.64-2.00; p < 0.001). A significant group × time interaction emerged for SBP (η² = 0.09), indicating a blunted post-pain response in the NSSI group. Emotion regulation difficulties were positively associated with PPT (r = 0.28). PPT was also positively correlated with sensation seeking (r = 0.36), autonomy (r = 0.34) and peer bonding (r = 0.36) functions of NSSI.

Conclusions: Adolescents with NSSI demonstrate elevated pain thresholds and altered autonomic reactivity. These findings highlight the importance of considering pain processing alongside psychological characteristics and NSSI functions in clinical assessment and intervention planning.

Background: Accurate trauma recollections are essential in legal and research contexts; however, studies frequently reveal significant inconsistencies in trauma reporting over time.

Aims: To investigate the trauma-reporting patterns among healthcare workers (HCWs) following their exposure to the Beirut port blast.

Method: This longitudinal study examined trauma memory alteration among 296 HCWs at 6 months (wave 3) and 2-2.5 years (wave 4) post-blast. Participants reported trauma exposure prior to the event, and probable post-traumatic stress disorder (PTSD) secondary to the Beirut port blast. Depression and psychological distress were analysed as potential predictors of memory alteration using multinomial models.

Results: The majority of participants (72.4%) exhibited inconsistent trauma reporting, with 36.43% exaggerating and 35.71% diminishing their trauma accounts over time. Developing probable depression and screening positive for PTSD at wave 4 were predictors of memory exaggeration (respectively odds ratio 5.71, 95% CI: 1.19-27.32; odds ratio 8.04, 95% CI: 0.98-65.73), while remitted psychological distress was protective (odds ratio 0.08, 95% CI: 0.01-0.99). No significant predictors were found for memory diminishment.

Conclusions: A substantial portion of HCWs exposed to the Beirut port blast demonstrated inconsistent trauma reporting, with mental health conditions such as depression and PTSD influencing memory exaggeration. These findings underscore the importance of considering memory reliability in trauma research, particularly in populations with mental health disorders and exposed to major disasters.

Background: Limited data exist on factors influencing the length of hospital stay (HLoS) in patients with schizophrenia.

Aims: This study aimed to identify and quantify patient characteristics associated with HLoS.

Method: A retrospective study was conducted on patients diagnosed with schizophrenia (F20, ICD-10) admitted to the County Emergency Hospital of Cluj-Napoca, Romania, from 2018 to 2022. Demographics, comorbidities, symptom severity (Positive and Negative Syndrome Scale/Brief Psychiatric Rating Scale), antipsychotic treatment and adverse effects data were collected from medical charts. Predictors of HLoS for patients with one hospitalisation were assessed using negative binomial regression.

Results: The sample comprised 288 patients aged 18-65 years, with 75% over 30 years and a balanced gender distribution. Most patients had no comorbidities (64.24%) whereas 49.46% reported addictions. Men had higher rates of tobacco use (62.00 v. 53.49%) and self-reported use of substances/drugs (15.49 v. 3.91%). Independent predictors of HLoS (P < 0.05) in the multivariable model included gender, being retired, experiencing fear or violence in the context of psychotic decompensation, percentage score reduction in symptom severity score, first-generation antipsychotics treatment and the presence of reasons for late discharge. Men had an expected HLoS 39% longer than women. Experiencing fear (adjusted incidence rate ratio (aIRR) 1.13, 95% CI [1.01; 1.27]) and violence in the context of psychotic decompensation (aIRR 1.19, 95% CI [1.06; 1.34]), and first-generation antipsychotics treatment (aIRR 1.17, 95% CI [1.02; 1.35]) were associated with longer stay, whereas being retired predicted shorter HLoS (aIRR 0.83, 95% CI [0.70; 0.98]).

Conclusions: The length of hospital stay in patients with schizophrenia is influenced by demographic, clinical and treatment factors. Targeted interventions addressing these predictors may optimise the duration of hospitalisation.

Background: Attention-deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity, resulting in impaired functioning in multiple settings, including home, school and in social settings. Disparities exist in ADHD care among children, with White male children experiencing increased access to diagnosis and treatment. Other children remain underdiagnosed, undertreated and subject to poorer functional outcomes. Factors that impact equitable ADHD treatment include gender, race, ethnicity and social determinants of health (SDOH), including household income, parental education, insurance status, neighbourhood deprivation and discrimination. Medication is effective, yet little is known regarding the impact of medication type and trajectories of use on functional outcomes.

Aims: Data from the first 6 time points of the Adolescent Brain and Cognitive Development℠ Study® (N = 11 868) will be used to address the following aims. Aim 1: identify typologies of children with distinct trajectories of medication use using multivariate latent class growth analysis. Aim 2: identify typologies of children with distinct trajectories of child-reported functional outcomes using latent class growth analysis. Aim 3: examine relationships of gender, race, ethnicity, SDOH and medication use with trajectories of functional outcomes using multinomial logistic regression.

Method: This study protocol describes the background and methods for an observational study seeking to better understand the impact of gender, race, ethnicity, SDOH and trajectories of medication use on child-reported functional outcome trajectories in a diverse group of US children with ADHD.

Conclusions: Findings will advance the understanding of effective ADHD treatment and highlight the importance of equitable treatment access.

Background: Late-life depression (LLD) is associated with cognitive impairment and an elevated risk of dementia, yet the influence of age at depression onset on cognitive prognosis remains unclear. Emerging evidence suggests that late-onset depression, defined as first depressive episode in later adulthood, may reflect distinct neuropathological mechanisms and predict more severe cognitive decline and greater dementia risk than early-onset depression.

Aims: This study aimed to investigate whether late-onset depression is linked to domain-specific cognitive impairment and higher risk of incident dementia among older adults with major depressive disorder.

Method: We analysed UK Biobank data from older adults (aged ≥60 years) with primary care linkage, classifying participants into depression-free controls, early-life depression, late-life depression with early onset (LLD-EO) and late-life depression with late onset (LLD-LO). Cognitive performance across these five domains was assessed cross-sectionally at baseline using touchscreen tasks. Incident dementia was evaluated prospectively using clinical records up to 2022. Multi-level models with inverse-probability weighting and survey-adjusted mixed modelling were applied to assess group differences in cognitive function, controlling for demographic covariates, lifestyle factors and physical and mental health conditions. A Cox regression model was employed to estimate dementia risk among groups.

Results: Among 75 064 participants aged ≥60 years, the LLD-LO group (n = 4858) showed significantly worse cognitive performance than healthy controls, particularly on fluid intelligence and visuospatial memory. The LLD-LO group performed worse than LLD-EO on fluid intelligence. During follow-up, LLD-LO was associated with a higher risk of incident dementia (hazard ratio 1.42-1.52) across all adjusted models. Deficits in fluid intelligence and visuospatial memory partially mediated the link between LLD-LO and subsequent dementia.

Conclusions: Late-onset depression showed more severe impairment in fluid intelligence compared with LLD-EO. Late-onset depression was associated with increased incident dementia compared with depression-free individuals.

Background: Adults with mental illness have higher smoking prevalence and face greater financial burdens from smoking compared with the general population.

Aims: This study explores how individuals' psychological distress and smoking status are jointly associated with household expenditure patterns in Australia.

Method: Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey over three waves. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10) and the mental health domain of Medical Outcomes Study Short-Form General Health Survey (SF-36 MHD). Household expenditure categories included alcohol, clothing, education, fuel, general insurance, medicines, health practitioners, groceries, meals eaten out, internet, utilities, public transport and rent. Regression models using the generalised estimating equation technique compared expenditure data, controlling for age, gender, household composition, socioeconomic position, education level and wave of data collection.

Results: Smokers and ex-smokers showed significant differences in expenditure across K10 psychological distress levels. At low and moderate distress levels, smokers spent more on alcohol and rent and less on insurance, health practitioners, meals out and medicines. At high distress levels, only education expenditure was significantly lower for smokers. Across SF-36 MHD tertiles, smokers spent less on education, insurance and medicine, but more on alcohol, especially at lower and moderate distress levels.

Conclusions: Smoking cessation for those with moderate psychological distress may be associated with a reallocation of spending, benefiting both households and their local communities. Targeted interventions addressing smoking cessation and mental health are crucial for reducing financial and health inequities.