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Objectives: To explore the experiences of women and health professionals when communicating about combined hormonal contraceptives (CHCs), with a focus on venous thromboembolism (VTE). We also focused on information sources consulted by women for their decision-making process regarding contraceptives., Design: Qualitative semistructured face-to-face interviews were conducted with 24 women and 16 health professionals. The study followed a phenomenological approach, and data were synthesised using the framework analysis method., Setting: Community health centres across three countries in the UK, Denmark, and Slovakia., Participants: Adult (aged 18+) women using CHC and health professionals eligible to prescribe CHC in their respective countries., Results: Women tended to be positive about CHC's safety and seek information about CHC through their health professionals, family and friends. They would like to receive further information from health professionals, particularly when it comes to risks of CHC and alternative methods of contraception. Health professionals reported using a variety of methods to communicate about CHC and generally report giving advice based on national and local guidelines. In line with women's perspectives, they reported time constraints and lack of resources as barriers to communication about CHC. Health professionals in our sample believed there is a lack of standardisation in the information offered and guidelines used to prescribe CHC, with little contact with international regulators such as the European Medicines Agency., Conclusions: It is necessary to improve the conditions under which contraceptive counselling is provided, as well as supporting health professionals in this task. Exploring the lived experiences of women and health professionals about how they discuss contraception choices can shed light on the best approaches to improve reproductive health consultations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities., Methods: We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL)., Results: The intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = -0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = -0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study., Limitations: The highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low., Conclusion: The trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services., Trial Registration: ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347)., Competing Interests: Declaration of competing interest All authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: To validate codelists for defining a range of mental health (MH) conditions with primary care data, using a mixed qualitative and quantitative approach and without requiring external data., Methods: We validated Read codelists, selecting and classifying them in three steps. The qualitative step included an in-depth revision of the codes by six doctors. Simultaneously, the quantitative step performed on UK primary care data included an exploratory factor analysis to cluster Read codes in MH conditions to obtain an independent classification. The statistical results informed the qualitative conclusions, generating a final selection and classification., Results: From a preselected list of 2007 Read codes, a total of 1638 were selected by all doctors. Later, they agreed on classifying these codes into 12 categories of MH disorders. From the same preselected list, a total of 1364 were quantitatively selected. Using data from 497,649 persons who used these Read codes at least once, we performed the exploratory factor analysis, retaining five factors (five categories). Both classifications showed good correspondence, while discrepancies informed decisions on reclassification., Conclusions: We produced a comprehensive set of medical codes lists for 12 MH conditions validated by a combination of clinical consensus panel and quantitative cluster analysis with cross-validation., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Background: Nearly 3% of adults have attention-deficit and hyperactivity disorder (ADHD), although in the UK, most are undiagnosed. Adults with ADHD on average experience poorer educational and employment outcomes, worse physical and mental health and are more likely to die prematurely. No studies have yet used mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD in the UK or worldwide., Aims: This study used the life-table method to calculate the life-expectancy deficit for people with diagnosed ADHD using data from UK primary care., Method: A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000-2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD., Results: Around 0.32% of adults in the cohort had an ADHD diagnosis, ~1 in 9 of all adults with ADHD. Diagnoses of common physical and mental health conditions were more common in adults with diagnosed ADHD than the comparison group. The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females., Conclusions: Adults with diagnosed ADHD are living shorter lives than they should. We believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions. This study included data from adults with diagnosed ADHD; the results may not generalise to the entire population of adults with ADHD, the vast majority of whom are undiagnosed.

Background Antidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults (e.g. falls, stroke, cognitive decline). Randomised Controlled Trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects. Aim To examine risk of PH associated with antidepressants in adults aged ≥60 in UK primary care. Design & setting Self-controlled case series using routinely collected primary care data from the IQVIA Medical Research Database (IMRD). Method We obtained data from >41,000 adults aged ≥60 in IMRD between 1 Jan 2000 to 31 Dec 2018. Antidepressant prescriptions were determined using code lists based on British National Formulary classification. Risk of PH was examined during four risk-periods (90-days pre-prescription; day 1-28, 29-56, 57+) compared with periods outside these risk windows. Results Amongst 41,005 people with incident PH in the study period, 8,313 were prescribed a selective-serotonin reuptake inhibitor (SSRI); 8,899 were prescribed a tricyclic antidepressant (TCA); and 4,656 were prescribed an "Other antidepressant". We observed a consistent increased risk of PH in day 1-28 in all antidepressants, that reduced thereafter. Risk of PH was highest with SSRIs (IRR 4.22, 95% CI: 3.76-4.74), followed by "Other antidepressants" (IRR 2.17 (95% CI: 1.76- 2.68), TCAs (IRR 2.12, 95% CI: 1.79-2.50). Conclusion A striking increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider PH monitoring when initiating antidepressants., (Copyright © 2024, The Authors.)

Background: There is some evidence that perinatal anxiety (PNA) is associated with lower rates of infant vaccinations and decreased access to preventative infant healthcare, but results across studies have not been conclusive., Objective: To investigate the relationship between maternal PNA and infant primary care use., Methods: Cohort study of mother-infant pairs identified between 1998 and 2016 using IQVIA Medical Research Database (IMRD). PNA was identified through prescription, diagnosis and symptom records from start of pregnancy up to 1 year after birth. Outcomes include primary care consultation rate, attendance at the 6-8 week infant check and uptake of the infant 5-in-1 vaccination, comparing unadjusted rates of consultations and using logistic regression to analyse other outcomes., Findings: Of the 248 618 women, 11 558 (4.7%) had a record of PNA. Infants of mothers with PNA had, on average, one more primary care consultation/person-year compared with those without (9.7 vs 8.7) in the year after birth. Mothers with PNA were more likely to have an infant who was vaccinated (adjusted OR (aOR) 1.33, 95% CI 1.20 to 1.48) but were less likely to have a record of attendance at the 6-8 week infant check (aOR 0.88, 95% CI 0.81 to 0.95)., Conclusions: Infants of mothers with PNA had, on average, a slightly higher rate of primary care consultations and were more likely to be vaccinated but less likely to have a record of an infant check., Clinical Implications: Midwives and General Practitioners (GPs) providing care should consider how PNA may impact on infant health and how infant health may impact on maternal anxiety., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ.)

Importance: Current evidence of the association between prenatal exposure to glucocorticoids and long-term mental disorders is scarce and has limitations., Objective: To investigate the association between prenatal exposure to systemic glucocorticoids and mental disorders in offspring at the age of 15 years, comparing exposed vs unexposed offspring born to mothers with the same underlying disease (risk of preterm delivery and autoimmune or inflammatory disorders)., Design, Setting, and Participants: This nationwide population-based cohort study used data from registries in Denmark with follow-up until December 31, 2018. Participants included all Danish infants born alive from 1996 to 2016. Analyses were performed from January to December 2023., Exposures: Prenatal exposure to systemic glucocorticoids., Main Outcomes and Measures: Fifteen-year crude and adjusted risks, risk differences, and risk ratios (RR) for mental disorders using Kaplan-Meier estimator comparing exposed vs unexposed offspring born to mothers with the same underlying disease., Results: A total of 1 061 548 infants (52% male) were included in the final study cohort, including 31 518 born to mothers at risk of preterm delivery and 288 747 born to mothers with autoimmune or inflammatory disorders. Among offspring born to mothers at risk of preterm delivery, the adjusted risks for exposed vs unexposed were 6.6% vs 4.3% (RR, 1.5 [95% CI, 1.2-1.9]) for autism spectrum disorders; 1.6% vs 1.3% (RR, 1.3 [95% CI, 0.8-1.8]) for intellectual disabilities; 5.8% vs 4.3% (RR, 1.3 [95% CI, 1.0-1.7]) for attention-deficit hyperactivity disorder (ADHD); and 7.2% vs 4.6% (RR, 1.5 [95% CI, 1.1-2.0]) for mood, anxiety, and stress-related disorders. Among offspring born to mothers with autoimmune or inflammatory disorders, the adjusted risks for exposed vs unexposed were 4.8% vs 3.8% (RR, 1.3 [95% CI, 1.1-1.5]) for autism spectrum disorders; 1.1% vs 0.8% (RR 1.4, [95% CI, 0.9-2.0]) for intellectual disabilities; 5.5% vs 4.4% (RR, 1.3 [95% CI, 1.0-1.5]) for ADHD; and 6.6% vs 4.6% (RR, 1.4 [95% CI, 1.2-1.8]) for mood, anxiety, and stress-related disorders. Findings were confirmed through an active comparator and sibling design. However, confounding by disease severity could not be ruled out., Conclusions and Relevance: In this cohort study, prenatal exposure to glucocorticoids was associated with higher risk of some mental disorders. These data support continued caution in the use of glucocorticoids in pregnant people.