Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide.

We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with and without SUDs.

We used data from the Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services, which is based on a national linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, to identify individuals who died by suicide within 1 year after last contact with mental health or substance use services (n = 1140). A questionnaire was retrieved for 1041 (91.3%) of these individuals. We used least absolute shrinkage and selection operator (LASSO) regression to select variables and compared patients with and without SUDs. Conditional selective inference was used to improve 90% confidence intervals and p-values.

The prevalence of self-harm was 55% in patients with SUDs and 52.6% in patients without SUDs. Suicidal ideation (odds ratio 2.98 (95% CI 1.74–5.10)) emerged as a factor shared with patients without SUDs, while personality disorders (odds ratio 1.96 (1.12–3.40)) and a history of violence (odds ratio 1.86 (1.20–2.87)) were unique factors for patients with SUDs.

A history of self-harm is prevalent in patients with SUDs who die by suicide and is associated with suicidal ideation, a history of violence and personality disorders in patients with SUDs.

While cognitive impairment is a core feature of psychosis, significant heterogeneity in cognitive and clinical outcomes is observed.

The aim of this study was to identify cognitive and clinical subgroups in first-episode psychosis (FEP) and determine if these profiles were linked to functional outcomes over time.

A total of 323 individuals with FEP were included. Two-step hierarchical and k-means cluster analyses were performed using baseline cognitive and clinical variables. General linear mixed models were used to investigate whether baseline cognitive and clinical clusters were associated with functioning at follow-up time points (6–9, 12 and 15 months).

Three distinct cognitive clusters were identified: a cognitively intact group (N = 59), a moderately impaired group (N= 77) and a more severely impaired group (N= 122). Three distinct clinical clusters were identified: a subgroup characterised by predominant mood symptoms (N = 76), a subgroup characterised by predominant negative symptoms (N= 19) and a subgroup characterised by overall mild symptom severity (N = 94). The subgroup with more severely impaired cognition also had more severe negative symptoms at baseline. Cognitive clusters were significantly associated with later social and occupational function, and associated with changes over time. Clinical clusters were associated with later social functioning but not occupational functioning, and were not associated with changes over time.

Baseline cognitive impairments are predictive of both later social and occupational function and change over time. This suggests that cognitive profiles offer valuable information in terms of prognosis and treatment needs.

We rely heavily on cut-off points of brief measures of psychological distress in research and clinical practice to identify those at risk of mental health conditions; however, few studies have compared the performance of different scales.

To determine the extent to which the child- and parent-report Strength and Difficulty Questionnaire (SDQ), Revised Children’s Anxiety and Depression Scale (RCADS), short Mood and Feeling Questionnaire (sMFQ) and child-report KIDSCREEN correlated and identified the same respondents above cut-off points and at risk of mental health conditions.

A cross-sectional survey was conducted among 231 children aged 11–16 years and 289 parents who completed all the above measures administered via a mobile app, MyJournE, including the SDQ, RCADS and sMFQ.

The psychopathology measures identified similar proportions of young people as above the cut-off point and at risk of depression (child report 14.7% RCADS, 19.9% sMFQ, parent report 8.7% RCADS, 12.1% sMFQ), anxiety (child report 24.7% RCADS, 26.0% SDQ-Emotional subscale, parent report 20.1% RCADS, 26% SDQ-Emotional subscale) and child-report internalising problems (26.8% RCADS, 29.9% SDQ). Despite strong correlations between measures (child report 0.77–0.84 and parent report 0.70–0.80 between the SDQ, sMFQ and RCADS) and expected directions of correlation with KIDSCREEN and SDQ subscales, kappa values indicate moderate to substantial agreement between measures. Measures did not consistently identify the same children; half (n = 36, 46%) of those on child report and a third (n = 30, 37%) on parent report, scoring above the cut-off point for the SDQ-Emotional subscale, RCADS total or sMFQ, scored above the cut-off point on all of them. Only half (n = 46, 54%) of the children scored above the cut-off point on child report by the SDQ-Internalising and RCADS total scales.

This study highlights the risk of using a screening test to ‘rule out’ potential psychopathology. Screening tests should not be used diagnostically and are best used together with broad assessment.

Within the medical model, ‘impairment’ is required for a diagnosis of autism. However, the diagnostic manuals provide limited guidance as to how to interpret impairment, which can impact diagnostic rates and the provision of support. Impairment is discussed within the context of the medical model and current sociocultural landscape.

Researchers explore the biology of painful experiences not primarily felt in the body (‘non-physical pain’), sometimes referred to as mental, social or emotional pain. A critical challenge lies in how to operationalise this subjective experience for biological research, a crucial process for translating findings into clinical practice.

To map studies investigating biological features of non-physical pain, focusing on their conceptual features (i.e. terms and definitions of non-physical pain) and methodological characteristics (e.g. experimental paradigms and measures).

This methodological systematic review searched reports of primary research on the biological features of non-physical pain across Embase, MEDLINE and Web of Science. Using a meta-research approach, we synthetised results on terms, definitions, populations, experimental paradigms, confounders, measures of non-physical pain and investigation methods (e.g. functional magnetic resonance imaging).

We identified 92 human studies, involving 7778 participants. Overall, 59.1% of the studies did not report any definition of non-physical pain, and 82% of studies did not use a specific measure. Regarding the possibility of translating results to clinical settings, most of the human studies involved only healthy participants (71.7%) and the seven different experimental paradigms used to induce non-physical pain had unknown external validity. Confounders were not considered by 32.4% of the experimental studies. Animal studies were rare, with only four rodent studies.

Biomedical studies of non-physical pain use heterogeneous concepts with unclear overlaps and methods with unknown external validity. As has been done for physical pain, priority actions include establishing an agreed definition and measurement of non-physical pain and developing experimental paradigms with good external validity.

Scalable assessment tools for precision psychiatry are of increasing clinical interest. One clinical risk assessment that might be improved by such approaches is assessment of violence perpetration risk. This is an important adverse outcome to reduce for some people presenting to services for first-episode psychosis. A prediction tool (Oxford Mental Illness and Violence (OxMIV)) has been externally validated in these services, but clinical acceptability and role need to be examined and developed.

This study aimed to understand clinical use of the OxMIV tool to support violence risk management in early intervention in psychosis services in terms of acceptability to clinicians, patients and carers, practical feasibility, perceived utility, impact and role.

A mixed methods approach integrated quantitative data on utility and patterns of use of the OxMIV tool over 12 months in two services with qualitative data from interviews of 20 clinicians and 12 patients and carers.

The OxMIV tool was used 141 times, mostly in new assessments. Required information was available, with only family history items scored unknown to any notable degree. The OxMIV tool was deemed helpful by clinicians in most cases, especially if there were previous risk concerns. It was acceptable practically, and broadly for the service, for which its concordance with clinical judgement was important. Patients and carers thought it could improve openness. There was some limited impact on plans for clinical support.

The OxMIV tool met an identified clinical need to support clinical assessment for violence risk. Linkage to intervention pathways is a research priority.

To develop effective mental health interventions for children and adolescents, it is essential to understand the intricate link between functional disability and mental well-being in this group.

To explore the network connections between various aspects of functional disability and mental well-being in young people with disabilities.

We analysed data from the Multiple Indicator Cluster Surveys in 47 low- and middle-income countries, tracking progress towards health-related sustainable development goals. Our focus was on children and adolescents aged 5–17 with functional disabilities. Mental well-being was gauged using carer-reported signs of depression, anxiety and disability on the Child Functioning Module. Network-analysis techniques were used to examine links between mental well-being and functional disability domains.

The study included 32 669 eligible children aged 5–17 with functional disabilities (14 826 females and 17 843 males). The core domains of disability with the strongest connections to poor mental well-being were difficulties in accepting change, making friends, behavioural control (controlling own behaviour) and remembering/concentrating. These associations remained largely consistent across different genders and developmental stages. However, there were notable gender differences and age-related shifts in the relationships between specific disabilities and mental well-being. In particular, signs of anxiety in males and depression in females were most associated with functional disability overall, while signs of depression had the closest links to disability in adolescents.

The network perspective may enable the design of tailored interventions and support services that consider age and gender differences. Further research should continue to explore these complex relationships, incorporating novel methodologies like network-analysis to enhance the understanding of these associations.

Despite a global decline in suicide rates, the USA has witnessed a concerning rise in suicide mortality over the past two decades.

This study aims to elucidate the changing patterns of suicide mortality in the USA from 1999 to 2019, with a particular focus on gender and racial differences.

We utilised national mortality data for causes of suicide (X60–X84, Y87.0) from the Centers for Disease Control and Prevention for 1999–2019. The age–period–cohort analysis was conducted to explore the effects of age, period and birth cohort effects on suicide mortality by gender and race.

Between 1999 and 2019, the suicide rate and the number of suicides in the USA increased 33% and 62%, respectively. We discerned an emerging peak of suicide among young adult populations even as increases affected nearly all groups. Females have shown increasing period risk, which has exceeded that of males since 2011. Their cohort risk, which slowly increased and exceeded males in post-1959 cohorts, exhibited a steep J-shaped pattern, especially among those born after 1977. Although Americans of all races have experienced increased period risk since 2011, it was highest among American Indians and Alaska Natives by the end of the 20-year span. With the mortality risk increasing rapidly in all post-1959 cohorts, the risk showed an obvious cliff-shaped pattern among the Asian/Pacific Islander population born after 1989.

The shifting burden of suicide mortality towards younger populations, transcending gender and racial boundaries, underscores the need for the implementation of tailored public health strategies.

A substantial subset of patients with major depressive disorder (MDD) experience treatment-resistant depression (TRD), typically defined as failure to respond to at least two sequential antidepressant trials at adequate dose and length.

To examine clinical and service-level associations of TRD, and the experiences of people with TRD and clinicians involved in their care within a large, diverse National Health Service trust in the UK.

This mixed-methods study integrated quantitative analysis of electronic health records with thematic analysis of semi-structured interviews. Chi-squared tests and one-way analysis of variance were used to assess associations between lines of antidepressant treatments and sociodemographic and clinical variables, and binary logistic regression was used to identify associations of TRD status.

Nearly half (48%) of MDD patients met TRD criteria, with 36.9% having trialled ≥4 antidepressant treatments. People with TRD had higher rates of recurrent depression (odds ratio = 1.24, 95% CI: 1.05–1.45, P = 0.008), comorbid anxiety disorders (odds ratio = 1.21, 95% CI: 1.03–1.41, P = 0.019), personality disorders (odds ratio=1.35, 95% CI: 1.10–1.65, P = 0.003), self-harm (odds ratio = 1.76, 95% CI: 1.06–2.93, P = 0.029) and cardiovascular diseases (odds ratio = 1.46, 95% CI: 1.02–2.07, P = 0.0374). Greater treatment resistance was linked to increased economic inactivity and functional loss. Qualitative findings revealed severe emotional distress and frustration with existing treatments, as well as organisational and illness-related barriers to effective care.

TRD is characterised by increasing mental and physical morbidity and functional decline, with individuals experiencing barriers to effective care. Improved pathways, service structures and more effective biological and psychological interventions are needed.