Research led by the University of Southampton and King’s College London examined the experiences of parents navigating waiting lists for ADHD diagnosis with Child and Adolescent Mental Health Services (CAMHS) in the UK.

NHS data for the end of September 2025 shows that of those children (up to 17 years old) waiting for an assessment with the service, over 63 percent spent more than a year on the list, and a third of these were waiting over two years.

“CAMHS are experiencing  enormous demand to offer timely support to young people. Staff working in these services are under huge pressure, and in-turn, parents and their children, are also suffering – with some concern that long wait times could exacerbate ADHD symptoms,” explains lead author Dr Ellen Hedstrom.

She adds: “Through our study, we wanted to better understand how parents experience the time between their child’s referral, an ADHD assessment, and a diagnostic outcome. Also, what impact this has on them and their child.”

Study findings are published in the journal Health Expectations.

The researchers conducted anonymised interviews with a total of 41 parents of children aged between five and 11 years old. Their wait times ranged between seven months and over two years. Thirty percent of participants fell between an 18 and 24 month wait, and ten percent over two years. About 50 percent of children hadn’t had their initial ADHD assessment at the time of interview.

Strong feedback was given to the research team by parents. Many of felt that:

• Communication about wait time status was either non-existent or unsatisfactory.

• Lengthy wait times negatively impacted the mental health and wellbeing of both themselves and their child.

• Uncertainty led them to feelings of powerlessness, anxiety and being forgotten.

• Finding a crisis care contact was a struggle, or that support they’d accessed was inadequate.

• There’s pressure to get a diagnosis because it can be essential to access support or treatment, for example at school.

Many parents believed there was a disparity between the support they felt they needed and the support they received.

As one parent, Jayne, put it: “It’s hard because there is no support, at the moment, until you get that diagnosis and you’re forever in limbo.”

Another, Jaz, said: “We’ve wasted over 2 years of her education, it is a huge percentage. And in that time, she was just getting further and further behind.”

Others were grappling with whether they should try and find the money to go private, as in the case of Sarah: “We are struggling a bit and it would be nice to know whether we should be trying to save up to get him seen privately, if it’s gonna be years and years, then that’s what we’d do. If it’s gonna be another 6 months, then we’ll wait.”

At the same turn, there was also empathy for health care staff and understanding that clinical services are under enormous strain. Some parents said they wanted to place as few demands as possible on staff, due to this.

Parents’ suggestions for improvement included regular updates of their status on the waiting list, including confirmation of wait times; a digitised system where parents could logon, check any progress, or book appointments; also, the idea of a named key-worker who they could turn to for help and support while waiting. Parents also expressed the need for help with skills and strategies for themselves to manage the behaviour of their children.

Meanwhile, the authors of the study point to a recent successful local authority scheme which piloted a neurodiversity tool – offering early profiling from trained professionals. This gave parents and schools  knowledge for early intervention to help children while they wait for formal diagnosis.

“Many tools and platforms already exist, or could be developed to meet the needs of CAMHS,” concludes Dr Hedstrom. “This would not only give parents more autonomy in the way that they manage their time on a wait list and how they access much-needed information, but also alleviate the burden on mental health services, resulting in a more efficient service.”

1. The paper, ‘Until You Get the Diagnosis You’re Forever in Limbo’—Parents’ Experiences of Waiting for an Attention-Deficit/Hyperactivity Disorder Assessment With Child and Adolescent Mental Health Services, is published in the journal Health Expectations – DOI: 10.1111/hex.70569 and can be read here: https://onlinelibrary.wiley.com/doi/10.1111/hex.70569
2. For interviews contact, Steve Williams, Media Manager, University of Southampton. +44 23 80593 212
3. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2026). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 25,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 300,000 alumni. www.southampton.ac.uk
4. For more about KCL visit: https://www.kcl.ac.uk/

Past scholarly research has found that most Americans say they support mental health policies. Jake Haselswerdt, an associate professor of political science in Mizzou’s College of Arts and Science, wanted to take the topic a step further by asking whether mental health policies actually matter when people choose to vote for a political candidate.

Drawing on a nationally representative sample of 1,000 adults from the 2024 Cooperative Election Study, Haselswerdt asked participants to choose between competing priorities. The results showed that even small differences could sway voters, and mental health was often the issue that tipped the scale in a candidate’s favor.

The results indicate mental health issues influence political decision making in substantive ways, Haselswerdt said.

“I assumed mental health would rank below topics that typically dominate public discussion, like border security,” he said. “But that’s not what I found. I found that people consider this to be as important as other issues that get a lot more news coverage.”

Mizzou’s study comes during a time when concerns about Americans’ mental well-being remain elevated across the country. Recent polling from the National Alliance on Mental Illness shows one in six adults reporting poor mental health, largely influenced by the cost of living, personal health concerns and the demands of daily life.

Haselswerdt said the findings point to a significant and often under-recognized opportunity for policymakers to take stronger action on mental health policies.

“If there’s one takeaway, it’s that political leaders should pay more attention to addressing the deepening mental health crisis in America,” he said.

The study, “Who cares about mental health? Benchmarking the issue importance of mental health for American voters” was published in PLOS One.

The study comes amid more than one million prescription approvals and a tripling of sales of cannabinoid medications (including both cannabidiol (CBD) and tetrahydrocannabinol (THC) products) in Australia over the past four years, often for the treatment of mental health and substance-use disorders.

The study’s lead author, Dr Jack Wilson at the University of Sydney’s The Matilda Centre, said the results call into question the approval of medicinal cannabis for the treatment of depression, anxiety and PTSD.

“Though our paper didn’t specifically look at this, the routine use of medicinal cannabis could be doing more harm than good by worsening mental health outcomes, for example a greater risk of psychotic symptoms and developing cannabis use disorder, and delaying the use of more effective treatments,” he said.

More than 700,000 Australians have reported using medicinal cannabis to treat over 250 different health conditions. The research found evidence to suggest that medicinal cannabis could potentially be beneficial for some conditions – such as the treatment of cannabis use disorder (otherwise known as cannabis dependency), autism, insomnia, and tics or Tourette’s syndrome.

Dr Wilson said: “But the overall quality of evidence for these other conditions, such as autism and insomnia, was low. In the absence of robust medical or counselling support, the use of medicinal cannabis in these cases are rarely justified.

“There is, however, evidence that medicinal cannabis may be beneficial in certain health conditions, such as reducing seizures associated with some forms of epilepsy, spasticity among those with multiple sclerosis, and managing certain types of pain, but our study shows the evidence for mental health disorders falls short.

“In the case of autism specifically, while the study showed some evidence medicinal cannabis could assist with a reduction in symptoms, it is worth noting that there is no one – or universal – experience of autism, so this finding should be treated with caution.”

The study found that medicinal cannabis was not effective for every type of substance-abuse disorder. While medicinal cannabis may help with cannabis dependence, it was found to increase cocaine cravings among people with cocaine-use disorder

“Similar to how methadone is used to treat opioid-use disorder, cannabis medicines may form part of an effective treatment for those with a cannabis-use disorder. When administered alongside psychological therapy, an oral formulation of cannabis was shown to reduce cannabis smoking,” Dr Wilson said.

“However, when medicinal cannabis was used to treat people with cocaine-use disorder, it increased their cravings. This means it should not be considered for this purpose and may, in fact, worsen cocaine dependence,” he said.

Researchers urge greater regulation for prescribing of medicinal cannabis 

The rapid expansion in medicinal cannabis use and prescribing rates has raised concerns among major medical bodies, including the Australian Medical Association (AMA) and the Pharmacy Guild of Australia, about the largely unregulated growth in prescribing and the uncertainty surrounding the efficacy and safety of these products.

In response, the Therapeutic Goods Administration (TGA) initiated a review of the regulatory oversight of medicinal cannabis, with more than 500 responses published in February.

“Our study provides a comprehensive and independent assessment of the benefits and risks of cannabis medicines, which may support the TGA and clinicians to make evidence-based decisions, helping to ensure patients receive effective treatments while minimising harm from ineffective or unsafe cannabis products,” Dr Wilson said.

The systematic review and meta-analysis included results from 54 randomised controlled trials (RCTs) published over a 45-year period (1980-2025) worldwide.

Research: Wilson, J et al, ‘The efficacy and safety of cannabinoids for the treatment of mental disorders and substance use disorders: a systematic review and meta-analysis’ (The Lancet Psychiatry, 2026)

DOI: https://doi.org/10.1016/S2215-0366(26)00015-5

The large register-based retrospective study was carried out in collaboration between the University of Eastern Finland, Karolinska Institutet in Stockholm and Griffith University in Australia.

As background, the authors noted that, “People with diabetes have an elevated risk of developing depression, anxiety, and suicide. GLP-1 receptor agonists are licensed to treat diabetes and obesity, but data on whether these medications alleviate or exacerbate anxiety, depression, and self-harm are mixed. We studied the risk of worsening mental illness in people already diagnosed with depression, anxiety, or both who were prescribed antidiabetic medications including GLP-1 receptor agonists.”

The investigators identified people from national Swedish electronic health registries who had received a diagnosis of depression or anxiety disorder and who had used any antidiabetic medication between the years 2009 and 2022.

They compared the psychiatric effects of GLP-1 receptor agonists, individually and as a class of drugs, to non-use of GLP-1 receptor agonists.

The primary outcome was worsening of mental illness, defined as a composite of psychiatric hospitalization, sick leave from work for more than 14 days for psychiatric reasons and hospitalization due to self-harm or death by suicide.

The investigators enrolled 95,490 subjects, 56,976 female and 38,514 male, with a mean age of 50.6 years.

GLP-1 receptor agonists were used by 22,480 of these subjects during the study period.

Treatment with GLP-1 medications, especially semaglutide, was associated with a reduction in sickness absence and hospital care due to psychiatric reasons. When semaglutide was used, the reduction was 42% compared with periods when GLP-1 medications were not used. For worsening depression, the risk was 44% lower when GLP-1 medications were used. And for worsening anxiety disorders it was 38% lower.

The investigators reported that hospital care and sickness absence related to substance use were 47% lower during periods of semaglutide use compared with periods without GLP-1 use.

Investigator Markku Lähteenvuo, MD, PhD Research Director, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences at the University of Eastern Finland, said, “Because this is a registry-based study, we cannot determine exactly why or how these medications affect mood symptoms, but the association was quite strong. It is possible that, in addition to factors such as reduced alcohol consumption, weight loss-related improvements in body image, or relief associated with better glycaemic control in diabetes, there may also be direct neurobiological mechanisms involved – for example, through changes in the functioning of the brain’s reward system.”

The research, published in the Journal of Medical Internet Research, established a significant and consistent association between Problematic Smartphone Use (PSU) – whereby an individual becomes behaviorally or psychologically reliant on their smartphone – and eating disorder symptom severity. Researchers argue this highlights the need for early intervention strategies specific to excessive phone use for young people displaying eating disorder symptoms.

While there has been research conducted into the negative impact that problematic internet usage, exposure to social media, and harmful online content can have on body image and body dysphoria in both clinical and non-clinical populations, none have specifically examined PSU.

Researchers identified 35 studies in which to include in this systematic review. The studies were from across the globe and provided researchers with a sample size of 52,584 participants with an average age of 17.

Their analysis of the data found that higher daily smartphone use was also related to greater food addiction symptoms, broader disordered eating behaviours like uncontrolled eating or emotional overeating, and body dissatisfaction in people with no diagnosis of an eating disorder. The association was particularly strong in those who use their phones for more than seven hours a day.

Ben Carter, Professor of Medical Statistics at King’s IoPPN and the study’s senior author said, “Smartphones have become ubiquitous in our everyday lives. It is apparent from our study that, even for people without a diagnosis of an eating disorder, the overuse of a smartphone is associated with poor body satisfaction and altered eating behaviours, and is a potential source of distress”

Dr Johanna Keeler, a Visiting Lecturer at King’s IoPPN and the study’s first author said, “Adolescence is a key stage of development as individuals evolve their sense of self by observing others. While smartphones might present an easy way for this to happen, being consistently exposed to idealised images can lead them to compare their own appearance with these “standards”, leading to poor self-esteem and appearance dissatisfaction – both risk factors for the development of an eating disorder.”

For more information, please contact Patrick O’Brien (Media Manager) on +44 020 7848 5377.

Problematic smartphone use and smartphone screen time are associated with eating disorder psychopathology in non-clinical samples: a systematic review (DOI )(Keeler, Carter et al) was published in the Journal of Internet Medical Research.

1. “Problematic Smartphone Use” is not “smartphone addiction” and should not be used interchangeably. While smartphone users can demonstrate addictive behaviours, significantly more research is required before the “addiction” moniker can be applied.

About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience

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King’s has more than 42,000 students (including more than 12,800 postgraduates) from some 190 countries worldwide, and 8,500 staff.

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In a paper, published today in the British Journal of Psychiatry, a group of experts led by Professor Samuele Cortese from the University of Southampton say there is no robust evidence that ADHD is over-diagnosed in the UK.

The new paper refutes the view that ‘nowadays everyone has ADHD’ which is gaining traction in public discourse and has been amplified by some leading politicians, as demand rises for NHS assessments and services.

Bringing together academics, clinicians, people with lived experience and carers, the group say this narrative risks misleading the public and policymakers and overshadows a more pressing concern – unmet need.

Professor Cortese said: “Rather than focusing on increases or decreases in diagnostic rates, attention should be directed toward the extent to which those with ADHD are being adequately diagnosed and treated.

“While misdiagnosis and inappropriate diagnosis do occur, the available evidence indicates that under diagnosis and under treatment remain the predominant challenges.”

When standardised diagnostic criteria are applied, the prevalence of ADHD internationally is around 5 per cent in children and 3 per cent in adults.

While prevalence has increased over time, NHS administrative data in England remains substantially below these expected levels, suggesting that many people with ADHD are living without a diagnosis and adequate support.

The group acknowledge that misdiagnosis can occur in some cases, particularly where assessments rely heavily on self-reporting or where alternative conditions are not fully considered.

Professor Tamsin Ford, Head of the Department of Psychiatry at the University of Cambridge, a coauthor on the paper, commented: “While many more people with ADHD are being recognised and treated, we are failing to support many more. Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits; and sadly, missed diagnoses remain common.”

The researchers stress that the absence of biological diagnostic markers means that thorough, multidisciplinary clinical assessment is essential. Field trials show that when clinicians are properly trained, an ADHD diagnosis is among the most reliable for a mental health condition.

“Similar to physiological traits, such as blood pressure or weight, ADHD symptoms are distributed along a continuum,” says coauthor Professor Chris Hollis from the University of Nottingham. “But as with hypertension or obesity, there are diagnostic severity thresholds that determine health risks and what interventions should be used. Similarly, in ADHD a risk-stratified stepped-care approach may be useful.”

Professor Cortese and colleagues highlight significant pressure on UK services, with long waiting times and growing demand, especially among adults who were not diagnosed in childhood.

They point to figures showing that around 27 per cent of children and young people diagnosed with ADHD reported waiting one to two years, while 14 per cent waited two to three years.

Evidence shows that untreated ADHD is associated with serious long-term risks, while effective treatments are available, backed by strong evidence, and generally well tolerated.

“The costs of untreated ADHD are often overlooked,” says Professor Cortese. “They include increased risk of academic failure, suicidal behaviour, substance abuse, criminality, injury and death. The failure to provide treatments which have been shown to reduce these risks represents a major ethical issue that needs to be urgently addressed.”

The authors call for improved funding, workforce training and a more balanced, evidence-based conversation to ensure accurate diagnosis while expanding access to care for those who need it.

The researchers are supported by the National Institute for Health and Care Research (NIHR), UK Research and Innovation (UKRI) and the Office for Life Sciences.

ADHD (over) diagnosis: fiction, fashion, and failure is published in the British Journal of Psychiatry and is available online.

Contact

Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

1. In 2018, the administrative prevalence was 2.5% in boys and 0.7% in girls, and 0.7% in men and 0.2% in women, respectively. Current post-pandemic administrative prevalence data are unavailable.
2. Figures on wait list times come from an online survey of 7,340 people, conducted by the House of Commons Petitions Committee between 2021 and 2022.
3. ADHD (over) diagnosis: fiction, fashion, and failure is published in the British Journal of Psychiatry here:ADHD (over) diagnosis: fiction, fashion and failure | The British Journal of Psychiatry | Cambridge Core
4. For interviews, please contact press@soton.ac.uk or 023 8059 3212.

The findings were published on March 9, 2026 in the CMAJ/Canadian Medical Association Journal.

“Our findings may reflect improved recognition and treatment of ADHD in adulthood; however, the speed and scale of this growth also raises important questions about how diagnoses are being made, and if this prescribing is always appropriate,” said Dr. Tara Gomes, program director of the Ontario Drug Policy Research Network at St. Michael’s Hospital, Unity Health Toronto and an ICES scientist, Toronto, Ontario.

As background, the researchers noted that, historically, stimulants have been prescribed mainly for pediatric cases of ADHD and some other conditions. But in the past 20 years, ADHD diagnoses and stimulant prescriptions have increased among adults, and data shows that this change accelerated after the start of the pandemic.

“We sought to examine patterns of stimulants dispensed to adults in Ontario and characterize adults who initiated such therapy before and during the pandemic,” the authors said.

The investigators used a regional database to identify monthly rates of new stimulant dispensations among adults in Ontario between January 2016 and June 2024

They found that among 327,053 adults who initiated stimulant therapy, the median age was 31 years and 55.4% were female.

When compared with stimulant prescribing before the COVID-19 pandemic, new adult users during the pandemic were more likely to be aged 25 to 34 years (26.5% v. 32.8%) and female (48.0% v. 59.0%). And the drugs were less likely to be prescribed by psychiatrists (25.5% v. 18.0%).

The rate of new stimulant dispensations rose from 0.16 to 0.44 new monthly dispensations per 1000 people between January 2016 and June 2024.

“Many of these findings are consistent with trends in stimulant prescribing observed globally in the post-pandemic era and are likely influenced by greater awareness of adult ADHD and improved access to care following a historical pattern of underdiagnosis of ADHD in adulthood — particularly among women,” said coauthor Dr. Mina Tadrous, associate professor, Leslie Dan Faculty of Pharmacy, University of Toronto. “However, the rising impact of social media influencers on ADHD awareness in young adults, as well as the rapid evolution of virtual health services that support online assessments and treatment, may also be contributing to misdiagnoses and potential harm.”

The authors concluded, “In Ontario, rates of new prescriptions for stimulants dispensed to adults accelerated rapidly during the COVID-19 pandemic. Monitoring and evaluation are needed to ensure appropriateness of use and safeguard against potential harms.”

The researchers analysed Finnish national registry data on 209,346 older adults living at home who did not have Alzheimer’s disease. They compared three groups: off-label users, people taking antipsychotics for an official indication, and those not using the medications at all.

The results were striking: 70 percent of all antipsychotic use fell into the off-label category. Use of these medications off-label also increased over the course of the study period. Risperidone and quetiapine were the most commonly used antipsychotics off-label.

Physicians often prescribe antipsychotics to older patients to manage prolonged behavioural symptoms or insomnia, despite the absence of official approval for these conditions. Previous research has even suggested that using these drugs without alternative non-drug treatments can constitute a form of elder abuse. Limited resources in elderly care and a lack of non-pharmacological options appear to have contributed to the growing use of these medications.

The study found that off-label users were more likely than other groups to have cardiovascular diseases and cerebrovascular disorders. They were also more likely to be using opioids.

“Surprisingly, off-label users had cardiovascular and cerebrovascular conditions even more frequently than patients prescribed antipsychotics for an approved indication, such as psychotic disorders,” said postdoctoral researcher Tuomas Majuri of the University of Oulu.

Majuri noted that this finding could reflect insufficient monitoring of the metabolic side effects of these medications when used off-label.

The researchers say their findings underscore the need for alternative treatments for symptoms currently managed with off-label antipsychotic use.

“Clearer guidelines are needed for monitoring metabolic side effects, and measures must be taken to promote safer prescribing practices,” Majuri added.

The study was funded by the Päivikki and Sakari Sohlberg Foundation and the Research Council of Finland.

Article: Majuri T*, Silvan J*, Tolppanen A-M, Hartikainen S, Huotari T, Rautio N, Miettunen J, Nordström T, Jääskeläinen E, Haapea M. Characteristics and predictors of antipsychotic medication off-label use among community-dwelling older people. Nord J Psychiatry 2026. Published online 16 Feb 2026.

The findings were published on Feb. 23, 2026 in CANCER, a journal of the American Cancer Society.

“Over the past several years, we’ve had an increasing appreciation for the important relationship between cancer, its treatment, and mental health,” said lead author Julian Hong, MD, MS, of the University of California, San Francisco. “This study reproduces our prior work by leveraging the shared experience across the University of California system, reinforcing a relationship between mental health conditions and mortality for patients with cancer and highlighting the need to prioritize and manage mental health.”

The researchers used The University of California Data Discovery Platform, in which data on all patients at University of California–affiliated hospitals are recorded.

They identified adult patients with a cancer diagnosis and no documented mental health disorder prior to cancer diagnosis between 2013 and 2023.

Among 371,189 patients, 39,687 (10.6%) developed a mental health disorder within the first year after cancer diagnosis.

After adjusting the data for factors which might affect the primary outcome, the researchers reported that a mental health disorder diagnosis was linked to a 51% higher risk of all-cause death in the initial 1–3 years after cancer diagnosis. This elevated risk decreased to a 17% higher risk after 3–5 years. Then it disappeared.

The authors concluded, “Patients with cancer who experience a mental health condition are at an increased risk of all-cause mortality. This reinforces and emphasizes existing recommendations for prompt screening and management of distress and mental health following a cancer diagnosis.

An interdisciplinary George Mason University team led by Farrokh Alemi, an expert in machine-learning and AI, compared how effective recommendations were from AI-guided tools/models that knew the patient’s race and factors uniquely relevant to African American patients against tools/models that didn’t. The team found that recommendations based on “race-blind” AI models—those that do not know the patient’s race—tended to recommend medications that were less effective for African American patients.

“Anti-depressant recommendations from race-specific models outperformed recommendations from general models across all antidepressants studied. The findings highlight why clinical AI, like clinical practice, shouldn’t rely solely on general-population patterns when prescribing for African Americans with depression,” said Vladimir Cardenas, master of science in health informatics ’24.

Why This Matters

“If AI systems are not trained on correct information, including patient demographic information, such as race, it will give incorrect or inaccurate information, which can result in people ending up with less effective medications,” said Alemi.

Alemi and his co-researchers observed that when advising patients on options for treating depression. “AI systems could be biased against African Americans, recommending antidepressants that work for general, mostly White, patients but not for African Americans,” said Alemi.

The Details

Researchers looked at bias in an AI system meant to guide treatment for Major Depressive Disorder (MDD)—and whether race-blind models miss important signals for African American patients. The AI system used medical history—including whether a patient completed the full dose of the antidepressant—to recommend a medication. Researchers coded whether a patient discontinued the use of the antidepressant as a measure of AI-guided treatment failure or success.

The study underscores that race is not a biological determinant of depression or treatment response, emphasizing the social and environmental factors that affect depression. Some of these factors more common among African American patients may be poverty, low education, exposure to violence, discrimination, cultural stigma and negative attitudes toward mental health, and low access to mental health treatment resources.

“These data highlight the need to tailor antidepressants to fit the patient’s individual medical history. Clinicians do this, and, if done right, an AI system can help clinicians do so as well,” said Cardenas.

“I hope that our approach will help inform AI in health care design and governance. This way we can truly pursue AI that improves the health of all,” said Cardenas.

The research team included Kevin Lybarger, assistant professor in the College of Engineering and Computing, along with master of science in health informatics graduates Cardenas, Maria Kurian, and Rachel Christine King; and Niloofar Ramezani from Virginia Commonwealth University.

Bias in AI-guided management of patients with major depressive disorders was published in the Journal of Health Equity in January 2026. The study was supported by the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity. Research was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Award.

Key Takeaways

• AI systems for antidepressant guidance may be less effective for African American patients because models use data from general, primarily White, populations.
• Race-specific models were more accurate in predicting African Americans’ responses to medications across all antidepressants studied.
• Clinical AI treating mental health shouldn’t rely solely on general population data when prescribing antidepressants for African Americans with depression.

For the study, researchers looked at serotonergic antidepressants, which treat anxiety and depression by increasing serotonin activity in the brain. These included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).

“Concerns have previously been raised that serotonergic antidepressants might increase the risk of bleeding in the brain or complicate early recovery after traumatic brain injury,” said study author Jussi P. Posti, MD, PhD, of the University of Turku in Finland. “However, our study found no evidence to support those concerns.”

The study included 54,876 people in Finland who were 16 or older when hospitalized with a TBI. A total of 14% used serotonergic antidepressants at the time of the TBI.

Researchers reviewed national prescription records for preinjury antidepressant use and medical records to determine how many people died within a month, whether they needed emergency brain surgery, and how long they stayed in the hospital.

A total of 4,105 people died within a month. This included 7.6% of those taking antidepressants and 7.5% of people who did not.

After adjusting for factors such as age, sex and other health conditions, researchers found people taking antidepressants before injury were no more likely to die within a month than those not taking them.

Antidepressant users were slightly less likely to require emergency brain surgery to relieve pressure or bleeding in the brain and prevent further damage.

Of the total participants, 6.8% of the antidepressant users and 8.6% of those who did not use antidepressants needed emergency brain surgery. After adjustments, antidepressant users had an 11% lower risk.

The amount of time in the hospital was the same for both groups.

“These findings provide reassurance for people who take antidepressants that antidepressant use does not appear to worsen early recovery after traumatic brain injury,” said Posti. “Future studies should examine whether these results hold true for long-term recovery and across different health care settings.”

A limitation of the study was that it was conducted only at hospitals and health care centers in Finland, so results may vary in other areas.

The study was supported by the Finnish government, the Paulo Foundation, Paavo Nurmi Foundation, Research Council of Finland, Sigrid Jusélius Foundation and Finnish Foundation for Cardiovascular Research.

Discover more about traumatic brain injury at Brain & Life^®, from the American Academy of Neurology. This resource offers a website, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world’s leading experts in brain health. Follow Brain & Life^® on Facebook, X, and Instagram.

The American Academy of Neurology is the leading voice in brain health. As the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members, the AAN provides access to the latest news, science and research affecting neurology for patients, caregivers, physicians and professionals alike. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer’s disease, stroke, concussion, epilepsy, Parkinson’s disease, multiple sclerosis, headache and migraine.

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Indeed, a research letter by Rutgers and Columbia University researchers in JAMA Psychiatry shows those prescriptions are becoming more common in the United States, even though antipsychotic drugs do little for dementia and carry a black-box warning on their labels stating they increase the risk of death in senior patients.

Using a national prescription-claims database that captures more than 90% of retail pharmacy fills, researchers tracked antipsychotic use among adults 65 and older from 2015 through 2024 and found that the annual rate of any antipsychotic use increased nearly 52% to 4.05 per 100 from 2015 to 2024. Long-term use, defined as at least 120 days a year, rose 65% to 2.45 per 100 older adults. Rates were highest among people 75 and older, rising from 3.42 to 5.12 per 100.

The trend is striking because antipsychotics have limited proven effectiveness in people 65 and older and serious risks, including falls, fractures, cardiovascular and cerebrovascular events, pulmonary embolism and death.  Antipsychotics may be used as a last resort to manage severe behavioral and psychological symptoms of dementia, such as aggression, agitation, hallucinations, or delusions, especially when these symptoms pose a risk to the safety of the individual or others.  However, such use carries substantial risk and should be avoided in most cases and limited to short-term use whenever possible.

“The evidence is pretty solid on the risks,” said Stephen Crystal, the letter’s co-author and director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research.

The claims data don’t include diagnoses, so the researchers couldn’t determine why each prescription was written or whether it was appropriate. Antipsychotics remain essential for some people, including those with schizophrenia, bipolar disorder with psychosis or other severe psychiatric illnesses.

However, Crystal noted those conditions aren’t common enough in older populations to explain the surging number of antipsychotic prescriptions.

“We think that conditions like schizophrenia that have FDA-approved indications for antipsychotic treatment are unlikely to account for the majority of the rates of use that we observed,” he said.

The biggest concern for the researchers is using antipsychotics for the behavioral and psychological symptoms that can accompany dementia: agitation, wandering, acting out behavior and shouting. In many cases, the medications are used to “damp down” behaviors that are distressing to caregivers and disruptive to facilities, said Crystal, who also holds endowed professorships at the Institute for Health and Rutgers School of Social Work.

Because the drugs can be highly sedating, they reduce the tendency to roam and act out, but that sedation comes with a steep tradeoff for frail patients, increasing fall risk and reducing physical activity.

The study also reveals a shift in who manages cases. Among patients who took an antipsychotic in a given year, the share with at least one prescription from a psychiatrist fell from 30% in 2015 to 20% in 2024. Over the same period, the share who filled an antipsychotic from a pharmacy in a long-term care facility rose from 14% to 21%.

Crystal said the decline in psychiatrist involvement matters because optimal care for behavioral symptoms in dementia often starts with careful evaluation rather than a quick prescription. Clinicians may need to confirm the diagnosis and look for treatable causes that can mimic or worsen confusion, including medication interactions, infections, depression and unmanaged pain. Even when dementia is the main driver, nondrug approaches can work, but they require training, staffing and time.

“This can look like managing symptoms,” Crystal said. “Which is common because it’s so much easier to write a prescription than do the work of addressing the underlying condition, particularly at nursing home and assisted living facilities that are dangerously short-staffed.”

There was one potentially encouraging sign in the data: the use of first-generation antipsychotics, which are associated with higher mortality risk in older patients than second-generation medications, declined from 22% to 14%.

Still, the overall rise in use and the growth in long-term prescribing suggest a system leaning more heavily on medication to solve problems that are often social, environmental and staffing-related. The authors have called for renewed efforts to evaluate and spread nonpharmacological interventions that can reduce reliance on antipsychotics in older adults.

For families contending with a new prescription, the study’s lead author, Mark Olfson of the Columbia University Department of Psychiatry, said that it is reasonable to ask what problem the drug is meant to address and what other steps have been tried. Just as important is what happens next: whether the clinician has a plan to reassess, taper and stop the medication once a crisis has passed.

“These are high-stakes decisions,” he said.