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The current review aims to focus on how risk and protective factors for self-harm in secure mental health hospitals are captured in the literature.

Fifty-seven articles were included in a systematic review, drawn from an initial 1,119 articles, post duplicate removal. Databases included Psycinfo, Psycarticles, Psycnet, Web of Science and EBSCO host. A thematic analysis was used, which included a meta-ethnographic approach for considering qualitative papers.

There was a clear focus on risk factors, with eight identified (in order of occurrence): raised emotional reactivity and poor emotion regulation; poor mental health; traumatic experiences; personality disorder diagnosis and associated traits; increased use of outward aggression – dual harm; constraints of a secure environment and lack of control; previous self-harm and suicide attempts; and hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence): positive social support and communication; positive coping skills; and hope/positive outlook.

This includes a proposal to move focus away from “risk” factors, to incorporate “needs”, in terms of individual and environmental factors. There is also a need for more attention to focus on developing high quality research in this area.

The research captures an area where a synthesis of research has not been comprehensively undertaken, particularly with regards to capturing protective as well as risk factors.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

The purpose of this paper is to provide an example of patient-led co-production.

The New Economics Foundation’s six principles of co-production (nef, 2013) have been used to frame the activities undertaken during the author’s relationship with a community mental health nurse.

This paper describes a co-produced project between a patient and a community mental health nurse to create a range of resources and to deliver training, resulting in mutual benefit for both parties.

This paper invites policy makers to consider the unique role that community mental health nurses can play in supporting patients with long-term challenges that have developed because of an imbalance and an abuse of power within earlier relationships; by adopting a co-production approach, centred on the patient’s interests and skills, a working partnership can be achieved wherein both parties feel that they matter.

Co-production is usually used with groups of stakeholders working together in an equitable way to design or deliver a new service; this paper, however, seeks to demonstrate how the process can be effectively used when the project is patient-led within the context of a therapeutic relationship.

The prevalence of exposure to adversity is elevated in autistic populations, compared to neurotypical peers. Despite this, the frequency and nature of early adverse experiences are not well understood in autistic adults, with several underlying methodological limitations in the available literature. The purpose of this study is to systematically synthesise and analyse the prevalence of childhood adversity in this marginalised population, in accordance with the adverse childhood experiences (ACEs) framework.

Peer-reviewed empirical research articles were systematically searched for from electronic databases and screened against established inclusion criteria. Pooled prevalence rates for individual ACE types were calculated.

Four papers were included (N = 732), all of which used a predominantly or exclusively female sample. Only sexual abuse was reported in all papers, with a pooled prevalence rate of 38%. Physical abuse and emotional abuse were less frequently explored, with two papers reporting on these ACEs, though obtained comparable and higher pooled prevalence rates (39% and 49%, respectively). Pooled prevalence rates could be calculated for neither neglect nor “household” ACEs because of insufficient data. The limited state of the evidence, in conjunction with high levels of heterogeneity and poor sample representativeness found, positions the ACEs of autistic adults as a critical research priority.

To the best of the authors’ knowledge, this study is the first to systematically synthesise the prevalence of early childhood adversities, as conceptualised in accordance with the ACEs framework, in adults with autistic traits.

People who identify as transgender face stigma, isolation and harassment while often struggling to come to terms with their gender identity. They also disproportionately experience mental health difficulties. The purpose of this paper is to present the voices of transgender people in the Republic of Ireland (RoI) in regard to the issues they are facing, improvements they would like to see made to schools, workplaces, services and society in general and whether mental health supports fulfil their needs.

Ten open questions were embedded within a quantitative online survey (LGBTIreland study) on factors impacting social inclusion, mental health and care. These open questions were re-analysed with exclusive focus on the transgender participants (n = 279) using content/thematic analysis.

The participants in this study reported significant signs of mental distress. The following themes emerged: impact of stigma, deficiencies in mental health services, need for education on transgender identity, importance of peer support, achieving self-acceptance and societal inclusion questioned.

Efforts to recruit young participants have led to a possible over-representation in this study.

The findings suggest the need for improvement in mental health support services, including further education in how to meet the needs of transgender individuals.

Transgender people in Ireland experience social exclusion. The need for more inclusivity was emphasised most in secondary schools. Education on transgender identities in all contexts of society is recommended by the participants.

This study reports on the largest group of transgender participants to date in RoI. Their voices will affect perceptions on social inclusion and mental health care.

Coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented mental health repercussions in the lives of every individual including university students. Therefore, study on students’ psychological state and its associated factors during the pandemic are of importance. This study aims to discuss the aforementioned issue.

An online survey was done on a total of 207 university students of Pakistan to collect information on socio-demographic characteristics, concerns or fears amidst COVID-19 and mental distress. Validated tools; Perceived Stress Scale (PSS), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9)-Depression were used to assess stress, anxiety and depression, respectively.

Around 14% of the university students were experiencing severe stress and anxiety, while 8.2% had severe depression. The authors found that stress among university students was related to psychiatric illness or symptoms (OR = 5.1: 1.1, 22.9) and unpredictability due to the pandemic (OR = 3.7: 1.2, 11.2). The significant determinants of anxiety were psychiatric illness/symptoms (OR = 6.6: 3.4, 12.9), implementation of public health measures (OR = 3.7: 1.1, 11.6), employed mothers (OR = 2.4: 1.1, 5.0) and lack of support from university administration (OR = 2.2: 1.0, 5.0). While the factors associated with depression included psychiatric illness or symptoms (OR = 8.4: 3.3, 21.5), unpredictability due to pandemic (OR = 6.8: 2.2, 20.7), impaired social support system (OR = 3.7: 1.3, 10.4) and studying without a scholarship (OR = 2.1: 1.0, 4.4).

These findings call for an urgent need to develop appropriate interventions and educational programs that could address the psychological needs of students.

The study directs the role of university and faculty in dealing the mental health needs of the student in COVID-19 pandemic time.

Educational programs are important that could address the psychological needs of students in COVID-19 pandemic.

University students reported mental distress during COVID-19 pandemic which shows that younger people are at risk of COVID-19 repercussions. Moreover, several stressors (i.e. impaired social support system and lack of support from universities) were revealed that could be mitigated by implementing appropriate strategies.

This study aims to evaluate and summarize the effectiveness of cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) interventions on relapse prevention and severity of symptoms among individuals with major depressive disorder (MDD). CBT is one of the most used and suggested interventions to manage MDD, whereas ICBT is a novel effective proposed approach.

The review was conducted following the preferred reporting items for systematic review and meta-analysis protocol. A comprehensive and extensive search was performed to identify and evaluate the relevant studies about the effectiveness of CBT and ICBT on relapse prevention and severity of symptoms among patients with MDD.

A total of eight research studies met the inclusion criteria and were included in this systematic review. RCT studies were conducted to assess and evaluate the effectiveness of CBT and ICBT on relapse prevention and severity of symptoms among patients with MDD. It has been found that CBT is a well-supported and evidently based effective psychotherapy for managing depressive symptoms and reducing the relapse and readmission rate among patients diagnosed with MDD. The ICBT demonstrated greater improvements in depressive symptoms during major depressive episodes among patients with MDDS. The ICBT program had good acceptability and satisfaction among participants in different countries.

Despite the significant findings from this systematic review, certain limitations should be acknowledged. First, it is important to note that all the studies included in this review were exclusively conducted in the English language, potentially limiting the generalizability of the findings to non-English speaking populations. Second, the number of research studies incorporated in this systematic review was relatively limited, which may have resulted in a narrower scope of analysis. Finally, a few studies within the selected research had small sample sizes, which could potentially impact the precision and reliability of the overall conclusions drawn from this review. The authors recommend that nurses working in psychiatric units should use CBT interventions with patients with MDD.

This paper, a review of the literature gives an overview of CBT and ICBT interventions to reduce the severity of depressive symptoms and prevent patients’ relapse and rehospitalization and shows that CBT interventions are effective on relapse prevention among patients with MDD. In addition, there is still no standardized protocol to apply the CBT intervention in the scope of reducing the severity of depressive symptoms and preventing depression relapse among patients with major depressive disorder. Further research is needed to confirm the findings of this review. Future research is also needed to find out the most effective form and contents of CBT and ICBT interventions for MDD.

CBT is a psychological intervention that has been recommended by the literature for the treatment of major depressive disorder (MDD). It is a widely recognized and accepted approach that combines cognitive and behavioral techniques to assist individuals overcome their depressive symptoms and improve their overall mental well-being. This would speculate that effectiveness associated with several aspects and combinations of different approaches in CBT interventions and the impact of different delivery models are essential for clinical practice and appropriate selection of the interventional combinations.

This systematic review focuses on the various studies that explore the effectiveness of face-to-face CBT and ICBT in reducing depressive symptoms among patients with major depressive disorder. These studies were conducted in different countries such as Iran, Australia, Pennsylvania and the USA.

A quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients’ clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions.

Data was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient’s clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment.

Most of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines.

To the best of the authors’ knowledge, this is an original article following the pilot study completed by the authors.

Paramedics are responsible for managing emergencies, caring for patients and performing life-saving procedures under heavy workloads, which can have a significant negative effect on their emotional eating and food addiction (FA) behaviors. Thus, this cross-sectional study aims to shed light on the relationship between emotional eating tendencies and FA in paramedics by considering their food preferences, sex, and body mass index (BMI) factors.

The questionnaire consisted of Yale Food Addiction Scale and Emotional Eating Questionnaire (EEQ), as well as sex, age, weight, height and number of snacks and main meals collected face-to-face from the 196 paramedics.

The FA prevalence was 14.9%, and more than half of the paramedics were emotional eaters. The total score of the EEQ was significantly higher in the FA diagnosed group than in the group FA not diagnosed (p < 0.001). The food preferences of the paramedics were found to differ significantly depending on whether they were diagnosed with FA or emotional eating. Being a food addict or emotional eater significantly increases the odds of consuming chocolate-wafer, pie-cake, chips, pastries, pasta and fries (p < 0.05), and participants with FA diagnosis and emotional eaters were more likely to prefer these foods than those with nondiagnosis and nonemotional eaters (p < 0.05).

Findings highlighted the connection between FA and the emotional eating behavior of paramedics, indicating that they attempt to compensate for their emotional ups and downs through eating. The job-related stress and emotional eating behaviors of paramedics may increase their BMI and susceptibility to FA.

Violence toward frontline health-care workers (HCWs) from patients and visitors is a pervasive issue that ranges from verbal and psychological abuse to physical assault. The emergence of the COVID-19 pandemic has led to increased reports of escalated verbal workplace aggressions (VWPAs); however, most studies have been conducted internationally. Studies based in the USA have focused on physical violence experienced by nurses and paramedics in emergency situations. The purpose of this study is to learn about the experiences of different levels of frontline HCWs with VWPA from patients and visitors and discover ways to address this issue.

This qualitative descriptive study asked registered nurses, licensed practical nurses and patient care technicians from one health-care system about their experiences with patient and visitor VWPA using an anonymous, voluntary open-ended survey and in-person interviews. In all, 31 participants completed the survey and 2 were interviewed. Data were analyzed using content analysis.

Three themes emerged from the data: the experience, moving through and moving forward. Frontline HCWs described experiences of VWPA, indicating its forms, frequency and conditions. They used coping, along with personal and professional measures, to manage and move through the situation. Moving forward was captured as suggestions for the future and conveyed hope for a perfect state.

The experiences of frontline HCWs offered insight into how they perceive and cope with difficult encounters. Recommendations relate to not only implementing interventions that support frontline HCWs but also creating a culture where aggression is not tolerated and addressing perpetrator behavior is a priority.