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Introduction In France, chronic insomnia affects 15.8% of the general population. It is frequently observed among people with psychiatric disorders, and significantly impacts clinical outcomes, treatment responses, functional abilities, quality of life, and sleep medication use. In France, public outpatient psychiatric services represent the main access point to psychiatric care. However, to date, we found no study that explored the prevalence of insomnia among patients receiving care in these settings. This study aimed to estimate the prevalence of insomnia in outpatient public psychiatric services and to describe associated factors and current care management. Method We conducted a monocentric, descriptive, cross-sectional study using a patient questionnaire and a pseudo-random sampling method. All adult patients getting care appointment on January 18, 2024, in the Community Mental Health Centers, Community-Based Rehabilitation Centers, and Psychiatric Day Hospitals affiliated with the Guillaume Régnier Psychiatric Hospital in Rennes, France, were eligible. Insomnia was assessed using the Insomnia Severity Index (score of ≥ 15 indicating clinical insomnia). Sociodemographic, clinical, comorbidity, and sleep hygiene data were collected through the questionnaire and compared between patients with and without insomnia via logistic regression. Results Out of 624 eligible individuals, 511 completed the survey (participation rate: 81.9%). The prevalence of clinical insomnia was 34.8%. In multivariate analysis, higher education level (A-Level: Odds Ratio 2.11, p  = 0.019; Post-A-Level: OR 2.06, p  = 0.007), depressive disorders (OR 2.16, p  = 0.039), nighttime exposure to light/noise (OR 1.82, p  = 0.013), and screen use before bedtime (OR 1.90, p  = 0.021) were significantly associated with a higher probability of having insomnia, conversely to financial stability (It’s all right: OR 0.38, p  = 7.1 E − 4 ; It’s tigh: OR 0.40, p  = 0.003) and regular sleep schedules (OR 0.25, p  = 2.1 E − 9 ) significantly associated with a lower probability. The main care management was sleep medication (61.2% of those with insomnia vs. 45.3% without). Non-pharmacological approaches such as CBT-I (4.5%), and sleep hygiene education groups (3.7%) were infrequently used. Conclusion This study reveals the high prevalence of clinical insomnia among individuals receiving outpatient psychiatric care. It highlights specific risk factors and underlines the predominance of pharmacological care management, raising concerns about iatrogenic effects. There is a need to develop accessible and adapted non-pharmacological treatments. Clinical trial number Not applicable.

Background: Perfectionism has been linked to suicide. According to the Narrative-Crisis Model of suicide, individuals with trait vulnerabilities are prone to develop a certain mindset, known as a Suicidal Narrative, which may precipitate the Suicide Crisis Syndrome (SCS), culminating in suicide. The purpose of this study was to investigate the association between perfectionism (trait vulnerability), fear of humiliation (component of the Suicidal Narrative), SCS, and prospective near-term suicidal thoughts and behaviors (STB). Methods: Adult psychiatric outpatient participants (N = 336) were assessed at baseline with the Suicidal Narrative Inventory for perfectionism and fear of humiliation. The questions used to assess perfectionism were adapted from the Multidimensional Perfectionism Scale. The severity of the SCS was calculated using the Suicide Crisis Inventory. STB were assessed at baseline and after one month using the Columbia Suicide Severity Rating Scale. Serial mediation analyses were conducted using PROCESS version 3.3 in SPSS. Results: While the direct effect of perfectionism on prospective STB was not significant (b = 0.01, p = 0.19), the indirect effect of perfectionism on STB, through serial mediation by fear of humiliation and the SCS, was significant (indirect effect p = 0.007, 95% CI [0.003, 0.013]). The indirect effect was not significant for models that did not include both mediators. Limitations: Variables were assessed at one time only. Conclusion: Perfectionism did not directly modulate STB. Perfectionism may be related to suicidal behavior through fear of humiliation, leading to the SCS. These results support the Narrative-Crisis Model of suicide and clarify the role of perfectionism in the etiology of suicide.

Restless Legs Syndrome (RLS) is a prevalent yet underdiagnosed neurological disorder that significantly affects quality of life. It is commonly associated with psychiatric conditions, particularly depression and anxiety. Epidemiological data on RLS prevalence among psychiatric populations are limited and virtually absent in Lebanon. This study estimated RLS prevalence among psychiatric outpatients and assessed its impact on sleep quality, daytime sleepiness, anxiety, and depression, comparing findings to international literature. In this cross-sectional study, adult psychiatric outpatients were screened using International Restless Legs Syndrome Study Group (IRLSSG) criteria. Additional questionnaires included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9(PHQ-9), and Generalized Anxiety Disorder-7(GAD-7). Bivariate analysis compared patients with and without RLS. Multivariate regressions were utilized to adjust for potential confounders. Of 130 participants 25.4% had RLS. These patients showed significantly poorer sleep (PSQI = 11.18vs.8.10, p  = 0.002), more depressive symptoms(PHQ-9 = 15.52vs.9.88, p  < 0.001), and greater anxiety(GAD-7 = 15.26vs.9.51, p  < 0.001), however, no significant difference was found in daytime sleepiness (ESS = 8.42vs.7.63, p  = 0.405 ). RLS was significantly associated with suicidal ideation( p  < 0.001). Correlation analysis revealed significant associations between RLS severity and both sleep disruption and psychiatric symptom severity. In conclusion, RLS is highly prevalent among psychiatric outpatients in Lebanon and is strongly associated with worse mental health and increased suicidal ideation.

Abstract Introduction: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. Methods: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Results: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, −0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. Conclusions: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies. Resumo Introdução: O Patient Health Questionnaire-9 (PHQ-9) é uma ferramenta breve de triagem e diagnóstico para depressão. Tem sido usado em pesquisa e na prática clínica primária e em outros contextos clínicos e não clínicos. O PHQ-9 não teve sua validade examinada em contextos psiquiátricos e psicológicos no Irã. Métodos: Um estudo transversal foi conduzido para investigar a validação da versão persa do PHQ-9. Uma amostra de conveniência de 130 pacientes psiquiátricos ambulatoriais iranianos foi selecionada em clínicas psiquiátricas e psicológicas. Os pacientes completaram o PHQ-9, Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5) e a forma abreviada do Beck Depression Inventory-13 (BDI-13). Os dados foram analisados por estatística descritiva, α de Cronbach, coeficiente de correlação de Pearson, análise de componentes principais e análise fatorial exploratória e confirmatória. Resultados: O escore médio do PHQ-9 foi 12,83 (desvio padrão=6,25), indicando depressão moderadamente severa na amostra. O α de Cronbach para PHQ-9 foi 0,88, e a confiabilidade teste-reteste de uma semana 0,79. O PHQ-9 apresentou correlação de 0,64 com PHQ-15, −0,35 com WHO-5 e 0,70 com BDI-13, indicando boa validade do construto e dos critérios relacionados. Os resultados da análise fatorial dos itens do PHQ-9 identificaram, e a análise fatorial confirmatória confirmou, um único fator, chamado depressão geral. Conclusões: O PHQ-9 parece ter uma estrutura unidimensional, validade e confiabilidade adequadas, e pode ser útil em contextos epidemiológicos e de pesquisa. Com base na literatura prévia e neste estudo, o PHQ-9 pode ter aplicabilidade em outros contextos na população estudada, mas isso precisa ser confirmado.

Background Initial adherence is a predictor of long-term adherence and thus is a crucial metric to explore and support. This study aimed to investigate initial adherence by psychiatric outpatients and relevant personal factors. Methods The study surveyed psychiatric outpatients using a 30-day timely return visit rate (TRVR) after the first visit to indicate initial adherence. All participants agreed to engage in the self-designed survey and assessments of the Eysenck Personality Questionnaire (EPQ) and Symptoms Checklist-90 (SCL-90). Clients who missed timely return visits received telephone follow-up to determine the main reasons. Results The overall TRVR was 59.4, and 40.6% of clients missed return visits. Logistic regression analysis revealed risk factors for initial adherence were work, tense family atmosphere, negative attitudes towards medication, higher EPQ psychoticism score, and lower SCL-90 phobic anxiety score. The main reasons given for non-timely return visits were improvement suggesting lack of need for a return visit, various barriers, no improvement, and side effects. Conclusion Psychiatric outpatients had poor initial adherence related to multiple dimensional factors, including job, family, personality characteristics, mental status, and thoughts about mental illness and treatments.

•Mortality and suicide death rates were high in discharged forensic patients.•Suicide accounted for over half of all the deaths.•Proportion for death by natural causes was low.•Univariate analysis showed that women had higher suicide death risk than men. Japanese forensic mental health services for patients with psychiatric disorders under the Medical Treatment and Supervision Act was initiated in 2005; however, the prognosis of those patients is not well-known, particularly regarding mortality and suicide. This study aimed to evaluate the all-cause mortality and suicide rate in forensic psychiatric outpatients who had been discharged from forensic psychiatric wards in Japan. Participants included 966 patients who had been discharged from forensic psychiatric wards. Data were collected from July 15, 2005 to July 15, 2018 at 29 of the 33 forensic psychiatric wards in Japan. Only the patients who provided written informed consent were included. We and collaborators at each forensic psychiatric ward identified demographic data of participants from the medical records for the inpatient treatment period. The reintegration coordinators, who belonged to the Ministry of Justice, investigated the prognosis of the participants during the outpatient treatment order period. We then connected demographic data and participants’ prognosis for analysis. The crude rates (CRs) and standardized mortality ratios (SMRs) were calculated to analyze all-cause mortality and suicide rates. Univariate analysis was performed to examine the factors associated with all-cause mortality and suicide rates using the Cox proportional hazards ratio model. The participants included 3.3 times as many men (n=739) compared to women (n=227), and their combined mean age was 47.3 (SD=12.9). The most common primary psychiatric diagnosis was psychotic disorders (81.3%). The mean follow-up period was 790.2 days (SD=369.6). The total observation period was 2091.2 person-years. The CR for all-cause death was 812.9 per 100,000 person-years (95% CI [426.5, 1199.4]), while the SMR for all-cause death was 2.2 (95% CI [1.3, 3.5]). The CR for completed suicide was 478.2 per 100,000 person-years (95% CI [181.8, 774.6]). The suicide SMR was 17.9 (95% CI [8.6, 32.9]) overall, 7.7 (95% CI [2.5, 18.0]) for men, and 79.4 (95% CI [25.8, 185.2]) for women. Univariate analysis showed that women had higher completed suicide risk than men (hazard ratio=3.599, 95% CI [1.041, 12.445]). The all-cause mortality and completed suicide rates were higher in participants than observed in the general population consistent with the results of previous international studies.

BackgroundThis cross-sectional study aimed to explore health-related quality of life (HRQoL) in a large heterogeneous patient sample seeking outpatient treatment at a specialist mental health clinic.MethodA sample of 1947 patients with common mental disorders, including depressive-, anxiety-, personality-, hyperkinetic- and trauma-related disorders, completed the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) to assess HRQoL. We investigated clinical and sociodemographic factors associated with the EQ-5D index and the EQ Visual Analogue Scale (VAS) using regression analyses.ResultsThe sample reported lower HRQoL compared with the general population and primary mental health care patients. Sick leave, disability pension, work assessment allowance, and more symptoms of anxiety and depression were associated with lower EQ-5D index and EQ VAS scores. Furthermore, being male, use of pain medication and having disorders related to trauma were associated with reduced EQ-5D index scores, while hyperkinetic disorders were associated with higher EQ-5D index scores.ConclusionHRQoL of psychiatric outpatients is clearly impaired. This study indicated a significant association between employment status, symptom severity, and HRQoL in treatment-seeking outpatients. The findings highlight the importance of assessing HRQoL as part of routine clinical assessment.

Introduction In response to the COVID-19 pandemic, a general lockdown was enacted across Germany in March 2020. As a consequence, patients with mental health conditions received limited or no treatment in day hospitals and outpatient settings. To ensure continuity of care, the necessary technological preparations were made to enable the implementation of telemedical care via telephone or video conferencing, and this option was then used as much as possible. The aim of this study was to investigate the satisfaction and acceptance with telemedical care in a heterogeneous patient group of psychiatric outpatients in Germany during the first COVID-19 lockdown. Methods In this observational study, patients in ongoing or newly initiated outpatient psychiatric therapy as well as those who had to be discharged from the day clinic ahead of schedule received telemedical treatment via telephone. Data collection to assess the patients’ and therapists’ satisfaction with and acceptance of the telemedical care was adjusted to the treatment setting. Results Of 60 recruited patients, 57 could be included in the analysis. 51.6% of the patients and 52.3% of their therapists reported that the discussion of problems and needs worked just as well over the phone as in face-to-face consultations. In the subgroup of patients who were new to therapy due to being discharged from hospital early, acceptance was higher and telemedicine was rated as equally good in 87.5% of contacts. Both patients and therapists felt that telemedicine care during lockdown was an alternative for usual therapy in the outpatient clinic and that the option of telemedicine care should continue for the duration of the coronavirus pandemic. Discussion The results show a clear trend towards satisfaction with and acceptance of telemedicine care in a heterogeneous group of unselected psychiatric patients. Although the number of patients is small, the results indicate that the mostly positive results of telemedicine concepts in research projects can probably be transferred to real healthcare settings. Conclusions Telemedicine can be employed in healthcare for psychiatric patients either an alternative treatment option to maintain continuity of care or as a potential addition to regular care.

Abstract Introduction: The association between psychological well-being and physical and mental health has been shown in the literature. Psychological well-being is a multifaceted concept. The World Health Organization-5 Well-Being Index (WHO-5) is a 5-item instrument used to screen for depression. However, the validity of the WHO-5 has not been investigated in Iranian psychiatric or psychological settings. Objective: To investigate the validation of the Farsi version of the WHO-5 in a sample of Iranian psychiatric outpatients. Methods: A cross-sectional study was conducted with a convenience sample of 116 Iranian volunteer psychiatric outpatients selected from the psychiatric and psychological clinics at the School of Behavioral Sciences and Mental Health - Tehran Institute of Psychiatry, Iran University of Medical Sciences. Patients completed the WHO-5, the Patient Health Questionnaire-9 (PHQ-9), the Patient Health Questionnaire-15 (PHQ-15), and the short form of the Beck Depression Inventory-13 (BDI-13). Results: The mean score of the WHO-5 was 8.95 (standard deviation [SD] = 5.49). Cronbach's α for the WHO-5 was 0.91. The WHO-5 negatively correlated with PHQ-9 (-0.358), PHQ-15 (-0.328), and BDI-13 (-0.475), indicating good validity. Factor analysis of the WHO-5 items identified one factor labeled psychological well-being. Conclusions: The WHO-5 has a single dimensional structure and acceptable psychometric parameters. The results of this study suggest that WHO-5 can be used in a clinical context in Iran. Resumo Introdução: A associação entre bem-estar psicológico e saúde física e mental tem sido demonstrada na literatura. Bem-estar psicológico é um conceito multifacetado. O World Health Organization-5 Well-Being Index (WHO-5) é um instrumento composto por 5 itens utilizado para avaliar depressão. No entanto, a validade do WHO-5 não foi investigada em contextos psiquiátricos ou psicológicos iranianos. Objetivo: Investigar a validade da versão persa do WHO-5 em uma amostra de pacientes psiquiátricos ambulatoriais iranianos. Métodos: Um estudo transversal foi conduzido com uma amostra de conveniência composta por 116 pacientes psiquiátricos ambulatoriais iranianos voluntários selecionados nas clínicas psiquiátrica e psicológica da School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences. Os pacientes completaram o WHO-5, o Patient Health Questionnaire-9 (PHQ-9), o Patient Health Questionnaire-15 (PHQ-15) e a versão abreviada do Beck Depression Inventory-13 (BDI-13). Resultados: O escore médio obtido no WHO-5 foi de 8,95 (desvio padrão = 5,49). O alfa de Cronbach para o WHO-5 foi 0,91. O WHO-5 se correlacionaram negativamente com o PHQ-9 (-0,358), o PHQ-15 (-0,328) e o BDI-13 (-0,475), indicando validade adequada. A análise fatorial dos itens do WHO-5 identificaram um único fator, a saber, bem-estar psicológico. Conclusão: O WHO-5 tem uma estrutura dimensional única e parâmetros psicométricos aceitáveis. Os resultados deste estudo sugerem que o WHO-5 pode ser usado em contextos clínicos no Irã.

This study aimed to investigate the immediate and short-term impact of the pandemic on the psychological well-being of Italian children and adolescents with psychiatric disorders and their families. Overall, 56 patients aged 6–18 (M = 13.4 years, SD = 2.77) and their parents were evaluated during the COVID-19 lockdown (T0) and after 4 months (T1). An ad hoc data sheet, Youth Self-Report 11–18 (YSR), Child Behavior Checklist 6–18 (CBCL), and Depression Anxiety Stress Scale-21 (DASS-21) were administered. Patients, mainly suffering from internalizing disorders, overall demonstrated a good adaptation to the pandemic context. Moreover, patients with behavioral disorders showed a greater psychological discomfort at both T0 and T1 compared to patients with internalizing disorders. Over time, patients presented an improvement on the emotional side, as proven by a significant decrease in internalizing and post-traumatic stress problems. Finally, no significant differences were found in the emotional-behavioral profile of patients according to the means of conducting neuropsychiatric interventions during the lockdown (i.e., in person/remotely/interrupted), thus allowing us to exclude important negative effects caused by the transition to remote therapy. Concerning parents, an inverse relationship emerged between the DASS-21 scores and the level of resilience, which therefore represents a protective factor against psychological maladjustment. Over time, an improvement in the psychological well-being of parents was observed, as shown by a significant decrease in mothers’ anxiety and fathers’ stress.