Worldwide, billions of children and young people live in areas affected by war. Suicide remains one of the three leading causes of death worldwide among people aged 15–29 years. However, little is known about the effect of war on suicidal behaviours in this group. This review aims to assess suicides, suicide attempts and suicidal ideation among children and young people exposed to war or armed conflict.

A scoping review of studies was conducted using Web of Science, PubMed, Embase and PsycINFO databases from their inception to 18 November 2025, without any restrictions on geographical location. We included only observational studies with full-text, peer-reviewed English articles reporting any suicides, suicide attempts and suicidal ideation of children and young people aged 0–24 years exposed to war. The quality of the included articles was assessed using the Quality Assessment with Diverse Studies. The protocol of the review was registered with the Open Science Framework on 29 March 2022 (https://osf.io/7kszh/).

Of the 3229 articles retrieved, 37 studies were eligible for review, providing data from 24 countries and covering a period of almost a hundred years (1921–2025). Most studies (>20) focused on conflicts ongoing during or until the 2000s, whereas only three focused on World War II. The reported outcomes were suicides (n=9), suicide attempts (n=15) and suicidal ideation (n=21). Included studies spanned six continents, from Latin America (n=5, Colombia only) to Europe (n=10). We assessed the suicide rates during and after wars. There was some evidence of a decrease in suicide rates during war, but no clear trend in suicide rates post-war was observed. The prevalence rates of suicide attempts and suicidal ideation varied widely, without uniformity in the definitions used. War-related trauma, mental health problems, substance abuse and exposure to suicide or suicide attempts were identified as risk factors, while protective factors included family and social support.

There is a need for more methodologically consistent and rigorous research on suicidal thoughts and behaviours in children and young people exposed to war or armed conflicts. Future research should identify mediator/moderating factors influencing suicidal behaviours and their links to mental health.

To explore the acceptability of the Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS) intervention and trial procedures for participants.

A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone.

Primary care.

Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30–60 min.

COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes.

Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally.

Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions.

These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial.

Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.

To synthesise evidence on the association between any diagnosed or self-reported mental health problems prior to pregnancy (pre-existing mental health problems) and birth outcomes including preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), neonatal unit (NNU) admission and mode of birth (instrumental birth, planned or unplanned caesarean section).

Systematic searches were conducted in MEDLINE, CINAHL, Embase and PsycINFO in December 2024 for studies examining the association between any pre-existing mental health problems and PTB, LBW, SGA, NNU admission and mode of birth. Only articles published in English were included with no restriction on year of publication. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklists. Random-effects meta-analyses were conducted to pool crude and adjusted ORs (aORs) and risk ratios (aRR) with 95% CIs. ORs and RRs were analysed separately. Between-study heterogeneity was quantified using the I² statistic.

Of 15 467 records screened, 33 studies met the inclusion criteria. Women with any pre-existing mental health problems had higher odds and risks of adverse birth outcomes, including PTB (aOR 1.41, 95% CI 1.27 to 1.56) (aRR 1.36, 95% CI 1.21 to 1.51), LBW (aOR 1.28, 95% CI 1.22 to 1.33) (aRR 1.32, 95% CI 1.04 to 1.68), SGA (aOR 1.27, 95% CI 1.07 to 1.51) (aRR 1.34, 95% CI 1.19 to 1.51) and NNU admission (aOR 1.44, 95% CI 1.19 to 1.74). Adjusted estimates were based on multivariable models that commonly controlled for maternal age, parity and socio-demographic factors. No consistent associations were observed between pre-existing mental health problems and mode of birth.

Pre-existing mental health problems were associated with increased risks and odds of several adverse birth outcomes. These findings highlight the importance of early identification and targeted support for women with mental health problems before pregnancy to strengthen preconception and maternity care planning.

CRD42023485834.

Global increases in armed conflict, forced displacement, pandemics and economic instability have contributed to rising levels of psychological distress worldwide, placing relevant segments of the population at increased risk of developing mental health conditions. This burden is particularly pronounced in humanitarian and low-resource settings where access to specialist mental health services is limited. Scalable, low-intensity, evidence-based psychological interventions are therefore urgently needed. In response, the WHO has developed transdiagnostic programmes, including Self-Help Plus (SH+) and Doing What Matters in Times of Stress (DWMS). Although these interventions are increasingly implemented across humanitarian and public health contexts, evidence for their effectiveness and implementation has not yet been systematically synthesised.

This preregistered systematic review and meta-analysis will be conducted in accordance with Cochrane Collaboration standards and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will include randomised controlled trials evaluating the effectiveness of SH+ or DWMS, alongside qualitative and mixed-methods studies examining their implementation among stressor-exposed individuals of any age. Outcomes will include symptoms of depression and anxiety, general distress and post-traumatic stress symptoms. Moreover, we will examine effects on well-being, psychosocial functioning, adverse events and implementation outcomes (eg, acceptability, feasibility, fidelity). We will search Cochrane CENTRAL, APA PsycNet, Web of Science Core Collection, Embase and Scopus for records published from 2016 onwards. Searches will be supplemented by hand-searching preprint repositories and citation tracking. Risk of bias will be assessed using the Revised Cochrane Risk of Bias Tool and a customised appraisal tool for studies on implementation. Quantitative data will be synthesised using random-effects multilevel meta-analyses, with meta-regression models applied to examine moderators. Bayesian meta-analyses will be conducted where appropriate as sensitivity analyses to assess the robustness of the findings. Certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Ethical approval is not required. Findings will be disseminated through an open-access peer-reviewed publication, a plain-language summary, and the Open Science Framework, where all materials will be made publicly available.

CRD420251168521.

To estimate the prevalence and frequency of workplace incivility and bullying across multiple healthcare roles; compare experiences among occupational groups; examine associations with psychological symptoms (stress, anxiety and depression); assess interrelations among mistreatment dimensions (experienced workplace incivility (EWI), witnessed workplace incivility (WWI), instigated workplace incivility (IWI and experienced workplace bullying (EWB)); and evaluate associations with demographic and contextual variables.

Cross-sectional study.

Three teaching hospitals in Arak, Iran, between March and December 2023.

A stratified random sample of 550 healthcare workers was invited; 392 responded (response rate 71.3%) and 359 with complete data were included, comprising nurses, interns, residents, general practitioners and administrative staff.

Workplace incivility (Workplace Incivility Scale), workplace bullying (Negative Acts Questionnaire-Revised) and psychological symptoms (Depression, Anxiety and Stress Scale-21 Items).

The sample (N=359) was 64% female with a mean age of 32 years. Significant differences were observed across occupational groups for WWI, IWI and EWB (all p

Workplace incivility and bullying are widespread across healthcare roles, with broadly comparable exposure across clinical staff. Direct experiences of mistreatment showed the most consistent associations with psychological distress, and mistreatment dimensions appeared to operate within interconnected patterns. Addressing these issues requires system-level interventions targeting structural and cultural drivers to promote psychologically safe clinical environments.

Obsessive-compulsive disorder (OCD) is characterised by obsessive thoughts and compulsive actions. These obsessive-compulsive symptoms (OCS) are subclinical manifestations that do not meet the full diagnostic criteria for OCD and are associated with anxiety, depression and lower quality of life (QoL). Medical students are vulnerable to developing OCS due to stress in medical school. This study assessed OCS prevalence and its association with the mental well-being and QoL of medical students in Egypt.

A nationwide cross-sectional study was conducted across 15 Egyptian medical schools. Using convenience sampling, 1850 students participated by completing a self-administered questionnaire that used validated scales. We assessed OCS with the Obsessive-Compulsive Inventory-Revised (OCI-R) using a screening cut-off of ≥21, QoL with the Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-QSF), and anxiety and depression with the 4-item Patient Health Questionnaire (PHQ-4). Descriptive statistics and logistic regression were employed.

Clinically significant OCS prevalence among medical students was 51.1%. Significant predictors for OCS included being female (adjusted OR (AOR)=1.25), attending a private university (AOR=1.64), and having personal (AOR=2.05) or combined personal and family history of mental illness (AOR=2.69). OCS presence was associated with a lower QoL score (Q-LES-QSF: 41.00 vs 43.97) and higher psychological distress score (PHQ-4: 5.93 vs 3.57) compared with students without OCS (p

OCS are prevalent among Egyptian medical students, especially females, private university attendees and those with a personal or family history of mental illness. These symptoms are associated with higher psychological distress and a lower QoL. As OCS were identified using a screening cut-off, and given the cross-sectional design, findings should be interpreted cautiously, warranting further longitudinal investigation. Universities should consider implementing mental health support, screening and awareness programmes to address these issues.

The important role of responsible media reporting as a low-cost, effective population-level suicide prevention strategy is well documented. However, research into its potential to generate protective effects and how this is perceived by audiences is underexplored in the Indian context. This qualitative study aimed to explore young adults’ experiences of exposure to current suicide-related and purpose-designed content in the media.

This qualitative study was nested within a larger randomised controlled trial. A semi-structured interview guide was designed to explore participant perspectives and experiences regarding exposure to media content.

The study was conducted with media professionals in Nepal.

A purposive sample of 20 young adults (10 males, 10 females) participated in the study. Interviews were audio-recorded and transcribed, and an inductive-deductive approach to thematic analysis was followed.

Participants shared a range of contrasting experiences related to suicide content in the media and their responses to purpose-designed media content. They reported typical characteristics of current media reporting of suicides involving sensationalism, exaggeration and simplistic assumptions and underscored its impact on mental health. The purpose-designed content elicited a sense of surprise among participants. It stimulated curiosity, improved understanding, challenged misconceptions and instilled hope. In contrast to existing media coverage, they viewed protective content as a valuable means of educating people about recovery and encouraging help-seeking.

This study uncovers unique insights into how young adults in the Indian context perceive and experience suicide reporting in the media. Our audience research indicates that current reporting styles may have harmful effects, while a more hopeful, recovery-oriented approach could offer significant benefits. These insights can be used to support meaningful collaborations between stakeholders in our efforts to encourage safe and respectful reporting that meets audiences’ needs to be kept informed.

CTRI/2022/09/045439.

Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12 week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD and to explore preliminary changes in PTSD symptoms.

Single-group feasibility trial.

Save the Children, Sweden.

Twenty-two adolescents (13–17 years, 82% female) with primary PTSD.

A 12 week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent–caregiver activities.

Feasibility measures included recruitment pace, participant retention, treatment adherence (module completion) and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects and reported adverse events. Within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1 month follow-up (primary endpoint).

Recruitment was completed after 7 months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen’s d=1.27) and CATS-2 (Cohen’s d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD.

Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes.

NCT06185244.

The COVID-19 pandemic has disproportionately impacted the mental health of young people from minority ethnic communities, yet effective interventions such as mental health psychoeducational workshops, shown to work for other populations, have rarely been offered or investigated among this population.

This qualitative study examines the impact, challenges and benefits of mental health psychoeducational workshops co-created with and for 12-to-16-year-olds from black and mixed ethnic minority groups in London, UK.

12 (8 female: 3 male) black and mixed ethnic minority 12-to-16-year-olds (M=16, SD=1.55 years) currently attending a West London community centre co-created, participated in, and fed back on the impact of five mental health and life-skill workshops through one-on-one semi-structured interviews (M=10 min 8 s, range=3–16 min), which were transcribed verbatim.

Interpretative Phenomenological Analysis of the interviews revealed three superordinate themes, with a total of eight codes clustered: (1) workshop features promoting positive mental health, (2) positive mental health outcomes and (3) workshop features impeding positive mental health outcomes. Overall, young people perceived workshops to have a positive impact on their mental health and helped provide support in coping with the challenges of the COVID-19 pandemic.

Study findings highlight the potential benefits and barriers to entry of mental health and life-skill workshops for young people from minority ethnic communities.

Community-based and co-produced workshops were perceived as beneficial to mental health by Black, Asian, Minority Ethnic young people, warranting greater consideration and implementation in practice.

Transcranial pulse stimulation (TPS) is a novel technology with therapeutic promise for Alzheimer’s disease. Given its novelty and the rapidly evolving research in neurology and mental health using this technology, large randomised controlled trials are expected. Therefore, an independent and up-to-date synthesis of the available evidence is needed. In our effort to create a living systematic review of the clinical efficacy of TPS across various conditions, we aim to describe its methodology to ensure its transparency and scientific rigour. This protocol details the predefined methods related to search frequencies, updates to the review and quantitative synthesis.

We will only include randomised controlled trials involving clinically diagnosed populations and comparing active TPS to sham TPS. We will search MEDLINE, CENTRAL and Web of Science, as well as trial registries and grey literature. The principal searches in databases and trial registries will be rerun monthly, and new evidence will be integrated. Study selection, data extraction and risk-of-bias assessments will be performed independently and in duplicate. All relevant clinical outcomes measured with validated psychometric scales and tests will be collected. The relevance of a quantitative synthesis, the studies to be included in pairwise meta-analysis, appropriate scales, questionnaires and time points will be discussed by the research team annually. If a meta-analysis is conducted, we will use the standardised mean difference as the measure of effect size. We will assess our confidence in the cumulative evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

For this systematic review and meta-analysis, we will collect existing data without generating new datasets. Therefore, ethics approval or consent to participate is not required.

We will publish our initial systematic review when a total of four randomised controlled trials across different health conditions using active TPS compared with sham TPS are available. At this stage of our project, we anticipate updating the living systematic review annually following the publication of the baseline review. We will conclude the living phase of the review when high certainty of evidence is achieved or if the topic loses its relevance.

CRD42024595947.

Public health students face academic and training pressures as well as challenges arising from patient and community expectations, which may adversely affect their quality of life (QoL) and contribute to burnout and student dropout. This study aimed to examine psychological self-care, burnout and QoL as well as the factors associated with these outcomes among university students.

A cross-sectional study conducted between January and March 2024.

Universities in northern, southern and northeastern Thailand.

A total of 1426 health-related students aged 18–25 years were recruited using non-probability sampling.

Data were collected using a self-administered questionnaire, which included the Thai version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF-THAI), the Maslach Burnout Inventory to assess emotional exhaustion (EE) and cynicism (CY) and a psychological self-care assessment.

Most participants (79.9%) reported a moderate level of QoL. The prevalence of burnout was 18.9%. Pearson’s correlation analysis indicated statistically significant relationships between psychological self-care, EE, CY and QoL (all p values

Good mental healthcare behaviours and lower levels of burnout are associated with higher QoL among public health students. Universities and programme administrators should implement mental health support strategies, including routine screening, counselling services and self-care promotion, to reduce burnout and improve students’ overall well-being.

Each year, suicide claims approximately 700 000 lives worldwide and generates a significant financial burden. Integrating genomic data, exposomic factors and digital phenotypes can enhance the development of short-term predictive models. Current knowledge and available tools provide the basis for designing personalised treatment strategies that incorporate real-time interventions to prevent suicide attempt recurrence cost-effectively. This study aims to develop a predictive algorithm for suicidal behaviour integrating psychiatric assessments, genetic risk markers, digital phenotypes and exposomic data.

This protocol describes a retrospective multicentre study that will recruit participants with a clinical history of suicide across 25 hospitals across Spain with a catchment area of 8.6 million people (17.8% of Spain’s population). Our sample target is over 5000 participants, aged over 12 years old, ensuring 93.5% statistical power for genetic analysis. Eligible participants must be over 12 years old. Data collection will include psychiatric assessments, biospecimen collections (DNA, RNA, plasma and serum), Google Takeout data for digital phenotyping, and a standardised set of administrative and clinical data registered for each patient. Genotyping will be performed with the Axiom Spanish array (>750 000 markers), and genome-wide association studies (GWAS) will be performed after genetic imputation in a whole sample of >10 000 individuals (5000 suicide attempters; 5000 controls). Prescription and clinical history will also be retrospectively integrated, and codified data statistics forms will periodically be sent to the Government. Statistical analyses will combine traditional regression models and AI-based algorithms to identify predictive behavioural, genomic profiles, and digital markers of suicidal behaviour. Cost-effectiveness analyses of pharmacogenomic markers for antidepressant response will also be conducted.

By successfully implementing this project, we aim to help reduce suicide reattempts and lessen the emotional and economic burden on families and the healthcare system.

This study has been approved by the Ethics Committee of the Fundación Jiménez Díaz (PIC301-24_FJD) and complies with the Declaration of Helsinki. It adheres to the GDPR (EU Regulation 2016/679), Spain’s Organic Law 3/2018 on Personal Data Protection and Digital Rights, and Law 41/2002 on patient autonomy. All required data protection measures will be implemented, including those under Real Decreto 1718/2010 on prescriptions and treatment adherence. Underaged participants will require parental consent for participation. The results will be disseminated through publication in peer-reviewed scientific journals and presentations at psychiatric conferences.

NCT07422090.

Misophonia is a newly recognised sound sensitivity disorder with clinically significant symptoms affecting up to 18% of the population. It is characterised by extreme negative reactions to specific sounds which are often repetitive and generated by the human oral-nasal tract (eg, sniffing and eating sounds). Although misophonia currently has no standard treatment, research suggests that transcutaneous auricular vagus nerve stimulation (taVNS) holds promise therapeutically. This study aims to investigate both the effects of 4 weeks taVNS (compared with sham) on misophonia and related symptoms as well as its underlying neurophysiological mechanisms. To our knowledge, this is the first trial on taVNS in misophonia.

This is a single-centre double-blind sham-controlled trial in which 60 participants with clinically significant misophonia are randomly allocated in a 1:1 ratio to receive taVNS or sham stimulation. The intervention will be self-administered over 4 weeks (two times per day for 30 mins each). The primary efficacy outcome is self-reported misophonia severity with secondary outcomes, including mental health and audiological symptoms. In addition, all participants will undergo preintervention and postintervention testing, including MRI and physiology to investigate neurophysiological mechanisms underlying taVNS effects.

The study has been approved by the Brighton and Sussex Medical School ethics board (ER/GLP28/4). Results will be submitted for publication in peer-reviewed journals. Data will be anonymised and made available for sharing after completion of the study.

This trial is registered in ISRCTN; ISRCTN79500062.

Depression is up to four times more common among individuals with cancer compared with the general population. Psychological therapies are effective in treating depression among patients in cancer care, but access is often delayed, which can exacerbate symptoms, increase dropout and reduce therapeutic effectiveness. This study evaluates the clinical and cost-effectiveness of a therapy preparation intervention (TPI) designed to enhance engagement and outcomes among patients awaiting psychological therapy in cancer care.

This study is a parallel-group, two-arm, multicentre, single-blind randomised controlled trial. A total of 150 adults (≥18 years) living with or beyond cancer and experiencing moderate-to-severe depression will be recruited from health services in the East Midlands region of England. Participants will be randomised (1:1) to receive either TPI plus treatment as usual (TAU) or TAU alone.

The primary outcome is depression severity measured using the Patient Health Questionnaire 9-items (PHQ-9) over a 24-week follow-up. Secondary outcomes include anxiety, functioning, mental well-being, patient activation, readiness for change, health-related quality of life and health economics, and therapy engagement including attendance and dropout. Hope and in-session patient activation, assessed using recorded treatment preparation sessions, will be explored as additional mechanistic variables. Health economic outcomes will be assessed at baseline and 24 weeks. Data will be collected via online or telephone surveys at baseline, and at 4, 8, 12 and 24 weeks post randomisation. Qualitative interviews with a subset of participants will explore intervention experiences, analysed using reflexive thematic analysis.

Ethical approval has been obtained from the Health Research Authority and National Health Service Research Ethics Committee (Bromley) (REC reference: 24/LO/0610). Findings will be disseminated through peer-reviewed journals, academic conferences and clinical and patient networks.

ISRCTN registry: ISRCTN13692666, registered on 18 October 2024.

Practice-oriented research uses scientific methods to generate practice-based evidence on psychotherapy processes and outcomes. The Consorcio Latinoamericano de Investigación en Psicoterapia (CLIP) unifies data collection across multiple sites to enhance the value of routine outcome monitoring. This project aims to generate practice-based evidence on the implementation, progress and predictors of change in psychological interventions within Ecuador’s routine mental health settings, using CLIP’s unified data forms.

This is a protocol for an observational, naturalistic, longitudinal study. From February 2025 to February 2028, we will describe implementation processes and examine intervention progress and outcomes across 11 Ecuadorian mental health services. Participants will include adolescents (11–17 years) and adults (≥18 years) seeking psychological intervention along with their therapists and trainees. Clients’ change will be monitored through psychological distress measures. Socio-demographic and intervention satisfaction data will be collected alongside information on therapists and services. Analyses will include initial contact characterisation, reliable change, outcome predictors and the examination of how time, therapist and service characteristics each contribute to clients’ change.

The protocol for this study was approved by the Human Research Ethics Committee of the Universidad de Las Américas, Ecuador (ID: 2024-OBS-033). The results will be disseminated within the services for service improvement, in peer-reviewed scientific articles and at conferences and workshops.

NCT07257848.

Major depressive disorder (MDD) is a leading cause of disability among adolescents, yet available treatments remain limited. Bright light therapy (BLT) is a non-pharmacological intervention with demonstrated efficacy in adults. However, its clinical utility and underlying neural mechanisms in adolescents remain unclear. This trial aims to evaluate the clinical efficacy, time to onset, safety and applicability of home-based BLT in outpatient adolescents with MDD, and to explore its underlying neural mechanisms using functional near-infrared spectroscopy (fNIRS).

This is a randomised, placebo-controlled, three-arm multicentre clinical trial. A total of 126 outpatient adolescents aged 13–17 years with MDD will be randomly assigned to receive high-intensity BLT, medium-intensity BLT or placebo dim red light using a portable light box in a home-based setting for 40 min each morning over 4 weeks, followed by a 2-week follow-up. 42 age-matched and gender-matched healthy controls will also be enrolled for baseline assessments only, serving as normative references for comparison. The primary outcome will be the change in total scores on the 17-item Hamilton Rating Scale for Depression from baseline to week 4. All analyses will follow an intention-to-treat framework to ensure methodological rigour. The primary outcome will be analysed using analysis of covariance and linear mixed-effects models. Secondary outcomes will include response and remission rates, time to onset, maintenance of efficacy, self-reported depressive symptoms, sleep quality, cognitive function, anxiety, irritability, suicidal ideation, non-suicidal self-injury, self-efficacy and the overall safety profile of BLT. Prefrontal cortical activity will be measured using fNIRS at baseline and week 4 to explore potential neural mechanisms. Approximately 15% of participants will additionally take part in a qualitative substudy exploring experiences and acceptability of BLT.

The study protocol has been approved by the Ethics Committee of Peking University Sixth Hospital (approval number: 2025–24). Written informed consent will be obtained from all participants and their legal guardians prior to enrolment. Study findings will be disseminated through peer-reviewed journals and conference presentations.

NCT06913309.

Perinatal depression is a common, yet understudied, mental health disorder among women and contributes to poor engagement in prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa. Male partners are positioned to provide critical forms of social and economic support during pregnancy and postpartum, and also may contribute to women’s stress, depression and anxiety through intimate partner violence and withholding of social support. Despite the critical role of men in pregnancy outcomes and HIV prevention, few interventions have engaged men around women’s depressive symptoms, nutrition and health, and engagement in PMTCT. We will conduct a pilot trial of Mphatso, a couple-based intervention based on problem-solving therapy with couple relationship skills to reduce depressive symptoms in perinatal women, improve food insecurity and prevent HIV transmission to the infant.

We will employ a two-arm pilot randomised controlled trial in the Zomba district of Malawi to assess the feasibility and acceptability of Mphatso (meaning ‘gift’ or the child) and explore health impacts on depressive symptoms, PMTCT engagement and food insecurity. We will enrol 60 pregnant women in the second or third trimester who are living with HIV and meet criteria for probable depression based on the Edinburgh Postnatal Depression Scale and their male partners. Couples will be randomised to receive either five sessions of Mphatso (problem-management skills plus health education and relationship skills) or enhanced usual care. Feasibility and acceptability outcomes will include session attendance rates, satisfaction levels and retention at 3 months and 6 months postpartum. Exploratory analyses using regression models including time and treatment arm will be conducted to explore effects on the mothers’ and fathers’ depressive symptoms, adherence to PMTCT (antiretroviral therapy, nevirapine use, HIV testing and exclusive breastfeeding) and food insecurity.

The pilot trial has been approved by the University of California, San Francisco (Human Research Protection Program (HRPP); Protocol Number 23-40685), and the study has also been approved by the National Health Sciences Research Committee in Malawi (NHSRC; Protocol Number 24/05/4431). Results will be disseminated to study participants, health officials, policymakers, community leaders and care providers, as well as through presentations at conferences and publications in peer-reviewed journals.

NCT06659315.

Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression.

Systematic review of the available literature.

MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026.

Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified.

Three reviewers independently extracted information on study characteristics, exposure and outcomes.

From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8–67.2%) and depression (4.7–77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety.

Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts.

CRD42018102628.

Research and mental health services agree that more youth co-production in service design and delivery is needed, but there is little consensus on how to do it well. This study is trying to find agreement about the best ways to do this.

A realist eDelphi study will be conducted. People with experience of co-production and engagement in youth mental health services will be invited to participate. This will include young people with relevant lived experience, family members/carers of young people with mental ill health, youth mental health researchers and other professionals with experience of youth engagement work (eg, mental healthcare staff, mental health service managers and participation/engagement professionals in the sector). The target is to recruit 10–20 participants from each of these four groups (40–80 participants total).

The following steps will be taken: (1) an advisory group of young people will use results from a realist literature review completed prior to this study, to generate the first list of items for the survey; (2) using the online survey tool Qualtrics, participants will be invited to rate these items in an online survey. A prompt question formatted using a realist framework will allow participants to comment on their rating and how this survey item works (or does not work) in this context, for young people or other stakeholders. Participants will be able to add further suggestions at this stage; (3) using Qualtrics, a second survey round will be completed which will include the new suggestions from participants, and original items with their average participant ratings and comments displayed. Participants will be asked to rerate items in this round; (4) a list of items will be generated that comprises survey items believed to be ‘essential’ or ‘important’ by 80% or more of the participants; (5) this list will be discussed with the Youth Advisory Group to generate a final recommendations document and consider creative outputs and dissemination methods. Data analysis will include raw numbers, means and frequencies.

Ethical approval has been granted by the University of Birmingham Research Ethics Committee (Ref: ERN_1550-Apr2024). Both traditional and non-traditional outputs will be created (eg, conference presentations, publications, a plain English summary and social media infographics).

To validate the cross-national psychometric properties of the Mental Health Quality of Life questionnaire (MHQoL) and to develop an open-source toolbox for its scoring, transformation and presentation.

Secondary analysis of data from a multicentre international randomised controlled trial (EMPOWER).

Workplace settings in small-sized and medium-sized enterprises (SMEs) and public sector organisations in Finland, Spain and the UK.

The sample included 564 employees: 122 from Finland, 114 from Spain and 328 from the UK. Most were white-collar workers in SMEs or public organisations, mainly in public administration, manufacturing, health/life sciences or higher education. Women were the majority (56%–91% across countries), and mean age ranged from 43 to 48 years.

No intervention was delivered for this analysis; data were drawn from baseline assessments.

Primary outcomes were internal consistency and construct validity of the MHQoL, evaluated using Cronbach’s alpha, measurement invariance testing and multilevel analyses of associations between MHQoL dimensions and its visual analogue scale (VAS). Secondary outcomes were convergent validity, assessed through correlations between MHQoL scores and other mental health and quality of life measures (EuroQol 5-Dimension 5- level questionnaire (EQ-5D-5L), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Insomnia Severity Index, Perceived Stress Scale-4 (PSS-4), Psychosocial Risk Scale, and World Health Organization Five Well-Being Index (WHO-5)).

The MHQoL showed good internal consistency across countries, with Cronbach’s alpha ranging from 0.741 in Finland to 0.806 in Spain (overall α=0.787). Measurement invariance across Finland, Spain and the UK supported construct validity. Multilevel regression analyses showed associations between MHQoL dimensions and the MHQoL-VAS, with strongest contributions from Self-Image, Daily Activities, Mood and Future. Convergent validity was supported by moderate to strong correlations between MHQoL, EQ-5D-5L and related mental health measures. An open-source R package and Shiny web application (‘MHQoL Toolbox’) were developed for scoring, transformation and visualisation

The MHQoL is a reliable and valid measure of mental health-related quality of life across countries. The MHQoL toolbox supports consistent, transparent implementation, facilitating use in research, clinical practice and economic evaluations.

NCT04907604.