Today the problem of suicide remains one of the topical issues among Asian countries like South Korea. The primary objective of this Systematic Review (SR) was the identification of the risk factors in suicide attempts and completions in South Korea. South Korea has one of the highest reported suicide rates in the world, and there was no prior systematic review on this topic. The main intention was to provide evidence-based results for future research studies and to inform suicide prevention policies.

PubMed, Science Direct, and Medline databases were searched from 1990 to October 2022. Studies focused on the problem of suicide in South Korea were selected with an emphasis on risk factors. Since the rate of suicide rises with age, studies examining 18-year-olds and above were included. Studies examining people of different sociodemographic backgrounds and people diagnosed with psychiatric/psychological disorders and those who attempted suicide, as well as those without a psychiatric/psychological problem, were also included. To assess the overall quality of the included studies, the Critical Appraisal Skills Programme (CASP) checklist was applied for the evaluation of case-control and cohort studies. The National Institutes of Health (NIH) Quality Assessment Tool was implemented for the evaluation of cross-sectional studies. The Jadad Scale was used to assess the risk of bias. PRISMA reporting guidelines were followed.

Ten studies met the eligibility criteria to be included in SR: Four cross-sectional, two cross-cultural, and four cohort studies. Risk of bias assessment demonstrated low quality and moderate risk of bias. The quality assessment showed an acceptable level of relevance and quality. Findings suggested factors leading to suicide in South Korea were mental health conditions, financial status, such as unemployment and low income, education level less than high school, and households with poor living conditions. The identified risk factors significantly increased the likelihood of suicide ideation, suicide attempt and suicide completion among people in South Korea. Stigma was identified as a barrier to those with mental health conditions seeking professional help.

The identified risk factors are similar across the world; however, the suicide rates are not as high in other Western cultures as they are in South Korea. Future studies could compare Western countries to hierarchical countries to identify if there are any local risk factors that can help guide local prevention policies and educational programs with city officials’ engagement. Moreover, it would be essential to investigate the impact of stigma thoroughly since it is still hard to clarify whether it is a cultural issue or a worldwide issue preventing individuals from getting professional help.

Aim 1: Identify the proportion of 11–19-year-olds in the Mental Health of Children and Young People 2017 survey screening positive for a possible eating problem, using the Development and Wellbeing Assessment.

Aim 2: Describe patterns of service contact in individuals screening positive for possible eating problems.

We used data from the Mental Health of Children and Young People 2017 survey, a stratified probability sample of children and their parents and teachers across England. The screening questions from the Eating Disorders module of the Development and Wellbeing Assessment (DAWBA) was completed by all children aged 11–19, all parents of children ages 11–16 and parents of children ages 17–19 where consent was given. Individuals were classified as screening positive for possible eating problems if they had one or more self-reported symptoms, or two or more parent-reported symptoms. We describe the proportion of individuals screening positive by age, sex, co-morbidities, and household income.

Individuals also answered questions about help seeking from different sources (in relation to any mental health concern). We classify these sources of support as informal, professional and specialist.

We analysed all data using Stata 17.

A total of 36.4% (95% CI 34.8, 38.1) of children and young people aged 11–17 in England screened positive for a possible eating problem, including 47.6% of females (95% CI 45.3, 50.0) and 25.6% of males (95% CI 23.7, 27.8). 60.7% (95% CI 57.9, 63.4) of individuals who screened positive reported that they received no help over the previous year; 13.1% (95% CI 11.2, 15.4) had received informal help only; 17.0% (95% CI 15.0, 19.3) had professional but not specialist help; and 9.13% (95% CI 7.67, 10.9) had received specialist help. High proportions of individuals who received support from formal services during the year prior to the survey screened positive for possible eating problems: 42.7% (95% CI 38.6, 47.0) for teachers, 46.9% (95% CI 40.9, 53.0) for GPs, 32.2% (95% CI 23.1, 42.9) for Paediatrics and Child Health and 50.0% (95% CI 43.1, 56.8) for Mental Health Services.

Despite high numbers of young people screening positive for a possible eating problem, rates of help seeking in this group were low. Conversely, high proportions of those seeking professional help have a possible eating problem.

Clinicians should be aware of the high proportions of individuals with possible eating problems accessing their services. Future research should aim to increase help seeking in individuals with possible eating problems.

Eating disorders do not only affect the person who is suffering, but also their family. This qualitative study aims to understand the impacts on individuals who have an adult family member with an eating disorder, and what support they seek for their own well-being.

A convenience sample of 11 volunteer participants (10 family members and 1 charity worker) from the United Kingdom (UK) were recruited for interviews. Four UK eating disorder charities assisted with outreach by sharing the Participant Information Sheet to their service users. Semi-structured interviews were conducted between February and March 2023. Interviews lasted on average 54 minutes and were recorded on video call (n = 9) or face-to-face on the University of Edinburgh campus (n = 2). Transcripts were analysed using thematic analysis, following a grounded-theory constructivist approach.

Participants discussed how their lives were changed by engaging with the care of their family member, leading to a shift in family dynamics and a change in understanding of what it means to be a ‘normal’ family. Most interviewees perceived their relative's eating disorder as a negative disruption to their own life, however one participant said that it had no negative impact on his well-being at all. Conflict in the household was a regular outcome, with four interviewees all using the phrase “treading on eggshells”. Siblings of adults with an eating disorder were described by their parents as being excluded from the family due to the ongoing parental focus on the healing of their child. Some participants accessed support groups and social media to connect with other families working through similar challenges.

Having an adult family member with an eating disorder impacts the wider social network of the family. This dissertation argues that the socially constructed meanings of ‘care’ and ‘normality’, alongside the social relations with people placed in similar positions, inform the lived experiences of these individuals. This study's newfound illness narrative of ‘normality’ theorises that some people do not strive to help their relative with an eating disorder because it has already constructed the meaning of their normal life. Future research should aim to recruit a greater variation of participants, including more fathers, children, and siblings. This work endeavours to increase awareness of the support which families need during this time. It therefore opens the opportunity to consider how existing resources and services, both in healthcare and the third-sector, can be improved in the future.

Suicide is a serious global public health concern. Most suicide related deaths occur in low- and middle-income countries (LMICs) such as Pakistan. Self-harm is a major predictor of death by suicide and has cost implications both in terms of treatment and subsequent suicide. Therefore, culturally relevant interventions that have the potential to reduce self-harm in Pakistan may have major implications for the costs incurred by service provision and productivity losses due to illness or premature death. This trial investigated the clinical and cost effectiveness of the CMAP intervention verses enhanced treatment as usual (E-TAU) to reduce self-harm over 12 months in Pakistan.

Participants were recruited from emergency departments, primary care settings, medical units of participating hospitals and self-referral from community settings in Karachi, Lahore, Rawalpindi, Quetta and Peshawar. Eligible consented participants were assessed at baseline, 3- (end of intervention), 6-, 9- and 12-month post-randomization. Participants in the intervention arm received 6 one-to-one sessions of culturally adapted manual assisted psychological intervention (CMAP) over 3 months. The Client Service Receipt Inventory was used to record health service utilization, both formal and informal. Health related quality of life was measured using the EQ-5D-3L. The Thailand tariff value set (developed by the EuroQol Organization) was used to calculate quality-adjusted life year (QALY) because Thailand was deemed similar to Pakistan. The Incremental Cost Effectiveness Ratio (ICER) was calculated based on between arm differences in estimated cost and Quality Adjusted Life Years (QALYs) gains in the sampled population. Costs were converted to US dollars using the currency exchange rate on February 2024 (US$1 = PKR276)

A total of 901 participants were randomized into either the CMAP arm (n = 440) or E-TAU arm (n = 461). Total QALY gained in the CMAP arm was 0.40 (95% CI: 0.36–0.45) and in the E-TAU arm was 0.33 (95% CI: 0.30–0.38) at 12-month post-randomization. The additional QALY gained due to CMAP intervention is 0.07. The difference in costs per participant between CMAP and TAU arms was US$59. The ICER for the CMAP versus E-TAU was US$843 per QALY gain.

Results revealed that the CMAP intervention is likely to be cost-effective compared with the E-TAU, given the cost-effectiveness threshold. These findings suggest that implementing culturally relevant self-harm and suicide prevention measures such as CMAP can lead to significant societal cost savings by preventing self-harm and suicides.

Severe Mental Illnesses (SMI) are a group of disorders which can have a debilitating impact on an individual's daily life functioning. The National Institute for Health and Care Excellence (NICE) has set out clinical guidelines for the treatment of SMI including the use of Second Generation Antipsychotic (SGA) medication as well as psychological therapies. However, Treatment Resistant Schizophrenia (TRS) affects approximately 34% of patients with schizophrenia. Clozapine, a SGA, has shown superiority in treatment resistant schizophrenia as well as its potential benefits in reducing suicidality and improving functioning.

The following study aimed to examine the longitudinal trends in prescribing clozapine based on the NHS Digital prescription cost analysis (PCA) between 2015–2023.

The results show that a number of prescriptions decrease simultaneously from the financial year 2015 (n = 5536) to 2023 (n = 3059). The cost was also found to be reducing until the financial year 2018–19 where there was an increase in costs which reached the maximum (14%) despite the number of prescriptions being lower as compared with 2015–16. In addition, it was found that clozapine prescribing trends have been reducing over time, despite a large proportion of service users with schizophrenia experiencing TRS (34%). Overall, since 2015–2023 a total of n = 34,440 items of clozapine were prescribed costing £1,252,052.27.

Considering clozapine's superior efficacy in the treatment of TRS, further research is required to better understand prescribing practices, monitoring compliance of clozapine and treatment adherence. Further qualitative research is needed to better understand the views and perspectives of both service users and prescribers in the clinical use of clozapine. Future research may also look at referrals of clozapine-prescribed patients to psychological services, the impact of clozapine in TRS patients who are offered psychological therapy, and the potential clinical and cost implications of not prescribing clozapine.

Psychosis is one of the leading causes of disability. First Episode Psychosis (FEP) significantly impacts the long-term course of the disorder. While a majority of FEP service users show signs of ‘recovery' within 12 months of treatment, the early course involves frequent relapses, with up to 80% relapsing within five years. This elevates the risk of persistent psychotic symptoms, affecting cognitive, social, and occupational functioning. Medication, the core treatment, reduces relapse by 75%, necessitating additional psychosocial treatments. Mobile-based interventions are recognized for meeting families' needs in terms of information, guidance, and support. This paper explores stakeholder views on developing mobile interventions for those experiencing their first psychosis episode.

This qualitative paper was part of the TechCare app development process in which face-to-face interviews with patients (17), and 4 focus groups with health professionals were carried out. The qualitative interviews and focus groups explored the views of stakeholders on the need for mobile-based treatment, the structure of the application, the content of the application and barriers and challenges were also explored in detail. All the audio-recorded interviews were transcribed and analyzed through a framework approach.

Qualitative analysis revealed three themes. The first theme centers on stakeholders' views about mobile-based treatment. Health professionals reported that app-based treatment enhances help-seeking behavior, reduces societal stigma, and aids in managing treatment and activities. The second theme focuses on suggestions for the Techcare application, emphasizing logical and easy-to-understand content, with a major focus on crisis management, hallucinations, and psycho-education about symptoms. Participants also highlighted the need for a section providing psycho-education for families. Carers emphasized the necessity of an activity plan in the app, including an activity log for medication management and activities. The third theme delves into barriers and challenges in app-based treatment, including difficulty levels and privacy concerns. Stakeholders stressed the importance of content in simple Urdu language for broader understanding.

In conclusion, mobile-based treatment contributes to reducing stigma, increasing awareness about the illness in its early stages, and facilitating the management of functional activities for patients. The insights gathered from stakeholders provide valuable guidance for the development of an effective and culturally sensitive mobile-based intervention for individuals experiencing FEP.

This interdisciplinary research explored how responsibility is attributed to patients with personality disorders (PDs). The attribution of responsibility to this group has been extensively discussed by philosophers, and appears to be associated with negative attitudes towards the diagnosis amongst clinicians. This research aimed to both examine the philosophical literature available on this topic, and to explore how future clinicians make judgements of these patients’ responsibility.

A qualitative study was conducted to answer the following four research questions:

1. 1. What do medical students think responsibility means in the context of healthcare?

2. 2. What factors influence when medical students consider patients with mental health disorders, in particular PDs, responsible for their behaviours?

3. 3. How responsible do medical students consider patients with PDs for their behaviours in comparison to patients with other mental health conditions?

4. 4. Do medical students think that responsibility attributions could affect the stigmatisation of the condition and patient care?

Seven in-depth semi-structured interviews were conducted, involving the discussion of a case report. Interviews had a mean length of 53 minutes. They were then transcribed, coded, and thematic analysis of the data was undertaken. Four main themes were identified: understanding of responsibility, the factors affecting responsibility attribution, stigma and responsibility attribution, and the role of the clinician and the healthcare service.

It was found that medical students considered similar conditions and factors in attributing responsibility to those identified in the philosophical literature. However, several important practical concerns about responsibility attribution in practice were raised, including the possible impact on the therapeutic relationship, difficulties in separating responsibility and blame, and the impact comorbidities and misdiagnoses can have on attributions. Participants believed that stigma towards the diagnosis remains prevalent amongst healthcare professionals, due to stereotypes of these patients being manipulative, and insufficient education about the condition. Additionally, participants highlighted that patient responsibility may be reduced when clinicians and the healthcare service fail to meet their own responsibilities to these patients.

Future research into how other groups of healthcare professionals attribute responsibility is recommended, alongside research into how improved education could reduce stigma and inform responsibility attribution. It is suggested that further education is provided to healthcare professionals about the condition, and more support is offered to those working with patients with PDs to reduce stigma and make the attribution of responsibility fairer to these patients.

To compare the funding, courses and delivery modalities of parenting training delivered across London borough councils, metropolitan district councils, and county councils in England.

Freedom of Information requests were piloted on 5 local authorities. Following optimisation, requests were sent out to 74 local authorities across England requesting information on funding for parenting training programmes (26 London Borough Councils, 16 County Councils, and 29 Metropolitan Borough Councils). 26/32 London Boroughs, 16/21 County Councils, and 29/36 Metropolitan Boroughs were sent requests. No follow-up emails were sent chasing responses; however, clarification was provided where necessary. Data were analysed on Excel to observe patterns and disparities.

We received responses from 74 local authorities, and 50 were usable. The mean amount of funding spent across local authorities was £881,254 (standard deviation 1,627,921). There were 18 parenting programmes used, the most common was Triple-P. The average number of parents supported by parenting programmes per local authority was 949 (standard deviation 1410). Local authorities reported spending an average of £27,430 (standard deviation 41005) on digital parenting programmes. The mean number of parenting staff was 36 (standard deviation 59).

We found wide disparities in spending, staffing, and programme choices representing a fragmented landscape of parenting training provision. Several local authorities could not separate spending on parenting training, and parental engagement was not reported consistently. We recommend more consistent reporting of parental initiation, engagement, and completion of training programmes to ensure equitable access and provision of parenting training nationwide.

The number of children and young people across the UK experiencing mental health difficulties is rising, with 1 in 6 young people aged 6–16 with a diagnosable mental health condition.

The school environment can be a crucial setting for mental health promotion as it can reach such a large number of young people.

The application of mindfulness for wellbeing is becoming increasingly popular. Research demonstrates mindfulness is an effective treatment for many psychological conditions and adding a yoga element is thought to bring additional benefits.

Interventions focusing on wellbeing are found to demonstrate more consistent improvements when parents are involved, supporting the concept of a family intervention.

A 6 week family intervention was developed specifically for children, to promote overall wellbeing.

Aim:

1. 1. To ascertain the acceptability of yoga as a family intervention.

2. 2. To ascertain the acceptability of family journals as method to collect data.

• • 6 weekly, 1hr, yoga and mindfulness intervention.

• • 9 children aged 6–11, 9 adults.

• • A weekly family journal was used collect data.

• • Data from the journals were analysed using Thematic Analysis.

• • A Linear Numeric Scale was used pre and post intervention rating 1–5: asking the participants to rate their confidence in relation to breathing techniques, yoga, working as part of a group, and understanding mindfulness.

1. Acceptability of yoga as a family intervention

Results from the pre post tests, indicate a significant relationship between the intervention and the participants.

Confidence in yoga P < 0.008 (mean pre test 1, post test 4).

Confidence with breathing P < 0.008 (mean pre test 3, post test 5).

Confidence with mindfulness P < 0.004 (mean pre test 1, post test 4).

Working as part of a group P < 0.004 (mean pre test 3, post test 5).

2. Acceptability of family journals as a method to collect data

The journals provided sufficient qualitative responses and meaningful quantitative data to consider the intervention acceptable. The weekly logs in the family journals were thematically analysed and four key themes were identified as having a positive impact: yoga, breathing techniques, mindfulness activities, improved connection.

This study has highlighted promising findings relating to yoga as a family intervention.

Families reported applying the techniques, outside of the sessions to manage emotions. The family journals were a space where adults had the freedom to choose what they wrote, this method allowed us to identify the intervention had a positive impact upon family connections. Using the journals was a simple way to capture the voices of the participants.

Compared with general population average, people experiencing severe mental illness (SMI) have lower levels of physical activity, high levels of sedation, and more sleep problems (Soundy et al. 2013; Vancampfort et al. 2015). This is linked to symptoms of depression, lower wellbeing, hopelessness, lower quality of life and physical health conditions, such as: cardiovascular disease (CVD), stroke, hypertension, osteoarthritis, diabetes, and chronic obstructive pulmonary disease (COPD) (Rhodes et al. 2017; Schuch et al. 2017). Engaging in physical activity improves quality of life, psychotic symptomatology, cognition, functioning and physical health (Mittal et al. 2017). Improved sleep is associated with enhanced social interaction, feeling energised, and improved engagement in activities (Waite et al. 2016). NHS Long-Term Plan (2022) is to ensure that at least 80% of people with SMI receive an annual 12 point physical health check. Professor Helen Lester stated: 'Don't just screen, intervene'. There is an urgent need to provide interventions that improve the healthy lifestyles of people with SMI, but there is a lack of suitable and effective interventions. To be effective, interventions need to be individualised (Griffiths et al. 2021).

Intervention and aims

Well-Track is the provision of a Fitbit and its software apps, sleep hygiene and physical activity guidance, motivational interviewing, workbook goal setting through three sessions with a health coach. Aim was to improve sleep, physical activity, wellbeing, and healthy lifestyles.

Outcome measure data collection from baseline to 3 and 6 week follow-ups. Change in sleep quality and wellbeing were assessed in 50 participants, and participant feedback was obtained.

Improvements were found in sleep quality and wellbeing. Most patients attended all three sessions and actively used the Fitbit and its software apps, guidance and workbook to set goals and to make positive changes to their lifestyle and daily routines to improve motivation, quality of sleep, and level of physical activity.

Healthy effective sleep and physical activity/exercise are important to SMI patients’ wellbeing and mental and physical health. A health coach successfully and fully integrated the Well-Track intervention into routine service provision. The intervention was beneficial, relatively easy and low cost to implement, and well-liked by patients and staff; and therefore, could be offered by all community mental health teams (CMHTs) and physical health check services. SMI services should consider and assess sleep and physical activity/exercise issues and promote healthy effective sleep and physical activity/exercise within a recovery focused practice.

Flow is a transcranial direct current stimulation (tDCS) treatment for depression without major side effects that patients use at home. Over 30 years of research/clinical use show tDCS is safe (Razza et al., 2020). Flow is CE-marked for treating depression in Europe. Recent NICE briefing published (NICE, 2023). The patient self-administers and remains awake (NICE, 2015), treatment sessions last for about 30 minutes, and are repeated 5 times weekly for three weeks (Flow, 2023). After the initial three-week period, patients self-administer 3 sessions per week for 3 weeks, and then as long as required (Flow, 2023). Meta-analyses of randomised sham-controlled trials (RCT) show tDCS is associated with significant improvements in depressive symptoms and high rates of clinical response and remission relative to placebo sham stimulation (Mutz et al., 2018, 2019; Moffa et al., 2020; Razza et al., 2020). Flow RCT study depression remission rates are 45% (Fu et al., In Press). Flow incorporates an evidence backed healthy lifestyle behaviour training software app, and depression symptom tracking that enables users to monitor their progress/symptoms. Training modules on: ‘Behaviour activation’, ‘Mindfulness’, ‘Exercise for your brain’, ‘An anti-depression diet’, and ‘Therapeutic sleep’. Flow also provides an integrated platform for clinicians to monitor use and depression symptoms.

In a first for the NHS, in a post-marketing informed consent study, NHFT's community mental health team (CMHT) offered Flow to their patients with a diagnosis of depression and evaluated the feasibility and impact.

Outcome measure data collection from baseline to 6 week follow-up point. Self-report measures used were depression: Personal Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS); health related quality of life: EQ-5D-5L; and functioning: Work and Social Adjustment Scale (WSAS). In-depth interviews were undertaken with 14 patients.

There has been high level of adherence (70%) to treatment protocol. There has been statistically significant and ‘reliable improvement’ in depression symptoms. There was statistically significant improvements in real world meaningful functioning and quality of life. Most participants described a positive impact on depressive symptoms, sleep, and functioning.

Flow has been successfully integrated into CMHT treatment offer. It is important to offer CMHT patients an evidence-backed alternative to existing depression treatments (antiddepressant medication and talking therapies). Findings provide support for the approach of delivering together both tDCS and evidence-backed wellbeing behaviour therapy training to patients of CMHTs with experience of depression.

Despite the high prevalence of mental health disorders in children and young people (CYP) with long-term health conditions (LTCs), these difficulties are often overlooked and untreated. Previous research demonstrated the effectiveness of low intensity psychological support provided via a drop-in mental health centre in a single specialist paediatric hospital. The aim of this study is to determine the effectiveness and acceptability of accessible low intensity mental health services for CYP attending a general hospital.

This project was part of a wider prospective non-randomised single-arm multi-centre interventional study (Trial registration: ISRCTN15063954). CYP aged up to 25 years old with a LTC, who had been receiving care for their LTC for 6 months or more, and their parent/carer were eligible to be referred by their clinician or self-refer to the trial. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or CYP between baseline and 6 months. Interventions provided were: low intensity CBT, onward referral or signposting.

53 families were recruited at this hospital which made up 44% of the total study sample (120 families). Patients recruited were made up of 34 females, 18 males and one young person who identified as non-binary. The mean age of the CYP was 16.13 years and they were living with a range of different LTCs including cancer, asthma and diabetes. At baseline the average self-reported and parent reported SDQ scores were within the “very high” range (21.52 and 22.03, respectively). All participants were offered an initial assessment within 3 weeks of consenting (average 19.6 days) and treatment began within a month. Qualitative feedback from families has identified how the service “fills a gap” between physical and mental health and their satisfaction with how “time-sensitive” support was available.

There is significant demand for this service and CYP living with different LTCs are accessing and utilising the service provided. This model of intervention allows timely access to evidence-based mental health support for CYP attending a general hospital for their physical health needs, compared with standard waiting times in other services.

While there is research on physical exercise and cognitive training on cognitive improvement in older adults, there is none comparing these two interventions for their efficacy on executive functioning specifically in the population with a diagnosis of Mild Cognitive Impairment (MCI) or dementia. This study aims to bridge this gap and determine the superiority between the two interventions to enhance executive functions among individuals with MCI or dementia. Besides establishing evidence for the benefits of these socially prescribed interventions, it also aims to highlight their differential effects on executive functions. Additionally, it seeks to evaluate the feasibility of implementing these interventions to provide evidence-based insights that inform clinical practice.

Sixteen randomised control trials were meticulously selected using the Cochrane selection manual and PRISMA guidelines from an extensive search across prominent academic databases. Stringent quality assessment was conducted for each study using the modified Centre for Reviews and Dissemination checklist, Jadad and PEDro scales and the Cochrane Risk of Bias tool ensuring methodological rigour. The studies provided a total of 1593 participants with a mean age of 74.36 (SD = 5.54), randomly allocated in various intervention groups. Each study was critically appraised, analysed and the findings presented as a narrative synthesis and a meta-analysis performed with the available data.

Physical exercise showed statistically insignificant improvement on the Stroop Test (p = 0.19) while no significant correlation was seen in Verbal Fluency (p = 0.032). Cognitive Training intervention had a significant improvement in both Stroop test (P = 0.0009) and Verbal Fluency (p = 0.00). The study also found that diverse contextual and personal factors like socioeconomic levels, education, personal preferences, general health conditions, mood, dependence on others, and genetics, are some factors that influence an individual's response to intervention and hence determine its efficacy.

There is limited statistical evidence to conclude the superiority of one intervention over the other. However, this systematic review highlights that the effectiveness of an intervention cannot be assessed solely on its statistical effect size. Rather, one must go beyond numerical assessments for a comprehensive understanding of individual circumstances that may pose barriers to engagement with the interventions, thus influencing their acceptability and effectiveness. A holistic and multidimensional perspective of the disease with a personalised intervention plan may be the new solution.

Whether focusing on clinical or non-clinical roles, activity within organizations (and, by extension, outcomes) depends on decision-making. The conscious experience of decision-making (as if it is the outcome of an objective and explicit appraisal of pertinent information) belies the complex nexus of influences on this process. Whilst extensive research has been undertaken on both organizational and clinical decision-making, these literatures have largely remained separate. The authors contend that, when account is taken not only of the interplay between decisions that are deemed either ‘organizational’ or ‘clinical’, but also that this dichotomy itself is invalid, there is an imperative to take a whole system approach to decision-making in health organizations.

The aim of this study was to develop a framework for understanding decision-making that has applicability across a complex mental health system.

• • Step 1: Define the domain of discourse (i.e. decision-making in a complex adaptive mental health system including clinical and non-clinical settings);

• • Step 2: Generate a dataset of domain-relevant statements by iterative reflection on the respective areas of practice (clinical and non-clinical);

• • Step 3: Thematically analyse the dataset to identify a thematic structure.

A hierarchical thematic structure was identified. At the highest order, this structure comprises a dichotomy between embodied and disembodied conceptualizations. The embodied theme is further divisible by perspectives that are intra- or inter-personal. The former includes ways of thinking, assumptions, approximations, uncertainty, holding the model, and epistemic humility; and the latter includes relationships, trust/resentment, and disagreeing well. The disembodied theme incorporates both broad-brush characteristics of the system (such as holistic, connections, relata and complexity) and those characteristics with explanatory power (such as nonlinear, fuzziness and nondeterministic).

The framework defined by this analysis has the potential to facilitate the examination of facets of, and influences on, decision-making across a mental health organization. With further empirical testing and revision, such a framework can be used to inform the improvement of approaches to making decisions.

The pursuit of a career in medicine, while potentially rewarding, is undeniably accompanied by demanding challenges. These challenges encompass not only rigorous academic demands and long work hours but also contend with a competitive academic environment, conflicts in maintaining a study-life balance, and a multitude of other stressors unique to the medical profession. Amidst this backdrop, concerns are growing worldwide about the mental health challenges that medical students face as they start their careers in medicine. Coping can play a pivotal role in overcoming these challenges. This study explores how coping is associated with wellbeing aspects, i.e., anxiety and depression, as well as personality, and looks into the coping strategies adopted by medical students, specifically focusing on whether they predominantly employ problem-focused or emotion-focused coping. Additionally, it aims to explore contextual factors influencing students' coping strategies, which is crucial for informing wellbeing interventions and support services.

This study used a mixed-methods approach, employing quantitative data on coping, personality, stress, anxiety and depression and qualitative data from semi-structured interviews with preclinical and clinical year medical students at the University of Nottingham.

Regression findings revealed that medical students primarily used emotion-focused over problem-focused coping. Interestingly, thematic analysis showed that medical students employ problem-focused coping strategies in rigorous, academically challenging and controllable situations such as upcoming exams; they prioritise structured study schedules, seek additional academic resources, and actively engage with faculty to enhance their understanding of complex topics; conversely, emotion-focused coping emerged prominently in the face of personal or interpersonal stressors, particularly in situations perceived as uncontrollable. In such instances, like unexpected setbacks or health concerns, students may acknowledge and express their emotions and engage in activities for emotional relief, including seeking wellbeing support.

The study reveals a dynamic interplay between problem-focused and emotion-focused coping strategies in medical students. Recognising that medical students tend to adopt different coping strategies in different situations, medical education systems should aim to develop or tailor existing resources to provide appropriate academic and wellbeing support.

Low mood is a common clinical symptom during the perimenopause and menopause. However, the extent to which low mood in menopausal women intersects with thoughts of self-harm and suicidal ideation is largely unknown. In this study we aimed to explore these questions by using two different validated symptom scores.

We administered a modified version of the Greene Climacteric Symptom Questionnaire (Greene 1976) to all new patients attending the Newson Health Menopause and Wellbeing Clinic, Stratford-upon-Avon, between 1 September 2023 and 31 December 2023. Patients were also asked to complete the PHQ-9 symptom questionnaire, an instrument for diagnosing and measuring the severity of depression. Data were collected from electronic health records and analysed using descriptive statistics.

1,212 patients were included in the study and completed the Greene Climacteric and PHQ-9 questionnaires at baseline and after 3 months. Mood and mental health symptoms including self-reported anxiety and depression affected 98% of patients. 16% of respondents indicated that they had thoughts of self-harm or suicidal ideation on at least some days in the 2 weeks prior to their initial appointment (Question 9 of the PHQ-9).

The findings of our study demonstrate that negative mood symptoms are common in perimenopausal and menopausal women. 1 in 6 women reported thoughts of self-harm prior to initiation of HRT. Our observational data suggest that mood symptoms are highly prevalent and some women have severe symptoms and may experience suicidal ideation. Our findings should inform better mental health support and access to treatment for women experiencing negative mood symptoms in the menopause transition.

It is estimated that approximately 15% of adults over 60 years old suffer from a mental disorder. Self-harm and suicidal ideation are associated with a range of mental disorders, and high rates of suicide. The aim of this project is to identify the characteristics of older people who present with self-harm and suicidal ideation to an emergency department (ED) in a university hospital. In examining the variables associated with self-harm we may be better able to identify the characteristics of older adults who are at highest risk.

We conducted a cohort study of older adults (aged 65 years+) who presented to the Mater Misericordiae University Hospital with a mental health problem from 2008–2022 (a 15-year cohort). Data were extracted from the Electronic Patient Records including all patients who presented to the ED in that time period with a mental health triage code. We examined this cohort to collect detailed information on the characteristics of those older people presenting with self-harm and suicidal ideation.

We identified 30,941 ED attendances with a mental health triage code between 2008 and 2022. Of these, 946 (3.1%) were older adults. One-fifth (20%) presented with self-harm, a further 21% reported suicidal ideation. Of these, 8% reported previous self-harm and 32% had previously been reviewed by psychiatry. Over one-third (38%) were admitted. Of those, the majority (78%) were admitted to a medical or surgical ward, 16% to a psychiatric ward and 5% to critical care.

Of those presenting with self-harm 37% were admitted to hospital – 32% to a medical or other ward and 5% to psychiatric unit. There was a significant difference in those who were admitted with self-harm versus suicidal ideation (p < 0.001).

Our results demonstrate key insights into older adults who presented to the ED with self-harm and suicidal ideation. These patients were more likely to be admitted to a medical ward than a psychiatric unit, and those with self-harm were more likely to be admitted medically compared with those with suicidal ideation.

Possible reasons for these results include the higher rate of medical co-morbidity in older adults and the potential high lethality of self-harm in this cohort. Another explanation could be the scarcity of acute psychiatric beds necessitating medical admission. There is a need for further exploration of this high-risk population.

Older people (people aged 65 and older) have high rates of suicide, and self-harm is a major risk factor for suicide. While rates of self-harm decrease with age, rates of suicide increase amongst this age group. The aim of this project is to analyse data collected by the National Clinical Programme for Self-Harm and Suicide-related Ideation (NCPSHI) to identify real-life evidence of the characteristics associated with older people who present with self-harm and suicidal ideation to emergency departments (ED) in Ireland. In examining the variables associated with self-harm we may be better able to identify the characteristics of older adults who are at highest risk, including those presenting with high lethality attempts.

The NCPSHI collects data on all patients who present with self-harm or suicide-related ideation to EDs in Ireland. We utilised a six-year cohort of anonymised data from the NCPSHI from 2018–2023, representing 5,041 presentations of older people (aged 60 and over); 6.9% of all presentations with self-harm and suicide-related ideation. We examined sociodemographic variables including sex, ethnic background, type of self-harm, lethality of self-harm and substance use contributing to the presentation, in addition to service use variables.

Older people were less likely to present with self-harm – 45% of older people vs 52% of adults under 60 (p < 0.001). However, those episodes of self-harm were more likely to be categorised as “high lethality” – 20% vs 12% of people under 60 (p < 0.001). Older people were also more likely to have a mental health admission – 25% vs 16% (p < 0.001). Older people were much less likely to present with substance misuse: 30% vs 45% (p < 0.001). There were also significant differences in methods of self-harm. Older people were more likely to attempt drowning (1.5% vs 1.1%) or overdose (21% vs 20%). This was the common method of self-harm across all age groups.

Our results demonstrate the significant differences in characteristics of older people presenting to Irish emergency departments with self-harm versus younger people, where previously a paucity of data existed. The high lethality of self-harm amongst older people makes it imperative to identify the characteristics of self-harm in this population to understand the factors associated with increased risk and help us to develop treatments and services to meet their needs It also highlights the importance of providing education to staff working with this cohort to appropriately stratify and manage risk.

The NHS long-term plan focuses on the improvement of Child and Adolescent Mental Health (CAMHS) community services including the roll out of 24/7 Crisis teams universally across the country. Crisis and Liaison teams form an important alternative to inpatient admission, offering intense, short-term support to young people in mental health crisis and often high levels of risk. The number of referrals to Crisis and Liaison services are rising. In order to maintain patient flow and meet demand, these teams also need safe, evidence-based protocols for efficient discharge, transition and handover of young people to community teams and services. The SAFER care bundle was designed to facilitate discharges from hospital, and this has been adapted to the SAFER-YMH bundle for discharges from adolescent mental health wards. A similar care bundle for discharge from teams offering alternatives to inpatient care has not yet been developed.

This study aimed to investigate the acceptability and necessary adaptations required for the use of the SAFER-YMH care bundle to facilitate transitions out of CAMHS Crisis and Liaison teams.

This study used stakeholder feedback from multiple sources through focus groups to adapt the SAFER-YMH care bundle for use in young people in transitions out of CAMHS Crisis and Liaison teams. Normalisation process theory was utilised as the theoretical foundation upon which the development of the adapted care bundle, and its potential implementation in the complex multifaceted healthcare landscape was based.

Initial focus groups were held with young people, parents/carers, healthcare professionals from CAMHS crisis and liaison teams, CAMHS NHS management, NHS IT services, community CAMHS teams and NHS commissioners in two trusts in England. Following each focus group adaptations were made to the care bundle in an iterative manner. In the second round of focus groups, the adapted care bundle was presented to a mixed group of participants and agreed to be acceptable.

Through stakeholder feedback this study has adapted the SAFER-YMH to create the SAFER-YCL care bundle; an acceptable version for use in discharges from CAMHS crisis and liaison services. End-user design and involvement is vital in the development of clinical applications and pathways which are user-friendly and time-saving for healthcare professionals and also helpful for young people and their families.

Self-harm is the preventable cause of premature death by suicide. In adolescents suicide is the fourth leading cause of death and Pakistan is one of the youngest nations in the world. Culturally relevant solutions for the prevention of self-harm among adolescent are almost non-existent in LMICs. The aim of this trial is to assess the clinical and cost-effectiveness of a culturally adapted manual assisted problem-solving intervention for youth (YCMAP) with history of self-harm (within 3 months) to reduce self-harm repetition over the period of 12 months.

This was a rater-blind, multicenter randomised controlled trial, with a nested qualitative component to explore perceived usefulness of the intervention from the perspective of different stakeholders. Primary care centers, emergency departments, medical units from participating healthcare facilities in Karachi, Hyderabad, Lahore, Rawalpindi and Multan, Pakistan served as recruitment sites in addition to self-referrals. Patients with a recent history of self-harm (n = 684) were assessed and randomised (1:1) into either of the two trial arms; YCMAP with enhanced treatment as usual (E-TAU) or E-TAU. The YCMAP is a manualized, psychological intervention based on problem-solving therapy, principles of cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), psychoeducation, and a comprehensive assessment of the self-harm attempt using stories of four young people, comprising 8–10 one-to-one sessions delivered over three months by trained therapists. Primary outcome was the reduction in the self-harm repetition at 12-month post-randomisation and secondary outcomes were distress, suicidal ideation, hopelessness, health-related quality of life (QoL), and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation.

We screened 1099 young people for eligibility and 684 eligible, consented patients were randomly assigned to the YCMAP plus E-TAU arm (n = 342) and E-TAU arm (N = 342). Improvement in repetition rates of self-harm, hopelessness, suicidal ideation and psychological distress were clinically significant in YCMAP arm as compared with E-TAU. Thematic analysis of interviews with adolescents who participated in the intervention arm (N = 20) highlighted the intervention as useful in improving their mental health and well-being, and easy to understand.

Adolescents are an important target population for the prevention of suicide and other mental health problems. Implementation strategies are needed such as digitalization of culturally adapted manual assisted psychological interventions or task shifting approach for scalable suicide prevention interventions in low resource settings like Pakistan to meet mental health needs.