Matters of the heart and mind

Stigma continues to challenge the lives of people with mental illness who fear disclosure and avoid seeking help: men, young people, military personnel, ethnic minorities and health professionals are the most affected. ^{Reference Clement, Schauman, Graham, Maggioni, Evans-Lacko and Bezborodovs1} Diagnostic labels are often blamed for adding to stigma. Ellison et al’s study (pp. ) tested reactions to vignettes of people with mental illness. A less stigmatising label of ‘integration disorder’ rather than schizophrenia produced surprising findings: although there was less perceived dangerousness and more attributions of biopsychosocial causation, the respondents conveyed greater social distance. This contrasts with the findings for a label of bipolar disorder rather than manic depression, where social distance and fear were positively associated and both diminished. Contrary to public perceptions of dangerousness among the mentally ill, Khalifeh et al (pp. ) show that people with mental illness are actually more likely to be victims of both non-violent and violent crime, and women with mental illness are especially likely to suffer community, sexual and domestic violence.

Stigma and negative attitudes towards mental illness may affect career choices in medicine, ^{Reference Shen, Dong, Fan, Zhang, Li and Lv2} yet there is uncertainty about which interventions are effective and can be scaled in diverse settings and countries. ^{Reference Stubbs3,Reference Clement, Lassman, Barley, Evans-Lacko, Williams and Yamaguchi4} The extent to which discrimination is experienced as a consequence of stigma remains controversial and less well researched. An important influence is the quality of medical care received by people with mental illness. There is evidence of variation in take-up of screening to provide early intervention and to improve recovery from illnesses. ^{Reference Aggarwal, Pandurangi and Smith5–Reference Foley, Mackinnon, Morgan, Watts, Shaw and Magliano9} These disparities may explain a higher mortality among those with mental illness. ^{Reference Whiteford, Ferrari, Degenhardt and Feigin10–Reference Charlson, Baxter, Dua, Degenhardt, Whiteford and Vos12} The research of Krivoy et al (pp. ) and Chen et al (pp. ) suggest that the treatment and aetiology of vascular and psychiatric disorders are closely linked, and their new data show that vascular disease might lead to neuropsychiatric symptoms including depression, ^{Reference Taylor, Aizenstein and Alexopoulos13} movement disorders and dementia. ^{Reference Stanimirovic and Friedman14} These findings are complemented by Li et al (pp. ) and Pan et al (pp. ) finding important structural and functional brain correlates of the psychiatric disorders including mood states and suicidal thinking. Continuing this theme, Allan et al (pp. ) show that hypertension may lead to white matter hyperintensities, associated with global or hippocampal atrophy, further revealing a potential pathway linking vascular disease to neuropsychiatric disorders. Smoking and physical inactivity profiles are implicated as behavioural factors and can be modified. ^{Reference Kilbourne, Morden, Austin, Ilgen, McCarthy and Dalack15} However, the profile of causes of mortality may be quite different in lower-income countries where infectious diseases may still be relevant and offer important preventive targets (see Fekadu and colleagues, pp. ). More data on mortality, treatment and prognosis are needed from all countries (see Ran et al’s study (pp. ) of poor prognosis among men with severe mental illness in China). However, we also need ways of ensuring that the data are well managed and reflect phenotypic comorbidities and shared aetiologies, rather than convenient but simplistic analysis of single diagnostic groups. ^{Reference Charlson, Baxter, Dua, Degenhardt, Whiteford and Vos12}

What makes a BJPsych paper? This is an important question. Papers in this month’s issue highlight the essential elements. Cognitive–behavioural therapy may help secure employment (Fournier et al, pp. ) and Yesufu-Udechuku et al (pp. ) show the importance of psychoeducation to reduce carer burden and psychological distress. And negative studies are welcome, for example, Okereke et al’s paper (pp. ) on folic acid, B₆ and B₁₂; these are not effective in the treatment of depression. All papers accepted by BJPsych show strong and innovative methodology, definitive findings (positive or negative), a sufficient advance in knowledge with potential or actual clinical impact; and the findings, even if located in a particular setting or country, should have international relevance for the practice of psychiatry and for the provision of mental healthcare. As outlined in previous comments on editorial policy, we welcome cross-disciplinary research that meets these essential criteria. Positive reviews are not always sufficient for acceptance in the BJPsych and many sound papers do not make it in the competition for limited space. In order to promote dissemination of research, public education and better-informed clinical care, we wish to publish all methodologically sound papers. Hence, our new open access journal BJPsych Open is now accepting submissions. BJPsych Open will consider a wider range of original papers. I welcome two deputy editors to BJPsych Open: Gin Malhi from Sydney and Kenneth Kaufman from New Brunswick, New Jersey. And Amanda Baxter, Peter Byrne and Anne-Lingford Hughes form the new members of the BJPsych Open editorial board, supported by the existing BJPsych board members. All papers will be peer-reviewed, and we hope to make speedier decisions using previous reviews of your papers where available. Fast track for BJPsych and BJPsych Open should only be requested where the findings of your paper might have an impact on immediate practice, or the findings should be placed in the public domain for reasons of patient safety or to mandate a change in practice where previous practice is no longer acceptable or ethical on the basis of the findings. I look forward to seeing your best research papers, full of heart and mind, and powerful enough to improve the quality and range of clinical care for people with mental illnesses.