BJPsych Open最新文献

Background: People with severe mental Illness (SMI) bear an excessive burden of periodontal disease, which can exacerbate their mental and physical multimorbidity. Therefore, improving and sustaining good oral hygiene is key.

Aims: To co-create a theory-driven oral hygiene intervention for people with SMI.

Method: A two-stage, eight-step method was followed drawing on the Behaviour Change Wheel. Stage 1, understanding the problem, involved evidence review and stakeholder consultations. Stage 2 focused on identifying theoretical barriers and facilitators through semi-structured interviews (n = 20) and co-designing the intervention content alongside people with SMI, carers, primary care, mental health and dental professionals and clinical leads. Interview data were analysed using framework analysis. Identified barriers and facilitators were mapped to the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework. Intervention functions, policy categories and behaviour change techniques were identified and mapped accordingly.

Results: The target behaviour of twice-daily toothbrushing was addressed through understanding the consequences of improving oral health and brushing, forming a brushing habit, brushing instructions and demonstration with consideration of cognitive capacity and exploring the need for financial and social support. Recommendations for intervention delivery included integrating it into the SMI physical health checks, training and remunerating primary care and mental health professionals to deliver it as part of a personalised and integrated care approach to rebuilding broader lifestyle routines; and maintaining engagement through follow-up appointments.

Conclusions: This is the first study to co-create a theory-driven toothbrushing intervention for people with SMI, delivered by primary care and mental health professionals.

Background: Depression severity is a well-established risk factor for suicidal ideation, but the extent to which sociodemographic and employment-related factors contribute independently remains unclear.

Aims: Complete data from doctors (N = 4055) presenting to National Health Service Practitioner Health (NHS-PH) in 2022-2023 were used to test the hypothesis that depression severity is the largest determinant of suicide ideation risk (defined by Patient Health Questionnaire 9 (PHQ-9) question 9 score) among doctors.

Method: Using PHQ-8 score (PHQ-9, excluding the item on suicide ideation) as a proxy for depression severity, the case-control discriminatory capacity of receiver operating characteristic curves (AUCs) were evaluated for (a) a univariable model studying modified PHQ-9 alone as the predictor of severe suicide ideation; and (b) a multivariable model integrating modified PHQ-9 and multiple sociodemographic and employment factors as the predictor of severe suicide ideation. Models were compared both descriptively and through a likelihood ratio test.

Results: The univariable model using depression severity alone as the predictor of severe suicide ideation yielded an AUC of 0.921. The addition of sociodemographic and employment factors improved the fit significantly (likelihood ratio test with (χ²(14) = 50.26, P < 0.001), amended AUC 0.930). Having both a disability and a relationship status of 'no partner' was significantly independently associated with suicide ideation in the multivariable model.

Conclusions: In this national cohort of doctors, depression severity was strongly associated with suicidal ideation. However, disability and lack of a partner were also independently linked to increased risk, suggesting that suicidal ideation is not solely driven by symptom severity. Social and functional factors may help identify higher-risk individuals and inform targeted support.

Background: This concurrent, exploratory, mixed-methods process evaluation, embedded within a randomised controlled trial, investigates how the 'active prevention in people at risk of dementia through lifestyle behaviour change and technology to build resilience' (APPLE-Tree) secondary dementia prevention intervention might support behavioural and lifestyle goal attainment, through determining the contexts influencing engagement and testing intervention theoretical assumptions.

Aims: We aimed to investigate (a) intervention reach, dose and fidelity, (b) contexts influencing engagement and (c) alignment of findings with theoretical assumptions about how the intervention might have supported participants to meet personalised behavioural and lifestyle goals.

Method: We measured intervention reach and dose. We selected interviewees for setting, gender and ethnic diversity from the 374 APPLE-Tree trial participants randomised to the intervention arm. We interviewed 25 intervention participants, 12 facilitators and 3 study partners. Additionally, we analysed 11 interviews previously conducted during or after intervention delivery for an ethnography, and 233 facilitator-completed participant goal records. We thematically analysed data, combining inductive/deductive approaches informed by the 'capability, opportunity and motivation-behaviour' (COM-B) behaviour change model. We video-recorded a randomly selected tenth of sessions and rated fidelity.

Results: A total of 346 of 374 (92.5%) intervention arm participants received some intervention (reach), and 305 of 374 (81.6%) attended ≥5 main sessions (predefined as adhering: dose). According to facilitator records, participants met a mean of 5.1 of 7.5 (68.3%) goals set. We generated three themes around (a) building capability and motivation, (b) connecting with other participants and facilitators and (c) flexibility and a tailored approach.

Conclusions: The intervention supported behaviour change, through increasing knowledge and providing space to plan, implement and evaluate new strategies and make social connections. Feedback indicated that the intervention was flexible and inclusive of diverse preferences and needs.

Background: Some adolescents can achieve academic success and maintain well-being despite their engagement in video gaming. Social factors may play a role in their vulnerability to mental health problems.

Aims: This study examined the role of perceived peer support and childhood experiences of optimal parenting in the association between video-gaming duration and depressive symptoms in adolescents.

Method: A sample of 1071 adolescents (mean age 13.62 years, s.d. = 0.95) completed a questionnaire on video-game usage. Their perceptions of parental care and support since childhood were assessed using the Parental Bonding Instrument, whereas their perceived peer friend support was assessed using the friend support subscale of the Multidimensional Scale of Perceived Social Support. Their depressive symptoms were measured using the depression subscale of the Depression Anxiety Stress Scales. Moderated mediation analysis was conducted to examine the associations of these variables. Family socioeconomic status and symptoms of attention-deficit hyperactivity disorder were included as covariates.

Results: Longer durations of video gaming were associated with higher levels of depressive symptoms. The role of perceived peer support in this association was moderated by childhood experiences of optimal parenting. Specifically, the mediating role of perceived friend support was significant only for adolescents who lacked optimal parenting.

Conclusions: The relationship between frequent video gaming and depressive symptoms in adolescents is complex and may depend on the levels of peer and parental support. Lacking support from both parents and peers can increase adolescents' risk of depression associated with frequent video gaming.

Background: To date, no research has explored the impact of the COVID-19 pandemic on psychotropic prescription patterns among young people in Japan, where lockdown measures were relatively less stringent.

Aims: This study aimed to investigate changes in the prescription patterns of psychotropic medications for Japanese young people before and after the COVID-19 pandemic, using the DeSC Database.

Method: We conducted an interrupted time-series analysis, with data from February 2016 to November 2022, to assess the pandemic's effects on psychotropic prescriptions for children, adolescents and young adults. The analysis included subgroups based on age (6-11, 12-17 and 18-22 years) and gender. The number of patients prescribed psychiatric drugs before and after the pandemic was analysed.

Results: Among 93 385 individuals, psychotropic prescriptions - except anxiolytics - increased overall, although not uniformly across age and gender groups. Significant upward trends were observed in the prescription rates of antidepressants (from 2.53 (95% CI 2.21-2.84) to 6.47 (95% CI 5.89-7.05) patients per month), anxiolytics (from -1.83 (95% CI -2.52 to -1.13) to 7.37 (95% CI 6.06-8.67) per month) and hypnotics/sedatives (from -1.48 (95% CI 0.73-2.24) to 6.62 (95% CI 5.21-8.03) per month).

Conclusions: A persistent increase in psychotropic medication prescriptions was observed after the COVID-19 pandemic. Given the influence of age and gender, clinicians and society must prioritise the mental health needs of the female and adolescent populations. These findings may be generalisable to other countries that implemented less stringent lockdown measures.

Background: Non-suicidal self-injury (NSSI) displays an alarmingly high prevalence rate among university students, placing them at high risk for adverse long-term outcomes, including suicide.

Aims: This study aimed to achieve a better understanding of factors contributing to NSSI in university student populations by examining reasons for NSSI and histories of stressful events and coping strategies.

Method: A total of 185 university students with a lifetime history of NSSI were assessed for depressive symptoms and NSSI characteristics. They completed three questionnaires on NSSI reasons, stressful events and coping strategies during childhood and adolescence. Each questionnaire included an 'others' option combined with an open-ended response box. After descriptive analysis of the closed questions, these open-ended responses were qualitatively categorised and analysed as predictors of depression severity and NSSI continuation from adolescence into adulthood.

Results: Qualitative analysis identified eight, five and ten categories from the open-ended responses for NSSI reasons, stressful events and coping strategies, respectively, with substantial to almost perfect interrater reliability. Two qualitative reason categories, one stressful event category and two coping strategy categories significantly predicted depression severity (β = 0.21-0.23). Participants reporting events in the stressful events category 'Traumatisation and experiences of violence' were three times more likely to continue NSSI into adulthood (f² = 0.07).

Conclusions: This study demonstrates the value of mixed-methods approaches. Stable qualitative categories highlight the need to capture individual variations in NSSI-related factors. It emphasises trauma-related stressors due to their influence on depression severity and persistence of NSSI into adulthood.

Background: Suicide is a significant global public health problem, with a disproportionately large burden among youth in low- and middle-income countries (LMICs). Despite growing awareness of the problem, evidence-based interventions in these settings are scarce.

Aims: This systematic review aims to identify and synthesise the evidence-based literature on the effectiveness of psychosocial-interventions to prevent suicide among young people aged 10-24 years in LMICs to reduce the risk of suicide and improve their mental-wellbeing.

Method: After registering protocol with the PROSPERO database of systematic reviews (CRD 420251016364), we searched electronic databases (e.g., PubMed, Medline, Cochrane Library, APA PsycINFO, Scopus, EMBASE, Web of Science and Google Scholar) for potential studies. We considered relevant literature in the English language and published from January 2000 to March 2025. Studies eligible for inclusion were psychosocial interventions compared with a control group, conducted on adolescents in LMICs, and with suicidal-ideation and suicide attempt as primary outcome. Reducing symptoms of anxiety and depression as well as improvements in quality of life were considered as secondary outcomes.

Results: Among 1,223 identified studies, only four met the inclusion criteria. Despite the limited evidence base, all included trials reported reductions in suicidal ideation and improvements in emotional well-being, suggesting the potential effectiveness of culturally adapted psychosocial approaches. Estimated intervention effect sizes ranged from large to extremely large (Cohen's d = 1.46, 2.08, 1.30 and 3.02, respectively), compared with small-to-moderate effect sizes from high-income countries (d ≈ 0.24 to 0.54). Secondary benefits were noted for hopelessness, depressive symptoms and quality of life. However, interpretation is limited by small samples and inconsistent methods, reducing comparability with high-income data.

Conclusions: The review highlights major gaps in youth suicide prevention within LMICs, emphasising the urgent need for contextually relevant, evidence-based psychosocial interventions and policy frameworks. Findings suggest moderate effectiveness of current interventions, underscoring the importance of culturally tailored implementation to enhance impact.

Background: Bilateral sensory stimulation (BLS), such as eye movements or alternating tactile stimulation, is a key component of Eye Movement Desensitisation and Reprocessing (EMDR), a recommended treatment for post-traumatic stress disorder (PTSD). However, the neurophysiological mechanisms underlying BLS remain poorly understood.

Aims: This study examined the physiological effects of visual and tactile BLS on frontal electroencephalography (EEG) activity and autonomic arousal in patients with PTSD and healthy controls, by varying the type of stimulation in different emotional stimuli.

Method: Twenty female PTSD patients and twenty matched healthy controls participated in a counterbalanced, within-subjects design. Participants recalled a subjectively stressful or neutral event while receiving visual or tactile BLS. Frontal EEG and peripheral psychophysiological measures were recorded before and after stimulation. Data were analysed using mixed model analysis to examine the effects of stimulation type, memory condition and group.

Results: Both visual and tactile BLS significantly increased the total power of frontal EEG and decreased spectral edge frequency and peripheral physiological activation. These effects were consistent between the groups and memory conditions.

Conclusions: BLS, regardless of visual or tactile modality or emotional memory content, is associated with increased frontal EEG activity and reduced autonomic arousal. These findings support the hypothesis that BLS facilitates top-down cortical regulation, potentially aiding emotional processing in EMDR by using an inherent mechanism to promote psychological recovery. More research is needed to clarify the neural mechanisms and clinical implications.

Background: Despite overlapping diagnostic criteria and aetiology, the frequency of complex post-traumatic stress disorder (C-PTSD) in people being treated for borderline personality disorder (BPD) is unknown.

Aims: To establish the frequency and correlates of probable C-PTSD in people meeting the diagnostic criteria and being treated for BPD.

Method: C-PTSD was assessed in 87 patients meeting the diagnostic criteria for BPD and initiating treatment in out-patient personality disorder services in the UK, using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders diagnostic interview, items from the Structured Interview for Disorders of Extreme Stress - Self Report and other measures. The cross-sectional association between C-PTSD and demographics, trauma and clinical variables was evaluated with logistic, ordinal and linear regression.

Results: A total of 93% of participants reported a trauma history (95% CI 88-98%), and 57% met the criteria for probable C-PTSD (95% CI 47-67%). Previous sexual trauma increased the odds of probable C-PTSD (odds ratio 6.22, 95% CI 2.21-17.54, P < 0.001). Probable C-PTSD was associated with an increased odds of self-harm in the past 12 months (odds ratio 9.41, 95% CI 1.87-47.27, P = 0.01) and higher levels of abandonment fears (odds ratio 2.78, 95% CI 1.17-6.55, P = 0.02), abandonment-avoidant behaviour (odds ratio 4.25, 95% CI 1.30-13.91, P = 0.02) and identity instability (odds ratio 4.39, 95% CI 1.79-10.78, P < 0.01).

Conclusions: C-PTSD symptoms are likely to be common in people diagnosed with BPD, and are associated with higher overall psychiatric severity, with potential implications for formulation and treatment.