North East London NHS Foundation Trust

Introduction Long-term follow-ups and evaluation of health and treatment of patients has been a challenge always. Dropout of patients or not following up can put their health at risk, leading to relapse or poor compliance. For patients with mental disorders, it can affect their well-being, mental health, and quality of life. Materials and Methods In this study, patients who attended psychiatry outpatient department or inpatient department for 1 year were assessed. The 201 patients who fulfilled the inclusion criteria and had stopped follow-ups were called, and reasons were noted for the same. Verbal consent was obtained. A semi-structured pro forma was filled telephonically, and confidentiality was maintained. Results Out of the 263 patients who stopped follow-up in 1 year period, only 201 fulfilled the inclusion criteria. The number of females (53.7%) was more than males. Majority of the patients were married (81.6%). Majority of the patients belonged to neurotic, stress-related, and somatoform disorders (44.8%), followed by mood (affective) disorders (40.3%). Out of the reasons, the most common were “complete improvement and no further follow-up and treatment required” (26.4%) and “changed to another doctor, after no improvement reported within 1 month of treatment” (21.9%). Discussion Loss to follow-up is quite common and an area of concern. There is a lack of data to give an overview of the reasons for this. This area needs to be looked into to stop the dropout of treatment and have a more holistic approach of treatment.

Introduction Mental health problems are important causes of disability and economic costs worldwide. Randomised clinical trials examining the treatment of mental health disorders measure heterogeneous outcomes, causing difficulties in data synthesis, interpretation and translation into clinical practice. The aim of the Patient Important Outcomes in Psychiatry (PIO-Psych) Initiative is to develop an overarching, transdiagnostic research-based and consensus-based core outcome set for adult mental health disorders. Methods and analysis The development of the PIO-Psych transdiagnostic core outcome set will include three phases: (1) a systematic scoping review of the literature to develop the initial list of outcomes for the Delphi study; (2) a Delphi study in three rounds including people with lived experience of mental health disorders and their relatives, clinicians, researchers and others (administrators, mental healthcare policymakers, philosophers); (3) a hybrid consensus meeting to agree on the final overarching, transdiagnostic core outcome set and corresponding time points of assessment of each outcome. Ethics and dissemination Ethical approval is not applicable to this study according to the Research Ethics Committee of the Capital Region of Denmark, as it is not an interventional study. All data will be reported anonymously, and it will not be possible to identify study participants. Results will be disseminated via stakeholder and research networks and peer-reviewed publications. Trial registration details The PIO-Psych Initiative was pre-registered with COMET (Core Outcome Measures for Effectiveness Trials) on 17 May 2024 ( https://www.comet-initiative.org/Studies/Details/3125 ).

Objective To evaluate the effect of obstructive sleep apnoea (OSA) surgery on insomnia in patients with co-morbid insomnia and sleep apnoea (COMISA). Methods A retrospective interventional study was conducted on fifty consecutive adult patients with OSA who underwent surgery for OSA. Outcome measures included the Insomnia Severity Index (ISI) and the following polysomnography (PSG) indices: apnoea-hypopnea index (AHI), oxygen saturation index (ODI), lowest oxygen saturation (LOS) and Epworth Sleepiness Score (ESS) before treatment and at 4 months post-operatively. Results In our study, 36% of the patients had clinical insomnia (ISI score > 15) prior to surgery. Following OSA surgery, there was an average improvement in the total ISI scores from 19.82 to 5.65 (p < 0.05). One patient continued to have moderate to severe clinical insomnia. Overall OSA parameters following surgery showed AHI decreased from 33.38 ± 23.76 to 18.37 ± 22.94 (p < 0.05); ODI reduced from 30.85 ± 22.37 to 16.77 ± 21.73 (p < 0.05); LOS significantly increased from 74.42 ± 11.93 to 87.70 ± 7.59 (p < 0.05); ESS showed significant reduction from 10 ± 5.9 to 6.55 ± 5.18 (p < 0.05). Conclusion Our results showed a reduction in the insomnia scores of our COMISA subgroup and a significant post-operative improvement in ambulatory polysomograph variables. OSA and insomnia are strongly correlated and surgical treatment of OSA appears to be effective in reducing the insomnia burden in COMISA patients.

Background Eating disorders and psychotic disorders represent two of the most serious psychiatric conditions. Emerging lines of evidence from genetic and epidemiological studies suggest that these disorders may commonly co-occur. This systematic review investigated the association between these disorders across community and clinical populations. Method A systematic review was preregistered (CRD42021231771) and conducted according to PRISMA guidelines. Web of Science, PsycINFO and Medline were searched for articles on the association and comorbidity between psychosis and eating disorders up to the 26th February 2024. A random effects meta-analysis was conducted for studies reporting comorbidity of eating disorders and psychotic disorders based on clinical diagnosis or interview measures, to estimate prevalence of the comorbidity between these disorders. A narrative synthesis was conducted for all other studies and grouped by sample (general population, eating disorders or psychotic disorders). Results In total 43 studies met inclusion criteria for the systematic review and 16 were included in the meta-analysis. Findings suggest substantial comorbidity between eating disorders and psychotic disorders, with a pooled comorbidity prevalence of 8% (CI: 3, 14) based on clinical diagnosis or interview measures. Studies using self-report questionnaires also highlight the association between eating disorders and psychosis across clinical and community populations. Conclusions Eating disorders and psychotic disorders frequently co-occur. Further research should investigate the temporal order of symptom development and consider the need for novel interventions targeted at overlapping psychotic and eating disorder symptoms and associated phenomena.

Background Sleep disturbances are common for people with dementia and can be distressing for them and their family. People with dementia live with an average of five other long-term conditions (LTCs). Little is known about the impact of LTCs on dementia and sleep. We aimed to explore this within the DREAMS START (Dementia Related Manual for Sleep; Strategies for relatives) trial of a multi-component intervention delivered to family carers, to consider how symptoms of LTCs impacted on carer ability to implement DREAMS START intervention strategies. Method We conducted a qualitative interview study recruited participants from the intervention arm of the DREAMS START trial in English NHS sites. Participants were 17 family carers of people with dementia, other LTCs and sleep disturbances. We used a semi-structured topic guide and conducted interviews, analysed using reflective thematic analysis. Results We identified two overarching themes. Firstly, there was a complex interaction of LTCs, sleep and dementia. LTCs including pain, interacted with dementia symptoms to worsen sleep and physical symptoms. Carers reported dilemmas about whether to give analgesia, primarily understanding their relatives’ sleep disturbances in terms of dementia diagnosis. Secondly carers were exhausted from lack of sleep and physical health difficulties made it harder to, for example, increase daytime activity for their relative. Conclusions There is a complex relationship between LTCs, dementia and sleep and the effect of LTCs in someone with dementia may be underestimated. It is important that families know that people with dementia need adequate analgesia. In addition, tiredness and illness in family carers may mean they need support to implement strategies, or they will be unable to break the cycle of exhaustion.

Multidisciplinary teams (MDTs) and their meetings are central to cancer care and other chronic conditions: promoting treatment standardization, reducing geographical variability, and improving patient outcomes. However, increasing complexity, workload pressures, and resource constraints require effective leadership and chairing. Leadership sets strategic goals, shapes team culture, and drives long-term improvement, while chairing ensures operational efficiency through structured and efficient discussions. These complementary roles demand adaptive styles to balance inclusivity and efficiency within and beyond meetings. Transformational and facilitative leadership inspire innovation and collaboration, while directive approaches help maintain focus in high-pressure contexts. Human factors, including cognitive fatigue and authority gradients, influence MDT dynamics, highlighting the need for workflow optimization, shared responsibilities, and fatigue management. Equally important is empowering followers through training in communication and collaborative skills, which further mitigates power imbalances. By aligning chairing and leadership styles with meeting demands and integrating supportive technologies, MDTs can sustain their pivotal role in patient-centred care and achieve both strategic and operational success in cancer treatment planning.

As cities continue to expand and evolve, it becomes imperative to examine the intricate relationship of urbanization and suicidal behaviour. The chapter delves into what urbanization entails, global urbanization trends, followed by a thorough exploration of theoretical perspectives. From Durkheim's seminal work to more recent frameworks like the Three Step Theory and concept of Urban Stress, we trace the evolution of thought connecting urban life to suicidal tendencies. Central to this discussion is an exhaustive examination of key urban factors influencing suicidal behaviours. These include social fragmentation, economic disparities, population density, and environmental stressors unique to urban living. A range of interventions, from community-based initiatives fostering social cohesion to environmental modifications and economic measures, are described. Alongside these, role of mental health services, leveraging technology and urban planning to create more supportive city environments, has been described rigorously. The chapter concludes by identifying critical gaps in the current research landscape, advocating for future studies that explore the nuanced dynamics of urbanization and suicidality. This comprehensive examination aims to inform policymakers, mental health professionals, and researchers about the complexities of urbanization and its implications for suicidal behaviour.

Introduction: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary condition primarily caused by mutations on the NOTCH3 gene, leading to hypoperfusion and ischaemic events, with two-thirds of cases having lacunar infarcts mostly within the basal ganglia, thalamus, and brainstem. Here, we focus on an individual with CADASIL who had a thalamic stroke, which preceded symptoms of visual and somatic disturbances. Methods: A single-case report is used to describe the visual and somatic disturbances experienced by a 52-year-old gentleman following a left-sided thalamic stroke, who is genetically heterozygous for c449A > G p.(Tyr150Cys) mutation in the NOTCH3 gene consistent with CADASIL, as well as their response to various psychotropic medications, through information gathered from the patient's clinical records. Results: After trialling several antidepressants, and a trial of a cholinesterase inhibitor, there was no perceived benefit reported; with only lamotrigine, previously prescribed for thalamic pain, and olanzapine, providing the least amount of distress associated with their symptoms. Conclusions: As the management of CADASIL appears to focus on symptom control, this case highlights the need for further research to elucidate the mechanisms driving such unusual perceptual disturbances to inform potential future treatments.

Psychiatric crisis care is under great pressure, with the number of psychiatric presentations to emergency departments increasing and inpatient wards operating with occupancy rates above recommended levels. Internationally, hospital-based short-stay crisis units (named Psychiatric Decision Units; (PDU) in the UK) have been introduced to address these challenges, but the current evidence for their effectiveness is limited. We estimated the effects of PDUs in four geographic locations in England, linked to three National Health Service (NHS) mental health trusts and six NHS acute hospital trusts. Using national data sets to create synthetic controls from areas without PDUs (following the generalised synthetic control method), we estimated trust-wide changes to the primary outcomes of psychiatric inpatient admissions and psychiatric presentations to emergency departments (ED), compared to the synthetic controls, alongside secondary outcomes. We used meta-analysis to robustly combine outcomes. We analysed NHS hospital activity data for adults aged between 18 and 75 years covering 24 months preceding and following the introduction of each PDU (November 2012 to January 2021). We found no significant impacts of PDUs on primary outcomes, except at Sheffield Teaching Hospitals NHS Foundation Trust with 1.5 fewer psychiatric presentations to ED per 10,000 trust population per month (relative difference: 24.9%, p = 0.034) than the synthetic control. We found mixed effects of the opening of PDUs on secondary outcomes. Meta-analyses indicated a significantly lower mean length of stay for psychiatric admissions (-6.4 days, p < 0.001) for patients in mental health trusts with a PDU compared to the synthetic control and no significant effects on other outcomes. Heterogeneity of effect across sites probably reflects variation in PDU configuration and implementation. Further research should explore the intended aims of PDUs alongside how they operate in practice. Registration: The study is registered with the ISRCTN (ISRCTN77588384)

This chapter focuses on clinical assessment of spirituality in mental health settings. It is intended primarily for mental health professionals with different clinical backgrounds, although we hope it can be useful to other clinicians in different settings where spirituality is associated with mental health problems. A flexible schema is proposed through use of spiritual screening and history, followed by a formulation phase to help in articulating relationships between the patient’s spirituality and mental health experiences. A few psychotherapeutic ideas are then discussed which may be beneficial to the process of spiritual assessment. In giving spiritual assessment such a focus, we aim to offer techniques which may be useful in developing spiritual enquiry with patients, while also helping the clinician reflect on his/her own experiences. We also aim to show how spiritual assessment, in turn, can be therapeutic for patients by promoting capacity for curiosity and reflection, developing connections, and considering alternative perspectives. We conclude with a clinical vignette.

We examined associations between body mass index (BMI), waist circumference (WC), and dementia risk, and differences in BMI and WC trajectories before dementia diagnosis. We included 9,739 participants (54% women) aged 70+ from the Trøndelag Health Study (HUNT4 70+). BMI was measured four times (1984–2019) and WC three times (1995–2019). Dementia diagnoses were clinically assessed at HUNT4 70+ . Women and men with dementia had higher midlife BMI and WC than those without dementia. These differences diminished closer to diagnosis, especially in women. Midlife obesity in both sexes and midlife overweight, high WC, and overweight/obesity with high WC in men were linked to higher dementia risk. Lower dementia risk was observed with late-life overweight for both sexes, late-life high WC in women, late-life overweight/obesity with normal WC in men or high WC in women. Adiposity measures and their changes influence dementia risk differently in women and men.

Introduction Emotional disorders (ED) are highly prevalent worldwide. The PsicAP trial, conducted in Spain, demonstrated the benefits of adding transdiagnostic cognitive behavioural therapy (TD-CBT) to treatment as usual (TAU) for the attention of these disorders in primary care (PC). Here we describe the design of a stepped wedge randomized controlled trial (RCT), inspired by the PsicAP project. This RCT has two main aims: 1) to test the implementation of the PsicAP protocol in a real clinical setting, further evaluating possible mechanisms of change underlying the efficacy of TD-CBT (emotional regulation, alliance, and therapist experience and training), and 2) to assess the impact of psychotropic medication use on neuropsychological function and treatment outcomes. Methods A single-blind multicentre RCT with a stepped wedge design will be conducted. Participants (N=320) will be randomly assigned to an experimental group (EG1) or to a waiting list group (WG). The EG1 will receive immediate treatment and the WG will remain on the waiting list for 3 months. After this time, the WG will become a second experimental group (EG2) that will receive the same treatment as EG1 (PsicAP protocol). Patients will be assessed at post-treatment, at 3 and 9 months. Before starting treatment, a random subsample of patients (n=90) will undergo a neuropsychological assessment. These patients will be assigned to three groups based on their use of psychotropic medication at the time of randomization: no psychotropic medication, short-term use (< 3 months) and long-term use (≥ 3 months). All 90 participants will undergo the same neuropsychological assessment at one year. The RCT is expected to run from 01/05/23 to 01/10/25. Discussion The results of this trial are expected to provide further support for the efficacy of the PsicAP TD-CBT protocol, as well as insight into the mechanisms of change that lead to the positive therapeutic outcomes of this protocol. In addition, this study will help determine the effects of short- and long-term psychotropic use on neuropsychological function and therapeutic outcomes. In short, it is hoped that this RCT will help to better understand how to implement evidence-based psychological treatment in the PC setting. Trial registration EURADICT 2013-001955-11/ ISRCTN58437086.

Background Having a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process. Aims To assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose reduction versus maintenance treatment. Methods The trial involved participants with a diagnosis of schizophrenia or recurrent, non-affective psychosis. Relapse was defined as admission to hospital or significant deterioration (assessed by a blinded end-point committee). We analysed the relationship between relapse during the trial and social functioning, quality of life, symptom scores (Positive and Negative Syndrome Scale) and rates of being in employment, education or training at 24-month follow-up. We also analysed changes in these measures during the trial among those who relapsed and those who did not. Sensitivity analyses were conducted examining the effects of ‘severe’ relapse (i.e. admission to hospital). Results During the course of the trial, 82 out of 253 participants relapsed. There was no evidence for a difference between those who relapsed and those who did not on changes in social functioning, quality of life, symptom scores or overall employment rates between baseline and 24-month follow-up. Those who relapsed showed no change in their social functioning or quality of life, and a slight improvement in symptoms compared to baseline. They were more likely than those who did not relapse to have had a change in their employment status (mostly moving out of employment, education or training), although numbers changing status were small. Sensitivity analyses showed the same results for those who experienced a ‘severe’ relapse. Conclusions Our data provide little evidence that relapse has a detrimental effect in the long term in people with schizophrenia and recurrent psychosis.

Importance Identifying whether people of minoritized religious identities are less likely to benefit from psychological therapy is key to tackling inequalities in mental health treatment. Objective To assess inequalities in the effectiveness of routinely delivered psychological therapy across religious groups and by the intersections with ethnicity. Design, Setting, and Participants Retrospective cohort study including all patients who completed a course of treatment at 5 London-based National Health Service Talking Therapies for anxiety and depression (NHS TTad) services between 2011 and 2020. Individuals reported their religion using routine patient records collected by the services. Data were analyzed from September 2023 to October 2024. Exposures Self-identified religion was categorized into (1) no religion, (2) Christian, (3) Muslim, and (4) other (which was further categorized into Buddhist, Hindu, Jewish, Sikh, and any other in a sensitivity analysis). Ethnicity was conceptualized as a potential confounder and separately as an effect modifier. Self-reported ethnicity was categorized based on UK Census codes into Asian, Black, mixed race, White, and other ethnic groups. Main Outcomes and Measures Psychological treatment outcomes used to assess NHS TTad services nationally, including reliable recovery, recovery, and reliable deterioration. Dropout from treatment was also examined. These outcomes were defined based on pre-post treatment changes in depression and anxiety symptom measures according to national guidelines. Results A total of 70 098 patients with data on self-reported religion were included in the study (mean [SD] age at referral, 39.2 [14.1] years; 47 797 [68.2%] female). After adjusting for sociodemographic, treatment-related, and clinical characteristics, the odds of reliable recovery were higher in patients who did not have any religious belief (odds ratio [OR], 1.34; 95% CI, 1.26-1.42) or self-reported Christian (OR, 1.39; 95% CI, 1.31-1.48) and other religion (OR, 1.25; 95% CI, 1.17-1.34) compared with Muslim patients. While treatment outcomes improved each year in all groups, Muslim patients remained least likely to improve and more likely to deteriorate. There were interactions between religion and ethnicity; in particular, Muslim patients of White or other ethnic backgrounds had worse outcomes than Muslim patients of Asian, Black, or mixed race ethnic backgrounds and compared with non-Muslim patients of those ethnicities. Conclusions and Relevance In England, patients who identified as Muslim, and particularly those of White or other ethnicities, had poorer outcomes from psychological therapies for depression and anxiety disorders than patients who reported no religion or any other religion. This may be partly due to unmeasured characteristics that warrant further investigation (eg, nationality and asylum-seeking or refugee status). Best practice guidelines on working with people of minoritized ethnicities may inform some of the changes needed to reduce inequalities, but must address religious identity separate from ethnicity, as well as their intersections.

Background Metformin is a pharmacological candidate to mitigate second-generation antipsychotic (SGA)-induced weight gain in patients diagnosed with severe mental illnesses (SMI). Objective To determine the incidence, prevalence and demographic patterns of metformin co-prescription among patients diagnosed with SMI initiating SGAs. To estimate the impact of metformin co-prescription on weight over 2 years post-SGA initiation. Methods A cohort study of patients diagnosed with SMI initiating aripiprazole, olanzapine, quetiapine or risperidone in 2005–2019 using primary care data from Clinical Practice Research Datalink. We estimated cumulative incidence and period prevalences of co-prescription and explored prescribing differences by demographic and clinical factors. We compared weight change among patients prescribed an SGA-only versus an SGA plus metformin, accounting for confounders using linear regression. Findings Among 26 537 patients initiating SGAs, 4652 were ever prescribed metformin and 21 885 were not. The two-year incidence of first metformin prescription was 3.3%. The SGA plus metformin group were more ethnically diverse, had greater social deprivation, more comorbidities and higher baseline weight (mean 90.4 vs 76.8 kg). By 2 years post-SGA initiation, mean weight in the SGA-only group had changed by +4.16% (95% CI −1.26 to +9.58) compared with −0.65% (95% CI −4.26 to +2.96) in the SGA plus metformin group. After confounder adjustment, the 2-year mean difference in weight with metformin co-prescription was −1.48 kg (95% CI −4.03 to 1.07) among females and −1.84 kg (95% CI −4.67 to 0.98) among males. Conclusion Metformin is infrequently co-prescribed, despite apparent efficacy and guidelines. Clinical implications Primary and secondary care collaboration should be strengthened and barriers to co-prescribing addressed.

Background We rely heavily on cut-off points of brief measures of psychological distress in research and clinical practice to identify those at risk of mental health conditions; however, few studies have compared the performance of different scales. Aim To determine the extent to which the child- and parent-report Strength and Difficulty Questionnaire (SDQ), Revised Children’s Anxiety and Depression Scale (RCADS), short Mood and Feeling Questionnaire (sMFQ) and child-report KIDSCREEN correlated and identified the same respondents above cut-off points and at risk of mental health conditions. Method A cross-sectional survey was conducted among 231 children aged 11–16 years and 289 parents who completed all the above measures administered via a mobile app, MyJournE, including the SDQ, RCADS and sMFQ. Results The psychopathology measures identified similar proportions of young people as above the cut-off point and at risk of depression (child report 14.7% RCADS, 19.9% sMFQ, parent report 8.7% RCADS, 12.1% sMFQ), anxiety (child report 24.7% RCADS, 26.0% SDQ-Emotional subscale, parent report 20.1% RCADS, 26% SDQ-Emotional subscale) and child-report internalising problems (26.8% RCADS, 29.9% SDQ). Despite strong correlations between measures (child report 0.77–0.84 and parent report 0.70–0.80 between the SDQ, sMFQ and RCADS) and expected directions of correlation with KIDSCREEN and SDQ subscales, kappa values indicate moderate to substantial agreement between measures. Measures did not consistently identify the same children; half ( n = 36, 46%) of those on child report and a third ( n = 30, 37%) on parent report, scoring above the cut-off point for the SDQ-Emotional subscale, RCADS total or sMFQ, scored above the cut-off point on all of them. Only half ( n = 46, 54%) of the children scored above the cut-off point on child report by the SDQ-Internalising and RCADS total scales. Conclusion This study highlights the risk of using a screening test to ‘rule out’ potential psychopathology. Screening tests should not be used diagnostically and are best used together with broad assessment.

Decisions around psychiatric interventions for children and young people involve balancing respect for the child’s wishes, the need to provide benefit and relevant risk factors. We recommend establishing a framework for assessment of interventions for children with mental disabilities, using a human-rights-based approach that can be applied across jurisdictions, alongside national laws.

Objective Autism and eating disorders (ED) frequently co‐occur, particularly in women. Autistic individuals are often undiagnosed when they present to mental health services and many receive their autism diagnosis during or after ED treatment. This study sought to understand the experiences of autistic women with co‐occurring anorexia nervosa (AN) receiving an autism diagnosis. Method Secondary data analysis was conducted on 17 semi‐structured interviews with autistic women with AN using reflexive thematic analysis. Participants had a diagnosis of autism, had current or past experience of AN, were female‐identifying and aged 18 or above. Results Participants experienced missed opportunities for autism diagnosis along with misdiagnoses and misunderstandings from healthcare professionals. Participants tended to receive their diagnosis at the point of crisis and experienced being passed between autism and ED services. Receiving a diagnosis helped participants make sense of their experiences and take control of their lives but also brought feelings of shock and distress. Conclusions While autism diagnosis is often a positive experience for autistic women with AN, a range of emotions can be experienced. The findings highlight a need for better and earlier identification of autism among women with EDs, alongside appropriate post‐diagnosis support and ED treatment that is adapted to autistic individuals' needs.

Background There is evidence that attachment, trauma, and voice appraisals individually impact voice hearing in psychosis, but their intersectional relationship has not been examined. The aim of this study was to identify subgroups of individuals from the intersectional relationship between these factors and examine differences between subgroups on clinical outcomes. Methods A latent profile analysis was conducted on baseline data from the AVATAR2 trial ( n = 345), to identify statistically distinct subgroups of individuals with psychosis who hear distressing voices based on co-occurring patterns of trauma, fearful attachment, and voice appraisals. The association between profile membership and demographic characteristics, voice severity, posttraumatic stress disorder symptoms, emotional distress, and difficulties with motivation and pleasure was then examined. Experts by experience were consulted throughout the process. Results Four profiles were identified: ‘adverse voices and relational trauma’, ‘low malevolent and omnipotent voices’, ‘adverse voices yet low relational trauma’, and ‘high benevolent voices’. Negative voice appraisals occurred in the presence of high and low trauma and attachment adversities. The first profile was associated with being female and/or other non-male genders and had worse voice severity and emotional distress. High adversities and worse emotional distress occurred in the presence of voice benevolence and engagement. Black and South Asian ethnicities were not associated with specific profiles. Conclusions The identified profiles had negative and positive voice appraisals associated with higher and lower occurrence of adversities, and different clinical outcomes. These profiles could inform detailed case formulations that could tailor interventions for voice hearers.