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COVID-19 has significant impacts on young peoples’ lives and emotions. Understanding how young people maintain well-being in the face of challenges can inform future mental health intervention development. Here we applied network analysis to well-being data gathered from 2532 young people (12-25 years) residing in the UK during the COVID-19 pandemic to identify the structure across well-being and crucially, its central defining features. Gender and age differences in networks were also investigated. Across all participants, items emerged in two clusters: 1) optimism, positive self-perception, and social connectedness, and 2) processing problems and ideas. The two central features of well-being were: “I’ve been dealing with problems well” and “I’ve been thinking clearly”. There were minimal age and gender differences. Our findings suggest that the perception of being able to process problems and ideas efficiently could be a hallmark of well-being, particularly in the face of challenging circumstances. These findings contrast with pre-pandemic studies that point to positive affect as central aspects of well-being networks. Future interventions that encourage problem-solving and mental flexibility could be useful in helping young people maintain well-being during times of stress and uncertainty.

Objective Parental depression is one of the biggest risk factors for youth depression. This parallel randomized controlled trial evaluates the effectiveness of the German version of the family-group-cognitive-behavioral (FGCB) preventive intervention for children of depressed parents. Methods Families with (i) a parent who has experienced depression and (ii) a healthy child aged 8–17 years (mean = 11.63; 53% female) were randomly allocated (blockwise; stratified by child age and parental depression) to the 12-session intervention (EG; n = 50) or no intervention (CG; usual care; n = 50). Self-reported (unblinded) outcomes were assessed immediately after the intervention (6 months). We hypothesized that CG children would show a greater increase in self-reported symptoms of depression (DIKJ) and internalising/externalising disorder (YSR/CBCL) over time compared to the EG. Intervention effects on secondary outcome variables emotion regulation (FEEL-KJ), attributional style (ASF-KJ), knowledge of depression and parenting style (ESI) were also expected. Study protocol (Belinda Platt, Pietsch, Krick, Oort, & Schulte-Körne, 2014) and trial registration (NCT02115880) reported elsewhere. Results We found significant intervention effects on self-reported internalising ($$\eta_{p}^{2}$$ η p 2 = 0.05) and externalising ($$\eta_{p}^{2}$$ η p 2 = 0.08) symptoms but did not detect depressive symptoms or parent-reported psychopathology. Parental depression severity did not modify these effects. Both groups showed equally improved knowledge of depression ($$\eta_{p}^{2}$$ η p 2 = 0.06). There were no intervention effects on emotion regulation, attributional style or parenting style. Conclusion The German version of the FGCB intervention is effective in reducing symptoms of general psychopathology. There was no evidence that the mechanisms targeted in the intervention changed within the intervention period.

Anorexia nervosa (AN) is characterized by attention biases for eating disorder-related information as well as altered attentional processing of social information. However, little is known about the interplay between the altered attentional processing of these two types of information. The present study investigates attention biases for eating disorder-related information (pictures of bodies) versus social information (pictures of faces), in adolescents with AN. Attention biases were assessed via eye-tracking during a passive-viewing task in which female bodies and faces were presented simultaneously and thus competed directly for attention. Female adolescents (13–18 years) with AN (n = 28) were compared to a clinical comparison group (adolescents with major depression; n = 20) and a comparison group of adolescents with no mental illness (n = 24). All groups looked longer at bodies than at faces, i.e., showed attention biases for bodies in maintenance of attention. These biases were more pronounced in adolescents with AN than in both comparison groups, particularly for underweight bodies, at the expense of looking less at social stimuli. The results indicate “dual” attention biases in adolescents with AN (i.e., towards bodies and away from emotional faces) which could have a twofold negative impact on eating disorder psychopathology: increased attention to eating disorder-related information might directly influence eating disorder symptoms while less attention to social information might have an indirect influence through the amplification of interpersonal difficulties.

Background In a parallel randomized controlled trial the effectiveness of the family- and group-based cognitive-behavioural “Gug-Auf” intervention in preventing depression in children of depressed parents was evaluated. We hypothesized that the intervention would be associated with reduced incidence of depression at 15 months as well as with reduced symptom severity at 6, 12, and 15 months. We also made predictions about the role of a number of mediators and moderators. Methods Families were included if a parent (n = 100, mean age = 46.06, 61% female) had experienced depression and children (n = 135, aged 8–17 years, 53% female) without a mental illness. Families (91.5% German) were randomly allocated (50:50 block-wise; stratified by child age and parental depression) to the 12-session “GuG-Auf” intervention or no intervention. Outcomes were assessed (on an intention-to-treat basis) at 0-(T1), 6-(T2), 12-(T3) and 15-months(T4) after baseline. Primary outcome (onset of depression; T4) was assessed with standardized (blinded) clinical interviews. Secondary (unblinded) outcome was risk of depression (at T2-T4) indicated by internalizing, externalizing and symptoms of depression. Potential mediators were emotion regulation, attributional style, knowledge of depression and parenting style. Potential moderators were parental depression severity and negative life events. Analyses were conducted on an intention-to-treat basis. Results None of the children who received the intervention developed depression, whereas two of those in the control group did. The intervention significantly reduced internalizing symptoms at T3 (p = .027, d = -0.45) and T4 (p = .035, d=-0.44). Both groups showed reduced depressive symptoms (p = .029, d = -0.44). Cognitive problem-solving and negative parenting emerged as mediators. No adverse events were observed. Conclusions GuG-Auf is effective in reducing children’s risk of depression. Despite some limitations in the generalizability, these findings contribute substantially to reducing the burden of youth depression. Registration: The trial was registered on 16/04/2014 at ClinicalTrials.gov (NCT02115880) and study protocol published in BMC Psychiatry (https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0263-2).

Children of depressed parents are at heightened risk for developing depression, yet relatively little is known about the specific mechanisms responsible. Since preventive interventions for this risk group show small effects which diminish overtime, it is crucial to uncover the key risk factors for depression. This study compared various potential mechanisms in children of depressed (high-risk; n = 74) versus non-depressed (low-risk; n = 37) parents and explored mediators of parental depression and risk in offspring. A German sample of N = 111 boys and girls aged 8 to 17 years were compared regarding children’s (i) symptoms of depression and general psychopathology, (ii) emotion regulation strategies, (iii) attributional style, (iv) perceived parenting style and (v) life events. Children in the high-risk group showed significantly more symptoms of depression and general psychopathology, less adaptive emotion regulation strategies, fewer positive life events and fewer positive parenting strategies in comparison with the low-risk group. Group differences in positive and negative attributional style were small and not statistically significant in a MANOVA test. Maladaptive emotion regulation strategies and negative life events were identified as partial mediators of the association between parental depression and children’s risk of depression. The study highlights the elevated risk of depression in children of depressed parents and provides empirical support for existing models of the mechanisms underlying transmission. Interestingly, the high-risk group was characterised by a lack of protective rather than increased vulnerability factors. These results are crucial for developing more effective preventive interventions for this high-risk population. Electronic supplementary material The online version of this article (10.1007/s10578-019-00930-4) contains supplementary material, which is available to authorized users.

Objective Parental depression is one of the biggest risk factors for youth depression. This parallel randomized controlled trial evaluates the effectiveness of the German version of the family-group-cognitive-behavioral (FGCB) preventive intervention for children of depressed parents.Methods Families with i) a parent who has experienced depression and ii) a healthy child aged 8–17 years (mean = 11.63; 53% female) were randomly allocated (blockwise; stratified by child age and parental depression) to the 12-session intervention (EG; n = 50) or no intervention (CG; usual care; n = 50). Self-reported (unblinded) outcomes were assessed immediately after the intervention (6 months). We hypothesized that CG children would show a greater increase in self-reported symptoms of depression (DIKJ) and internalizing/ externalizing disorder (YSR/CBCL) over time compared to the EG. Intervention effects on secondary outcome variables emotion regulation (FEEL-KJ), attributional style (ASF-KJ), knowledge of depression and parenting style (ESI) were also expected. Study protocol (Belinda Platt, Pietsch, Krick, Oort, & Schulte-Körne, 2014) and trial registration (NCT02115880) reported elsewhere.Results We found significant intervention effects on self-reported internalising (ηp²=0.05) and externalising (ηp²=0.08) symptoms but not depressive symptoms or parent-reported psychopathology. Parental depression severity did not modify these effects. Both groups showed equally improved knowledge of depression (ηp²=0.06). There were no intervention effects on emotion regulation, attributional style or parenting style.Conclusion The German version of the FGCB intervention is effective in reducing symptoms of general psychopathology. There was no evidence that the mechanisms targeted in the intervention changed within the intervention period.

Courses that teach evidence-based interventions to enhance well-being are a public health tool that could be used to improve mental health in the population. We compared the well-being of six cohorts of adult students before and after they completed one of two massive open online courses: The Science of Well-Being (N = 581; 441; 1,228) and a control course, Introduction to Psychology (N = 677; 480; 1,480). Baseline well-being levels were equivalent across all six samples. Students in both courses increased in their well-being from baseline to follow-up in all three samples (p < .001); however, at follow-up, students in The Science of Well-Being course had higher subjective well-being than the control course (sample 1: r = .18, d = .37, p < .001; sample 2: r = .21, d = .43, p < .001; sample 3: r = .19, d = .38, p < .001). Overall, across three samples, we found that students who completed either of these online psychology courses increased in their well-being––but that students in The Science of Well-Being course showed greater improvement. These findings suggest that large free online courses that teach evidence-based approaches to well-being could positively impact mental health at large scales.

Background Although there is good evidence to support the effectiveness of cognitive behavioral therapy (CBT) for the outpatient treatment of adolescent major depressive disorder (MDD), evidence-based manuals for the inpatient setting are lacking. This pilot study sought to (i) adapt an existing CBT manual (treatment of adolescent depression; TADS) to an inpatient setting (TADS-in), (ii) test its effectiveness at symptom reduction and remission of MDD in a pre-post design, and (iii) assess the strengths and limitations of the manual via a focus-group with clinicians. Methods Twenty nine adolescents aged 12–17 years with a primary ICD-10 diagnosis of MDD being treated as inpatients at a psychiatric clinic were included. Embedded in the regular inpatient treatment course (8 weeks), patients received 12 sessions of the TADS-in manual. Quantitative assessment of symptom reduction and remission of MDD was conducted using a non-controlled pre-post design. The quantitative results were supplemented by a focus group with participating psychotherapists. Results Of the 29 patients included in the study at the beginning, 19 (65.5%) remained in the study at week 8. Symptoms of depression were statistically significantly lower at the end of treatment than at baseline according to self- (d = 1.38; mean change = 19.88; 95% CI = 12.48–27.28) and other reports (d = 0.64, mean change = 0.35; 95% CI = 0.08–0.62). Clinicians ratings of improvement (CGI-I) suggested that at the end of treatment, 15.8% were very much improved, 68.4% much improved, and 15.8% were minimally improved. According to diagnostic interviews with patients conducted at the end of treatment, 73.3% were in remission. The qualitative analysis showed that on the whole, the TADS-in manual is suitable for the inpatient setting. However, clinicians believed the effectiveness of TADS-in was limited by patient comorbidity and the fact that the inpatients were unable to practice incorporating techniques learnt into everyday life. Conclusions This study is the first to adapt the TADS manual to the inpatient setting. The sample of depressed adolescents showed reduced symptomology following treatment, although these findings require replicating in a randomized controlled trial before effects can be attributed to the TADS-in manual specifically. This pilot study informs further development of the manual as well as representing an important first step in the evaluation of the inpatient treatment of adolescent depression. The study was retrospectively registered (DRKS00017308) and received no external funding.

Background Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence (EC) skills via a mobile app may be an effective, scalable and acceptable way to do this. However, few large-scale controlled trials have examined the efficacy of mobile apps in promoting mental health in young people; none have tailored the app to individual profiles. Method/design The Emotional Competence for Well-Being in Young Adults cohort multiple randomised controlled trial (cmRCT) involves a longitudinal prospective cohort to examine well-being, mental health and EC in 16–22 year olds across 12 months. Within the cohort, eligible participants are entered to either the PREVENT trial (if selected EC scores at baseline within worst-performing quartile) or to the PROMOTE trial (if selected EC scores not within worst-performing quartile). In both trials, participants are randomised (i) to continue with usual practice, repeated assessments and a self-monitoring app; (ii) to additionally receive generic cognitive-behavioural therapy self-help in app; (iii) to additionally receive personalised EC self-help in app. In total, 2142 participants aged 16 to 22 years, with no current or past history of major depression, bipolar disorder or psychosis will be recruited across UK, Germany, Spain, and Belgium. Assessments take place at baseline (pre-randomisation), 1, 3 and 12 months post-randomisation. Primary endpoint and outcome for PREVENT is level of depression symptoms on the Patient Health Questionnaire-9 at 3 months; primary endpoint and outcome for PROMOTE is emotional well-being assessed on the Warwick-Edinburgh Mental Wellbeing Scale at 3 months. Depressive symptoms, anxiety, well-being, health-related quality of life, functioning and cost-effectiveness are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. Conclusions The trial aims to provide a better understanding of the causal role of learning EC skills using interventions delivered via mobile phone apps with respect to promoting well-being and preventing poor mental health in young people. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective Mobile-health public health strategies for preventing poor mental health and promoting well-being. Trial registration ClinicalTrials.gov (www.clinicaltrials.org). Number of identification: NCT04148508 November 2019.

One major predictor of depression onset is having a depressed parent. This study provides the first systematic review and meta-analysis of preventive interventions for offspring of depressed parents. We searched six literature databases and included randomized controlled trials which concerned the non-depressed offspring (aged 18 or younger) of a depressed parent, who received a preventive intervention designed to reduce the risk of depression or a comparison condition. Primary and secondary outcome measures were the severity and incidence of childhood depression. 14 publications reporting data from seven trials (n=935 children) were included and were of relatively high quality. The effect of the interventions (versus any control condition) on depressive and internalising symptoms at post-intervention follow-up (up to four months) was small but significant [g'=-0.20, 95% CI (-0.34; -0.06), p=0.005; I2=0.00%]. The interventions also had a small but significant effect on depression incidence [Risk Ratio=0.56; 95% CI(0.41;0.77); d'=-0.42]. Intervention effects were not present in the short-term (up to 12months post-intervention) or long-term (15-72months post-intervention) follow-ups. Interventions targeting the offspring of depressed parents show promise not only in reducing symptoms of depression but also in preventing the onset of depression, at least immediately after the intervention.

The present study explored the neurophysiological correlates of perception and recognition of emotional facial expressions in adolescent anorexia nervosa (AN) patients using event-related potentials (ERPs). We included 20 adolescent girls with AN and 24 healthy girls and recorded ERPs during a passive viewing task and three active tasks requiring processing of emotional faces in varying processing depths; one of the tasks also assessed emotion recognition abilities behaviourally. Despite the absence of behavioural differences, we found that across all tasks AN patients exhibited a less pronounced early posterior negativity (EPN) in response to all facial expressions compared to controls. The EPN is an ERP component reflecting an automatic, perceptual processing stage which is modulated by the intrinsic salience of a stimulus. Hence, the less pronounced EPN in anorexic girls suggests that they might perceive other people’s faces as less intrinsically relevant, i.e. as less “important” than do healthy girls.

BACKGROUND: Depression is the most common psychiatric disorder in adolescence, and is characterised by an inability to down-regulate negative emotional responses to stress. Adult studies suggest this may be associated with reduced functional connectivity between prefrontal and subcortical regions, yet the neurological mechanisms in adolescence remain unclear. METHODS: We developed a novel, age-appropriate, reappraisal paradigm to investigate functional connectivity during reappraisal of a real-life source of stress in 15 depressed and 15 non-depressed adolescents. During fMRI, participants i) attended to, and ii) implemented reappraisal techniques (learnt prior to fMRI) in response to, rejection. RESULTS: Reappraisal reduced negative mood and belief in negative thoughts in both groups alike, however during reappraisal (versus attend) trials, depressed adolescents showed greater connectivity between the right frontal pole and numerous subcortical and cortical regions than non-depressed adolescents. CONCLUSIONS: These findings tentatively suggest that, when instructed, depressed adolescents do have the ability to engage neural networks involved in emotion regulation, possibly because adolescence reflects a period of heightened plasticity. These data support the value of cognitive reappraisal as a treatment tool, identify neural markers that could be used to optimise current therapies, and lay the foundations for developing novel neuroscientific techniques for the treatment of adolescent depression. Language: en

Anorexia nervosa (AN) has been suggested to be associated with abnormalities in facial emotion recognition. Most prior studies on facial emotion recognition in AN have investigated adult samples, despite the onset of AN being particularly often during adolescence. In addition, few studies have examined whether impairments in facial emotion recognition are specific to AN or might be explained by frequent comorbid conditions that are also associated with deficits in emotion recognition, such as depression. The present study addressed these gaps by investigating recognition of emotional facial expressions in adolescent girls with AN (n = 26) compared to girls with major depression (MD; n = 26) and healthy girls (HC; n = 37). Participants completed one task requiring identification of emotions (happy, sad, afraid, angry, neutral) in faces and two control tasks. Neither of the clinical groups showed impairments. The AN group was more accurate than the HC group in recognising afraid facial expressions and more accurate than the MD group in recognising happy, sad, and afraid expressions. Misclassification analyses identified subtle group differences in the types of errors made. The results suggest that the deficits in facial emotion recognition found in adult AN samples are not present in adolescent patients.

Depression is one of the most common mental health problems in childhood and adolescence. Although data consistently show it is associated with self-reported negative cognitive styles, less is known about the mechanisms underlying this relationship. Cognitive biases in attention, interpretation and memory represent plausible mechanisms and are known to characterise adult depression. We provide the first structured review of studies investigating the nature and causal role of cognitive biases in youth depression. Key questions are (i) do cognitive biases characterise youth depression? (ii) are cognitive biases a vulnerability factor for youth depression? and (iii) do cognitive biases play a causal role in youth depression? We find consistent evidence for positive associations between attention and interpretation biases and youth depression. Stronger biases in youth with an elevated risk of depression support cognitive-vulnerability models. Preliminary evidence from cognitive bias modification paradigms supports a causal role of attention and interpretation biases in youth depression but these paradigms require testing in clinical samples before they can be considered treatment tools. Studies of memory biases in youth samples have produced mixed findings and none have investigated the causal role of memory bias. We identify numerous areas for future research in this emerging field.

It has recently been shown that the proportional mortality ratio for suicide by veterinarians is one of the highest of all occupational groups. The reasons for this alarming statistic are unclear although it has been postulated that alcohol or drug misuse may be significant risk factors which contribute towards the high incidence of suicide within the profession. However, there have been few studies on alcohol misuse by veterinarians and so the aim of this study was to investigate the incidence of alcohol-related deaths in the veterinary profession in England and Wales between 1993 and 2005. The proportional mortality ratio for alcohol-related deaths for veterinarians was not significantly higher than the general population during this time period. Future studies should focus on establishing the incidence of sub-lethal alcohol misuse within the veterinary profession.

Magnetic resonance imaging (MRI) has become a ubiquitous research tool for developmental neuroscientists interested in brain structure and function in children and adolescents. However, ethical concerns are sometimes raised about using MRI with children and adolescents, especially when participants have anxiety. We asked 17 clinically/sub-clinically anxious and 19 non-anxious adolescents about their experiences of taking part in MRI for research purposes. Although the anxious group reported experiencing more anxiety during the scan, these differences had attenuated by the time participants got home. We found no evidence that anxious adolescents would be less likely to choose to have another scan or would feel more nervous during another scan. There was some evidence that more trait anxious adolescents found the MRI study enjoyable. These findings should give ethics committees, clinicians, and parents confidence that so long as researchers exercise appropriate care, MRI research is acceptable to adolescents, including those with clinical anxiety. © 2012 Springer Science+Business Media New York.

Adolescence is a vulnerable time for the onset of depression. Recent evidence from adult studies suggests not only that negative attention biases are correlated with symptoms of depression, but that reducing negative attention biases through training can in turn reduce symptomology. The role and plasticity of attention biases in adolescent depression, however, remains unclear. This study examines the association between symptoms of depression and attention biases, and whether such biases are modifiable, in a community sample of adolescents. We report data from 105 adolescents aged 13–17 who completed a dot-probe measure of attention bias before and after a single session of visual search-based cognitive bias modification training. This is the first study to find a significant association between negative attention biases and increased symptoms of depression in a community sample of adolescents. Contrary to expectations, we were unable to manipulate attention biases using a previously successful cognitive bias modification task. There were no significant effects of the training on positive affect and only modest effects of the training, identified in post-hoc analyses, were observed on negative affect. Our data replicate those from the adult literature, which suggest that adolescent depression is a disorder associated with negative attention biases, although we were unable to modify attention biases in our study. We identify numerous parameters of our methodology which may explain these null training effects, and which could be addressed in future cognitive bias modification studies of adolescent depression.

Background Depression is one of the most common psychiatric illnesses worldwide, but is nevertheless preventable. Since the children of parents who have depression are at greatest risk of developing depression themselves, prevention programmes for this population are a major public health priority. Here we report the study protocol of a randomised controlled trial of a group-based psychological intervention for families with i) at least one parent who suffers (or has suffered) from depression and ii) at least one child who has no current or previous psychiatric diagnosis. Methods/Design Eligible families will be randomly allocated to receive either a German adaptation of the 12-session cognitive-behavioural Raising Healthy Children intervention (Gesund und glücklich aufwachsen; N = 50), or no intervention (usual care; N = 50). The primary outcome (child diagnosis of an episode of depression) will be assessed at 15-month follow-up. The secondary outcomes (child psychopathological symptoms) will be assessed immediately following completion of the intervention (6-months), as well as at 9- and 15-month follow-up. We hypothesise that children in the intervention condition, compared with those who do not receive the intervention, will show fewer symptoms of psychopathology, and be less likely to meet diagnostic criteria for a depressive episode, at follow-up. Discussion Despite their elevated risk of developing depression, there is little formal support available for the children of parents with depression. This study provides an important step in the development of more effective depression prevention measures, which are needed if the personal, social and economic burden of depression is to be reduced. Trial registration Clinical Trials NCT02115880. Registered April 7 2014.

Adolescence is a period of major risk for depression, which is associated with negative personal, social, and educational outcomes. Yet, in comparison to adult models of depression, very little is known about the specific psychosocial stressors that contribute to adolescent depression, and whether these can be targeted by interventions. In this review, we consider the role of peer rejection. First, we present a comprehensive review of studies using innovative experimental paradigms to understand the role of peer rejection in adolescent depression. We show how reciprocal relationships between peer rejection and depressive symptoms across adolescence powerfully shape and maintain maladaptive trajectories. Second, we consider how cognitive biases and their neurobiological substrates may explain why some adolescents are more vulnerable to the effects of, and perhaps exposure to, peer rejection compared to others. Finally, we draw attention to emerging cognitive and functional magnetic resonance imaging-based neurofeedback training, which by modifying aspects of information processing may promote more adaptive responses to peer rejection. A better understanding of the mechanisms underlying adolescent depression may not only alleviate symptoms during a period of substantial developmental challenges, but may also reduce the burden of the disorder across the lifespan. © 2013 Wiley Periodicals, Inc.

Background: Suicide rates are elevated in the veterinary profession in several countries, yet little is known about possible contributory and preventive factors. Aims: To obtain information from veterinarians with a history of suicidal ideation or behavior about the factors associated with suicidality in their profession. Methods: We conducted a mixed-methods interview study with 21 UK veterinarians who had attempted suicide or reported recent suicidal ideation. Interview topics included work and nonwork contributory factors, coping mechanisms, and preventive factors. Results: Self-poisoning was the most common method used or considered by participants. Common contributory factors were workplace relationships, career concerns, patient issues, number of hours and volume of work, and responsibility, although two-thirds of participants reported co-occurring difficult life events. Around half had received a psychiatric diagnosis following their suicidal behavior. Several possible preventive measures were suggested by participants. Conclusions: Several work- and non-work-related contributory factors to suicidality in the veterinary profession were identified. Future preventive measures may involve better promotion of support services, formal support for recent graduates, and improving employers’ attitudes toward work-life balance.

Background: Suicide risk may be elevated in 'medical' occupational groups, although results of studies are inconsistent. National data are required to examine this issue. It is also important to investigate the possible contribution of psychiatric disorder and access to specific suicide methods. Methods: In a nested case-control design we used data from Danish national registers for 1981-2006 to examine risk of suicide in nurses, physicians, dentists, pharmacists and veterinary surgeons compared to teachers and the general population, and associations with psychiatric service contact and suicide methods. Results: Crude age- and gender-adjusted rate ratios for suicide compared to teachers were significantly elevated in nurses (RR 1.90, 95% CI 1.63-2.21), physicians (RR 1.87, 95% CI 1.55-2.26), dentists (RR 2.10, 95% CI 1.58-2.79) and pharmacists (RR 1.91, 95% CI 1.26-2.87), but not veterinary surgeons. Risk was also elevated in nurses, physicians and dentists compared with the rest of the general population, the relative risk increasing following adjustments for psychiatric service contact, marital status, gross income and labour market status. Results were similar in both genders. The elevated risk in nurses and dentists decreased during the study period. Elevated risks were not associated with greater psychiatric service contact. Medicinal drugs were commonly used for suicide by nurses, physicians and pharmacists. Limitations: The study was based in one country. Conclusions: Risk of suicide is increased in nurses, physicians, dentists and pharmacists in Denmark. This is not reflected in excess psychiatric service contact. Ready access to medicinal drugs may influence risk in nurses, physicians and pharmacists. © 2011 Elsevier B.V. All rights reserved.

Purpose Rates of suicide are elevated among veterinary surgeons in several countries, yet little is known about contributory factors. We have conducted a systematic review of studies investigating suicidal behaviour and psychosocial problems in veterinary surgeons. Methods A systematic search of the international research literature was performed in May 2008. Data from 52 studies of non-fatal suicidal behaviour, mental health difficulties, stress and burnout, occupational difficulties, and psychological characteristics of veterinary surgeons were extracted by two independent reviewers and analysed. Studies were rated for quality and greater emphasis placed on findings from higher quality studies. Results The majority of studies were of stress and occupational difficulties experienced by veterinary surgeons. Occupational stressors included managerial aspects of the job, long working hours, heavy workload, poor work-life balance, difficult client relations, and performing euthanasia. Few studies investigated suicidal behaviour or mental health difficulties in the profession. Some studies suggested that young and female veterinarians are at greatest risk of negative outcomes such as suicidal thoughts, mental health difficulties, and job dissatisfaction. Conclusions The review highlights the difficulties faced by veterinary surgeons that may contribute to poor mental wellbeing and suicidal behaviour. Future research might include further examination of the influence of euthanasia on attitudes towards suicide and more direct examination of the impact that occupational risk factors might have on suicidal behaviour. Suggestions about the review's implications for suicide prevention in this group are also made. © Springer-Verlag 2010.