Peter Martin

Background: Rates of mental health problems in adolescents have increased in the last decade, prompting urgent calls for effective, scalable preventative interventions. To determine whether a novel, group-based, transdiagnostic indicated prevention programme (Building Resilience through Socioemotional Training; ReSET), delivered through existing school mental health provision, improves mental health and wellbeing in at-risk adolescents.Methods: Two-arm cluster randomised controlled superiority trial (1:1) evaluating ReSET plus usual care versus usual care only, with outcomes assessed immediately post-intervention and at 12-month follow-up. Adolescents aged 12–14 identified through whole-school screening as scoring in the top 25th percentile for overall psychopathology symptoms, in schools selected to over-represent high-need communities (≥30% free school meals eligibility). ReSET is an 8-session group -based intervention that targets two key mechanisms implicated in risk for psychopathology in adolescents – social functioning and emotional processing. Pre-registered co-primary outcomes were overall self-reported psychopathology (SDQ) and wellbeing (WEMWBS), assessed immediately post-intervention and at 12-month follow-up.Results: Of 4,005 adolescents screened, 1465 met eligibility, 727 consented and 560 were enrolled. There was no evidence of intervention effects on either co-primary outcome immediately post-intervention. At 12-month follow-up, there was evidence of improvement in overall psychopathology (adjusted mean difference −1.36, 97.5% CI −2.23 to −0.50, p=0.0004; SMD=0.25, 95% CI 0.11 to 0.42). Secondary outcomes showed a consistent pattern: no effects immediately post-intervention, but significant benefits for anxiety, depression, general psychopathology, and internalising symptoms at 12-month follow-up. No effects on externalising symptoms were observed at either timepoint.Conclusions: The delayed emergence of benefit is consistent with a skills-based prevention model in which adolescents acquire skills that support resilient functioning when facing subsequent emotional and interpersonal challenges. These findings suggest that transdiagnostic interventions targeting socioemotional processes have the potential to prevent common adolescent mental health problems, though replication and longer-term evaluation are needed.

Statistical hypothesis tests and p values are poorly understood by many students of statistics. Poor application and misinterpretation of statistical inference procedures are common in published research. Over‐reliance on the “ p < 0.05” threshold to claim “statistical significance” often masks weaknesses in the evaluation of statistical evidence. This state of affairs presents a challenge for statistics education. This article proposes to teach statistical inference in the context of teaching statistical thinking. We need to introduce students to the different ways in which statistical inference is conducted in real research, demonstrate good practice, and show what can go wrong when p values are misinterpreted, misapplied, or intentionally gamed. Narratives from the history of statistics and science can aid in this endeavor. They provide context‐rich examples that show in specific yet generalizable ways the uses and pitfalls of hypothesis tests and other inferential procedures.

Introduction: Cumulative interpersonal traumatisation increases the risk of psychosis and is linked to psychotic symptom severity and reduced recovery rates. Psychosis and treatment themselves can also be traumatising, with a first episode of psychosis posing challenges to one’s identity. Despite a growing evidence base for the safety and effectiveness of trauma therapies for psychosis, implementation remains poor in early intervention for psychosis (EIP) services, partly due to resource constraints. Narrative exposure therapy (NET) is an effective intervention for post-traumatic stress disorder in ethnically diverse populations. Crucially it has potential to address barriers to implementation of trauma therapies in EIP as it has a brief duration with minimal training requirements. This feasibility study will evaluate the feasibility and acceptability of conducting a definite trial of NET in people with early psychosis. Methods and analysis: An individually randomised parallel groups feasibility randomised controlled trial with embedded qualitative evaluation will be conducted. 50 individuals with first episode psychosis and a history of multiple trauma under the care of an EIP service in two NHS trusts in England will be recruited. Participants will be randomised to receive either 15 sessions of NET in addition to treatment as usual or treatment as usual alone. Assessor blinded assessments will be conducted at baseline, 4 months (post-intervention) and 8 months (follow-up). Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects to inform planning for a fully powered trial. Qualitative interviews will be carried out with participants allocated to NET and clinicians to investigate acceptability, barriers and facilitators, possible mechanisms of change, potential benefits or harms and recommendations. A sub-study in the NET group will investigate acceptability of completing Experience Sampling Data daily during therapy to monitor changes on candidate primary and secondary outcomes. Ethics and dissemination: This study received REC/HRA ethical approval from the London - City & East Research Ethics Committee (REC) (25/LO/0350). The results of the study will be reported and disseminated at international conferences and in open-access peer-reviewed scientific journals. Trial registration number: ISRCTN39471182 .

Background: Depression is a highly prevalent disorder. Yet, there is still a considerable treatment gap because of capacity issues across clinical services, which create barriers to access to effective psychological therapies. In addition, many individuals with depression do not seek treatment, and waiting lists for psychotherapy are typically very long. Blended psychotherapy, which combines online components and in-person sessions, may help bridge the treatment gap as a cost-effective intervention that complements other types of treatment for depression, as it may reduce therapist time and potentially lower the threshold for people to seek treatment for their depression. Objective: This study aims to investigate the clinical effectiveness and cost-effectiveness of blended psychodynamic therapy (PDT) and cognitive behavioral therapy (CBT) for depression compared with face-to-face (FTF) PDT and CBT. Methods: A pragmatic, single-blind, multisite, noninferiority trial will randomize adult patients referred to mental health care centers in Flanders, Belgium, and diagnosed with major depressive disorder (MDD; n=504), to FTF or blended PDT and CBT. The primary outcome is to investigate whether blended therapy for depression (ie, blended PDT and CBT) is noninferior from baseline to 6-month follow-up after treatment termination compared with FTF PDT and CBT in terms of severity of depression assessed with the Beck Depression Inventory-II (BDI-II) based on intention-to-treat analyses. Secondary outcomes include severity of depression as measured with the BDI-II at 1 and 2 years after treatment termination; recovery from depression as assessed with the Structured Clinical Interview for DSM-5 disorders – Clinical Trials Version (SCID-5-CT) and the Patient Health Questionnaire-9 (PHQ-9) at treatment termination and at 6-month, 1-year, and 2-year follow-up; and quality of life as measured with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) at treatment termination and at 6-month, 1-year, and 2-year follow-up. The feasibility of implementing blended care will be investigated, and health economic analyses will address the cost-effectiveness of blended care versus FTF psychotherapy. Exploratory analyses will focus on possible predictors of treatment outcome and mechanisms of change. Sensitivity analyses will address the potential impact of the COVID-19 pandemic on therapeutic outcomes. Finally, a qualitative substudy aims to address patients’ and therapists’ subjective experience of blended psychotherapy. Results: The study was funded in July 2018, and the first patient was included in April 2019. As of September 2025, we have enrolled 463 patients. The first data lock (primary outcome) will take place in October 2025, and the results of the primary outcome are expected in February 2026. The second data lock is expected in March 2027, and the results of the 2-year follow-up are expected in September 2027. Conclusions: This trial promises to inform decisions concerning the implementation of blended versus FTF therapy for individuals with depression in routine clinical care.

Introduction Self-harm is the strongest predictor of suicide in young people. Self-harm presentations to the emergency department (ED) are associated with repeat self-harm and suicide. Rapid follow-up contact after ED offers an opportunity to intervene before self-harm becomes an established coping strategy. Despite recent progress in self-harm treatment, currently, there are no evidence-based interventions to prevent future self-harm and suicide offered to young people after visits to the ED. Preliminary evidence suggests therapeutic assessment and rapid follow-up contacts may reduce self-harm and improve engagement in follow-up care. In this study, we assess the clinical and cost-effectiveness of a brief psychological intervention, supporting adolescents with self-harm (SASH), in addition to standard care in a randomised controlled trial, compared with standard care only. As per National Institute for Health and Care Excellence guidelines, standard care involves at least one follow-up by a mental health professional within 7 days of ED discharge. Methods and analysis The SASH intervention comprises up to six follow-up contacts with a mental health professional delivered over approximately 2 months for young people and their carers using a solution-focused approach, shortly after presenting to the ED. Participants are aged 12–18, presenting to the ED with self-harm or suicidal ideation (with self-harm in the past month), with capacity to consent. We aim to recruit 144 young people into the trial who will be randomised on a 1:1 basis to the SASH intervention or treatment as usual. Participants are assessed postintervention/standard care and at 6-month follow-up after randomisation. Self-reported self-harm is assessed via text message survey every 2 weeks during the 6-month follow-up period. The primary outcome is self-reported episodes of self-harm in the past month assessed at 6 months by summing three behavioural domains of the self-injurious thoughts and behaviours interview. We hypothesise that the therapeutic relationship with the mental health practitioner will mediate this relationship. Secondary outcomes include symptoms of depression and anxiety, frequency of reattendance at ED, death by suicide, school attendance, well-being and additional domains of self-harm-related behaviour and thoughts in the past month. The trial will also consider service use, costs to carer and carer health-related quality of life to evaluate the costs and cost-effectiveness of the intervention. Ethics and dissemination London-Riverside Nation Health Service REC (22/LO/0400) provided a favourable ethical opinion. Findings will be disseminated through social media, a website, scientific papers, conferences and reports, in collaboration with our Young Person’s Lived Experience Advisory Group. Trial registration number ISRCTN81846131. Protocol version 13.0, 30.06.2025.