research topics in mental health

Research Topics & Ideas: Mental Health

100+ Mental Health Research Topic Ideas To Fast-Track Your Project

If you’re just starting out exploring mental health topics for your dissertation, thesis or research project, you’ve come to the right place. In this post, we’ll help kickstart your research topic ideation process by providing a hearty list of mental health-related research topics and ideas.

PS – This is just the start…

We know it’s exciting to run through a list of research topics, but please keep in mind that this list is just a starting point . To develop a suitable education-related research topic, you’ll need to identify a clear and convincing research gap , and a viable plan of action to fill that gap.

If this sounds foreign to you, check out our free research topic webinar that explores how to find and refine a high-quality research topic, from scratch. Alternatively, if you’d like hands-on help, consider our 1-on-1 coaching service .

Overview: Mental Health Topic Ideas

Mood disorders
Anxiety disorders
Psychotic disorders
Personality disorders
Obsessive-compulsive disorders
Post-traumatic stress disorder (PTSD)
Neurodevelopmental disorders
Eating disorders
Substance-related disorders

Mood Disorders

Research in mood disorders can help understand their causes and improve treatment methods. Here are a few ideas to get you started.

The impact of genetics on the susceptibility to depression
Efficacy of antidepressants vs. cognitive behavioural therapy
The role of gut microbiota in mood regulation
Cultural variations in the experience and diagnosis of bipolar disorder
Seasonal Affective Disorder: Environmental factors and treatment
The link between depression and chronic illnesses
Exercise as an adjunct treatment for mood disorders
Hormonal changes and mood swings in postpartum women
Stigma around mood disorders in the workplace
Suicidal tendencies among patients with severe mood disorders

Anxiety Disorders

Research topics in this category can potentially explore the triggers, coping mechanisms, or treatment efficacy for anxiety disorders.

The relationship between social media and anxiety
Exposure therapy effectiveness in treating phobias
Generalised Anxiety Disorder in children: Early signs and interventions
The role of mindfulness in treating anxiety
Genetics and heritability of anxiety disorders
The link between anxiety disorders and heart disease
Anxiety prevalence in LGBTQ+ communities
Caffeine consumption and its impact on anxiety levels
The economic cost of untreated anxiety disorders
Virtual Reality as a treatment method for anxiety disorders

Psychotic Disorders

Within this space, your research topic could potentially aim to investigate the underlying factors and treatment possibilities for psychotic disorders.

Early signs and interventions in adolescent psychosis
Brain imaging techniques for diagnosing psychotic disorders
The efficacy of antipsychotic medication
The role of family history in psychotic disorders
Misdiagnosis and delayed treatment of psychotic disorders
Co-morbidity of psychotic and mood disorders
The relationship between substance abuse and psychotic disorders
Art therapy as a treatment for schizophrenia
Public perception and stigma around psychotic disorders
Hospital vs. community-based care for psychotic disorders

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Personality Disorders

Research topics within in this area could delve into the identification, management, and social implications of personality disorders.

Long-term outcomes of borderline personality disorder
Antisocial personality disorder and criminal behaviour
The role of early life experiences in developing personality disorders
Narcissistic personality disorder in corporate leaders
Gender differences in personality disorders
Diagnosis challenges for Cluster A personality disorders
Emotional intelligence and its role in treating personality disorders
Psychotherapy methods for treating personality disorders
Personality disorders in the elderly population
Stigma and misconceptions about personality disorders

Obsessive-Compulsive Disorders

Within this space, research topics could focus on the causes, symptoms, or treatment of disorders like OCD and hoarding.

OCD and its relationship with anxiety disorders
Cognitive mechanisms behind hoarding behaviour
Deep Brain Stimulation as a treatment for severe OCD
The impact of OCD on academic performance in students
Role of family and social networks in treating OCD
Alternative treatments for hoarding disorder
Childhood onset OCD: Diagnosis and treatment
OCD and religious obsessions
The impact of OCD on family dynamics
Body Dysmorphic Disorder: Causes and treatment

Post-Traumatic Stress Disorder (PTSD)

Research topics in this area could explore the triggers, symptoms, and treatments for PTSD. Here are some thought starters to get you moving.

PTSD in military veterans: Coping mechanisms and treatment
Childhood trauma and adult onset PTSD
Eye Movement Desensitisation and Reprocessing (EMDR) efficacy
Role of emotional support animals in treating PTSD
Gender differences in PTSD occurrence and treatment
Effectiveness of group therapy for PTSD patients
PTSD and substance abuse: A dual diagnosis
First responders and rates of PTSD
Domestic violence as a cause of PTSD
The neurobiology of PTSD

Free Webinar: How To Find A Dissertation Research Topic

Neurodevelopmental Disorders

This category of mental health aims to better understand disorders like Autism and ADHD and their impact on day-to-day life.

Early diagnosis and interventions for Autism Spectrum Disorder
ADHD medication and its impact on academic performance
Parental coping strategies for children with neurodevelopmental disorders
Autism and gender: Diagnosis disparities
The role of diet in managing ADHD symptoms
Neurodevelopmental disorders in the criminal justice system
Genetic factors influencing Autism
ADHD and its relationship with sleep disorders
Educational adaptations for children with neurodevelopmental disorders
Neurodevelopmental disorders and stigma in schools

Eating Disorders

Research topics within this space can explore the psychological, social, and biological aspects of eating disorders.

The role of social media in promoting eating disorders
Family dynamics and their impact on anorexia
Biological basis of binge-eating disorder
Treatment outcomes for bulimia nervosa
Eating disorders in athletes
Media portrayal of body image and its impact
Eating disorders and gender: Are men underdiagnosed?
Cultural variations in eating disorders
The relationship between obesity and eating disorders
Eating disorders in the LGBTQ+ community

Substance-Related Disorders

Research topics in this category can focus on addiction mechanisms, treatment options, and social implications.

Efficacy of rehabilitation centres for alcohol addiction
The role of genetics in substance abuse
Substance abuse and its impact on family dynamics
Prescription drug abuse among the elderly
Legalisation of marijuana and its impact on substance abuse rates
Alcoholism and its relationship with liver diseases
Opioid crisis: Causes and solutions
Substance abuse education in schools: Is it effective?
Harm reduction strategies for drug abuse
Co-occurring mental health disorders in substance abusers

Choosing A Research Topic

These research topic ideas we’ve covered here serve as thought starters to help you explore different areas within mental health. They are intentionally very broad and open-ended. By engaging with the currently literature in your field of interest, you’ll be able to narrow down your focus to a specific research gap .

It’s important to consider a variety of factors when choosing a topic for your dissertation or thesis . Think about the relevance of the topic, its feasibility , and the resources available to you, including time, data, and academic guidance. Also, consider your own interest and expertise in the subject, as this will sustain you through the research process.

Always consult with your academic advisor to ensure that your chosen topic aligns with academic requirements and offers a meaningful contribution to the field. If you need help choosing a topic, consider our private coaching service.

Good morning everyone. This are very patent topics for research in neuroscience. Thank you for guidance

What if everything is important, original and intresting? as in Neuroscience. I find myself overwhelmd with tens of relveant areas and within each area many optional topics. I ask myself if importance (for example – able to treat people suffering) is more relevant than what intrest me, and on the other hand if what advance me further in my career should not also be a consideration?

This information is really helpful and have learnt alot

Phd research topics on implementation of mental health policy in Nigeria :the prospects, challenges and way forward.

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150+ Trending Mental Health Research Topics For Students (2023)

Mental health is an important part of our well-being, encompassing our emotional, psychological, and social health. In the United States, the importance of addressing mental health has gained recognition, with growing concerns about stress, anxiety, and depression.

In this blog, we will guide you the meaning of mental health research topics with our 5 useful tips. Moreover, we give you a list of 150+ Mental Health Research Topics in 2023, including qualitative, interesting, and even controversial ones, you’ll find options that suit your interests. From the impact of social media to the intersection of Mental Health with political science and music therapy, we’ve got you covered.

Stay tuned for more on mental health research topics, and do not forget our bonus tips for selecting the best topics.

What Is Mental Health?

Table of Contents

Mental health is about how we feel and think inside our minds. It’s like taking care of our thoughts and emotions, just like we take care of our bodies. When our mental health is good, we usually feel happy and calm and can handle life’s challenges. But when our mental health is not so good, we might feel sad, anxious, or overwhelmed.

What Are Mental Health Research Topics?

Mental health research topics are subjects that scientists and experts study to learn more about our thoughts and emotions. These topics include things like understanding what causes mental health problems, finding better ways to help people who are struggling, and figuring out how to prevent these issues from happening. Researchers also examine how different treatments, like therapy or medication, can help improve mental health.

These research topics are important because they help us learn more about our minds and how to keep them healthy. By studying these topics, scientists can discover new ways to support people who are facing mental health challenges, making it easier for everyone to lead happier and more balanced lives.

5 Useful Tips For Choosing Mental Health Research Topics

Here are some useful tips for choosing mental health research topics:

1. Your research will be more focused and impactful.

2. You will be more likely to find funding and support.

3. You will be more likely to publish your research in peer-reviewed journals.

4. You will be more likely to make a huge contribution to the field of mental health research.

5. You will be more likely to enjoy your research experience.

Choosing the right mental health research topic is essential for success. By following the tips above, you can choose a topic that is focused, impactful, and relevant to your interests and expertise.

150+ Mental Health Research Topics In 2023

In this section, we will explore 150+ mental health research topics on different categories:

Mental Health Research Topics For College Students

College students often face unique mental health challenges. Here are 15 research topics for studying mental health in this demographic:

The impact of academic stress on college students’ mental health.
Exploring the relationship between sleep patterns and mental well-being among college students.
Analyzing the effectiveness of campus mental health services.
Investigating the prevalence of substance abuse and its effects on mental health in college students.
The role of peer support groups in reducing anxiety and depression among college students.
Examining the influence of social media usage on the mental health of college students.
The correlation between mental stress and financial stress issues in college students.
The value of practicing mindfulness and meditation for college students’ mental health.
Getting a better idea of how different cultures affect college students’ mental health.
Trying to figure out how mental health and physical movement affect college students.
Investigating the stigma surrounding mental health issues in college environments.
Analyzing the role of academic pressure in the onset of eating disorders among college students.
The effectiveness of online mental health resources and apps for college students.
Examining the mental health challenges faced by LGBTQ+ college students.
The impact of COVID-19 and remote learning on the mental health of college students.

Mental Health Research Topics For High School Students

High school students also encounter unique mental health concerns. Here are 15 research topics for studying mental health in this age group:

The effects of academic pressure on the mental health of high school students.
Investigating the role of family dynamics in the emotional well-being of high school students.
Analyzing the impact of bullying and cyberbullying on the mental health of teenagers.
The relationship between social media use and body image issues in high school students.
Examining the effectiveness of mental health education programs in high schools.
Investigating the prevalence of self-harm and suicidal ideation among high school students.
Analyzing the influence of peer relationships on the mental health of adolescents.
The role of extracurricular activities in promoting positive mental health in high school students.
Exploring the effects of substances abuse on the mental well-being of teenagers.
Investigating the stigma surrounding mental health issues in high schools.
The effects of COVID-19 and remote learning on the mental health of high school students.
Examining the mental health challenges faced by immigrant and refugee high school students.
Analyzing the relationship between sleep patterns and mental health in adolescents.
The effectiveness of art and creative therapies in treating mental health issues in high school students.
Investigating the role of teachers and school counselors in supporting students’ mental health.

Mental Health Research Topics For Nursing Students

Nursing students play a vital role in mental health care. Here are 15 research topics relevant to nursing students:

The impact of nursing education on students’ mental health.
Investigating the effectiveness of therapeutic communication in psychiatric nursing.
Analyzing the role of psychiatric medications in mental health treatment.
The importance of self-care practices for nursing students’ mental well-being.
Exploring the challenges faced by nursing students in caring for patients with severe mental illness.
Investigating the influence of nursing curricula on reducing mental health stigma.
Analyzing the role of clinical placements in preparing nursing students for mental health nursing.
The effects of peer support programs on nursing students’ mental health.
Examining the prevalence of burnout and stress among nursing students.
The importance of cultural skills in nursing care for different mental health patients.
Investigating the impact of technology and telehealth on mental health nursing practices.
Analyzing the ethical dilemmas faced by nursing students in mental health care.
Exploring the use of simulation training in psychiatric nursing education.
The effectiveness of mindfulness and stress management programs for nursing students.
Finding out what nursing students think about the healing model in mental health care is the goal of this study.

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Psychology Culture, And Mental Health Research Topics

Psychology and culture intersect in complex ways. Here are 15 research topics in this area:

Cross-cultural variations in the manifestation of mental disorders.
The influence of cultural beliefs on help-seeking behaviors for mental health issues.
Analyzing cultural factors in the diagnosis and treatment of depression.
The effect of acculturation on the mental health of newcomers.
Exploring cultural stigma surrounding mental illness in different societies.
Investigating the role of traditional healing practices in mental health care.
Cross-cultural perspectives on the concept of resilience in mental health.
Analyzing cultural variations in the experience of anxiety disorders.
The role of cultural competence in psychotherapy and counseling.
Exploring indigenous perspectives on mental health and well-being.
The impact of globalization on cultural attitudes toward mental health.
Investigating the influence of religion and spirituality on mental health outcomes.
Analyzing cultural differences in the perception and treatment of eating disorders.
The role of cultural identity in coping with trauma and adversity.
Cross-cultural perspectives on the use of psychotropic medications in mental health treatment.

Community Mental Health Research Topics

Community mental health research is crucial for improving public well-being. Here are 15 research topics in this field:

Evaluating the effectiveness of community-based mental health programs.
Investigating the role of peer support networks in community mental health.
Analyzing the impact of housing instability on mental health in urban communities.
Why early intervention programs are so important for avoiding serious mental illness.
Exploring the use of telemedicine in delivering mental health services to underserved communities.
Investigating the integration of mental health care into primary care settings.
Analyzing the effectiveness of crisis intervention teams in community policing.
The role of community art and creative programs in promoting mental well-being.
Examining the mental health challenges faced by homeless populations.
The impact of community outreach and education on reducing mental health stigma.
Investigating the use of community gardens and green spaces for improving mental health.
Analyzing the relationship between neighborhood characteristics and mental health disparities.
Exploring the role of community leaders and advocates in mental health policy.
The effectiveness of community-based substance abuse treatment programs.
Finding out what part social determinants of health play in the mental health of a community.

Global Mental Health Research Topics

Mental health is a global issue with unique challenges. Here are 15 research topics in global mental health:

Analyzing the burden of mental illness on global public health.
Investigating the cultural variations in mental health stigma worldwide.
The impact of arms conflict and displacement on mental well-being.
Exploring the use of teletherapy for improving access to mental health care in low-resource settings.
Analyzing the role of traditional healers in global mental health care.
Investigating the mental health challenges faced by refugees and asylum seekers.
The effectiveness of international mental health aid and interventions.
Examining the mental health implications of weather change and natural disasters.
Analyzing the global prevalence and treatment of common mental disorders.
Exploring the intersection of infectious diseases (e.g., HIV/AIDS) and mental health.
Mental Health in Urban Environments: Analyzing the unique challenges faced by individuals living in densely populated urban areas.
Mental Health and Digital Technology: Exploring the impact of digital technology on mental well-being across cultures and age groups.
Mental Health in Indigenous Communities: Investigating mental health disparities among indigenous populations and the role of cultural preservation.
Mental Health in the Workplace: Examining workplace-related stressors and policies to support employees’ mental well-being globally.
Youth Mental Health: Studying mental health challenges among children and adolescents, considering factors like education and family dynamics.

Qualitative Mental Health Research Topics

Qualitative research in mental health can provide rich insights into individuals’ experiences and perceptions. Here are 15 qualitative research topics in mental health:

Exploring the lived experiences of individuals with schizophrenia.
Qualitative analysis of the stigma associated with seeking mental health treatment.
Understanding the coping mechanisms of parents with children diagnosed with autism spectrum disorder.
Investigating the narratives of individuals recovering from addiction.
Analyzing the cultural perceptions of depression and its treatment.
Examining the subjective experiences of caregivers of dementia patients.
Discussing the role of spirituality in the recovery process for people with mental illness.
Qualitative assessment of the impact of mindfulness-based interventions on stress reduction.
Investigating the narratives of survivors of suicide attempts.
Understanding the experiences of LGBTQ+ individuals in mental health care.
Analyzing the perceptions of veterans regarding post-traumatic stress disorder (PTSD) treatment.
Exploring the subjective experiences of individuals with eating disorders.
Qualitative assessment of the role of peer support groups in recovery from substance abuse.
Investigating the stigma and barriers faced by individuals with bipolar disorder.
Understanding the cultural variations in perceptions of anxiety disorders.

Interesting Mental Health Research Topics

Fascinating mental health topics can engage researchers and readers alike. Here are 15 intriguing research topics in mental health:

The impact of virtual reality therapy on anxiety and phobias.
Investigating the connection between creativity and mental well-being.
Analyzing the role of pet therapy in reducing stress and anxiety.
Exploring the effects of nature and green spaces on mental health.
The relationship between personality types (e.g., introversion, extroversion) and mental health outcomes.
Investigating the benefits of laughter therapy on mood and stress.
Analyzing the effects of lucid dreaming on nightmares and trauma.
Exploring the mental health benefits of volunteering and altruism.
The impact of time-restricted eating on mood and cognitive function.
Investigating the use of virtual support groups for individuals with social anxiety.
Analyzing the relationship between music and memory in Alzheimer’s disease.
Exploring the mental health effects of color psychology and interior design.
The role of adventure therapy in enhancing self-esteem and resilience.
Investigating the influence of childhood hobbies on adult mental well-being.
Analyzing the connection between humor and emotional intelligence in mental health promotion.

Social Media On Mental Health Research Topics

Social media’s impact on mental health is a timely and relevant research area. Here are 15 research topics on this subject:

Analyzing the relationship between social media use and feelings of loneliness.
Investigating the effects of cyberbullying on adolescent mental health.
The influence of social media comparison on body image dissatisfaction.
Exploring the role of social media in the dissemination of mental health information.
Analyzing the impact of social media detoxes on well-being.
Investigating the link between excessive screen time and sleep disturbances.
The effects of online support communities on mental health recovery.
Exploring the role of influencer culture in shaping mental health perceptions.
Analyzing the relationship between social media activism and mental well-being.
Investigating the impact of “FOMO” (Fear of Missing Out) on anxiety levels.
The role of social media in spreading wrong information about mental health.
Exploring the effects of targeted advertising on mental health outcomes.
Analyzing the relationship between online gaming and addictive behaviors.
Investigating the influence of social media on political polarization and mental health.
The role of social media in fostering a sense of community among marginalized groups with mental health issues.

Cool Mental Health Research Topics

Cool mental health topics can pique interest and lead to innovative research. Here are some cool research topics in mental health:

Investigating the therapeutic potential of psychedelic substances for mental health treatment.
Analyzing the impact of virtual reality gaming on managing stress and anxiety.
Exploring the use of artificial intelligence and chatbots in mental health counseling.
The effectiveness of mindfulness apps and wearable devices in promoting mental well-being.
Investigating the role of gut microbiota in mood and mental health.
Analyzing the use of neurofeedback technology for improving attention and focus in ADHD.
Exploring the benefits of equine-assisted therapy for individuals with PTSD .
The potential of psychedelic-assisted psychotherapy for treating depression.
Investigating the use of art therapy and virtual art galleries for mental health support.
Analyzing the impact of music and sound therapy on sleep quality and anxiety.
Exploring the use of scent and aroma therapy in mood regulation.
The role of biofeedback and wearable sensors in managing panic disorders.
Investigating the mental health benefits of urban gardening and green rooftops.
Analyzing the use of brain-computer interfaces in enhancing emotional regulation.
Exploring the connection between outdoor adventure activities and resilience in mental health recovery.

1. Choose a research topic according to your interest ,expertise, and career goals.
2. Make sure the topic is feasible and can be completed within the given time and resources.
3. Choose a topic that will make a meaningful contribution to the mental health field.
4. Consider the ethical implications of your research and ensure that it protects the rights and well-being of 5. participants.
5. Select a topic that is original and innovative and not simply a rehash of existing research.

Understanding what mental health is and exploring various mental health research topics is crucial in addressing the challenges individuals face today. Choosing the right topic involves considering your audience and interests, as highlighted in our five tips. With 150+ mental health research topics for 2023, we have provided options for college, high school, and nursing students and those interested in psychology, culture, and global perspectives.

Moreover, qualitative and intriguing topics offer diverse avenues for exploration while acknowledging the impact of social media on mental health is essential. Remember our bonus tips when selecting your mental health research topic – prioritize relevance and impact to make a meaningful contribution to this vital field.

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Home » 300+ Mental Health Research Topics

300+ Mental Health Research Topics

Mental health is a complex and multi-faceted topic that affects millions of people worldwide. Research into mental health has become increasingly important in recent years, as the global burden of mental illness continues to rise. From identifying risk factors and developing effective treatments, to addressing social and cultural influences, mental health research covers a broad range of topics . In this blog post, we will explore some of the most important and fascinating mental health research topics that are currently being studied by experts in the field.

Mental Health Research Topics

Mental Health Research Topics are as follows:

The impact of social media on mental health
The effectiveness of mindfulness-based interventions for reducing stress and anxiety
The relationship between childhood trauma and adult mental health outcomes
The role of exercise in promoting mental health and well-being
The impact of COVID-19 on mental health and well-being
The effectiveness of cognitive-behavioral therapy for treating depression and anxiety
The impact of sleep deprivation on mental health and cognitive functioning
The relationship between diet and mental health outcomes
The effectiveness of virtual reality therapy for treating mental health disorders
The impact of workplace stress on mental health
The effectiveness of group therapy for treating mental health disorders
The relationship between substance abuse and mental health outcomes
The impact of stigma on mental health treatment-seeking behavior
The effectiveness of animal-assisted therapy for improving mental health
The impact of environmental factors on mental health outcomes
The relationship between chronic illness and mental health outcomes
The effectiveness of art therapy for treating mental health disorders
The impact of cultural factors on mental health outcomes
The relationship between personality traits and mental health outcomes
The effectiveness of music therapy for treating mental health disorders
The impact of trauma on memory and cognitive functioning
The relationship between socioeconomic status and mental health outcomes
The effectiveness of acceptance and commitment therapy for treating mental health disorders
The impact of social support on mental health outcomes
The relationship between perfectionism and mental health outcomes
The effectiveness of exposure therapy for treating anxiety disorders
The impact of early intervention on mental health outcomes
The relationship between attachment styles and mental health outcomes
The effectiveness of narrative therapy for treating mental health disorders
The impact of technology on mental health outcomes
The relationship between resilience and mental health outcomes
The effectiveness of family therapy for treating mental health disorders
The impact of gender on mental health outcomes
The relationship between creativity and mental health outcomes
The effectiveness of dialectical behavior therapy for treating borderline personality disorder
The impact of personality disorders on mental health outcomes
The relationship between trauma and addiction
The effectiveness of cognitive remediation therapy for improving cognitive functioning in individuals with mental illness
The impact of discrimination on mental health outcomes
The relationship between emotional intelligence and mental health outcomes
The effectiveness of play therapy for treating mental health disorders in children
The impact of attachment trauma on relationships in adulthood
The relationship between religious or spiritual beliefs and mental health outcomes
The effectiveness of psychodynamic therapy for treating mental health disorders
The impact of chronic pain on mental health outcomes
The relationship between self-esteem and mental health outcomes
The effectiveness of eye movement desensitization and reprocessing (EMDR) for treating trauma-related disorders
The impact of parenting style on mental health outcomes in children
The relationship between mindfulness and mental health outcomes
The effectiveness of equine-assisted therapy for improving mental health.
The relationship between childhood trauma and mental illness
The effectiveness of mindfulness-based interventions for treating anxiety disorders
The role of genetics in the development of mental illness
The effectiveness of cognitive-behavioral therapy for treating depression
The impact of exercise on mental health
The prevalence and causes of burnout among healthcare professionals
The effectiveness of group therapy for treating substance abuse disorders
The impact of sleep on mental health
The relationship between trauma and dissociation
The effectiveness of virtual reality therapy for treating phobias
The relationship between gut health and mental health
The impact of stigma on seeking mental health treatment
The relationship between spirituality and mental health
The impact of adverse childhood experiences on mental health
The relationship between attachment style and mental health
The effectiveness of art therapy for treating PTSD
The impact of chronic illness on mental health
The relationship between personality traits and mental illness
The effectiveness of narrative therapy for treating depression
The relationship between social support and mental health
The effectiveness of eye movement desensitization and reprocessing therapy for treating trauma
The impact of discrimination on mental health
The relationship between parental bonding and mental health
The effectiveness of family therapy for treating eating disorders
The impact of environmental factors on mental health
The relationship between hormonal changes and mental health
The effectiveness of equine therapy for treating addiction
The impact of trauma on attachment
The relationship between exercise addiction and mental health
The effectiveness of acceptance and commitment therapy for treating anxiety disorders
The impact of racism on mental health
The relationship between animal-assisted therapy and mental health
The effectiveness of exposure therapy for treating OCD
The impact of gender identity on mental health
The relationship between social anxiety and substance abuse
The effectiveness of emotion-focused therapy for treating relationship issues
The impact of social inequality on mental health
The relationship between spirituality and substance abuse
The effectiveness of schema therapy for treating personality disorders
The impact of peer support on mental health
The effectiveness of psychodynamic therapy for treating depression
The impact of poverty on mental health
The relationship between sleep disorders and mental health
The effectiveness of mindfulness-based interventions for treating addiction
The impact of immigration on mental health
The relationship between self-esteem and mental health.
The effectiveness of cognitive-behavioral therapy in treating anxiety disorders
The relationship between childhood trauma and adult mental health
The effectiveness of mindfulness-based interventions for depression
The impact of exercise on mental health outcomes
The role of sleep disturbances in the development of psychiatric disorders
The effectiveness of pharmacological treatments for bipolar disorder
The relationship between alcohol use and mental health outcomes
The effectiveness of psychotherapy in treating post-traumatic stress disorder
The impact of nutrition on mental health outcomes
The relationship between chronic pain and mental health
The effectiveness of group therapy in treating depression
The role of stigma in mental health treatment-seeking behaviors
The relationship between trauma exposure and suicidal behavior
The effectiveness of telehealth interventions for mental health care
The role of attachment styles in the development of mental illness
The effectiveness of mindfulness-based interventions for anxiety
The impact of work-related stress on mental health
The relationship between physical activity and mental health outcomes
The effectiveness of cognitive remediation in treating schizophrenia
The role of family dynamics in the development of mental illness
The relationship between childhood adversity and substance use disorders
The effectiveness of dialectical behavior therapy in treating borderline personality
The effectiveness of psychoanalytic therapy in treating depression
The impact of peer support groups on mental health outcomes
The role of spirituality in coping with mental illness
The effectiveness of acceptance and commitment therapy in treating anxiety
The impact of trauma-informed care on mental health treatment outcomes
The relationship between body image and mental health
The effectiveness of art therapy in treating PTSD
The role of cognitive biases in the development of mental illness
The relationship between social isolation and mental health outcomes
The effectiveness of virtual reality therapy in treating phobias
The impact of stigma on mental health among LGBTQ+ individuals
The relationship between trauma and eating disorders
The effectiveness of emotion regulation interventions in treating borderline personality disorder
The role of attachment styles in the treatment of anxiety disorders
The relationship between childhood abuse and dissociative disorders
The effectiveness of family-based interventions in treating adolescent depression
The relationship between social inequality and mental health outcomes
The effectiveness of mindfulness-based interventions for substance use disorders
The role of cognitive-behavioral therapy in treating OCD
The relationship between emotional regulation and addiction recovery
The impact of trauma-focused therapy on PTSD symptoms in military veterans
The relationship between sleep disorders and mood disorders
The effectiveness of exercise interventions in treating depression
The role of trauma-informed care in treating substance use disorders
The relationship between trauma and personality disorders
The effectiveness of interpersonal therapy in treating depression
The impact of cultural factors on mental health treatment outcomes
The relationship between stigma and medication adherence in mental health treatment
The effectiveness of behavioral activation interventions in treating depression
The role of cognitive biases in addiction recovery
The relationship between social support and addiction recovery
The effectiveness of acceptance and commitment therapy in addiction recovery
The impact of comorbid medical conditions on mental health outcomes
The effectiveness of mindfulness-based interventions for chronic pain management
The role of coping strategies in the treatment of anxiety disorders
The relationship between anxiety and substance use disorders
The impact of COVID-19 on mental health outcomes
The effectiveness of narrative therapy in treating trauma
The role of social support in trauma recovery.
The relationship between trauma and depression
The effectiveness of dialectical behavior therapy in treating substance use disorders
The impact of adverse childhood experiences on mental health outcomes
The role of cultural competence in mental health treatment
The relationship between childhood obesity and mental health
The effectiveness of art therapy in treating anxiety disorders
The impact of mindfulness on workplace mental health
The effectiveness of group therapy in treating substance use disorders
The role of spirituality in addiction recovery
The relationship between personality disorders and addiction
The effectiveness of psychodynamic therapy in treating anxiety disorders
The impact of social support on PTSD treatment outcomes
The relationship between social anxiety and substance use disorders
The effectiveness of virtual reality therapy in treating PTSD
The role of resilience in mental health recovery
The relationship between addiction and trauma in veterans
The effectiveness of cognitive remediation in treating ADHD
The impact of parental mental illness on children’s mental health outcomes
The relationship between trauma and bipolar disorder
The effectiveness of narrative therapy in treating depression
The role of mindfulness in addiction recovery
The relationship between borderline personality disorder and substance use disorders
The effectiveness of cognitive-behavioral therapy in treating eating disorders
The impact of workplace bullying on mental health outcomes
The relationship between trauma and self-harm behaviors
The effectiveness of family therapy in treating addiction
The role of stigma in addiction recovery
The effectiveness of schema therapy in treating personality disorders
The impact of childhood neglect on mental health outcomes
The relationship between anxiety and chronic pain
The effectiveness of psychodynamic therapy in treating personality disorders
The role of self-compassion in mental health recovery
The relationship between trauma and dissociative disorders
The effectiveness of acceptance and commitment therapy in treating personality disorders
The impact of adverse work conditions on mental health outcomes
The relationship between addiction and sleep disorders
The effectiveness of exposure therapy in treating phobias
The role of emotional regulation in addiction recovery
The relationship between trauma and addiction in women
The impact of childhood bullying on mental health outcomes
The effectiveness of cognitive-behavioral therapy in treating personality disorders
The role of resilience in addiction recovery
The relationship between ADHD and substance use disorders
The impact of social support on eating disorder treatment outcomes
The effectiveness of mindfulness-based interventions in treating personality disorders
The role of positive psychology in mental health recovery
The relationship between trauma and PTSD in children
The effectiveness of family-based interventions in treating substance use disorders
The relationship between social media use and body image concerns
The effectiveness of group therapy for substance use disorders
The role of resilience in coping with mental illness
The impact of trauma on attachment patterns in adulthood
The relationship between childhood neglect and depression
The role of emotional intelligence in mental health outcomes
The effectiveness of family therapy for eating disorders
The impact of mindfulness on emotion regulation in borderline personality disorder
The relationship between childhood ADHD and substance use disorders in adulthood
The role of social support in preventing suicide
The effectiveness of cognitive-behavioral therapy for insomnia
The impact of trauma on the development of borderline personality disorder
The relationship between childhood bullying and anxiety disorders in adulthood
The effectiveness of dialectical behavior therapy for eating disorders
The role of attachment styles in the treatment of personality disorders
The impact of family conflict on adolescent mental health
The relationship between childhood maltreatment and self-harm behaviors
The effectiveness of exposure therapy for PTSD
The role of social support in the treatment of depression
The impact of trauma on the development of dissociative identity disorder
The relationship between childhood abuse and addiction
The effectiveness of mindfulness-based interventions for ADHD
The role of cognitive biases in the development of OCD
The impact of perfectionism on mental health outcomes
The relationship between childhood trauma and schizophrenia
The effectiveness of cognitive remediation for executive functioning deficits in bipolar disorder
The role of cognitive-behavioral therapy in the treatment of hoarding disorder
The impact of societal expectations on mental health in minority groups
The relationship between childhood trauma and borderline personality disorder
The effectiveness of acceptance and commitment therapy for chronic pain
The role of social support in the treatment of substance use disorders
The impact of trauma on attachment patterns in childhood
The relationship between childhood ADHD and depression in adulthood
The effectiveness of cognitive-behavioral therapy for social anxiety disorder
The role of emotional regulation in preventing self-harm behaviors
The impact of societal stigma on mental health treatment-seeking behaviors
The relationship between childhood trauma and eating disorders
The effectiveness of interpersonal therapy for depression
The role of cognitive-behavioral therapy in the treatment of panic disorder
The impact of trauma on the development of anxiety disorders
The relationship between childhood trauma and bipolar disorder
The effectiveness of exposure and response prevention for OCD
The role of cognitive biases in the treatment of PTSD
The impact of social support on mental health outcomes in LGBTQ+ individuals
The relationship between childhood trauma and social anxiety disorder
The effectiveness of psychoanalytic therapy for personality disorders
The role of emotional regulation in the treatment of anxiety disorders
The impact of childhood trauma on substance use disorders in adulthood
The relationship between childhood ADHD and anxiety disorders in adulthood
The relationship between social media use and body image dissatisfaction
The role of childhood attachment in the development of anxiety disorders
The relationship between social support and PTSD recovery
The effectiveness of psychotherapy for treating substance use disorders
The impact of trauma exposure on cognitive functioning
The relationship between sleep disorders and anxiety
The role of childhood adversity in the development of eating disorders
The effectiveness of virtual reality exposure therapy for anxiety disorders
The impact of racial discrimination on mental health outcomes
The role of emotion dysregulation in the development of personality disorders
The effectiveness of family-based interventions in treating eating disorders
The impact of childhood trauma on self-esteem
The role of attachment styles in the treatment of PTSD
The effectiveness of dialectical behavior therapy for treating eating disorders
The impact of parental stress on child mental health outcomes
The relationship between childhood ADHD and substance use disorders
The role of resilience in the treatment of trauma
The effectiveness of motivational interviewing in treating substance use disorders
The impact of childhood trauma on physical health outcomes
The relationship between anxiety and perfectionism
The role of cultural factors in the development of eating disorders
The effectiveness of mindfulness-based interventions for trauma
The impact of peer victimization on mental health outcomes
The role of self-compassion in the treatment of depression
The effectiveness of exposure therapy for OCD
The impact of childhood trauma on social relationships
The relationship between childhood trauma and psychosis
The role of cognitive biases in the development of eating disorders
The effectiveness of transdiagnostic treatments for anxiety and depression
The impact of chronic illness on mental health outcomes
The role of self-esteem in the treatment of anxiety disorders
The effectiveness of psychodynamic therapy in treating trauma
The impact of maternal depression on child mental health outcomes
The relationship between trauma and dissociative symptoms
The role of attachment styles in the treatment of eating disorders
The effectiveness of cognitive remediation in treating eating disorders
The impact of adverse childhood experiences on the development of addiction
The relationship between anxiety and hoarding behavior
The role of cognitive biases in the development of substance use disorders
The effectiveness of cognitive-behavioral therapy for chronic pain management
The impact of childhood trauma on emotional regulation
The relationship between childhood trauma and suicidal behavior
The role of mindfulness in the treatment of depression
The effectiveness of cognitive-behavioral therapy for substance use disorders.

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Muhammad Hassan

Researcher, Academic Writer, Web developer

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The Top 10 Most Interesting Mental Health Research Topics

In the United States, the majority of people have been diagnosed with at least one mental disorder. Once considered shameful, mental health issues are now being discussed more openly through various online platforms, such as the best mental health podcasts and blogs, which have made information more accessible. As a result, more people are seeking forms of mental healthcare and researchers are learning even more.

While research on mental health has come a long way, there is still a long way to go in destigmatizing mental health conditions and spreading mental health awareness. If you are looking for mental health research paper topics and are struggling to narrow down your list, take a look at the top 10 most interesting mental health research topics to help get you started.

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What makes a strong mental health research topic.

The best way for you to develop a strong mental health research topic is by first having a specific and well-defined area of interest. Your research topic should provide a clear and simple roadmap to help you focus your research paper. Additionally, consider your audience and the topic’s significance within the mental health field. What does it contribute?

Tips for Choosing a Mental Health Research Topic

Choose a topic that is interesting to you. You may be writing to share your findings with your peers, but your topic should excite you first and foremost. You will spend a significant amount of time on it, so it should be work you are eager to dive into.
Choose a fresh approach. There is an extensive amount of mental health research conducted by mental health professionals. Use your research skills to choose a topic that does more than just restate the same facts and information. Say something that hasn’t been said before.
Choose a topic that matters. The topic you choose should make a contribution to all the mental health education and research that already exists. Approach your topic in a way that ensures that it’s of significance within the field.
Choose a topic that challenges you. A sure-fire way to find out if your topic meets the criteria of being interesting, fresh, and significant, is if it challenges you. If it’s too easy, then there must be enough research available on it. If it’s too difficult, it’s likely unmanageable.
Choose a topic that’s manageable. You should aim to choose a topic that is narrow enough in its focus that it doesn’t overwhelm you. Consider what’s feasible for you to dedicate to the research in terms of resources and time.

What’s the Difference Between a Research Topic and a Research Question?

The purpose of a research topic is to let the reader know what specific area of mental health research your paper will focus on. It is the territory upon which your research paper is based. Defining your topic is typically the initial step of any research project.

A research question, on the other hand, narrows down the scope of your research and provides a framework for the study and its objectives. It is based on the research topic and written in the form of a question that the research paper aims to answer. It provides the reader with a clear idea of what’s to be expected from the research.

How to Create Strong Mental Health Research Questions

To create a strong research question, you need to consider what will help guide the direction your research takes. It is an important part of the process and requires strong research methods . A strong research question clearly defines your work’s specific focus and lets your audience know exactly what question you intend to answer through your research.

2. The Psychology of Gender Identity, Inclusivity, and Diversity

With the conversations surrounding gender and identity in recent times, a research topic on the psychology of gender identity, inclusivity, and diversity is a good option. Our understanding of gender now, in the 21st century, has evolved and gender identity has become non-binary, more inclusive, and more diverse.

3. The Psychological Effects of Social Phobia on Undergraduate Students

Some of the most common mental illnesses in the United States are phobias, so the topic of the psychology and effects of phobias is interesting and relevant to the majority of people. There are various categories of phobias that have been identified by the American Psychiatric Association that you could choose to focus on.

4. Eating Disorders Among Teenagers and Adolescents

Eating disorders among teenagers and adolescents in the United States are prevalent, especially among young women. The statistics surrounding mental health issues show that 10 in 100 young women suffer from eating disorders such as anorexia nervosa and bulimia, as well as a preoccupation with food and body dysmorphia.

5. The Correlation Between Childhood Learning Disabilities and Mental Health Problems in Adulthood

When groups of people with learning disorders (LD) were compared with groups that had no known history of LD, a correlation between childhood LD and mental health issues in adulthood was found. This research is important because it helps us to understand how childhood LD increases mental health risks in adulthood and affects emotional development.

6. How Mental Disorder is Glamorized and Sensationalized in Modern Media

Shows and movies centered around the depiction of mental illness have become more popular in recent years. The portrayal of characters with mental illnesses can often be damaging and fail to take into account the complexities of mental disorders, which often leads to stigmatization and discrimination, and a reluctance to seek mental health care.

7. The Relationship Between Self-esteem and Suicide Rates Among Adolescents

A relationship between self-esteem and suicide rates among adolescents has been found when looking into their suicidal tendencies. This is more so the case with any individual who already suffers from a mental health issue. Low self-esteem has been linked to increased levels of depression and suicide ideation, leading to higher chances of suicide attempts among adolescents.

8. Destigmatizing Mental Illness and Mental Disorders

The rates at which people are diagnosed with mental illnesses are high. Even so, their portrayal in the media has resulted in the belief that those who suffer from a mental health issue or live in mental health facilities are dangerous. Conducting research on abnormal psychology topics and destigmatizing mental illness and mental disorders is important for mental health education.

9. Psychological Trauma and the Effects of Childhood Sexual Abuse

Mental health statistics show that most abuse happens in childhood, causing long-lasting psychological trauma. The type of trauma caused by child abuse and childhood sexual abuse affects development in infants and children. It has been linked to higher levels of depression, anxiety, guilt, sexual issues, dissociative patterns, and relationship issues, to name a few.

10. Effects of the COVID-19 Pandemic on Psychological Well-Being

There is no doubt about the effects of the COVID-19 pandemic and COVID-19 confinement on psychological well-being. The threat to public health, the social and economic stresses, and the various reactions by governments and individuals have all caused unexpected mental health challenges. This has affected behaviors, perceptions, and the ways in which people make decisions.

Mental Health Research Questions

Are digital therapy sessions as impactful as face-to-face therapy sessions for patients?
What are the best methods for effectively using social media to unite and connect all those suffering from a mental health issue in order to reduce their isolation?
What causes self-destructive behavior in some children?
Can introducing mental health topics in the school curriculum help to create understanding and reduce the stigmatization of mental disorders?
What are the most effective methods to improve brain health and emotional intelligence as we go through the aging process?

Choosing the Right Mental Health Research Topic

When choosing the right mental health research question, it is essential to figure out what single issue you want to focus on within the broader topic of mental conditions. The narrower your scope, the easier it will be to conduct thorough and relevant research. Vagueness can lead to information overload and a lack of clear direction.

However, even though it needs to be specific, your research question must also be complex enough to allow you to develop your research. If it’s too narrow in its focus, you won’t give yourself enough room to flesh out your findings as you build on your research. The key is to find the middle ground between the two.

Mental Health Research Topics FAQ

A mental disorder refers to any of the various conditions that affect and alter our behavior, thoughts, and emotions. More than half of Americans get diagnosed with a mental disorder at some point in their lives. They are common and manageable with the right support. Some mental illnesses are occasional, such as postpartum depression, while others are long-term, such as panic attacks.

Mental health research raises awareness of mental health disorders and promotes mental health care. It provides support and evidence for the effectiveness of mental health services and programs designed for psychiatric patients and those with mental health disorders. The information provided by the research helps us better understand mental illnesses and how best to approach treatment plans.

Behavioral health and emotional health are part of a person’s overall mental health since they are all interlinked and each one affects the other. When we speak of mental health, we are referring to behavioral, cognitive, and emotional well-being, which can also affect physical health.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the five main categories of mental illness include dementia, mood disorders such as bipolar disorder, anxiety disorders, feeding and eating disorders, and personality disorders such as obsessive-compulsive disorder.

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Research articles

Neocortical serotonin 2A receptor binding, neuroticism and risk of developing depression in healthy individuals

In this study, the authors used molecular brain imaging and measures of neuroticism to identify that high 5-HT 2A R binding and higher levels of neuroticism predicted an increased risk of developing depression up to 19 years after assessment.

Anjali Sankar
Simon C. Ziersen
Vibe G. Frokjaer

Mapping cerebellar anatomical heterogeneity in mental and neurological illnesses

This study maps cerebellar anatomy across the lifespan using over 54,000 brain scans from 132 scanning sites and identifies that patients with autism spectrum disorder, mild cognitive impairment, Alzheimer disease, and schizophrenia are likely to have deviations in cerebellar anatomy.

Esten Leonardsen
Torgeir Moberget

Exploration of first onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause

The authors investigate first onsets of psychiatric disorders during perimenopause, finding higher incidence rates of major depressive disorder and mania.

Lisa M. Shitomi-Jones
Clare Dolman
Arianna Di Florio

Building machine learning prediction models for well-being using predictors from the exposome and genome in a population cohort

Machine learning prediction models for adult well-being were built on longitudinal data from the Netherlands Twin Register population cohort. The exposome, but not the genome, predicted well-being in adulthood, with key factors including optimism, personality, social support and neighborhood housing characteristics.

Dirk H. M. Pelt
Philippe C. Habets
Meike Bartels

Brain, lifestyle and environmental pathways linking physical and mental health

In a large-scale UK Biobank study of multimodal brain imaging and physiological markers, the authors find brain-mediated patterns of organ function and lifestyle pathways that are predictive of specific mental health outcomes.

Ye Ella Tian
James H. Cole
Andrew Zalesky

Mood instability metrics to stratify individuals and measure outcomes in bipolar disorder

This study introduces a method to measure outcomes in bipolar disorder by quantifying mood instability over time.

Sarah H. Sperry
Anastasia K. Yocum
Melvin G. McInnis

Different hierarchical reconfigurations in the brain by psilocybin and escitalopram for depression

Psilocybin and escitalopram create significantly different reconfigurations in the global functional hierarchy of brain dynamics with opposite statistical effect responses in people with major depressive disorder.

Gustavo Deco
Yonatan Sanz Perl
Morten L. Kringelbach

Modeling impulsivity and risk aversion in the subthalamic nucleus with deep brain stimulation

Using a card gambling task paired with intracranial recordings and deep brain stimulation of the right subthalamic nucleus, the authors dissociate objective and subjective markers of risk taking and demonstrate the role of stimulation localization on risk-related behavior.

Valerie Voon
Luis Manssuer

Childhood-onset type 1 diabetes and subsequent adult psychiatric disorders: a nationwide cohort and genome-wide Mendelian randomization study

In this study, analyzing Czech national register-based data and using genome-wide Mendelian randomization, the authors report elevated risk for developing substance use, mood, anxiety and personality disorders in individuals with childhood-onset type 1 diabetes, and show that these associations are unlikely to be explicable by common underlying biological mechanisms.

Tomáš Formánek
Benjamin I. Perry

Depressive symptoms and sex differences in the risk of post-COVID-19 persistent symptoms: a prospective population-based cohort study

In this cohort study, the authors find that depressive symptoms at the beginning of the pandemic may partially explain why women participants who had a COVID-19 episode were more likely than their male counterparts to report at least one post-COVID-19 persistent symptom seven to ten months later.

Joane Matta
Baptiste Pignon
Cédric Lemogne

Shared genetics of ADHD, cannabis use disorder and cannabis use and prediction of cannabis use disorder in ADHD

In this study, the authors use a combination of genetic methodologies to investigate the genetic associations between attention-deficit/hyperactivity disorder, cannabis use disorder and cannabis use.

Trine Tollerup Nielsen
Jinjie Duan
Ditte Demontis

Deep brain stimulation of habenula reduces depressive symptoms and modulates brain activities in treatment-resistant depression

Using deep brain stimulation of the habenula with implanted electrodes in patients with treatment-resistant depression, this study found a substantial reduction in depression scores at follow-up over multiple time points.

Zhiyan Wang

Tumor location is associated with mood dysfunction in patients with diffuse glioma

The authors report how the anatomical location of diffuse gliomas is related to the occurrence of severe depressive symptoms or the absence of depressive symptoms.

Maisa N. G. van Genderen
Vera Belgers
Philip C. De Witt Hamer

Individual differences in autism-like traits are associated with reduced goal emulation in a computational model of observational learning

Using a computational approach, Wu et al. find that autism-related traits are associated with reduced observational learning specifically through reduced goal emulation, revealing difficulties in social goal inference.

Qianying Wu
Caroline J. Charpentier

Opioid-induced neuroanatomical, microglial and behavioral changes are blocked by suvorexant without diminishing opioid analgesia

The authors demonstrate that, in a mouse model of heroin use disorder, co-administration of morphine and suvorexant prevented both morphine-induced anatomical changes in hypocretin neurons and morphine anticipation and reduced morphine withdrawal behavior but spared analgesia, suggesting applications for reducing opioid addiction potential in humans.

Ronald McGregor
Ming-Fung Wu
Jerome M. Siegel

A cognitive neural circuit biotype of depression showing functional and behavioral improvement after transcranial magnetic stimulation in the B-SMART-fMRI trial

The authors investigate functional connectivity before and after transcranial magnetic stimulation in veterans with treatment-resistant depression stratified by cognitive biotype, demonstrating associated brain connectivity-mediated improvement in cognitive behavioral task performance.

Leonardo Tozzi
Claire Bertrand
Leanne Maree Williams

Characterizing the phenotypic and genetic structure of psychopathology in UK Biobank

In this study using UK Biobank and genomic data, the phenotypic and genetic factor structures across ten psychiatric conditions are analyzed, finding general genetic and phenotypic consistency but greater potential gene and environment disparities in conditions associated with externalizing disorders.

Camille M. Williams
Franck Ramus

Prenatal cannabis exposure, the brain, and psychopathology during early adolescence

The authors used data from the ABCD Study to examine the effects of prenatal cannabis exposure on neuroimaging metrics and mental health in adolescents.

David A. A. Baranger
Alex P. Miller
Ryan Bogdan

The role of prepulse inhibition in predicting new-onset postpartum depression

In this study the authors investigate whether prepulse inhibition, measured in late pregnancy, could predict depressive symptom status at 6 weeks postpartum.

Allison Eriksson
Richelle D. Björvang
Alkistis Skalkidou

Prevalence and patterns of methamphetamine use and mental health disparity in the United States

Investigating the influence of using methamphetamine on the rate of admissions for mental health disorders, this study finds that concurrent methamphetamine use increased mental health-related hospital admissions 10.5-fold. Increased prevalence was also found for men, non-Hispanic Black people, middle-aged adults, and people living in the South.

Diensn G. Xing
Farhan Mohiuddin
Mohammad Alfrad Nobel Bhuiyan

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World Psychiatry
v.21(3); 2022 Oct

Mental health care for older adults: recent advances and new directions in clinical practice and research

Charles f. reynolds, 3rd.

1 University of Pittsburgh School of Medicine, Pittsburgh PA, USA

Dilip V. Jeste

2 Department of Psychiatry, University of California San Diego, La Jolla CA, USA

Perminder S. Sachdev

3 Centre for Healthy Brain Ageing, University of New South Wales, Sydney NSW, Australia

Dan G. Blazer

4 Department of Psychiatry and Behavioral Sciences, Duke University, Durham NC, USA

The world's population is aging, bringing about an ever‐greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor‐intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry – one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient‐focused and family‐centered, we call for further research into enhancing the well‐being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late‐life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.

By the year 2050, according to the United Nations (UN), one in six persons will be 65+ years of age 1 . Given this increasing number of people entering the worldwide aging community, coupled with lower birth rates – especially in high‐income and some middle‐income countries – there is concern about the old‐age dependency ratio, that is, the number of people 65+ years of age per 100 persons in the working age group (ages 15‐64). That ratio is increasing significantly, especially in countries such as China 2 .

A common misconception is that elders are mostly a burden to society. The fact is, instead, that many of them keep on contributing in many ways, such as continued work, childcare, maintenance of the household, and meal preparation. Most live independently. Many contribute several hours a week to volunteer activities or serve in leadership roles in community organizations. Yet, as these elders continue to age, they often face increasing disabilities, perhaps minor initially but gradually leading to significant impairments.

Mental disorders are major contributors to these disabilities. They often coexist with each other, e.g. comorbid depression and cognitive impairment, or with physical diseases, e.g. hearing impairment and paranoid thoughts 3 . In many cases, comorbidity spans multiple mental and physical disorders.

Despite the “aging tsunami” we are currently witnessing, the rise of special care for older adults has been slow to develop. Psychiatry has lagged behind medicine, yet it is increasing its knowledge base as well as recruiting sub‐specialists, unfortunately not at a rate which can serve the unique needs of older adults with mental disorders, even in high‐income countries. The International Psychogeriatric Association, founded in 1982, has been instrumental in encouraging meetings and programs in many low‐ and middle‐income countries, as well as providing a forum for geriatric psychiatrists from throughout the world. In both clinical practice and research within geriatric psychiatry, interdisciplinary collaboration has been foundational and essential, given the complexity of the problems faced by older adults experiencing mental illness.

Both basic and applied research have appreciably increased the evidence base for the diagnosis, treatment and prevention of late‐life mental disorders. For example, although we have no pharmacological agent yet proven to prevent or retard the progression of Alzheimer's disease, evidence has accumulated to support the importance of preventive measures, such as education, physical activity and control of vascular risk factors 4 . In depression of older adults, treatment with a combination of pharmacotherapy and psychotherapy, especially learning‐based forms such as cognitive behavioral therapies (CBT), has been shown to be effective 5 , 6 . Alcohol use disorders among older adults are more common than often realized by clinicians, especially in men, so that careful screening for these disorders is now regarded as essential 7 .

While negative views of aging continue to permeate the beliefs of many, more positive views have emerged in recent years, as exemplified in the MacArthur Research Network on Successful Aging 8 . They have defined successful aging, in contrast to usual aging, as low probability of disease, high cognitive and physical function, and active engagement with life. Others have also included wisdom as a characteristic of positive aging 9 , 10 .

In this paper, we provide an overview of the burden of mental health problems in older adults, with a focus on neurocognitive disorders, major depressive disorder, schizophrenia, and substance use disorders. For each of these disorders – which can be better understood as groups of disorders – we cover the epidemiology, prevention, recent treatment advances, and emerging models of service delivery. Further, for each group of disorders, we touch briefly upon heterogeneity at several levels: etiology, clinical presentation, and variability in response to intervention. In so doing, we describe directions for the future of clinical practice and research.

We begin the overview by contextualizing considerations of neurocognitive disorders, major depression, schizophrenia, and substance use disorders within the sciences of positive aging and cognitive aging, including a summary of the social determinants of well‐being in older adults. Our view is that the positive elements of aging need to be highlighted, not only to reduce the triple jeopardies of ageism, mentalism and ableism (i.e., discrimination against people on the basis of their age, mental health problems, and disability), but also to provide hope to patients and family caregivers.

SOCIAL DETERMINANTS OF MENTAL HEALTH IN OLDER ADULTS

Social determinants of health are non‐medical factors that influence health outcomes and have a significant effect on health inequalities 11 . Prominent examples of these social determinants include nutrition, education, employment and living environment, and these apply to the entire population.

Older adults with mental disorders are impacted by several types of these determinants 12 : a) social determinants that affect overall health, b) unique social determinants of mental health, such as stigma against mental illnesses, mental health care disparity, flawed criminal justice system, and homelessness 13 , and c) aging‐related social determinants, such as ageism, workforce shortage, and social isolation/loneliness. There are, however, also some positive social determinants of health relevant to old age, such as wisdom, resilience, meaning in life, and community engagement. Evaluating and addressing these determinants at individual and community levels is critical for prevention of mental disorders and enhancement of well‐being in older adults in general 9 , 10 , 11 , 13 , 14 , 15 .

Ageism and stigma

Ageism is defined by stereotypes, prejudice and discrimination directed toward people on the basis of their age 16 . Called “an insidious scourge on society” 17 , it can be institutional, interpersonal and/or self‐directed. Aging and older adults are often discussed by the general public and the media using negative stereotypes, such as a decline in mental and cognitive function. Unfortunately, this type of pejorative view of later life may be internalized by older individuals themselves and enacted, creating a vicious circle resulting in poor mental health.

Ageism causes inequalities and has detrimental effects on the individual, community and society 17 . Combating ageism is one of the four action areas of the Decade of Healthy Ageing (2021‐2030) declared by the UN and the World Health Organization (WHO) 16 .

The stigma against mental disorders is even greater in later life. An example is the stigma against agitation in dementia patients, many of whom spend days or weeks in emergency rooms because long‐term care facilities would no longer admit them, and the society has not provided alternatives. Equally sadly, there are more people with severe mental disorders (excluding dementia) and substance use disorders who are aging in prisons and jails than in hospitals in the US 11 , 12 .

Workforce shortage

The geriatric mental health workforce is slim, even in the most developed countries 18 . Despite the increased number of older adults, the number of psychiatrists trained in geriatric psychiatry has not increased. We know what to do, but how to recruit professionals across multiple disciplines to improve geriatric care in various cultural contexts is an abiding question that needs to be addressed for the future of clinical care and research in this field.

Also as a consequence of this workforce shortage, with the increase of physical and functional challenges in older patients, the need for a caregiver usually arises. The primary caregiver is often a spouse or adult child of the older patient. The role of the caregiver is wrought with physical, psychological and emotional challenges when caring for someone with dementia and/or serious physical illness. The caregivers themselves often suffer from significant morbidity 19 .

Loneliness and social isolation

A recent report from the National Academies of Science, Engineering, and Medicine 20 highlighted the public health significance of loneliness (i.e., subjective distress arising from an imbalance between desired and perceived social relationships) and objectively measurable social isolation. Older adults are at a particularly high risk for both loneliness and social isolation 21 . Aging‐related risk factors include widowhood, physical disability, poor health, and caregiving responsibilities.

Loneliness and social isolation are associated with adverse mental and physical health outcomes – including alcohol and drug abuse, suicidality, poor nutrition, sedentary lifestyle, inadequate sleep, and worsening physical functioning 22 . Loneliness and social isolation are as dangerous to health as smoking and obesity 23 , and are an important risk factor for Alzheimer's disease, major depression, and generalized anxiety disorder, as well as for cardiovascular and metabolic diseases 24 , 25 , 26 . More Americans die from loneliness‐ and social isolation‐related conditions than from stroke or lung cancer 27 .

Loneliness is more common in people with severe mental disorders such as schizophrenia than in the general population 28 . The evidence base for social isolation regarding adverse outcomes is much greater than for loneliness, yet the evidence for adverse effects of loneliness is increasing 21 .

The National Academies report 20 urges further research to establish the strength of the predictive association of loneliness and social isolation with mortality, and to clarify how these two entities interact with other facets of social relationships, including social support.

Wisdom is a personality trait comprised of several components: prosocial attitudes and behaviors (empathy and compassion), self‐reflection, emotional regulation, acceptance of uncertainty and diversity of perspectives, social decision‐making and, possibly, spirituality 29 , 30 . Commonly used self‐report‐based scales for assessing wisdom with good psychometric properties include the San Diego Wisdom Scale or Jeste‐Thomas Wisdom Index 31 , the Three‐Dimensional Wisdom Scale 32 , and the Self‐Assessed Wisdom Scale 33 .

Across the lifespan, wisdom is associated with positive outcomes, including better overall physical and mental health, happiness, and lower levels of depression and loneliness 34 , 35 . Amongst older adults, numerous investigations have demonstrated that wisdom is associated with life satisfaction, subjective well‐being, and greater resilience 29 , 30 . These studies have reported that older adults score higher than younger adults on several components of wisdom, especially prosocial behaviors, self‐reflection, and emotional regulation 36 . Some empirical evidence indicates that wisdom has a curvilinear relationship with age, peaking in the 70s or early 80s 34 .

Neurobiological investigations show that prefrontal cortex (especially dorsolateral, ventromedial, and anterior cingulate), insula, and limbic striatum (especially amygdala) are involved in the various components of wisdom 29 . Intergenerational activities, such as grandparents' help in raising grandchildren, have been found to benefit both the generations biologically, cognitively and psychosocially 37 .

A number of recent clinical and biological studies have reported a strong inverse relationship between loneliness and wisdom, especially its compassion component 38 , 39 , 40 . This evidence suggests potential use of individual‐ and societal‐level interventions to enhance compassion and other components of wisdom in older adults, so as to reduce loneliness and improve well‐being 40 . There are indeed reports of psychosocial group interventions in older people producing a significant improvement in wisdom 41 .

Resilience is a trait or outcome that describes recovery or bounce‐back from adverse situations or a process of adapting well in the face of adversity, trauma, threats or other sources of major stress 21 . Commonly used measures of resilience include self‐report scales such as the Connor‐Davidson Resilience Scale 42 and the Grit Scale 43 . Resilience is highly relevant to healthy aging and well‐being, and should be viewed as a public health concept 44 . A framework for resilience to the challenges associated with aging is required to complement ongoing risk reduction policies, programs and interventions 45 .

Men experience greater feelings of loneliness and have increased difficulty in adjusting to widowhood compared to women, with the exception of veterans. Male veterans exposed to death while serving in the military show greater resilience and report less loneliness than civilian widowers 23 . Resilience has been shown to be associated with better health and functioning as well as greater longevity in all age groups, but especially in the very old adults 46 . Resilience interventions in older adults include mindfulness training, CBT, well‐being therapy, social support, lifestyle and mind‐body interventions, and phone coaching. Studies applying valid and reliable measures of resilience have reported positive outcomes with small to medium effect sizes using some of these interventions 47 .

The COVID‐19 pandemic has been particularly isolating to older adult populations, given their lower familiarity with technologies to facilitate social interactions or virtual visits by family, friends, or even health professionals. However, despite these obstacles, preliminary evidence indicates that older adults have been more resilient, experiencing fewer negative mental health outcomes compared to other age groups. In a recent study of over 5,000 American adults, adverse mental or behavioral health symptoms were much more prevalent among adults aged 18‐25 compared to those aged 65 years or older 48 .

Meaning in life

Meaning or purpose in life is the value and importance attributed to one's own life and activities, and the core significance of one's personal existence 49 . There are a number of validated instruments to assess meaning in life, such as the Meaning in Life Questionnaire 50 .

Multiple research studies have demonstrated a strong link between purpose in life and better physical, psychosocial and overall health outcomes, including social engagement, in older adult populations 51 , 52 . Meaning in life may also be a protective factor against suicide 53 . A recent study reported that the presence of meaning showed an inverted U‐shaped pattern across the life span, peaking around the age of 60 and decreasing subsequently as physical health declines 50 .

Life review therapy is an individual or group story‐telling intervention with a focus on integrating life stories through different phases in life. A randomized controlled trial found that life review therapy significantly improved the quality of life of older participants 54 . A meta‐analysis of randomized controlled trials showed that life review therapy has moderate effects on depressive symptoms in older adults 55 .

Community engagement

Community engagement is a key beneficial social determinant of mental health in older adults. There are many communities across the world, including those which are formally part of the WHO's Age‐Friendly Communities (AFC) Network, in which older adults are actively involved, valued and supported, with a focus on affordable housing, built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and leadership, intergenerational programs, and accessible health and wellness services 56 .

The Compassionate Communities and Cities (CCC) movement seeks to promote the motivation of communities and cities to take greater responsibility for the care of people near the end of life. A systematic review of the studies of CCC programs reported that the evidence for their implementation is still limited 57 . A global model for the development and evaluation of CCC in palliative care is warranted.

POSITIVE PSYCHIATRY AND SUCCESSFUL AGING

Positive psychiatry is the science and practice of psychiatry that seeks to understand and promote well‐being through assessment and interventions involving positive psychosocial factors in people with or without mental or physical illnesses 58 . A critical construct in positive psychiatry that relates to older adults is “successful aging”.

The definition of successful aging and its determinants remains variable. The original model by Rowe and Kahn 8 , derived from the MacArthur Research Network, included three domains: absence of disease and disability, high cognitive and physical functioning, and active engagement with life. This model has been criticized for its overemphasis on physical health, which fails to account for many older individuals with physical morbidity who subjectively rate themselves as aging successfully and report a high degree of satisfaction in later life stages 59 , and for ignoring a dynamic lifespan perspective 60 .

Qualitative studies of successful aging indicate that older adults consider the ability to adapt to circumstances and the positive attitude toward the future as being more important to their sense of well‐being than an absence of physical disease and disability 59 . Investigations have also revealed a paradox of aging: even as physical health declines, self‐rated successful aging and other indicators of psychosocial functioning improve in later life 61 . Largely similar findings have also been reported in Eastern cultures 62 .

A broad definition of successful aging should have the following components: a) subjective well‐being, with low level of perceived stress (the extent to which an individual perceives that current demands or challenges exceed his/her ability to cope with them); b) flourishing, which involves eudemonic well‐being, including meaning in life and close social relationships 63 ; c) post‐traumatic growth; d) sustained remission or recovery in people with severe mental disorders, that typically includes an absence or a marked reduction of symptoms along with functional independence.

Neuroscience research during the past three decades has demonstrated a neurobiological basis for successful aging, despite age‐associated degenerative changes. There is strong evidence for neuroplasticity in active older adults – i.e., if there is optimal physical, cognitive and social activity, the development of new synapses, dendrites, blood vessels, and even neurons in specific subcortical regions, such as the dentate gyrus of hippocampus, can and does take place 64 , 65 .

Clinical research supports a model in which positive psychological traits such as wisdom, resilience and social engagement interact with and feed into each individual's evaluation of the degree of well‐being and are stronger predictors of outcomes such as self‐rated successful aging than physical health. We must add that aging is characterized by notable heterogeneity and, therefore, the proposed model would not apply to all the older adults.

COGNITIVE AGING

Cognitive aging is a process that is ubiquitous with humans and occurs gradually throughout adult life 66 . Clinicians caring for older adults should be aware of this process because it does impact social functioning.

Episodic memory and executive function are crucial domains affected by the aging process, and exhibit on average a gradual decline over many years, accelerating in later life 67 . Even normal changes in cognition, however, are quite variable, within and between individuals 61 . Some functions may improve over time, such as wisdom, altruism, prosocial behaviors and reasoning ability in social conflicts 68 , 69 .

The evaluation of the person with potential cognitive aging cannot be limited to the use of typical screening tools such as the Mini‐Mental State Examination (MMSE) 70 or the Montreal Cognitive Assessment (MoCA) 71 . The family is perhaps the best source of information. Queries which can be informative include: “Is __ as sharp as he/she was before?”; “Does __ have greater difficulty managing finances and other business matters than in the past?”; “Has __ become lost for brief periods in familiar places?”; “Does ___ have more difficulty recalling the names of acquaintances of long standing but which he/she has not encountered recently?”; and “Does __ have more problems with cooking and have to refer to recipes more frequently than in the past?”. Individuals with cognitive aging may also be more reluctant to participate in social gatherings. Each of these changes in behavior may be barely noticeable, yet close friends and family typically do notice.

These age‐related problems do not derive simply from a milder form of neuronal loss or plaque formation which is less extensive than in Alzheimer's disease. Brain changes do occur, however, such as changes in astrocyte and microglial function and synaptic plasticity 72 . Genetic predisposition, traumatic brain injury, adverse environmental childhood exposures, and poor educational and cognitive enrichment experiences may also contribute 73 . In other words, many external experiences which potentially can be ameliorated render prevention of greater cognitive decline with aging important across the life cycle, though some causative factors are inherent to the aging brain.

Many comorbid conditions can cause or exacerbate cognitive aging, including diabetes mellitus, vascular conditions of the brain and heart, chronic lung and liver conditions, renal failure, sepsis, delirium, chronic obstructive pulmonary disease, multiple sclerosis, vision and hearing loss, and sleep disorders 74 . Successful treatment of these conditions can often mitigate the cognitive dysfunction 74 . Additionally, many mental disorders have been associated with cognitive decrements, such as major depression (especially treatment‐resistant forms), bipolar disorder, schizophrenia, various types of substance abuse, and anxiety disorders 75 .

A number of non‐pharmacological interventions may be effective on cognitive aging. These include exercise, which is perhaps the most important preventive tool. Physical activity has been found in several studies to assist individuals in maintaining both their physical and cognitive function throughout life, as well as preventing some important chronic conditions 76 . The evidence derives from both observational and intervention studies 77 , 78 .

In addition, reduction of cardiovascular and related metabolic risk factors, such as treating hypertension and diabetes as well as cessation of smoking and losing weight, have been demonstrated effective 79 . The mantra “What is good for the heart is good for the brain” appears to hold true 66 . For example, evidence is mounting that diets, such as the Dietary Approaches to Stop Hypertension (DASH) or the Mediterranean Diet, may be useful 80 , 81 .

Many medications, especially diphenhydramine and benzodiazepines, can produce cognitive decline, and clinicians must take care in their prescription to older adults. Long‐term effects, namely a persistence of cognitive dysfunction secondary to the drugs, are less substantiated by the literature. Sleep problems, such as chronic insomnia or sleep‐related breathing disorder such as obstructive sleep apnea, may also contribute 74 . Lack of education and little cognitive stimulation may also be involved, yet the evidence for these risk factors is not as strong as for those listed above 82 .

A number of somatic interventions have been suggested 66 . Yet, none of these has held up under strict empirical clinical trials. These include stimulant drugs, such as caffeinated beverages, brain stimulating computer‐based games, and electrical brain stimulation procedures, such as transcranial direct current stimulation 83 , 84 , 85 .

Given the lack of clearly effective interventions and the apparent minor impairment secondary to cognitive aging, clinicians may be hesitant to devote time to helping affected people and their families. Yet, cognitive aging can benefit from discussions by these clinicians with older adults and their relatives, as attention to risk and protective factors can have a significant positive impact.

One area where intervention can clearly be important is alerting the family of the potential for fraud perpetrated upon older adults 86 . The frequency of fraud has increased dramatically in high‐income countries, and perhaps in low‐ and middle‐income countries as well. When disturbing messages are delivered to these elders coupled with a demand for immediate response, the potential for fraud that can be very harmful is high. For example, in the US, elders may be telephoned with fraudulent alerts that they owe taxes and may be jailed if these are not paid immediately, coupled with a demand for their social security number. Warnings to older adults and their families can be most helpful in mitigating these threats 86 .

NEUROCOGNITIVE DISORDERS

The DSM‐5 87 has introduced the term “neurocognitive disorders” to describe the group of disorders with cognitive impairment as the salient feature, encompassing major (or dementia) and mild neurocognitive disorders, and delirium 88 . The term dementia, however, remains the most frequently used, and mild neurocognitive disorder is used interchangeably with the expression “mild cognitive impairment”.

The DSM‐5 has tried to bring coherence to the criteria for the various subtypes of these disorders under one framework, but its widespread adoption has been limited largely to psychiatry and psychology. The National Institute of Aging‐Alzheimer's Association (NIA‐AA) Criteria for dementia 89 and mild cognitive impairment 90 are widely used in the neurology literature. The DSM‐IV criteria for dementia 91 are still in use, with the major distinction from the DSM‐5 being that significant impairment in one cognitive domain is sufficient as long as the functional criteria are met.

The distinction between dementia and mild cognitive impairment is based on the severity of the cognitive deficits and, more importantly, on their functional consequences. For mild cognitive impairment, the International Working Group criteria are commonly applied 92 . With the increasing interest in preclinical syndromes, the concept of “subjective cognitive decline” (i.e., subjective report of decline in cognitive abilities from a previous level, unrelated to an acute event, with normal performance on standard cognitive tests, accounting for age, gender and education) has also received much attention in recent years 93 .

The DSM‐5 describes cognitive dysfunction by delineating six domains: complex attention, executive function, learning and memory, language, perceptual‐motor and social cognition. It recognizes that varying degrees of cognitive impairment are present in several mental disorders, but cognitive dysfunction must be the salient and defining feature for a diagnosis of neurocognitive disorder 88 . The formal acknowledgement of social cognition as a specific cognitive domain in the DSM‐5 has spurred much research and clinical interest 94 .

Dementia and mild neurocognitive disorder

Dementia and mild neurocognitive disorder are discussed together for several reasons. They are syndromes with shared etiology, with the main difference being the severity of cognitive impairment and its functional consequences 92 . Cognitive impairment should, in fact, be considered to be on a continuum, with mild cognitive impairment and dementia being categorical constructs imposed on that continuum. This is consistent with the understanding that the pathology underlying dementia, in particular that due to Alzheimer's disease 95 , can take several decades to build up in the brain, and cognitive impairment is similarly slow to develop and progress 95 .

Epidemiology

While there are many challenges in “counting” cases of dementia, partly related to the purpose for which this is being done 96 , several systematic efforts have been made. The latest global estimate from the Global Burden of Disease Study 2019 is 57.4 million (95% CI: 50.4‐65.1) cases worldwide in 2019, projected to increase to 152.8 million (95% CI: 130.8‐175.6) in 2050. This rise in prevalence is attributable to the increase in the elderly population, with the age‐standardized prevalence remaining stable 97 . There is much regional variation, with the smallest increases projected for Western Europe and high‐income Asia‐Pacific, and the largest increases for North Africa, Middle East, and Eastern sub‐Saharan Africa.

The incidence of dementia is showing a different trend, with several studies from high‐income countries, and one from Nigeria, showing a decline, especially in the last three decades 98 , 99 . No specific cause for this decline has been found, but changes in education, living conditions and health care are thought to have contributed.

The epidemiology of mild cognitive impairment has been less well studied. The published prevalence estimates vary by the diagnostic criteria being used 92 . Applying uniform criteria in the Cohort Studies of Memory in an International Consortium (COSMIC), the crude prevalence in those over 60 years was 5.9% (95% CI: 5.5‐6.3) overall, increasing from 4.5% at age 60‐69 to 5.8% at 70‐79, and to 7.1% at 80‐89 years. This was unaffected by gender and did not differ between White Caucasian and Chinese groups 100 .

Risk and protective factors

Twelve potentially modifiable risk/protective factors for dementia have been recently identified, as listed in Table Table1 1 101 . To the previously documented nine risk factors with good supporting evidence (less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact), three new ones have been added (excessive alcohol consumption, traumatic brain injury, and air pollution).

Modifiable risk factors of all‐cause dementia (adapted from Livingston et al 101 )

	Relative risk for dementia (95% CI)	Weighted population attributable fraction (%)
Less education	1.6 (1.3‐2.0)	7.1
Hearing impairment	1.9 (1.4‐2.7)	8.2
Traumatic brain injury	1.8 (1.5‐2.2)	3.4
Hypertension	1.6 (1.2‐2.2)	1.9
Excessive alcohol consumption (>21 units/week)	1.2 (1.1‐1.3)	0.8
Obesity (body mass index ≥30)	1.6 (1.3‐1.9)	0.7
Smoking	1.6 (1.2‐2.2)	5.2
Depression	1.9 (1.6‐2.3)	3.9
Social isolation	1.6 (1.3‐1.9)	3.5
Physical inactivity	1.4 (1.2‐1.7)	1.6
Diabetes	1.5 (1.3‐1.8)	1.1
Air pollution	1.1 (1.1‐1.1)	2.3
Total		39.7

Together, these factors account for about 40% of dementia risk worldwide, which can theoretically be prevented 102 . The potential is greater in low‐income countries, in which the prevalence of some of the risk factors is higher. An ambitious prevention program in terms of both policies and individual action has been therefore proposed, while recognizing that individual behavioral change, on which much of this depends, is difficult to achieve 102 . There has also been an international consensus on enlarging the vista of dementia to include cerebrovascular disease, with the Berlin manifesto of “preventing dementia by preventing stroke” 103 .

The evidence that the modification of lifestyle and other risk factors can slow cognitive decline and potentially delay the onset of dementia, or prevent it, is gradually accumulating 102 .

For most risk factors, the evidence comes largely from observational studies, although some controlled trials are also available 101 . While individual factors – such as education, physical activity, and control of vascular risk factors – are important to address, it is the lifelong cumulation of risk that appears to be most potent. Multimodal interventions over long periods have therefore been investigated.

The best‐known investigation is the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER Trial) 104 , a 2‐year multi‐domain randomized controlled trial in which the active arm included dietary counseling, physical exercise, cognitive training, and vascular and metabolic risk monitoring. Over 24 months, the improvement in global cognition was 25% higher in the intervention group compared to the general health advice control group. The improvement was observed regardless of demographic and socioeconomic factors, and was also seen in people with genetic susceptibility ( APOE*4 positive) to Alzheimer's disease 105 . Long‐term data from this trial, to explore whether the intervention did indeed prevent dementia, are not yet available.

While the FINGER trial generated much enthusiasm, two other large multi‐domain trials, the Multi‐domain Alzheimer Preventive Trial (MAPT) 106 from France and the Dementia by Intensive Vascular Care (PreDIVA) 107 from the Netherlands, were negative on their primary outcomes (respectively, cognitive decline and all‐cause dementia). Sub‐analyses of these trials, however, revealed that there was benefit in people with increased risk of dementia.

This highlighted the need for further research and resulted in the development of an international network of trials called the World‐Wide FINGERS (WW‐FINGERS) 108 , which encompasses 25 countries, including some low‐ and middle‐income countries. Some of the trials, such as the Maintain Your Brain Trial in Australia 109 , are completely online. This network, with the stated objective of data sharing and joint analyses, has the potential to provide the evidence base to develop prevention of dementia policies across communities and jurisdictions.

While policy change will need to await such evidence, it is reasonable, at an individual level, to advise older people at risk of cognitive decline to implement the measures of controlling vascular risk factors, optimizing their physical, mental and social activities, reducing stress, treating depression if present, and following a balanced Mediterranean‐like diet 110 . Indeed, it would be reasonable to argue that dementia prevention is a life‐long endeavor, the seeds of which are sown in childhood with good education and a nurturing environment.

Neuropsychiatric symptoms of dementia

Neuropsychiatric symptoms are a common reason for referral of a dementia patient to a psychiatric service. They also lead to much distress, both for the patient and his/her caregivers, and contribute to hospitalization and early admission to residential care 111 .

Several approaches have been used for the categorization of these symptoms, with none being completely satisfactory. They include agitation and aggression, psychotic symptoms (delusions, hallucinations), mood symptoms (depression, anxiety, elation, apathy), sleep and appetite disturbances, and ruminative, repetitive and somatoform behaviors 112 . Apathy has been reported to be the most common symptom, followed by depression and agitation/aggression 113 .

The Neuropsychiatric Inventory (NPI) 114 is the most commonly used instrument for the assessment of these symptoms in clinical trials, but it does not include all of them and is based on informant report. Other commonly used measures are the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE‐AD) 115 and the Cohen‐Mansfield Agitation Inventory 116 .

Recent work has shown that neuropsychiatric symptoms may occur early in the course of dementia, at the stage of mild cognitive impairment or even before that. This has resulted in the concept of “mild behavioral impairment” 117 . There is some evidence that individuals with mild cognitive impairment who also have neuropsychiatric symptoms are at risk of faster progression to dementia 118 .

The treatment of neuropsychiatric symptoms remains a challenge. The current evidence suggests that the role of drug treatment is limited, and non‐pharmacological strategies are first line 119 , in particular some behavioral management techniques, especially those involving caregiver‐ and staff‐oriented interventions 120 . However, drug treatment is still common, with frequent adverse effects. Antipsychotics such as risperidone, aripiprazole and quetiapine have evidence supporting short‐term use for agitation or psychotic symptoms, but with increased risk of stroke and confusion or cognitive decline, along with extrapyramidal and metabolic adverse effects 121 . Other drugs used in some patients include antidepressants (e.g., citalopram, sertraline, mirtazapine), cholinesterase inhibitors, memantine, benzodiazepines and analgesics, all with limited evidence 112 .

A number of small drug trials have also been conducted to treat neuropsychiatric symptoms in frontotemporal dementia 122 and dementia with Lewy bodies 123 , but with limited evidence of success. A narrative review 124 and a Delphi consensus group 125 supported the use of donepezil and rivastigmine for neuropsychiatric symptoms of dementia with Lewy bodies, although a network meta‐analysis found that these drugs improved neuropsychiatric symptoms in Parkinson's disease dementia, but not in dementia with Lewy bodies 123 . Among antipsychotics, aripiprazole was reported in a small study to be effective and well tolerated for the treatment of psychotic symptoms in patients with dementia with Lewy bodies 126 .

There is an ongoing attempt to better understand the neurobiology of neuropsychiatric symptoms of dementia, so that rational therapeutics can be developed 112 .

Organization of services

The journey of a person with dementia is long and arduous, and often begins with a delay in diagnosis or its lack altogether. A pooled analysis reported that rates of undiagnosed dementia are as high as 70.7% in Canada, 43.1% in UK, 58.2% in Europe, and 61.7% worldwide 127 . The WHO Global Dementia Action Plan 128 aims to reduce this to 50% in 50% of countries by the year 2025.

The communication of the diagnosis to the patient and/or his/her family, once it is made, is often poor, with only 34% of primary care physicians and 48% of specialists routinely informing the individual about the diagnosis 129 . A negative reaction to the diagnosis is common, which is understandable considering the prevalent anti‐dementia stigma in society 130 , 131 .

The diagnosis of dementia should be followed by a management plan for the short and long term, to maintain optimal function and quality of life as long as possible. Too often, the diagnosis is followed instead by advice for disengagement from society 132 , which may set up the path to more rapid decline.

There are several worldwide challenges to providing high‐quality care to persons with dementia and their families. Both the direct and indirect costs of care are high, and public investment in this area has been inadequate, even in high‐income countries, although dementia was declared a public health priority by the WHO in 2015 133 .

The capacity to provide care at home is often insufficient, and systems to ensure the safety and quality of care are not commonly implemented. Institutional care is frequently of poor quality, because of lack of resources and adequately trained staff. People with young‐onset dementia and those from ethnic or other cultural minorities are often poorly catered for.

As the world faces a growing dementia population, the health services, and society in general, need a concerted and coordinated response underpinned by high quality. Several international examples of good practices are available for adoption in diverse settings 134 , 135 . The Global Dementia Observatory of the WHO monitors the public response to dementia in all countries on 35 key indicators, with the objective of achieving the global targets of the Global Dementia Action Plan by 2025 136 .

Directions for future clinical practice and research in dementia are provided in Table 2 .

Directions for future clinical practice and research in dementia

	Neurocognitive disorders should remain categorized as mental disorders in the DSM and ICD, and psychiatry should play a major role in comprehensively assessing and treating these conditions.
	A global effort should be made to better understand the origins and disease mechanisms of the various dementia subtypes.
	An international effort should be promoted to improve epidemiology research on dementia in low‐ and middle‐income countries and to develop global platforms for data sharing.
	A global effort should be made to develop prevention strategies which are tailored to different populations based on differential risk factor profiles and behavioral repertoires.
	Clinical services and diagnostic pathways should be improved, so that patients with dementia and mild cognitive impairment can receive an early and accurate diagnosis.
	Better models of collaborative care for dementia should be developed that are accessible to all, both in the immediate period after a diagnosis and in the longer term.
	The neuropsychiatric symptoms of dementia should be better understood, so that neurobiologically informed treatments can be developed.
	The newly developed biomarkers of Alzheimer's disease should be made affordable and clinically available, and biomarkers should be developed for the other dementia subtypes.
	Drug development for dementia should become a global effort, with the objective that new treatments are tested in all populations, and when brought to the market are affordable and accessible to all.
	All societies should develop policies and procedures to address ageism and stigma against dementia.

Specific dementias

There have been major advances in the last two decades in our understanding of the pathophysiology and biomarkers of specific dementias, in particular Alzheimer's disease. There have also been significant developments in the knowledge about pathology of dementia, including the description of a potentially new form, limbic‐predominant age‐related TDP‐43 encephalopathy (LATE).

Alzheimer's disease

While the hallmark features of plaques and tangles in Alzheimer's disease have been known for over a century, the understanding of the detailed pathologies involved is more recent. The pathogenesis of the protein abnormalities, the β‐amyloid (Aβ) peptides that aggregate to form the amyloid fibrils of the neuritic plaque, and the hyperphosphorylated tau that forms the neurofibrillary tangles, is now much better understood 137 .

This is associated with other processes such as neuroinflammation, oxidative stress, autophagy, dysfunction of the glymphatic system, alteration in blood vessels, leakage of the blood‐brain barrier, and abnormality in the gut microbiome, all contributing to the cellular pathology underlying Alzheimer's disease 138 .

There has long been a controversy on the relative importance of amyloid and tau in the pathogenesis of Alzheimer's disease. The most popular model is the “amyloid hypothesis”, which posits that Aβ, most likely in its soluble oligomeric form, initiates a pathophysiological cascade which leads to the hyperphosphorylation and misfolding of tau 139 . The misfolded tau is then propagated through the cortex in a prion‐like fashion, leading to cellular failure and the development of cognitive deficits 140 . The complex Aβ‐tau interactions are incompletely understood, and it seems likely that both pathologies are important and have a synergistic effect 139 .

Diagnosis and biomarkers

Alzheimer's disease accounts for 55‐60% of all cases of dementia. The clinical features are well described, with salience of disturbance of episodic memory in the early stages. The clinical criteria used most commonly are the NIA‐AA criteria for dementia 89 and mild cognitive impairment 90 due to Alzheimer's disease.

With the recent development of biomarkers for amyloid (A), tau (T) and neurodegeneration (N), Alzheimer's disease has also been described using the AT(N) framework, with a diagnosis requiring the presence of both A and T 141 . This approach distinguishes the pathological process of the disease from the clinical syndrome, recognizing that pathology precedes the development of neurodegeneration and clinical features by several years, if not decades.

A hypothetical model of dynamic biomarkers has been proposed to explain the pathophysiological process of Alzheimer's disease 142 , in which Aβ deposition occurs independently and accelerates tauopathy, which then leads to neurodegeneration detectable on magnetic resonance imaging (MRI) and positron emission tomography (PET) before cognitive symptoms become manifest.

There have been updates of the AT(N) classification to accommodate vascular pathology 143 and other pathologies such as neuroimmune dysregulation, synaptic disruption and blood‐brain barrier breakdown 144 .

One of the most significant recent advances in Alzheimer's disease has been the development of biomarkers, as listed in Table 3 . PET imaging was first established for amyloid 145 and later for tau 146 , and both are now in clinical use. It is now possible to assess amyloid and tau status with high specificity and sensitivity by the cerebrospinal fluid measurement of Aβ42 level, Aβ42/Aβ40 ratio and phospho‐tau (pTau) levels, for which standardized procedures have been developed 144 .

Biomarkers in the diagnosis of common dementing disorders

	Biomarker class	Imaging	Cerebrospinal fluid	Blood
Alzheimer's disease	Amyloid (A)	PET (Pittsburgh compound‐B, F ligands)	Aβ42 level; Aβ42/Aβ40 ratio	Aβ42 level; Aβ42/Aβ40 ratio
	Tau (T)	PET	pTau	pTau181; pTau217; pTau231
	Neurodegeneration (N)	MRI, FDG PET	tTau; NfL	NfL
	Synaptic loss	FDG PET	Neurogranin
	Neuroinflammation	TSPO PET	GFAP; TREM2	GFAP
Dementia with Lewy bodies	Neurodegeneration	MRI, FDG PET
	Parkinsonism	DAT imaging, MIBG heart scintigraphy
Frontotemporal dementia	Neurodegeneration	MRI, FDG PET	NfL	NfL

PET – positron emission tomography, FDG – fluorodeoxyglucose, MRI – magnetic resonance imaging, Aβ – amyloid beta, pTau – phosphorylated tau, tTau – total tau, NfL – neurofilament light chain, GFAP – glial fibrillary acidic protein, TREM2 – triggering receptor expressed on myeloid cells‐2, TSPO – translocator protein (18 kDa), DAT – dopamine transporter, MIBG – 123 I‐metaiodobenzylguanidine

More recently, the development of blood biomarkers for Alzheimer's disease has raised the prospect of affordable and readily accessible tests. While Aβ42/Aβ40 ratio shows promise, more work is needed to standardize its measurement before clinical use 147 . Some pTau fragments (pTau181, pTau217 and pTau231) in the blood have been shown to accurately reflect brain pathology and are rapidly emerging as biomarkers 148 . Blood levels of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) may accurately reflect neurodegeneration and neuroinflammation, respectively 148 .

The genetics of Alzheimer's disease has seen major advances in recent years. The fully penetrant mutations in three genes (amyloid precursor protein, presenilin 1 and presenilin 2), that cause disease of early onset, have been known for some time 149 . The main risk gene for sporadic disease is the ε4 allele of the apolipoprotein E gene ( APOE*4 ), which increases risk by 2‐3 fold in the heterozygous state and 10‐12 fold in the homozygous condition.

Genome‐wide association studies and next generation sequencing have led to the discovery of an additional >40 genes with small effect (odds ratios of 1.05 to 1.20). Collectively, the polygenic risk score for Alzheimer's disease can distinguish patients from controls with 75‐85% accuracy 150 .

The recent approval by the US Federal Drug Administration (FDA) of a disease‐modifying drug, aducanumab 151 , has been seen as a major milestone 152 . This is a human monoclonal antibody that targets the amyloid protein and is administered by monthly intravenous infusions.

However, its approval has generated considerable controversy. Phase 3 studies were initially terminated after a futility analysis, but a post‐hoc analysis led to “accelerated” approval by the FDA because it showed reduction of brain amyloid as a surrogate marker, even though the clinical benefit criterion was not met 153 , and the drug showed significant adverse effects in the form of cerebral edema and hemorrhage. This approval occurred despite the advice of the independent advisory committee of the FDA, and came with a price tag of US$ 56,000 per year for the drug.

The validity of reduced amyloid in the brain as a surrogate marker for clinical benefit has been questioned 154 . Nevertheless, many clinicians are preparing for the rollout of the drug in the US, and approval in other countries is being sought. The manufacturers of aducanumab have been given 6‐year approval by the FDA to provide evidence of clinical benefit. Guidelines for its appropriate use are beginning to be published 155 . Aducanumab may be the first of several disease‐modifying drugs coming to the clinic, and has generated renewed interest in drug treatment of Alzheimer's disease and other dementias.

Other dementias

Advances in other dementias – such as vascular dementia, dementia with Lewy bodies, and frontotemporal dementia – have been significant, but not as striking as those in Alzheimer's disease.

Vascular cognitive impairment and dementia

Vascular dementia has seen a broadening of the concept to vascular cognitive impairment and dementia 156 , and new diagnostic criteria 157 , 158 have been proposed.

Vascular dementia is the second most common form of dementia, accounting for about 15‐20% of all cases 159 . Vascular contributions to dementia are, however, much more common in autopsy studies, with up to 75% having some vascular pathology 160 and about one‐third having significant vascular pathology 161 .

Recently, international collaborations, such as the Stroke and Cognition Consortium (STROKOG) 162 and the METACOHORTS Consortium 163 , have been formed to expedite the development of new treatments and prevention efforts. A framework for research priorities in the cerebrovascular biology of cognitive decline has been proposed 164 . The priorities include the development and validation of imaging and biospecimen‐based biomarkers, better experimental models, and increased understanding of the underlying molecular and physiological mechanisms – white matter disease, infarction, microhemorrhage, vascular autoregulation, glymphatic flow, metabolic processes – and the interaction between vascular and Alzheimer pathologies 164 .

Dementia with Lewy bodies

Dementia with Lewy bodies has seen the publication of the fourth consensus report on its diagnosis and management 165 , which has clearly distinguished between clinical features and diagnostic biomarkers. The report gave more weighting to rapid eye movement (REM) sleep disorder, that involves recurrent dream enactment behavior, in the clinical criteria. The disproportionate deficits in the cognitive domains of attention, executive function and visual processing relative to memory and naming were highlighted.

While there are still no direct biomarkers to establish dementia with Lewy bodies, indicative biomarkers include reduced dopamine transporter (DAT) uptake in the basal ganglia on single photon emission computerized tomography (SPECT) or PET imaging 165 , 166 , reduced iodine‐metaiodobenzylguanidine (MIBG) myocardial scintigraphy uptake 165 , and polysomnographic confirmation of REM sleep without atonia 167 .

While the genetic architecture of this form of dementia is poorly understood, genome sequencing has identified new loci, and genetic risk scores suggest that it shares risk profiles with Alzheimer's and Parkinson's diseases 168 .

There is evidence for the beneficial effects of cholinesterase inhibitors, but not memantine, on cognition 169 , but parkinsonism is less likely to respond to dopaminergic drugs compared to Parkinson's disease, with an increased risk of psychosis 170 .

Frontotemporal dementia

Frontotemporal dementia is an umbrella term for a diverse group of neurodegenerative disorders characterized by atrophy in the frontal and temporal lobes, with a clinical picture dominated by a behavioral‐executive dysfunction (behavioral variant) or a language disturbance (semantic and progressive non‐fluent aphasia variants) 171 .

Because of the psychiatric features of the behavioral variant, psychiatrists are often the first professionals to see such patients 172 , and the condition may be misdiagnosed as obsessive‐compulsive disorder, schizophrenia, bipolar disorder or depression, because of some shared features 172 . Personality change is often an early feature of this behavioral variant; there may be features of borderline, antisocial, schizoid or schizotypal personality. Substance abuse may be present 172 . About 50% of patients with frontotemporal dementia initially receive one of the above‐mentioned psychiatric diagnoses, leading to a delay in the correct diagnosis of up to 5‐6 years 171 .

Frontotemporal dementia is usually a young‐onset disorder, being the second or third most common cause of dementia of young onset, accounting for 3‐26% of such cases in various studies 173 . About a third of cases are familial, with three autosomal dominant genes commonly implicated: progranulin (GRN), chromosome 9 open reading frame 72 (C9orf72), and microtubule‐associated protein tau (MAPT). However, several other genes have been involved. Rare mutations include TAR DNA‐binding protein 43 (TDP‐43), fused‐in sarcoma (FUS), valosin‐containing protein (VCP), and the CHMP2B genes. The C9orf72 mutations are the most common genetic form and may initially present as a late‐onset psychosis. These mutations have also been rarely reported in patients with schizophrenia and bipolar disorder 174 , 175 .

The inclusions in frontotemporal dementia contain tau, TDP‐43 or FUS proteins. There is increasing research in developing fluid biomarkers for this form of dementia, with NfL showing promise as marker of neurodegeneration 176 , but without specificity.

Differential diagnosis from psychiatric disorders and other neurodegenerative diseases is often aided by neuroimaging, using MRI and PET. There is predominant atrophy of frontal and temporal lobes, which is asymmetrical in the early stages, and this is associated with hypometabolism and hypoperfusion in these regions. Differential diagnosis from the frontal variant of Alzheimer's disease is assisted by amyloid imaging 177 .

There is currently no approved drug treatment for frontotemporal dementia. The focus of treatment is on the management of neuropsychiatric symptoms. The symptoms targeted have been apathy, disinhibition, obsessive‐compulsive and hoarding behaviors, loss of empathy and prosocial behavior, loss of insight, and psychosis, but results thus far have not been conclusive for the various interventions investigated 122 . Drugs to modulate the serotonergic and dopaminergic systems are used off‐label to treat these symptoms, but with modest success 122 .

Limbic‐predominant age‐related TDP ‐43 encephalopathy ( LATE )

LATE is a recently described entity which affects older people and presents with an amnestic picture resembling Alzheimer's disease 178 . Its pathology – which typically involves the amygdala, hippocampus and middle frontal gyrus – is common in older brains, seen in nearly 25% of brains at autopsy in a community cohort 179 .

The pathogenesis and clinical picture of this condition, and its status in relation to Alzheimer's disease and frontotemporal dementia, are only beginning to be understood.

The DSM‐5 recognizes delirium as a cognitive disorder with a disturbance of attention (i.e., reduced ability to direct, focus, sustain and shift attention) and awareness (i.e., reduced orientation to the environment). This often leads to what has been referred to as a confusional state or reduced level of consciousness 180 .

The presentation is multifaceted, with several cognitive domains being affected, along with altered sleep‐wake cycle, emotional lability, delusions, agitation, and other motor and behavioral disturbances. Two forms of delirium – hyperactive and hypoactive – have been described, with the hypoactive form being more common in older people and having a worse prognosis 181 .

Delirium remains a clinical diagnosis, with no validated biomarkers. Various inflammatory, metabolic and neurotransmitter‐based markers have been investigated, but their clinical application is limited 182 . The electroencephalogram (EEG) may be used as a supportive test, but it has low specificity and sensitivity, and its application is mainly to distinguish delirium from a primary mental disorder or a non‐convulsive status epilepticus 183 .

The lack of biomarkers and the diverse and sometimes subtle clinical features of delirium often result in its under‐recognition. In one study 184 , conducted in the context of palliative care, 60% of patients with delirium had not been diagnosed by the treating physician. A high index of suspicion, especially in older individuals in settings where delirium is most likely, is important, preferably complemented by a delirium screening tool 185 . One of the most widely used is the Confusion Assessment Method (CAM) 186 , which can alert the clinician to the likelihood of delirium in an individual case.

The pathophysiology of delirium is incompletely understood. Older age is an independent risk factor, and this has been attributed to several changes associated with brain aging, which include reduced blood flow and vascular density, neuronal loss, and changes in neurotransmitters and intracellular signal transduction systems 187 . Numerous predisposing and precipitating factors for delirium have been identified, resulting in its characterization as a state of acute brain failure through multiple pathways. Several hypotheses for its development have been proposed, such as the oxidative stress hypothesis 188 , the neuroinflammatory hypothesis 189 , the neuroendocrine hypothesis including the role of aberrant stress 190 , and the circadian rhythm dysregulation hypothesis 190 .

Since the various pathways do not occur in isolation, and do not lead to distinct consequences, delirium is best understood as a large‐scale neural network disruption 182 , with several processes (i.e., neuroinflammation, neurotransmitter dysregulation, oxidative stress, neuroendocrine disturbance, and circadian rhythm dysregulation) contributing to varying degrees in different situations.

Several clinical management guidelines for delirium have been published 191 , which include those from the UK National Institute for Health and Care Excellence (NICE) 192 and the American Geriatrics Society 193 . The emphasis is on prevention, with the use of multicomponent non‐pharmacological approaches. The various components are attention to the environment, encouraging ambulation and exercise, early mobilization following surgery, maintaining a fluid balance, attention to adequate nutrition, improving vision and hearing, sleep enhancement, infection prevention, pain management, hypoxia control, and optimization of medications 180 . A non‐pharmacological approach based on the above‐mentioned components is also the mainstay of treatment. Drug treatment is generally avoided, except for benzodiazepines in delirium from alcohol or benzodiazepine withdrawal.

While antipsychotics such as risperidone, haloperidol, ziprasidone and olanzapine are sometimes used to manage agitation or psychotic symptoms in delirium, there is a lack of strong evidence to support their use 194 .

LATE‐LIFE MAJOR DEPRESSION

The recognition of major depression is of great clinical importance across the life cycle, and no less so in older adults 195 . This condition presents increasing public health challenges to both high‐income and low‐ and middle‐income countries, reflecting demographic shifts to older populations and scarcity of treatment resources 195 , 196 . It is the second leading cause of disability worldwide, up from the third as of 1990 197 .

The hallmark of major depression in old age is its co‐occurrence with physical disorders and frailty, mild cognitive impairment, social determinants of health (e.g., major role transitions, bereavement, loneliness and social isolation), exposure to polypharmacy, and heightened risk for suicide. Late‐life major depression is also a significant source of caregiver burden for family members.

Approximately 6.7% to 7.5% of older adults report an episode of major depression within one year, among those attending primary care clinics 195 . Rates are still higher among medical inpatients and residents in long‐term care, rising with increasing disability and frailty. Women experience 1.7 times the risk as men. Prevalence rates are likely to be higher in marginalized groups, such as those of lower socioeconomic status. The lifetime suicide rate is 25 times greater in major depression than in the general population, with highest rates amongst older adults 196 , 197 , 198 .

Major depressive disorder and depressive symptoms not only bring suffering to those afflicted, but also produce amplification of disability from co‐occurring physical disorders, poor adherence to co‐prescribed treatments, failure to make healthy lifestyle choices, and increased risk for frailty, dementia, and early death. On the other hand, evidence‐based treatments work, if delivered appropriately, and may both prolong life and enhance its quality 199 .

In essence, the global public health and clinical burden of depression in old age has three dimensions: it is a mirror of brain aging, a mediator of bad outcomes, and a murderer that leads to dementia and to suicide. It is also an unwanted co‐traveler with the ills of aging: cancer, cardiovascular disease, and neurodegenerative disorders 195 , 196 , 197 .

Major depression in older adults is characterized by variability at multiple levels: etiopathogenesis, clinical presentation, and response to prevention and treatment. A staging‐model perspective, analogous to oncology, is useful 200 , 201 . Some older adults may present with mild or subsyndromal symptoms; some with new‐onset major depression; some with recurrent episodes which began earlier in life and show in later years shortening inter‐episode intervals and increasing treatment resistance; and still others are ravaged by chronic depression and its sequelae.

Staging has implications for differential diagnosis, intervention and prognosis 202 . Subsyndromal pictures represent opportunities for the indicated prevention of major depression. First episodes, while treatable, may also be prodromal expressions of dementia. Recurrent depressive episodes and chronic depression pose challenges of increasing treatment resistance and heightened risk for dementia. As in oncology, early intervention to prevent the transition to incident episodes and to recurrence may be life‐saving and life‐enhancing, by taking advantage of neuroprotective mechanisms early in the course of illness, while reversibility may still be attainable 200 , 201 .

In this context, the relationship of insomnia disorder to depression is clinically relevant, because insomnia is not only a symptomatic manifestation of major depression, but also a risk factor for incident and recurrent depressive episodes. Persistent insomnia (insomnia disorder) heightens the risk for a chronic relapsing course and thus warrants independent clinical attention to optimize outcomes 203 .

Insomnia may partially mediate depression risk for Alzheimer's and related dementias via beta‐amyloid accumulation, tau protein aggregation, inflammation and blood‐brain‐barrier disruption 204 , 205 , 206 . It is also a driver of suicidal ideation and behavior, and may be a modifiable risk factor for suicide 203 , 207 . .

A long‐term view of late‐life depression is necessary clinically: getting well is not enough, it is staying well that counts, given the propensity of depression to relapse, recurrence, chronicity, and treatment resistance, not to mention heightened risk for dementia and suicide.

Major depression can be prevented across the life cycle 196 , 208 . The case for its prevention in the later years of life is important from both public health and clinical perspectives. Major depression is prevalent, persistent and burdensome in respect to both morbidity and mortality. Treatment is only partially effective in reducing years lived with disability. There is, moreover, limited access to treatment, related to both mental health workforce issues and barriers confronting socially disadvantaged older adults and those from racial/ethnic minorities. The social inequalities of risk widen with age, generating disparities of access, utilization and response. This treatment gap reinforces the need for the development and implementation of pragmatic prevention programs 208 .

A meta‐analysis 209 estimated a reduction of about 20% in the incidence of major depressive episodes over 1‐2 years, compared with care as usual or waitlist, through the use of brief behavioral or learning‐based psychotherapies (such as CBT, interpersonal psychotherapy, problem‐solving therapy, and behavioral activation). The 38 randomized controlled trials included in the meta‐analysis enrolled mixed aged (adult and geriatric) participants, receiving care in high‐income countries. Studies investigated either indicated prevention (in persons already living with mild or subsyndromal symptoms) or selective prevention (in those with physical or psychosocial risk factors for depression, such as stroke or age‐dependent macular degeneration).

Only one randomized controlled trial of depression prevention specifically focused on older adults with mild symptoms (indicated prevention) has been conducted in a low‐ or middle‐income country 210 . The “DIL” intervention (meaning “Depression in Later Life” and also representing the local Konkani word for “heart”) was delivered by lay counselors to older adults at rural and urban primary care clinics in Goa, India. The intervention model was multi‐pronged, grounded in the strategies of behavioral activation 211 , but also including brief behavioral treatment for insomnia 212 , education in better self‐care for common physical disorders such as diabetes and osteoarthritis, and assistance in accessing medical and social services.

Over one year, DIL led to a reduction in the incidence of major depressive episodes compared to care as usual (4.4% versus 14.4%, log rank p=0.04) and in the burden of depressive and anxiety symptoms (group x time interaction: p<0.001). Participants randomly assigned to DIL reported to more frequently engage in pleasurable social and physical activities – a countermeasure to the “tension” and worry that plagued their daily lives. They took a more active hand in managing their health, coming to feel more in control and less helpless 210 . If these findings are replicated, the DIL intervention may be scalable to other low‐ or middle‐income countries.

More recently, the VITAL‐DEP randomized clinical trials examined the efficacy of two nutraceuticals, vitamin D and fish oils, in preventing incident and recurrent major depressive episodes in over 23,000 older adults, with an over‐sampling of African Americans 213 , 214 . The scope of the trials was wide, examining universal, selective and indicated prevention of depression. The trials did not, however, detect evidence for efficacy, relative to placebo, with either nutraceutical, despite a cogent neurobiological rationale for positing the prophylactic effect of each, singly and in combination. For example, vitamin D and/or fish oils could lower depression risk via reduction in inflammation and oxidative stress, and improvement in vascular/metabolic health and neuroprotection. These processes represent senescence‐associated secretory phenotypes (SASPs), i.e., molecular signatures of aging 215 .

Studies such as DIL and VITAL‐DEP highlight the importance of addressing the interplay between behavioral and biological factors involved in aging processes. Moreover, attention to workforce issues (via the use of task sharing or shifting to lay counsellors) and to the streamlining of evidence‐based behavioral interventions and psychotherapies, with sensitivity to differing cultural contexts, may help to optimize cost‐utility of prevention interventions. Identifying biomarkers of risk that may mediate or moderate response to preventive interventions remains a vital part of the research agenda in late‐life depression.

Treatment goals for major depressive disorder in older adults should include not only symptomatic remission, but also functional recovery; reduction of risk for relapse, recurrence and chronicity; and protection and maintenance of brain health and cognitive fitness 216 . Combined treatment (antidepressant medication plus depression‐specific psychotherapy) may be more effective than either alone in some populations, but side effect risks and patient demands/burdens may be greater 5 , 6 , 195 , 217 .

Psychotherapies may have a greater impact than antidepressant medication in the long run 216 , 217 . Moderators of outcome include individual patient‐level differences such as those concerning gender, ethnicity, disability status, neurocognitive performance, and physical comorbidity. Therapist competence (including ability to tailor treatment to the individual), therapeutic alliance, and patient preferences all influence the strength of response to treatment 6 .

The limitations of the available evidence include little comparative research, together with a need for greater attention to long‐term effects, comorbidity, and diverse populations. With respect to antidepressant pharmacotherapy, response rates in older adults are greater in trials lasting 10‐12 weeks than in those lasting 6‐8 weeks. Antidepressants are moderately effective in bringing about remission relative to pill placebo, with numbers needed to treat in the range of 8‐13 218 . Learning‐based psychotherapies (CBT, interpersonal psychotherapy, problem‐solving therapy, behavioral activation) are also moderately effective in bringing about remission 216 .

Continuing antidepressant medication in those who have initially done well appears to be effective in preventing relapse during 6‐12 months of continuation therapy, and in preventing recurrence for up to three years during longer‐term maintenance treatment, with reported numbers needed to treat of about 4 219 . Going forward, pharmacogenomics‐informed clinical decision making is likely to continue emerging as a useful strategy in probing treatment response variability (both efficacy and tolerability/safety) and contributing to better outcomes 220 , 221 .

Failure to achieve symptomatic remission after two or more trials of antidepressant pharmacotherapy is common in older adults with major depression. The largest published randomized controlled trial to date amongst older adults (“IRL GREY”) – a multi‐site, double‐blind, placebo‐controlled trial of aripiprazole augmentation of primary pharmacotherapy with venlafaxine – demonstrated efficacy for augmentation, yielding a 44% remission rate versus 29% with placebo (number needed to treat: 6.6) 222 . Aripiprazole was well tolerated in analyses of both cardiometabolic and neurological outcomes, and led to a reduction in the prevalence and severity of suicidal ideation.

A randomized pragmatic trial comparing augmentation versus switching class of antidepressant medications for treatment‐resistant late‐life major depression has recently been completed 223 . Preliminary analyses suggest that pharmacotherapy augmentation strategies (e.g., with bupropion or aripiprazole) are superior to switching strategies (to another monotherapy) in bringing about remission, and are no less safe with respect to such adverse events as falls.

A psychotherapy called “Engage”, rooted in a neurobiological framework addressing the reward system network, and streamlined for effective administration by community‐based psychotherapists, has been shown to be non‐inferior to problem‐solving therapy in late‐life depression 224 , and proposed for combination with pharmacotherapy in patients with persistent symptoms.

Prolonged grief disorder (PGD) is an important but often unrecognized factor in late‐life treatment‐resistant depression. The ICD‐11 and the DSM‐5‐TR have provided clinical guidelines and diagnostic criteria, respectively, for its diagnosis 225 . In PGD, acute grief becomes chronic, with intense yearning for the deceased, and accompanying symptoms of anguish, loneliness, suicidal ideation and pervasive functional impairment. PGD represents a failure to adapt to loss and to restore meaning in life without the lost loved one. This condition, which frequently coexists with major depression in older adults, responds well to grief‐specific psychotherapy, but not to antidepressant pharmacotherapy or to interpersonal psychotherapy for depression 226 .

We do not know if treating depression in older adults reduces the risk for dementia 101 . However, slowing cognitive decline in elderly with treatment‐resistant depression is now recognized as an important front in the fight against dementia, and a vital aspect in the staging of late‐life major depression 101 , 201 .

Progression of late‐life depression to Alzheimer's and related dementias is likely to be a multi‐mechanism process. Data‐driven proteomic analyses have revealed several biological pathways and molecular functions associated with cognitive impairment in late‐life major depression, related to neuro‐inflammatory control, neurotrophic support, cell survival/apoptosis, endothelial function, and lipid/protein metabolism 204 , 205 , 206 . Experimental studies of dementia prevention in late‐life major depression will need to monitor accumulation of tau and beta amyloid, and white matter disease, provide measures of cognitive and brain health, and document course of depressive illness.

The central question, as yet unanswered, is whether the modulation of biologic cascades related to the pathogenesis of cognitive impairment in late‐life major depression can also retard cognitive decline and reduce dementia incidence, particularly in more treatment‐resistant depression.

What do we know about the integration of primary care and behavioral health care for the treatment and prevention of major depression in older adults? How do we translate intervention science to real‐world care and management of suicide risk?

Collaborative care models integrate behavioral health care and primary care 227 , 228 . They are the best‐known real‐world enactments of measurement‐based care in older adults. Measurement‐based care includes standardized assessment of depressive symptoms, medication side effects, and patient adherence. It uses a multi‐step decision tree (algorithm) in treatment planning and patient follow‐up. While it provides feedback to assist in the management of patients, it is not a substitute for clinical judgment.

A Cochrane database systematic review has shown that collaborative care models (in mixed‐age samples) yield significant improvement in depression and anxiety outcomes compared with usual care. Improvement is evident over the short, medium and long term, with standardized mean differences of 0.25‐0.35 227 . Examples of successful models of collaborative care for midlife and older adults in high‐, middle‐ and low‐income countries include Improving Mood Promoting Access to Collaborative Care Treatment (IMPACT) 228 , Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) 229 , Friendship Bench in Zimbabwe 230 , and MANAS 231 and DIL 210 in India.

IMPACT and PROSPECT addressed population‐ and patient‐centered care in older adults with major depression. These studies, showcasing the principal characteristics of collaborative care, embodied evidence‐, team‐, measurement‐, and algorithmic‐based strategies to achieve and sustain remission in older adults attending rural and urban primary care clinics. These models facilitate a personalized approach to treating depression in older adults, starting with interventions requiring fewer specialized resources and moving to more elaborate interventions as needed.

In IMPACT 228 , over half of the participants in collaborative care reported at least a 50% reduction in depressive symptoms at 12 months, as compared with only 19% of participants in usual care. The benefits persisted for at least one year, when IMPACT resources were no longer available. IMPACT participants experienced more than 100 additional depression‐free days over a two‐year period.

In PROSPECT 229 , resolution of suicidal ideation was faster among intervention participants as compared with usual care; differences peaked at 8 months (70.7% vs. 43.9%). In addition, follow‐up after a median interval of 98 months found a 24% reduction in all‐cause mortality relative to care‐as‐usual participants 198 . Post‐hoc analysis showed that the decline in mortality reflected fewer deaths from cancer. The mechanism of this protective effect could involve an interplay between behavioral factors (e.g., better self‐care) and cellular or molecular processes of aging. Thus, a key question for research going forward is whether treating depression effectively modifies the risk architecture for cancer at either or both behavioral and molecular levels.

Further enhancements of collaborative care occur through the use of lay counsellors or community health workers, especially to reach under‐served racial/ethnic minorities. The MANAS 231 and the DIL 210 trials, deploying lay counsellors for the treatment and prevention of depression, respectively, in primary care patients (adults and older adults), provide compelling examples of task sharing/shifting to confront workforce issues that impede access to care in under‐resourced areas of the world.

Similarly, Chibanda et al 230 have shown that the use of lay health workers for delivering problem‐solving therapy (“Friendship Bench”) in a resource‐poor setting such as Zimbabwe may be effective in the primary care of common mental disorders. Community health workers and lay counselors perform a number of tasks, including screening for depression, relaying results to supervising clinicians, educating persons with depression and their caregivers about the illness and its treatment, facilitating identification of local resources for social and economic support, encouraging self‐care and cooperation with primary care for co‐occurring physical problems, and delivering depression‐specific psychotherapies, such as interpersonal therapy, behavioral activation, and problem‐solving therapy, in one‐on‐one or group formats.

Collaborative care models also facilitate re‐engineering care delivery to improve management of suicidal risk in depressed patients. In most countries, suicide rates are highest among older adults, and suicide attempts by older adults are frequently serious, with high lethality potential. Collaborative care promotes an explicit focus on factors that contribute to distress and to suicidal urges versus those that contribute to constraint and resistance 232 . It also integrates counseling with patients and family caregivers to reduce access to lethal means for suicide, together with safety planning and attention to family discord, victimization, and the need for social support. These and other elements of re‐engineering practice have been shown in the UK to yield suicide reductions of 22‐29% 233 .

Going forward, the use of machine learning to identify relevant data in electronic health records 234 and the use of adaptive screening tools 235 may improve our ability to match the intensity of services to level of suicide risk – thereby enacting a fundamental principle of collaborative, stepped‐based care. In addition, more research into both the short‐term and long‐term (maintenance) efficacy and safety of ketamine for the rapid reduction of suicidal ideation in older adults with major depression is warranted 236 . Finally, addressing depression‐related reductions in top‐down cognitive control should be a goal of psychotherapy in suicide attempters. Deficits in cognitive control result in disadvantageous decision‐making and limited problem‐solving, contributing to feelings of entrapment and hopelessness 237 .

Access to mental health services by older adults with major depression is driven by a shortage and skewed geographical distribution of providers. User‐facing apps coupled with assistance from coaches, and other telepsychiatry tools, can help address the treatment gap, but barriers related to culture, policy and funding issues remain 195 , 238 . Collaborative care models of service delivery should invest in supporting telepsychiatry.

In summary, the scalability of collaborative care is promising, not only because of its demonstrated effectiveness and, increasingly, the use of community health workers and lay counselors, but also because of its potential for cost‐offsetting impact. The evidence for cost‐effectiveness remains inconclusive, but certain policies do promote its implementation and uptake. For example, the Center for Medicare and Medicaid Services in the US now allows the use of current procedural terminology codes (so‐called CPT codes) to facilitate reimbursement of mental health specialists for work in primary care settings, including consultation on clinical management even when the psychiatrists may not have personally examined the patient.

Directions for future clinical practice and research in late‐life major depression are provided in Table 4 .

Directions for future clinical practice and research in late‐life depression

	Pragmatic intervention programs (e.g., collaborative, stepped‐care models) should be further developed and implemented, using both pharmacotherapy and depression‐specific psychotherapies (e.g., problem‐solving therapy, cognitive behavioral therapy, and interpersonal psychotherapy), amenable for use also in low‐ and middle‐income countries.
	Further comparative effectiveness/safety/tolerability research should be conducted to develop staged algorithms of care for use in both primary and specialty mental health settings, that will match needs of patients with intensity of intervention.
	Measurement‐based care should be promoted to optimize efficacy, tolerability, safety, and treatment adherence.
	The implications of staging models of depression for assessment, prevention and treatment should be further investigated.
	Indirect, less‐stigmatized approaches to depression prevention in older adults, such as treatment of insomnia disorder, should be further investigated.
	The use of lay counsellors, community health workers, and peer‐support specialists should be expanded through task sharing/shifting, to address the dearth of mental health specialists in low‐, middle‐ and high‐income countries.
	The use of telepsychiatry, especially to better reach under‐served and rural older adults, should be further integrated.
	There should be a focus on health‐span, not only on lifespan, in clinical care and in cost‐benefit analyses.
	A focus of research should be whether preventing and treating depression effectively modifies the risk for the major scourges of old age: cardiovascular disease, dementia and cancer.
	Further research should be conducted into suicide prevention in older adults, especially addressing high‐risk periods such as transitions from more to less intensive care settings.
	Research on ketamine should be expanded to include older adults, in order to further address the clinical care of those with treatment‐resistant depression, suicidal ideation, and cognitive impairment.
	Research in psychedelic‐assisted psychotherapy (e.g., psilocybin) for treatment‐resistant depression in older adults should be expanded.
	Pharmacogenomically‐informed clinical decision‐making for the care to older adults with major depression should be further explored.

SCHIZOPHRENIA

The disorders that feature prominently in the differential diagnosis of an older adult with psychotic symptoms include schizophrenia, delusional disorder, substance/medication‐induced psychotic disorder, psychotic disorder due to another medical condition, and major or minor neurocognitive disorder with behavioral disturbance in the form of psychotic symptoms. Here we focus mainly on schizophrenia, as the prototypical psychotic disorder which has generated more research than most other mental disorders over the past 150 years.

A number of studies of schizophrenia in older adults have challenged the Kraepelinian concept of dementia praecox. While Eugen Bleuler also believed in worsening of this mental illness with age, his son Manfred disagreed, as he found that the course was highly heterogeneous. Half of the patients had an undulating course with remissions, and 12‐15% recovered fully 239 . Manfred Bleuler also reported that schizophrenia could have its onset in later life.

Although the Epidemiologic Catchment Area study found prevalence rates of schizophrenia of only 0.3% among persons aged 65 and over, it seemed to under‐sample in areas where persons with mental illness may be concentrated 240 . The actual prevalence rate is probably around 1%, and about 85% are living in the community 241 . A systematic review of literature published between 1960 and 2016 found that the pooled incidence of schizophrenia in those over 65 was 7.5 per 100,000 person‐years at risk, with an increased risk in women (OR=1.6, 95% CI: 1.0‐2.5) 242 .

Schizophrenia is associated with accelerated biological aging. Yet, it does not follow the course of known neurodegenerative disorders such as Alzheimer's disease, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia, which are all accompanied by major atrophic changes in specific regions of the brain. There are no specific and observable degenerative changes that can be seen on an MRI or in neuropathological examinations of the brains of people with schizophrenia who die at older age 243 .

While there is aging‐associated cognitive decline, studies have found no significant difference in the rate of change in cognition in adults with versus without chronic schizophrenia 244 . However, cognitive trajectories differ significantly between institutionalized patients and outpatients with schizophrenia. The deterioration observed in the former patients seems to be related to greater illness severity, heavier medication load, vascular risk factors, and lack of stimulation 245 .

Several longitudinal investigations have shown that the clinical course of schizophrenia in late stages is often relatively stable and non‐deteriorating 246 , 247 , 248 . With aging, there is frequently an improvement in psychotic symptoms 246 . Most hospitalizations in older persons with schizophrenia are due to physical rather than psychological problems.

Studies have found that, relative to their younger counterparts, middle‐aged and older adults with schizophrenia tend to have better psychosocial functioning, including better adherence to medications and self‐rated mental health, and lower prevalence of substance use and psychotic relapse. A common explanation offered for this observation is the so‐called survivor bias – i.e., the sickest people died young from serious psychopathology, including suicide or drug use‐related events, so those who survive into older age are less sick. However, longitudinal studies show that, when people with schizophrenia are followed for many years, a sizable proportion do show progressive improvement in their functioning with age 248 . This improvement may reflect better ability to handle stress and engage in healthful behavior.

Both schizophrenia and aging are characterized by heterogeneity. It is not surprising, therefore, that the course of schizophrenia in later life is highly variable, ranging from complete remission to a dementia‐like state 241 . Reported predictors of sustained remission include greater social support, being (or having been) married, higher level of cognitive/personality reserve, and early initiation of treatment. Patients with very chronic illness, severe symptoms including disorganized thinking and behavior, resistance to treatment, and brain abnormalities are at higher risk of poor prognosis 247 , 248 .

It is important to recognize that some people with schizophrenia can and do have positive traits and states such as resilience and happiness. One study using a validated scale of happiness found that, although the mean level was lower in patients with schizophrenia than in healthy comparison subjects, 38% of the patients had happiness ratings in the highest range, despite worse physical health and objectively more stressors 249 . Associations of greater happiness include higher levels of resilience, optimism, and personal mastery, and healthier levels of biomarkers of stress 250 .

There are possible neurobiological explanations for improvement in mental function with aging in general, including in patients with schizophrenia. These include aging‐associated reductions in dopaminergic, noradrenergic and serotonergic activity leading to decreased severity of positive symptoms and decreased impulsivity; reduced stimulation of reward circuitry resulting in decreased illicit substance use; and reduced amygdala activation with negative emotional stimuli contributing to decreased emotional negativity. Several studies have reported posterior‐to‐anterior shift with aging (PASA), resulting in better executive functioning 251 . Obviously, these are largely speculative hypotheses in terms of inferring causality.

Compared to the general population, persons with schizophrenia have an 8.5‐fold greater risk of suicide. However, much less is known regarding suicidal behavior in older patients with schizophrenia 252 . The literature mostly consists of mixed samples of middle‐aged and older individuals. It suggests that depressive symptoms, hopelessness, previous attempts, low quality of life, and history of trauma are likely risk factors 252 , 253 , 254 . While depression is a well‐known risk factor for suicide in schizophrenia, a qualitative study found that delusions and hallucinations were central to suicidal behavior in some patients 255 .

Patients with schizophrenia require thorough assessment for the presence and nature of suicidal ideation or behavior, suicide risk, and factors contributing to suicidality. An integrated approach incorporating different psychosocial modalities relevant to the individual is recommended. CBT helps persons with schizophrenia having suicidal ideation or behavior 256 . Second‐generation antipsychotics may be more effective than first‐generation ones in reducing suicide risk, although few studies have examined their impact on suicidality in older patients with schizophrenia 257 . While clozapine has been reported to be particularly effective in reducing suicidal behavior, its use in older patients is restricted due to its strong anticholinergic side effects as well as granulocytopenia. While there is some evidence for a possible antisuicidal role of selective serotonin reuptake inhibitors in patients with schizophrenia, there is a dearth of such studies in older patients 258 .

Late‐onset schizophrenia and very late‐onset schizophrenia‐like psychosis

The term “late‐onset schizophrenia” was coined by Manfred Bleuler in 1943 to describe a form of schizophrenia with an onset between the ages of 40 and 60 259 . He found that 15% of his patients with schizophrenia met this definition, with only a small number of cases presenting later. These patients' symptoms were fundamentally similar to those in persons with earlier onset, and there were no cognitive or physical signs suggesting a degenerative brain disease.

Roth and Kay 260 described “late paraphrenia”, characterized by a well‐organized system of paranoid delusions with onset after age 45, with or without hallucinations, in the setting of a well‐preserved personality and affective response. They did not consider this to be a subtype of schizophrenia.

The DSM has changed its stance on distinguishing late‐onset from earlier‐onset schizophrenia over the past four editions. The DSM‐III did not allow a diagnosis of schizophrenia if symptoms emerged after the age of 45 261 . The DSM‐III‐R removed this restriction and introduced a “late‐onset” specifier for onset after age 44 years 262 . That specifier was removed in the DSM‐IV 91 .

In 2000, the International Late‐Onset Schizophrenia Group proposed the term “late‐onset schizophrenia” for cases with onset between 40 and 60 years, and “very late‐onset schizophrenia‐like psychosis” for those presenting first after age 60 263 . This distinction was supported by empirical evidence, although the threshold of 40 years for the diagnosis of the former condition was somewhat arbitrary. The group felt that both conditions had clinical usefulness and that their identification could promote research in the field. Late‐onset schizophrenia appeared to be as stable a diagnosis as early‐onset schizophrenia; both diagnoses remained unchanged in up to 93% of cases in a follow‐up, and only rarely were they reclassified as mood disorders 263 , 264 . However, few studies have focused on the diagnosis of very late‐onset schizophrenia‐like psychosis. The DSM‐5 88 does not use an age cutoff in the diagnostic criteria for schizophrenia, nor does the ICD‐11 265 .

Studies have shown similarity between late‐onset and early‐onset schizophrenia in terms of family history of the illness, presence of minor physical anomalies, brain abnormalities such as slightly enlarged ventricles on MRI, nature of psychopathology, and type of cognitive impairment 266 . However, there are also differences between the two conditions. A noteworthy difference is related to gender. Early‐onset schizophrenia is more common in men, whereas late‐onset schizophrenia is much more common in post‐menopausal women than in age‐comparable men, suggesting a possible protective effect of estrogen in pre‐menopausal women. The finding does not seem to arise from gender differences in care‐seeking and societal role expectations or in delay between symptom emergence and service contact 263 .

The higher frequency of late‐onset schizophrenia in women has led to trials of estrogen therapy. In a recent 8‐week, double‐blind, randomized, placebo‐controlled parallel‐group study of 200 women with schizophrenia randomized to a 200 μg estradiol patch or placebo added to antipsychotics, participants receiving estradiol had significant improvement in positive and negative symptoms as well as general psychopathology 267 . Obviously, further clinical trials of this type are needed to establish the value of estrogen in women with late‐onset schizophrenia.

The severity of psychopathology as well as that of cognitive impairment tends to be lower in late‐onset than early‐onset schizophrenia 263 , and patients with the former condition may require lower dosages of antipsychotics than age‐comparable persons with the latter 259 . Thus, late‐onset schizophrenia may be a distinct subtype of the illness.

Aging‐associated psychosocial factors such as retirement, financial difficulties, bereavement, deaths of peers, or physical disability may contribute to the precipitation of the symptoms of schizophrenia in later life 263 . However, the role of these factors has not been studied systematically. Sensory deficits, especially long‐standing conductive deafness, are common in the late‐onset form 264 , but may primarily reflect the patients' reluctance to seek corrective measures or their inability to get correction of these deficits because of poor access to quality health care. Premorbid educational, occupational and psychosocial functioning is less impaired in the late‐onset than in the early‐onset form 268 . The relatives of patients with very late‐onset schizophrenic‐like psychosis have a lower morbid risk for schizophrenia than the relatives of those with the early‐onset form 266 .

Late‐onset schizophrenia does not appear to be a prodrome of Alzheimer's disease, as patients do not demonstrate faster decline in memory beyond age‐associated loss 244 , 266 . Individuals with schizophrenia are known to have reduced cognitive reserve that puts them at increased risk of a dementia diagnosis as they age. However, there is no evidence of higher rates of Alzheimer's disease in patients with schizophrenia 268 . A post‐mortem study found that Alzheimer's disease pathology was rare among cognitively impaired persons with very chronic psychosis 243 .

Treatment: pharmacotherapy

Antipsychotics constitute the backbone of treatment of schizophrenia at all ages, including older patients. During the last three decades, first‐generation antipsychotics have been largely replaced in older persons by second‐generation ones, because of the side effects of the former, such as tardive dyskinesia. However, the newer drugs have proven to be far from optimal in terms of both efficacy and safety. While they control the positive symptoms and prevent relapses similarly to first‐generation medications, they are no more efficacious than the older drugs.

One study compared the longer‐term safety and effectiveness of the four most commonly used second‐generation antipsychotics (aripiprazole, olanzapine, quetiapine and risperidone) in 332 patients, aged >40 years, having psychosis associated with schizophrenia, mood disorders, post‐traumatic stress disorder, or dementia 269 . The overall results suggested a high discontinuation rate (median duration 26 weeks prior to discontinuation), lack of significant improvement in psychopathology, and high cumulative incidence of metabolic syndrome (37% in one year) and of serious (24%) and non‐serious (51%) adverse events with all the four antipsychotics 269 .

Pharmacokinetic and pharmacodynamic changes that occur with age lead to an increased sensitivity to antipsychotics in older individuals, and increase the risk of side effects, especially parkinsonism, tardive dyskinesia, sedation, hypotension and falls 270 . Given the improvement in psychotic symptoms with age in a number of patients with schizophrenia, a progressive reduction in daily dose over a period of weeks or months may be attempted. A watchful eye should be kept on signs of early relapse, so that the dose can be increased as and when needed. In a minority of aging patients with schizophrenia, eventual discontinuation of antipsychotics is feasible, but the patients should be followed carefully 271 .

Modifiable risk factors for tardive dyskinesia should be identified, to minimize its incidence and severity. These include diabetes mellitus, smoking, substance abuse including alcohol and cocaine, and anticholinergic co‐treatment 272 . Two novel vesicular monoamine transporter type 2 (VMAT2) function inhibitors, valbenazine and deutetrabenazine, have been approved in the US as add‐on therapy for persons with tardive dyskinesia 273 . VMAT2 inhibitors may be used to address tardive dyskinesia‐associated impairments and impact on psychosocial functioning 274 .

Treatment: psychosocial interventions

Clinicians should combine pharmacotherapy with appropriate psychosocial interventions in older patients with schizophrenia. There are three skills training programs specifically designed for older adults with severe mental illness and shown to be effective in randomized clinical trials: cognitive‐behavioral social skills training (CBSST), functional adaptation skills training (FAST), and Helping Older People Experience Success (HOPES). They are all group‐based; provide accommodations for persons with physical or cognitive disabilities; help develop skills in incremental steps; and use age‐appropriate psychosocial training techniques to meet the needs of older persons 275 .

The CBSST 276 , 277 is a manualized group intervention, within the framework of the biopsychosocial stress‐vulnerability model of schizophrenia, consisting of three modules, each with four‐weekly sessions, to be repeated, for a total of 24 sessions. The modules focus on thought challenging, seeking social support, and solving problems, with homework assignment after each session. Skills include promoting cognitive behavioral strategies, recognition of early warning signs of relapse, improved communication with health care professionals and social interactions in everyday activities, treatment adherence, and behavioral strategies for coping with psychiatric symptoms.

Randomized controlled trials of CBSST in older adults with schizophrenia have shown a high rate of adherence and low dropout rates 276 . While there was no significant change in psychopathology in pharmacologically stabilized patients, there was significant improvement in social activities, cognitive insight and mastery of problem‐solving skills, as well as a reduction in defeatist attitudes, at the end of the intervention. Some improvement was sustained 6 months post‐treatment 277 .

The FAST 278 focuses on communication, transportation, medication management, social skills, organization and planning, and financial management in 24 semi‐weekly two‐hour group sessions. Active learning approaches include in‐session skills practice, behavioral modeling, role‐playing and reinforcement, and homework practice assignments.

A randomized controlled trial including 240 older adults with schizophrenia showed that FAST participants, compared to a time‐equivalent attention‐control group, had significant improvement in everyday functional skills as well as social and communication skills at the end of treatment and three months later 278 . A pilot study of an adapted version of the FAST program showed improved functioning and well‐being in middle‐aged and older Latinos with severe mental illness 279 .

The HOPES 280 integrates psychosocial skills training and preventive health care management. The skills training component includes classes, role‐play exercises, and community‐based homework assignments in social skills, community living skills, and healthy living. The weekly skills class curriculum provided over 12 months consists of seven modules: communicating effectively, making and keeping friends, making the most of leisure time, healthy living, using medications effectively, and making the most of a health care visit.

A randomized controlled trial of HOPES including 183 older adults with severe mental illness showed significantly greater improvement in skills performance, psychosocial functioning, self‐efficacy, and psychopathology at one‐year and three‐year follow‐up compared to usual care 281 . A greater proportion of HOPES participants received flu shots, hearing tests, eye exams, mammograms, PAP smears, and completed advanced directives than the usual care recipients.

Randomized controlled trials have also shown significant improvement with other manualized psychosocial interventions in older patients with schizophrenia, such as supported employment without and with compensatory cognitive training to help them obtain and retain paid jobs 282 , 283 .

Recent advances in technology along with the COVID‐19‐associated social distancing have hastened a rapid growth of psychosocial interventions administered remotely. For example, computer‐initiated text messaging three times per day for 12 weeks, or live telephone interaction two times per week, can be used to promote self‐management in people with severe mental illness. Following initial training in the use of the necessary technology, people with schizophrenia have minimal dropout rates, few broken devices, and high patient satisfaction 284 . There is a need for more research in this area among older adults with schizophrenia.

In the past few decades, there has been a dramatic decline in the number of persons with schizophrenia living in mental institutions, and an increase in the number of older outpatients 241 . Thus, there is an increasing pressure for community programs to provide services to older persons. As mentioned above, older persons with schizophrenia have higher frequency and severity of physical diseases than people without severe mental illness, and yet receive much less than adequate health care. Also, for schizophrenia patients of all ages, the Epidemiologic Catchment Area Study reported a lifetime prevalence of 33% and 28% for alcoholism and drug abuse disorders, respectively 285 .

Structural barriers in the health care system as well as physician attitudes create impediments to care. A Scottish study reported that primary care doctors were less willing to have persons with schizophrenia on their practice list, and more likely to believe that such persons were apt to be violent 286 . In the US, there are considerable racial inequalities in health status due to diminished access to health care, poorer health practices, and lower socioeconomic status among marginalized ethnic groups compared to non‐Latino Whites 287 .

The excess risk of early mortality, physical comorbidity, early institutionalization, and high costs among older adults with schizophrenia require the development and dissemination of effective and sustainable integrated care models that simultaneously address both mental and physical health care needs. Current evidence‐based integrated care models primarily adopt three approaches: psychosocial skills training, integrated illness self‐management, and collaborative care and behavioral health homes. The next step should be the development of innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology, and peer support, and strategies implemented successfully in developing economies 275 .

An optimal mental health care system for older persons with schizophrenia should have a full multidisciplinary range of clinical, rehabilitative, preventive and supportive services 288 . These include comprehensive assessment; case management; intensive outreach; smooth coordination of mental health, physical health, and social services; appropriate community and inpatient mix; and provisions for maintenance of family caregivers' mental and physical health. Unfortunately, such a system does not exist, and services remain fragmented and under‐utilized by this highly disenfranchised population 289 .

Successful aging with schizophrenia

Despite the above‐mentioned biological and societal issues, successful aging is not an oxymoron even among aging adults with schizophrenia. The clinical practice of positive psychiatry discussed above applies to these people too. The strategies necessary for seeking this goal include appropriate pharmacotherapy and psychosocial interventions, along with healthful diet, physical exercise, non‐toxic environment (e.g., cessation of smoking), and positive attitude on everyone's part. It is never too early nor too late to start on this path.

Positive psychiatric care of people with schizophrenia should include assessment not just of psychopathology but also of well‐being, strengths, perceived stressors, and lifestyle. This can be done by completing validated brief questionnaires in waiting room or online at home. Using these data, the clinician can identify treatment targets such as lifestyle (e.g., sedentary behavior) or social network, and implement appropriate interventions 290 .

A prescription given to a person with schizophrenia must go beyond an antipsychotic drug. It must include enhancement of personal psychosocial strengths, appropriately individualized behavioral interventions, and healthy lifestyle strategies such as physical, cognitive and social activities, adequate sleep, and nutritious diet. In the coming years, there will be an increasing use of digital technologies to disseminate evidence‐based interventions to large numbers of patients. Directions for future clinical practice and research in older adults with schizophrenia are provided in Table 5 .

Directions for future clinical practice and research in older people with schizophrenia

	A full multidisciplinary range of clinical, rehabilitative, preventive and supportive services – including comprehensive assessment, case management, intensive outreach, and smooth coordination of mental health, physical health, social services and peer support – should be implemented.
	Efficacious antipsychotics without metabolic side effects should be investigated.
	Well‐designed randomized controlled trials of psychotherapeutic interventions incorporating principles of cognitive behavioral therapy and socialization training should be conducted.
	Individual or group interventions, such as cognitive training, to promote brain fitness in older patients should be used.
	Treatment targets such as lifestyle (e.g., sedentary behavior) should be identified, and appropriate interventions (e.g., regular physical activities) should be implemented.
	“Wellness within illness” should be assessed and promoted: well‐being, resilience, optimism, personal mastery, wisdom, social engagement, and social support.
	Social determinants of mental health in aging, such as loneliness and social isolation, should be evaluated, and interventions targeting these features in individual patients – e.g., psychosocial skills training – should be used.
	Mobile interventions, including use of smartphones to deliver psychosocial interventions, should be implemented to promote self‐management of illness, using user‐friendly technologies.
	Collaborative care and behavioral health homes should be further established and evaluated.
	Medications and non‐pharmacological treatments for cognitive impairment in older patients with schizophrenia should be investigated.
	Pragmatic trials of hormone therapies such as estrogen derivatives in post‐menopausal women with schizophrenia should be conducted.
	Anti‐suicidal medications useful for older patients with schizophrenia should be investigated.
	Effectiveness and safety of anti‐inflammatory and other medications to slow down accelerated aging in schizophrenia should be explored.
	Digital phenotyping at the level of sensors, data science and health care should be investigated, to help in relapse prediction and prevention in old age schizophrenia, possibly using machine learning and other relevant technologies.
	Further research on caregivers of older people with schizophrenia should be conducted, and further appropriate interventions should be developed.

All this must be accompanied by community support. Just as it takes a village to raise a child, it takes a community, which does not carry stigma against mental illnesses and their treatments, to provide optimal care to older people with schizophrenia.

SUBSTANCE USE DISORDERS

Substance use disorders are often overlooked worldwide as causes of problems for older adults, overshadowed by emergencies such as the opioid crisis among young and middle‐aged adults in high‐income countries. The extant literature reflects this deficit. Empirical studies of substance use among older adults are sparse to non‐existent from virtually all low‐ and middle‐income countries, and infrequent even in high‐income countries. Yet, these disorders are more frequent than many mental health workers believe, and their adverse consequences can be highly impairing.

In addition, interventions directed to these disorders in the elderly have been sparsely studied. Usually, however, diagnoses and interventions for younger adults can be applied to these elders, with judicious implementation which considers the biological, psychological and social factors unique to the elderly 291 , 292 .

Among the older adults, there are many challenges which may be exacerbated by alcohol and drug misuse, including functional and cognitive decline, compromised immune function, falls, other household injuries and depression. This reinforces the need for psychiatrists and all physicians to be more alert to and screen for substance use disorders, despite the many competing health concerns with which older adults present to them 293 .

Epidemiological studies from the US and many parts of Europe have found that the number of older persons in treatment for drug use problems has increased in recent years, most likely due to the aging of the baby‐boom generation who were born between 1946 and 1964. As birth rates in high‐income countries have now declined, the baby boomers have contributed to the “squaring of the age pyramid” leading to major increases in persons 65+ years who bring with them higher levels of illicit drug use and prescription drug misuse than previous age cohorts 294 , 295 .

In the US, nearly 1 million adults aged 65 and older live with a substance use disorder, as reported in 2018 data 296 . While the total number of admissions due to substance use disorders between 2000 and 2012 differed slightly, the proportion of admissions of older adults increased from 3.4% to 7.0% during this time 297 . In a study from Germany among subjects aged 60‐79 years, 69% consumed alcohol regularly and 17% consumed it at some risk 295 . From 2007 to 2016, prevalence rates of drug use among those in the 50‐59 and 60 and older age groups in Australia increased by 60‐70% 295 .

Yet another factor requires physicians, especially those who treat many older adults, to be more vigilant. Older adults in high‐income countries take a plethora of prescribed and over‐the‐counter medications 298 . Over a seven‐year period, non‐medical use or misuse of pain relievers doubled (from 0.8% in 2012 to 1.7% in 2019) among people aged 65 or older in the US, while among the total population there was a slight decrease (from 4.8% in 2012 to 3.5% in 2019) 296 . Combinations of acetaminophen and hydrocodone or propoxyphene were the most commonly used drugs 299 .

Social factors are the most important risks for substance use in older adults. For example, being divorced, separated or single is associated with increased or unhealthy drinking in late life in the US, though this may differ across genders 300 , 301 . Another factor is having drugs available in the house or from friends. Risk factors for drug use in late life further include physical problems, especially uncontrolled pain following surgery. Pain from back or shoulder strain may also be involved.

Mental health problems also contribute to increased drug use, especially depression and anxiety. Men are more like to have a long history of alcohol intake which extends into late life, and they tend to drink greater quantities. Overall decline in physical health may contribute as well 292 .

Screening and diagnosis

The first step by the clinician in addressing potential drug use is screening. Many tools have been demonstrated effective in eliciting the problem among older adults. These include the Alcohol Use Disorders Identification Test‐Concise (AUDIT‐C) 302 and the CAGE Questionnaire Adapted to Include Drugs (CAGE‐AID) 303 . The AUDIT‐C questions specific amounts of alcohol a person consumes 302 . The CAGE‐AID focuses upon the symptoms that derive from substance use disorder. Both the AUDIT and CAGE screening scales are used internationally.

The CAGE‐AID tool contains the following four questions, which can be used for both alcohol and other substance use 303 : 1. Have you ever felt that you should Cut down on your drinking or drug use?; 2. Have people Annoyed you by criticizing your drinking or drug use?; 3. Have you ever felt bad or Guilty about your drinking or drug use?; 4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover ( Eye‐opener )?

This screening should be part of the usual evaluation of the older adult, for all too often the clinician may wrongly assume that the elder has no problem with substances. Substance use may be overlooked by family members or not considered important. Clinicians may also believe that problems from substance use are not critical or that little can be done to decrease use 292 .

The DSM‐5 criteria capture a wider proportion of older adults with substance use disorders compared to DSM‐IV ones. Even so, many elders will likely remain unidentified 304 . Age‐associated physiological changes that increase the effects of alcohol and other substances cause older adults to experience a reduction of tolerance to these substances, thus interfering with one of the hallmarks of substance use disorder, namely increased tolerance 291 . Furthermore, interruption in social and vocational activities or other social consequences of drinking or drug use may be less likely to occur or less noticeable in old age.

Using item response theory with the 2009 National Survey on Drug Use and Health data, one study explored whether there were age‐related biases among the DSM‐5 criteria for alcohol use disorder 304 . The findings revealed that there were differential responses among older versus middle‐aged adults, such that older adults were half as likely to endorse the criteria related to tolerance, activities to obtain alcohol, social/interpersonal problems, and physically hazardous situations. The criteria that were most effective in identifying alcohol use disorder among older adults were unsuccessful efforts to cut back, withdrawal, and social and interpersonal problems.

Treatment and organization of services

Some assume that older adults who abuse substances experience such a chronic condition that they will not respond to treatment. On the contrary, they have demonstrated treatment outcomes that are as good, or even better, than those seen in younger groups 291 .

Nevertheless, access to specialized services tailored for older adults is limited 305 . Brief interventions by health care professionals are the first and one of the most important steps in a treatment plan. The older adult who is gently alerted about the problems with substances may take heed when the health care professional warns of the danger, yet otherwise ignoring warnings coming from friends and family.

A common thread of most brief interventions is the use of elements of motivational interviewing 306 . Such interventions provide education about the substance and how it might be harmful, thereby enhancing motivation for change. One approach is “normative feedback”, in which a patient's drinking is compared with his/her peers. This feedback is then combined with brief advice about how to cut down or eliminate substance use 306 .

This approach on the surface is appealing to clinicians working with older adults and the elders themselves 306 . Unfortunately, little high‐quality evidence of the effectiveness of standardized brief interventions, such as motivational interviewing, is available, although naturalistic studies are promising 292 . Older persons are more likely to complete treatment than younger persons.

Medication use is essential for withdrawal from alcohol and other substances. Symptoms associated with alcohol withdrawal include increased pulse rate, blood pressure and temperature, as well as restlessness, disturbed sleep, anxiety and, when severe, delirium, seizures and hallucinations 292 . Medications used to alleviate alcohol withdrawal syndromes are usually benzodiazepines, which are tapered over a few days, primarily to prevent delirium and seizures. They should only be used on a short‐term basis.

Only two medications have been used extensively for the treatment of alcohol use disorder in older adults. Disulfiram was the first, yet the data on its use in preventing alcohol abuse among older adults are unclear. Furthermore, clinicians have been reluctant to use the medication, given its side effects if alcohol is ingested. Nevertheless, at a usual dose of 250 mg daily, the drug is considered safe for older adults who are otherwise in good health 307 . Of interest, limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults 308 .

Buprenorphine is the preferred treatment for opioid dependence, and appears to be safer than methadone. Nevertheless, to prescribe buprenorphine in the US requires special training. Drugs approved by the US FDA for the treatment of opioid dependence include sublingual buprenorphine and buprenorphine/naloxone tablets or strips. Because of safety issues, buprenorphine/naloxone is the preferred formulation 309 , 310 . Treatment with buprenorphine is safe and effective. Many patients can manage the induction period on their own at home.

Naltrexone is the most well‐studied medication used for substance use disorder treatment among older adults, and it has demonstrated effectiveness with this population. Naltrexone is an opioid receptor antagonist and is thought to reduce craving for opioids as well as alcohol by blocking dopamine release in the brain. Its major limitation in older adult people, many of whom have chronic pain, is that it blocks the effect of opiate‐based pain medications, often used following surgery. It can also potentiate the symptoms of a preexisting major depression. Patients with histories of comorbid depression should therefore be closely monitored 311 . Naltrexone is usually accepted by older adults, and its effectiveness is about equivalent of what is found in younger adults 308 .

Overall, group support for abuse and addiction is the most valuable long‐term intervention. Groups such as Alcoholics or Narcotics Anonymous (AA) can help older adults with a substance use disorder by reducing isolation, shame and stigma, though there have been no systematic studies on their effects. Elders use AA frequently worldwide in over 180 countries 312 . Yet they may face the same barriers to participation in self‐help groups as they do with formal treatment: stigma and shame of needing to attend to these issues in late life. If their primary substance use problem is alcohol, they often experience discomfort in attending meetings that include younger poly‐substance users. Such discomfort may not be as acute for baby boomers.

Traditional self‐help groups can be modified for older adults. For example, slowing the pace of the meeting to reflect cognitive changes in aging, and devoting attention to handling losses and extending social support, could be critical for recovery 291 , 313 .

Despite decades of research and clinical trials, the treatment and prevention of substance use disorders in older adults has been of marginal success. This is frustrating to patients as well as clinicians. The need for improved treatments tailored for older adults is critical (see Table 6 ).

Directions for future clinical practice and research in late‐life substance use disorders

	Clinicians and lay persons should be educated about the importance of substance use disorders in older adults, including their medical sequelae such as falls, cognitive decline, and worsening of co‐occurring physical and mental disorders.
	Screening for substance use disorders should be integrated in both primary care and specialty mental health services for older adults.
	The most important risk factors for substance use disorders in older adults – particularly social isolation, loneliness, bereavement, and felt loss of purpose and meaning in life – should be better known, evaluated and addressed.
	Self‐help groups should be adapted for older adults, e.g., by slowing the pace to accommodate cognitive impairment, and/or by addressing issues related to social support.
	The silos of mental health and substance abuse services should be broken down.
	Possible adaptations of diagnostic criteria/guidelines for substance use disorders should be considered to improve their performance in older adults.
	Further research should be conducted into the effectiveness of standardized brief interventions, such as motivational interviewing, in older adults.
	Further research should be carried out into the effectiveness and safety of using medications such as buprenorphine and naltrexone in older adults with substance use disorders.
	Factors in midlife which predispose to the development of substance use disorders in late life should be explored.
	Differences in substance use disorders by ethnicity, gender and geography should be investigated, and risks associated with disruptions in the lives of older adults that might lead to these disorders should be explored.

CONCLUSIONS

Mental disorders in older adults are a leading cause of suffering and disability in the world, much of it avoidable. These disorders are common, impairing social functioning and economic productivity, undermining adherence to co‐prescribed medical treatments, and increasing the risk for loss of independence and early mortality from suicide and physical illness. Prevention, timely recognition and treatment are global public health and moral priorities.

Within the broader context of a positive psychiatry of aging, and as a countermeasure to ageism and stigma, it is essential to champion the assessment and promotion of wellness within illness, in order to enhance well‐being, resilience, optimism, and self‐efficacy/personal mastery. Moreover, it is important to evaluate the social determinants of mental illness in older adults, particularly loneliness and social isolation, and to use interventions that target these issues in individual patients and the family caregivers.

Because older adults with mental illness often engage in unhealthy lifestyles, particularly lack of physical activity, it is important to identify and implement appropriate interventions that will repay both mental and physical health benefits. Interventions to promote brain and cognitive fitness may be offered in individual and in group formats that provide rewards and reinforcement for adopting healthier behaviors in physical activity, diet and sleep.

Recent technological developments now allow the use of mobile interventions, including “just‐in‐time” interventions such as the use of smartphones for computer‐initiated text‐messaging or live telephone interactions to promote and enhance self‐management of illness. In addition, further use and investigation of digital phenotyping at the levels of sensors, data science and health care may prove useful in relapse prevention – given the frequently relapsing and chronic course of mental disorders in old age.

Future practice and research need to combat the fragmentation of clinical care through the establishment and evaluation of collaborative care and behavioral health homes. Such models should build on comprehensive approaches incorporating novel use of telehealth, mobile health technology, and peer support, capitalizing on strategies implemented successfully in low‐ and middle‐income countries. Team‐based care needs to become increasingly measurement‐based and interdisciplinary, incorporating and enacting a range of clinical, rehabilitative, preventive and supportive services. These services should include comprehensive assessment, clinical management, intensive outreach, and coordination of mental health, physical health and social services.

We also underscore the importance of care that is not only patient‐focused but also family‐centered. The caregivers of older persons with mental disorders are themselves burdened and in need of information and support. Including them as informal members of the caregiving team repays benefits to the identified patient and to caregivers alike and facilitates accurate clinical assessment and targeted interventions to promote wellness and to prevent serious adverse events (including suicide).

Cutting across all of the diagnostic entities considered in this paper is the need for further investigations of medications that can ameliorate cognitive impairment and slow down its progression. Medications that may reduce risk for suicide are also sorely needed, together with research on how best to use them within clinical care and systems of care. Further development and evaluation of medications without metabolic, cardiovascular and neurological side effects is needed to optimize safety and tolerability as well as efficacy and effectiveness.

Mental disorders of old age are heterogeneous at multiple levels: etiopathogenesis, clinical presentation, and response to intervention. They reflect genetic, environmental, social and developmental vulnerabilities as well as resilience. Taking these dimensions into account is critical to implementing personalized and effective treatment approaches and to doing meaningful research.

Because response variability to medications and other psychosocial and psychotherapeutic interventions is great among older adults, further investigation of moderators and mediators of response variability during acute, continuation and maintenance treatment is needed. This may allow clinicians to better personalize treatment, by understanding what works for whom, when and how. Finally, in the translational and clinical neuroscience space, further investigation of anti‐inflammatory medications to slow down accelerated aging is highly relevant to advances in clinical care.

Fortunately, science in the service of promoting healthy brain aging and cognitive fitness in the later years of life has become increasingly compelling. We believe that strategies for health promotion and care for older adults living with mental disorders are deeply linked.

Drawing upon the lessons learned in cardiovascular medicine and oncology, we suggest that detecting and diagnosing later‐life mental disorders early in their course is crucial to preventing their complications (such as treatment resistance, cognitive impairment, and mortality). Early detection and diagnosis facilitate care that is both evidence‐based and proportionate to the needs of the individual patient and family caregivers. Staging approaches that take into account where a patient is in the trajectory of his/her illness have clear clinical relevance, power and utility across the life cycle into old age.

Given the complexity of mental disorders in older adults, team‐based collaborative care models provide an evidence‐based and scalable way for health systems to implement prevention and personalized care. Furthermore, the use of telemedicine and the integration of peer‐support specialists, lay counselors and community health workers are helping to bridge the gap created by the worldwide paucity of geriatric mental health clinicians. They are also powerful antidotes to the barriers posed by fear and stigma.

In essence, addressing the rights and needs of older people and their families living with mental disorders remains a global public health and – no less – a moral imperative born of progress in discovery and applied sciences.

ACKNOWLEDGEMENT

The authors would like to thank C. Buchweitz, D. Korzon and S. Dean for their assistance with finalizing the manuscript.

Open access
Published: 30 August 2024

Research landscape analysis on dual diagnosis of substance use and mental health disorders: key contributors, research hotspots, and emerging research topics

Waleed M. Sweileh 1

Annals of General Psychiatry volume 23 , Article number: 32 ( 2024 ) Cite this article

Metrics details

Substance use disorders (SUDs) and mental health disorders (MHDs) are significant public health challenges with far-reaching consequences on individuals and society. Dual diagnosis, the coexistence of SUDs and MHDs, poses unique complexities and impacts treatment outcomes. A research landscape analysis was conducted to explore the growth, active countries, and active journals in this field, identify research hotspots, and emerging research topics.

A systematic research landscape analysis was conducted using Scopus to retrieve articles on dual diagnosis of SUDs and MHDs. Inclusion and exclusion criteria were applied to focus on research articles published in English up to December 2022. Data were processed and mapped using VOSviewer to visualize research trends.

A total of 935 research articles were found. The number of research articles on has been increasing steadily since the mid-1990s, with a peak of publications between 2003 and 2012, followed by a fluctuating steady state from 2013 to 2022. The United States contributed the most articles (62.5%), followed by Canada (9.4%). The Journal of Dual Diagnosis , Journal of Substance Abuse Treatment , and Mental Health and Substance Use Dual Diagnosis were the top active journals in the field. Key research hotspots include the comorbidity of SUDs and MHDs, treatment interventions, quality of life and functioning, epidemiology, and the implications of comorbidity. Emerging research topics include neurobiological and psychosocial aspects, environmental and sociocultural factors, innovative interventions, special populations, and public health implications.

Conclusions

The research landscape analysis provides valuable insights into dual diagnosis research trends, active countries, journals, and emerging topics. Integrated approaches, evidence-based interventions, and targeted policies are crucial for addressing the complex interplay between substance use and mental health disorders and improving patient outcomes.

Introduction

Substance use disorders (SUDs) refer to a range of conditions characterized by problematic use of psychoactive substances, leading to significant impairment in physical, psychological, and social functioning [ 1 ]. These substances may include alcohol, tobacco, illicit drugs (e.g., cocaine, opioids, cannabis), and prescription medications. The global burden of SUDs is substantial, with far-reaching consequences on public health, socio-economic development, and overall well-being. For instance, alcohol abuse accounts for 3 million deaths worldwide annually, while the opioid crisis has escalated to unprecedented levels in certain regions, such as North America, resulting in tens of thousands of overdose deaths per year [ 2 , 3 , 4 ]. Mental health disorders (MHDs) encompass a wide range of conditions that affect mood, thinking, behavior, and emotional well-being [ 5 ]. Examples of MHDs include depression, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and eating disorders. These conditions can significantly impair an individual's ability to function, negatively impacting their quality of life, relationships, and overall productivity [ 6 , 7 , 8 ]. Furthermore, certain MHD such as major depressive disorder and anxiety are often associated with specific affective temperaments, hopelessness, and suicidal behavior and grasping such connections can help in crafting customized interventions to reduce suicide risk [ 9 ]. In addition, a systematic review of 18 studies found that demoralization with somatic or psychiatric disorders is a significant independent risk factor for suicide and negative clinical outcomes across various populations [ 10 ]. The coexistence of SUDs and MHDs, often referred to as dual diagnosis or comorbidity, represents a complex and prevalent phenomenon that significantly impacts affected individuals and healthcare systems [ 11 , 12 , 13 , 14 , 15 ]. For instance, individuals with depression may be more likely to self-medicate with alcohol or drugs to cope with emotional distress [ 16 ]. Similarly, PTSD has been linked to increased rates of substance abuse, as individuals attempt to alleviate the symptoms of trauma [ 17 , 18 ]. Moreover, chronic substance use can lead to changes in brain chemistry, increasing the risk of developing MHDs or exacerbating existing conditions [ 17 , 19 , 20 , 21 ]. The coexistence of SUDs and MHDs presents unique challenges from a medical and clinical standpoint. Dual diagnosis often leads to more severe symptoms, poorer treatment outcomes, increased risk of relapse, and higher rates of hospitalization compared to either disorder alone [ 22 ]. Additionally, diagnosing and treating dual diagnosis cases can be complex due to overlapping symptoms and interactions between substances and psychiatric medications. Integrated treatment approaches that address both conditions simultaneously are essential for successful recovery and improved patient outcomes [ 20 ]. Patients grappling with dual diagnosis encounter a multifaceted web of barriers when attempting to access essential mental health services. These barriers significantly compound the complexity of their clinical presentation. The first barrier pertains to stigma, where societal prejudices surrounding mental health and substance use disorders deter individuals from seeking help, fearing discrimination or social repercussions [ 23 ]. A lack of integrated care, stemming from fragmented healthcare systems, poses another significant hurdle as patients often struggle to navigate separate mental health and addiction treatment systems [ 24 ]. Insurance disparities contribute by limiting coverage for mental health services and imposing strict criteria for reimbursement [ 25 ]. Moreover, there is a shortage of adequately trained professionals equipped to address both substance use and mental health issues, creating a workforce barrier [ 26 ]. Geographical disparities in access further hinder care, particularly in rural areas with limited resources [ 27 ]. These barriers collectively serve to exacerbate the clinical complexity of patients with dual diagnosis, and ultimately contributing to poorer outcomes.

A research landscape analysis involves a systematic review and synthesis of existing literature on a specific topic to identify key trends, knowledge gaps, and research priorities [ 28 , 29 ]. Scientific research landscape analysis, is motivated by various factors. First, the rapid growth of scientific literature poses a challenge for researchers to stay up-to-date with the latest developments in their respective fields. Research landscape analysis provides a structured approach to comprehend the vast body of literature, identifying crucial insights and emerging trends. Additionally, it plays a vital role in identifying knowledge gaps, areas with limited research, or inadequate understanding. This pinpointing allows researchers to focus on critical areas that demand further investigation, fostering more targeted and impactful research efforts [ 30 ]. Furthermore, in the realm of policymaking and resource allocation, evidence-based decision-making is crucial. Policymakers and funding agencies seek reliable information to make informed decisions about research priorities. Research landscape analysis offers a comprehensive view of existing evidence, facilitating evidence-based decision-making processes [ 28 ]. When it comes to the research landscape analysis of dual diagnosis of SUDs and MHDs, there are several compelling justifications to explore this complex comorbidity and gain a comprehensive understanding of its interplay and impact on patient outcomes. Firstly, the complexity of the interplay between SUDs and MHDs demands a comprehensive examination of current research to unravel the intricacies of this comorbidity [ 31 ]. Secondly, dual diagnosis presents unique challenges for treatment and intervention strategies due to the overlapping symptoms and interactions between substances and psychiatric medications. A research landscape analysis can shed light on effective integrated treatment approaches and identify areas for improvement [ 18 ]. Moreover, the public health impact of co-occurring SUDs and MHDs is substantial, resulting in more severe symptoms, poorer treatment outcomes, increased risk of relapse, and higher rates of hospitalization. Understanding the research landscape can inform public health policies and interventions to address this issue more effectively [ 32 ]. Lastly, the holistic approach of research landscape analysis enables a comprehensive understanding of current knowledge, encompassing epidemiological data, risk factors, treatment modalities, and emerging interventions. This integrative approach can lead to more coordinated and effective care for individuals with dual diagnosis [ 22 ]. Based on the above argument, the current study aims to conduct a research landscape analysis of dual diagnosis of SUDs and MHDs. The research landscape analysis bears a lot of significance for individuals and society. First and foremost, it’s a beacon of hope for individuals seeking help. Research isn’t just about dry statistics; it's about finding better ways to treat and support those facing dual diagnosis. By being informed about the latest breakthroughs, healthcare professionals can offer more effective, evidence-backed care, opening the door to improved treatment outcomes and a brighter future for those they serve. Beyond the individual level, this understanding has profound societal implications. It has the power to chip away at the walls of stigma that often surround mental health and substance use issues. Greater awareness and knowledge about the complexities of dual diagnosis can challenge stereotypes and biases, fostering a more compassionate and inclusive society. Additionally, society allocates resources based on research findings. When we understand the prevalence and evolving nature of dual diagnosis, policymakers and healthcare leaders can make informed decisions about where to channel resources most effectively. This ensures that the needs of individuals struggling with co-occurring disorders are not overlooked or under-prioritized. Moreover, research helps identify risk factors and early warning signs related to dual diagnosis. Armed with this information, we can develop prevention strategies and early intervention programs, potentially reducing the incidence of co-occurring disorders and mitigating their impact. Legal and criminal justice systems also stand to benefit. Understanding dual diagnosis trends can inform policies related to diversion programs, treatment alternatives to incarceration, and the rehabilitation of individuals with co-occurring disorders, potentially reducing rates of reoffending. Moreover, dual diagnosis research contributes to public health planning by highlighting the need for integrated mental health and addiction services. This knowledge can guide the development of comprehensive healthcare systems that offer holistic care to individuals with co-occurring disorders. Families and communities, too, are vital players in this narrative. With a grasp of research findings, they can provide informed, empathetic, and effective support to their loved ones, contributing to better outcomes.

The present research landscape analysis of dual diagnosis of SUDs and MHDs was conducted using a systematic approach to retrieve, process, and analyze relevant articles. The following methodology outlines the key steps taken to address the research questions:

Research Design The present study constitutes a thorough and robust analysis of the research landscape concerning the dual diagnosis of SUD and MHD. It's important to note that the research landscape analysis differs from traditional systematic or scoping reviews. In conducting research landscape analysis, we made deliberate methodological choices aimed at achieving both timely completion and unwavering research quality. These choices included a strategic decision to focus our search exclusively on a single comprehensive database, a departure from the customary practice of utilizing multiple databases. Furthermore, we streamlined the quality control process by assigning specific quality checks to a single author, rather than following the conventional dual-reviewer approach. This approach prioritized efficiency and expediency without compromising the rigor of our analysis. To expedite the research process further, we opted for a narrative synthesis instead of a quantitative one, ensuring that we provide a succinct yet highly informative summary of the available evidence. We place a premium on research transparency and, as such, are committed to sharing the detailed search string employed for data retrieval. This commitment underscores our dedication to fostering reproducibility and transparency in research practices.

Ethical considerations Since the research landscape analysis involved the use of existing and publicly available literature, and no human subjects were directly involved, no formal ethical approval was required.

Article retrieval Scopus, a comprehensive bibliographic database, was utilized to retrieve articles related to the dual diagnosis of SUDs and MHDs. Scopus is a multidisciplinary abstract and citation database that covers a wide range of scientific disciplines, including life sciences, physical sciences, social sciences, and health sciences. It includes content from thousands of scholarly journals.

Keywords used To optimize the search process and ensure the inclusion of pertinent articles, a set of relevant keywords and equivalent terms were employed. Keywords for “dual diagnosis” included dual diagnosis, co-occurring disorders, comorbid substance use, comorbid addiction, coexisting substance use, combined substance use, simultaneous substance use, substance use and psychiatric, co-occurring substance use and psychiatric, concurrent substance use and mental, coexisting addiction and mental, combined addiction and mental, simultaneous addiction and mental, substance-related and psychiatric, comorbid mental health and substance use, co-occurring substance use and psychiatric, concurrent mental health and substance use, coexisting mental health and substance use, combined mental health and substance use, simultaneous mental health and substance use, substance-related and coexisting psychiatric, comorbid psychiatric and substance abuse, co-occurring mental health and substance-related, concurrent psychiatric and substance use, coexisting psychiatric and substance abuse, combined psychiatric and substance use, simultaneous psychiatric and substance use, substance-related and concurrent mental, substance abuse comorbidity. Keywords for “Substance use disorders” included substance abuse, substance dependence, drug use disorders, addiction, substance-related disorders, drug abuse, opioid use disorder, cocaine use disorder, alcohol use disorder, substance misuse, substance use disorder, substance-related, substance addiction. Keywords for “Mental health disorders” included psychiatric disorders, mental illnesses, mental disorders, emotional disorders, psychological disorders, schizophrenia, depression, PTSD, ADHD, anxiety, bipolar disorder, eating disorders, personality disorders, mood disorders, psychotic disorders, mood and anxiety disorders, mental health conditions. To narrow down the search to focus specifically on dual diagnosis, we adopted a strategy that involved the simultaneous presence of SUDs and MHDs in the presence of specific keywords in the titles and abstracts such as “dual,” “co-occurring,” “concurrent,” “co-occurring disorders,” “dual disorders,” “dual diagnosis,” “comorbid psychiatric,” “cooccurring psychiatric,” “comorbid*,” and “coexisting”.

Inclusion and exclusion criteria To maintain the study’s focus and relevance, specific inclusion and exclusion criteria were applied. Included articles were required to be research article, written in English, and published in peer-reviewed journals up to December 31, 2022, Articles focusing on animal studies, internet addiction, obesity, pain, and validity of instruments and tools were excluded.

Flow chart of the search strategy Supplement 1 shows the overall search strategy and the number of articles retrieved in each step. The total number of research articles that met the inclusion and exclusion criteria were 935.

Validation of search strategy The effectiveness of our search strategy was rigorously assessed through three distinct methods, collectively demonstrating its ability to retrieve pertinent articles while minimizing false positives. First, to gauge precision, we meticulously examined a sample of 30 retrieved articles, scrutinizing their alignment with our research question and their contributions to the topic of dual diagnosis. This manual review revealed that the majority of the assessed articles were highly relevant to our research focus. Second, for a comprehensive evaluation, we compared the articles obtained through our search strategy with a set of randomly selected articles from another source. This set comprised 10 references sourced from Google Scholar [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], and the aim was to determine if our strategy successfully identified articles selected at random from an alternative database. Impressively, our analysis showed that the search strategy had a notably high success rate in capturing these randomly selected articles. Lastly, to further corroborate the relevance of our retrieved articles, we investigated the research interests of the top 10 active authors and the subject scope of the top 10 active journals. This exploration confirmed that their areas of expertise and the journal scopes were in alignment with the field of mental health and/or substance use disorders. These three validation methods collectively reinforce the reliability of our search strategy, affirming that the vast majority of the retrieved articles are indeed pertinent to our research inquiry.

Data processing and mapping Data extracted from the selected articles were processed and organized using Microsoft Excel. Information on the titles/abstracts/author keywords, year of publication, journal name, authors, institution and country affiliation, and number of citations received by the article were extracted. To visualize and analyze the research landscape, VOSviewer, a bibliometric analysis tool, was employed [ 43 ]. This software enables mapping and clustering of co-occurring terms, authors, and countries, providing a comprehensive overview of the dual diagnosis research domain.

Interpreting VOSviewer maps and generating research topics

We conducted a rigorous analysis and generated a comprehensive research landscape using VOSviewer, a widely acclaimed software tool renowned for its expertise in mapping research domains. We seamlessly integrated pertinent data extracted from the Scopus database, including publication metadata, into VOSviewer to delve into the frequency of author keywords and terminologies. The resulting visualizations provided us with profound insights into the intricate web of interconnected research topics and their relationships within the field. Interpreting VOSviewer maps is akin to navigating a vibrant and interconnected tapestry of knowledge. Each term or keyword in the dataset is depicted as a point on the map, represented by a circle or node. These nodes come in varying sizes and colors and are interconnected by lines of differing thicknesses. The size of a node serves as an indicator of the term’s significance or prevalence within the dataset. Larger nodes denote that a specific term is frequently discussed or plays a pivotal role in the body of research, while smaller nodes signify less commonly mentioned concepts. The colors assigned to these nodes serve a dual purpose. Firstly, they facilitate the categorization of terms into thematic groups, with terms of the same color typically belonging to the same cluster or sharing a common thematic thread. Secondly, they aid in the identification of distinct research clusters or thematic groups within the dataset. For instance, a cluster of blue nodes might indicate that these terms are all associated with a particular area of research. The spatial proximity of nodes on the map reflects their closeness in meaning or concept. Nodes positioned closely together share a robust semantic or contextual connection and are likely to be co-mentioned in research articles or share a similar thematic focus. Conversely, nodes situated farther apart indicate less commonality in terms of their usage in the literature. The lines that link these nodes represent the relationships between terms. The thickness of these lines provides insights into the strength and frequency of these connections. Thick lines indicate that the linked terms are frequently discussed together or exhibit a robust thematic association, while thinner lines imply weaker or less frequent connections. In essence, VOSviewer maps offer a visual narrative of the underlying structure and relationships within your dataset. By examining node size and color, you can pinpoint pivotal terms and thematic clusters. Simultaneously, analyzing the distance between nodes and line thickness unveils the semantic closeness and strength of associations between terms. These visual insights are invaluable for researchers seeking to unearth key concepts, identify research clusters, and track emerging trends within their field of study.

Growth pattern, active countries, and active journals

The growth pattern of the 935 research articles on dual diagnosis of substance use disorders and mental health disorders shows an increasing trend in the number of published articles over the years. Starting from the late 1980s and early 1990s with only a few publications, the research interest gradually picked up momentum, and the number of articles has been consistently rising since the mid-1990s. Table 1 shows the number of articles published in three different periods. The majority of publications (52.2%) were produced between 2003 and 2012, indicating a significant surge in research during that decade. The subsequent period from 2013 to 2022 saw a continued interest in the subject, accounting for 35.5% of the total publications. The number of articles published per year during the period from 2013 to 2022 showed a fluctuating steady state with an average of approximately 33 articles per year. The earliest period from 1983 to 2002 comprised 12.3% of the total publications, reflecting the initial stages of research and the gradual development of interest in the field.

Out of the total 935 publications, the United States contributed the most with 585 publications, accounting for approximately 62.5% of the total research output. Canada follows with 88 publications, making up around 9.4% of the total. The United Kingdom and Australia also made substantial contributions with 70 and 53 publications, accounting for 7.5 and 5.7%, respectively. Table 2 shows the top 10 active countries.

Based on the list of top active journals in the field of dual diagnosis of substance use and mental health disorders, it is evident that there are several reputable and specialized journals that focus on this important area of research (Table 3 ). These journals cover a wide range of topics related to dual diagnosis, including comorbidity, treatment approaches, intervention strategies, and epidemiological studies. The Journal of Dual Diagnosis appears to be a leading and comprehensive platform for research on dual diagnosis. It covers a broad spectrum of studies related to substance use disorders and mental health conditions. The Journal of Substance Abuse Treatment ranked second while the Mental Health and Substance Use Dual Diagnosis journal ranked third and seems to be dedicated specifically to the intersection of substance use disorder and mental health disorders, providing valuable insights and research findings related to comorbidities and integrated treatment approaches.

Most frequent author keywords

Mapping author keywords with a minimum occurrence of five (n = 96) provides insights in research related to dual diagnosis. Figure 1 shows the 96 author keywords and their links with other keywords. The number of occurrences represent the number of times each author keyword appears in the dataset, while the total link strength (TLS) indicates the combined strength of connections between keywords based on their co-occurrence patterns. The most frequent author keywords with high occurrences and TLS represent the key areas of focus in research on the dual diagnosis of substance use and mental health disorders.

“Comorbidity” is the most frequent keyword, with 144 occurrences and a high TLS of 356. This reflects the central theme of exploring the co-occurrence of substance use disorders and mental health conditions and their complex relationship. “Substance use disorder” and “dual diagnosis” are also highly prevalent keywords with 122 and 101 occurrences, respectively. These terms highlight the primary focus on studying individuals with both substance use disorders and mental health disorders, underscoring the significance of dual diagnosis in research. “Co-occurring disorders” and “substance use disorders” are frequently used, indicating a focus on understanding the relationship between different types of disorders and the impact of substance use on mental health. Several specific mental health disorders such as “schizophrenia,” “depression,” “bipolar disorder,” and “PTSD” are prominent keywords, indicating a strong emphasis on exploring the comorbidity of these disorders with substance use. “Mental health” and “mental illness” are relevant keywords, reflecting the broader context of research on mental health conditions and their interaction with substance use. “Treatment” is a significant keyword with 34 occurrences, indicating a focus on investigating effective interventions and treatment approaches for individuals with dual diagnosis. “Addiction” and “recovery” are important keywords, highlighting the interest in understanding the addictive nature of substance use and the potential for recovery in this population. The mention of “veterans” as a keyword suggests a specific focus on the dual diagnosis of substance use and mental health disorders in the veteran population. “Integrated treatment” is an important keyword, indicating an interest in studying treatment approaches that address both substance use and mental health disorders together in an integrated manner.

Network visualization map of author keywords with a minimum occurrence of five in the retrieved articles on dual diagnosis of substance use and mental health disorders

Most impactful research topics

To have an insight into the most impactful research topics on dual diagnosis, the top 100 research articles were visualized and the terms with the largest node size and TLS were used to. To come up with the five most common investigated research topics:

Dual diagnosis and comorbidity of SUDs and MHDs: This topic focuses on the co-occurrence of substance use disorders and various mental health conditions, such as schizophrenia, bipolar disorder, PTSD, anxiety disorders, and major depressive disorder. This research topic explored the prevalence, characteristics, and consequences of comorbidity in different populations, including veterans, adolescents, and individuals experiencing homelessness [ 13 , 19 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].

Treatment and interventions for co-occurring disorders: This topic involves studies on different treatment approaches and interventions for individuals with dual diagnosis. These interventions may include motivational interviewing, cognitive-behavioral therapy, family intervention, integrated treatment models, assertive community treatment, and prolonged exposure therapy. The goal is to improve treatment outcomes and recovery for individuals with co-occurring substance use and mental health disorders [ 48 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ].

Quality of life and functioning in individuals with dual diagnosis: This research topic explores the impact of dual diagnosis on the quality of life and functioning of affected individuals. It assesses the relationship between dual diagnosis and various aspects of well-being, including social functioning, physical health, and overall quality of life [ 60 , 61 , 62 , 63 , 64 ].

Epidemiology and prevalence of co-occurring disorders: This topic involves population-based studies that investigate the prevalence of comorbid substance use and mental health disorders. It examines the demographic and clinical correlates of dual diagnosis, as well as risk factors associated with the development of co-occurring conditions [ 50 , 52 , 60 , 65 , 66 , 67 ].

Implications and consequences of comorbidity: This research topic explores the consequences of comorbidity between substance use and mental health disorders, such as treatment utilization, service access barriers, criminal recidivism, and the impact on suicidality. It also investigates the implications of comorbidity for treatment outcomes and the potential risks associated with specific comorbidities [ 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ].

Emerging research topics

Upon scrutinizing the titles, abstracts, author keywords, and a visualization map of the 100 recently published articles, the research themes listed below came to the forefront. It’s worth noting that some of the research themes in the 100 recently published articles were not groundbreaking; rather, they represented a natural progression of ongoing research endeavors, and that is why they were not listed as emerging research themes. For instance, there was a continuation of research into the prevalence and epidemiology of co-occurring mental illnesses and substance use disorders and characteristics of various cases of co-morbid cases of SUDs and MHDs. The list below included such emergent themes. It might seem that certain aspects within these research themes duplicate the initial research topics, but it’s crucial to emphasize that this is not the case. For example, both themes delve into investigations concerning treatment, yet the differentiation lies in the treatment approach adopted.

Neurobiological and psychosocial aspects of dual diagnosis: This research topic focuses on exploring the neurobiological etiology and underlying mechanisms of comorbid substance use and mental health disorders. It investigates brain regions, neurotransmitter systems, hormonal pathways, and other neurobiological factors contributing to the development and maintenance of dual diagnosis. Additionally, this topic may examine psychosocial aspects, such as trauma exposure, adverse childhood experiences, and social support, that interact with neurobiological factors in the context of comorbidity [ 76 ].

Impact of environmental and sociocultural factors on dual diagnosis: This research topic delves into the influence of environmental and sociocultural factors on the occurrence and course of comorbid substance use and mental health disorders. It may explore how cultural norms, socioeconomic status, access to healthcare, and societal attitudes toward mental health and substance use affect the prevalence, treatment outcomes, and quality of life of individuals with dual diagnosis [ 77 , 78 ].

New interventions and treatment approaches for dual diagnosis: This topic involves studies that propose and evaluate innovative interventions and treatment approaches for individuals with dual diagnosis. These interventions may include novel psychotherapeutic techniques, pharmacological treatments, digital health interventions, and integrated care models. The research aims to improve treatment effectiveness, adherence, and long-term recovery outcomes in individuals with comorbid substance use and mental health disorders [ 79 , 80 , 81 , 82 , 83 , 84 ].

Mental health and substance use in special populations with dual diagnosis: This research topic focuses on exploring the prevalence and unique characteristics of comorbid substance use and mental health disorders in specific populations, such as individuals with eating disorders, incarcerated individuals, and people with autism spectrum disorder. It aims to identify the specific needs and challenges faced by these populations and develop tailored interventions to address their dual diagnosis [ 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ].

Public health implications and policy interventions for dual diagnosis: This topic involves research that addresses the public health implications of dual diagnosis and the need for policy interventions to address this complex issue. It may include studies on the economic burden of comorbidity, the impact on healthcare systems, and the evaluation of policy initiatives aimed at improving prevention, early intervention, and access to integrated care for individuals with dual diagnosis [ 81 , 96 , 97 , 98 , 99 , 100 , 101 ].

Comparison in research topics

The comparison between the most impactful research topics and emerging research topics in the field of dual diagnosis reveals intriguing insights into the evolving landscape of this critical area of study (Table 4 ). In the most impactful research topics, there is a strong emphasis on the epidemiology of dual diagnosis, indicating a well-established foundation in understanding the prevalence, characteristics, and consequences of comorbid SUDs and MHDs. Treatment and interventions also receive considerable attention, highlighting the ongoing efforts to improve outcomes and recovery for individuals with dual diagnosis. Quality of life and medical consequences are additional focal points, reflecting the concern for the holistic well-being of affected individuals and the health-related implications of comorbidity.

On the other hand, emerging research topics signify a shift towards newer methods and interventions. The exploration of neurobiology in the context of dual diagnosis reflects a growing interest in unraveling the underlying neurobiological mechanisms contributing to comorbidity. This shift suggests a deeper understanding of the neural pathways and potential targets for intervention. The consideration of dual diagnosis in special groups underscores a recognition of the unique needs and challenges faced by specific populations, such as individuals with autism spectrum disorder. This tailored approach acknowledges that one size does not fit all in addressing dual diagnosis. Finally, the exploration of environmental and psychosocial contexts highlights the importance of socio-cultural factors, policy interventions, and societal attitudes in shaping the experience of individuals with dual diagnosis, signaling a broader perspective that extends beyond clinical interventions. In summary, while the most impactful research topics have laid a strong foundation in epidemiology, treatment, quality of life, and medical consequences, the emerging research topics point to a promising future with a deeper dive into the neurobiology of dual diagnosis, a focus on special populations, and a broader consideration of the environmental and psychosocial context. This evolution reflects the dynamic nature of dual diagnosis research as it strives to advance our understanding and improve the lives of those affected by comorbid substance use and mental health disorders.

The main hypothesis underlying the study was that dual diagnosis, or the comorbidity of SUDs and MHDs, was historically underrecognized and under-researched. Over time, however, there has been a significant increase in understanding, appreciation, and research into this complex interplay in clinical settings. This was expected to manifest through a growing number of publications, increased attention to integrated treatment approaches, and a heightened recognition of the complexities and public health implications associated with dual diagnosis. The study aims to analyze this progression and its implications through a research landscape analysis, identifying key trends, knowledge gaps, and research priorities. The research landscape analysis of the dual diagnosis of SUDs and MHDs has unveiled a substantial and evolving body of knowledge, with a notable rise in publications since the mid-1990s and a significant surge between 2003 and 2012. This growing research interest underscores the increasing recognition of the importance and complexity of dual diagnosis in clinical and public health contexts. The United States has emerged as the most active contributor, followed by Canada, the United Kingdom, and Australia, with specialized journals such as the Journal of Dual Diagnosis playing a pivotal role in disseminating research findings. Common keywords such as “comorbidity,” “substance use disorder,” “dual diagnosis,” and specific mental health disorders highlight the primary focus areas, with impactful research topics identified as the comorbidity of SUDs and MHDs, treatment and interventions, quality of life, epidemiology, and the implications of comorbidity. Emerging research themes emphasize neurobiological and psychosocial aspects, the impact of environmental and sociocultural factors, innovative treatment approaches, and the needs of special populations with dual diagnosis, reflecting a shift towards a more holistic and nuanced understanding. The study highlights a shift from traditional epidemiological studies towards understanding the underlying mechanisms and broader social determinants of dual diagnosis, with a need for continued research into integrated treatment models, specific needs of diverse populations, and the development of tailored interventions.

The findings of this research landscape analysis have significant implications for clinical practice, public health initiatives, policy development, and future research endeavors. Clinicians and healthcare providers working with individuals with dual diagnosis can benefit from the identified research hotspots, as they highlight crucial aspects that require attention in diagnosis, treatment, and support. The prominence of treatment and intervention topics indicates the need for evidence-based integrated approaches that address both substance use and mental health disorders concurrently [ 102 , 103 , 104 ]. The research on the impact of dual diagnosis on quality of life and functioning underscores the importance of holistic care that addresses psychosocial and functional well-being [ 63 ]. For public health initiatives, understanding the prevalence and epidemiological aspects of dual diagnosis is vital for resource allocation and the development of effective prevention and early intervention programs. Policymakers can use the research landscape analysis to inform policies that promote integrated care, reduce barriers to treatment, and improve access to mental health and substance abuse services [ 15 , 105 ]. Furthermore, the identification of emerging topics offers opportunities for investment in research areas that are gaining momentum and importance.

The present study lays a robust groundwork, serving as a catalyst for the advancement of research initiatives and the formulation of comprehensive policies and programs aimed at elevating the quality of life for individuals grappling with the intricate confluence of SUDs and MHDs. Within the realm of significance, it underscores a critical imperative—the urgent necessity to revolutionize the landscape of tailored mental health services offered to patients harboring this challenging comorbidity. The paper distinctly illuminates the exigency for a heightened quantity of research endeavors that delve deeper into unraveling the temporal intricacies underpinning the relationship between SUDs and MHDs. In so doing, it not only unveils potential risk factors but also delves into the far-reaching consequences of treatment modalities over the extended course of time. This illumination, therefore, not only beckons but virtually ushers in a promising trajectory for prospective research endeavors, a path designed to uncover the intricate and evolving journey of dual diagnosis. A profound implication of this study is the direct applicability of its findings in the corridors of policymaking. By leveraging the insights encapsulated within the paper, policymakers stand uniquely equipped to sculpt policies that unequivocally champion the cause of integrated care. The remarkable emphasis on themes of treatment and intervention, permeating the research's core, emphatically underscores the urgent demand for dismantling barriers obstructing access to mental health and substance abuse services. It is incumbent upon policymakers to heed this call, for policies fostering the integration of care can inexorably elevate the outcomes experienced by patients grappling with dual diagnosis. Furthermore, this study artfully directs policymakers to allocate their resources judiciously by identifying burgeoning areas of research that are surging in prominence and pertinence. These emergent topics, discerned within the study, are not just topics; they are emblematic of windows of opportunity. By investing in these areas, policymakers can tangibly bolster research initiatives that are primed to tackle the multifaceted challenges inherent in the realm of dual diagnosis, addressing both current exigencies and future prospects. Additionally, the paper furnishes the foundational blueprint essential for the development of screening guidelines and clinical practice protocols that truly grasp the complexity of dual diagnosis. Clinical practitioners and healthcare establishments would be remiss not to harness this invaluable information to augment their own practices, thereby delivering more effective and empathetic care to individuals contending with dual diagnosis. In essence, this study serves as the compass guiding the way toward a more compassionate, comprehensive, and efficacious approach to mental health and substance abuse care for those in need.

The current landscape analysis of reveals significant implications and highlights the growing research interest in this field since the late 1980s. This increasing trend underscores the complexities and prevalence of comorbid conditions, which necessitate focused research and intervention strategies. The results can be generalized to guide future research priorities, inform clinical guidelines, shape healthcare policies, and provide a framework for other countries to adapt and build upon in their context.

The key take-home message emphasizes the importance of recognizing the high prevalence and intricate relationship between SUDs and MHDs, necessitating integrated and tailored treatment approaches. Additionally, the study advocates for employing efficient research methodologies to synthesize vast amounts of literature and identify emerging trends, focusing on quality of life, treatment outcomes, and the broader socio-cultural and policy contexts to improve care and support for individuals with dual diagnosis. Finally, the research underscores the critical need for continued focus on dual diagnosis, advocating for comprehensive, integrated, and innovative approaches to research, clinical practice, and policymaking to improve outcomes for affected individuals.

Despite the comprehensive approach adopted in this research landscape analysis, several limitations must be acknowledged. The exclusive reliance on Scopus, while extensive, inherently limits the scope of the analysis, potentially omitting relevant articles indexed in other databases such as the Chinese scientific database, thus not fully representing the entire research landscape on dual diagnosis of SUDs and MHDs. Assigning quality control responsibilities to a single author, rather than employing a dual-reviewer system, may introduce bias and affect the reliability of the quality assessment. Although this approach was chosen to expedite the process, it might have compromised the thoroughness of quality checks. The use of narrative synthesis instead of a quantitative synthesis limits the ability to perform meta-analytical calculations that could provide more robust statistical insights. This choice was made for efficiency, but it may affect the depth of the analysis and the generalizability of the conclusions. The reliance on specific keywords to retrieve articles means that any relevant studies not containing these exact terms in their titles or abstracts may have been overlooked, potentially leading to an incomplete representation of the research domain. The restriction to English-language articles and peer-reviewed journals may exclude significant research published in other languages or in non-peer-reviewed formats, introducing linguistic and publication type bias that could skew the results towards predominantly English-speaking regions and established academic journals. The inclusion of articles up to December 31, 2022, means that any significant research published after this date is not considered, potentially missing the latest developments in the field. The validation of the search strategy using a small sample of 30 articles and a comparison with 10 randomly selected articles from Google Scholar may not be sufficient to comprehensively assess the effectiveness of the search strategy; a larger sample size might provide a more accurate validation. Some of the research topics and findings may be specific to particular populations (e.g., veterans) and might not be generalizable to other groups, highlighting the need for caution when extrapolating the results to broader contexts. Although no formal ethical approval was required due to the use of existing literature, ethical considerations related to the interpretation and application of findings must still be acknowledged, particularly in terms of representing vulnerable populations accurately and sensitively. Acknowledging these limitations is crucial for interpreting the findings of this research landscape analysis and for guiding future research efforts to address these gaps and enhance the robustness and comprehensiveness of studies on the dual diagnosis of SUDs and MHDs.

In conclusion, the research landscape analysis of dual diagnosis of substance abuse and mental health disorders provides valuable insights into the growth, active countries, and active journals in this field. The identification of research hotspots and emerging topics informs the scientific community about prevailing interests and potential areas for future investigation. Addressing research gaps can lead to a more comprehensive understanding of dual diagnosis, while the implications of the findings extend to clinical practice, public health initiatives, policy development, and future research priorities. This comprehensive understanding is crucial in advancing knowledge, improving care, and addressing the multifaceted challenges posed by dual diagnosis to individuals and society.

Availability of data and materials

All data presented in this manuscript are available on the Scopus database using the search query listed in the methodology section.

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Waleed M. Sweileh

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Sweileh, W.M. Research landscape analysis on dual diagnosis of substance use and mental health disorders: key contributors, research hotspots, and emerging research topics. Ann Gen Psychiatry 23 , 32 (2024). https://doi.org/10.1186/s12991-024-00517-x

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Mental Health Research Paper Topics

Exploring the wide array of mental health research paper topics can be an enriching experience for students studying health sciences. This subject matter is not only relevant but is also critically important in today’s context, given the rising prevalence of mental health issues in society. In this guide, we will navigate through a comprehensive list of potential topics, categorized into ten major areas of mental health. Additionally, this page provides expert advice on how to choose and delve into these topics effectively, as well as guidance on constructing a well-written mental health research paper. As a supplementary service, we also present iResearchNet’s professional writing offerings. iResearchNet specializes in providing students with high-quality, custom-written research papers on any topic of their choice. With a potent combination of expert degree-holding writers, meticulous research, and adherence to the highest standards of academic integrity, iResearchNet offers unparalleled support to students aiming to excel in their academic endeavors.

100 Mental Health Research Paper Topics

Embarking on the exploration of mental health research paper topics presents an incredible opportunity to delve into diverse areas of study and reveal intriguing insights. From understanding the human psyche to unraveling the intricate workings of various mental disorders, this domain offers a wide array of research avenues. In this section, we present a comprehensive list of 100 mental health research paper topics, neatly organized into ten major categories. This catalog is designed to cater to different interests, offer fresh perspectives, and stimulate thought-provoking discussions.

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The impact of social media on mental health
The psychological effects of bullying
Role of personality traits in mental health
Nature vs. nurture debate in psychology
Psychological effects of long-term stress
The role of psychology in pain management
The impact of sleep disorders on mental health
Effects of meditation on mental health
The psychology of decision-making
Understanding cognitive biases
Impact of parenting styles on children’s mental health
Childhood trauma and its long-term effects
Understanding Attention Deficit Hyperactivity Disorder (ADHD)
The role of school environments in child mental health
Adolescent depression: Causes and effects
The impact of divorce on children
Childhood Autism Spectrum Disorders
Eating disorders in adolescents
Impact of physical activity on children’s mental health
Childhood anxiety disorders
Impacts of work stress on mental health
Understanding Bipolar Disorder
Adult PTSD and its management
Role of exercise in mental health maintenance
The link between adult obesity and mental health
Alcoholism and its mental health implications
Understanding Schizophrenia
Mental health impacts of sexual assault
The effect of childlessness on mental health
The role of religion and spirituality in mental health
Mental health issues in aging population
Understanding Alzheimer’s Disease
Role of family in elder mental health
Depression in the elderly
Cognitive decline in aging: Prevention and management
The impact of retirement on mental health
Mental health effects of elder abuse
The role of social interactions in elder mental health
Understanding Parkinson’s Disease
Dementia and mental health
Global mental health policies: A comparative analysis
Role of mental health legislation in patient rights
Impact of health insurance policies on mental health services
Mental health in prisons: Policy implications
The impact of mental health stigma on policy making
Mental health policies in schools
Workplace mental health policies
Mental health parity laws
Policy implications of mental health in homelessness
Impact of COVID-19 on mental health policies
Cognitive-Behavioral Therapy (CBT) in mental health
Role of medication in mental health treatment
Efficacy of group therapy in mental health
Role of art therapy in mental health treatment
Understanding Electroconvulsive Therapy (ECT)
The role of lifestyle changes in mental health treatment
Psychodynamic therapy in mental health
The use of virtual reality in mental health treatment
Mindfulness-based therapies in mental health
Role of family therapy in mental health treatment
Understanding personality disorders
The psychopathology of addiction
Eating disorders: Causes, impacts, and treatments
Psychopathology of self-harm behaviors
Understanding anxiety disorders
The psychopathology of suicidal behavior
Psychopathology of mood disorders
Understanding obsessive-compulsive disorder (OCD)
The psychopathology of paranoia and delusional disorders
Impact of traumatic experiences on psychopathology
Impact of job satisfaction on mental health
Role of organizational culture in employee mental health
Mental health implications of job burnout
The role of work-life balance in mental health
Understanding the concept of ‘Blue Monday’
Mental health implications of remote work
The role of employee assistance programs in mental health
Mental health effects of workplace harassment
Impact of job insecurity on mental health
The role of workplace wellness programs in mental health
Cross-cultural perspectives on mental health
The impact of cultural stigma on mental health outcomes
Cultural variations in mental health treatments
Understanding mental health in indigenous populations
Mental health impacts of acculturation
The role of cultural competence in mental health services
Culture-bound syndromes
Impact of cultural beliefs on mental health
Role of language in mental health contexts
Cross-cultural communication in mental health care
Role of schools in mental health education
Impact of mental health literacy on outcomes
The role of media in mental health education
Mental health promotion in communities
Importance of mental health education in medical curricula
The role of peer educators in mental health promotion
Impact of stigma reduction campaigns on mental health
The role of mental health first aid
The use of technology in mental health education
Mental health education for parents

As we culminate this extensive list of mental health research paper topics, it is essential to remember that each topic presents a unique chance to broaden our understanding of mental health and contribute to this important field. As aspiring health science students, you have the power to make a difference in enhancing mental health awareness and outcomes. As you traverse this exciting journey, always remember that research is not merely a pursuit of knowledge, but a powerful tool for instigating change. Embrace the opportunity with curiosity, passion, and determination, and let your research pave the way for a mentally healthier world.

Choosing Mental Health Research Paper Topics

Choosing a compelling and relevant mental health research paper topic is crucial for creating a meaningful and impactful study. To assist you in this process, we have gathered expert advice from professionals in the field of mental health research. Consider the following ten tips to guide you in selecting an engaging and significant topic for your research:

Identify Current Mental Health Issues : Stay updated on the latest developments and trends in mental health research. Explore current issues, emerging challenges, and unanswered questions within the field. This will help you select a topic that is relevant, timely, and has the potential for making a meaningful contribution.
Reflect on Personal Interests : Consider your own passions and interests within the broad field of mental health. Reflect on the areas that resonate with you the most. Researching a topic that you are genuinely interested in will fuel your motivation and dedication throughout the research process.
Consult Academic Journals and Publications : Explore reputable academic journals and publications dedicated to mental health research. Reading articles and studies within your area of interest will provide insights into existing research gaps, ongoing debates, and potential areas for further exploration.
Analyze Existing Literature : Conduct a thorough literature review to identify key themes, theories, and research findings in your chosen area of mental health. Understanding the current body of knowledge will help you narrow down your research focus and identify research gaps that need to be addressed.
Consider the Population of Interest : Mental health research encompasses various populations, such as children, adolescents, adults, or specific demographic groups. Consider the population you want to focus on and explore their unique mental health challenges, interventions, or outcomes.
Examine Cultural and Social Factors : Mental health is influenced by cultural and social factors. Investigate how cultural norms, societal expectations, or environmental contexts impact mental health outcomes. Understanding these factors will add depth and richness to your research.
Think Interdisciplinary : Mental health is a multidisciplinary field that intersects with psychology, sociology, neuroscience, public health, and more. Consider integrating perspectives from other disciplines to gain a comprehensive understanding of mental health issues and approaches to addressing them.
Explore Innovative Interventions and Technologies : Investigate novel interventions, therapies, or technologies that are emerging in the field of mental health. Exploring innovative approaches can lead to exciting research opportunities and contribute to advancements in mental health care.
Address Stigmatized or Understudied Topics : Mental health encompasses a wide range of conditions and experiences, some of which may be stigmatized or underrepresented in research. Consider topics that address the mental health needs of marginalized populations or shed light on less-discussed mental health conditions.
Seek Guidance and Collaboration : Consult with your professors, mentors, or peers who specialize in mental health research. Seek their guidance in selecting a research topic and consider opportunities for collaboration. Collaborative research can provide valuable insights and support throughout the research process.

By incorporating these expert tips into your topic selection process, you can choose a mental health research paper topic that is not only academically rigorous but also personally meaningful. Remember to strike a balance between your interests, the existing body of knowledge, and the potential for making a significant impact in the field of mental health research. With a well-chosen topic, you will embark on a rewarding research journey that contributes to the understanding and well-being of individuals with mental health concerns.

How to Write a Mental Health Research Paper

Writing a mental health research paper requires careful planning, critical thinking, and effective communication of your findings. To help you navigate this process successfully, we have compiled ten essential tips to guide you in crafting a well-structured and impactful paper:

Define Your Research Question : Begin by clearly defining your research question or objective. This will serve as the foundation for your paper, guiding your literature review, methodology, and analysis.
Conduct a Thorough Literature Review : Familiarize yourself with existing research and theories related to your topic through a comprehensive literature review. This will help you identify gaps in the literature, build on existing knowledge, and situate your research within the broader context of mental health.
Select an Appropriate Methodology : Choose a research methodology that aligns with your research question and objectives. Consider whether qualitative, quantitative, or mixed-method approaches are best suited for your study. Justify your choice and outline your methodology clearly.
Ethical Considerations : Ensure that your research adheres to ethical guidelines and protects the rights and well-being of participants. Obtain necessary approvals from ethical review boards and maintain confidentiality and anonymity when reporting your findings.
Collect and Analyze Data : Collect data using appropriate methods, whether through surveys, interviews, observations, or existing datasets. Analyze your data using sound statistical techniques or qualitative analysis methods, depending on your research design.
Structure Your Paper : Organize your mental health research paper into sections, including an introduction, literature review, methodology, results, discussion, and conclusion. Use headings and subheadings to clearly delineate each section and guide the reader through your paper.
Craft a Compelling Introduction : Begin your paper with an engaging introduction that captures the reader’s attention and provides the necessary background information. Clearly state your research question, the significance of your study, and the gaps you aim to address.
Interpret Your Findings : In the results section, present your findings objectively and concisely. Use tables, graphs, or figures to enhance clarity and provide a comprehensive overview of your results. Interpret your findings in light of your research question and existing literature.
Engage in a Thoughtful Discussion : In the discussion section, critically analyze and interpret your results, discussing their implications for theory, practice, and future research. Compare your findings with previous studies and identify areas of agreement or divergence.
Conclude with Key Takeaways : Summarize your main findings, restate the significance of your study, and discuss potential avenues for further research. Highlight the contributions your research makes to the field of mental health and offer practical implications for mental health professionals or policymakers.

Additional Tips:

Use clear and concise language, avoiding jargon whenever possible. Define any technical terms or acronyms for clarity.
Properly cite all sources using a recognized citation style, such as APA, MLA, Chicago/Turabian, or Harvard, to give credit to the original authors and avoid plagiarism.
Seek feedback from professors, mentors, or peers to refine your writing and ensure the clarity and coherence of your paper.
Revise and edit your paper multiple times to polish your arguments, improve sentence structure, and eliminate grammatical errors.

By following these tips, you can confidently navigate the process of writing a mental health research paper. Remember to maintain a logical flow, support your arguments with evidence, and engage in critical analysis to contribute to the understanding and advancement of mental health research.

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Research Article

The role of mental health in the relationship between nursing care satisfaction with nurse-patient relational care in Chinese emergency department nursing

Roles Conceptualization, Formal analysis, Investigation, Methodology

Affiliation Department of Infusion Room for Adults, Affiliated Hospital of Nantong University, Nantong University, Nantong, China

Roles Data curation, Formal analysis, Methodology, Project administration, Software

Affiliation Department of Rehabilitation, Hai’an Traditional Chinese Medicine Hospital, Hai’an, China

Roles Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation

Affiliation Department of Urinary Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, China

Roles Formal analysis, Methodology, Supervision, Validation, Visualization

Affiliation Department of Endoscopic Center, Affiliated Hospital of Nantong University, Nantong University, Nantong, China

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Validation

Affiliation Department of Otolaryngology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China

Roles Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected] , [email protected]

Affiliation Department of Outpatient Injection, Affiliated Hospital of Nantong University, Nantong University, Nantong, China

Hui Huang,
Jing Cui,
Hua Zhang,
Yuhui Gu,
Haosheng Ni,

Published: September 3, 2024
https://doi.org/10.1371/journal.pone.0309800
Peer Review
Reader Comments

The relationship between a nurse and a patient is a key part of nursing that can impact how happy the patient is with the care they receive. It appears that the nurse’s mental health can also affect this connection. However, there is little research on this topic. So, the aim of the present study was to determine the correlation of nurse’s mental health with nurse–patient relational care and nursing care satisfaction.

A total of 532 nurses and 532 patients from 13 Level-III hospitals of Hubei province (China) completed a China Mental Health Survey, general information questionnaire, the Nursing Care Satisfaction Scale, and Relational Care Scale.

Age, nurse working years, and night shift last month were correlated with mental health score ( r = -0.142, r = -0.150, r = 0.164, p < 0.05). Nurse’s mental health was correlated with relational care score and nursing care satisfaction score (r = -0.177, r = -0.325, p < 0 . 05 ). Also, relational care score, patients age and gender were correlated with nursing care satisfaction score ( r = 0.584 and r = 0.143, x 2 = 11.636, p < 0.05). Descriptive information of nurses had a direct impact on nurses’ mental health (direct effect = 0.612, 0.419–0.713). Nurses’ mental health had a direct effect on relational care score (direct effect = 0.493, 0.298–0.428) and an indirect effect on nursing care satisfaction score (indirect effect = 0.051, 0.032–0.074). Relational care score and patient’s descriptive information had also a direct effect on nursing care satisfaction score (direct effect = 0.232, 0.057–0.172 and 0.057, 0.347–0.493).

This study showed that the better the mental health of nurses, the more patients feel satisfied with nursing services.

Citation: Huang H, Cui J, Zhang H, Gu Y, Ni H, Meng Y (2024) The role of mental health in the relationship between nursing care satisfaction with nurse-patient relational care in Chinese emergency department nursing. PLoS ONE 19(9): e0309800. https://doi.org/10.1371/journal.pone.0309800

Editor: Sadia Malik, University of Sargodha, PAKISTAN

Received: June 5, 2024; Accepted: August 20, 2024; Published: September 3, 2024

Copyright: © 2024 Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript.

Funding: This study was funded by Nantong Science and Technology Project, China (Grant number: MS22022113). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Every patient has the right to feel satisfied with the services provided by the hospital. For this reason, hospitals and many healthcare centers strive to fulfill patients’ needs through the provision of quality services such as shortening wait times and preventing unnecessary delays that can be harmful, ensuring that the quality of care is consistent, regardless of a person’s gender, race, where they live, or how much money they have, offering a complete set of health services for all stages of life, and using resources effectively to get the most benefit and not wasting them [ 1 ].

Patient satisfaction with the services provided by the hospital has various benefits. For example, it less likely that patient will sue for malpractice. It also encourages patients to be more involved in their treatment, helps healthcare centers do better financially in a competitive market, and increases the chances of improving patients’ overall health [ 2 ].

In China, there has been more focus on patient-centered care in recent years. So that, the Chinese government started a big program in 2015 to make healthcare better across the country, with goals to improve how patients feel about their care and their experiences [ 3 ]. In this system, healthcare policymakers and providers have realized the significance of patient satisfaction and have begun to view it as an indicator of care quality [ 4 ]. To achieve this goal, it is crucial to examine the diverse aspects of structural, medical, nursing, and support services. These factors contribute to the overall experience of patients.

In hospitals, emergency departments play a crucial role in shaping a patient’s first impression as they enter the healthcare system [ 5 ]. A visit to the emergency department is usually the first time a patient interacts with a hospital system. Thus, this is a special opportunity to make a positive first impression.

However, the challenges in creating a pleasant experience should not be underestimated. Many patients consider their visit to the emergency department as the worst day of their lives. This already negative view makes it harder to provide a good experience [ 6 ]. Moreover, patient satisfaction in the emergency department depends on knowing how long they’ll wait, the conditions of the section, and how well it’s organized [ 7 ].

Also, the quality of interactions with emergency staff, like nurses, also impacts patient satisfaction [ 8 ]. Some studies in emergency departments showed that patients who saw a specific healthcare provider and younger patients had more negative communication experiences than other patients [ 9 , 10 ].

Nurses with good mental health show better communication skills. They listen carefully, understand patients’ concerns, and offer caring responses [ 11 , 12 ]. Although many studies have been done to improve patient satisfaction, only a few have focused on communication between patients and nurses. In this study, it is assumed that the nurse’s mental health affects the relationship between nursing care satisfaction scale and relational care. Therefore, the aim of the present study was to determine the mental health of nurses and its relationship with nurse–patient relational care and nursing care satisfaction.

Study design and participants

We carried out a cross-sectional, hospital-based, multicenter study in Hubei province, China, from November 10 to December 30, 2023. According to China’s hospital grading system, hospitals were categorized into three levels from Grade III to Grade I, with Grade III hospitals representing advanced medical and nursing capabilities. To equalize the conditions, only Grade III hospitals were selected. Since three cities lacked Level-III hospitals, a total of 13 Level-III hospitals were included. The nurses who met the inclusion criteria were as follows: (1) nurses working in an emergency department unit; (2) with at least one year of working experience; (3) willing to provide consent for participation in the study. On the other hand, the nurses who did not meet the inclusion criteria were excluded based on the following criteria: (1) nurses who had taken a leave for more than six months in the previous year due to different reasons; (2) nurses who were absent from work (either on leave or vacation) during the administration of the questionnaire; (3) nurses who were not directly involved in patient care, such as the head of the nursing department and head nurse. The patients who met the inclusion criteria were as follows: (1) patients who needed emergency department services; (2) patients who were under the care of one of the selected nurses in our study; (3) patients who expressed their willingness to participate in the study by giving consent. On the other hand, the exclusion criteria included: (1) patients with cognitive impairment or those unable to complete the survey; (2) patients who had already been discharged. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the medical research ethics committee of affiliated hospital of Nantong university (No.20231030-42). Also, written consent was received from the participants to participate in the study.

The minimum sample size was determined by estimating the sample size according to the WHO recommendations for epidemiological studies [ 13 ]. The confidence interval (CI) was set at 95%, the standard deviation (SD) was 0.5, and the margin of error was 0.5. Additionally, a 10% contingency was added to account for non-response. Finally, the minimum sample size was 430. We invited all the nurses who had been employed in the emergency department of these 13 Level-III hospitals to participate in the study. At first, questionnaires related to nurses were distributed (November 10 to 30, 2023). After identifying the nurses who filled the questionnaires correctly, a questionnaire was given to one of the patients who received services from these nurses (December 1 to 30, 2023.)

For the purposes of modeling, values were assigned to variables including nurse and patient age (18–64 years old), nurse and patient gender (female and male), nurse working years (≥1 year), marital status of nurse and patient (married, never married, and divorced/deceased), night shift last month, weekly hours of working, nurse mental health, relational care, nursing care satisfaction, and annual income (Yuan) of patients,

Demographic information

In the present study, demographic information of nurses was including gender, age, years of working, night shift last month, marital status, and weekly hours of working were recorded. The demographic information of patients was including gender, age, annual income, and marital status.

Nursing care satisfaction scale

In this study, the scale designed by the Nursing Care Quality Control Committee of Houston Health Care System was used [ 14 ]. The Chinese version of this questionnaire has already been used in other studies [ 15 ]. This particular scale comprises of 20 items that was assigned a score ranging from 1 to 6 points, with options such as "never," "rarely," "sometimes," "often," "most of the time," and "always." The total score on the scale amounted to 120, with higher scores indicating greater patient satisfaction with the nurses’ care. The reliability of this scale in the study was assessed using Cronbach’s alpha coefficient, which yielded a value of 0.92, indicating good reliability.

Relational care scale

The scale developed by Ray and Turkel (2001), was used to measure nurse-patient relationship [ 16 ]. The patient version comprises 15 items categorized into three dimensions: work trust, ethics, and care. Each item is rated on a scale of 1 to 5, ranging from "strongly disagree" to "strongly agree". The total score possible is 75 points, with a higher score indicating a stronger nurse-patient relationship. The Chinese version of this questionnaire has already been used in other studies [ 15 ]. In this study, the Cronbach’s alpha coefficient for the overall scale was 0.83.

Mental health

The GHQ-12 assesses the mental health status of nurses through 12 self-assessment items. Each item presents four options (A, B, C, and D), and utilizes a bimodal scoring method (0-0-1-1). The scoring method was as follows selecting A or B results in a score of 0, while choosing C or D leads to a score of 1. A cumulative score of ≥ 4 was considered a positive mental health screening rate, indicating conditions such as anxiety, depression, or insomnia [ 17 ]. A higher score indicates a more severe mental health condition. The Chinese versions of GHQ-12 for professional groups, healthcare workers, and the general population demonstrated high internal consistency [ 18 , 19 ] featured good reliability and validity. In this study, the Cronbach’s alpha coefficient of this scale was 0.89.

Statistical analysis

Demographic data, mental health, and nursing care satisfaction scale and relational care scale were summarized using descriptive statistics and analyzed through the correlation matrix, chi-square (χ 2 ) test, and nonparametric tests in SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Proportions were utilized for qualitative and ordinal data, while means and standard deviations (SD) were used for quantitative data. The structural equation modeling was carried out with AMOS 26.0 version. The fitness of the model was assessed using fitness indices such as goodness-of-fit index (GFI), the normal fit index (NFI), comparative fit index (CFI), adjusted goodness-of-fit index (AGFI), root mean square error of approximation (RMSEA), and Tacker-Lewis index (TLI). The GFI and the AGFI should be > 0.95 and > 0.90 [ 20 ]. CFI should be > 0.96 [ 21 ] or > 0.90 [ 20 ]. NFI should be > 0.90 [ 20 ] or > 0.95 [ 22 ]. RMSEA should be < 0.05 [ 23 ].

In total, 582 questionnaires were filled by nurses. However, 532 questionnaires were approved and incompletely filled questionnaires were not included in the statistical analysis. According to the selection of one patient from each nurse who provided services to her, a total of 532 patients’ questionnaires were included in the statistical analysis. The characteristics of the participants are shown in detail in Table 1 . 69% of nurses and 53% of patients were female. 75% of nurses and 71% of patients were married. The mean of working years, night shift per last month, and weekly hours of nurses were 7.00 ± 3.815 years, 4.822 ± 4.542 night, and 41.185 ± 4.314 hours, respectively. Also, the average score of nurses’ mental health was 2.52 ± 1.529 and the positive rate of mental health status was 26.19%.

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https://doi.org/10.1371/journal.pone.0309800.t001

The mean annual income of patients, patients’ satisfaction with nursing care and relational care were 333,765 ± 311,476.5 Yuan, 53.9 ± 34.793 and 38.902 ± 18.825, respectively. No significant difference was observed between female and male nurses and female and male patients in the research variables (p > 0.05).

Pearson correlation and χ 2 tests were used to explore the correlation between variables (Tables 2 and 3 ). Nurse age was correlated with nurse working years ( r = 0.841, p < 0.05), night shift last month (r = -0.226, p < 0.05) and mental health score ( r = -0.142, p < 0.05). Nurse working years was correlated with mental health score ( r = -0.150, p < 0.05). Night shift last month was correlated with weekly hours of working ( r = 0.164, p < 0.05) and mental health (r = -0.275, p < 0.05). Nurse mental health was correlated with relational care score ( r = -0.325, p < 0.05) and nursing care satisfaction score (r = -0.177, p < 0.05). Also, relational care score, patients age and gender were correlated with nursing care satisfaction score ( r = 0.584 and r = 0.143, x 2 = 11.636, p < 0.05).

https://doi.org/10.1371/journal.pone.0309800.t002

https://doi.org/10.1371/journal.pone.0309800.t003

Descriptive information of nurses and patients, mental health, relational care score and nursing care satisfaction score were entered into the model. The final structural equation model fitted well with the study data ( χ 2 = 439.188, p < 0.001, GFI = 0.959, AGFI = 0.939, RMSEA = 0.049) ( Fig 1 ). All effects were significant ( p < 0.001).

*The goodness-of-fit indices were: CFI = 0.962, NFI = 0.951, TLI = 0.949, GFI = 0.959, AGFI = 0.939, RMSEA = 0.049. * P < 0.05; X1 = nurse age; X2 = nurse gender; X3 = nurse working years; X4 = marital status of nurse; X5 = night shift last month; X6 = weekly hours of working; DIN = descriptive information of nurses; X7 = mental health score; X8 = relational Care score; X9 = nursing care satisfaction score; DIP = descriptive information of patients; X10 = patient age; X11 = patient gender; X12 = annual income (Yuan) of patients; X13 = marital status of patient.

https://doi.org/10.1371/journal.pone.0309800.g001

Table 4 shows the standardized direct, indirect, and total effects, and the 95% confidence interval (CI) for each construct. Four direct, one indirect, and five total effects were significant. Descriptive information of nurses had a direct impact on nurses’ mental health (direct effect = 0.612, 0.419–0.713). Nurses’ mental health had a direct effect on relational Care score (direct effect = 0.493, 0.298–0.428) and an indirect effect on nursing care satisfaction score (indirect effect = 0.051, 0.032–0.074). Relational Care score and patient’s descriptive information had also a direct effect on nursing care satisfaction score (direct effect = 0.232, 0.057–0.172 and 0.057, 0.347–0.493).

https://doi.org/10.1371/journal.pone.0309800.t004

Patient satisfaction and their expectations of care are important indicators of high-quality nursing care in hospitals and healthcare facilities. Because of this, these centers are looking for ways to improve patient satisfaction by providing good services. It is important to understand what factors affect how satisfied patients are.

The current study found that male patients were more satisfied with nursing care than female patients. This result is consistent with the findings of Rafii et al (2009) and Guo et al. (2023), which also showed that male patients were more satisfied with the nursing care they received [ 15 , 24 ]. Men usually have lower expectations and are less sensitive than women, and they often receive more information from nurses, which might make them more satisfied with the nursing care [ 15 , 25 ].

Another finding from this study is that age had a positive correlation with nursing care satisfaction; In addition, age had a direct effect on nursing care satisfaction. This means that patients who are older were more satisfied than younger patients. These results are consistent with other studies [ 15 , 26 , 27 ].

It appears that older patients have lower expectations for nursing services and fewer needs compared to younger patients, which makes them more likely to be satisfied. Additionally, older patients may be more socially aware, more forgiving, and more appreciative and empathetic towards their caregivers [ 27 ].

Nurses often interact the most with patients. The correlation analysis of this study showed that when nurses have good relationships with patients, the patients are more satisfied with the care they receive. Also, analysis indicated that the nurse-patient relational care score directly affects nursing care satisfaction, which is consistent with other studies results [ 15 , 28 ]. Good communication between nurses and patients is important for the patients and their families to feel satisfied with the care. If communication is poor, it can cause a lack of trust and harm the relationship between the patient and the nurse [ 29 , 30 ]. Some studies suggest that better training can help nurses improve their communication skills, which can lead to safer care, better health results, patients following their treatment plans, and overall satisfaction with the care they receive. Moreover, it helps healthcare workers feel more valued and effective [ 31 , 32 ].

The role of the nurse in the relationship between nurse-patient relational care score with nursing care satisfaction has been less investigated. One of the aspects that can be paid attention to is the role of the nurse’s mental health in the relationship between nurse-patient relational care score with nursing care satisfaction.

However, this issue has not been given much attention in the study so far. In our study, we found that the mental health of nurses can indirectly affect patient satisfaction through influencing the nurse-patient relational care. Good mental health in nurses can increase their self-confidence and ability to do their job well by talking with patients. This helps them share information effectively and handle difficult situations without feeling stressed. Showing respect and understanding the needs of patients with dual diagnosis is very important in providing good care. Research has shown that understanding the perspectives of these individuals can be very beneficial [ 33 ].

Considering the importance of the role of mental health of nurses in the relationship between nurse-patient relational care score with nursing care satisfaction, it’s important to focus on what affects nurses’ mental health. In this study, it was found that older nurses who have been working longer tend to have better mental health, meaning they experience less stress, anxiety, and depression. This is likely because they have more experience and maturity. In fact, age and years of work were found to be factors that reduce the chances of poor mental health. Other studies have also shown that younger nurses with less experience are more likely to feel stressed [ 34 , 35 ].

In this research, it was found that the more night shifts nurses worked each month, the worse their mental health tended to be. A study conducted by Torquati et al., (2019) showed that working shifts increased the chances of having mental health problems like depression and anxiety [ 36 ]. Normally, people sleep at night and are awake during the day. However, to keep the healthcare system running well, many healthcare workers, like nurses, have to work night shifts either regularly or permanently [ 37 ].

The night nurses give constant care and watch over patients, and they also give out medicine. However, working night shifts regularly can lead to poor mental health, which can cause them to feel different emotions, have trouble thinking, not want to do things, do their job worse, be more likely to get hurt, and have changes in their body [ 38 ]. Some studies showed that nurses who moved from night shifts to day shifts experienced a significant reduction in symptoms of depression and anxiety over a 2-year period [ 39 , 40 ].

It is important to acknowledge some limitations of this study. Firstly, the use of a cross-sectional design prevents the identification of a causal relationship between variables. Secondly, the number of questions and the time required to fill them can make the participants tired and impatient.

Overall, this study found that the mental health of nurses is one of the indirect factors affecting patients’ satisfaction. So, focusing on nurses’ mental well-being and helping them feel better could be a way to make patients more satisfied with their nursing care.

Acknowledgments

We thank all the nurses and patients who participated in this study.

View Article
Google Scholar
2. Ferreira D.C., et al. Patient satisfaction with healthcare services and the techniques used for its assessment: a systematic literature review and a bibliometric analysis. in Healthcare. 2023. MDPI.
PubMed/NCBI
16. Ray M. and Turkel C., Relational caring questionnaires. Assessing and measuring caring in nursing and health sciences (3rd ed., pp. 213–234). Springer Publishing, 2019.
20. Byrne B.M., Structural equation modeling with EQS and EQS/Windows: Basic concepts, applications, and programming. 1994: Sage.
22. Schumacker R.E. and Lomax R.G., A beginner’s guide to structural equation modeling. 2004: psychology press.

61 intriguing psychology research topics to explore

Last updated

11 January 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

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Psychology is an incredibly diverse, critical, and ever-changing area of study in the medical and health industries. Because of this, it’s a common area of study for students and healthcare professionals.

We’re walking you through picking the perfect topic for your upcoming paper or study. Keep reading for plenty of example topics to pique your interest and curiosity.

How to choose a psychology research topic

Exploring a psychology-based topic for your research project? You need to pick a specific area of interest to collect compelling data.

Use these tips to help you narrow down which psychology topics to research:

Focus on a particular area of psychology

The most effective psychological research focuses on a smaller, niche concept or disorder within the scope of a study.

Psychology is a broad and fascinating area of science, including everything from diagnosed mental health disorders to sports performance mindset assessments.

This gives you plenty of different avenues to explore. Having a hard time choosing? Check out our list of 61 ideas further down in this article to get started.

Read the latest clinical studies

Once you’ve picked a more niche topic to explore, you need to do your due diligence and explore other research projects on the same topic.

This practice will help you learn more about your chosen topic, ask more specific questions, and avoid covering existing projects.

For the best results, we recommend creating a research folder of associated published papers to reference throughout your project. This makes it much easier to cite direct references and find inspiration down the line.

Find a topic you enjoy and ask questions

Once you’ve spent time researching and collecting references for your study, you finally get to explore.

Whether this research project is for work, school, or just for fun, having a passion for your research will make the project much more enjoyable. (Trust us, there will be times when that is the only thing that keeps you going.)

Now you’ve decided on the topic, ask more nuanced questions you might want to explore.

If you can, pick the direction that interests you the most to make the research process much more enjoyable.

61 psychology topics to research in 2024

Need some extra help starting your psychology research project on the right foot? Explore our list of 61 cutting-edge, in-demand psychology research topics to use as a starting point for your research journey.

Psychology research topics for university students

As a university student, it can be hard to pick a research topic that fits the scope of your classes and is still compelling and unique.

Here are a few exciting topics we recommend exploring for your next assigned research project:

Mental health in post-secondary students

Seeking post-secondary education is a stressful and overwhelming experience for most students, making this topic a great choice to explore for your in-class research paper.

Examples of post-secondary mental health research topics include:

Student mental health status during exam season

Mental health disorder prevalence based on study major

The impact of chronic school stress on overall quality of life

The impacts of cyberbullying

Cyberbullying can occur at all ages, starting as early as elementary school and carrying through into professional workplaces.

Examples of cyberbullying-based research topics you can study include:

The impact of cyberbullying on self-esteem

Common reasons people engage in cyberbullying

Cyberbullying themes and commonly used terms

Cyberbullying habits in children vs. adults

The long-term effects of cyberbullying

Clinical psychology research topics

If you’re looking to take a more clinical approach to your next project, here are a few topics that involve direct patient assessment for you to consider:

Chronic pain and mental health

Living with chronic pain dramatically impacts every aspect of a person’s life, including their mental and emotional health.

Here are a few examples of in-demand pain-related psychology research topics:

The connection between diabetic neuropathy and depression

Neurological pain and its connection to mental health disorders

Efficacy of meditation and mindfulness for pain management

The long-term effects of insomnia

Insomnia is where you have difficulty falling or staying asleep. It’s a common health concern that impacts millions of people worldwide.

This is an excellent topic because insomnia can have a variety of causes, offering many research possibilities.

Here are a few compelling psychology research topics about insomnia you could investigate:

The prevalence of insomnia based on age, gender, and ethnicity

Insomnia and its impact on workplace productivity

The connection between insomnia and mental health disorders

Efficacy and use of melatonin supplements for insomnia

The risks and benefits of prescription insomnia medications

Lifestyle options for managing insomnia symptoms

The efficacy of mental health treatment options

Management and treatment of mental health conditions is an ever-changing area of study. If you can witness or participate in mental health therapies, this can make a great research project.

Examples of mental health treatment-related psychology research topics include:

The efficacy of cognitive behavioral therapy (CBT) for patients with severe anxiety

The benefits and drawbacks of group vs. individual therapy sessions

Music therapy for mental health disorders

Electroconvulsive therapy (ECT) for patients with depression

Controversial psychology research paper topics

If you are looking to explore a more cutting-edge or modern psychology topic, you can delve into a variety of controversial and topical options:

The impact of social media and digital platforms

Ever since access to internet forums and video games became more commonplace, there’s been growing concern about the impact these digital platforms have on mental health.

Examples of social media and video game-related psychology research topics include:

The effect of edited images on self-confidence

How social media platforms impact social behavior

Video games and their impact on teenage anger and violence

Digital communication and the rapid spread of misinformation

The development of digital friendships

Psychotropic medications for mental health

In recent years, the interest in using psychoactive medications to treat and manage health conditions has increased despite their inherently controversial nature.

Examples of psychotropic medication-related research topics include:

The risks and benefits of using psilocybin mushrooms for managing anxiety

The impact of marijuana on early-onset psychosis

Childhood marijuana use and related prevalence of mental health conditions

Ketamine and its use for complex PTSD (C-PTSD) symptom management

The effect of long-term psychedelic use and mental health conditions

Mental health disorder research topics

As one of the most popular subsections of psychology, studying mental health disorders and how they impact quality of life is an essential and impactful area of research.

While studies in these areas are common, there’s always room for additional exploration, including the following hot-button topics:

Anxiety and depression disorders

Anxiety and depression are well-known and heavily researched mental health disorders.

Despite this, we still don’t know many things about these conditions, making them great candidates for psychology research projects:

Social anxiety and its connection to chronic loneliness

C-PTSD symptoms and causes

The development of phobias

Obsessive-compulsive disorder (OCD) behaviors and symptoms

Depression triggers and causes

Self-care tools and resources for depression

The prevalence of anxiety and depression in particular age groups or geographic areas

Bipolar disorder

Bipolar disorder is a complex and multi-faceted area of psychology research.

Use your research skills to learn more about this condition and its impact by choosing any of the following topics:

Early signs of bipolar disorder

The incidence of bipolar disorder in young adults

The efficacy of existing bipolar treatment options

Bipolar medication side effects

Cognitive behavioral therapy for people with bipolar

Schizoaffective disorder

Schizoaffective disorder is often stigmatized, and less common mental health disorders are a hotbed for new and exciting research.

Here are a few examples of interesting research topics related to this mental health disorder:

The prevalence of schizoaffective disorder by certain age groups or geographic locations

Risk factors for developing schizoaffective disorder

The prevalence and content of auditory and visual hallucinations

Alternative therapies for schizoaffective disorder

Societal and systematic psychology research topics

Modern society’s impact is deeply enmeshed in our mental and emotional health on a personal and community level.

Here are a few examples of societal and systemic psychology research topics to explore in more detail:

Access to mental health services

While mental health awareness has risen over the past few decades, access to quality mental health treatment and resources is still not equitable.

This can significantly impact the severity of a person’s mental health symptoms, which can result in worse health outcomes if left untreated.

Explore this crucial issue and provide information about the need for improved mental health resource access by studying any of the following topics:

Rural vs. urban access to mental health resources

Access to crisis lines by location

Wait times for emergency mental health services

Inequities in mental health access based on income and location

Insurance coverage for mental health services

Systemic racism and mental health

Societal systems and the prevalence of systemic racism heavily impact every aspect of a person’s overall health.

Researching these topics draws attention to existing problems and contributes valuable insights into ways to improve access to care moving forward.

Examples of systemic racism-related psychology research topics include:

Access to mental health resources based on race

The prevalence of BIPOC mental health therapists in a chosen area

The impact of systemic racism on mental health and self-worth

Racism training for mental health workers

The prevalence of mental health disorders in discriminated groups

LGBTQIA+ mental health concerns

Research about LGBTQIA+ people and their mental health needs is a unique area of study to explore for your next research project. It’s a commonly overlooked and underserved community.

Examples of LGBTQIA+ psychology research topics to consider include:

Mental health supports for queer teens and children

The impact of queer safe spaces on mental health

The prevalence of mental health disorders in the LGBTQIA+ community

The benefits of queer mentorship and found family

Substance misuse in LQBTQIA+ youth and adults

Collect data and identify trends with Dovetail

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Take the headache out of analyzing your data and instantly access the insights you need to complete your next psychology research project by teaming up with Dovetail today.

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Brain Health and Clinical Neuroscience
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Exercising body & brain: the effects of physical exercise on brain health

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The relationship between physical exercise and brain health is a burgeoning field of research in neuroscience, with a pivotal impact on our understanding of cognitive well-being, mental health, and aging. Existing studies evidence the positive influences of regular physical activity on brain health, suggesting its implications on learning, memory, and mood. Despite significant advancements, comprehensive analysis incorporating broader perspectives and deeper explorations remain scarce. The objective of this Research Topic is to create an enriching platform for focused discourse on the interconnection between physical exercise and brain health. The goal is to bring together theoretical and experimental research papers that depict a comprehensive overview of recent developments, examine the mechanistic underpinnings of the exercise-brain interaction, and delve into the future potential of this promising area. We welcome contributions that explore, but are not limited to, the following themes: • Impact of various types of exercises on mental health and cognitive functions. • Role of physical activity in stress, anxiety, and mood disorders management. • The molecular and neurochemical effects of exercise on the brain. • Exercise mitigating neurodegenerative disorders and age-related cognitive decline. • Effects of physical exercise on brain development and neuroplasticity. Manuscript types desired for this topic are Original Research, Review, Systematic Review, Mini Review, Perspective, and Opinion articles. Emphasis is on rigorous and high-quality methodology, analysis, and data presentation. The Research Topic places a high priority on interdisciplinary approaches and the potential practical implications of research findings.

Keywords : yoga, physical exercise, mental health

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Mental health

Affordable, effective and feasible strategies exist to promote, protect and restore mental health.
The need for action on mental health is indisputable and urgent.
Mental health has intrinsic and instrumental value and is integral to our well-being.
Mental health is determined by a complex interplay of individual, social and structural stresses and vulnerabilities.

Concepts in mental health

Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.

Mental health is more than the absence of mental disorders. It exists on a complex continuum, which is experienced differently from one person to the next, with varying degrees of difficulty and distress and potentially very different social and clinical outcomes.

Mental health conditions include mental disorders and psychosocial disabilities as well as other mental states associated with significant distress, impairment in functioning, or risk of self-harm. People with mental health conditions are more likely to experience lower levels of mental well-being, but this is not always or necessarily the case.

Determinants of mental health

Throughout our lives, multiple individual, social and structural determinants may combine to protect or undermine our mental health and shift our position on the mental health continuum.

Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems.

Exposure to unfavourable social, economic, geopolitical and environmental circumstances – including poverty, violence, inequality and environmental deprivation – also increases people’s risk of experiencing mental health conditions.

Risks can manifest themselves at all stages of life, but those that occur during developmentally sensitive periods, especially early childhood, are particularly detrimental. For example, harsh parenting and physical punishment is known to undermine child health and bullying is a leading risk factor for mental health conditions.

Protective factors similarly occur throughout our lives and serve to strengthen resilience. They include our individual social and emotional skills and attributes as well as positive social interactions, quality education, decent work, safe neighbourhoods and community cohesion, among others.

Mental health risks and protective factors can be found in society at different scales. Local threats heighten risk for individuals, families and communities. Global threats heighten risk for whole populations and include economic downturns, disease outbreaks, humanitarian emergencies and forced displacement and the growing climate crisis.

Each single risk and protective factor has only limited predictive strength. Most people do not develop a mental health condition despite exposure to a risk factor and many people with no known risk factor still develop a mental health condition. Nonetheless, the interacting determinants of mental health serve to enhance or undermine mental health.

Mental health promotion and prevention

Promotion and prevention interventions work by identifying the individual, social and structural determinants of mental health, and then intervening to reduce risks, build resilience and establish supportive environments for mental health. Interventions can be designed for individuals, specific groups or whole populations.

Reshaping the determinants of mental health often requires action beyond the health sector and so promotion and prevention programmes should involve the education, labour, justice, transport, environment, housing, and welfare sectors. The health sector can contribute significantly by embedding promotion and prevention efforts within health services; and by advocating, initiating and, where appropriate, facilitating multisectoral collaboration and coordination.

Suicide prevention is a global priority and included in the Sustainable Development Goals. Much progress can be achieved by limiting access to means, responsible media reporting, social and emotional learning for adolescents and early intervention. Banning highly hazardous pesticides is a particularly inexpensive and cost–effective intervention for reducing suicide rates.

Promoting child and adolescent mental health is another priority and can be achieved by policies and laws that promote and protect mental health, supporting caregivers to provide nurturing care, implementing school-based programmes and improving the quality of community and online environments. School-based social and emotional learning programmes are among the most effective promotion strategies for countries at all income levels.

Promoting and protecting mental health at work is a growing area of interest and can be supported through legislation and regulation, organizational strategies, manager training and interventions for workers.

Mental health care and treatment

In the context of national efforts to strengthen mental health, it is vital to not only protect and promote the mental well-being of all, but also to address the needs of people with mental health conditions.

This should be done through community-based mental health care, which is more accessible and acceptable than institutional care, helps prevent human rights violations and delivers better recovery outcomes for people with mental health conditions. Community-based mental health care should be provided through a network of interrelated services that comprise:

mental health services that are integrated in general health care, typically in general hospitals and through task-sharing with non-specialist care providers in primary health care;
community mental health services that may involve community mental health centers and teams, psychosocial rehabilitation, peer support services and supported living services; and
services that deliver mental health care in social services and non-health settings, such as child protection, school health services, and prisons.

The vast care gap for common mental health conditions such as depression and anxiety means countries must also find innovative ways to diversify and scale up care for these conditions, for example through non-specialist psychological counselling or digital self-help.

WHO response

All WHO Member States are committed to implementing the “Comprehensive mental health action plan 2013–2030" , which aims to improve mental health by strengthening effective leadership and governance, providing comprehensive, integrated and responsive community-based care, implementing promotion and prevention strategies, and strengthening information systems, evidence and research. In 2020, WHO’s “Mental health atlas 2020” analysis of country performance against the action plan showed insufficient advances against the targets of the agreed action plan.

WHO’s “World mental health report: transforming mental health for all” calls on all countries to accelerate implementation of the action plan. It argues that all countries can achieve meaningful progress towards better mental health for their populations by focusing on three “paths to transformation”:

deepen the value given to mental health by individuals, communities and governments; and matching that value with commitment, engagement and investment by all stakeholders, across all sectors;
reshape the physical, social and economic characteristics of environments – in homes, schools, workplaces and the wider community – to better protect mental health and prevent mental health conditions; and
strengthen mental health care so that the full spectrum of mental health needs is met through a community-based network of accessible, affordable and quality services and supports.

WHO gives particular emphasis to protecting and promoting human rights, empowering people with lived experience and ensuring a multisectoral and multistakeholder approach.

WHO continues to work nationally and internationally – including in humanitarian settings – to provide governments and partners with the strategic leadership, evidence, tools and technical support to strengthen a collective response to mental health and enable a transformation towards better mental health for all.

Urgent need to address mental health effects of climate change, says report

Mental Health
Applied Psychology
Climate Change

Offers recommendations for building resilience and taking action by individuals, communities

WASHINGTON — With a large majority of Americans concerned about climate change and an increasing number expressing alarm and distress, it is past time to address this burgeoning public health crisis at the individual, community and societal levels, according to a report from the American Psychological Association and ecoAmerica.

“Our climate is changing at an unprecedented and alarming rate with profound impacts on human life,” said the report, entitled, “Mental Health and Our Changing Climate: Impacts, Inequities, and Responses” (PDF, 4.27MB) . “Climate change-fueled acute disaster events are causing deleterious impacts on human health. Longer term climate change leads to temperature-related illness and mortality, spread of vector-borne disease, respiratory issues and allergic response, compromised fetal and child development, and threats to water and food supply and safety—among other impacts.”

The effects of climate change on humans, however, go beyond physical health.

“Climate change is one of the most crucial issues facing our nation and the world today, and it is already taking a huge toll on the mental health of people around the globe,” said APA CEO Arthur C. Evans Jr, PhD. “Psychology, as the science of behavior, will be pivotal to making the wholesale changes that are imperative to slow—and, we hope, stop—its advance.”

The report, an update to a 2017 report (PDF, 3.37MB) also issued by APA and ecoAmerica, is intended to inform and empower health and medical professionals, community and elected leaders and the public to pursue solutions to climate change that will support mental health and well-being. This is particularly important as world leaders proceed with climate negotiations at COP26, the United Nations Climate Change Conference.

Over three-quarters of Americans report that they are concerned about climate change, and about 25% say they are “alarmed,” nearly double the percentage who reported feeling alarm in 2017, according to the latest report.

The most immediate effects on mental health can be seen in the aftermath of increasing disaster events fueled by climate change, such as hurricanes, wildfires and floods. These effects can include trauma and shock, post-traumatic stress disorder, feelings of abandonment, and anxiety and depression that can lead to suicidal ideation and risky behavior. At the community level, these disasters can strain social relationships, reduce social cohesion and increase interpersonal violence and child abuse.

In the long term, climate change has equally profound mental health impacts. Rising temperatures can fuel mood and anxiety disorders, schizophrenia and vascular dementia, and can increase emergency room usage and suicide rates, according to the report. Changes in the local environment can cause grief, disorientation and poor work performance, as well as harm to interpersonal relationships and self-esteem. People displaced by climate change events, such wildfires or droughts, can experience loss of personal identity, among other more severe impacts. Ultimately, mass migrations spurred by long-term climate change can lead to intergroup hostilities, political conflicts, terrorism and even war.

Concern about climate change coupled with worry about the future can lead to fear, anger, feelings of powerlessness, exhaustion, stress and sadness, often referred to as “eco-anxiety” or “climate anxiety.” Studies indicate this anxiety is more prevalent among young people; it has been linked to increases in substance use and suicidal ideation.

The destructive effects of climate change are likely to fall disproportionately on communities that are already disadvantaged by historic and current social, economic and political oppression. For example, discriminatory housing policies, such as redlining and racially restrictive covenants, mean that people of color are significantly more likely to live in areas prone to risk. Indigenous people, children, older adults, women, people with disabilities or existing mental health conditions, and outdoor workers are additional groups that may be more prone to mental health difficulties from a changing climate. These impacts can include PTSD, behavioral problems, cognitive deficits, reduced memory, poorer academic performance and lower IQ, higher exposure to violence and crime, and higher rates of incarceration.

“Like climate change itself, these mental health implications and the related inequities cannot be ignored,” said Meighen Speiser, executive director of ecoAmerica. “We need to surface and address them immediately, and we can. America and Americans have the will and wherewithal to protect our climate and our future.”

The report offers a series of constructive solutions that can be applied by individuals and whole communities to help mitigate the mental health impacts of climate change. Key among them is encouraging resilience, or the ability of a person or a community to function, survive and even thrive in the face of adversity. Strategies include fostering a sense of optimism, bolstering social connections, and incorporating personal items that can preserve or strengthen mental health into emergency preparedness plans (e.g., religious items, toys for small children, favorite foods), among many additional recommendations.

Communities should also involve mental health professionals in expanding or strengthening plans for mental health care and support in response to local and regional disasters, according to the report. Mental health professionals can help with plans to increase social cohesion in the community, such as social programs and infrastructure planning to increase communal parks and other green spaces. The report likewise recommends that members from the community, including from a diversity of backgrounds, cultures, and abilities, be included in resiliency planning to account for varying needs.

And while efforts to boost resilience are necessary to protect physical and mental health in the face of climate change, the report also emphasizes the need to address the root of the problem by enacting policies to mitigate climate change at all levels of governance. National and local policymakers, businesses and nonprofits, mental health and other professionals and individuals can all help to bring forth these policies while also advancing climate resilience and action. The report outlines these opportunities and provides related tools and resources.

The report was written by Susan Clayton, PhD, Whitmore-Williams professor of psychology, College of Wooster; Christie Manning, PhD, director of sustainability and assistant professor of environmental studies, Macalester College; Meighen Speiser, executive director, ecoAmerica; and Nicole Hill, ecoAmerica.

Jennifer Giordano for ecoAmerica

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Kim I. Mills

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The Declining Mental Health of the Young in the UK

We show the incidence of mental ill-health has been rising especially among the young in the years and especially so in Scotland. The incidence of mental ill-health among young men in particular, started rising in 2008 with the onset of the Great Recession and for young women around 2012. The age profile of mental ill-health shifts to the left, over time, such that the peak of depression shifts from mid-life, when people are in their late 40s and early 50s, around the time of the Great Recession, to one’s early to mid-20s in 2023. These trends are much more pronounced if one drops the large number of proxy respondents in the UK Labour Force Surveys, indicating fellow family members understate the poor mental health of respondents, especially if those respondents are young. We report consistent evidence from the Scottish Health Surveys and UK samples from Eurobarometer surveys. Our findings are consistent with those for the United States and suggest that, although smartphone technologies may be closely correlated with a decline in young people’s mental health, increases in mental ill-health in the UK from the late 1990s suggest other factors must also be at play.

David G. Blanchflower and Alex Bryson would like to thank the Human Development Report Office, United Nations Development Programme for support. The copyright for all research commissioned by the Human Development Report Office will be held by UNDP. We thank the ESRC Data Archive for access to the data. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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207 Mental Health Research Topics For Top Students

College and university students pursuing psychology studies must write research papers on mental health in their studies. It is not always an exciting moment for the students since getting quality mental health topics is tedious. However, this article presents expert ideas and writing tips for students in this field. Enjoy!

What Is Mental Health?

It is an integral component of health that deals with the feeling of well-being when one realizes his or her abilities, cope with the pressures of life, and productively work. Mental health also incorporates how humans interact with each other, emote, or think. It is a vital concern of any human life that cannot be neglected.

How To Write Mental Health Research Topics

One should approach the subject of mental health with utmost preciseness. If handled carelessly, cases such as depression, suicide or low self-esteem may occur. That is why students are advised to carefully choose mental health research paper topics for their paper with the mind reader.

To get mental health topics for research paper, you can use the following sources:

The WHO website
Websites of renowned psychology clinics
News reports and headlines.

However, we have a list of writing ideas that you can use for your inspiration. Check them out!

Mental Illness Research Questions

The role of antidepressant medicines in treating mental illnesses
How taxation of alcoholic beverages and their restriction can help in curbing mental illnesses
The impact of mental illnesses on the economic development of a country
Efficient and cost-effective ways of treating mental illnesses
Early childhood interventions to prevent future mental illnesses
Why children from single-parent families are prone to mental illnesses
Do opportunities for early learning have a role in curbing mental diseases?
Life skills programmes that everyone should embrace to fight mental illnesses
The role of nutrition and diet in causing mental illness
How socio-economic empowerment of women can help promote mental health
Practical social support for elderly populations to prevent mental illnesses
How to help vulnerable groups against mental illnesses
Evaluate the effectiveness of mental health promotional activities in schools

Hot Mental Health Topics For Research

Do stress prevention programmes on TV work?
The role of anti-discrimination laws and campaigns in promoting mental health
Discuss specific psychological and personality factors leading to mental disorders
How can biological factors lead to mental problems?
How stressful work conditions can stir up mental health disorders
Is physical ill-health a pivotal contributor to mental disorders today?
Why sexual violence has led many to depression and suicide
The role of life experiences in mental illnesses: A case of trauma
How family history can lead to mental health problems
Can people with mental health problems recover entirely?
Why sleeping too much or minor can be an indicator of mental disorders.
Why do people with mental health problems pull away from others?
Discuss confusion as a sign of mental disorders

Research Topics For Mental Health Counseling

Counselling strategies that help victims cope with the stresses of life
Is getting professional counselling help becoming too expensive?
Mental health counselling for bipolar disorders
How psychological counselling affects victims of mental health disorders
What issues are students free to share with their guiding and counselling masters?
Why are relationship issues the most prevalent among teenagers?
Does counselling help in the case of obsessive-compulsive disorders?
Is counselling a cure to mental health problems?
Why talking therapies are the most effective in dealing with mental disorders
How does talking about your experiences help in dealing with the problem?
Why most victims approach their counsellors feeling apprehensive and nervous
How to make a patient feel comfortable during a counselling session
Why counsellors should not push patients to talk about stuff they aren’t ready to share

Mental Health Law Research Topics

Discuss the effectiveness of the Americans with Disabilities Act
Does the Capacity to Consent to Treatment law push patients to the wall?
Evaluate the effectiveness of mental health courts
Does forcible medication lead to severe mental health problems?
Discuss the institutionalization of mental health facilities
Analyze the Consent to Clinical Research using mentally ill patients
What rights do mentally sick patients have? Are they effective?
Critically analyze proxy decision making for mental disorders
Why some Psychiatric Advance directives are punitive
Discuss the therapeutic jurisprudence of mental disorders
How effective is legal guardianship in the case of mental disorders?
Discuss psychology laws & licensing boards in the United States
Evaluate state insanity defence laws

Controversial Research Paper Topics About Mental Health

Do mentally ill patients have a right to choose whether to go to psychiatric centres or not?
Should families take the elderly to mental health institutions?
Does the doctor have the right to end the life of a terminally ill mental patient?
The use of euthanasia among extreme cases of mental health
Are mental disorders a result of curses and witchcraft?
Do violent video games make children aggressive and uncontrollable?
Should mental institutions be located outside the cities?
How often should families visit their relatives who are mentally ill?
Why the government should fully support the mentally ill
Should mental health clinics use pictures of patients without their consent?
Should families pay for the care of mentally ill relatives?
Do mentally ill patients have the right to marry or get married?
Who determines when to send a patient to a mental health facility?

Mental Health Topics For Discussion

The role of drama and music in treating mental health problems
Explore new ways of coping with mental health problems in the 21 st century
How social media is contributing to various mental health problems
Does Yoga and meditation help to treat mental health complications?
Is the mental health curriculum for psychology students inclusive enough?
Why solving problems as a family can help alleviate mental health disorders
Why teachers can either maintain or disrupt the mental state of their students
Should patients with mental health issues learn to live with their problems?
Why socializing is difficult for patients with mental disorders
Are our online psychology clinics effective in handling mental health issues?
Discuss why people aged 18-25 are more prone to mental health problems
Analyze the growing trend of social stigma in the United States
Are all people with mental health disorders violent and dangerous?

Mental Health Of New Mothers Research Topics

The role of mental disorders in mother-infant bonding
How mental health issues could lead to delays in the emotional development of the infant
The impact of COVID-19 physical distancing measures on postpartum women
Why anxiety and depression are associated with preterm delivery
The role of husbands in attending to wives’ postpartum care needs
What is the effectiveness of screening for postpartum depression?
The role of resilience in dealing with mental issues after delivery
Why marginalized women are more prone to postpartum depression
Why failure to bond leads to mental disorders among new mothers
Discuss how low and middle-income countries contribute to perinatal depression
How to prevent the recurrence of postpartum mental disorders in future
The role of anti-depression drugs in dealing with depression among new mothers
A case study of the various healthcare interventions for perinatal anxiety and mood disorders

What Are The Hot Topics For Mental Health Research Today

Discuss why mental health problems may be a result of a character flaw
The impact of damaging stereotypes in mental health
Why are many people reluctant to speak about their mental health issues?
Why the society tends to judge people with mental issues
Does alcohol and wasting health help one deal with a mental problem?
Discuss the role of bullying in causing mental health disorders among students
Why open forums in school and communities can help in curbing mental disorders
How to build healthy relationships that can help in solving mental health issues
Discuss frustration and lack of understanding in relationships
The role of a stable and supportive family in preventing mental disorders
How parents can start mental health conversations with their children
Analyze the responsibilities of the National Institute for Health and Care Excellence (NICE)
The role of a positive mind in dealing with psychological problems

Good Research Topics On Refugees Mental Health

Why do refugees find themselves under high levels of stress?
Discuss the modalities of looking after the mental health of refugees
Evaluate the importance of a cultural framework in helping refugees with mental illnesses
How refugee camp administrators can help identify mental health disorders among refugees
Discuss the implications of dangerous traditional practices
The role of the UNHCR in assisting refugees with mental problems
Post-traumatic Stress Disorder among refugees
Dealing with hopelessness among refugees
The prevalence of traumatic experiences in refugee camps
Does cognitive-behavioural therapy work for refugees?
Discuss the role of policy planning in dealing with refugee-mental health problems
Are psychiatry and psychosomatic medicine effective in refugee camps?
Practical groups and in‐group therapeutic settings for refugee camps

Adolescent Mental Health Research Topics

Discuss why suicide is among the leading causes of death among adolescents
The role of acting-out behaviour or substance use in mental issues among adolescents
Mental effects of unsafe sexual behaviour among adolescents
Psychopharmacologic agents and menstrual dysfunction in adolescents
The role of confidentiality in preventive care visits
Mental health disorders and impairment among adolescents
Why adolescents not in school risk developing mental disorders
Does a clinical model work for adolescents with mental illnesses?
The role of self-worth and esteem in dealing with adolescent mental disorders
How to develop positive relationships with peers
Technology and mental ill-health among adolescents
How to deal with stigma among adolescents
Curriculum that supports young people to stay engaged and motivated

Research Topics For Mental Health And Government

Evaluate mental health leadership and governance in the United States
Advocacy and partnerships in dealing with mental health
Discuss mental health and socio-cultural perspective
Management and coordination of mental health policy frameworks
Roles and responsibilities of governments in dealing with mental health
Monitoring and evaluation of mental health policies
What is the essence of a mental health commission?
Benefits of mental well-being to the prosperity of a country
Necessary reforms to the mental health systems
Legal frameworks for dealing with substance use disorders
How mental health can impede the development of a country
The role of the government in dealing with decaying mental health institutions
Inadequate legislation in dealing with mental health problems

Abnormal Psychology Topics

What does it mean to display strange behaviour?
Role of mental health professionals in dealing with abnormal psychology
Discuss the concept of dysfunction in mental illness
How does deviance relate to mental illness?
Role of culture and social norms
The cost of treating abnormal psychology in the US
Using aversive treatment in abnormal psychology
Importance of psychological debriefing
Is addiction a mental disease?
Use of memory-dampening drugs
Coercive interrogations and psychology

Behavioural Health Issues In Mental Health

Detachment from reality
Inability to withstand daily problems
Conduct disorder among children
Role of therapy in behavioural disorders
Eating and drinking habits and mental health
Addictive behaviour patterns for teenagers in high school
Discuss mental implications of gambling and sex addiction
Impact of maladaptive behaviours on the society
Extreme mood changes
Confused thinking
Role of friends in behavioural complications
Spiritual leaders in helping deal with behavioural issues
Suicidal thoughts

Latest Psychology Research Topics

Discrimination and prejudice in a society
Impact of negative social cognition
Role of personal perceptions
How attitudes affect mental well-being
Effects of cults on cognitive behaviour
Marketing and psychology
How romance can distort normal cognitive functioning
Why people with pro-social behaviour may be less affected
Leadership and mental health
Discuss how to deal with anti-social personality disorders
Coping with phobias in school
The role of group therapy
Impact of dreams on one’s psychological behaviour

Professional Psychiatry Research Topics

The part of false memories
Media and stress disorders
Impact of gender roles
Role of parenting styles
Age and psychology
The biography of Harry Harlow
Career paths in psychology
Dissociative disorders
Dealing with paranoia
Delusions and their remedy
A distorted perception of reality
Rights of mental caregivers
Dealing with a loss
Handling a break-up

Consider using our expert research paper writing services for your mental health paper today. Satisfaction is guaranteed!

Queensland research finds young people 'burnt out and in need of help'

By Claudia Williams

Topic: Mental Health

New research shows almost nine out of 10 young Queenslanders have seen a negative change in their health and wellbeing in the past year. ( ABC News: Stephanie Anderson )

It is impossible to ignore the negative impacts of smartphones and social media on the mental health and wellbeing of young people, Queensland’s chief health officer says.

The comments come as new research shows almost nine out of 10 young Queenslanders have seen a negative change in their health and wellbeing in the past year.

The survey of 1,424 young people conducted by the state's prevention agency, Health and Wellbeing Queensland, found more than half of respondents reported feeling stressed or anxious.

Chief Health Officer Dr John Gerrard said while less people were dying from heart disease and strokes, the mental health of young people was "getting worse very rapidly".

"It appears to be a real phenomenon and not the result of better reporting," he said. "I believe this is a very significant concern.

"One of the most dramatic indicators is the instances of hospitalisation due to self-harm in young children aged 10 to 14 has almost [tripled] over the last decade."

John Gerrard says the mental ill-health of young people is a very real phenomenon being seen across the world. ( ABC News: Claudia Williams )

Dr Gerrard said the mental health decline in young people had been seen on a global scale since 2010, in the years following the release of the first smartphone.

He said there were no simple solutions, adding the community at-large has not spoken about "this enough".

"It is not clear at this stage what to do about this specific problem, but I have been meeting with Commonwealth agencies to discuss these issues."

'Burnt out and in need of help'

The research, commissioned by the Queensland government, found more than half of those aged 15 to 24 reported feeling tired for no reason or that everything was an effort in the four weeks prior to being surveyed.

Health and Wellbeing Queensland deputy chief executive Gemma Hodgetts said these were the warning signs of a generation "burnt out and in need of help".

"Young Queenslanders who should be our most vibrant, energetic and hopeful generation are struggling," she said.

Gemma Hodgetts says the research shows young people are struggling. ( ABC News: Claudia Williams )

"Almost one in two Queenslanders will experience mental ill-health in their lifetime ... about 75 per cent of mental disorders emerge before the age of 24 years, so we need to act now."

The research found those experiencing mental health challenges were more likely to rate their health significantly lower.

The report said the findings suggest increased stress, along with poorer diets, may be negatively impacting the mental health of young Queenslanders, particularly young adults.

According to the research, women, girls and mothers are also more likely to experience negative impacts, which may in part be due to their lower activity levels.

Ms Hodgetts said the report laid the foundation for an Australian-first strategy which would take a deliberate wellbeing approach to mental health.

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Strategic Research Plan

Faculty of medicine and health sciences.

Our Faculty’s approach is to build on disciplinary excellence in fundamental, clinical, and populational research and promote interdisciplinary work that connects these strengths. Both are essential for delivering novel solutions to improve health. We identify 4 key themes where strong existing research capacity aligns with pressing health challenges:

Infection & Inflammation as Persistent Threats

Infectious diseases remain top health threats locally and globally, as painfully illustrated by the recent COVID-19 pandemic. FMHS will continue to study infections and their treatment, focusing on existing and new pathogens and anti-microbial resistance. Major related topics include antibiotic overuse, and the mechanisms of inflammation triggered by infections, tissue injury, or related to autoimmunity in chronic inflammatory disorders, such as inflammatory bowel syndrome, multiple sclerosis, arthritis, and asthma. The influences of the microbiome and of external factors including pollution, climate change, and migration in modulating infection and immunity are increasingly emerging as important avenues within this theme.

Interdisciplinarity and translation will be promoted through new and established research hubs: McGill’s International TB Center, and the research centres on Antimicrobial Resistance, Viral Diseases, Structural Biology and the Microbiome. The McGill Interdisciplinary Initiative in Infection & Immunity (MI4) will play a key coordinating role to promote collaboration across this theme.

Cancer as a Complex Global Challenge

Cancer remains a leading cause of premature death around the globe, with increasing prevalence in developing countries. Discovery research is increasingly tightly linked to the clinic, yielding breakthroughs to improve prevention and early detection, and delineating mechanistic pathways that offer novel therapeutic targets. Clinical research is emphasizing interactions between cancer and chronic co-morbidities such as obesity or diabetes, and focusing on patient-centered outcomes addressing quality of life. The FMHS has established strengths in researching the complex interactions between genetics, environmental factors and behavioral risk factors in cancer. These efforts require more consideration of biological variations and social inequities affecting cancer risk and treatment outcomes within diverse populations, as well as the heterogeneity of cancer across individuals, including genetic and epigenetic factors and the dynamics of tumor microenvironments. Understanding individual and populational variability will spur both high impact prevention strategies and new precision diagnostics and therapeutics.

McGill researchers are encouraged to establish multidisciplinary teams to study the complex interactions between, for example, endocrine, metabolic, and immune systems, in the pathophysiology of cancer. The development of biobanks and continued focus on clinical trials and outcomes research will be encouraged. The Goodman Cancer Institute, along with the McGill Centre for Translational Research on Cancer, the Gerald Bronfman Department of Oncology and related units and networks based at the Research Institutes at FMHS-affiliated teaching hospitals will continue to play a major catalytic role in these areas.

Understanding the Brain to Heal the Body and the Mind

Chronic conditions of the nervous system, whether in the domain of neurology or psychiatry, affect individuals across all age groups. With an aging population, more people are affected by neurodegenerative diseases. The COVID-19 pandemic has had enduring repercussions on mental health, especially in youth. Chronic pain continues to be a major and poorly managed burden. The opioid crisis and other forms of addiction and behavioral disorders have devastating individual and societal consequences. Individuals with neurodevelopmental disorders are in dire need of improved early interventions to help them thrive.

FMHS researchers have considerable strengths in these areas, advancing neurobiological knowledge at the molecular, cellular and systems levels, in relation to complex symptoms and behavior. More work is required to identify robust disease markers and transfer these to clinical use, along with better rehabilitation strategies and care delivery models that address the needs of patients and their families. Drug development for these complex conditions would benefit from new models of industry partnership.

FMHS researchers are encouraged to integrate neuroscience knowledge across various scales—from genes to cells, neural circuits, brain networks, and ultimately, behavior. Furthermore, emerging treatments for neuropsychiatric disorders, such as different forms of neurostimulation, represent promising research areas that warrant further exploration.

As in other disease areas, this endeavor calls for the adoption of new methods and technologies to continue at the cutting edge of individual disciplines, as well as concerted efforts to work across disciplines. Established hubs of neuroscience research at McGill, including the Montreal Neurological Institute, the Douglas Mental Health University Institute, and cross-cutting units such as the Brain Repair and Integrative Neuroscience Program at the RI-MUHC, the Azrieli Centre for Autism Research, the Alan Edwards Centre for Research on Pain, and the FRQ-supported Centre for Research on Brain, Language & Music, among others, provide a rich ecosystem for cross-cutting research.

Unlocking RNA For Enhanced Diagnoses and Novel Therapies

Recently discovered classes of non-coding RNAs have essential roles in gene expression and are often impaired in diseases like cancer, genetic and infectious diseases. Mutations in their expression can be used as biomarkers of disease and disease trajectory or prognosis. The remarkable potential for harnessing the breadth and flexibility of RNA function to treat and cure a variety of human diseases, from viral and parasitic infectious infections to cancer was highlighted by the COVID-19 pandemic, which demonstrated that RNA-based therapeutic compounds can be rapidly identified and synthesized, and readily optimized or changed with input from genomics platforms. These developments promise rapid delivery of novel treatment interventions to silence or edit genes, replace defective proteins, and improve cell-based therapeutics.

The combination of large and diversified data repositories and biobanks with advanced computing, biochemical and biophysical modeling and machine learning are revolutionizing high-dimensional genotyping and phenotyping for patient stratification. FMHS researchers are encouraged to explore the full potential of these approaches for both fundamental research on biological mechanisms at all scales, and next-generation clinical trials. Priorities include the discovery of disease biomarkers and therapeutic targets to assist in individualized treatment decisions and the monitoring of their outcomes.

FMHS strategy in these areas The FMHS strategy aims to leverage both established and developing areas of excellence. It underscores the necessity of fostering greater interaction among core disciplines, thereby maximizing the translational impact of biomedical and health research. Consequently, the FMHS cultivates innovative synergies among fundamental biomedical and behavioral researchers, experts in clinical research, data and computational scientists, industry specialists, and health and social policy experts. Large-scale -omics approaches harnessing machine learning and data-driven methods and technologies are also a strategic priority. This includes a focus on the creation and curation of patient and data repositories for research that better represent the diversity of McGill’s RUISSS. Our commitment to interdisciplinary collaboration is evident in several key initiatives. While the list below is not exhaustive, it showcases the diversity and potential of current collaborative efforts aimed at inspiring further interdisciplinary projects across our campus and affiliated institutions. D2R Program : McGill's recent CFREF award for the D2R program charts a path for an interdisciplinary approach in RNA-based therapeutics development. This major program, initiated in 2023 for the next 7 years, integrates novel computational techniques, analytics, and a robust network of clinical, pharmaceutical, and biotechnological partners. By combining bio- and chemical-engineering with genomics and RNA research expertise, D2R is positioned to establishing a pipeline from discovery to commercialization and clinical application. Integrated Disease Research : The D2R program supports research spanning infectious diseases, cancer, and neurogenetic disorders. The establishment of the Dahdaleh Institute for Genomic Medicine and the McGill Centre for RNA Sciences epitomizes our ambition to lead in vaccine development and precision healthcare across a broad disease spectrum. Precision and Regenerative Medicine: The McGill Regenerative Medicine Network and The Neuro’s Early Drug Discovery Unit are at the forefront of stem cell research, particularly induced pluripotent stem cell technology, for discovering and testing novel therapeutic avenues and drugs. These units are poised to multiply the impact of the new CERC in Regenerative Lung Medicine to advance regenerative medicine through cell replacement therapies for damaged organs and tissues. Leveraging Structural Biology: The FRQS-funded Centre for Structural Biology is a FMHS hub for studies of protein structure and function at the atomic level, that operates in synergy with the considerable expertise and infrastructure hosted at the Facility for Electron Microscopy Research. Embracing advanced bioimaging, alongside novel artificial intelligence and data science methodologies, will enable FMHS researchers to unravel the complex biological puzzles associated with protein structure, assembly and dynamics in relation to their functions in health and disease. Cancer Research and Personalized Medicine : With the Goodman Cancer Institute and hospital-based Research Institutes, we are pushing the boundaries of precision cancer treatment. Our focus includes exploiting cancer vulnerabilities, immuno-profiling, and leveraging patient-derived models, among other innovative strategies. FMHS’ prowess in structural biology, imaging, digital and molecular pathology, computational models, and population health research complements these efforts. Strategic Cohort Development: The COVID-19 pandemic underscored the complex interplay between infections and various body systems, necessitating a multidisciplinary response. Notably, primary clinical symptoms like respiratory distress often coincided with severe neurological events and both acute and chronic mental health challenges. This complexity, characteristic of syndromes induced by new pathogens, demands comprehensive recognition, documentation, and study. For research, creating high-quality cohorts of patients with broad and detailed phenotyping is crucial for uncovering the biological and other factors influencing disease progression and treatment responses. The Quebec COVID-19 Biobank, led by McGill’s CER in Genomic Medicine, exemplifies the ambitious and systematic research methodology we advocate. This approach—centering on large, meticulously curated patient cohorts and leveraging cutting-edge computational techniques from structural biology to epidemiology—facilitates both personalized and community-level strategies against infectious diseases. Extending this model to other major diseases is highly recommended. Expanding Interdisciplinary Frontiers: The establishment of the new CERC in Metabolism and the Brain significantly enhances our comprehension of the gut-brain axis. Together with substantial investments in the international Modern Diet and Physiology Research Centre (MDPRC), focused on neurometabolic science, McGill is positioned to become a frontrunner in the interdisciplinary exploration of diet's impact on health. Given the strong association between diet, metabolism, and diseases such as diabetes and cardiovascular disease—areas where McGill already excels—this research direction not only promotes cross-disciplinary studies but also addresses critical issues relevant to our Faculty. These include the health of underserved and vulnerable groups, who are disproportionately affected by these comorbidities. Other interdisciplinary efforts towards advancing mechanical and stem cell engineering for tissue replacement and the creation of innovative materials and devices are highly supported. FMHS encourages researchers to pursue interdisciplinary bioengineering initiatives to facilitate developments in these areas, ensuring their swift translation into clinical settings.

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NIH Women's Health Roundtable: Maternal Mental Health Research

Elevating Women's Voices to Improve Maternal Mental Health

Date and Time

Elevating Women's Voices to Improve Maternal Mental Health is the third event in the NIH Women’s Health Roundtable Series , which focuses on important women’s health topics, such as maternal mental health, as part of the White House Initiative on Women’s Health Research . This series was developed as a recommended action in response to the Presidential Memorandum to bring attention to priority topics within the Department of Health and Human Services (HHS) and to disseminate information on federally supported research areas.

The roundtable is also featured in the National Institute of Mental Health’s (NIMH) Office of Disparities Research and Workforce Diversity Webinar Series , which focuses on mental health equity research topics. The event is co-hosted by the NIH Office of Research on Women’s Health (ORWH) and NIMH.

The goals of this roundtable are to:

Spotlight high-priority research areas related to women's mental health during pregnancy and the postpartum period, up to one year following childbirth.
Share information on how NIMH-supported research advances the development of and access to screening, diagnostics, and preventive and treatment interventions to improve women’s mental health during the perinatal period.
Explain how maternal mental health research can reduce the burden of mental illnesses that contribute to maternal morbidity and mortality.
Identify and explore gaps in areas critical to women’s research outlined within the Executive Order on Advancing Women's Health Research and Innovation (EO 14120) and the 2024-2028 NIH-Wide Strategic Plan for Research on the Health of Women .

Registration

This webinar is free, but registration is required .

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September National Health Observances: Healthy Aging, Sickle Cell Disease, and More

Each month, we feature select National Health Observances (NHOs) that align with our priorities for improving health across the nation. In September, we’re raising awareness about healthy aging, sickle cell disease, substance use recovery, and HIV/AIDS.

Below, you’ll find resources to help you spread the word about these NHOs with your audiences.

Healthy Aging Month Each September, we celebrate Healthy Aging Month to promote ways people can stay healthy as they age. Explore our healthy aging resources , bookmark the Healthy People 2030 and Older Adults page , share our Move Your Way® materials for older adults , and check out the Physical Activity Guidelines for Americans Midcourse Report . You can also share resources related to healthy aging from the National Institute on Aging — and register for the 2024 National Healthy Aging Symposium to hear from experts on innovations to improve the health and well-being of older adults.
National Recovery Month The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors National Recovery Month to raise awareness about mental health and addiction recovery. Share our MyHealthfinder resources on substance use and misuse — and be sure to check out Healthy People 2030’s evidence-based resources related to drug and alcohol use .
National Sickle Cell Awareness Month National Sickle Cell Awareness Month is a time to raise awareness and support people living with sickle cell disease. Help your community learn about sickle cell disease by sharing these resources from the National Heart, Lung, and Blood Institute (NHLBI) . You can also encourage new and expecting parents to learn about screening their newborn baby for sickle cell . And be sure to view our Healthy People 2030 objectives on improving health for people who have blood disorders .
National HIV/AIDS and Aging Awareness Day (September 18) On September 18, we celebrate HIV/AIDS and Aging Awareness Day to encourage older adults to get tested for HIV. Share CDC’s Let’s Stop HIV Together campaign to help promote HIV testing, prevention, and treatment. MyHealthfinder also has information for consumers about getting tested for HIV and actionable questions for the doctor about HIV testing . Finally, share these evidence-based resources on sexually transmitted infections from Healthy People 2030.
National Gay Men’s HIV/AIDS Awareness Day (September 27) National Gay Men’s HIV/AIDS Awareness Day on September 27 highlights the impact of HIV on gay and bisexual men and promotes strategies to encourage testing. Get involved by sharing CDC’s social media toolkit and HIV information to encourage men to get tested — and share our MyHealthfinder resources to help people get tested for HIV and talk with their doctor about testing .

We hope you’ll join us in promoting these important NHOs with your networks to help improve health across the nation!

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100+ Mental Health Research Topic Ideas (+ Free Webinar)
In this post, we'll help kickstart your research topic ideation process by providing a hearty list of mental health-related research topics and ideas. PS - This is just the start… We know it's exciting to run through a list of research topics, but please keep in mind that this list is just a starting point.
150+ Trending Mental Health Research Topics For Students
Here are 15 research topics for studying mental health in this demographic: The impact of academic stress on college students' mental health. Exploring the relationship between sleep patterns and mental well-being among college students. Analyzing the effectiveness of campus mental health services.
300+ Mental Health Research Topics
300+ Mental Health Research Topics. March 26, 2024. by Muhammad Hassan. Mental health is a complex and multi-faceted topic that affects millions of people worldwide. Research into mental health has become increasingly important in recent years, as the global burden of mental illness continues to rise.
55 Research Questions About Mental Health
Mental health and related conditions are a hot-button healthcare topic in 2024. With an estimated one in five Americans living with a mental health condition, ongoing research into the causes, treatment options, and possible triggers has never been more necessary.. Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals ...
Mental Health Research Topics
Top 10 Mental Health Research Paper Topics. 1. The Effects of Social Media Platforms on the Mental Well-Being of Children. The effects of social media platforms on the mental well-being of children is a research topic that is especially significant and relevant today. This is due to the increasing usage of online social networks by children and ...
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This Mental Health Awareness Week, we highlight the remarkable work of scientists driving open research that helps everyone achieve better mental health. Here are five Research Topics that study themes including how we adapt to a changing world, the impact of loneliness on our wellbeing, and the connection between our diet and mental health.
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Prevalence and patterns of methamphetamine use and mental health disparity in the United States. Investigating the influence of using methamphetamine on the rate of admissions for mental health ...
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Type at least 3 characters. Frontiers' most popular mental health Research Topics. On World Mental Health Day 2023, the World Health Organization (WHO) declared mental health a fundamental human right that should be accessible to everyone, regardless of location or background. In support of WHO's mission, we have compiled a list of leading ...
Social Media Use and Its Connection to Mental Health: A Systematic
Impact on mental health. Mental health is defined as a state of well-being in which people understand their abilities, solve everyday life problems, work well, and make a significant contribution to the lives of their communities [].There is debated presently going on regarding the benefits and negative impacts of social media on mental health [9,10].
Mental health care for older adults: recent advances and new directions
Access to mental health services by older adults with major depression is driven by a shortage and skewed geographical distribution of providers. User‐facing apps coupled with assistance from coaches, and other telepsychiatry tools, can help address the treatment gap, but barriers related to culture, policy and funding issues remain195, 238 ...
Research landscape analysis on dual diagnosis of substance use and
Based on the list of top active journals in the field of dual diagnosis of substance use and mental health disorders, it is evident that there are several reputable and specialized journals that focus on this important area of research (Table 3).These journals cover a wide range of topics related to dual diagnosis, including comorbidity, treatment approaches, intervention strategies, and ...
Mental Health Research Paper Topics
100 Mental Health Research Paper Topics. Embarking on the exploration of mental health research paper topics presents an incredible opportunity to delve into diverse areas of study and reveal intriguing insights. From understanding the human psyche to unraveling the intricate workings of various mental disorders, this domain offers a wide array ...
Mental health
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All Mental Health Articles
Published September 1, 2024. People with post-traumatic stress disorder (PTSD) are especially vulnerable to cardiovascular problems, including a 40% increased risk of heart attack. The amygdala, a brain structure involved in processing anxiety, fear, and stress, is overactive in people with PTSD. But these people also have decreased activity in ...
Health Topics
Health Topics. The National Institute of Mental Health (NIMH), the lead federal agency for research on mental disorders, offers basic information on mental disorders, a range of related topics, and the latest mental health research. It is not the intention of NIMH to provide specific medical advice, but rather to provide users with information ...
COVID-19 and Mental Health
NIMH is supporting research to understand and address the impacts of the pandemic on mental health. This includes research to understand how COVID-19 affects people with existing mental illnesses across their entire lifespan. NIMH also supports research to help meet people's mental health needs during the pandemic and beyond.
Mental Health Research News -- ScienceDaily
Read the latest research as well as in-depth information on clinical depression, schizophrenia, bipolar disorder, ADHD and other mental health disorders in adults, teens, and children.
The role of mental health in the relationship between nursing care
Background The relationship between a nurse and a patient is a key part of nursing that can impact how happy the patient is with the care they receive. It appears that the nurse's mental health can also affect this connection. However, there is little research on this topic. So, the aim of the present study was to determine the correlation of nurse's mental health with nurse-patient ...
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Examples of systemic racism-related psychology research topics include: Access to mental health resources based on race. The prevalence of BIPOC mental health therapists in a chosen area. The impact of systemic racism on mental health and self-worth. Racism training for mental health workers.
Topic Finder
The Division of Intramural Research Programs (IRP) is the internal research division of the NIMH. Over 40 research groups conduct basic neuroscience research and clinical investigations of mental illnesses, brain function, and behavior at the NIH campus in Bethesda, Maryland. Learn more about research conducted at NIMH.
Exercising body & brain: the effects of physical exercise on brain health
The relationship between physical exercise and brain health is a burgeoning field of research in neuroscience, with a pivotal impact on our understanding of cognitive well-being, mental health, and aging. Existing studies evidence the positive influences of regular physical activity on brain health, suggesting its implications on learning, memory, and mood. Despite significant advancements ...
Psychology topics
Plain-language explanations of how our mental health and behavior play a role in everyday issues such as: aging, depression, eating disorders, emotional health, marriage and divorce, parenting, sexuality, sleep, stress and trauma. ... Topics in Psychology. Explore how scientific research by psychologists can inform our professional lives ...
Mental health
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The incidence of mental ill-health among young men in particular, started rising in 2008 with the onset of the Great Recession and for young women around 2012. The age profile of mental ill-health shifts to the left, over time, such that the peak of depression shifts from mid-life, when people are in their late 40s and early 50s, around the ...
207 Great Mental Health Research Topics For Students
Conduct disorder among children. Role of therapy in behavioural disorders. Eating and drinking habits and mental health. Addictive behaviour patterns for teenagers in high school. Discuss mental implications of gambling and sex addiction. Impact of maladaptive behaviours on the society. Extreme mood changes.
New research finds young people 'burnt out and in need of help'
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September National Health Observances: Healthy Aging, Sickle Cell
The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors National Recovery Month to raise awareness about mental health and addiction recovery. Share our MyHealthfinder resources on substance use and misuse — and be sure to check out Healthy People 2030's evidence-based resources related to drug and alcohol use.

Research Topics & Ideas: Mental Health

Overview: Mental Health Topic Ideas

Mood Disorders

Anxiety Disorders

Psychotic Disorders

Personality Disorders

Obsessive-Compulsive Disorders

Post-Traumatic Stress Disorder (PTSD)

Neurodevelopmental Disorders

Eating Disorders

Substance-Related Disorders

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2. The Psychology of Gender Identity, Inclusivity, and Diversity

3. The Psychological Effects of Social Phobia on Undergraduate Students

4. Eating Disorders Among Teenagers and Adolescents

5. The Correlation Between Childhood Learning Disabilities and Mental Health Problems in Adulthood

6. How Mental Disorder is Glamorized and Sensationalized in Modern Media

7. The Relationship Between Self-esteem and Suicide Rates Among Adolescents

8. Destigmatizing Mental Illness and Mental Disorders

9. Psychological Trauma and the Effects of Childhood Sexual Abuse

10. Effects of the COVID-19 Pandemic on Psychological Well-Being

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Research articles

Neocortical serotonin 2A receptor binding, neuroticism and risk of developing depression in healthy individuals

Mapping cerebellar anatomical heterogeneity in mental and neurological illnesses

Exploration of first onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause

Building machine learning prediction models for well-being using predictors from the exposome and genome in a population cohort

Brain, lifestyle and environmental pathways linking physical and mental health

Mood instability metrics to stratify individuals and measure outcomes in bipolar disorder

Different hierarchical reconfigurations in the brain by psilocybin and escitalopram for depression

Modeling impulsivity and risk aversion in the subthalamic nucleus with deep brain stimulation

Childhood-onset type 1 diabetes and subsequent adult psychiatric disorders: a nationwide cohort and genome-wide Mendelian randomization study

Depressive symptoms and sex differences in the risk of post-COVID-19 persistent symptoms: a prospective population-based cohort study

Shared genetics of ADHD, cannabis use disorder and cannabis use and prediction of cannabis use disorder in ADHD

Deep brain stimulation of habenula reduces depressive symptoms and modulates brain activities in treatment-resistant depression

Tumor location is associated with mood dysfunction in patients with diffuse glioma

Individual differences in autism-like traits are associated with reduced goal emulation in a computational model of observational learning