BJPsych Open最新文献

Background: Co-occurring self-harm and aggression (dual harm) is particularly prevalent among forensic mental health service (FMHS) patients. There is limited understanding of why this population engages in dual harm.

Aims: This work aims to explore FMHS patients' experiences of dual harm and how they make sense of this behaviour, with a focus on the role of emotions.

Method: Participants were identified from their participation in a previous study. Sixteen FMHS patients with a lifetime history of dual harm were recruited from two hospitals. Individuals participated in one-to-one, semi-structured interviews where they reflected on past and/or current self-harm and aggression. Interview transcripts were analysed using reflexive thematic analysis.

Results: Six themes were generated: self-harm and aggression as emotional regulation strategies, the consequences of witnessing harmful behaviours, relationships with others and the self, trapped within the criminal justice system, the convergence and divergence of self-harm and aggression, and moving forward as an FMHS patient. Themes highlighted shared risk factors of dual harm across participants, including emotional dysregulation, perceived lack of social support and witnessing harmful behaviours. Participants underlined the duality of their self-harm and aggression, primarily utilising both to regulate negative emotions. These behaviours also fulfilled distinct purposes at times (e.g. self-harm as punishment, aggression as defence). The impact of contextual factors within FMHSs, including restrictive practices and institutionalisation, were emphasised.

Conclusions: Findings provide recommendations that can help address dual harm within forensic settings, including (a) transdiagnostic, individualised approaches that consider the duality of self-harm and aggression; and (b) cultural and organisational focus on recovery-centred practice.

Background: Exposure to maternal mental illness during foetal development may lead to altered development, resulting in permanent changes in offspring functioning.

Aims: To assess whether there is an association between prenatal maternal psychiatric disorders and offspring behavioural problems in early childhood, using linked health administrative data and the Australian Early Development Census from New South Wales, Australia.

Method: The sample included all mother-child pairs of children who commenced full-time school in 2009 in New South Wales, and met the inclusion criteria (N = 69 165). Univariable logistic regression analysis assessed unadjusted associations between categories of maternal prenatal psychiatric disorders with indicators of offspring behavioural problems. Multivariable logistic regression adjusted the associations of interest for psychiatric categories and a priori selected covariates. Sensitivity analyses included adjusting the final model for primary psychiatric diagnoses and assessing association of interest for effect modification by child's biological gender.

Results: Children exposed in the prenatal period to maternal psychiatric disorders had greater odds of being developmentally vulnerable in their first year of school. Children exposed to maternal anxiety disorders prenatally had the greatest odds for behavioural problems (adjusted odds ratio 1.98; 95% CI 1.43-2.69). A statistically significant interaction was found between child biological gender and prenatal hospital admissions for substance use disorders, for emotional subdomains, aggression and hyperactivity/inattention.

Conclusions: Children exposed to prenatal maternal mental illness had greater odds for behavioural problems, independent of postnatal exposure. Those exposed to prenatal maternal anxiety were at greatest risk, highlighting the need for targeted interventions for, and support of, families with mental illness.

Background: The school-vacation cycle may have impacts on the psychological states of adolescents. However, little evidence illustrates how transition from school to vacation impacts students' psychological states (e.g. depression and anxiety).

Aims: To explore the changing patterns of depression and anxiety symptoms among adolescent students within a school-vacation transition and to provide insights for prevention or intervention targets.

Method: Social demographic data and depression and anxiety symptoms were measured from 1380 adolescent students during the school year (age: 13.8 ± 0.88) and 1100 students during the summer vacation (age: 14.2 ± 0.93) in China. Multilevel mixed-effect models were used to examine the changes in depression and anxiety levels and the associated influencing factors. Network analysis was used to explore the symptom network structures of depression and anxiety during school and vacation.

Results: Depression and anxiety symptoms significantly decreased during the vacation compared to the school period. Being female, higher age and with lower mother's educational level were identified as longitudinal risk factors. Interaction effects were found between group (school versus vacation) and the father's educational level as well as grade. Network analyses demonstrated that the anxiety symptoms, including 'Nervous', 'Control worry' and 'Relax' were the most central symptoms at both times. Psychomotor disturbance, including 'Restless', 'Nervous' and 'Motor', bridged depression and anxiety symptoms. The central and bridge symptoms showed variation across the school vacation.

Conclusions: The school-vacation transition had an impact on students' depression and anxiety symptoms. Prevention and intervention strategies for adolescents' depression and anxiety during school and vacation periods should be differentially developed.

Background: Research suggests that those caring for a loved one with an eating disorder in the UK report unmet needs and highlight areas for improvement. More research is needed to understand these experiences on a wider, national scale.

Aims: To disseminate a national survey for adults who had experience caring for a loved one with an eating disorder in the UK, informed by the findings of a smaller scale, qualitative study with parents, siblings and partners in the UK.

Method: A cross-sectional web-based survey was disseminated to adults who had experience caring for a loved one with an eating disorder in the UK.

Results: A total of 360 participants completed the survey. Participants described experiences of care received in both children and young people's, and adult services. Those receiving care from children and young people's services generally reported more timely care, greater involvement in care and more confidence managing their loved one's symptoms post-discharge. In both settings, participants identified a number of areas for improvement, including more timely access to care, improved transition processes and discharge planning, and increased involvement in their loved one's care.

Conclusions: This survey captures the experiences of individuals caring for a loved one with an eating disorder in the UK. There are identified discrepancies between experiences of care in children and young people services compared with adult services. Clinical implications and recommendations for improvement are discussed, including improved transition and discharge processes, increased involvement of and/or support for carers themselves, and more timely access to support services for the unwell individual.

Background: Research shows initial COVID-19 lockdowns increased population mental distress. Yet, the mental health impact of repeated lockdowns in England remains unknown.

Aims: To: (a) explore changes in population mental health symptoms over the COVID-19 pandemic period (March 2020 to March 2021) in England, comparing this with trends from a decade before (2009-2019) as well as after (2021-2023); (b) compare the mental health impact of each of the three lockdowns in England with periods of eased restrictions, determining who was most affected; (c) examine the impact of demographics and distinct time periods on the prevalence of mental health symptoms.

Method: A secondary analysis of a national longitudinal cohort study, utilising data from Waves 1-13 of the UK Household Longitudinal Study and from Waves 1-9 of the COVID-19 Survey. Mental health was assessed using the 12-item General Health Questionnaire. Student t-tests and logistical regressions were conducted.

Results: There was a significant increase in the prevalence of self-reported symptoms of mental health during England's pandemic period, encompassing three lockdowns, compared with the average of rates from 10 years before. Rates of reported mental health symptoms were not significantly different across each lockdown, but were significantly higher than pre-pandemic rates, declining with eased restrictions. Rates from the end of lockdown to May 2023 revealed elevated mental health symptoms compared with pre-pandemic. Elevated symptoms were observed for women, people homeworking, those with health conditions, individuals aged 30-45 years and those experiencing loneliness.

Conclusion: Repeated lockdowns in England had a substantial impact on mental health, indicating requirements for ongoing mental health support.

Background: Alcohol use in autism spectrum disorder (ASD) is under-researched. Previous reviews have explored substance use as a whole, but this neglects individual characteristics unique to different substances. Alcohol use in non-clinical samples is associated with diverse responses. To advance practice and policy, an improved understanding of alcohol use among people with ASD is crucial to meet individual needs.

Aims: This was a narrative systematic review of the current literature on the association between alcohol use and ASD, focusing on aetiology (biological, psychological, social and environmental risk factors) and implications (consequences and protective factors) of alcohol use in autistic populations who utilise clinical services. We sought to identify priority research questions and offer policy and practice recommendations.

Method: PROSPERO Registration: CRD42023430291. The search was conducted across five databases: CINAHL, EMBASE, MEDLINE, PsychINFO and Global Health. Included studies explored alcohol use and ASD within clinical samples.

Results: A total of 22 studies was included in the final review. The pooled prevalence of alcohol use disorder in ASD was 1.6% and 16.1% in large population registers and clinical settings, respectively. Four components were identified as possible aetiological risk factors: age, co-occurring conditions, gender and genetics. We identified ten implications for co-occurring alcohol use disorder in ASD, summarised as a concept map.

Conclusion: Emerging trends in the literature suggest direction and principles for research and practice. Future studies should use a standardised methodological approach, including psychometrically validated instruments and representative samples, to inform policy and improve the experience for autistic populations with co-occurring alcohol use.

Background: Understanding the place of death for individuals with mental and behavioural disorders (MBDs) is essential for identifying disparities in healthcare access and outcomes, as well as addressing broader health inequities within this population.

Aims: To examine the place of death among individuals in Sweden with the underlying cause of death reported as a MBD and compare variations between diagnostic groups, as well as explore associations between place of death and individual, sociodemographic and clinical factors.

Method: This population-level analysis used death certificate data (gender, age, underlying cause of death and place of death) recorded between 2013 and 2019 and other national register data. MBD group differences were compared using chi-square tests (χ²) and multinominal logistic regressions explored variations in place of death.

Results: The final sample consisted of 2875 individuals. Our regression model revealed that individuals with MBDs other than intellectual disabilities were less likely to die in hospitals (odds ratio 0.60-0.134 [95% CI = 0.014-0.651]) or care homes (odds ratio 0.11-0.97 [95% CI = 0.003-0.355]) than at home. Substance use disorders were the most common underlying cause of death (61.3%). This group consisted predominantly of men (78.8%, χ², P < 0.001), and tended to be younger (χ², P < 0.001).

Conclusions: Individuals with intellectual and developmental disabilities are more likely to die in hospitals or care homes than at home. Those with MBDs, particularly substance use disorders, face a high risk of premature death, highlighting gaps in healthcare and palliative care provision for these populations.

Background: History of prior mental disorder, particularly post-traumatic stress disorder (PTSD), increases risk for PTSD following subsequent trauma exposure. However, limited research has examined differences associated with specific prior mental disorders among people with PTSD.

Aims: The current study examined whether different prior mental disorders were associated with meaningful differences among individuals presenting to a specialist service for severe earthquake-related distress following the Canterbury earthquakes (N = 177).

Method: Two sets of comparisons were made: between participants with no history of prior disorder and participants with history of any prior disorder; and between participants with history of prior PTSD and those with history of other prior disorders. Comparisons were made in relation to sociodemographic factors, earthquake exposure, peri-traumatic distress, life events and current psychological functioning.

Results: Participants with any prior mental disorder had more current disorders than those with no prior disorder. Among participants with history of any prior disorder, those with prior PTSD reported more life events in the past 5 years than those with other prior disorders.

Conclusions: Findings suggest a history of any prior mental disorder contributes to increased clinical complexity, but not increased PTSD severity, among people with PTSD seeking treatment. Although post-disaster screening efforts should include those with prior mental disorders, it should also be recognised that those with no prior disorders are also at risk of developing equally severe PTSD.

Background: Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains.

Aims: We investigated employment and relationship status changes among patients across the affective and psychotic spectrum - in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions.

Method: The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status.

Results: The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls.

Conclusion: Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.