Despite a global decline in suicide rates, the USA has witnessed a concerning rise in suicide mortality over the past two decades.

This study aims to elucidate the changing patterns of suicide mortality in the USA from 1999 to 2019, with a particular focus on gender and racial differences.

We utilised national mortality data for causes of suicide (X60–X84, Y87.0) from the Centers for Disease Control and Prevention for 1999–2019. The age–period–cohort analysis was conducted to explore the effects of age, period and birth cohort effects on suicide mortality by gender and race.

Between 1999 and 2019, the suicide rate and the number of suicides in the USA increased 33% and 62%, respectively. We discerned an emerging peak of suicide among young adult populations even as increases affected nearly all groups. Females have shown increasing period risk, which has exceeded that of males since 2011. Their cohort risk, which slowly increased and exceeded males in post-1959 cohorts, exhibited a steep J-shaped pattern, especially among those born after 1977. Although Americans of all races have experienced increased period risk since 2011, it was highest among American Indians and Alaska Natives by the end of the 20-year span. With the mortality risk increasing rapidly in all post-1959 cohorts, the risk showed an obvious cliff-shaped pattern among the Asian/Pacific Islander population born after 1989.

The shifting burden of suicide mortality towards younger populations, transcending gender and racial boundaries, underscores the need for the implementation of tailored public health strategies.

Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of osteoporosis, and sertraline may be more potent than citalopram in this regard. Here, target trial emulation was used to investigate whether sertraline, citalopram and escitalopram (the S-enantiomer of citalopram) i) differentially affect the risk of osteoporosis, and ii) increase the risk of osteoporosis in a dose-response-like manner.

Danish nationwide registers were used to identify all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram between January 1, 2007, and March 1, 2019. These individuals were followed until development of osteoporosis, death, or end of follow-up. Cox proportional hazards regression was used to adjust for relevant baseline covariates to emulate randomized treatment allocation to compare the rate of osteoporosis for individuals treated with sertraline, citalopram or escitalopram. Subsequently, the cumulative dose of sertraline, citalopram, and escitalopram was calculated, and Cox proportional hazards regression was used to assess dose-response-like relationships with osteoporosis.

We identified 27,280, 65,529, and 17,703 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. There was no material or statistically significant differential risk of osteoporosis between these groups (hazard rate ratio, HRR=0.98 for citalopram versus sertraline and HRR=0.94 for escitalopram versus sertraline). The results were not indicative of the SSRIs having a dose-response-like effect on osteoporosis risk.

Sertraline, citalopram and escitalopram do not appear to differentially affect the risk of osteoporosis. The lack of clear dose-response-like relationships suggest that they do not have a causal effect on osteoporosis risk.

Little is known about the dose and pattern of moderate-to-vigorous physical activity (MVPA) to prevent depression. We aimed to assess the prospective association of dose and pattern of accelerometer-derived MVPA with the risk of diagnosed depression.

We included 74,715 adults aged 40–69 years from the UK Biobank cohort who were free of severe disease at baseline and participated in accelerometer measurements (mean age 55.2 years [SD 7.8]; 58% women). MVPA at baseline was derived through 1-week wrist-worn accelerometry. Diagnosed depression was defined by hospitalization with ICD-10 codes F32.0-F32.A. Restricted cubic splines and Cox regression determined the prospective association of dose and pattern of MVPA with the risk of incident depression.

Over a median 7.9-year follow-up, there were 3,089 (4.1%) incident cases of depression. Higher doses of MVPA were curvilinearly associated with lower depression risk, with the largest minute-per-minute added benefits occurring between 5 (HR 0.99 [95% CI 0.96–0.99]) and 280 (HR 0.67 [95% CI 0.60–0.74]) minutes per week (reference: 0 MVPA minutes).

Regardless of pattern, higher doses of MVPA were associated with lower depression risk in a curvilinear manner, with the greatest incremental benefit per minute occurring during the first 4–5 h per week. Optimal benefits occurred around 15 h/week.

Current knowledge on psychiatric illness following periods of social distancing during the COVID-19 pandemic is mostly limited to smaller studies in selected populations. This nationwide study of all 4.6 million Danish adults examined if periods of social distancing were associated with changes in surrogate measures of mental health.

All Danish adults (≥18 years) were included and rates of collection of antidepressant prescriptions, psychiatric hospital admissions, and suicide or suicide attempts for the periods March 12, 2020–May 20, 2020 (lockdown period 1), and December 21, 2020–March 1, 2021 (lockdown period 2), were compared to corresponding periods 1 year prior. Individuals were censored due to death or SARS-CoV-2 infection.

Antidepressant consumption increased for both period 1 and period 2, with an incidence rate ratio (IRR) of 1.02 (95% CI: 1.01–1.02, p < 0.001) and IRR 1.08 (95% CI: 1.08–1.09, p < 0.001) respectively, compared to the control periods. Psychiatric hospitalization rates decreased significantly, with an IRR of 0.65 (95% CI: 0.63–0.66, p < 0.001) for period 1, and IRR 0.86 (95% CI: 0.84–0.88, p < 0.001) for period 2. The risk of suicide did not increase in period 1, IRR 0.96 (95% CI: 0.82–1.13, p = 0.64), but seemed increased during period 2, IRR 1.19 (95% CI: 1.02–1.38, p = 0.03).

Periods of social distancing during the COVID-19 pandemic were associated with an increase of antidepressant consumption, but decreased rates of psychiatric hospitalization. Suicide risk seemed increased during the second lockdown period.

An equitable child mental health service provides access to treatment proportionally to the need of individual demographic groups. Despite qualitative and survey-based evidence of barriers disadvantaging some demographic groups, it is not well understood how these barriers translate into quantifiable inequities. We calculated the treatment access rate for English children aged 6–16 years in 2021–2022, using the patient-level Mental Health Services Data Set and Mental Health of Children and Young People Survey.

The number of primary school children in treatment needs to increase nationally by 173%, the number of boys by 65% and the number of children from a White ethnic background by 31%, to achieve equity in treatment access. There was no evidence of inequities by area deprivation.

Child mental health services in England should not only increase overall access rates, but also pay more attention to equity in access across different demographic groups.

Many psychiatric and somatic comorbidities increase the risk of suicidal behavior, but the effect of co-existing comorbidities is sparsely elucidated. We described co-existence of psychiatric and somatic comorbidities and the influence of the combined comorbidity burden on the risk of suicidal behavior.

We defined two case populations above 10 years in the Danish health registries: those who 1) died by suicide (2010–2020) and 2) had an incident suicide attempt (2010–2021). Co-existing somatic and psychiatric comorbidities and relative odds of suicidal behavior at increasing comorbidity burden were assessed.

Among 5.9 million Danish citizens (2021), 6,257 individuals died by suicide whereas 30,570 had an incident suicide attempt. More than half had ≥2 co-existing psychiatric and/or somatic comorbidities. Of those who died by suicide, 18% had co-existing mood disorders and stress disorders, while 5% had both mood disorders and cancer. An 88-fold increase of odds for attempting suicide and a 35-fold increase of odds for suicide were observed among those with the highest combined burden of somatic and psychiatric comorbidities relative to those without. The presence of somatic comorbidities seemed to protect against suicide in older individuals.

Psychiatric and somatic comorbidities commonly co-exist in individuals with suicidal behavior. Higher combined burden of psychiatric and somatic comorbidities increased the odds of suicidal behavior, though the presence of somatic diseases had a potential protective effect on the risk of suicide in older individuals. This warrants collaboration and enhanced awareness of suicidal behavior risks across somatic and psychiatric departments.

Intergenerational transmission of mental disorders has been well established, but it is unclear whether exposure to a child's mental disorder increases parents' subsequent risk of mental disorders.

We examined the association of mental disorders in children with their parents' subsequent mental disorders.

In this population-based cohort study, we included all individuals with children born in Finland or Denmark in 1990–2010. Information about mental disorders was acquired from national registers. The follow-up period began when the parent's eldest child was 5 years old (for ICD-10 codes F10–F60) or 1 year old (for codes F70–F98) and ended on 31 December 2019 or when the parent received a mental disorder diagnosis, died, or emigrated from Finland or Denmark. The associations of mental disorders in children with their parents' subsequent mental disorders were examined using Cox proportional hazards models.

The study cohort included 1 651 723 parents. In total, 248 328 women and 250 763 men had at least one child who had been diagnosed with a mental disorder. The risk of a parent receiving a mental disorder diagnosis was higher among those who had a child with a mental disorder compared with those who did not. For both parents, the hazard ratios were greatest in the first 6 months after the child's diagnosis (hazard ratio 2.04–2.54), followed by a subtle decline in the risk (after 2 years, the hazard ratio was 1.33–1.77).

Mental disorders in children are associated with a greater risk of subsequent mental disorders among their parents. Additional support is needed for parents whose children have been recently diagnosed with a mental disorder.

Suicide in women in the UK is highest among those in midlife. Given the unique changes in biological, social and economic risk factors experienced by women in midlife, more information is needed to inform care.

To investigate rates, characteristics and outcomes of self-harm in women in midlife compared to younger women and identify differences within the midlife age-group.

Data on women aged 40–59 years from the Multicentre Study of Self-harm in England from 2003 to 2016 were used, including mortality follow-up to 2019, collected via specialist assessments and/or emergency department records. Trends were assessed using negative binomial regression models. Comparative analysis used chi-square tests of association. Self-harm repetition and suicide mortality analyses used Cox proportional hazards models.

The self-harm rate in midlife women was 435 per 100 000 population and relatively stable over time (incident rate ratio (IRR) 0.99, p < 0.01). Midlife women reported more problems with finances, alcohol and physical and mental health. Suicide was more common in the oldest midlife women (hazard ratio 2.20, p < 0.01), while psychosocial assessment and psychiatric inpatient admission also increased with age.

Addressing issues relating to finances, mental health and alcohol misuse, alongside known social and biological transitions, may help reduce self-harm in women in midlife. Alcohol use was important across midlife while physical health problems and bereavement increased with age. Despite receiving more intensive follow-up care, suicide risk in the oldest women was elevated. Awareness of these vulnerabilities may help inform clinicians’ risk formulation and safety planning.

Depressive disorders pose a significant global public health challenge, yet evidence on their burden remains insufficient.

To report the global, regional and national burden of depressive disorders and their attributable risk factors from 1990 to 2021.

Data from the Global Burden of Disease 2021 were analyzed for 204 countries and territories from 1990 to 2021. We explored the age-standardised incidence, prevalence and disability-adjusted life years (DALYs) of depressive disorders by age, gender and sociodemographic index.

In 2021, there were 357.44 million incident cases, 332.41 million prevalent cases and 56.33 million DALYs. Age-standardised rates for incidence, prevalence and DALYs were 4333.62, 4006.82 and 681.14 per 100 000 persons, with annual declines of 0.06%, 0.03% and 0.04%. Uganda, Greenland and Lesotho had the highest prevalence, while Spain, Mexico and Uruguay showed the largest increases. Greenland and Brunei Darussalam had the highest and lowest age-standardised DALYs rates, respectively. DALYs peaked in the 55–59 age group for men and 60–64 for women, with higher rates in women. Regionally, a U-shaped association was found between the sociodemographic index and DALYs rates. Population growth was the main driver for the increase in DALYs cases. Childhood maltreatment was the leading risk factor, with intimate partner violence affecting more females and childhood sexual abuse more males.

Despite decreasing trends in incidence, prevalence and DALYs rates, absolute case numbers and age-standardised rates continue to increase for depressive disorders. Tackling childhood abuse and improving depressive disorder management are crucial to reducing future burdens.

The lifetime prevalence of PTSD ranges from 6 to 20% and is often associated with comorbid disorders. Despite the significant impact of PTSD, specific data on healthcare utilization related to PTSD remain limited. This study aims to characterize PTSD-related hospitalizations in France over the past decade.

This nationwide longitudinal retrospective study analyzed PTSD-related hospitalizations in France from 2013 to 2022 using the French National Hospitals Database. Data included discharge records from general and psychiatric hospitals, detailing demographics, admission/discharge dates, ICD-10 diagnoses, and hospitalization specifics.

Between 2013 and 2022, 69,108 patients underwent 125,349 hospitalizations with a PTSD diagnosis (0.4% of all inpatient cases) in France. Psychiatric facilities accounted for 74,988 hospitalizations (1% of all psychiatric inpatient cases in France), while general hospitals recorded 50,361 hospitalizations (0.02% of all non-psychiatric inpatient cases). The percentage of inpatients diagnosed with PTSD increased from 0.68 to 2.22% in psychiatric facilities and from 0.02 to 0.04% in general hospitals over the study period. Females were younger in both settings and had longer stays compared to males in psychiatric facilities. Over time, there was a decrease in median age and an increase in part-time hospitalizations in psychiatric facilities. Mood disorders, stress-related disorders, and substance use disorders were prevalent comorbidities in both settings.

This study highlights a rise in PTSD-related hospitalizations in France, particularly in psychiatric facilities and after 2019, with high rates among women and an increase in hospitalization of younger individuals. These findings highlight the necessity for improved care strategies tailored to the increasing number of younger patients with PTSD.

Cannabis is the most commonly used illicit substance in Ireland and globally. It is most likely to be used in adolescence, a period of biopsychosocial vulnerability to maladaptive behaviours. This study aims to investigate the risk and protective factors for cannabis use among adolescents.

This study is a secondary analysis of the cross-sectional Planet Youth survey (2021). The sample comprised 4,404 adolescents aged 15–16 from one urban and two rural areas in Ireland. The outcome of interest was current cannabis use, defined as cannabis use within the last 30 days. Independent variables i.e., risk and protective factors, were selected a priori following a literature review. Associations between cannabis use and the independent variables were explored using mixed-effects logistic regressions.

The prevalence of current cannabis use was 7.3% and did not differ significantly between males and females. In fully-adjusted models, significant risk factors for cannabis use were: Having peers that used cannabis (Adjusted Odds Ration (aOR) 10.17, 95% CI: 5.96–17.35); Parental ambivalence towards cannabis use (aOR 3.69, 95% CI: 2.41–5.66); Perception of cannabis as non-harmful (aOR 2.32,95% CI 1.56–£.45): Other substance use (aORs ranging from 2-67–3.15); Peer pressure to use cannabis (aOR 1.85,95% CI 1.05–3.26), and Low parental supervision (aOR 1.11, 95% CI: 1.01–1.22).

This study identified key individual, peer-to-peer and parental risk factors associated with adolescent cannabis use, several of which have the potential to be modified through drug prevention strategies.

Individuals with diminished social connections are at higher risk of mental disorders, dementia, circulatory conditions and musculoskeletal conditions. However, evidence is limited by a disease-specific focus and no systematic examination of sex differences or the role of pre-existing mental disorders.

We conducted a cohort study using data on social disconnectedness (loneliness, social isolation, low social support and a composite measure) from the 2013 and 2017 Danish National Health Survey linked with register data on 11 broad categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences (IRDs), and explore sex differences and interaction with pre-existing mental disorders.

Among 162,497 survey participants, 7.6%, 3.5% and 14.8% were classified as lonely, socially isolated and with low social support, respectively. Individuals who were lonely and with low social support had a higher incidence rate in all 11 categories of medical conditions (interquartile range [IQR] of IRRs, respectively 1.26–1.49 and 1.10–1.14), whereas this was the case in nine categories among individuals who were socially isolated (IQR of IRRs, 1.01–1.31). Applying the composite measure, the highest IRR was 2.63 for a mental disorder (95% confidence interval [CI], 2.38–2.91), corresponding to an IRD of 54 (95% CI, 47–61) cases per 10,000 person-years. We found sex and age differences in some relative and absolute estimates, but no substantial deviations from additive interaction with pre-existing mental disorders.

This study advances our knowledge of the risk of medical conditions faced by individuals who are socially disconnected. In addition to the existing evidence, we found higher incidence rates for a broad range of medical condition categories. Contrary to previous evidence, our findings suggest that loneliness is a stronger determinant for subsequent medical conditions than social isolation and low social support.

A preregistered analysis plan and statistical code are available at Open Science Framework (https://osf.io/pycrq).