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Adverse events of mood monitoring and ambulatory assessment in depression and bipolar disorder : systematic review and meta-analysis
Get PDF© Laurence Astill Wright, Jonathan Monk-Cunliffe, Boliang Guo, Richard Morriss. Originally published in JMIR Mental
Health (https://mental.jmir.org), 23.Oct.2025. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The
complete bibliographic information, a link to the original publication on https://mental.jmir.org/, as well as this copyright and
license information must be included.Background: Mood monitoring and ambulatory assessment offer improvements in measuring mood and behavior for mental health research and clinical practice. However, concerns about adverse effects and usability may hinder their implementation. Objective: This systematic review and meta-analysis assessed the prevalence of adverse events, barriers and facilitators to use, and suggestions for improvement in quantitative mood monitoring studies involving people with depression and bipolar disorder. Methods: We conducted a systematic review and meta-analysis of 77 quantitative studies that used mood monitoring or ambulatory assessment in depression and bipolar disorder, assessing adverse events, barriers and facilitators to use, and suggestions for improvement. Adverse events data were pooled to identify prevalence. Results: Of the 77 studies, 15 (19%) reported adverse events, and 20 (26%) reported usability issues. Pooled prevalence of adverse events was 0.04 (95% CI 0.03-0.06; P<.001). Specific adverse effects included increased burden or stress (0.04, 95% CI 0.02-0.07; P<.001), mood worsening (0.02, 95% CI 0.01-0.02; P=.001), self-harm (0.05, 95% CI-0.02 to 0.10; P=.007), and hospitalization (0.06, 95% CI 0.04-0.09; P=.26). The top facilitators were perceived helpfulness and ease of use, the top barriers included technical challenges and the time-consuming nature of the interventions, and the top suggested improvement was personalization. Conclusions: A small number of mood monitoring or ambulatory assessment users experienced negative psychological effects; however, we were unable to infer causality. Due to the severe underreporting of adverse events as well as heterogeneity and publication bias in the included studies, there was limited certainty in the prevalence, duration, and severity of these adverse events. More systematic monitoring of adverse events is needed to optimize safety and usability. Many mood monitoring protocols may require additional development to decrease adverse events and improve acceptability.https://mental.jmir.org/2025/1/e79500 https://doi.org/10.2196/7950
Closing the gap in acute NIV: A scalable nurse-led approach to optimising time-critical care.
Get PDFIntroduction The 2023 BTS RSU audit demonstrated a lower all-cause mortality for hospitals with an RSU and enhanced staffing ratios. At Sherwood Forest Hospitals (SHFT), an acute NIV nurse-led outreach and retrieval service, based on an RSU with enhanced staffing and central monitoring of observations, has been in place for over 8 years. However, data demonstrated our median gas and door-to-mask times were 03:29hrs, and 04:15hrs respectively, with delays noted in performing and interpretation of blood gases. Methods We created a digital tracker focusing on gas and door-to-mask times as our improvement measures. Following process mapping and root cause analysis, we redesigned our referrals process and developed an early assessment model for all acute patients. Acute NIV nurses perform an early clinical review at the initial identification of possible NIV patients, optimising patient care, ensuring timely blood gases and earlier ringfencing of RSU beds. Adopting and supplementing the BTS care bundle,2 we added 3 additional locally conceived standards to match our new delivery model and created a checklist to ensure consistency and completeness. We audited the utilisation of our standards before and after the intervention. Results Audit data demonstrated that pre-intervention, only 10% of sampled patients from 2024 received all elements of the care bundle, improving to 74%. Delivery of acute NIV improved with a reduction in both gas and door-to-mask times of 43 minutes and 1 hour 09 minutes, respectively. Conclusion Early results demonstrate an improvement in treatment times. The development of the locally enhanced care bundle enabled the reduction in variation of care and empowered the team to utilise their skills, experience and knowledge. We believe the continuous development of our acute NIV nurse model to now include earlier optimisation and identification of patients is sustainable, cost-effective and applicable to similar services.https://thorax.bmj.com/content/80/Suppl_2/A294.
A reduced multicomponent bandage compression system in the management of venous leg ulcers: a clinical evaluation.
No full textObjective: Lower limb assessment, patient adherence to treatment and timely initiation of compression therapy are major issues for most healthcare services managing patients with leg ulcers (LUs). Various guidelines recommend that if a patient has a LU and no 'red flag' symptoms, then 'mild' or 'reduced' compression therapy (20mmHg) is better than no compression while they await an ankle-brachial pressure index (ABPI), or if patients with a venous leg ulcer (VLU) cannot tolerate prescribed high compression therapy (40mmHg). The aim of this clinical study was to document the performance of a multicomponent bandage compression system applying reduced pressure in real-life practice, as recommended in national guidance. Method: A retrospective, multicentre, non-comparative clinical study was carried out within community settings in the UK. Eligible patients were consecutive adult outpatients with a VLU (or suspected VLU) treated with the evaluated compression system (UrgoKTwo Reduced; Laboratoires Urgo, France), after 'no red flags' for reduced compression therapy were identified. The primary endpoint was the rate of complete ulcer closure by week 12. Main secondary endpoints included time-to-heal in days, oedema resolution, patient adherence and local adverse events (AEs). Results: Data from 102 patients (35-99 years old, 60% female, 58% overweight or obese) who had been treated with the evaluated compression system for an average period of 50±32 days were included in this clinical study. The prescription of the compression system was justified for 84% of patients by poor tolerance of high compression, and for 16% by the absence of a complementary vascular examination (ABPI). UrgoStart Plus dressings (Laboratoires Urgo, France) were combined with the compression system in 43% of wounds, while antimicrobial dressings were frequently applied in cases of local wound infection. During the treatment period, patient adherence to compression therapy was rated 'very good' or 'good' in 99% of cases (wearing the compression bandages 24 hours a day until the next nurse visit). By the end of the treatment period, 75% of wounds healed, with a median time-to-heal of 45 days (interquartile range: 33 days, 63 days), 23% improved and 2% worsened. The highest wound closure rates were achieved in cases of recent wounds or wounds treated with the UrgoStart Plus treatment range (91% and 89%, respectively). The shortest healing times were observed with smaller wounds or those treated with UrgoStart Plus dressings (13 and 10 days sooner, respectively). By the final visit, oedema was resolved in 63% of patients who had oedema at baseline. Once their ulcer healed, 75% of patients received subsequent compression hosiery to prevent ulcer recurrence. Throughout the study period, only one AE was documented by the healthcare professionals: a local wound infection, unrelated to the compression system evaluated, but for which compression therapy was discontinued because of the associated pain. Conclusion: These findings are consistent with previous evidence available on this reduced compression system and support its use as a first-line treatment in patients with a suspected VLU until a full vascular assessment indicates that stronger compression is appropriate, as well as in patients who are unable to tolerate high compression therapy.https://www.magonlinelibrary.com/doi/full/10.12968/jowc.2025.045
What is the experience of adults assigned male at birth with a diagnosis of Gender Incongruence at an NHS gender identity clinic in England who have sought treatment but decided to detransition or retransition during the treatment pathway?
No full textThe phenomenon of gender identity detransition broadly speaking happens when someone re-identifies with their assigned-sex after transitioning their gender identity. There is a growing body of evidence exploring the prevalance of detransition yet few studies have sought to understand the lived experience of gender detransition, and those who also retransition. Five participants were recruited from an NHS GIC and interviewed about their experience of detransition. Interview transcripts were analyzed using interpretative phenomenological analysis. There were four main themes: (a) a sense of difference from childhood is experienced; (b) gender transition is challenging in multiple ways; (c) conflicts are experienced; and (d) stopping transition has challenges and benefits. Gender identity transition and detransition is a varied experience and people have multiple needs.https://www.tandfonline.com/doi/full/10.1080/00918369.2025.258049
Patient and public involvement in secure mental health research : setting-specific considerations and a protocol for involvement in the CORAS study (COllaborative Risk ASsessment and management)
Get PDF© Crown 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits
use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original
author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third
party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the mate rial. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation
or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
http://creativecommons.org/licenses/by/4.0/BACKGROUND: Patient and Public Involvement and Engagement (PPIE) is important in secure psychiatric research because it can help ensure that research is relevant and meaningful, and a positive experience for those participating. However, there are significant challenges to embedding PPIE in research in secure hospital settings, including practical barriers to involvement. A lack of reporting of PPIE practices makes it harder for researchers to learn from previous projects, leading to missed opportunities to improve PPIE in secure settings, and there are no current setting-specific guidelines for best practice. The CORAS study aims to examine collaborative risk assessment within secure psychiatric settings. In this study, PPIE is fully integrated throughout the research cycle, and this protocol describes the PPIE methodology being adopted. By highlighting these approaches and principles, this protocol is intended to be used as a transferrable framework for developing best practice for PPIE in research in these settings. METHOD: This protocol describes the ways in which we will ensure that PPIE remains central to each stage of the research project, from the formation of a smaller grant application PPIE group, through to dissemination of outputs. We discuss principles of recruitment into the PPIE group, ensuring that all areas of the secure mental health pathway are represented, and formally embracing equality, diversity and inclusion principles through the use of an Equality Impact Assessment. We also describe the core activities of the PPIE group, including the co-design of the research materials, recruitment strategies and dissemination plans, how the impact of PPIE will be examined, and practical elements such as around reimbursement and ensuring the wellbeing of PPIE group members. CONCLUSIONS: PPIE in secure mental health service research is important and challenging. This protocol outlines how we will address these challenges and ensure that PPIE is fully embedded in the design and delivery of a large study in secure settings. Although the prospective nature of this protocol precludes the sharing of outcomes and learning from the PPIE, it can nevertheless serve as a transferrable framework for the development that is urgently required in this clinical research field, as well as allow transparent future reporting of what was achieved. Involving people with their own lived experience in the design and running of clinical research studies can improve the quality and impact of these studies, as well as the experience for people taking part in them. In some clinical settings this involvement might be more difficult. In secure psychiatric hospitals things like security can make it difficult for people to be involved in this way in research. There is not much guidance available for researchers on how to do this better when running studies in secure settings. The CORAS study (COllaborative Risk ASsessment and management in secure services) is a research study in these settings that is exploring how to involve patients and carers in their risk assessments and risk management plans (or safety plans). We have developed detailed plans for how to make sure that patients and carers have a central role in all areas of this study, including designing parts of the study and how best to make sure that the results of the study reach patients and carers. This paper outlines how we are planning to do this, so that other researchers designing studies in these clinical settings can understand and build on some of the practical ways of involving people with lived experience. eng publication: N/A. Competing interests: The authors declare no competing interests.https://link.springer.com/article/10.1186/s40900-025-00768-
Stakeholder acceptability of the ROWTATE vocational rehabilitation intervention in England : an interview study
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employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ GroupOBJECTIVES: The ROWTATE intervention helps people experiencing trauma to return to work (RTW) through vocational rehabilitation (VR) support from occupational therapists (OTs) and clinical psychologists (CPs). This study aims to explore and understand the acceptability of VR after traumatic injury for patients, therapists and employers. DESIGN AND SETTING: Qualitative interviews in eight major trauma regions, UK. PARTICIPANTS: Interviews were undertaken with a range of stakeholders-15 patients, 15 therapists and 6 employers. Data were analysed using the theoretical framework of acceptability. RESULTS: Stakeholders understood the aim of the intervention was to support people to RTW and perceived it as effective in achieving this. Patients and therapists understood the benefits of working with a combination of occupational therapy and clinical psychology. The intervention fits with the values of patients wanting to recover, therapists wanting to offer support and line managers wanting to meet employer and employee needs.Patients reported they could not have achieved RTW without the intervention, and their therapist helped them feel less alone. Therapists felt that their work was rewarding, effective and had good outcomes. Patients perceived remote delivery as less burdensome than attending in person. Therapists felt they wasted time on non-patient activity, such as (re-)arranging appointments.Employers discussed the difficulty of balancing employer and employee needs and managing uncertainty. Some workplace policies lacked flexibility, and without the ROWTATE intervention, employers lacked confidence in supporting employees RTW. CONCLUSIONS: A VR intervention delivered remotely by OTs and CPs is acceptable to patients, therapists and employers. TRIAL REGISTRATION NUMBER: ISRCTN43115471.https://bmjopen.bmj.com/content/15/10/e09804
Respiratory failure with pregnancy: acute exacerbation of asthma or cardiogenic pulmonary oedema
No full textWe present a complex case involving a 37-year-old pregnant woman at 13 weeks of gestation who developed respiratory failure. The patient had a known history of asthma, which initially created a diagnostic challenge, resulting in treatment for an acute asthma exacerbation. However, as the patient's clinical condition deteriorated, further investigations were conducted, leading to a diagnosis of severe rheumatic mitral valve stenosis. The patient underwent emergency mitral valve replacement, unfortunately resulting in a miscarriage. Nevertheless, the final maternal outcome was favourable.https://www.cureus.com/articles/411860-respiratory-failure-with-pregnancy-acute-exacerbation-of-asthma-or-cardiogenic-pulmonary-oedema#!
Investigating inequalities in admissions of young people out-of-area or to adult psychiatric wards : a qualitative study
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing,
adaptation, distribution and reproduction in any medium or format,
as long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons licence, and indicate
if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless
indicated otherwise in a credit line to the material. If material is not
included in the article’s Creative Commons licence and your intended
use is not permitted by statutory regulation or exceeds the permitted
use, you will need to obtain permission directly from the copyright
holder. To view a copy of this licence, visit http://creativecommons.o
rg/licenses/by/4.0/.High occupancy rates and uneven bed distribution throughout England mean some young people are admitted to Child and Adolescent Mental Health Service beds out-of-area or to adult psychiatric wards in Adult Mental Health Services. No previous research has investigated how the characteristics of young people, families, or services may influence the impact of these types of admissions.https://link.springer.com/article/10.1007/s00787-025-02849-
Predictors of psychological well-being during imposed prolonged absence from work
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article
are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the
article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to
obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Background Between March 2020 and September 2021, 11.7 million employee jobs were furloughed through the UK Coronavirus Job Retention Scheme (JRS). Imposed work absence shielded workers from job loss, but furloughed workers had increased risk of poor mental health compared to those who stayed working. Understanding the factors that mitigate psychological distress during imposed work absence can inform actions to be taken in future crises. Aims To explore the relationships between (a) work and home demands with well-being outcomes, and (b) personal and organisational resources with well-being outcomes, during periods of imposed prolonged absence and uncertainty. Methods We analysed online survey data collected with furloughed workers in the UK ‘Wellbeing of the Workforce Study’. Measures included psychological well-being, anxiety, life satisfaction, job insecurity, home demands (quantitative and emotional), organisational support for work-family balance, and personal resources (resilience, purpose, and coping ability). Results Psychological well-being was associated positively with quantitative home demands (β = 0.24, p < 0.05) and personal resources (β = 0.45, p < 0.001). Life satisfaction was associated negatively with emotional demands at home (β = –0.26, p < 0.05) and positively with personal resources (β = 0.30, p < 0.05). Perceived job insecurity was positively associated with anxiety (β = 0.36, p < 0.001). Conclusions Job-related factors are less influential during periods of employment uncertainty compared to personal and home resources. Decision-makers should provide psychological support during periods of job uncertainty and bolster the essential benefits of personal and home resources. Moving forwards, these findings may have broader applicability to other challenges and crises, such as suspension from work, or role changes resulting from organisational restructuring.https://link.springer.com/article/10.1186/s12982-025-01056-
Evaluation of a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France : stepped-wedge cluster randomised controlled trial protocol
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International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you
give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the
licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the
material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or
exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati
vecommons.org/licenses/by-nc-nd/4.0/While recovery orientation is national policy in many countries, evidence remains limited for the effectiveness at a service level. This paper describes the protocol for implementing a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France. The aim is to evaluate whether REFOCUS-RETAFORM plus usual care leads to improved outcomes for adolescent and adult mental health service users compared with usual care alone.https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-07253-