Blinding of randomised controlled trials (RCTs) is very important for the accurate assessment of drug efficacy. Without proper blinding, the effect of the intervention may be overestimated. Fergusson et al investigated the top journals in psychiatry from 1998 to 2001 and reported that blinding assessments were conducted in only 8 of 94 studies across psychiatric disorders.1 However, no studies on antipsychotic

It has become increasingly apparent that rapidly available information about the occurrence of suicides is needed, particularly to support suicide prevention efforts. Concerns about the potential impact of the COVID-19 pandemic on vulnerability to suicide highlighted the need for such early data internationally. Here, we set out the nature, current status and content of a real-time suicide monitoring

Background Cut-offs on self-report depression screening tools are designed to identify many more people than those who meet criteria for major depressive disorder. In a recent analysis of the European Health Interview Survey (EHIS), the percentage of participants with Patient Health Questionnaire-8 (PHQ-8) scores ≥10 was reported as major depression prevalence. Objective We used a Bayesian framework

Background Hundreds of randomised controlled trials and dozens of meta-analyses have examined psychotherapies for depression—yet not all points in the same direction. Are these discrepancies a result of specific meta-analytical decisions or do most analytical strategies reaching the same conclusion? Objective We aim to solve these discrepancies by conducting a multiverse meta-analysis containing all

Background Cue reactivity, the enhanced sensitivity to conditioned cues, is associated with habitual and compulsive alcohol consumption. However, most previous studies in alcohol use disorder (AUD) compared brain activity between alcohol and neutral conditions, solely as cue-triggered neural reactivity. Objective This study aims to find the neural subprocesses during the processing of visual alcohol

Welcome to BMJ Mental Health . In January 2023, Evidence-Based Mental Health ( EBMH ) has changed its name to BMJ Mental Health , after 25 years of activity (the journal was founded in 1998) and after recently becoming one of the top 10 psychiatric journals in terms of impact factor. BMJ Mental Health is now online only and entirely open access. Changing name is not just a rebranding exercise. It is

Background Cognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment. Objectives This study aimed to identify whether CBT and CfD target different symptoms and explore the implications of modelling choices

Objective Umbrella reviews are a new form of literature review that summarises the strength and/or quality of the evidence from all systematic reviews and meta-analyses conducted on a broad topic. This type of review thus provides an exhaustive examination of a vast body of information, providing the highest synthesis of knowledge. A critical strength of umbrella reviews is recalculating the meta-analytic

Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited. Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands. Methods We conducted a single-blind, randomised

Background Dementia incidence is increasing across the globe and currently there are no disease-modifying pharmaceutical treatments. The Lancet Commission on dementia identified 12 modifiable risk factors which explain 40% of dementia incidence. However, whether these associations are causal in nature is unclear. Objective To examine the modifiable risk factors for dementia as identified in the Lancet

Question Are antipsychotic dose equivalents between acute mania and schizophrenia the same? Study selection and analysis Six databases were systematically searched (from inception to 17 September 2022) to identify blinded randomised controlled trials (RCTs) that used a flexible-dose oral antipsychotic drug for patients with acute mania. The mean and SD of the effective dose and the pre–post changes

Question Digital interventions based on cognitive–behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence. Study selection and

Background Despite uncertain benefits, people with personality disorder are commonly treated with antipsychotic medication. Objective To investigate the association between antipsychotics and violent crimes and suicidal behaviour in individuals with personality disorder. Methods We used nationwide Danish registries to identify all individuals with diagnosed personality disorder aged 18–64 years during

Background Behavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19. Objectives We undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial

Background Non-serious adverse events (NSAEs) should be captured and reported because they can have a significant negative impact on patients and treatment adherence. However, the reporting of NSAEs in randomised controlled trials (RCTs) is limited. Objective To identify the most important NSAEs of antidepressants for patients and clinicians, to be evaluated in RCTs and meta-analyses. Methods We conducted

Objective A network meta-analysis (NMA) usually assesses multiple outcomes across several treatment comparisons. The Vitruvian plot aims to facilitate communication of multiple outcomes from NMAs to patients and clinicians. Methods We developed this tool following the recommendations on the communication of benefit–risk information from the available literature. We collected and implemented feedback

Background Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. Objective To examine the efficacy of five components of iCBT for subthreshold depression. Methods We conducted an factorial

Background Most people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic. Objective To examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step

Objectives The WHO’s Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH). Design We searched studies excluded from our updated mhGAP-IG systematic review, and included in other

Objective There is little evidence for finding optimal antipsychotic treatment for schizophrenia, especially in paediatrics. To evaluate the performance and clinical benefit of several prediction methods for 1-year treatment continuation of antipsychotics. Design and Settings Population-based prognostic study conducting using the nationwide claims database in Korea. Participants 5109 patients aged

Nine years ago, in my first editorial for Evidence-Based Mental Health (EBMH) as editor in chief, I wrote that ‘EBMH should be seen as a tool to engage new generations of psychiatrists and psychologists to develop and implement the evidence-based approach into daily clinical practice.’ I took the job when I moved to Oxford and one of the main reasons why I accepted the challenge of editing this journal

> Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods.1 These are all linked to physical and

Question Effective prevention of suicide requires a comprehensive understanding of risk factors. Study selection and analysis Five databases were systematically searched to identify psychological autopsy studies (published up to February 2022) that reported on risk factors for suicide mortality among adults in the general population. Effect sizes were pooled as odds ratios (ORs) using random-effects

Background Predictors of antidepressant response in older patients with major depressive disorder (MDD) need to be confirmed before they can guide treatment. Objective To create decision trees for early identification of older patients with MDD who are unlikely to respond to 12 weeks of antidepressant treatment, we analysed data from 454 older participants treated with venlafaxine XR (150–300 mg/day)

Background Available prediction models of cardiovascular diseases (CVDs) may not accurately predict outcomes among individuals initiating pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). Objective To improve the predictive accuracy of traditional CVD risk factors for adults initiating pharmacological treatment of ADHD, by considering novel CVD risk factors associated with

Ostinelli et al developed an interesting visualisation tool, the Vitruvian plot, to present multiple outcomes in network meta-analysis.1 We write to make some suggestions and potential improvements. First, to present the strength of statistical evidence, the authors colour the sectors according to the p values of a Z-test. According to the Cochran handbook,2 this could lead to over-reliance and misinterpretation

Background The COVID-19 pandemic has caused an increase in mental ill health compared with prepandemic levels. Longer-term trajectories of depression in adults during the pandemic remain unclear. Objective We used latent growth curve modelling to examine individual trajectories of depression symptoms, and their predictors, beyond the early stage of the pandemic. Methods Data were collected in three

Question Although mental pain is present in many mental disorders and is a predictor of suicide, it is rarely investigated in research or treated in care. A valid tool to measure it is a necessary first step towards better understanding, predicting and ultimately relieving this pain. Study selection and analysis Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines

Because of the rapidly increasing number of randomised controlled trials (RCTs) and meta-analyses in many fields, there is an urgent need to step up from meta-analyses to higher levels of aggregation of outcomes of RCTs. Network meta-analyses and umbrella reviews allow higher levels of aggregation of RCT outcomes, but cannot adequately cover the evidence for a whole field. The ‘Meta-Analytic Research

Background There is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people. Objective To measure these risks in young people discharged from a psychiatric hospital as compared with both non-affected controls and non-hospitalised affected controls. Methods Data were extracted from the French

Background Studies report an increased risk of self-harm or suicide in people prescribed mirtazapine compared with other antidepressants. Objectives To compare the risk of serious self-harm in people prescribed mirtazapine versus other antidepressants as second-line treatments. Design and setting Cohort study using anonymised English primary care electronic health records, hospital admission data and

Question Amphetamine use is a risk factor for psychosis, which imposes a substantial burden on society. We aimed to investigate the incidence of psychosis associated with illicit amphetamine use and whether rehabilitation treatments could influence the psychosis risk. Study selection and analysis A retrospective cohort study was conducted using the population based Taiwan Illicit Drug Issue Database

Improving child and adolescent mental health requires the careful development and rigorous testing of interventions and delivery methods. This includes universal school-based mindfulness training, evaluated in the My Resilience in Adolescence (MYRIAD) trial reported in this special edition. While discovering effective interventions through randomised controlled trials is our ultimate aim, null or negative

Universal school programmes aimed at the prevention of depression and other common mental health problems in adolescents are attractive because they are less stigmatising than targeted interventions, have a high uptake and may shift the ‘normal distribution’ of mental health problems in the positive direction. Research up to now shows small effects of these interventions, but even small effects may

Background Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health. Objective The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU). Methods MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and

Background Previous research suggests that mindfulness training (MT) appears effective at improving mental health in young people. MT is proposed to work through improving executive control in affectively laden contexts. However, it is unclear whether MT improves such control in young people. MT appears to mitigate mental health difficulties during periods of stress, but any mitigating effects against

Background Preventing mental health problems in early adolescence is a priority. School-based mindfulness training (SBMT) is an approach with mixed evidence. Objectives To explore for whom SBMT does/does not work and what influences outcomes. Methods The My Resilience in Adolescence was a parallel-group, cluster randomised controlled trial (K=84 secondary schools; n=8376 students, age: 11–13) recruiting

Background Education is broader than academic teaching. It includes teaching students social–emotional skills both directly and indirectly through a positive school climate. Objective To evaluate if a universal school-based mindfulness training (SBMT) enhances teacher mental health and school climate. Methods The My Resilience in Adolescence parallel group, cluster randomised controlled trial (registration:

Question Mindfulness-based programmes (MBPs) are an increasingly popular approach to improving mental health in young people. Our previous meta-analysis suggested that MBPs show promising effectiveness, but highlighted a lack of high-quality, adequately powered randomised controlled trials (RCTs). This updated meta-analysis assesses the-state-of the-art of MBPs for young people in light of new studies

In 2019, the Topol review was published on behalf of the secretary of state for health and social care in the UK, preparing the healthcare workforce to deliver the digital future.1 A multidisciplinary team of experts, including clinicians, researchers, ethicists, computer scientists, engineers and economists, reviewed the available data and projected into the future (ie, next 20 years) two key questions:

Background Task-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other LMICs, is one example of this type of treatment model using lay health workers (LHWs) to deliver treatment. Objective To consider the level of treatment coverage

Background Antipsychotics are increasingly used among women of childbearing age and during pregnancy. Objective To determine whether children exposed to antipsychotics in utero are at increased risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), accounting for maternal diagnoses of bipolar, psychotic and other psychiatric disorders. Design Population-based cohort

Background The association between serum folate deficiency and the risk of dementia in old age is unclear, perhaps owing to small sample sizes, the competing risk of mortality or reverse causation. Objective To examine the associations between serum folate deficiency and the risks of incident dementia and all-cause mortality in a large national sample of older adults. Methods A prospective cohort aged

Background Advances in genetics and digital phenotyping in psychiatry have given rise to testing services targeting young people, which claim to predict psychiatric outcomes before difficulties emerge. These services raise several ethical challenges surrounding data sharing and information privacy. Objectives This study aimed to investigate young people’s interest in predictive testing for mental health

Introduction Clinical depression is usually treated in primary care with psychological therapies and antidepressant medication. However, when patients do not respond to at least two or more antidepressants within a depressive episode, they are considered to have treatment resistant depression (TRD). Previous small randomised controlled trials suggested that pramipexole, a dopamine D2/3 receptor agonist

Question The aim was to systematically collate and synthesise existing, publicly available patient-reported outcome measure (PROM) information suitable for quality of life (QOL)/well-being measurement in mental health economic evaluations, with specific focus on their applicability in multisectoral, multinational, multiperson economic evaluations and to develop an electronic PROM compendium with meta-data

Objective The current practice in meta-analysis of the effects of psychopharmacological interventions ignors the administered dose or restricts the analysis in a dose range. This may introduce unnecessary uncertainty and heterogeneity. Methods have been developed to integrate the dose–effect models in meta-analysis. Methods We describe the two-stage and the one-stage models to conduct a dose–effect

Background A relationship between caesarean section and offspring cognitive ability has been described, but data are limited, and a large-scale study is needed. Objective To determine the relationship between mode of delivery and general cognitive ability. Methods A cohort of 579 244 singleton males, born between 1973 and 1987 who conscripted before 2006, were identified using the Swedish population-based

Background Adjunctive metformin is the most well-studied intervention in the pharmacological management of antipsychotic-induced weight gain (AIWG). Although a relatively unaddressed area, among guidelines recommending consideration of metformin, prescribing information that would facilitate its applied use by clinicians, for example, provision of a dose titration schedule is absent. Moreover, recommendations

Background Compared with traditional screening questionnaires, computerised adaptive tests for severity of depression (CAT-DI) and computerised adaptive diagnostic modules for depression (CAD-MDD) show improved precision in screening for major depressive disorder. CAT measures have been tailored to perinatal women but have not been studied in low-income women of colour despite high rates of perinatal

Question Suicide is a global public and mental health problem. The effectiveness of social support interventions has not been widely demonstrated in the prevention of suicide. We aimed to describe the methods of social support interventions in preventing suicide and examine the efficacy of them. Study selection and analysis We searched literature databases and conducted clinical trials. The inclusion

Question Mental disorders typically start in childhood and persist, causing high individual and collective burdens. To inform policymaking to address children’s mental health in high-income countries we aimed to identify updated data on disorder prevalence. Methods We identified epidemiological studies reporting mental disorder prevalence in representative samples of children aged 18 years or younger—including

Research-active clinical services have lower mortality rates and produce higher quality care outcomes, however, recruiting participants to clinical research in the National Health System (NHS) remains challenging.1 A recent study, assessing the feasibility of clinical staff electronically documenting patient consent to discuss research participation, indicated very low patient uptake, limiting its

Objective We aim to explain the unadjusted, adjusted and marginal number needed to treat (NNT) and provide software for clinicians to compute them. Methods The NNT is an efficacy index that is commonly used in randomised clinical trials. The NNT is the average number of patients needed to treat to obtain one successful outcome (ie, response) due to treatment. We developed the nntcalc R package for

Background Around 40% of patients with bipolar disorder (BD) additionally have anxiety disorder. The prevalence of anxiety in patients with newly diagnosed BD and their first-degree relatives (UR) has not been investigated. Objective To investigate (1) the prevalence of a comorbid anxiety diagnosis in patients with newly diagnosed BD and their UR, (2) sociodemographic and clinical differences between

Background Accurate estimation of daily dosage and duration of medication use is essential to pharmacoepidemiological studies using electronic healthcare databases. However, such information is not directly available in many prescription databases, including the Swedish Prescribed Drug Register. Objective To develop and validate an algorithm for predicting prescribed daily dosage and treatment duration

Background Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain. Objective We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents. Methods We searched eight databases and other international registers up to 31 December 2020

Background The effects of COVID-19 on the shift to remote consultations remain to be properly investigated. Objective To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak. Methods We used deidentified electronic health records routinely collected from two UK mental

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (Conference of the Parties (COP)26) in Glasgow, UK. Ahead of these pivotal meetings

Furukawa et al 1 posed the question: how can we estimate quality-adjusted life years (QALYs) based on Patient Health Questionnaire-9 (PHQ-9) scores? They recommend equipercentile linking analysis between the depression severity PHQ-9 and preference-based EQ-5D three-level version (EQ-5D-3L; UK value set), the latter used to estimate utility data for QALYs. Furukawa et al 1 refer to the process of ‘cross-walking’