BJPsych Open最新文献

Background: Attention deficit hyperactivity disorder (ADHD) is often associated with psychosocial functioning difficulties and valid measures of disability are needed for this population. The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is widely used to measure disability but has not been validated in the adult ADHD population.

Aims: This study aims to assess the psychometric properties of the WHODAS 2.0 in adults with ADHD, and to examine differences in disability levels between ADHD subtypes and gender.

Method: A cross-sectional study was conducted with 577 adults with ADHD (mean age: 38.24, s.d = 12.23; 52.3% male). ADHD severity was assessed using the ADHD Rating Scale (ADHD-RS) and Clinical Global Impression-Severity (CGI-S) Scale, while functionality was measured with the WHODAS 2.0 and the Functioning Assessment Short Test (FAST). Analyses included: (a) Cronbach's α for internal consistency, (b) Pearson's correlation for convergent validity, (c) Confirmatory Factor Analysis (CFA) for factor structure and (d) t-tests to compare disability levels across ADHD subtypes and gender.

Results: The WHODAS 2.0 demonstrated good internal consistency (Cronbach's α = 0.89). Scores were significantly correlated with psychosocial functioning (FAST, r = 0.476, p < 0.001) and clinical measures. CFA supported the original six-factor structure (root mean square error of approximation 0.039, Comparative Fit Index 0.998, Tucker-Lewis Index 0.996). When comparing ADHD subtypes, participants with the combined subtype had higher WHODAS 2.0 total scores than those with the inattentive subtype (p = 0.006). Additionally, gender differences were identified, with females displaying higher disability levels (p = 0.005).

Conclusions: The WHODAS 2.0 demonstrates psychometric properties that suggest it is a valid and reliable tool for assessing disability in adults with ADHD.

Background: Financial strain is increasingly recognised as a contributor to psychological distress, which may in turn elevate the risk of developing mental disorder. However, few large-scale longitudinal studies have investigated its predictive role using diagnostic outcomes among higher education students.

Aims: To examine whether financial strain predicts a major depressive episode (MDE) one year later among Norwegian students, and whether associations are explained by sociodemographic factors or baseline psychological distress.

Method: Data were drawn from the national Students' Health and Wellbeing Study 2022 (SHoT2022) survey (N = 53 362), with a diagnostic follow-up one year later (N = 10 460) using the self-administered Composite International Diagnostic Interview version 5.0 (CIDI 5.0). Inverse probability weighted Poisson regression with robust standard errors estimated the risk of 30-day DSM-5-defined MDE for each financial indicator.

Results: Financial strain was widespread: 6% reported frequent financial difficulties, 27% were unable to cover an emergency expense of 5000 Norwegian kroner (NOK; approximately €450/$500, and 35% spent 60% or more of their income on housing. Several indicators significantly predicted later MDE. Students frequently experiencing financial difficulties had a 3.55-fold increased risk (95% CI:2.97-4.22), attenuating to 1.53 (1.28-1.83) after full adjustment. Similar patterns emerged for most indicators. Associations were largely unaffected by sociodemographic adjustment, but were substantially reduced after accounting for baseline psychological distress.

Conclusions: Financial strain was associated with increased risk of MDE one year later, although much of the association was explained by baseline distress. Policies should address both financial and psychological vulnerabilities through strengthened financial support, alignment with living costs and targeted measures such as financial counselling and housing assistance.

Background: Off-licence psychotropic use in people with intellectual disability and/or autism, in the absence of psychiatric illness, is a major public health concern in England.

Aims: To ascertain and compare views of psychiatrists and non-psychiatrists working with people with intellectual disability and/or autism on psychotropic medication optimisation for this population.

Method: A cross-sectional survey of 13 questions was disseminated online among psychiatrists and other health professionals working with people with intellectual disability and/or autism across England, using a non-discriminatory exponential snowballing technique leading to non-probability sampling. The questionnaire covered demographic characteristics, perceived barriers/benefits of psychotropic optimisation (including ethnicity) and views on implementation of a national medicine optimisation programme. Quantitative analysis used chi-squared, Mann-Whitney and unpaired t-tests, with significance taken as P < 0.05. Thematic analysis of free-text responses was undertaken with Braun and Clarke's methodology.

Results: Of 219 respondents, significant differences in attitudes to most issues emerged between psychiatrists (n = 66) and non-psychiatrists (n = 149). Psychiatrists had less optimism of a successful national medication optimisation programme if commissioned, or achieving 50% reduction in psychotropic overprescribing and inappropriate psychotropic prescribing generally. Perceived barriers to reducing overmedication differed significantly between the psychiatrists and non-psychiatrists, Thematic analysis identified five themes (system issues, resources, medication challenges, family and carers, and training and alternatives/structure).

Conclusions: This is the first study to highlight important differences between psychiatrists and non-psychiatrists' attitudes to psychotropic optimisation despite respondents overall being broadly supportive of its need. A major finding is the hitherto unquantified concerns of patient ethnicity and its impact on psychotropic optimisation principles.

Background: Depression is the most common psychiatric disorder among patients with end-stage renal disease (ESRD), yet the risk factors for mortality in this population remain unclear.

Aims: To identify risk factors for mortality in ESRD patients with depression and assess the incidence of suicide attempts.

Method: We used Taiwan's National Health Insurance Research Database to identify adult patients who initiated maintenance dialysis between 1997 and 2012. Two ESRD cohorts were established at a depression-to-non-depression ratio of 1:8, matched by age and gender (n = 3289 with depression; n = 26 312 without depression). Outcomes included all-cause mortality and suicide attempts, with additional subgroup analyses by baseline depression severity.

Results: ESRD patients with depression had a higher mortality risk (hazard ratio 1.15, 95% CI: 1.10-1.21) than those without. Risk factors for mortality included male gender, older age, diabetes and cardiovascular disease. Patients with depression also had a higher risk of suicide attempts (hazard ratio 3.02, 95% CI: 1.68-5.42). ESRD patients with severe depression had a significantly higher rate of hospital admissions for depression compared to those with non-severe depression (incidence rate ratio (IRR): 1.82, 95% CI: 1.14-2.93). Furthermore, patients with severe depression were associated with a significantly higher mortality rate compared to those without depression (IRR: 1.42, 95% CI: 1.15-1.76).

Conclusions: Depression is linked to poor survival in ESRD patients, with underlying comorbidities playing a key role in mortality. Given the increased risk of mortality, suicide attempts and hospital admissions, these high-risk patients require enhanced medical attention, particularly those with severe depression.

Background: Early Intervention Psychosis Services (EIPS) provide multimodal interventions for young people who are at risk of, or have experienced, a first episode of psychosis. Although recent studies have begun to examine this critical period in a young person's personal recovery in more depth, little is known about how young people experience EIPS in general, and its influences on their clinical and psychosocial recovery in particular.

Aims: This study aimed to explore young people's experience of EIPS, specifically the factors that have affected their (a) clinical and (b) psychosocial recovery.

Method: This study purposively sampled 27 young people from a range of backgrounds at 6 community-based EIPS in Australia. Audio-recorded, semi-structured interviews were conducted and reflexive thematic analysis was used to analyse this data-set.

Results: Four themes of how EIPS enabled recovery were identified. The first three - a safe space, unconditional support and active involvement - were foundational to a fourth theme of gradual self-management. In earlier-stage self-management, participants relied on practical supports to make connections and find education and employment opportunities. By later-stage self-management, they had developed the tools to do these things for themselves. Participants' movement between earlier- and later-stage self-management was connected to their overall EIPS engagement and, for some, to their engagement with peer support.

Conclusions: Providing a safe space, unconditional support and active involvement for clients and their families created the foundational conditions for improved clinical and psychosocial recovery. Peer support programmes, increasing engagement when situational changes such as employment occur and the provision of culturally sensitive care appeared valuable to this process.

Background: Previous research has demonstrated that the COVID-19 pandemic led to a global increase in mental distress. However, few studies have examined the impact of the pandemic on mental health stigma.

Aims: To investigate changes in measures of mental health stigma, including knowledge, attitudes and behavioural intentions, in 2021 and 2023 in Hong Kong; to examine the mediating role of attitudes on the relationship between knowledge and behavioural intentions; and to explore how disclosure of mental illness contributes to enhanced overall well-being.

Method: Data were collected as part of a larger research project focusing on mental well-being in Hong Kong. A total of 1010 and 1014 participants were surveyed in 2021 and 2023, respectively. The participants were Hong Kong residents aged 18 years and above.

Results: Our findings demonstrate that all measures of mental health stigma showed increases in severity between 2021 and 2023. In addition, our mediation analyses observed both full and partial mediation effects of attitudes on the relationship between knowledge and behavioural intentions. The results also showed that mental illness disclosure was associated with higher well-being; however, despite these benefits, there was a decrease in willingness to disclose in 2023 compared with 2021.

Conclusions: This study highlights the ongoing issue of mental health stigma in Hong Kong. Future mental health programmes and interventions should aim to address various facets of mental health knowledge, including symptom recognition, access to support resources and the deleterious consequences of mental health stigma.

Background: Schizophrenia is associated with premature mortality, but most evidence comes from high-income regions.

Aims: This study aimed to estimate the excess mortality associated with schizophrenia in southern China.

Method: We linked register data from a nationwide information system for psychosis to death registers. Individuals diagnosed with schizophrenia and residing in Guangzhou between 2014 and 2021 were included. Standardised mortality ratios (SMRs) were calculated to compare the mortality of people with schizophrenia with that of the general population. Life expectancy, potential years of life lost (PYLL) and years of life lost (YLL) were estimated for all-cause mortality and specific causes of death. Gender difference in these metrics was examined.

Results: There were 3684 deaths (11.3%) during the study period. The leading causes of death were circulatory, neoplastic and respiratory diseases. The mortality rate among people with schizophrenia was twofold greater than in the general population, with a greater risk associated with unnatural causes than natural causes. The risk of mortality due to suicide was 15-fold higher than that of the general population. The life expectancy in schizophrenia was around 60 years, which is 21 years shorter than that for the general population. Schizophrenia was associated with substantial premature mortality burden, showing greater impact in men than women.

Conclusions: Schizophrenia is associated with increased premature mortality, reduced life expectancy and substantial PYLL. The enduring disparity in mortality underscores an imminent call for targeted interventions aimed at suicide prevention and enhancement of the physical well-being of people with schizophrenia.

Background: Trauma- and stressor-related disorders (TSRD) are debilitating mental health conditions. Given the barriers to traditional services, remote and online technologies are increasingly used in treating TSRD.

Aims: This mixed-methods systematic review aimed to identify remote technologies and assessed their feasibility and acceptability in treating adults with post-traumatic stress disorder (PTSD), acute stress disorder and adjustment disorder (AjD).

Method: The databases MEDLINE, CINAHL, Embase, PsycInfo, PubMed and the Cochrane Library were screened to identify studies investigating the feasibility and acceptability of remote interventions for PTSD, acute stress disorder and AjD in adults. Studies that obtained poor-quality ratings on critical appraisal tools were excluded. Results were synthesised using a narrative review approach.

Results: In total, there were 74 studies evaluating 27 remote interventions for TSRD: online interventions (k = 47, 63.51%), mobile applications (k = 17, 22.97%), video conferencing (k = 9, 12.16%) and message-based systems (k = 1, 1.35%). Findings from the review showed higher feasibility and acceptability for interventions with an interactive clinician-patient component. Among self-directed interventions, only two applications and eight online interventions provided a clinician component. Most studies targeted PTSD, with few targeting other diagnoses.

Conclusions: Recommendations related to remote interventions for TSRDs should be broadened to include AjD and other underrepresented diagnoses, and tailored to individual patients' profiles, including their ability to sustain engagement and clinical needs, using a stepped-care approach.

Background: Mental health disorders such as depression and anxiety are highly prevalent among ophthalmic patients, particularly those with progressive vision impairment. Despite the strong interconnection between mental health and vision-related disabilities, mental health support remains underintegrated into ophthalmic care. The economic burden of untreated mental health conditions in visually impaired patients is understudied, particularly in middle-income countries such as Turkey and Bulgaria.

Aims: This study aims to examine the economic impact of untreated mental health disorders among ophthalmic patients, focusing on financial burden, healthcare access disparities and quality of life outcomes. In addition, the study compares barriers to mental healthcare across ophthalmic conditions and between Turkey and Bulgaria.

Method: A qualitative study was conducted using structured surveys and in-depth interviews with 214 ophthalmic patients (107 in Turkey, 107 in Bulgaria). Mental health symptoms were assessed using the Patient Health Questionnaire-9 (for depression) and Generalized Anxiety Disorder-7 (for anxiety) scales. Thematic analysis was applied to qualitative responses.

Results: Over 50% of participants exhibited moderate-to-severe depression and anxiety, with diabetic retinopathy and retinal disease patients experiencing the highest distress levels. Financial barriers were more pronounced in Bulgaria, whereas long psychiatric wait times disproportionately affected retinal patients. Mental health stigma was higher in Bulgaria, limiting care access.

Conclusions: Findings underscore the urgent need for integrating mental health services into ophthalmic care. Policy interventions should focus on financial support, stigma reduction and improved interdisciplinary care models to enhance mental health outcomes for visually impaired individuals.