Recent Submissions

  • How effective is group intervention in the treatment of unaccompanied and accompanied refugee minors with mental health difficulties: A systematic review

    Majumder, Pallab (2021)
    Background:Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited.Aims:To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions.Methods:Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population.Results:Seventeen papers met eligibility criteria with a total of N?=?1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM.Conclusions:The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed.
  • Inpatient institutional care: The forced social environment

    Crawford, Paul (2021)
    The landscape of mental health recovery is changing; there have been calls for a shift from the clinical expertise being the dominant voice within mental healthcare towards a more personalised and collaborative service that supports those in need of mental healthcare to define what recovery is for the individual. Within this new recovery movement, there has been a recognition of the importance of the social environment in which individuals are situated and the relationship of this to mental health and wellbeing. Included in this is the importance of an individual's role within society and the ways in which knowledge, such as experts by experience, can hold an important value. The argument then, is that social connectedness forms part of the recovery journey and that relationships can help us develop or re-connect with who we are in powerful ways. Such a view has only been strengthened by the recent and ongoing global COVID-19 pandemic. Within the UK, discussions of the importance of our wellbeing have become commonplace within the context of restricted social contact. With this heightened awareness of how the social contributes to wellbeing, it is important to consider the environments in which those in receipt of mental healthcare are situated. One of which is institutionalised care, where it is commonplace to restrict social contact. For example, by virtue of being within a locked environment, individuals' freedom of movement is often non-existent and thus contacts with those not residing or working within the institution is restricted. While such restrictions may be deemed necessary to protect the individual's mental health, such environments can be unintentionally toxic. Data are presented from an ethnography that was conducted within an inpatient forensic mental health hospital in the UK to highlight the problematic social environment which some individuals experience. Key interpersonal issues are presented, such as, trust, racism, the threat of physical violence and bullying that was experienced by staff and residents at the hospital. Consideration is given to the coping strategies enacted by residents and the pathologising of such behaviour. The consequences on interpersonal wellbeing are explored.
  • Clinical case formulation of suboptimal engagement

    Jones, Lawrence F.; Guha, Sunita (2020)
    Case formulation creates a coherent account of the complex array of events, situations, and circumstances within a person's lifetime which may impact upon their attitudes and behavior in the current setting. Case formulation in health settings can involve applying psychological concepts to understand the difficulties experienced by people seeking treatment and to identify ways in which these difficulties may be managed. This chapter presents a number of frameworks to support the formulation of complex patterns of engagement in healthcare treatment, as well as identifying significant factors which may be included in the formulation. The case has been made for a systematic attempt to think about the "why?" question in relation to suboptimal engagement. Why has this individual developed the views that they have, why do they feel the way they do and behave in the way they do? The case formulation will require the practitioner to work in collaboration with the person receiving care and to adopt an open-minded approach. Use of a recognized framework of factors to support the case formulation will help to ensure that the formulation is comprehensive and has considered a range of causal factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved) (Source: chapter)
  • Young people, living in care and adopted, talk about their experiences of receiving an nhs therapeutic intervention. Qualitative research analysed using interpretative phenomenological analysis

    Herring, Nicola (2021)
    This study explores the views and experiences of young people, adopted and in the care of a local authority who had received a therapeutic intervention from an NHS Attachment and Trauma Specialist Agency. Three children were interviewed, aged between 10 and 14 years, using semi‐structured interviews. The interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). The analysis of the results met with the findings in the literature that young people want to have access to non‐judgmental therapy which both meets their needs and is creative. Recommendations for clinicians include giving adequate preparatory information and ensuring on‐going collaboration with young people receiving therapeutic interventions through the use of on‐going feedback about what works for them. Practitioner points Practitioners should consider carefully how young people in public care are 'invited' to therapy, and give adequate pre‐session information to help to reduce anxiety. Children and young people in public care engaging in therapy prefer a practitioner style which is creative, playful and enjoyable. A systemic framework can be integrated with attachment and trauma focused models of intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved) (Source: journal abstract)
  • Beta-frequency electrophysiological bursts: BOLD correlates and relationships with psychotic illness

    Briley, Paul M.; Liddle, Elizabeth B. (2021)
    Aims To identify the BOLD (blood oxygenation level dependent) correlates of bursts of beta frequency band electrophysiological activity, and to compare BOLD responses between healthy controls and patients with psychotic illness. The post movement beta rebound (PMBR) is a transient increase in power in the beta frequency band (13-30 Hz), recorded with methods such as electroencephalography (EEG), following the completion of a movement. PMBR size is reduced in patients with schizophrenia and inversely correlated with severity of illness. PMBR size is inversely correlated with measures of schizotypy in non-clinical groups. Therefore, beta-band activity may reflect a fundamental neural process whose disruption plays an important role in the pathophysiology of schizophrenia. Recent work has found that changes in beta power reflect changes in the probability-of-occurrence of transient bursts of beta-frequency activity. Understanding the generators of beta bursts could help unravel the pathophysiology of psychotic illness and thus identify novel treatment targets. Method EEG data were recorded simultaneously with BOLD data measured with 3T functional magnetic resonance imaging (fMRI), whilst participants performed an n-back working memory task. We included seventy-eight participants – 32 patients with schizophrenia, 16 with bipolar disorder and 30 healthy controls. Beta bursts were identified in the EEG data using a thresholding method and burst timings were used as markers in an event-related fMRI design convolved with a conventional haemodynamic response function. A region of interest analysis compared beta-event-related BOLD activity between patients and controls. Result Beta bursts phasically activated brain regions implicated in coding task-relevant content (specifically, regions involved in the phonological representation of letter stimuli, as well as areas representing motor responses). Further, bursts were associated with suppression of tonically-active regions. In the EEG, PMBR was greater in controls than patients, and, in patients, PMBR size was positively correlated with Global Assessment of Functioning scores, and negatively correlated with persisting symptoms of disorganisation and performance on a digit symbol substition test. Despite this, patients showed greater, more extensive, burst-related BOLD activation than controls. Conclusion Our findings are consistent with a recent model in which beta bursts serve to reactivate latently-maintained, task-relevant, sensorimotor information. The increased BOLD response associated with bursts in patients, despite reduced PMBR, could reflect inefficiency of burst-mediated cortical synchrony, or it may suggest that the sensorimotor information reactivated by beta bursts is less precisely specified in psychosis. We propose that dysfunction of the mechanisms by which beta bursts reactivate task-relevant content can manifest as disorganisation and working memory deficits, and may contribute to persisting symptoms and impairment in psychosis.
  • Mental health-related police incidents: Results of a national census exercise in England and Wales

    Kane, Eddie (2021)
    BACKGROUND: The level of mental state incidents dealt with by police and the police resource involved is under-researched, often giving rise to un-evidenced claims around demand, response and resources. The 2019 National Police Chiefs' Council and College of Policing definition of such incidents provides a useful basis for more accurate calculation: 'Any police incident thought to relate to someone's mental health where their vulnerability is at the centre of the incident or where the police have had to do something additionally or differently because of it'. AIMS: To establish the nature and frequency of incidents involving the police when mental state is a primary reason for the involvement. METHODS: In this mixed methods study, we first analysed data from records in two mixed inner city/urban/rural forces and one large multi-local authority metropolitan force. Secondly, we made an in-depth analysis of a sample of mental state-related incidents (n = 320) in two of these forces. Thirdly, we took a 24-hour snapshot of all such incidents in England and Wales. RESULTS: Mental state-related incidents accounted for 5.1% of recorded police contacts from the public, rising to just 7.8% when confining attention only to contacts that generated a police response beyond taking the call and recording it. Length of time between an incident being reported and first response was similar between mental state-related and non-mental state-related incidents, but response to closure time was shorter for the former. CONCLUSIONS: While incidents relating to mental state problems do consume police resources, they do not represent disproportionate demand in terms of numbers or time spent. That said, only about a quarter of the police work recorded was related to possible crimes, and the possibility of conflating perception of wider social need with mental state problems may further account for an apparent mismatch between the perceived and actual proportion of the workload spent on these incidents.
  • Uses and misuses of recorded mental health lived experience narratives in healthcare and community settings: systematic review

    Yeo, Caroline; Rennick-Egglestone, Stefan; Franklin, Donna; Llewellyn-Beardsley, Joy; Ng, Fiona; Thorpe, Naomi; Slade, Mike (2021)
    Mental health lived experience narratives are first-person accounts of people with experience of mental health problems. They have been published in journals, books and online, and used in healthcare interventions and anti-stigma campaigns. There are concerns about their potential misuse. A four-language systematic review was conducted of published literature characterising uses and misuses of mental health lived experience narratives within healthcare and community settings. 6,531 documents in four languages (English, Danish, Swedish, Norwegian) were screened and 78 documents from 11 countries were included. 27 uses were identified in five categories: political, societal, community, service level and individual. Eleven misuses were found, categorised as relating to the narrative (narratives may be co opted, narratives may be used against the author, narratives may be used for different purpose than authorial intent, narratives may be reinterpreted by others, narratives may become patient porn, narratives may lack diversity), relating to the narrator (narrator may be subject to unethical editing practises, narrator may be subject to coercion, narrator may be harmed) and relating to the audience (audience may be triggered, audience may misunderstand). Four open questions were identified: does including a researcher’s personal mental health narrative reduce the credibility of their research?: should the confidentiality of narrators be protected?; who should profit from narratives?; how reliable are narratives as evidence?)
  • Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: A regression discontinuity in time design

    Nixon, Neil L. (2021)
    Objectives To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 'lockdown' policy in Spring 2020. Design A regression discontinuity in time (RDiT) analysis of daily service-level activity. Setting and participants Mental healthcare data were extracted from 10 UK providers. Outcome measures Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (AE). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 'lockdown' policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites. Results Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect. Conclusions MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences. Copyright © 2021 BMJ Publishing Group. All rights reserved.
  • Recorded mental health recovery narratives as a resource for people affected by mental health problems: Development of the Narrative Experiences Online (NEON) intervention

    Slade, Mike; Rennick-Egglestone, Stefan; Llewellyn-Beardsley, Joy; Yeo, Caroline; Roe, James; Hui, Ada; Grundy, Andrew; Charles, Ashleigh; Hare-Duke, Laurie (2021)
    BACKGROUND: The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs). OBJECTIVE: This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs. METHODS: Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made.RESULTSKI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8% (105/330) of narrative accesses. CONCLUSIONS: RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health.
  • Measuring recovery in Arabic countries: Translation of the self-efficacy for personal recovery scale

    Slade, Mike (2021)
    AIMTo translate the Self-Efficacy for Personal Recovery Scale (SEPRS) into Arabic and evaluate the psychometric properties of the Arabic version.METHODSAn established translation methodology was employed, involving back-translation, comparison, forward-translation, comparison, and piloting. The pre-final version of the Arabic translated scale was tested for clarity with young people with a primary diagnosis of mental health problem. The final Arabic version and standardized measures of hope and loneliness were administered to 119 young people in two rounds.RESULTSInternal consistency was adequate (Cronbach's alpha = 0.87 in round 1, 0.91 in round 2). Consistent with the English version, a one-factor solution best fitted the data. The correlation between SEPRS and hope was R = 0.60 (round 1) and R = 0.61 (round 2), indicating convergent validity. The correlation between SEPRS and loneliness was R = -0.52 (round 1) and R = -0.60 (round 2). Correlation between test and retest was R = -0.998 indicated adequate test-retest reliability. Minimal floor and ceiling effects were detected.CONCLUSIONThe use of the Arabic SEPRS with Arabic-speaking samples is supported. Further research to investigate divergent validity is warranted.
  • Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders

    Slade, Mike (2021)
    BACKGROUND: Personal recovery has become an increasingly important approach in the care of people with severe mental disorders and consequently in the orientation of mental health services. The objective of this study was to assess the personal recovery process in people using mental health services, and to clarify the role of variables such as symptomatology, self-stigma, sociodemographic and treatment. METHODS: Standardised measures of personal recovery process, clinical recovery, and internalized stigma were completed by a sample of 312 participants in a Severe Mental Disorder program. RESULTS: Users valued most the recovery elements of: improving general health and wellness; having professionals who care; hope; and sense of meaning in life. Significant discrepancies between perceived experience and relative importance assigned to each of the components of the REE were observed. Regression modeling (χ2 = 6.72, p = .394; GFI = .99, SRMR = .03) identified how positive discrepancies were associated with a higher presence of recovery markers (β = .12, p = .05), which in turn were negatively related to the derived symptomatology index (β = -.33, p < .001). Furthermore, the relationship between clinical and personal recovery was mediated by internalized stigma. CONCLUSIONS: An improvement in psychiatric services should be focused on recovery aspects that have the greatest discrepancy between importance and experience, in particular social roles, basic needs and hope. Personal and clinical recovery are correlated, but the relationship between them is mediated by internalized stigma, indicating the need for clinical interventions to target self-stigma.
  • Management of a high-performing mental health recovery research group

    Slade, Mike (2021)
    A personal perspective is given on the processes involved in managing and sustaining a high-performing mental health recovery research group. The broader context of scholarship in the United Kingdom is outlined, in which academic productivity is commodified specifically in relation to peer-reviewed journal papers. Four leadership choices in developing a high-performing research group are discussed: optimal group size; sharing the workload; maintaining a programmatic focus; and performance expectations. Approaches to maximising innovation are identified, including emotional and intellectual engagement of team members, working with diverse stakeholders and convening communities of practice. We use a highly managed approach to publications from inception to acceptance, which is described in detail. The use of these approaches is illustrated in relation to the Recovery Research Team which was formed in 2009. Specific recovery-related issues covered include demonstrating the ability to develop a significant recovery research portfolio (our four current large [>UK£2 m] studies relate to recovery narratives, global mental health peer support work, digital interventions and Recovery Colleges); the positive implications of actively recruiting researchers with mental health lived experience; how performance issues are managed; our approach to involving lived experience co-authors in papers; and our decision to conduct mixed-methods rather than solely qualitative studies.
  • Recognizing service users' diversity: social identity narratives of British Pakistanis in a mental health context

    Repper, Julie; Stickley, Theodore (2021)
    Purpose This study aims to investigate how British Pakistani people talk about their social identity, in the context of mental health, and how this shapes their experiences and perceptions of care delivered by the National Health Service, UK. Design/methodology/approach Eight narrative interviews were conducted among members of the Pakistani community living in a city in the UK. The data were analyzed using a narrative analysis approach using "social identity" as a theoretical lens. Findings Considering Pakistani service users as a single social entity, and responding with generic approaches in meeting their mental health needs, may not be helpful in achieving equitable treatment. Study participants reject a simple conceptualization of race and ethnicity and how a response based upon stereotypes is woefully inadequate. The study revealed that people from one ethnic or national background cannot be assumed to have a fixed social identity. Originality/value This study broadens understanding of how people from a single ethnic background may construct and view their social identities markedly different to others from the same ethnic group. This has implications for service providers in understanding how their clients' social identity is treated and understood in practice.
  • Measuring online wellbeing: A scoping review of subjective wellbeing measures

    Perez Vallejos, Elvira; Rawsthorne, Mat (2021)
    With the increasing importance of the internet to our everyday lives, questions are rightly being asked about how its' use affects our wellbeing. It is important to be able to effectively measure the effects of the online context, as it allows us to assess the impact of specific online contexts on wellbeing that may not apply to offline wellbeing. This paper describes a scoping review of English language, peer-reviewed articles published in MEDLINE, EMBASE, and PsychInfo between 1st January 2015 and 31st December 2019 to identify what measures are used to assess subjective wellbeing and in particular to identify any measures used in the online context. Two hundred forty studies were identified; 160 studies were removed by abstract screening, and 17 studies were removed by full-text screening, leaving 63 included studies. Fifty-six subjective wellbeing scales were identified with 18 excluded and 38 included for further analysis. Only one study was identified researching online wellbeing, and no specific online wellbeing scale was found. Therefore, common features of the existing scales, such as the number and type of questions, are compared to offer recommendations for building an online wellbeing scale. Such a scale is recommended to be between 3 and 20 questions, using mainly 5-point Likert or Likert-like scales to measure at least positive and negative affect, and ideally life satisfaction, and to use mainly subjective evaluation. Further research is needed to establish how these findings for the offline world effectively translate into an online measure of wellbeing.
  • Perspectives on mental health recovery from Egyptian mental health professionals: A qualitative study

    Ng, Fiona; Slade, Mike (2021)
    INTRODUCTION: Recovery-oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. AIM: To explore perspectives of Egyptian mental health professionals on recovery METHOD: Semi-structured interviews were conducted with 15 mental health professionals identified through snowball sampling. RESULTS: The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self-awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. DISCUSSION: The concept of functional recovery predominates amongst nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. IMPLICATIONS FOR PRACTICE: There is a need nurses to be involved in designing intervention programs targeting the general public, and to support increased involvement of people with mental health issues.
  • Supporting women's sexual safety in acute mental health settings

    McGarry, Julie (2021)
    Sexual safety in mental health settings is being increasingly recognised as a complex issue and a crucial aspect of organisational and practice responsibilities. However, concerns have been raised in relation to sexual safety for service users admitted to mental health inpatient wards in the UK. While sexual safety is a concern for everyone, the experiences and nature of concerns may vary across different groups and between individuals. It is also acknowledged that although interest in sexual safety is increasing, there remains limited evidence available from the perspectives of those who use mental health services. This article defines sexual safety and discusses its various components, and discusses a project that was undertaken to explore women’s perspectives and experiences of sexual safety in inpatient mental health settings. It also provides recommendations for maintaining sexual safety in clinical practice.
  • Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65

    Junaid, Kehinde; Mittal, Shweta (2021)
    Introduction: The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number and type referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult. Method(s): We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. We described trends in the number, rate, age, mental health presentation, and time taken to assessment over a 7 years period. Result(s): Referral data from 28 EDs across England and Scotland were analysed (n = 18,828 referrals). There was a general trend towards increasing numbers of people referred to liaison psychiatry year on year. Variability in referral numbers between different departments, ranged from 0.1 to 24.3 per 1000 ED attendances. The most common reasons for referral were mood disorders, self-harm and suicidal ideas. The majority of referrals were assessed within 60 min, however there is variability between departments, some recording waits over 11 h. Discussion(s): The data suggests great inter-departmental variability in referral numbers. Is not possible to establish the cause of variability. However, the data highlights the importance of asking further questions about why the differences exist, and the impact that has on patient care.
  • Systematic review and meta-analysis: The science of early-life precursors and interventions for attention-deficit/hyperactivity disorder

    Idrees, Iman; Groom, Madeleine J. (2021)
    Objective: To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions. Method: We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0−5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges’ g) and pre-post-treatment change scores (SMD) were computed. Results: A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = −0.46 [95% CIs: −0.59, −0.33]), motor (g = −0.35 [CIs: −0.48, −0.21]) and language (g = −0.43 [CIs: −0.66, −0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to −0.87 [CIs: −1.35, −0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69]). Conclusion: Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study. © 2021 American Academy of Child & Adolescent Psychiatry
  • Institutional injustice: Implications for system transformation emerging from the mental health recovery narratives of people experiencing marginalisation

    Hui, Ada; Rennick-Egglestone, Stefan; Franklin, Donna; Llewellyn-Beardsley, Joy; Ng, Fiona; Roe, James; Yeo, Caroline; Deakin, Emilia; Pollock, Kristian; Slade, Mike (2021)
    Background Institutional injustice refers to structures that create disparities in resources, opportunities and representation. Marginalised people experience institutional injustice, inequalities and discrimination through intersecting personal characteristics and social circumstances. This study aimed to investigate sources of institutional injustice and their effects on marginalised people with experience of mental health problems. Methods Semi-structured interviews were conducted with 77 individuals from marginalised groups with experience of mental health problems, including psychosis, Black, Asian and minority ethnic (BAME) populations, complex needs and lived experience as a work requirement. These were analysed inductively enabling sensitising concepts to emerge. Findings Three processes of institutional injustice were identified: not being believed because of social status and personal backgrounds; not being heard where narratives did not align with dominant discourses, and not being acknowledged where aspects of identity were disregarded. Harmful outcomes included disengagement from formal institutions through fear and mistrust, tensions and reduced affiliation with informal institutions when trying to consolidate new ways of being, and damaging impacts on mental health and wellbeing through multiple oppression. Conclusions Institutional injustice perpetuates health inequalities and marginalised status. Master status, arising from dominant discourses and heuristic bias, overshadow the narratives and experiences of marginalised people. Cultural competency has the potential to improve heuristic availability through social understandings of narrative and experience, whilst coproduction and narrative development through approaches such as communities of practice might offer meaningful avenues for authentic expression.
  • Social connectedness in adults with mental disorders: ecological validation of a conceptual framework for novel complex interventions

    Hare-Duke, Laurie; Dening, Tom; Slade, Mike (2021)
    BACKGROUND: Social connectedness interventions may improve the clinical outcomes and personal recovery of adults with mental disorders but many interventions lack a clear theory-base and show limited effectiveness. AIM: To evaluate the validity of a newly developed conceptual framework (the CIVIC framework: Closeness, Identity, Valued relationships, Involvement and Cared for and accepted) to function as the theory-base for novel social connectedness-based mental health interventions. METHOD: Semi-structured interviews with adults with diagnostically heterogeneous mental disorders (n = 13) and mental health professionals (n = 9). Participants reported their social connectedness experiences, their views on the CIVIC framework and potential targets for new interventions. Sequential inductive and deductive thematic analyses were used. Data quality was assessed through respondent validation.: RESULTS: Both inductive and deductive analyses provided validation of the CIVIC framework. Additional themes of Stigma and Connectedness beyond social relationships were identified in the inductive analysis. Candidate interventions to target each CIVIC domain were identified.CONCLUSIONSThe CIVIC framework demonstrates ecological validity and can therefore serve as the theory-base for the development of novel social connectedness-based interventions. This study indicates that interventions would be most effective when they incorporate evidence-based approaches which target each of the categories described by the CIVIC framework.

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