Readmission rate is considered an indicator of the mental health care quality. Previous studies have examined a number of factors that are likely to influence readmission. The main objective of this systematic review is to identify the studied pre-discharge variables and describe their relevance to readmission among psychiatric patients. Studies on the association between pre-discharge variables and readmission after discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. Relevant publications published between January 1990 and June 2014 were included. For each variable, the number of papers that considered it as a predictor of readmission and that found a significant association was recorded, together with the association direction and whether it was found respectively in bivariate and in multivariate analyses. Of the 734 articles identified in the search, 58 papers were included in this review, mainly from the USA and concerning patients with severe mental disorders. Analysed variables were classified according to the following categories: patients’ demographic, social and economic characteristics; patients’ clinical characteristics; patients’ clinical history; patients’ attitude and perception; environmental, social and hospital characteristics; and admission and discharge characteristics. The most consistently significant predictor of readmission was previous hospitalisations. Many socio-demographic variables resulted as influencing readmission, but the results were not always homogeneous. Among other patients’ clinical characteristics, diagnosis and measures of functional status were the most often used variables. Among admission characteristics, length of stay was the main factor studied; however, the results were not very consistent. Other relevant aspects resulted associated with readmission, including the presence of social support, but they have been considered only in few papers. Results of quality assessment are also reported in the review. The majority of papers were not representative of the general psychiatric population discharged from an inpatient service. Almost all studies used multivariate analytical methods, i.e., confounders were controlled for, but only around 60% adjusted for previous hospitalisation, the variable most consistently considered associated to readmission in the literature. The results contribute to increase knowledge on pre-discharge factors that could be considered by researchers as well as by clinicians to predict and prevent readmissions of psychiatric patients. Associations are not always straightforward and interactions between factors have to be considered.

To compare second-generation antipsychotics (SGAs) and mood stabilizers (MSs) in youth with a bipolar disorder type-1 (BD-I) manic/mixed episode. Systematic PubMed/Embase/PsycInfo literature search until 12/31/2023 for randomized trials of SGAs or MSs in patients aged ≤18 years with BD-I manic/mixed episode. Network meta-analysis comparing treatments regarding mania symptoms and mania response (co-primary outcomes), and secondary efficacy and tolerability outcomes. Eighteen studies (n=2844, mean age=11.74, females=48.0%, mean study duration=5.4 weeks) comparing six SGAs (aripiprazole, asenapine, olanzapine, quetiapine, risperidone, ziprasidone) and four MSs (lithium, oxcarbazepine, topiramate, valproate) were meta-analyzed. All six SGAs outperformed placebo in reducing manic symptomatology, including risperidone (SMD=-1.18,95%CI=-0.92;-1.45, CINeMA= moderate confidence), olanzapine (SMD=-0.77,95%CI=-0.36;-1.18, low confidence), aripiprazole (SMD=-0.67,95%CI=-0.33;-1.01, moderate confidence), quetiapine (SMD=-0.60,95%CI=-0.32,-0.87, high confidence), asenapine (SMD=-0.54,95%CI=-0.19; -0.89, moderate confidence), and ziprasidone (SMD=-0.43,95%CI=-0.17-0.70, low confidence), while no mood stabilizer outperformed placebo. Concerning mania response, risperidone (RR=2.58,95%CI=1.88;3.54, low confidence), olanzapine (RR=2.42,95%CI=1.33-3.54, very low confidence), aripiprazole (RR=2.05,95%CI=1.44-2.92, low confidence), quetiapine (RR=1.89,95%CI=1.45-2.47, moderate confidence), asenapine (RR=1.81,95%CI=1.28-2.55, very low confidence) and lithium (RR=1.35,95%CI=1.00;1.83, p-value=0.049, very low confidence) outperformed placebo, without superiority of other MSs versus placebo. Individually, risperidone was more efficacious in reducing manic symptomatology than all other comparators, except olanzapine and topiramate, yet with low/very low confidence, and was associated with increased prolactin and glucose. Pooled together, SGAs outperformed both placebo and MSs for mania symptoms reduction (SMD=-0.68,95%CI=-0.86;-0.51 and SMD=-0.61,95%CI=-0.82;-0.40, moderate confidence), and mania response (RR=1.85,95%CI=1.53;2.24 and RR=1.65,95%CI=1.33-2.04, moderate confidence) without differences between MSs and placebo. There were no significant treatment-placebo differences for all-cause discontinuation, while lithium, ziprasidone and oxcarbazepine were associated with more adverse event-related drop-outs than placebo. Most SGAs were associated with more sedation, weight gain, and metabolic issues versus placebo and MSs. SGAs are more efficacious than placebo and MSs in treating acute mania symptoms, however, their use must be carefully weighed against important side effects.

Aims: As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. Methods: Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. Results: Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389–1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180–1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001). Conclusions: The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.

Aims: WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services’ utilisation, by considering psychiatric diagnoses and type of mental health contacts. Methods: The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A ‘difference in differences’ approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated. Results: In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients’ characteristics considered (except for people aged 18–24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (−33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions. Conclusions: Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.

Background: University students frequently face mental health challenges due to academic pressures, lifestyle changes, and developmental factors. Digital interventions, such as Doing What Matters in Times of Stress (DWM), a psychosocial e-mental health intervention developed by the World Health Organization (WHO), offer scalable approaches to address these issues. These data emerging from the literature provide the framework for the CAMPUS (Characterize and Address Mental health Problems in University Students) study aimed at supporting the mental health of students attending the University of Verona. Objective: This study aimed to assess the effectiveness and implementability of DWM as a psychological strategy for effective mental health prevention and promotion, as well as for reducing psychological symptoms and distress and improving well-being in university students. Methods: During the study period (October 2023-June 2024), we conducted a prospective hybrid type-1 nonrandomized follow-up study, with a pretest-posttest design. The study population consisted of students attending the University of Verona, who were recruited through university communication channels and participated via web-based platforms. Data were collected at baseline (T1) and after the intervention (T2) using an ad hoc sociodemographic information page and self-reported tools assessing psychological distress with the Kessler-10 (K-10), depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9) depression scale, anxiety symptoms with the Generalized Anxiety Disorder-7 (GAD-7) scale, and psychological well-being with the WHO-5 Well-Being Index (WHO-5). In addition, at postintervention, the implementability was assessed. Statistical analyses included Wilcoxon matched pairs signed rank tests and logistic regression models to identify associated factors. Results: Out of 2296 interested students, 1498 (65.24%) completed all DWM sessions and assessments. At T1, students exhibited mild psychological distress, anxiety, and depressive symptoms with moderate well-being. Significant improvements were observed postintervention: the K-10 scores decreased from 22.41 (SD 6.54) to 19.86 (SD 5.96), the GAD-7 scale scores decreased from 8.27 (SD 4.31) to 6.57 (SD 3.76), and the PHQ-9 scores decreased from 8.28 (SD 7.73) to 6.75 (SD 4.37; all P<.001). The WHO-5 well-being scores increased from 11.73 (SD 4.65) to 13.26 (SD 4.68; P<.001). Satisfaction was high, with 90.72% (1359/1498) of participants agreeing or strongly agreeing on satisfaction, 77.37% (1159/1498) agreeing or strongly agreeing on appropriateness, and 94.99% (1423/1498) finding the program easy to use. No significant differences in clinical outcomes were associated with sociodemographic or baseline mental health variables. Conclusions: The DWM intervention demonstrated positive effects on students’ mental health, showing reductions in distress, anxiety, and depressive symptoms, alongside improved well-being. The program’s high levels of acceptability, appropriateness, and feasibility highlight its potential for broader application as a digital mental health strategy for university students.