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Competing Interests: Declaration of interests PDM is a founding director, patron, and former founding board member of headspace. He is the executive director of Orygen, Australia's National Centre of Excellence in Youth Mental Health and lead agency for five headspace centres across northwest Melbourne. He is a past President of the International Association for Youth Mental Health, and a past President of the IEPA; Early Intervention in Mental Health and of the Schizophrenia International Research Society. S-JB has provided paid expert witness work for UK charities and legal organisations. She is the author of two books related to the brain, education, and learning, for which she receives royalties. She gives talks in schools in the state and private sector, at education conferences, for education organisations, and for other public, private, and third sector organisations (some talks are remunerated). She is a member of the Rethinking Assessment group, the Steering Committee of the Cambridge Centre of Science Policy, the Technical Advisory Group for the UK Government Department of Education's Education and Outcomes Panel-C Study, the Singapore Government National Research Foundation Scientific Advisory Board, and the Singapore Government Human Potential Scientific Advisory Board. She was a member of the Times Education Commission (2021–22). IBH has received honoraria for consultancy and educational activities from Janssen Cilag. He was a member of the Clinical Advisory Group for the evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative, and is a member of Mental Health Reform Advisory Committee (Department of Health). He is the Chief Scientific Advisor to and a 3·2% equity shareholder in InnoWell, which aims to transform mental health services through the use of innovative technologies. FAEA has received honoraria for consultancy from Grand Challenges Canada and is a past member of the World Economic Forum's Global Future Council on Mental Health. AMC is a director of headspace, Australia's National Youth Mental Health Foundation, and the National Education Alliance for Borderline Personality Disorder. AD is the Academic Secretary for the Royal College of Psychiatrists’ Faculty of Child and Adolescent Psychiatry, a research advisory group member of the UK National Society for the Prevention of Cruelty to Children, a member of the UK Trauma Council, and an evidence panel member of the Early Intervention Foundation. TF's research group receives funding for consultancy to Place2Be, a third sector organisation that provides mental health training, support, and interventions to schools across the UK. JH is executive director of Youth Wellness Hubs Ontario and receives funding from Graham Boeckh Foundation and other donors through the Centre for Addiction and Mental Health Foundation. AJ is a trustee of the Samaritans and MQ. She has received fees for lecturing from the Scottish Association of Mental Health. She is an advisory board member of Our Future Health, UK. FK-L's work is the subject of publishing contracts with multiple companies in the EU, Magellan, Cobalt Therapeutics in the USA, and the National Health Service in the UK. Although she has received no remuneration to date, she might receive royalties in the future. She is a non-executive director of Orygen. CK is the founder of Wida, a digital mental health platform. He has received consulting fees from the UN Children's Fund. He has received grants from MQ: Transforming Mental Health in the UK, the Royal Academy of Engineering in the UK, the National Institutes of Health in the USA, the Medical Research Council in the UK, and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul in Brazil. DR is a Chief Scientific Advisor to headspace, Australia's National Youth Mental Health Foundation. JT receives book royalties from Simon and Schuster, legal consulting fees from Bergman and Little and the Attorney General's office of the State of Tennessee, and honoraria for speaking engagements. EK is the immediate past President of the IEPA: Early Intervention in Mental Health, and during the period of the Commission was the President elect and President. All other authors declare no competing interests.

Background: The World Health Organisation declared the novel Coronavirus disease (COVID-19) a global pandemic on 11th March 2020. Since then, the world has been firmly in its grip. At the time of writing, there were more than 767,972,961 million confirmed cases and over 6,950,655 million deaths. While the main policy focus has been on controlling the virus and ensuring vaccine roll-out and uptake, the population mental health impacts of the pandemic are expected to be long-term, with certain population groups affected more than others., Methods: The overall objectives of our 'Coronavirus: Mental Health and the Pandemic' study were to explore UK adults' experiences of the Coronavirus pandemic and to gain insights into the mental health impacts, population-level changes over time, current and future mental health needs, and how these can best be addressed. The wider mixed-methods study consisted of repeated cross-sectional surveys and embedded qualitative sub-studies including in-depth interviews and focus group discussions with the wider UK adult population. For this particular inequalities and mental health sub-study, we used mixed methods data from our cross-sectional surveys and we carried out three Focus Group Discussions with a maximum variation sample from across the UK adult population. The discussions covered the broader topic of 'Inequalities and mental health during the Coronavirus pandemic in the UK' and took place online between April and August 2020. Focus Groups transcripts were analysed using thematic analysis in NVIVO. Cross-sectional survey data were analysed using STATA for descriptive statistics., Results: Three broad main themes emerged, each supporting a number of sub-themes: (1) Impacts of the pandemic; (2) Moving forward: needs and recommendations; (3) Coping mechanisms and resilience. Findings showed that participants described their experiences of the pandemic in relation to its impact on themselves and on different groups of people. Their experiences illustrated how the pandemic and subsequent measures had exacerbated existing inequalities and created new ones, and triggered various emotional responses. Participants also described their coping strategies and what worked and did not work for them, as well as support needs and recommendations for moving forward through, and out of, the pandemic; all of which are valuable learnings to be considered in policy making for improving mental health and for ensuring future preparedness., Conclusions: The pandemic is taking a long-term toll on the nations' mental health which will continue to have impacts for years to come. It is therefore crucial to learn the vital lessons learned from this pandemic. Specific as well as whole-government policies need to respond to this, address inequalities and the different needs across the life-course and across society, and take a holistic approach to mental health improvement across the UK., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Competing Interests: MH leads the RADAR-CNS consortium, a private–public pre-competitive collaboration on mobile health, through which his university receives in-kind and cash contributions from Janssen, Biogen, UCB, Merck, and Lundbeck. All other authors declare no competing interests.

Background: Research to date suggests older adults prefer a passive involvement in the clinical decision-making process; however, the empirical evidence underlying this claim in the mental health context is yet to be reviewed systematically., Aims: To understand whether older adults desire involvement in mental health-related clinical decisions., Method: A systematic review was conducted to identify primary research that explored mental-health decision-making preferences of people with a mean age of over 55 from January 1990 through to December 2018., Results: Three independent studies of varying design and quality were included. Study settings were in the USA, Germany, and the UK. A preference for shared decision-making was seen in two studies, while a preference for active decision-making was identified in one., Conclusions: In contrast to other reviews on clinical decision-making, this review focused on mental health-related decisions of older adults. The evidence suggests older adults desire involvement in mental health-related clinical decisions. Given the political drive to empower patients and the need to ensure evidence-based clinical practice, more high-quality research regarding the shared decision-making preferences and outcomes of older adults with mental ill-health is needed. Systematic Review Registration PROSPERO: CRD42018102009.

This document is a list of references for a research paper on various topics related to mental health, artificial intelligence, and data analysis. The references cover studies on loneliness and mental health during the COVID-19 pandemic, risk factors for suicidal thoughts and behaviors, medical big data, machine learning techniques, and the use of artificial intelligence in mental health research. The document also includes resources on the validation and accuracy of diagnoses, classification of psychiatric disorders, and the challenges and opportunities of data sharing in mental health research. [Extracted from the article]

Background: Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54–94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. Methods: This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation Results: All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24–10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. Conclusions: We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic increased public use of digital mental health technologies. However, little is known about changes in user engagement with these platforms during the pandemic. This study aims to assess engagement changes with a digital mental healthcare service during COVID-19. Methods: A cohort study based on routinely collected service usage data from a digital mental health support service in the United Kingdom. Returning users aged 14-25 years that interacted for a maximum of two months were included. The study population was divided into pre-COVID and COVID cohorts. Demographic and usage information between cohorts were compared and usage clusters were identified within each cohort. Differences were tested using Chi-squared, two-sample Kolmogorov-Smirnov tests and logit regressions. Results: Of the 624,103 users who joined the service between May 1, 2019, and October 1, 2021, 18,889 (32.81%) met the inclusion criteria: 5,048 in the pre-COVID cohort and 13,841 in the COVID cohort. The COVID cohort wrote more journals; maintained the same focus on messaging practitioners, posting discussions, commenting on posts, and having booked chats; and engaged less in writing journals, setting personal goals, posting articles, and having ad-hoc chats. Four usage profiles were identified in both cohorts: one relatively disengaged, one focused on contacting practitioners through chats/messages, and two broadly interested in writing discussions and comments within the digital community. Despite their broad similarities, usage patterns also exhibited differences between cohorts. For example, all four clusters had over 70% of users attempting to have ad-hoc chats with practitioners in the pre-COVID cohort, compared to one out of four clusters in the COVID cohort. Overall, engagement change patterns during the COVID-19 pandemic were not equal across clusters. Sensitivity analysis revealed varying strength of these defined clusters. Results: Of the 624,103 users who joined the service between May 1, 2019, and October 1, 2021, 18,889 (32.81%) met the inclusion criteria: 5,048 in the pre-COVID cohort and 13,841 in the COVID cohort. The COVID cohort wrote more journals; maintained the same focus on messaging practitioners, posting discussions, commenting on posts, and having booked chats; and engaged less in writing journals, setting personal goals, posting articles, and having ad-hoc chats. Four usage profiles were identified in both cohorts: one relatively disengaged, one focused on contacting practitioners through chats/messages, and two broadly interested in writing discussions and comments within the digital community. Despite their broad similarities, usage patterns also exhibited differences between cohorts. For example, all four clusters had over 70% of users attempting to have ad-hoc chats with practitioners in the pre-COVID cohort, compared to one out of four clusters in the COVID cohort. Overall, engagement change patterns during the COVID-19 pandemic were not equal across clusters. Sensitivity analysis revealed varying strength of these defined clusters. [ABSTRACT FROM AUTHOR]

This study aimed to assess the trajectory of wellbeing and psychological distress in a UK sample by comparing data taken from the first and second UK lockdowns. Wellbeing (indexed via the Warwick-Edinburgh Mental Wellbeing Scale) and psychological distress (indexed via the K10) were measured in two surveys in large online samples from Wales, UK. The first survey (n = 12,989) took place 11–16 weeks into the first UK lockdown and the second survey (n = 10,428) took place 4–11 weeks into the second UK lockdown. Levels of wellbeing were lower in the second survey compared to the first survey, which were already low compared to pre-pandemic data (2019). Clinically significant levels of psychological distress were found in 40.4% of participants in the second survey, representing a 9.8% increase in prevalence from the first survey. Poorer mental health was found in women, younger adults, and those from deprived areas. The greatest reduction in mental health was found in the youngest age group (16-24 years old). The COVID-19 pandemic and the measures taken to curb its spread continue to negatively impact the wellbeing of the UK population. [ABSTRACT FROM AUTHOR]

Background: Prevalence estimates of COVID‐19‐related posttraumatic stress disorder (PTSD) have ranged from 1% to over 60% in the general population. Individuals with lived experience of a psychiatric disorder may be particularly vulnerable to COVID‐19‐related PTSD but this has received inadequate attention. Methods: Participants were 1571 adults with lived experience of psychiatric disorder who took part in a longitudinal study of mental health during the COVID‐19 pandemic. PTSD was assessed by the International Trauma Questionnaire (ITQ) anchored to the participant's most troubling COVID‐19‐related experiencevent. Factors hypothesised to be associated with traumatic stress symptoms were investigated by linear regression. Results: 40.10% of participants perceived some aspect of the pandemic as traumatic. 5.28% reported an ICD‐11 PTSD qualifying COVID‐19 related traumatic exposure and 0.83% met criteria for probable ICD‐11 COVID‐19‐related PTSD. Traumatic stress symptoms were associated with younger age, lower income, lower social support, and financial worries, and lived experience of PTSD/complex PTSD. Depression and anxiety measured in June 2020 predicted traumatic stress symptoms at follow‐up approximately 20 weeks later in November 2020. Conclusions: We did not find evidence of widespread COVID‐19‐related PTSD among individuals with lived experience of a psychiatric disorder. There is a need for future research to derive valid prevalence estimates of COVID‐19‐related PTSD. [ABSTRACT FROM AUTHOR]

Introduction: Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK. Methods: A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11– 25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan–Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC). Results: Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12– 1.24) in WLGP and 1.17 (1.10– 1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20– 29.40) in WLGP and 4.50 (4.08– 4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00– 3.58) in WLGP and 2.59 (2.36– 2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78– 0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54– 0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84– 1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5– 10.0). Conclusion: Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Population‐based studies have observed sex biases in the diagnosis and treatment of attention‐deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions.The cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services.There were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3–30 years), with a male‐to‐female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (<12 years), with the lowest ratio (1.9:1) in those diagnosed as adults (>18). Males were younger at first recorded ADHD diagnosis (mean = 10.9 vs. 12.6 years), more likely to be prescribed ADHD medication and younger at diagnosis of co‐occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups.This study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. Further research and dissemination of findings to the public are needed to improve awareness, timely diagnosis and treatment of ADHD in females. [ABSTRACT FROM AUTHOR]

Parental difficulties, including mental ill health, substance misuse, domestic violence and learning disability have been associated with children entering out-of-home care. There is also evidence that these issues may co-occur within families. Understanding how the co-occurrence of these difficulties is associated with care entry is complex because they may co-occur in the same or different household members and have different impacts on the likelihood of care entry when they occur in mothers, fathers or in single parent households. Administrative data from local authority children's services in Wales were linked with demographic data to identify households in which children lived prior to entering care. Linkage to birth data identified biological mothers. Linkage with primary care, emergency department, hospital admissions and substance misuse services data enabled indicators of substance misuse, mental health, assaults in the home, learning disability and neurodivergence in the adults in those households to be identified. A series of multilevel binary logistic regression models were used to explore the odds of a household having one or more children entering care if risk factors were present. These considered the effects of individual risks, and cumulative risk both in individual adults in the household, and across the whole household. The effects of the number of adults, having adults with no risks and the differential impacts of risks in biological mothers, other women or men were also explored. Additional models explored these factors in single adult households. Cumulative risks increased the likelihood of care entry, however this effect disappeared when individual risks were controlled for. The presence of an individual with no risks in the household acted as a protective factor. Overall, the impact of the risks on the odds of care entry was substantially greater if the risks were present in the biological mother than if they occurred in other adults (men or women) in the household. In single adult households risk factors had a much greater impact when they occurred in households headed by women as opposed to men. Substantial differences in the effects of risk factors in female and male adults are apparent and further research is needed to understand why this is occurring to ensure that parents are treated equally in terms of support and statutory intervention regardless of their sex. 1 1 Throughout this paper we refer to the "sex" of the parents /adults in households, as opposed to their "gender." This is because in the analysis we carried out the sex of these individuals was determined by their GP records. We have chosen to use the term "sex," rather than "gender," as we believe this data is more likely to reflect their biological sex, rather the gender that the individuals identify as. [ABSTRACT FROM AUTHOR]

Background: Google Trends data are increasingly used by researchers as an indicator of population mental health, but few studies have investigated the validity of this approach during a public health emergency.Methods: Relative search volumes (RSV) for the topics depression, anxiety, self-harm, suicide, suicidal ideation, loneliness, and abuse were obtained from Google Trends. We used graphical and time-series approaches to compare daily trends in searches for these topics against population measures of these outcomes recorded using validated self-report scales (PHQ-9; GAD-7; UCLA-3) in a weekly survey (n = ~70,000) of the impact COVID-19 on psychological and social experiences in the UK population (21/03/2020 to 21/08/ 2020).Results: Self-reported levels of depression, anxiety, self-harm/suicidal ideation, self-harm, loneliness and abuse decreased during the period studied. There was no evidence of an association between self-reported anxiety, self-harm, abuse and RSV on Google Trends. Trends in Google topic RSV for depression and suicidal ideation were inversely associated with self-reports of these outcomes (p = 0.03 and p = 0.04, respectively). However, there was statistical and graphical evidence that self-report and Google searches for loneliness (p < 0.001) tracked one another.Limitations: No age/sex breakdown of Google Trends data available. Survey respondents were not representative of the UK population and no pre-pandemic data were available.Conclusion: Google Trends data do not appear to be a useful indicator of changing levels of population mental health during a public health emergency, but may have some value as an indicator of loneliness. [ABSTRACT FROM AUTHOR]