BJPsych Open最新文献

Background: Given the complex challenges facing people experiencing homelessness, existing mental health recovery models are probably insufficient for this population.

Aims: To investigate qualitative accounts of mental health personal recovery in people with experience of homelessness, and to adapt the widely adopted connectedness, hope, identity, meaning and empowerment (CHIME) model of personal recovery to better represent the experiences of this population.

Method: PROSPERO registration no. CRD42023366842. A systematic review identified qualitative studies investigating first-person accounts of mental health personal recovery in people with experience of homelessness. Nine databases were searched: CINAHL, SCOPUS, Embase, Medline, PsychINFO, PubMed, Web of Science, ASSIA and Social Services Abstracts. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist. Included studies underwent 'best fit' framework synthesis, comprising deductive analysis using the CHIME first- and second-order themes, as well as inductive analysis to capture aspects not covered by the a priori framework.

Results: The review expanded the CHIME model and identified the following recovery processes in this population: security and stability; encouragement and hope; constructing identity; understanding and meaning; relationships and connectedness; and empowerment and dual recovery (SECURED). Importantly, security and stability were identified as a necessary prerequisite for the other recovery processes. Challenges within each recovery process were also identified.

Conclusions: SECURED offers a transdiagnostic framework to support understanding of mental health personal recovery in the context of homelessness. Findings support the Housing First model of service provision. However, findings also highlight that housing alone is not sufficient and that the other processes must also be supported.

Systematic reviews and meta-analyses are often considered the highest level in evidence hierarchies, and therefore are often drawn upon when considering changes in policy. Despite journals implementing measures aiming to enhance the quality of systematic reviews they publish, the authorship raise concerns about the quality of existing and ongoing systematic reviews, particularly relating to transparency and bias minimisation. Building on the current guidelines, standards and tools, we suggest a 'meta checklist' which aims to maximise methodologically sound, unbiased and reproducible reviews of the best scientific quality while considering feasibility throughout the process.

Background: Adult cohorts with generalised joint hypermobility (GJH) report higher rates of neurodevelopmental problems (NDPs). However, the prevalence of GJH in community-dwelling children and its association with NDPs remains unexplored.

Aims: This study aimed to (a) assess the prevalence of GJH, (b) examine its link to musculoskeletal pain and (c) explore associations with NDPs in 11-year-old Swedish children.

Method: An in-school study was conducted as part of the 4th grade health check-up. It included a structured physical examination using the Beighton score (range 0-9) and a comprehensive neurodevelopmental assessment based on behavioural ratings, maternal interviews, medical records and academic performance.

Results: Of 348 eligible children from eight schools, 223 (64%) participated, with Beighton scores measured in 207 (59%). The median Beighton score was 1 (interquartile range 0-2), with no significant gender differences (Wilcoxon test, P = 0.17). A Beighton score of ≥6 approximated the 95th percentile in both sexes. No significant association was found between high Beighton scores and NDPs. Few children with GJH reported weekly pain, indicating a low prevalence of hypermobility spectrum disorders in this age group.

Conclusions: Our findings validate the age-specific Beighton score cut-off and suggest that GJH in children of this age is not linked to NDPs, differing from findings in adults. This may reflect developmental changes during puberty. Additionally, the high prevalence of weekly pain (42%) in the cohort warrants further investigation into its causes and impact.

Background: People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.

Aims: To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.

Method: This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive-behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.

Results: Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8-30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.

Conclusions: For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.

Background: Psilocybin-assisted psychotherapy (PAP) has gained attention as a promising intervention for conditions including depression, anxiety and post-traumatic stress disorder, but understanding of its side-effects is limited. This review evaluates the quality of side-effects reporting in PAP trials, to guide treatment, policy and research.

Aims: To assess side-effects reporting quality in PAP trials for psychiatric conditions, comparing published articles and ClinicalTrials.gov records.

Method: A PROSPERO-registered review (no. CRD42023458960) included English-language PAP trials (2005-2024) identified via Embase, CENTRAL, PubMed and reference searches. Reporting quality was assessed using the CONSORT Harms extension, categorised as either high (17-21), moderate (12-16), low (7-11) or very low (0-6). Randomised controlled trials underwent risk of bias analysis, and descriptive statistics compared side-effects across sources.

Results: Twenty-four trials were included. Reporting quality was high in six studies, moderate in four, low in nine and very low in five. All randomised controlled trials (n = 9) showed high risk of bias for side-effects outcomes. Variability in reporting hindered comparisons between articles and ClinicalTrials.gov, underscoring the need for standardisation. Overall, there was no evidence of systematic underreporting of side-effects in published articles compared with trial registers.

Conclusions: Side-effects reporting in PAP trials is inconsistent but is improving over time. Existing evidence has a high risk of bias. Future trials should align with best-practice guidelines for side-effects reporting. Discussions with patients should prioritise findings from high-quality studies and emphasise the current uncertainty regarding PAP side-effects.

Background: Trends in the US and Australian suicide mortality have shifted over the last 100 years, with notable differences between age groups and genders.

Aims: This study compared overall and gender- and age-specific suicide rates from 1921 to 2020 in the USA and Australia to determine long-term variation for each country.

Method: Suicide data (1921-2020, inclusive) were obtained from the US Centers for Disease Control and Prevention and the Australian Institute of Health and Welfare. Poisson regression was used to assess whether suicide rates between groups were significantly different.

Results: Overall suicide rates were higher in the USA compared to Australia, from 1921 to the 1940s, but were similar from the 1950s onwards. While male suicide rates fluctuated, female suicide rates were relatively stable (except for Australian women in the 1960s). In the USA and Australia, suicide rates for young males have significantly increased since the 1950s, while they have decreased for the older male population since the 1940s.

Conclusions: While overall national suicide rates were relatively stable over 100 years apart from during war and economic depression, male suicide rates in the USA and Australia experienced significant age-related changes over the century. These include major declines in males aged over 65 years but also an increase in suicides for those aged between 15 and 44. Suicide rates across age groups have therefore converged, regressing towards the mean for all age groups combined.

Background: Understanding gender identity in transgender and gender-diverse (TGD) individuals is crucial for effective care. The Gender Preoccupation and Stability Questionnaire (GPSQ) measures the preoccupation and stability of gender identity, but no Italian validation is available.

Aims: This study aimed to translate, culturally adapt and validate the Italian version of the GPSQ in a clinical sample of TGD adults.

Method: The GPSQ was translated with a forward-backward method and completed by 151 TGD adults at a gender clinic. Participants also filled out the Symptom Checklist-58 and Body Uneasiness Test. We assessed structural validity (EFA), internal consistency, test-retest reliability, and examined known-groups and predictive validity.

Results: The EFA supported a four-factor structure - Gender Identity Instability, Cognitive-Affective Salience, Preoccupation, and Distress/Intervention-Oriented Reflection - with good fit (root mean square error of approximation 0.06; Comparative Fit Index 0.95; Tucker-Lewis Index 0.93; standard root mean square residual 0.04). The GPSQ showed solid internal consistency (α = 0.78; ω = 0.73) and excellent test-retest reliability (r = 0.98; intraclass correlation coefficient 0.98). Higher scores correlated with psychological distress (r = 0.55, p < 0.001) and body image concerns (r = 0.48, p < 0.001). Preoccupation was most linked to obsessive-compulsive symptoms, and Cognitive-Affective Salience to body image concerns. Participants not on hormones scored higher (p = 0.010, Cohen's d = 0.36).

Conclusions: The Italian GPSQ is a reliable and valid tool to assess gender-related preoccupation and identity instability in TGD individuals. Its multidimensional structure makes it useful in both clinical practice and research in the Italian context.

Background: Prolonged grief disorder (PGD) is a chronic, impairing state of intense grief that is responsive to specialised intervention. Online journalling has the potential to reduce PGD symptoms.

Aims: To assess whether reminiscence via online journalling facilitates bereavement adjustment - specifically, to identify key themes in online grief journals and examine associations between types of reminiscence and changes in PGD symptom severity.

Method: A cohort of 96 bereaved adults completed 7 days of online journalling on the Living Memory Home (LMH) bereavement website. Participants were recruited from clinics, bereavement support groups and a National Institutes of Health-funded, web-based platform. The Prolonged Grief Disorder-Revised scale (PG-13-R) was administered at baseline and at 1-week and 1-month follow-up.

Results: Descriptive analysis revealed a reduction in PG-13-R scores from baseline to 1-week follow-up (mean difference -3.7, 95% CI: -4.9, -2.5, P < 0.001) and 1-month follow-up (mean difference -5.0, 95% CI: -6.4, -3.7. P < 0.001). Mixed-methods analysis revealed significant negative associations between reflection on negative traits of the deceased and PG-13-R score at all three time points, and between reflection on past experiences with the deceased and PG-13-R score at baseline. Expression of regret and guilt was significantly associated with reduction in PG-13-R scores from 1-week to 1-month follow-up.

Conclusions: Engagement in the LMH website demonstrated significant declines in PGD symptom severity after 1 week of online journalling and at 1-month follow-up. Guided reflection on memories of the deceased, and even on negative or emotionally challenging memories, shows potential for reducing symptoms of PGD.

Background: Behaviours that challenge are highly prevalent in children with an intellectual disability and can be detrimental to their quality of life and opportunities.

Aims: The systematic review aimed to investigate the effectiveness of current interventions in reducing behaviours that challenge in children with an intellectual disability (≤18 years-old).

Method: We searched five databases (PsychINFO, MEDLINE, Embase, Web of Science and CINAHL) on 26 April 2022 and 1 July 2024, and identified 18 randomised controlled trials (1443 participants) eligible for inclusion since 2014 - 11 investigated non-pharmacological and 9 investigated pharmacological interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Results: Non-pharmacological interventions (mostly psychosocial) were significantly effective (Hedges' g = -0.20; 95% CI [-0.35, -0.05]), whereas pharmacological interventions (including a wide range of drug classes and substances) were not (g = 0.03; 95% CI [-0.17, 0.24]). Studies using the Child Behaviour Checklist reported significant reductions (g = -0.18; 95% CI [-0.34, -0.02]), whereas studies using the Aberrant Behaviour Checklist did not (g = 0.04; 95% CI [-0.16, 0.25]). A random-effects meta-analysis indicated no overall significant reduction in behaviours that challenge (g = -0.12; 95% CI [-0.24, 0.00]).

Conclusions: It is important to note that most studies included were conducted in Western countries and had small sample sizes, and findings may be due to the outcome measures used. Findings support current recommendations that non-pharmacological interventions should be first-line treatment for behaviours that challenge in this population. Evidence highlighted the need for better quality, adequately powered randomised controlled trials.

Background: Withania somnifera (WS) is considered an adaptogen agent with reported antistress, cognition facilitating and anti-inflammatory properties, which may be beneficial in the treatment of mental disorders.

Aims: This systematic review investigated the efficacy and tolerability of Withania somnifera for mental health symptoms in individuals with mental disorders.

Method: The protocol of this review was registered with PROSPERO (CRD42023467959). PubMed, Scopus, PsycINFO, CINAHL, Embase and CENTRAL were searched for randomised controlled trials comparing Withania somnifera to any comparator, in people of any age, with any mental disorder. The meta-analyses were based on standardised mean differences (SMDs) and odds ratios with 95% confidence intervals, estimated through frequentist and Bayesian-hierarchical models with random-effects.

Results: Fourteen studies, corresponding to 360 people treated with Withania somnifera and 353 controls were included. Anxiety disorders were the predominant diagnostic category. Thirteen trials administered Withania somnifera orally (median dose 600 mg/day), one with Shirodhara therapy. The median follow-up time was 8 weeks. Although limited by the small number of studies, substantial between-study heterogeneity, and outlier effects, our investigation showed Withania somnifera effectiveness in improving anxiety (outlier-corrected SMD: -1.13 (95% CI: -1.65; -0.60), pooled SMD: -1.962 (95% CI: -2.66; -0.57)), depression (SMD: -1.28 (95% CI: -2.40; -0.16) and stress (SMD: -0.95 (95% CI: -1.46; -0.43) symptoms and sleep quality (SMD: -1.35 (95% CI: -1.79; -0.91). The effect size was confirmed using the Bayesian for anxiety but not for depression. No significant difference between Withania somnifera and the comparators was found for safety and tolerability.

Conclusions: We found evidence supporting the effectiveness of Withania somnifera in treating anxiety symptoms. Future trials should replicate this finding in larger samples and further clarify a possible Withania somnifera role in depression and insomnia treatment.