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Importance: Traditional observational epidemiological studies have consistently found an association between tobacco use, cannabis use and subsequent mental ill-health. However, the extent to which this association reflects an increased risk of new-onset mental ill-health is unclear and may be biased by unmeasured confounding. Objective: To examine the association between cannabis use, tobacco use and risk of incident mood, anxiety, and psychotic disorders, and explore risk of bias. Data Sources: CINAHL, Embase, MEDLINE, PsycINFO and ProQuest Dissertation and Theses were searched from inception until November 2022, in addition to supplementary searches. Study Selection: Longitudinal studies assessing tobacco use and cannabis use and their association with incident mood, anxiety or psychotic disorders were included. Studies conducted in populations selected on health status (e.g., pregnancy) or other highly-selected characteristics (e.g., incarcerated persons) were excluded. Data Extraction and Synthesis: A modified Newcastle Ottawa Scale was used to assess study quality. The confounder matrix and E-Values were used to assess potential bias due to unmeasured confounding. Summary risk ratios (RR) were calculated in random-effects meta-analyses using the generic inverse variance method. Main Outcome(s) and Measure(s): Exposures were measured via self-report and defined through status (e.g., current use) or heaviness of use (e.g., cigarettes per day). Outcomes were measured through symptom-based scales, interviews, registry codes and self-reported diagnosis or treatment. Effect estimates extracted were risk of incident disorders by exposure status. Results: Seventy-five out of 27789 records were included. Random effects meta-analysis demonstrated a positive association between tobacco use and mood disorder (RR:1.39, 95%CI:1.30,1.47) and psychotic disorder (RR:3.45, 95%CI:2.63,4.53), but not anxiety disorder (RR:1.21, 95%CI:0.87,1.68). Cannabis use was positively associated with psychotic disorders (RR:3.19, 95%CI:2.07,4.90), but not mood disorders (RR:1.31, 95%CI:0.92,1.86) or anxiety disorders (RR:1.10, 95%CI:0.99,1.22). Confounder matrix and E-value assessment indicated estimates were moderately biased by unmeasured confounding. Conclusions and Relevance: This systematic review and meta-analysis presents evidence for a longitudinal, positive association between both substances and incident psychotic disorders and tobacco use and mood disorders. There was no evidence to support an association between cannabis use and common mental health conditions. Existing evidence across all outcomes was limited by inadequate adjustment for potential confounders. Future research should prioritise methods allowing for stronger causal inference, such as Mendelian randomization and evidence triangulation.

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BackgroundHealth warning labels on tobacco packaging are a cost-effective means of health risk communication. However, while an extensive range of physical health risks are well-portrayed via current tobacco health warnings in the UK, there are none that currently portray the negative impact of smoking on mental health.Aims(i) develop novel mental health warning labels for tobacco packaging and (ii) test perceptions of these warnings in smokers and non-smokers, with and without mental health problems.MethodsSix mental health warning labels were developed with a consultancy focus group. These warning labels were tested in an online randomised experiment, where respondents (N = 687) rated six Mental Health Warning Labels (MHWLs) and six Physical Health Warning Labels (PHWLs) on measures of perceived effectiveness, believability, arousal, valence, acceptability, reactance and novelty of information.ResultsMHWLs were perceived as low to moderately effective (mean = 4.02, SD = 2.40), but less effective than PHWLs (mean = 5.78, SD = 2.55, p < 0.001, ηp2 = 0.63). MHWLs were perceived as less believable, arousing, unpleasant, and acceptable than PHWLs. MHWLs evoked more reactance and were rated as more novel. Perceptions of MHWLs did not differ in people with and without mental health problems except for reactance and acceptability, but consistent with the PHWL literature, perceptions of MHWLs differed between non-smokers and smokers.ConclusionMHWLs could be an effective means to communicate novel information about the effects of smoking on mental health. MHWLs are perceived as less effective, believable, arousing, unpleasant, and acceptable than PHWLs, but MHWLs evoke more reactance and are rated as more novel.

BACKGROUND This systematic review takes a transdiagnostic approach to synthesising the current, high-quality evidence of parent-led psychosocial interventions for children with neurodevelopmental disorders (NDDs). OBJECTIVE This study aims to inform the development of a novel intervention targeting psychosocial skills of children with Developmental Language Disorder (DLD), for whom there is no current support for the high levels of psychosocial difficulties they experience. METHODS Thirty-seven interventions met the pre-specified inclusion criteria; trials must have compared interventions to a control group, or have an eight-week follow-up, must have been published in English after 2000, with participants aged 2-13 years old who met diagnostic criteria for seven specified NDDs. For inclusion, interventions also had to include discrete parent-led components and measures of child psychosocial outcomes. Synthesis of evidence included: participant characteristics, intervention procedures, psychosocial outcomes of both child and parent, intervention contents, active components and quality of evidence. The Child Psychosocial Skills Taxonomy was also developed and used to understand the active components commonly used across the evidence-based interventions. RESULTS All interventions that met criteria were designed for children with autism spectrum disorder (n=17) or attention deficit hyperactive disorder (n=20). Interventions ranged hugely in their length (2-50 weeks; 3-34 sessions) and delivery (individual vs. group sessions; online vs. face-to-face sessions). Four intervention components were most used across effective interventions: parent-child interaction training, teaching parenting behaviours and emotion management for both parent and child. An association between parent wellbeing and improved child psychosocial outcomes is suggested, however this association is limited by the lack of data provided. Therapeutic and researcher contact appears to have a role in improving intervention engagement. Accessibility issues are discussed, with some studies reporting a bias in engagement towards families with higher education and lower life stressors, but higher symptom severity. CONCLUSIONS Evidence-based psychosocial interventions are required for children with NDDs other than autism spectrum disorder and attention deficit hyperactivity disorder. The active components identified should be considered in future intervention development, alongside therapeutic contact. Future studies need to improve accessibility of interventions to those from lower income and educational backgrounds, and those with more life stressors.