Suicide is a major public health concern among youth in Canada and worldwide. The most rapid increases in suicidal ideation, self-harm, and suicide attempts have been observed among adolescent girls, particularly since the COVID-19 pandemic. Recent studies report disproportionately high rates of emergency department visits and hospitalisations for suicide-related concerns among adolescent girls. Despite these concerning trends, limited evidence exists on the life trajectories, needs, and service pathways of adolescent girls who attempt suicide. This protocol describes a qualitative suicide audit focused on adolescent girls aged 12–17 who were hospitalised following a suicide attempt in two regions of the province of Québec, Canada. The aim is to understand developmental trajectories, document services received and identify individual, relational and systemic factors influencing these trajectories to generate recommendations that inform suicide prevention.

Using a narrative qualitative design and a community-based research approach, data will be collected from semi-structured interviews with adolescents and parents, parent questionnaires and hospital health records. These data will be integrated to develop anonymised case vignettes. A multidisciplinary panel, including clinicians, health system stakeholders, community partners and individuals with lived experience, will review each case to identify gaps and strengths in care and generate case-level and cross-case recommendations for clinical practice, health policy and professional training.

Ethics approval was obtained from the research ethics committee (REC) of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, which serves as the reviewing REC, with administrative reviews underway at two other health authorities. Findings will be disseminated through peer-reviewed publications, conference presentations and collaborative knowledge-mobilisation activities with clinical and community partners, including practice-oriented tools and accessible materials for adolescents and parents.

Up to 30% of individuals with depression develop persistent depressive disorder (PDD), an often disabling and difficult to treat condition. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only psychotherapy developed specifically for treating individuals with PDD. While several randomised controlled trials (RCTs) have demonstrated its efficacy in outpatient settings, evidence for its use in inpatient settings remains limited. Pilot studies of CBASP inpatient programmes in Germany have shown promising feasibility and effectiveness; however, no RCTs to date have systematically evaluated their outcomes. This study represents the first RCT to compare the short- and long-term efficacy and safety of CBASP with Behavioural Activation (BA), a first-line psychotherapy for depression, within an intensive multimodal inpatient setting.

In this prospective, multicentre, rater-blinded RCT with an active control group, we aim to recruit 396 adults (aged 18–70 years) with treatment-resistant PDD at eight German university hospitals. Participants will be randomly assigned to receive either (1) CBASP or (2) BA within an intensive treatment programme consisting of 10 weeks acute treatment in an inpatient and/or day clinic setting, followed by 6 weeks of outpatient continuation treatment. Primary and secondary outcome assessments will be conducted at multiple time points: baseline (T0), treatment onset (T1), after 5 and 10 weeks of acute treatment (T2, T3), at the end of continuation treatment (T4, week 16) and every 2 months up to week 64 (T5, naturalistic follow-up).

The primary outcome measure will be the change in depression severity, as assessed by the Hamilton Depression Rating Scale (24-item version), after 16 weeks of treatment (from T0 to T4). Secondary outcomes will include response, remission, deterioration and relapse rates, self-reported depression and anxiety symptoms and additional psychological variables. A cost-benefit analysis will evaluate the health-economic benefits of both interventions. Additionally, this RCT will explore personalised treatment selection and mechanisms of change, including potential moderators and mediators of treatment effects. The findings from this trial are expected to provide clinicians with evidence-based guidance on choosing CBASP versus BA for inpatients with treatment-resistant PDD.

This study has received ethical approval from the ethics committees of all participating university hospitals. All participants will provide written informed consent before enrolment. Study findings will be published in peer-reviewed journals and presented at national and international conferences. We have involved people with lived experience from the earliest pilots onward, using their feedback to refine our study design. Ongoing consultation at conferences and public events has further ensured that our research remains grounded in patient perspectives.

NCT04996433.

Philippe Pinel has been honoured in history for his ‘humane treatment’ and ‘unchaining the mentally ill’.1 However, the use of restrictive interventions (RIs) in psychiatric hospitals continues in the 21st century. Ensuring safety for self and others is one of the major reasons for using these RIs.2...

Conflict behaviours, such as aggression, along with containment practices like seclusion, adversely affect both patients’ well-being and staff safety.1–3 To create safer therapeutic environments, the Safewards model was developed, incorporating ten core interventions to enhance staff-patient interactions.1 3 These encompass strategies such as establishing clear mutual expectations, employing soft words and implementing...

Agitation is an acute behavioural emergency requiring immediate intervention in order to avoid further escalation to aggression/violence. Verbal de-escalation involves engaging the patient and helping him or her become an active partner in their evaluation and treatment in tandem with nonverbal approaches, such as voluntary medication and environment planning.1 This strategy is in contradistinction with the traditional use of restrictive measures, which...

Mental health issues among nurses are widespread and jeopardise healthcare systems and patient care.1 Yang et al2 conducted a pioneering scoping review using cohort study evidence to explore the risk factors and consequences...

Auditory hallucinations, commonly associated with schizophrenia, significantly impact individuals’ emotional well-being. With around 24 million people affected globally and notable rates in Ireland, the prevalence is alarming.1 Despite existing guidelines, Ireland lacks specific policies addressing auditory hallucinations, creating a critical practice gap.2 Nurses, the largest group in mental health services, play a...

Parents experience significant psychological stress when a child is diagnosed with cancer. More research is needed regarding stress and suicidal behaviour in this population. The aim of this study was to investigate parents’ risk of suicide attempt and risk of death by suicide in relation to having a child...

While the percentages of coercive interventions in psychiatry vary in different countries and clinical settings, global initiatives are increasingly aimed at preventing and reducing these interventions in the mental health and community settings.1–3 Policymakers, academics, healthcare leaders and clinicians urge...

Self-harm is defined as self-injury or self-poisoning, irrespective of the presence or absence of suicidal intent.1 Self-harm could be divided into the following categories: (1) self-harm with suicidal intent (suicide attempts); (2) self-harm without suicidal intent (non-suicidal self-injury and non-suicidal self-poisoning) and (3) self-harm with undetermined or mixed intent. Self-harm resulting in a presentation to an emergency room is the strongest known predictor of death by suicide.1

The prevalence of self-harm is just under...

This study explored the lived experiences of internet addiction among Taiwanese junior college students. Specifically, it examined their perceptions of addiction, experiences of excessive use and attempts to manage their online behaviours.

A descriptive phenomenological approach involving one-on-one, semi-structured, in-depth interviews was employed. Data analysis was conducted using Giorgi’s phenomenological method assisted by NVivo V.12.

The interviewees were from a junior college with two campuses in northern Taiwan.

Purposive and snowball sampling of 15 junior college students. All participants met the criteria for internet addiction using the Chen Internet Addiction Scale.

Three main themes and eight subthemes were identified: continuous provocation (childhood exposure and unexpected pandemic), continuous promotion (irresistible immersion and compensatory self-isolation) and continuous resistance (varied self-awareness, dilemmas, perceived insignificance and futility). This study also explored how junior college students with internet addiction repeatedly struggle to resist a seamless virtual world.

From the perspective of adolescents with internet addiction, early exposure to the internet, the boost of the pandemic, the growing demand, and negative beliefs and attitudes all contribute to the inability to overcome internet addiction. These findings offer valuable insights into the underlying mechanisms of internet addiction, providing mental health professionals with a deeper understanding and establishing a foundation for the development of future intervention strategies.

Guided parent-delivered cognitive behavioural therapy (GPD-CBT) is an evidence-based, low-burden treatment programme for childhood anxiety disorders with demonstrated efficacy, cost-effectiveness and accessibility. However, it has been tested primarily in Western countries, and the efficacy and cost-effectiveness have not been evaluated in Japanese families. The current study aims to examine GPD-CBT’s efficacy and cost-effectiveness in Japanese samples and explore potential cultural adaptations of the programme.

This study is designed as a Bayesian single-blind randomised controlled trial with two parallel groups: GPD-CBT (intervention group) and a waitlist control group. The primary outcome is remission of primary anxiety disorders evaluated through diagnostic interviews by independent evaluators. Secondary outcomes include child and parent-reported child anxiety symptoms, depressive symptoms and life interference. Additionally, measures of parental psychological characteristics, programme acceptability and quality of life are collected. We will conduct qualitative interviews with parents who participated in the programme and therapists who delivered the intervention to explore potential cultural adaptations. We aim to recruit 54–170 families, depending on the results of sequential Bayesian analyses. GPD-CBT consists of seven weekly 20 min sessions and a 1-month follow-up session. Assessments will be conducted at baseline, 13 weeks post randomisation (primary endpoint for between-group comparison), with an additional 25 weeks post randomisation. The waitlist control group will receive GPD-CBT after the 13-week assessment.

This study has been approved by the Ethics Review Committees of Chiba University and the University of Tokyo. We will disseminate results through academic conference presentations and peer-reviewed journal publications. If the GPD-CBT intervention proves efficacious, we will promote wider implementation in Japan through the development of training programmes for mental health professionals and key stakeholders.

jRCT1032250421 (https://jrct.mhlw.go.jp/latest-detail/jRCT1032250421) and jRCT1030250422 (https://jrct.mhlw.go.jp/latest-detail/jRCT1030250422) registered on 9 October 2025.

Bipolar disorder affects around 2% of the population and is linked with reduced life expectancy and socioeconomic burden. Depressive episodes are difficult to treat and typically more prevalent, enduring and burdensome than manic episodes. The use of antidepressants alone has limited effect and is associated with significant clinical risk through polarity switch. Current National Institute for Health and Care Excellence guidelines recommend quetiapine, olanzapine (with or without fluoxetine) and lamotrigine; however, these medications have limited efficacy, tolerability and acceptability. The ASCEnD study aims to assess the clinical and cost-effectiveness of aripiprazole plus sertraline compared with quetiapine, offering potential improvements for outcomes in bipolar depression. The study is funded by the National Institute for Health and Care Research Health Technology Assessment programme (NIHR132773).

ASCEnD is a prospective, two-arm, superiority, individually 1:1 randomised, controlled, pragmatic, parallel group, type A open-label clinical trial of aripiprazole/sertraline medication combination compared with quetiapine for bipolar depression. The study is conducted in the UK National Health Service setting with the aim of recruiting and randomising 270 participants followed-up for 24 weeks. Adults with bipolar disorder self-refer or are recruited through primary and secondary care services. The primary outcome is change in depressive symptoms 12–16 weeks after randomisation. Secondary outcomes include measures of symptom change, treatment satisfaction, tolerability, medication adherence, concomitant medication use, psychosocial functioning, quality of life and cost-effectiveness and informal carer measures of quality of life and costs of caring. The exploratory outcome is change in participant reward and punishment responsiveness. Analysis will follow a prespecified statistical analysis plan. A nested qualitative study is included to examine feasibility and acceptability of the trial design.

A Clinical Trial Authorisation from Medicines and Healthcare products Regulatory Agency, and approval from the Health Research Authority (IRAS 1007468) and North East – Newcastle and North Tyneside 1 Research Ethics Committee (23/NE/0132) were obtained. Results will be disseminated through peer-reviewed publications, conference presentations and lay summaries for participants and patient and public groups.

ISRCTN63917405.

Narrative interventions elicit personal stories from participants to impact outcome(s). The process of organising a troublesome experience into a cohesive story may benefit individuals dealing with a variety of complex medical conditions and psychosocial stressors. A better understanding of prior work is a critical step to guide further development, refinement and expansion of this under-recognised therapeutic modality for new populations.

This scoping review will follow recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to map and summarise the content and context of brief narrative interventions intended for individuals with chronic illness and/or psychosocial distress. Inclusion criteria are records describing brief (≤4 discrete session) interventions eliciting personal stories with the intent of impacting patient-centred outcomes (eg, depression, quality of life) delivered in any context. Participants will be adults (≥18 years old) living with chronic medical or psychiatric conditions (eg, metastatic cancer, chronic pain) or psychosocial distress (eg, grief, loneliness). Studies whose focus is not direct participant benefit or studies conducted in populations without evident illness or psychosocial stressors will be excluded. An initial search of PubMed (MEDLINE) identified sentinel articles; a comprehensive strategy was developed with the assistance of a librarian for systematically searching PubMed (MEDLINE), PsycInfo (EBSCOhost), CINAHL (EBSCOhost) and Embase (Ovid). Bibliographies of relevant articles will also be examined. Two independent reviewers will screen articles; disagreements will be discussed at regular meetings. U-M GPT, an artificial intelligence-powered institutional large language model, will perform initial data abstraction with a human reviewer verifying accuracy. Findings will be qualitatively summarised according to the three research questions, presented in tabular format, and described narratively.

As data will be obtained only from secondary sources, no ethics approval will be sought. Findings will be disseminated via the scoping review Open Science Framework (OSF) project site and submitted for peer review. Results will elucidate promising areas for future research, including narrative intervention development and refinement; these findings will guide expansion into new populations.

https://osf.io/85hjd/

This study was to estimate the potential social value and net benefit of OpenUp, a 24/7 text-based online counselling service for youth in Hong Kong, and draw policy-relevant conclusions for service provision.

A retrospective, model-based cost–benefit analysis using social return on investment (SROI) methods. Adopting a societal perspective, service, health and social outcomes were valued over a 1-year period, and productivity gains associated with avoided suicide deaths were valued over a 10-year period. Costs are reported in 2022 HK dollars (HK$; US$1=HK$7.8). Reporting was guided by Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement.

A text-based, synchronous online emotional support counselling platform in Hong Kong was accessible through WhatsApp, Facebook, SMS and the official web portal.

A total of 19 543 users aged 11–35 years accessed OpenUp services during the study period (1 December 2020 to 31 May 2022).

These included total social value (HK$), net social benefit (social value minus investment) and the SROI ratio. The secondary outcomes included monetised savings in medical and social services and productivity gains from avoiding suicide attempts and death.

The total social value was estimated to be HK$226 119 729 against an investment of HK$47 655 000 (SROI=4.74). Suicide risk reduction (productivity gains from avoided attempts and deaths) accounted for 75.4% of the social value. Deterministic one-way sensitivity analyses yielded SROI values ranging from 3.62 to 6.99 aggregated across the three groups, with results being most sensitive to assumptions about the duration of productivity impacts for avoided attempts and avoidable mortality.

Based on conservative assumptions, OpenUp can generate potential social value by providing an online emotional support service. Given the study’s reliance on modelling and proxy monetisation, these estimates should be interpreted with caution. Further integration of offline services with online intervention strategies requires continuous investment and evaluation.

To translate and culturally adapt six self-report measures for depression, anxiety, post-traumatic stress disorder (PTSD) and somatic symptom disorder into Hindi and determine their diagnostic accuracy against a diagnostic clinical interview.

Cross-sectional validation study.

Rural Kangra, Himachal Pradesh, northern India.

480 perinatal (pregnant or within 12 months postpartum) and non-perinatal (not currently pregnant and not given birth within 12 months) women at one tertiary hospital and district-level Anganwadi (community health) centres.

Symptom endorsement; and discriminant validity, sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) of the Kessler Scale of Psychological Distress (K10), Patient Health Questionnaire (PHQ9), Edinburgh Postnatal Depression Scale (EPDS), Generalised Anxiety Disorder Scale (GAD7), Perinatal Anxiety Screening Scale (PASS), PTSD Checklist (PCL-5) and Scale for the Assessment of Somatic Symptoms (SASS).

Complete data were available for 443 participants. Tiredness and body weakness were the most commonly endorsed symptoms among participants with common mental disorders. Among perinatal participants, the AUROC was highest for the GAD7 (0.88, 95% CI 0.79 to 0.96) and SASS (0.84, 95% CI 0.71 to 0.96). Among non-perinatal participants, the AUROC was highest for the SASS (0.92, 95% CI 0.88 to 0.97) and PHQ9 (0.91, 95% CI 0.86 to 0.96).

Measures which assess for fatigue, tiredness and somatic symptoms may help to identify women experiencing common mental disorders in this setting. Small numbers of participants with clinically diagnosed mental disorders in our sample mean results must be interpreted cautiously.

NCT05485701.

Alcohol use disorder and treatment-resistant depression (TRD) often co-occur, presenting a major clinical challenge with limited effective treatments. However, ketamine produces rapid antidepressant effects and has shown promise in reducing alcohol use, and acceptance and commitment therapy (ACT) can be effective for both substance use and mood disorders. This study explores the feasibility and acceptability of combining ACT with ketamine within the framework of the Montreal Model—a structured, integrative psychedelic ketamine therapy developed for severe TRD.

This study is a single-group, open-label feasibility trial at the Centre hospitalier de l'Université de Montréal (CHUM) Neuromodulation Ketamine Clinic in Montreal, Canada. 30 participants diagnosed with both alcohol use disorder and treatment-resistant depression will receive eight weekly in-person or virtual ACT sessions in addition to six intravenous ketamine infusions. The primary outcome is feasibility, assessed through study completion and protocol adherence. Secondary outcomes include recruitment rate, tolerability, safety, data completeness and healthcare resource use. Exploratory measures will examine changes in depressive symptoms, alcohol use and quality of life using validated tools. A subset of participants will participate in semistructured qualitative interviews to explore their experiences.

This study was approved by the ethics committee of the CHUM on 14 May 2025. The results of the trial, including primary and secondary outcomes, will be published in peer-reviewed scientific journals.

NCT06620276.

Severe mental illness such as psychosis is among the most disabling illnesses worldwide, disproportionately affecting minoritised ethnic groups and those in socioeconomic disadvantage. In the UK, people from Black ethnic backgrounds are more likely to experience a first episode of psychosis and to be detained under the Mental Health Act than White British people. There is a clear need for mental health services to improve cultural awareness and understanding of the broader social needs of minoritised groups, as well as the need to improve mental health literacy (MHL) within Black communities to empower individuals to seek timely mental health support. This protocol describes our programme of work which aims to assess the feasibility, acceptability and cost-effectiveness of Co-STARS, which is a co-produced, culturally appropriate tiered training package.

We co-produced a culturally appropriate, place-based, tiered MHL training package (Co-STARS) to deliver within underserved Black communities and via an e-learning package implemented among staff within mental health trusts. The training will be evaluated in stages. First, a pilot cluster randomised controlled trial will assess the feasibility and acceptability (defined as participants’ perceptions of the training’s relevance, usefulness and delivery) of a lived experience-led MHL training package delivered by Black young people with experience of mental ill health, to underserved communities in Birmingham, UK. Acceptability will be quantified through participation and completion rates and explored qualitatively via focus groups and interviews. Second, a stepped-wedge cluster randomised trial will evaluate the feasibility of an e-learning training programme for mental health professionals. We will embed a process evaluation to explore change mechanisms and identify barriers and enablers for future implementation. Third, we will use realist-informed participatory systems mapping and novel epidemiological analyses to explore downstream effects (ie, improved care access for Black ethno-racial groups within the intervention areas). Last, a cost-effectiveness framework will be developed to assess whether the intervention is good value for money in future efficacy trials. In the cluster trial, eight clusters will be randomised to the intervention arm (face-to-face training in the community) and control arm (display of MHL materials) with pre- and post-assessments in 120 participants from 8 clusters, 3 weeks apart. In the stepped wedge trial, six clusters (clinical teams within NHS mental health trusts) including 120 NHS staff in total, will move from control phase to intervention phase in a stepped wedge manner, with pre-assessments and post-assessments.

This proposal was reviewed by the Research Governance of the University of Birmingham and UK Research and Innovation (UKRI) grant reviewers. Ethics approval was granted by East of Scotland Research Ethics Service. The findings will be communicated in research conferences, stakeholder meetings, via social media, through publication in peer-reviewed journals and as a policy document.

ISRCTN10517405.

With the rapid ageing of the global population, the number of persons with dementia (PwDs) is increasing, placing substantial psychological and physical burdens on family caregivers. Acceptance and commitment therapy (ACT), a mindfulness and values-based psychological intervention, has shown potential in improving mental health outcomes across various populations. However, its effectiveness, specifically for dementia family caregivers, remains to be systematically evaluated. This review aims to evaluate the effects of ACT on psychological outcomes (eg, depression, anxiety, psychological flexibility), caregiver burden and health-related quality of life (HRQoL) among family caregivers of PwDs.

A comprehensive search of English and Chinese databases, including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, PsycInfo, CNKI, CBM and Wanfang Data, will be conducted from inception to July 2025. Randomised controlled trials involving family caregivers (aged ≥18) of PwDs will be included in which ACT is delivered either alone or as a core component. Outcomes include psychological outcomes (eg, depression, anxiety, psychological flexibility), caregiver burden and HRQoL. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane RoB 1.0 tool. Meta-analysis will be performed using RevMan V.5.4, with mean difference or standardised mean difference calculated for continuous outcomes. Random or fixed-effects models will be applied depending on heterogeneity. Subgroup analysis and evaluation of publication bias will also be conducted where applicable.

Ethical approval is not required because only published data will be used. Results will be disseminated through peer-reviewed publications and conference presentations.

CRD420251127238.

Psychedelic-assisted therapy shows promise for treating various mental health conditions; however, its reliance on intensive psychological preparation limits its broader application. Digital health interventions have the potential to address this limitation by providing structured, accessible and scalable preparation solutions. This randomised controlled feasibility trial aims to evaluate the feasibility and preliminary efficacy of the Digital Intervention for Psychedelic Preparation (DIPP), a 21-day mobile-accessible programme designed to prepare individuals for psychedelic experiences.

The study will recruit 40 non-treatment-seeking adults without a clinical diagnosis, randomly assigning them to one of two conditions: (1) DIPP-MEDITATE, which combines daily guided meditation with background music or (2) DIPP-MUSIC, which provides the same background music without guided meditation. Both groups will complete the 21-day digital intervention remotely. Following the intervention, participants will attend an in-person supervised psilocybin session, receiving a standardised 25 mg dose. Primary outcomes focus on feasibility metrics including recruitment efficiency, participant retention and adherence to the intervention protocol. Secondary outcomes assess subjective feasibility, acceptability and preliminary efficacy, specifically evaluating psychedelic preparedness, the quality of the psychedelic experience and changes in wellbeing, with follow-up assessments at 2 weeks, and at 3, 6 and 9 months post-session. Exploratory measures include neuroimaging, physiological, cognitive and psychological assessments, as well as voice note experience sampling through a chatbot (referred to as ‘DIPP-bot’) to monitor inner speech, thought and emotional states during the intervention and follow-up periods.

Approved by UCL Research Ethics Committee (ID: 19113/003), this study follows the Declaration of Helsinki. Results will be published in peer-reviewed journals and presented at conferences. Confidentiality will be maintained throughout.

NCT06815653.