Psychiatric adverse events associated with the COVID-19 vaccines approved in the Republic of Korea: a systematic review.

This systematic review evaluated psychiatric adverse events (AEs) following vaccination against coronavirus disease 2019 (COVID-19). We included studies that reported or investigated psychiatric AEs in individuals who had received an approved COVID-19 vaccine in the Republic of Korea. Systematic electronic searches of Ovid-Medline, Embase, CENTRAL, and KoreaMed databases were conducted on March 22, 2023. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-randomized Studies 2.0. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023449422). Of the 301 articles initially selected, 7 were included in the final analysis. All studies reported on sleep disturbances, and 2 highlighted anxiety-related AEs. Sleep disorders like insomnia and narcolepsy were the most prevalent AEs, while depression was not reported. Our review suggests that these AEs may have been influenced by biological mechanisms as well as the broader psychosocial context of the COVID-19 pandemic. Although this study had limitations, such as a primary focus on the BNT162b2 vaccine and an observational study design, it offered a systematic, multi-vaccine analysis that fills a critical gap in the existing literature. This review underscores the need for continued surveillance of psychiatric AEs and guides future research to investigate underlying mechanisms, identify risk factors, and inform clinical management.

[Depressive symptoms in older prisoners : Results of two studies]. / Depressive Symptome bei älteren Inhaftierten : Ergebnisse zweier Studien.

BACKGROUND: The proportion of prisoners aged 60 years and above is steadily rising both nationally and internationally. With advancing age the risk of developing physical and mental illnesses also increases. International studies have demonstrated a higher prevalence of mental disorders among older prisoners compared to the general population; however, there are few data on this, at least for Germany. OBJECTIVE: Collation of empirical data on the presence of depressive symptoms among older prisoners. MATERIAL AND METHODS: There were two independent cross-sectional studies conducted in North Rhine-Westphalia (NRW) and Rhineland-Palatinate (RLP), which included prisoners aged 50 years and above. In NRW a purely quantitative survey of depressive symptoms was carried out using the German version of the patient health questionnaire (PHQ-D) and in RLP the quantitative measurements using the general depression scale short form (ADS-K) were supplemented by qualitative interviews. RESULTS: In total, data from 315 inmates were available for a joint analysis (222 from RLP, 93 from NRW). Among the prisoners in RLP 63.4% exhibited mild to clinically significant depressive symptoms, while in NRW this was the case for 46.2%. The treatment with antidepressants was carried out only in a small proportion in both federal states. DISCUSSION: Both surveys showed a clearly elevated prevalence of depressive symptoms compared to the non-prison population. The results also suggest a need for optimization in terms of treatment. Particularly concerning potential interactions with somatic illnesses, efforts should be made to improve the diagnostics and treatment of depressive symptoms.

Associations between recorded loneliness and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study.

PURPOSE: Loneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in groups affected remain less well understood. METHOD: A cohort of patients receiving mental healthcare on 30th June 2012 was assembled from a large mental health records database covering a south London catchment area. Recorded loneliness within the preceding 2 years was extracted using natural language processing and outcomes were measured between 30th June 2012 until 30th December 2019, except for survival which applied a censoring point of 6th December 2020 according to data available at the time of extraction. The following mental healthcare outcomes: (i) time to first crisis episode; (ii) time to first emergency presentation; (iii) all-cause mortality; (iv) days active to service per year; and (v) face-to-face contacts per year. RESULTS: Loneliness was recorded in 4,483 (16.7%) patients in the study population and fully adjusted models showed associations with subsequent crisis episode (HR 1.17, 95% CI 1.07-1.29), emergency presentation (HR 1.30, 1.21-1.40), days active per year (IRR 1.04, 1.03-1.05), and face-to-face contacts per year (IRR 1.28, 1.27-1.30). Recorded loneliness in patients with substance misuse problems was particularly strongly associated with adverse outcomes, including risk of emergency presentation (HR 1.68, 1.29-2.18) and mortality (HR 1.29, 1.01-1.65). CONCLUSION: Patients receiving mental healthcare who are recorded as lonely have a higher risk of several adverse outcomes which may require a need for higher service input.

The relationship between self-reported poor mental health and complete tooth loss among the US adult population in 2019.

Objective: Very little is known about the association between poor mental health and poor oral health outcomes in the United Sates. This study investigated the prevalence of complete tooth loss among those with and without perceived poor mental health in a nationally representative sample of noninstitutionalized U.S. adults. Methods: Using a cross-sectional study design, we analyzed the 2019 Medical Expenditures Panel Survey to determine the unweighted and weighted prevalence of complete tooth loss among adults. Chi-squared and multivariate logit regression with marginal effects were used to measure the association between complete tooth loss and perceived poor mental health, controlling for respondent characteristics. Results: The prevalence of adults (ages 18 and older) experiencing complete tooth loss was 6% (95% CI: 5.6-6.4). Individuals who have perceived poor mental health were 1.90 percentage points (pps) more likely to report missing all their natural teeth (P = 0.006: 95% CI: 0.5-3.3). Other relevant predictors of complete tooth loss included current smoking status (5.9 pps; 95% CI: 4.5 to 7.2) and secondary education (-6.4 pps (95% CI: -7.0 to -4.8). Conclusions: Overall, self-reported poor mental health was found to be associated with a greater likelihood of reporting complete tooth loss. Findings from this study underscore the need for greater integration of care delivery between behavioral health specialists and dental providers.

Association of performance in medical residency selection with a psychiatric diagnosis, and depressive and anxiety symptoms.

OBJECTIVE: Few studies have focused on medical students and residents' mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD). METHODS: The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance. RESULTS: 515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD. CONCLUSION: The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly.

The burden for clinical services of persons with an intellectual disability or mental disorder convicted of criminal offences: A birth cohort study of 14,605 persons followed to age 64.

BACKGROUND: Intellectual disability (ID), schizophrenia spectrum disorder (SSD), bipolar disorder (BD), substance use disorder (SUD), and other mental disorders (OMDs) are associated with increased risks of criminality relative to sex-matched individuals without these conditions (NOIDMD). To resource psychiatric, addiction, and social services so as to provide effective treatments, further information is needed about the size of sub-groups convicted of crimes, recidivism, timing of offending, antecedents, and correlates. Stigma of persons with mental disorders could potentially be dramatically reduced if violence was prevented. METHODS: A birth cohort of 14,605 persons was followed to age 64 using data from Swedish national health, criminal, and social registers. RESULTS: Percentages of group members convicted of violence differed significantly: males NOIDMD, 7.3%, ID 29.2%, SSD 38.6%, BD 30.7%; SUD 44.0%, and OMD 19.3%; females NOIDMD 0.8%, ID 7.7%, SSD 11.2%, BD 2.4%, SD 17.0%, and OMD 2.1%. Violent recidivism was high. Most violent offenders in the diagnostic groups were also convicted of non-violent crimes. Prior to first diagnosis, convictions (violent or non-violent) had been acquired by over 90% of the male offenders and two-thirds of the female offenders. Physical victimization, adult comorbid SUD, childhood conduct problems, and adolescent substance misuse were each associated with increased risks of offending. CONCLUSION: Sub-groups of cohort members with ID or mental disorders were convicted of violent and non-violent crimes to age 64 suggesting the need for treatment of primary disorders and for antisocial/aggressive behavior. Many patients engaging in violence could be identified at first contact with clinical services.

Applicability and Psychometric Properties of General Mental Health Assessment Tools in Autistic People: A Systematic Review.

In recent years, there has been a proliferation of instruments for assessing mental health (MH) among autistic people. This study aimed to review the psychometric properties of broadband instruments used to assess MH problems among autistic people. In accordance with the PRISMA guidelines (PROSPERO: CRD42022316571) we searched the APA PsycINFO via Ovid, Ovid MEDLINE, Ovid Embase and the Web of Science via Clarivate databases from 1980 to March 2022, with an updated search in January 2024, to identify very recent empirical studies. Independent reviewers evaluated the titles and abstracts of the retrieved records (n = 11,577) and full-text articles (n = 1000). Data were extracted from eligible studies, and the quality of the included papers was appraised. In all, 164empirical articles reporting on 35 instruments were included. The review showed variable evidence of reliability and validity of the various instruments. Among the instruments reported in more than one study, the Aberrant Behavior Checklist had consistently good or excellent psychometric evidence. The reliability and validity of other instruments, including: the Developmental Behavior Checklist, Emotion Dysregulation Inventory, Eyberg Child Behavior Inventory, Autism Spectrum Disorder-Comorbid for Children Scale, and Psychopathology in Autism Checklist, were less documented. There is a need for a greater evidence-base for MH assessment tools for autistic people.

Enhancing psychiatric rehabilitation outcomes through a multimodal multitask learning model based on BERT and TabNet: An approach for personalized treatment and improved decision-making.

Evaluating the rehabilitation status of individuals with serious mental illnesses (SMI) necessitates a comprehensive analysis of multimodal data, including unstructured text records and structured diagnostic data. However, progress in the effective assessment of rehabilitation status remains limited. Our study develops a deep learning model integrating Bidirectional Encoder Representations from Transformers (BERT) and TabNet through a late fusion strategy to enhance rehabilitation prediction, including referral risk, dangerous behaviors, self-awareness, and medication adherence, in patients with SMI. BERT processes unstructured textual data, such as doctor's notes, whereas TabNet manages structured diagnostic information. The model's interpretability function serves to assist healthcare professionals in understanding the model's predictive decisions, improving patient care. Our model exhibited excellent predictive performance for all four tasks, with an accuracy exceeding 0.78 and an area under the curve of 0.70. In addition, a series of tests proved the model's robustness, fairness, and interpretability. This study combines multimodal and multitask learning strategies into a model and applies it to rehabilitation assessment tasks, offering a promising new tool that can be seamlessly integrated with the clinical workflow to support the provision of optimized patient care.

Common mental disorders and associated factors among mothers of children attending severe acute malnutrition treatment in Gedio Zone, Southern Ethiopia, 2022: a cross-sectional study.

BACKGROUND: Common mental disorders describe the physical, mental, and social disturbances that are more prevalent in low and middle-income countries. Mothers are among the more vulnerable groups especially mothers having children with under-nutrition. However, there are limited studies about the magnitude of common mental disorders among mothers of undernourished children in Ethiopia. Therefore, we aimed to assess the magnitude of common mental disorders and associated factors among mothers of children attending severe acute malnutrition treatment in Gedio Zone, Southern Ethiopia. METHODS: A cross-sectional study was employed on 405 systematically selected participants. The outcome variable was assessed by a self-reporting questionnaire (SRQ-20) which was applicable and validated in Ethiopia. Data were entered and analyzed by EPi data version 5 software and SPSS version 25 respectively. Model fitness was checked by Hosmer Lemeshow's test. Logistic regression was employed to identify significant determinants. A p-value < 0.05 was used to declare association and expressed by odds ratio with a 95% CI. RESULT: In this study, the magnitude of common mental disorders was 33.16% (95% CI [28.5-38])). In multivariable analysis, six factors poor social support [AOR: 14.0, 95% CI (5.45, 35.9)], educational status [AOR: 1.95, 95% CI (1.07. 3.55)], cigarette smoking [AOR: 10.9, 95% CI (1.78, 67.01)], mother of a child with another chronic disease [AOR: 3.19, 95% CI (1.13, 8.99)], sexual violence [AOR: 4.14, 95% CI (1.38, 12.4)] and mothers with chronic disease [AOR: 3.44, 95% CI (1.72, 6.86)] were significantly associated with common mental disorders. CONCLUSION: The magnitude of common mental disorders was high. Six factors were significantly associated with common mental disorders; social support, sexual violence, maternal chronic illness, educational status, smoking, and mother of child with other chronic disease. Community awareness regarding the effect of violence, substance use, and social support on mental health should be created by the local stakeholders.

Network analysis on psychopathological symptoms, psychological measures, quality of life and COVID-19 related factors in Chinese psychiatric patients in Hong Kong.

BACKGROUND: Psychiatric patients are susceptible to adverse mental health impacts during COVID-19, but complex interplays between psychopathology and pandemic-related variables remain elusive. This study aimed to investigate concomitant associations between psychopathological symptoms, psychological measures and COVID-19 related variables in Chinese psychiatric patients during the peak of fifth pandemic wave in Hong Kong. METHODS: We employed network analysis to investigate inter-relationships among psychopathological symptoms (including depression, anxiety, post-traumatic stress disorder-like [PTSD-like] symptoms, insomnia, psychotic symptoms), cognitive complaints, health-related quality of life, loneliness, resilience and selected pandemic-related factors in 415 psychiatric outpatients between 28 March and 8 April, 2022. Network comparisons between genders, diagnosis (common mental disorders [CMD] vs. severe mental disorders [SMD]), and history of contracting COVID-19 at fifth wave were performed as exploratory analyses. RESULTS: Our results showed that anxiety represented the most central node in the network, as indicated by its highest node strength and expected influence, followed by depression and quality of life. Three comparatively strong connections between COVID-19 and psychopathological variables were observed including: fear of contagion and PTSD-like symptoms, COVID-19 stressor burden and PTSD-like symptoms, and COVID-19 stressor burden and insomnia. Network comparison tests revealed significant network structural difference between participants with history of contracting COVID-19 and those without, but showed no significant difference between genders as well as between CMD and SMD patients. CONCLUSIONS: Our findings suggest the pivotal role of anxiety in psychopathology network of psychiatric patients amidst COVID-19. Pandemic-related variables are critically associated with trauma/stress and insomnia symptoms. Future research is required to elucidate potential network structural changes between pandemic and post-COVID periods.

COVID-19-Related Stressors and Psychophysical Health Conditions among Italian University Students: A Post Pandemic Insight.

The COVID-19 medical emergency has ended worldwide, yet the psychological impact of these years of unprecedented changes on students' lives still needs to be deepened. METHODS: This study aims to assess and compare COVID-19-related stressors (relationships and academic life; isolation; and fear of contagion) and psychophysical symptoms reported by 637 university students at three times, i.e., April 2020 (n = 197), April 2021 (n = 200), and April 2022 (n = 240). The impact of COVID-19-related stressors on psychophysical symptoms within each time was also tested. RESULTS: In April 2022, perceived isolation and fear of contagion decreased from the peak registered in April 2021, but stress related to relationships and academic life remained high. An ongoing increase in psychophysical symptoms was found. More than 50% of students reported clinical levels of sleep disorders, depression, psychoticism, and interpersonal sensitivity. In April 2022, students still perceiving stress related to relationships and academic life and isolation were at risk for anxiety, somatization, and sleep disorders. Students still perceiving stress related to fear of contagion were also at risk for depression, obsessive-compulsive symptoms, and psychoticism. CONCLUSION: The findings emphasized the long-lasting effects of COVID-19-related stress on students' psychophysical health. Interventions must aim at supporting students in dealing with the complex post-pandemic adjustment process.

Prescription opioid dispensing patterns among patients with schizophrenia or bipolar disorder.

BACKGROUND: Patients with schizophrenia (SZ) or bipolar disorder (BD) may have increased risk of complications from prescribed opioids, including opioid-induced respiratory depression. We compared prescription opioid pain medication dispensing for patients with SZ or BD versus controls over 5 years to assess dispensing trends. METHODS: This retrospective, observational study analysed US claims data from the IBM® MarketScan® Commercial and Multi-State Medicaid databases for individuals aged 18-64 years with prevalent SZ or BD for years 2015-2019 compared with age- and sex-matched controls. Baseline characteristics, comorbidities, and medication use were assessed. Proportions of individuals dispensed prescription opioids chronically (ie, ≥70 days over a 90-day period or ≥ 6 prescriptions annually) or nonchronically (≥1 prescription, chronic definition not met) were assessed. RESULTS: In 2019, the Commercial and Medicaid databases contained records for 4773 and 30,179 patients with SZ and 52,780 and 63,455 patients with BD, respectively. Patients with SZ or BD had a higher prevalence of comorbidities, including pain, versus controls in each analysis year. From 2015 to 2019, among commercially insured patients with SZ, chronic opioid-dispensing proportions decreased from 6.1% (controls: 2.7%) to 2.3% (controls: 1.2%) and, for patients with BD, from 11.4% (controls: 2.7%) to 6.4% (controls: 1.6%). Chronic opioid dispensing declined in Medicaid-covered patients with SZ from 15.0% (controls: 14.7%) to 6.7% (controls: 6.0%) and, for patients with BD, from 27.4% (controls: 12.0%) to 12.4% (controls: 4.7%). Among commercially insured patients with SZ, nonchronic opioid dispensing decreased from 15.5% (controls: 16.4%) to 10.7% (controls: 11.0%) and, for patients with BD, from 26.1% (controls: 17.5%) to 20.0% (controls: 12.2%). In Medicaid-covered patients with SZ, nonchronic opioid dispensing declined from 22.5% (controls: 24.4%) to 15.1% (controls: 12.7%) and, for patients with BD, from 32.3% (controls: 25.9%) to 24.6% (controls: 13.6%). CONCLUSIONS: The proportions of individuals dispensed chronic or nonchronic opioid medications each year were similar between commercially and Medicaid-insured patients with SZ versus controls and were higher for patients with BD versus controls. From 2015 to 2019, the proportions of individuals who were dispensed prescription opioids chronically or nonchronically decreased for patients with SZ or BD and controls.

Development and validation of a machine learning model for prediction of type 2 diabetes in patients with mental illness.

BACKGROUND: Type 2 diabetes (T2D) is approximately twice as common among individuals with mental illness compared with the background population, but may be prevented by early intervention on lifestyle, diet, or pharmacologically. Such prevention relies on identification of those at elevated risk (prediction). The aim of this study was to develop and validate a machine learning model for prediction of T2D among patients with mental illness. METHODS: The study was based on routine clinical data from electronic health records from the psychiatric services of the Central Denmark Region. A total of 74,880 patients with 1.59 million psychiatric service contacts were included in the analyses. We created 1343 potential predictors from 51 source variables, covering patient-level information on demographics, diagnoses, pharmacological treatment, and laboratory results. T2D was operationalised as HbA1c ≥48 mmol/mol, fasting plasma glucose ≥7.0 mmol/mol, oral glucose tolerance test ≥11.1 mmol/mol or random plasma glucose ≥11.1 mmol/mol. Two machine learning models (XGBoost and regularised logistic regression) were trained to predict T2D based on 85% of the included contacts. The predictive performance of the best performing model was tested on the remaining 15% of the contacts. RESULTS: The XGBoost model detected patients at high risk 2.7 years before T2D, achieving an area under the receiver operating characteristic curve of 0.84. Of the 996 patients developing T2D in the test set, the model issued at least one positive prediction for 305 (31%). CONCLUSION: A machine learning model can accurately predict development of T2D among patients with mental illness based on routine clinical data from electronic health records. A decision support system based on such a model may inform measures to prevent development of T2D in this high-risk population.

Human gut microbiome, diet, and mental disorders.

Diet is one of the most important external factor shaping the composition and metabolic activities of the gut microbiome. The gut microbiome plays a crucial role in host health, including immune system development, nutrients metabolism, and the synthesis of bioactive molecules. In addition, the gut microbiome has been described as critical for the development of several mental disorders. Nutritional psychiatry is an emerging field of research that may provide a link between diet, microbial function, and brain health. In this study, we have reviewed the influence of different diet types, such as Western, Mediterranean, vegetarian, and ketogenic, on the gut microbiota composition and function, and their implication in various neuropsychiatric and psychological disorders.

Effects of high-intensity interval training on depressive and anxiety symptoms in healthy individuals: A systematic review and meta-analysis of randomized clinical trials.

Although evidence regarding the effects of high-intensity interval training (HIIT) on mental health has increased in recent years, there is still no consensus regarding the effects of HIIT on the symptoms of depression and anxiety in a healthy population. Therefore, this systematic review aimed to investigate the effects of HIIT on depressive and/or anxiety symptoms in healthy individuals. The following four databases were searched: PubMed, Scopus, Embase, and PsycINFO. Only randomized clinical trials (RCTs) were included. We performed a random-effects meta-analysis based on standardized mean difference (SMD). The risk of bias was assessed using the RoB 2.0 tool, and the certainty of the evidence was evaluated based on recommendations GRADE. Eight RCTs evaluating 471 participants (81% female) were considered eligible for inclusion. The results of the meta-analysis showed that HIIT-based interventions had no significant effect on reducing anxiety (SMD = -0.17; 95% CI: -0.53, 0.19; p = 0.27) and depressive symptoms (SMD = -0.38; 95% CI: -1.06, 0.30; p = 0.17) compared with the passive control group. In conclusion, HIIT does not improve symptoms of depression and anxiety in healthy individuals. This finding is based on evidence of very low certainty. Therefore, the evidence is still not consistent enough to support HIIT as a viable strategy to reduce both outcomes because of the limited number of included studies and the overall quality of evidence.

Dissimulation in forensic psychiatric evaluations, a case-control study of the Millon Clinical Multiaxial Inventory-III.

The possible tendency of subjects to decrease, hide, or omit symptomatic aspects of their mental functioning is one of the main problems in forensic psychological and psychiatric evaluations. We aimed at verifying the possible existence of significant differences in the Millon Clinical Multiaxial Inventory-III (MCMI-III) scales scores between a sample of dissimulators (n = 40) and their non-dissimulator counterpart matched by age, sex, and diagnosis. Cases and comparisons were retrieved from the archive of a single university forensic psychiatric centre between 2013 and 2022. Results showed statistically significant higher scores in the sample of dissimulators in the Desirability, Histrionic, Narcissistic, and Compulsive MCMI-III scales than in the comparison sample. Point biserial correlation test disclosed a strong positive correlation between the Desirability, Histrionic, Narcissistic, and Compulsive scales of the MCMI-III and being in the dissimulator group of subjects while a negative correlation emerged for all the other scales except drug dependence. Key points: The forensic setting can affect a subject's behaviour.Dissimulation is a mechanism of minimization or concealment of a psycho-pathological condition.The MCMI-III can be a useful tool for a forensic psychiatrist or forensic psychologist in assessing dissimulation.

"I'm pulling through because of you": injured workers' perspective of workplace factors supporting return to work under the Saskatchewan Workers' Compensation Board scheme.

Background: Research demonstrates sustained return to work (RTW) by individuals on medical leave is influenced by personal and job resources and job demands. Relatively few studies have been conducted in the workers' compensation context that is known to have longer absence durations for RTW. Aims: This study sought to illuminate workers' experience as they returned to work following a work injury that was either psychological in nature or involved more than 50 days of disability, with a focus on the co-worker, supervisor, and employer actions that supported their return. Methods: Workers in Saskatchewan, Canada, with a work-related psychological or musculoskeletal injury, subsequent disability, and who returned to work in the last three years, were invited to complete an online survey comprising of free-text questions. Thematic analysis was used to explore participants' experiences. Results: Responses from 93 individuals were analysed. These revealed that persistent pain, emotional distress, and loss of normal abilities were present during and beyond returning to work. Almost two-thirds indicated that the supervisors' and co-workers' support was critical to a sustained return to work: their needs were recognized and they received autonomy and support to manage work demands. By contrast, one-third indicated that the support they expected and needed from supervisors and employers was lacking. Conclusions: Workers returning to work lacked personal resources but co-workers' and supervisors' support helped improve confidence in their ability to RTW. Supervisors and employers should acknowledge workers' experiences and offer support and autonomy. Likewise, workers can expect challenges when returning to work and may benefit from cultivating supportive relationships with co-workers and supervisors.

Average lifespan variation among people with mental disorders in Denmark: a nationwide, register-based cohort study.

AIMS: Mortality associated with mental disorders has been estimated using metrics such as mortality rate ratios and life expectancy. However, the variation around the average life expectancy has never been quantified. The main aim of this study was to measure life disparity for people with mental disorders as a measure of inequality at the time of death. METHODS: Using data from Danish registries, average life disparity was introduced and calculated to measure the lifespan variation associated with major types of mental disorders. Average life expectancy is also reported for completeness. RESULTS: Compared with the general population, people with mental disorders not only had shorter average life expectancy, but experienced larger average life disparity. For those diagnosed with a mental disorder, average life expectancy increased between 1995 and 2021; however, average life disparity declined in women only, and did not change for men. In addition, the differences in both metrics between those with mental disorders and the general population were largest for substance use disorders and schizophrenia spectrum disorders. For these disorders, the differences even increased during the study period. CONCLUSIONS: Mortality rates for individuals with mental disorders have been declining in recent decades in Denmark; however, the increase in the average life disparity emphasizes the increasing heterogeneity and inequality in lifespans within this group, which requires measures to promote a longer and more equal life for those with mental disorders.

Spiritual care for clients with mental illness from an Islamic background: Nursing students' perspectives.

WHAT IS KNOWN ON THE SUBJECT?: Spirituality is an important aspect for clients with mental illness. Spirituality is essential to holistic care in mental health nursing. Nurses found an apparent disconnection between the theory and practice of spiritual care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Nurses acknowledged that attitudes that allocate blame towards clients with mental illness have the most negative impact on clients' spiritual wellbeing. The conflicting worldviews between spiritual healing and a biomedical approach impact the provision of care as relationships among the mental health team are disrupted. The non-assessment of the client's spirituality hindered nurses from providing spiritual care. Language differences between nurses and clients impede nurses from providing spiritual care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The use of spiritual therapy as an element of nursing care works if clients and nurses are both aware of the importance of spirituality. Nursing staff must also be aware of several issues that may make it difficult for nurses to provide such therapy, including specific symptoms of mental illness. Nurses can apply spiritual care effectively when they have significant spirituality. Nurses with good competency in mental health nursing skills are more likely to provide efficient spiritual care as part of holistic care. ABSTRACT: INTRODUCTION: Spiritual care is essential to clients with mental illness. AIM: To explore mental health nursing students' perspectives on spirituality and spiritual care and how this impacts clients with mental illness in an Islamic context (Saudi Arabia). METHOD: Thematic analysis is used to analyse data from two focus groups of mental health nursing students (one comprising eight, the other six). RESULTS: Six themes emerged: factors affecting spirituality in mental illness, the impact of mental illness on spirituality, the use of spiritual healing in mental illness, nurses' use of spiritual healing; challenges in providing spiritual care and recommendations for improving spiritual care. DISCUSSION: Clients being blamed for having mental illness by health professionals and the community harmed their spirituality. The religious support of peers was a practical approach to spiritual therapy, asserted as a beneficial element of nursing care. However, nurses found providing such therapy challenging because of the language barrier and the lack of any assessment of clients' spirituality. It was also challenging when dealing with specific symptoms of mental illness. IMPLICATIONS FOR PRACTICE: The study asserts that spiritual therapy in nursing care will work if the client knows its importance. Nurses who have significant spirituality can apply it effectively.