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Camp J, Durante G, Cooper A, Smith P, Rimes KA. Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme. Behav Cogn Psychother 2024:1-19. [PMID: 38586939 DOI: 10.1017/s135246582400016x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people. AIMS This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK). METHOD Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms. RESULTS SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions. DISCUSSION These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.
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Affiliation(s)
- J Camp
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Micheal Rutter Centre, Maudsley Hospital, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - G Durante
- Department of Psychology, Goldsmiths University of London, Lewisham Way, London, UK
| | - A Cooper
- Department of Psychology, Goldsmiths University of London, Lewisham Way, London, UK
| | - P Smith
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
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Ghapanchi A, Abasi I, Rimes KA, Bitarafan M, Zarabi H, Derakhshan FS, Derakhshan MK, Ghanadanzadeh S, Whitley H, Shamsi A. Psychometric Evaluation of a Persian Version of Beliefs about Emotions Scale in Community and Clinical Samples. Iran J Psychiatry 2024; 19:89-98. [PMID: 38420278 PMCID: PMC10896760 DOI: 10.18502/ijps.v19i1.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 03/02/2024]
Abstract
Objective: This research is primarily conducted to determine the psychometric properties of the Beliefs about Emotions Scale (BES) in community and clinical samples. The BES is a scale measure used for evaluating individuals' beliefs in terms of how acceptable it is for them to experience and express their emotions. Method : This study was conducted on two separate samples. In the first part, 300 individuals were selected from a general sample in Tehran using the quota sampling method. For the second part of the study, we used purposive sampling to gather data from 119 patients suffering from Major Depressive Disorder (MDD) and 121 patients from Somatic Symptoms Disorder (SSD), whose disorders were diagnosed based on the DSM-5 diagnostic criteria. The BES structural validity was examined through Confirmatory Factor Analysis (CFA). Additionally, test-retest composite and internal consistency indices were explored to investigate the reliability of the BES score. Finally, the associations of the BES score with the Hospital Anxiety and Depression Scale (HADS), Young Schema Questionnaire (YSQ), Multidimensional Perfectionism Scale (MPS), Difficulties in Emotion Regulation Scale (DERS), and Emotion Regulation Questionnaire (ERQ) scores were highlighted to investigate the discriminant and convergent validity of the BES score. Results: According to CFAs, the one-factor model for the BES demonstrated a good fit with the data collected from both the clinical and community samples. The internal consistency (Cronbach's alpha) was satisfactory in the community sample (α = 0.84) and the clinical samples of SSD (α = 0.86) and MDD (α = 0.83). The community sample demonstrated high overall test-retest reliability (ICC = 0.93, P < 0.001; 95% CI: 0.89 - 0.95). In terms of convergent validity, the findings confirmed that in the MMD sample, there was a significant relationship between the BES and almost all measures (including Depression (r = 0.39, P < 0.01), Anxiety (r = 0.21, P < 0.05), Self-Sacrifice (r = 0.27, P < 0.01), MPS-total score (r = 0.22, P < 0.05), DERS total score (r = 0.50, P < 0.01), and Suppression (r = 0.38, P < 0.01). However, in the SSD group, this finding was not found. Conclusion: The results demonstrated that the Persian BES is a reliable and valid scale of maladaptive beliefs about emotions which could be implemented for both clinical and research aims.
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Affiliation(s)
- Ala Ghapanchi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Psychiatric Department, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Imaneh Abasi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maryam Bitarafan
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Zarabi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Kamran Derakhshan
- Psychosomatic Department, Taleqani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Ghanadanzadeh
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Helena Whitley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alireza Shamsi
- Department of Psychiatry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Camp J, Morris A, Wilde H, Smith P, Rimes KA. Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience. Cogn Behav Therap 2023; 16:s1754470x23000326. [PMID: 38125010 PMCID: PMC7615396 DOI: 10.1017/s1754470x23000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.
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Affiliation(s)
- J Camp
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - A Morris
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - H Wilde
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - P Smith
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
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Rimes KA, Smith P, Bridge L. Low self-esteem: a refined cognitive behavioural model. Behav Cogn Psychother 2023; 51:579-594. [PMID: 37170762 DOI: 10.1017/s1352465823000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Melanie Fennell's (1997) seminal cognitive approach to low self-esteem was published in Behavioural and Cognitive Psychotherapy. The current paper proposes a refined model, drawing on social theories, and research with people with socially devalued characteristics. This model emphasises how self-esteem relates to perceptions of one's value in the eyes of others. It is proposed that core beliefs typical of low self-esteem relate to one's value in relation to personal adequacy (e.g. having worth or status) and/or to social connection (e.g. being liked, loved, accepted or included). In each of these value domains, beliefs about both the self (e.g. 'I am a failure', 'I am unlovable') and others (e.g. 'Others look down on me', 'Others don't care about me') are considered important. The model suggests that everyone monitors their value but in people with low self-esteem, cognitive biases associated with underlying beliefs occur. In the context of trigger situations, this results in a greater likelihood of negative appraisals of perceived threat to one's value. Such appraisals activate underlying negative beliefs, resulting in negative mood (e.g. low mood, anxiety, shame, disgust) and other responses that maintain low self-esteem. Responses which can be used excessively or in unhelpful ways include (a) corrective behaviours; (b) compensatory strategies; (c) increased value monitoring; (d) safety-seeking behaviours; (e) rumination; (f) unhelpful mood regulation responses. These responses can adversely impact daily functioning or health, having the counterproductive effect of maintaining negative beliefs about one's value. Examples are provided for low self-esteem in lesbian, gay and bisexual individuals.
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Affiliation(s)
- Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Livia Bridge
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
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Skelton M, Carr E, Buckman JEJ, Davies MR, Goldsmith KA, Hirsch CR, Peel AJ, Rayner C, Rimes KA, Saunders R, Wingrove J, Breen G, Eley TC. Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems. Psychol Med 2023; 53:6183-6193. [PMID: 36510471 PMCID: PMC10520600 DOI: 10.1017/s0033291722003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/22/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class. METHODS Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership. RESULTS Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average. CONCLUSIONS Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.
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Affiliation(s)
- Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joshua E. J. Buckman
- Research Department of Clinical, Centre for Outcomes Research and Effectiveness (CORE), Educational and Health Psychology, University College London, London, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Molly R. Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Colette R. Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alicia J. Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Rayner
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rob Saunders
- Research Department of Clinical, Centre for Outcomes Research and Effectiveness (CORE), Educational and Health Psychology, University College London, London, UK
| | - Janet Wingrove
- Talking Therapies Southwark, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Thalia C. Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Bridge L, Langford K, McMullen K, Rai L, Smith P, Rimes KA. Acceptability, feasibility and preliminary efficacy of a compassion-based cognitive behavioural intervention for low self-esteem in sexual minority young adults. Clin Psychol Psychother 2023. [PMID: 37705342 DOI: 10.1002/cpp.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
Low self-esteem can impair daily functioning and is a risk or maintenance factor for several mental health problems. Sexual minority young adults, for example, those identifying as lesbian, gay or bisexual, on average have lower self-esteem than their heterosexual peers. Compassion-based interventions for low self-esteem might be especially beneficial for sexual minority young adults, whose higher levels of shame and self-criticism are likely to be contributing to maintenance of their low self-esteem. This study explored the acceptability, feasibility and preliminary efficacy of a new compassion-based cognitive behavioural intervention for low self-esteem tailored to sexual minority young adults. Participants were a community sample of 24 sexual minority young adults aged 16-24 experiencing clinically significant low self-esteem. An uncontrolled pre-/post-design was used with qualitative feedback and quantitative outcomes. Self-report standardised measures were completed at baseline, pre-intervention, intervention mid-point, post-intervention and 2-month follow up. Preliminary efficacy was examined through post-intervention changes in self-esteem, functioning, anxiety and depression. Potential mechanisms of change were examined through changes in self-compassion, self-criticism and unhelpful coping responses to minority stress. Results showed good acceptability and feasibility and preliminary evidence of intervention efficacy for improving self-esteem, functioning, depression and anxiety. There was evidence for improvement in self-compassion and reduction in self-criticism, and these constructs could be investigated in future studies as treatment mediators. Randomised controlled studies are needed to further examine efficacy of the intervention.
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Affiliation(s)
- Livia Bridge
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katie Langford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katrina McMullen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lovedeep Rai
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Harwood H, Rhead R, Chui Z, Bakolis I, Connor L, Gazard B, Hall J, MacCrimmon S, Rimes KA, Woodhead C, Hatch SL. Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychol Med 2023; 53:1084-1095. [PMID: 34334151 PMCID: PMC9976018 DOI: 10.1017/s0033291721002518] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. METHODS This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. RESULTS Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. CONCLUSIONS Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
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Affiliation(s)
- Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service & Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jheanell Hall
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Rayner C, Coleman JRI, Skelton M, Armour C, Bradley J, Buckman JEJ, Davies MR, Hirsch CR, Hotopf M, Hübel C, Jones IR, Kalsi G, Kingston N, Krebs G, Lin Y, Monssen D, McIntosh AM, Mundy JR, Peel AJ, Rimes KA, Rogers HC, Smith DJ, Ter Kuile AR, Thompson KN, Veale D, Wingrove J, Walters JTR, Breen G, Eley TC. Patient characteristics associated with retrospectively self-reported treatment outcomes following psychological therapy for anxiety or depressive disorders - a cohort of GLAD study participants. BMC Psychiatry 2022; 22:719. [PMID: 36401199 PMCID: PMC9675224 DOI: 10.1186/s12888-022-04275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Progress towards stratified care for anxiety and depression will require the identification of new predictors. We collected data on retrospectively self-reported therapeutic outcomes in adults who received psychological therapy in the UK in the past ten years. We aimed to replicate factors associated with traditional treatment outcome measures from the literature. METHODS Participants were from the Genetic Links to Anxiety and Depression (GLAD) Study, a UK-based volunteer cohort study. We investigated associations between retrospectively self-reported outcomes following therapy, on a five-point scale (global rating of change; GRC) and a range of sociodemographic, clinical and therapy-related factors, using ordinal logistic regression models (n = 2890). RESULTS Four factors were associated with therapy outcomes (adjusted odds ratios, OR). One sociodemographic factor, having university-level education, was associated with favourable outcomes (OR = 1.37, 95%CI: 1.18, 1.59). Two clinical factors, greater number of reported episodes of illness (OR = 0.95, 95%CI: 0.92, 0.97) and higher levels of personality disorder symptoms (OR = 0.89, 95%CI: 0.87, 0.91), were associated with less favourable outcomes. Finally, reported regular use of additional therapeutic activities was associated with favourable outcomes (OR = 1.39, 95%CI: 1.19, 1.63). There were no statistically significant differences between fully adjusted multivariable and unadjusted univariable odds ratios. CONCLUSION Therapy outcome data can be collected quickly and inexpensively using retrospectively self-reported measures in large observational cohorts. Retrospectively self-reported therapy outcomes were associated with four factors previously reported in the literature. Similar data collected in larger observational cohorts may enable detection of novel associations with therapy outcomes, to generate new hypotheses, which can be followed up in prospective studies.
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Affiliation(s)
- Christopher Rayner
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Cherie Armour
- Research Centre for Stress Trauma & Related Conditions (STARC), School of Psychology, Queen's University Belfast (QUB), Belfast, Northern Ireland, UK
| | - John Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, WC1E 7HB, London, UK
- iCope - Camden & Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, St Pancras Hospital, NW1 0PE, London, UK
| | - Molly R Davies
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Aarhus Business and Social Sciences, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Ian R Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Nathalie Kingston
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Georgina Krebs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - Yuhao Lin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jessica R Mundy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Daniel J Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Abigail R Ter Kuile
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Katherine N Thompson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - Janet Wingrove
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
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9
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Amirova A, Rimes KA, Hackett RA. Perceived discrimination in middle-aged and older adults: Comparison between England and the United States. Front Public Health 2022; 10:975776. [PMID: 36438296 PMCID: PMC9685535 DOI: 10.3389/fpubh.2022.975776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives This study examined differences in perceived discrimination across multiple characteristics in England and the United States (US), in middle- and older-aged adults. Methods Using data from the English Longitudinal Study of Aging (N = 8,671) and the US-based Health and Retirement Study (N = 7,927), we assessed cross-national differences in perceived discrimination attributed to disability, financial status, sex, race, sexual orientation, and weight. We also compared how perceived discrimination varied with socioeconomic position (SEP) based on wealth. Results Perceived discrimination due to financial status was more common in England (6.65%) than in the US (2.14%) adjusting for age, sex, and wealth [Odds Ratio (OR) = 1.09, 95% CI (1.07; 1.10)]. This affected people of low but not high SEP. Sexual orientation discrimination was more common in England [0.72 vs. 0.15%, OR = 4.61, 95% CI (2.48; 8.57)]. Sex-based perceived discrimination was more prevalent in the US (12.42%) than England (9.07%) adjusting for age and wealth [OR = 0.87, 95% CI (0.86; 0.89)]. Cross-national differences in sex discrimination did not vary with SEP. Racism was the most common type of perceived discrimination reported in both samples (England: 17.84%, US: 19.80%), with no significant cross-national differences after adjustment for sex. Discussion Perceived discrimination attributed to financial status and sexual orientation were more prevalent in England, while more women perceived sex discrimination in the US. This study suggests that country-specific and socioeconomic factors affect the prevalence of perceived discrimination. This may be relevant when targeting interventions aimed at reducing perceived discrimination.
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10
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Gnan G, Rahman Q, Rimes KA. Cognitive and behavioural factors contributing to distress in LGBTQ+students: a prospective mediation study. Int Rev Psychiatry 2022; 34:274-281. [PMID: 36151826 DOI: 10.1080/09540261.2022.2058871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We applied a cognitive behavioural therapy (CBT) model of psychological distress and examined cognitive and behavioural predictors and mediators of depression, anxiety and suicidality among lesbian, gay, bisexual, trans, queer and other sexual or gender minority (LGBTQ+) students. LGBTQ + university students (N = 385) completed questionnaires at baseline, 1 and 2 months. Structural equation modelling (SEM) was used to test the relationship between baseline negative beliefs (about the self, others and the future) and depression, anxiety and suicidality 2 months later, via cognitive and behavioural response mediators (perseverative thinking, avoidance and self-compassion) assessed at 1 month. The final model demonstrated acceptable fit: χ2 (16) = 73.36, p < .001, comparative fit index (CFI)=0.96, Tucker-Lewis index (TLI)=0.93, root-mean-square error of approximation (RMSEA) = 0.09 (90% CI [0.07-0.12]), standardized root-mean-square residual (SRMR) = 0.04, accounting for significant variance in depression/anxiety (48%) and suicidality (27%). For depression/anxiety, negative beliefs had a direct effect and an indirect effect via perseverative thinking and avoidance. For suicidality, negative beliefs had a direct effect. A cognitive behavioural conceptualization may improve our knowledge of the psychological mechanisms involved in depression, anxiety and suicidality in LGBTQ + students. Negative beliefs about the self, others or the future, perseverative thinking, and avoidance are promising targets for prevention and treatment.
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Affiliation(s)
- Georgina Gnan
- Department of Psychology, King's College London, London, UK
| | - Qazi Rahman
- Department of Psychology, King's College London, London, UK
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11
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Abstract
Sexual minorities (individuals with a lesbian, gay, bisexual, queer, or other non-heterosexual identity) are at elevated risk of developing common mental health disorders relative to heterosexual people, yet have less favourable mental health service experiences and poorer treatment outcomes. We investigated the experiences of sexual minority service users accessing mental health services for common mental health problems (e.g. depression or anxiety) in the UK. We recruited 26 sexual minority adults with experiences of being referred to Improving Access to Psychological Therapies (IAPT) or primary care counselling services. Semi-structured interviews explored participants' experiences of service use and views on service development. Interviews were analysed using thematic analysis. Barriers to effective relationships with practitioners included service users' fears surrounding disclosure, and practitioners' lack of understanding and/or neglect of discussions around sexuality. Regarding service development, participants highlighted the value of seeing practitioners with shared identities and experiences, visible signs of inclusivity, sexual minority training, tailored supports, and technological adjuncts. Our findings offer insights into possible contributory factors to treatment inequalities, and highlight potential methods for improving service provision for sexual minorities.
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Affiliation(s)
- Daniel D A Morris
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Fernandes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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12
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Bridge L, Smith P, Rimes KA. Sexual minority young adults' perspectives on how minority stress and other factors negatively affect self-esteem: a qualitative interview study. Int Rev Psychiatry 2022; 34:383-391. [PMID: 36151832 PMCID: PMC9519118 DOI: 10.1080/09540261.2022.2051444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sexual minority young adults (lesbian, gay and bisexual), are at increased risk of experiencing mental health problems than their heterosexual peers. On average they also have lower self-esteem which may contribute to the development or maintenance of mental illnesses. Interventions to improve self-esteem could improve well-being and reduce mental ill-health risk in sexual minority young adults. It is important to understand the processes that contribute to lower self-esteem in this population. The present study aimed to explore these processes. Semi-structured qualitative interviews were conducted with a sample of 20 sexual minority young adults (age 16-24 years) with a range of self-esteem levels. Using thematic analysis, three overarching areas were idenitified: 'Negative social evaluations and reduced belonging', 'Striving and failing to meet standards', and 'Negative sexual orientation processes'. These findings have theoretical implications for minority stress models of mental health inequalities, highlighting the potential interaction between minority-specific and more general risk factors for mental health problems. Findings also have clinical implications for the development of tailored interventions to help improve low self-esteem in sexual minority young adults.
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Affiliation(s)
- Livia Bridge
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Katharine A. Rimes
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,CONTACT Katharine A. Rimes Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, UK
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13
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Warren AS, Goldsmith KA, Rimes KA. Childhood gender-typed behaviour, sexual orientation, childhood abuse and post-traumatic stress disorder: a prospective birth-cohort study. Int Rev Psychiatry 2022; 34:360-375. [PMID: 36151838 DOI: 10.1080/09540261.2022.2064211] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
ALSPAC birth-cohort data were analysed to assess prospective associations between childhood gender nonconformity (CGN), childhood/adolescent abuse, and adulthood PTSD symptoms. Structural equation models assessed whether abuse mediated the relationship between CGN and PTSD. Sex and sexual orientation differences were investigated. For females, higher parent-rated CGN at 30, 42 and 57-months was associated with mother-reported abuse, self-reported physical/psychological abuse, and/or self-reported sexual abuse. Higher CGN at 30-months was associated with more PTSD symptoms at 23 years. Self-rated CGN in males and females, and parent-rated CGN in males, were not associated with abuse or PTSD. Sexual minority identification was associated with higher CGN and abuse and for females, PTSD symptoms. In females, the relationship between greater CGN at 30-months and PTSD symptoms was separately mediated by each abuse variable. Self-reported sexual abuse was no longer a significant mediator after sexual orientation adjustment. Self-reported physical/psychological abuse significantly mediated the association alone when it was entered together with mother-reported abuse, even after sexual orientation adjustment. In conclusion, childhood gender nonconformity in females may increase the risk for adult PTSD symptoms, possibly mediated by childhood abuse. In females, mediation of the relationship between CGN and PTSD by sexual abuse may be particularly relevant for sexual minority individuals.
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Affiliation(s)
- Anna-Sophia Warren
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kimberley A Goldsmith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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14
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Abstract
Research on mental health inequalities between sexual minority and heterosexual young adults has historically focussed on the additional stress processes that might explain this disparity. However, more recently there has been a shift towards research focussed on resilience factors that might promote mental health in sexual minority young adults. Self-esteem is one such proposed resilience factor. This study aimed to explore the factors that promote or protect self-esteem itself in sexual minority young adults. A semi-structured interview study was conducted with 20 sexual minority young adults (aged 16-24) to explore their perspectives on the factors, responses and strategies that have helped to protect or promote their self-esteem. Six themes were identified from thematic analysis: helpful responses to minority stress; sexuality acceptance; positive LGBTQ + social connections and representations; positive social relationships and evaluation; successes and positive qualities and general coping strategies for low self-esteem. Findings are discussed in terms of their theoretical implications.
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Affiliation(s)
- Livia Bridge
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,CONTACT Livia Bridge Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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15
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Camp J, Vitoratou S, Rimes KA. The Self-Acceptance of Sexuality Inventory (SASI): Development and validation. Psychology of Sexual Orientation and Gender Diversity 2022. [DOI: 10.1037/sgd0000445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Langford K, McMullen K, Bridge L, Rai L, Smith P, Rimes KA. A cognitive behavioural intervention for low self-esteem in young people who have experienced stigma, prejudice, or discrimination: An uncontrolled acceptability and feasibility study. Psychol Psychother 2022; 95:34-56. [PMID: 34459089 PMCID: PMC9292341 DOI: 10.1111/papt.12361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/05/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES Stigma has been found to be associated with lower self-esteem, which increases the risk of difficulties across life domains including vulnerability to mental health problems. There are no previous studies of interventions for people experiencing low self-esteem in the context of different stigmatized characteristics. This study evaluated feasibility, acceptability, and preliminary outcomes of an intervention targeting low self-esteem in stigmatized people aged 16-24 years. DESIGN An uncontrolled study with repeated measures. METHOD People with a range of stigmatized characteristics, who had low self-esteem and associated impaired daily functioning, were recruited from the general population. The individual six-session cognitive behavioural intervention had modules chosen according to participants' formulations. The CBT included compassion-focussed therapy methods and was informed by stigma research. Feasibility was assessed in relation to recruitment, retention, and protocol adherence. Acceptability was assessed through participant feedback. Questionnaires assessing self-esteem, functioning impairments, depression, anxiety, self-criticism, self-compassion, and responses to prejudice and discrimination were administered at baseline, pre-, mid-, post-intervention, and two-month follow-up. RESULTS Forty-four people completed screening; 73% were eligible. Of these, 78% consented and 69% (N = 22) started the intervention. Eighteen (82%) participants completed, and four dropped out. Follow-up measures were completed by all treatment completers. Treatment completers reported the intervention was useful, improved their self-esteem and coping, and would recommend it. Ratings of usefulness and frequency of use of intervention components were high at post-treatment and follow-up. CONCLUSIONS The intervention was feasible and highly acceptable to treatment completers. This suggests the intervention warrants investigation in a randomized-controlled trial. PRACTITIONER POINTS Young people with low self-esteem whom have been negatively affected by stigma may wish to access support and be willing to engage in psychological interventions. Cognitive behavioural therapy may be helpful for young people with low self-esteem who have experienced stigma, prejudice, or discrimination. Cognitive behavioural techniques such as self-compassionate thought records and behavioural experiments were considered acceptable and helpful by young people whose self-esteem has been affected by stigma. Addressing responses to stigma in therapy, such as rumination, avoidance, and perfectionism, appears to be feasible and acceptable.
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Affiliation(s)
- Katie Langford
- Department of PsychologyInstitute of Psychology, Psychology & NeuroscienceKing’s College LondonUK,South London and Maudsley NHS Foundation Trust, Bethlem Royal HospitalBeckenhamUK
| | - Katrina McMullen
- Department of PsychologyInstitute of Psychology, Psychology & NeuroscienceKing’s College LondonUK,South London and Maudsley NHS Foundation Trust, Bethlem Royal HospitalBeckenhamUK
| | - Livia Bridge
- Department of PsychologyInstitute of Psychology, Psychology & NeuroscienceKing’s College LondonUK
| | - Lovedeep Rai
- Department of PsychologyInstitute of Psychology, Psychology & NeuroscienceKing’s College LondonUK,South London and Maudsley NHS Foundation Trust, Bethlem Royal HospitalBeckenhamUK
| | - Patrick Smith
- Department of PsychologyInstitute of Psychology, Psychology & NeuroscienceKing’s College LondonUK,South London and Maudsley NHS Foundation Trust, Bethlem Royal HospitalBeckenhamUK
| | - Katharine A. Rimes
- Department of PsychologyInstitute of Psychology, Psychology & NeuroscienceKing’s College LondonUK,South London and Maudsley NHS Foundation Trust, Bethlem Royal HospitalBeckenhamUK
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17
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Lucassen MFG, Samra R, Rimes KA, Brown KE, Wallace LM. Promoting Resilience and Well-being Through Co-design (The PRIDE Project): Protocol for the Development and Preliminary Evaluation of a Prototype Resilience-Based Intervention for Sexual and Gender Minority Youth. JMIR Res Protoc 2022; 11:e31036. [PMID: 35103613 PMCID: PMC8848231 DOI: 10.2196/31036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sexual and gender minority youth (SGMY) are at an increased risk of a range of mental health problems. However, few evidence-informed interventions have been developed specifically to support their mental well-being. Interventions that are evidence-informed for the general population and are fine-tuned specifically with SGMY in mind proffer considerable potential. A particular opportunity lies in the delivery of engaging interventions on the web, where the focus is on enhancing the coping skills and building the resilience of SGMY, in a way that is directly relevant to their experiences. On the basis of earlier work related to an intervention called Rainbow SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), we seek to create a new resource, especially for SGMY in the United Kingdom. OBJECTIVE This project has 3 main objectives. First, together with SGMY as well as key adult experts, we aim to co-design a media-rich evidence-informed web-based SGMY well-being prototype toolkit aimed at those aged between 13 and 19 years. Second, we will explore how the web-based toolkit can be used within public health systems in the United Kingdom by SGMY and potentially other relevant stakeholders. Third, we aim to conduct a preliminary evaluation of the toolkit, which will inform the design of a future effectiveness study. METHODS The first objective will be met by conducting the following: approximately 10 interviews with SGMY and 15 interviews with adult experts, a scoping review of studies focused on psychosocial coping strategies for SGMY, and co-design workshops with approximately 20 SGMY, which will inform the creation of the prototype toolkit. The second objective will be met by carrying out interviews with approximately 5 selected adult experts and 10 SGMY to explore how the toolkit can be best used and to determine the parameters and user-generated standards for a future effectiveness trial. The final objective will be met with a small-scale process evaluation, using the think out loud methodology, conducted with approximately 10 SGMY. RESULTS The study commenced on September 1, 2021, and data gathering for phase 1 began in October 2021. CONCLUSIONS A considerable body of work has described the issues faced by the SGMY. However, there is a dearth of research seeking to develop interventions for SGMY so that they can thrive. This project aims to co-design such an intervention. TRIAL REGISTRATION Research Registry Reference researchregistry6815; https://www.researchregistry.com/browse-the-registry#home/registrationdetails/609e81bda4a706001c94b63a/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/31036.
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Affiliation(s)
- Mathijs F G Lucassen
- Department of Health and Social Care, The Open University, Milton Keynes, United Kingdom
| | - Rajvinder Samra
- Department of Health and Social Care, The Open University, Milton Keynes, United Kingdom
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katherine E Brown
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | - Louise M Wallace
- Department of Health and Social Care, The Open University, Milton Keynes, United Kingdom
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18
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Loades ME, Chalder T, Smakowski A, Rimes KA. Anticipation of and response to exercise in adolescents with CFS: An experimental study. J Psychosom Res 2021; 146:110490. [PMID: 33892206 DOI: 10.1016/j.jpsychores.2021.110490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Using a laboratory-based exercise task, this study investigated objective exercise performance as well as expectations, anxiety and perceived task performance ratings in adolescents with CFS compared to healthy controls and illness controls. METHOD Trials of a sit-stand exercise task (SST) were undertaken (CFS: n = 61, asthma (AS): n = 31, healthy adolescents (HC): n = 78). Adolescents rated their expectations, pre- and post-task anxiety, and perceived task difficulty. Their parents independently rated their performance expectations of their child. RESULTS The CFS group took significantly longer to complete the SST than the AS group (MD 3.71, 95% CI [2.41, 5.01] p < .001) and HC (MD 3.61, 95% CI [2.41, 4.81], p < .001). Adolescents with CFS had lower expectations for their performance on the exercise task than AS participants (MD -11.79, 95% CI [-22.17, -1.42] p = .022) and HC (MD -15.08, 95% CI [-23.01, -7.14] p < .001). They rated their perceived exertion as significantly greater than AS (MD 3.04, 95% CI [1.86, 4.21] p < .001) and HC (MD 2.98, 95% CI [1.99, 3.98], p < .001). The CFS group reported greater anxiety pre-task than AS (MD 14.11, 95% CI [5.57, 22.65] p < .001) and HC (MD 11.19, 95% CI [2.64, 19.75], p. = 007). Parental group differences showed similar patterns to the adolescents''. CONCLUSIONS Lower expectations and greater anxiety regarding exercise may reflect learning from previous difficult experiences which could impact future exercise performance. Further examination of pre-exercise expectations and post-exercise appraisals could improve our understanding of the mechanisms by which fatigue is maintained.
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Affiliation(s)
| | - T Chalder
- King's College London, UK; South London & Maudsley Hospital NHS Foundation Trust, UK
| | - A Smakowski
- South London & Maudsley Hospital NHS Foundation Trust, UK
| | - K A Rimes
- King's College London, UK; South London & Maudsley Hospital NHS Foundation Trust, UK.
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19
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Timmins L, Rimes KA, Rahman Q. Is Being Queer Gay? Sexual Attraction Patterns, Minority Stressors, and Psychological Distress in Non-Traditional Categories of Sexual Orientation. J Sex Res 2021; 58:599-611. [PMID: 33307829 DOI: 10.1080/00224499.2020.1849527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study examined characteristics of cisgender people who use non-traditional sexual orientation labels and investigated minority stress in these groups. Pansexual (n = 160), queer (n = 80), and asexual (n = 98) participants were compared with heterosexual (n = 1,021), bisexual (n = 1,518), and lesbian/gay (n = 2,730) individuals recruited from a cross-sectional survey. Participants were compared on sexual attraction, age, gender and childhood gender nonconformity. Hierarchical regression models with psychological distress as the dependent variable and outness, prejudice events, expectations of rejection, self-stigma, and rumination as independent variables were then tested in pansexual, queer, and asexual individuals. Sexual attraction, age, gender and recalled childhood gender nonconformity were significant predictors of group identity. Pansexual individuals were not significantly distinct from bisexual individuals in sexual attraction. Queer individuals fell between bisexual and lesbian/gay individuals in sexual attraction scores. Prejudice events and rumination were significantly associated with distress in all three non-traditional groups. Rumination scores attenuated the relationship between prejudice events and distress in all groups. These findings help characterize pansexual, asexual and queer individuals and suggest indirect effects of prejudice events on distress via rumination represent a worthy avenue for future minority stress research in these groups.
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Affiliation(s)
- Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Psychology, King's College London
| | | | - Qazi Rahman
- Department of Psychology, King's College London
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20
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Argyriou A, Goldsmith KA, Rimes KA. Mediators of the Disparities in Depression Between Sexual Minority and Heterosexual Individuals: A Systematic Review. Arch Sex Behav 2021; 50:925-959. [PMID: 33689086 PMCID: PMC8035121 DOI: 10.1007/s10508-020-01862-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 09/18/2020] [Accepted: 10/07/2020] [Indexed: 05/20/2023]
Abstract
Evidence suggests that sexual minorities (e.g., those identifying as lesbian, gay, or bisexual) experience increased rates of depression compared to heterosexual individuals. Minority stress theory suggests that this disparity is due to stigma experienced by sexual minorities. Stigma processes are proposed to contribute to reduced coping/support resources and increased vulnerability processes for mental health problems. This review provided a systematic examination of research assessing the evidence for mediating factors that help explain such disparities. A literature search was conducted using the databases PubMed, PsycINFO, and Web of Science. The review included 40 identified studies that examined mediators of sexual minority status and depressive outcomes using a between-group design (i.e., heterosexual versus sexual minority participants). Studies of adolescents and adult samples were both included. The most common findings were consistent with the suggestion that stressors such as victimization, harassment, abuse, and increased stress, as well as lower social and family support, may contribute to differing depression rates in sexual minority compared to heterosexual individuals. Differences in psychological processes such as self-esteem and rumination may also play a role but have had insufficient research attention so far. However, caution is needed because many papers had important methodological shortcomings such as the use of cross-sectional designs, inferior statistical analyses for mediation, or measures that had not been properly validated. Although firm conclusions cannot be drawn, the current evidence base highlights many factors potentially suitable for further exploration in high-quality longitudinal research or randomized studies intervening with the potential mediators.
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Affiliation(s)
- Angeliki Argyriou
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Kimberley A Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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21
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Camp J, Vitoratou S, Rimes KA. Correction to: LGBQ+ Self-Acceptance and Its Relationship with Minority Stressors and Mental Health: A Systematic Literature Review. Arch Sex Behav 2021; 50:385. [PMID: 33067697 PMCID: PMC7919772 DOI: 10.1007/s10508-020-01861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jake Camp
- Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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22
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Loades ME, Rimes KA, Chalder T. Sleep problems in adolescents with CFS: A case-control study nested within a prospective clinical cohort. Clin Child Psychol Psychiatry 2020; 25:816-832. [PMID: 32441119 PMCID: PMC7116133 DOI: 10.1177/1359104520918364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep problems have a negative impact on a range of outcomes and are very common in adolescents with chronic fatigue syndrome (CFS). We aimed to (a) establish whether adolescents with CFS have more self-reported sleep problems than illness controls as well as healthy controls, (b) investigate changes in sleep problems and (c) explore the extent to which sleep problems at baseline predict fatigue and functioning at follow-up in adolescents with CFS. The Insomnia Scale was completed by 121 adolescents with CFS, 78 healthy adolescents and 27 adolescents with asthma. Eighty (66%) treatment-naïve adolescents with CFS completed questionnaires approximately 3 months later. Adolescents with CFS reported increased sleep problems compared to healthy controls and adolescents with asthma. In CFS, there was no significant change in sleep problems without treatment over a 3-month follow-up. Sleep problems at baseline predicted a significant proportion of the variance in sleep problems at follow-up. Sleep problems should be targeted in treatment. Regulating the 'body clock' via the regulation of sleep could influence outcomes not assessed in this study such as school attainment.
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Affiliation(s)
- Maria Elizabeth Loades
- Department of Psychology, University of Bath, UK.,Bristol Medical School, University of Bristol, UK
| | - Katharine A Rimes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London & Maudsley NHS Foundation Trust, UK
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Camp J, Vitoratou S, Rimes KA. LGBQ+ Self-Acceptance and Its Relationship with Minority Stressors and Mental Health: A Systematic Literature Review. Arch Sex Behav 2020; 49:2353-2373. [PMID: 32504233 PMCID: PMC7497468 DOI: 10.1007/s10508-020-01755-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 05/27/2023]
Abstract
Many individuals who identify as lesbian, gay, bisexual, queer, and with other non-heterosexual orientations (LGBQ+) experience stigma, prejudice, and/or discrimination because of their sexuality. According to minority stress and identity development theories, these experiences can contribute to difficulties with self-acceptance of sexuality. Lower self-acceptance is considered a risk factor for adverse mental health outcomes. The current review aims to investigate whether self-acceptance of sexuality is associated with minority stressors or difficulties with mental health in LGBQ+ individuals, as well as whether there are differences in self-acceptance between different sexual orientations. Five bibliographic databases were searched. Thirteen studies were identified which used quantitative methodology to investigate associations between self-acceptance, minority stressors, and/or mental health within LGBQ+ samples, or differences in self-acceptance between different sexual orientations. The results from these cross-sectional studies suggested that lower self-acceptance of sexuality was associated with higher levels of self-reported minority stressors, including a lack of acceptance from friends and family, a lack of disclosure to others, and internalized heterosexism. Lower self-acceptance of sexuality was associated with poorer mental health outcomes, including greater global distress, depression symptoms, and lower psychological well-being. There was no significant relationship with suicidality. Studies also found that LGBQ+ individuals had lower general self-acceptance compared to heterosexual participants, bisexual individuals had lower sexuality self-acceptance compared to lesbian/gay individuals, and lesbian women had lower sexuality self-acceptance compared to gay men. Given the potential importance of self-acceptance for LGBQ+ populations, further research is required with more robust methodology. Self-acceptance could be a potential target in clinical interventions for LGBQ+ individuals.
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Affiliation(s)
- Jake Camp
- Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Armstrong L, Henderson C, Rimes KA. Development and psychometric validation of the Discrimination and Prejudice Responses Scale; the DAPR. Stigma and Health 2020. [DOI: 10.1037/sah0000204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Timmins L, Rimes KA, Rahman Q. Minority Stressors, Rumination, and Psychological Distress in Lesbian, Gay, and Bisexual Individuals. Arch Sex Behav 2020; 49:661-680. [PMID: 31332645 PMCID: PMC7031186 DOI: 10.1007/s10508-019-01502-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 05/24/2023]
Abstract
This study tested the mechanisms by which social stigma contributes to psychological distress in lesbian, gay, and bisexual individuals. A large community sample (N = 4248, M age = 29.9 years, 42.9% female, 57.1% male, 35.7% bisexual, 64.3% lesbian/gay, 9.9% non-white) was recruited using targeted and general advertisements for an online cross-sectional survey. Participants completed measures of childhood gender nonconformity, prejudice events, victimization, microaggressions, sexual orientation concealment, sexual orientation disclosure, expectations of rejection, self-stigma, rumination, and distress. Structural equation modeling was used to test the relationships between these variables in a model based upon minority stress theory and the integrative mediation framework with childhood gender nonconformity as the initial independent variable and distress (depression, anxiety, and well-being) as the final dependent variable. The results broadly support the hypothesized model. The final model had good fit χ2(37) = 440.99, p < .001, TLI = .96, CFI = .98, RMSEA = .05 [.05, .06] and explained 50.2% of the variance in psychological distress and 24.8% in rumination. Sexual orientation and gender had moderating effects on some individual paths. Results should be considered in the context of the cross-sectional nature of the data, which prevented tests of causality, and self-report measures used, which are vulnerable to bias. Findings indicate strong relationships between minority stressors and psychological distress in lesbian, gay, and bisexual individuals, which are partially accounted for by rumination. These results may inform the development of interventions that address the added burden of minority stress among lesbian, gay, and bisexual individuals.
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Affiliation(s)
- Liadh Timmins
- Department of Psychology, Institute of Psychiatry, King's College London, 5th Floor, Bermondsey Wing, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, King's College London, Denmark Hill, London, UK
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, King's College London, 5th Floor, Bermondsey Wing, Guy's Hospital Campus, London, SE1 9RT, UK
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26
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Bridge L, Smith P, Rimes KA. Sexual orientation differences in the self-esteem of men and women: A systematic review and meta-analysis. Psychology of Sexual Orientation and Gender Diversity 2019. [DOI: 10.1037/sgd0000342] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Davies MR, Kalsi G, Armour C, Jones IR, McIntosh AM, Smith DJ, Walters JTR, Bradley JR, Kingston N, Ashford S, Beange I, Brailean A, Cleare AJ, Coleman JRI, Curtis CJ, Curzons SCB, Davis KAS, Dowey LRC, Gault VA, Goldsmith KA, Bennett MH, Hirose Y, Hotopf M, Hübel C, Kanz C, Leng J, Lyall DM, Mason BD, McAtarsney-Kovacs M, Monssen D, Moulton A, Ovington N, Palaiologou E, Pariante CM, Parikh S, Peel AJ, Price RK, Rimes KA, Rogers HC, Sambrook J, Skelton M, Spaul A, Suarez ELA, Sykes BL, Thomas KG, Young AH, Vassos E, Veale D, White KM, Wingrove J, Eley TC, Breen G. The Genetic Links to Anxiety and Depression (GLAD) Study: Online recruitment into the largest recontactable study of depression and anxiety. Behav Res Ther 2019; 123:103503. [PMID: 31715324 PMCID: PMC6891252 DOI: 10.1016/j.brat.2019.103503] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/04/2019] [Accepted: 10/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Anxiety and depression are common, debilitating and costly. These disorders are influenced by multiple risk factors, from genes to psychological vulnerabilities and environmental stressors, but research is hampered by a lack of sufficiently large comprehensive studies. We are recruiting 40,000 individuals with lifetime depression or anxiety and broad assessment of risks to facilitate future research. METHODS The Genetic Links to Anxiety and Depression (GLAD) Study (www.gladstudy.org.uk) recruits individuals with depression or anxiety into the NIHR Mental Health BioResource. Participants invited to join the study (via media campaigns) provide demographic, environmental and genetic data, and consent for medical record linkage and recontact. RESULTS Online recruitment was effective; 42,531 participants consented and 27,776 completed the questionnaire by end of July 2019. Participants' questionnaire data identified very high rates of recurrent depression, severe anxiety, and comorbidity. Participants reported high rates of treatment receipt. The age profile of the sample is biased toward young adults, with higher recruitment of females and the more educated, especially at younger ages. DISCUSSION This paper describes the study methodology and descriptive data for GLAD, which represents a large, recontactable resource that will enable future research into risks, outcomes, and treatment for anxiety and depression.
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Affiliation(s)
- Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Chérie Armour
- School of Psychology, Queens University Belfast (QUB), Belfast, Northern Ireland, UK
| | - Ian R Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Sofie Ashford
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ioana Beange
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Anamaria Brailean
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Anthony J Cleare
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Charles J Curtis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Susannah C B Curzons
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Katrina A S Davis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Le Roy C Dowey
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK; GreenLight Pharmaceuticals Limited, Unit 2, Block E, Nutgrove Office Park, Dublin 14, Ireland
| | - Victor A Gault
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK
| | - Kimberley A Goldsmith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Megan Hammond Bennett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Yoriko Hirose
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carola Kanz
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jennifer Leng
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bethany D Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Monika McAtarsney-Kovacs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Alexei Moulton
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Nigel Ovington
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Elisavet Palaiologou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Carmine M Pariante
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Shivani Parikh
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Ruth K Price
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Jennifer Sambrook
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Anna Spaul
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Eddy L A Suarez
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Bronte L Sykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Keith G Thomas
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK
| | - Allan H Young
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Evangelos Vassos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Katie M White
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Janet Wingrove
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
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Abstract
BACKGROUND Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships. METHOD In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling. RESULTS Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex. CONCLUSIONS Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.
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Affiliation(s)
- O A Oginni
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Jones
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Q Rahman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Rimes KA, Ion D, Wingrove J, Carter B. Sexual orientation differences in psychological treatment outcomes for depression and anxiety: National cohort study. J Consult Clin Psychol 2019; 87:577-589. [PMID: 31219292 DOI: 10.1037/ccp0000416] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study investigates whether sexual minority patients have poorer treatment outcomes than heterosexual patients in England's Improving Access to Psychological Therapies (IAPT) services. These services provide evidence-based psychological interventions for people with depression or anxiety. METHOD National routinely collected data were analyzed for a cohort who had attended at least 2 treatment sessions and were discharged between April 2013-March, 2015. Depression, anxiety and functional impairment were compared for 85,831 women (83,482 [97.2%] heterosexual; 1,285 [1.5%] lesbian; 1,064 [1.2%] bisexual) and 47,092 men (44,969 [95.5%] heterosexual; 1,734 [3.7%] gay; 389 [0.8%] bisexual). Linear and logistic models were fitted adjusting for baseline scores, and sociodemographic and treatment characteristics. RESULTS Compared to heterosexual women, lesbian and bisexual women had higher final-session severity for depression, anxiety, and functional impairment and increased risk of not attaining reliable recovery in depression/anxiety or functioning (aORs 1.3-1.4) and reliable improvement in depression/anxiety or functioning (aORs 1.2-1.3). Compared to heterosexual and gay men, bisexual men had higher final-session severity for depression, anxiety, and functioning and increased risk of not attaining reliable recovery for depression/anxiety or functioning (aORs 1.5-1.7) and reliable improvement in depression/anxiety or functioning (aORs 1.3-1.4). Gay and heterosexual men did not differ on treatment outcomes. Racial minority lesbian/gay or bisexual patients did not have significantly different outcomes to their White lesbian/gay or bisexual counterparts. CONCLUSIONS The reasons for treatment outcome inequities for bisexual patients and lesbian women (e.g., 30-70% increased risk of not recovering) need investigation. Health services should address these inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Denisa Ion
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Janet Wingrove
- Talking Therapies Southwark, South London and Maudsley NHS Foundation Trust
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London
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Loades ME, Rimes KA, Ali S, Chalder T. Author response to letter to the editor. Clin Child Psychol Psychiatry 2019; 24:941-942. [PMID: 31266344 DOI: 10.1177/1359104519853860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maria Elizabeth Loades
- Department of Psychology, University of Bath, UK.,Bristol Medical School, University of Bristol, UK
| | - Katharine A Rimes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London & Maudsley NHS Trust, UK
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Warren AS, Goldsmith KA, Rimes KA. Childhood gender-typed behavior and emotional or peer problems: a prospective birth-cohort study. J Child Psychol Psychiatry 2019; 60:888-896. [PMID: 30907437 DOI: 10.1111/jcpp.13051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retrospective and cross-sectional studies often report associations between childhood gender nonconformity and greater emotional and peer difficulties. This study used the ALSPAC birth cohort to investigate relationships between childhood gender-typed behavior and peer and emotional problems throughout childhood and adolescence. METHODS A total of 11,192 participants had at least one measure of parent-rated gender-typed behavior in infancy; 7,049 participants had a measure of child-rated gender-typed behavior at 8.5 years. Separate linear mixed regression models were fitted to assess whether parent-rated and child-rated gender-typed behaviors were associated with emotional and peer problems across childhood and adolescence (6-16 years old). The effect of adding covariates (self-esteem, abuse, bullying, feeling accepted by peers, and feeling different) on these relationships was assessed. RESULTS For boys, more gender-nonconforming behavior was associated with greater subsequent emotional and peer problems in childhood and adolescence. Adjusting for self-esteem, relational bullying victimization, feeling different, or feeling accepted by peers reduced some of these associations. In contrast, for girls, more gender-nonconforming behavior was associated with fewer emotional problems in childhood and adolescence. In girls, self-reported gender-nonconforming behavior was also associated with fewer parent-rated peer problems but parent-rated gender-nonconforming behavior was associated with more parent-rated peer problems; this latter association was partly explained by self-esteem, bullying, and abuse victimization. These associations were statistically significant but small. CONCLUSIONS Overall, more female-typical behaviors were generally associated with greater subsequent emotional and peer problems, for both boys and girls. Future studies should investigate factors that reduced these associations, as well as potential negative effects of female-typical behaviors or advantages of male-typical ones. As this was a 14-year longitudinal study, the relationships between gender-role behaviors and emotional/peer problems warrant further research despite the small association sizes.
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Affiliation(s)
- Anna-Sophia Warren
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kimberley A Goldsmith
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Loades ME, Rimes KA, Ali S, Chalder T. Depressive symptoms in adolescents with chronic fatigue syndrome (CFS): Are rates higher than in controls and do depressive symptoms affect outcome? Clin Child Psychol Psychiatry 2019; 24:580-592. [PMID: 30945566 PMCID: PMC7099942 DOI: 10.1177/1359104519838584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Previous research has indicated that co-morbid depression is common in adolescents with chronic fatigue syndrome (CFS). OBJECTIVES We sought to compare the characteristics of depressive symptoms in adolescents with CFS to those of healthy controls (HCs) and illness controls (adolescents with asthma). DESIGN Case-control study nested within a prospective clinical cohort. METHODS A total of 121 adolescents with CFS who attended an initial assessment at two specialist CFS units completed the Children's Depression Inventory (CDI). Their responses were compared to 80 HCs and 27 adolescents with asthma (illness controls). The clinical cohort of adolescents with CFS completed questionnaires at assessment, and those who were seen subsequently for treatment at the CFS unit (68%) completed the measures again at their first treatment session. RESULTS CFS participants scored significantly higher on all the depression subscales than participants with asthma and HCs. Depression score explained 11% of the variance in subsequent fatigue, but only 1.9% of the variance in physical functioning. Depression score also explained most (68%) of the variance in subsequent depression. CONCLUSION Depressive symptoms are more prominent in adolescents with CFS than in HCs or illness controls. These symptoms also appear to remain over time during a naturalistic follow-up where no treatment was provided. This highlights the need for further research into depression in CFS, including stratifying treatment outcomes by depression status to determine what is effective at addressing these symptoms.
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Affiliation(s)
- Maria Elizabeth Loades
- 1 Department of Psychology, University of Bath, UK.,2 Bristol Medical School, University of Bristol, UK
| | - Katharine A Rimes
- 3 King's College London, UK.,4 South London and Maudsley NHS Foundation Trust, UK
| | - Sheila Ali
- 4 South London and Maudsley NHS Foundation Trust, UK
| | - Trudie Chalder
- 3 King's College London, UK.,4 South London and Maudsley NHS Foundation Trust, UK
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Loades ME, Rimes KA, Ali S, Lievesley K, Chalder T. Does fatigue and distress in a clinical cohort of adolescents with chronic fatigue syndrome correlate with fatigue and distress in their parents? Child Care Health Dev 2019; 45:129-137. [PMID: 30342433 DOI: 10.1111/cch.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Previous studies have found that parents of children with chronic fatigue syndrome (CFS) are more fatigued, and mothers are more distressed than healthy controls. Managing the disabling symptoms of CFS can result in disruption and burden for the family. Most research has focused on mothers. This study sought to further explore the associations between adolescent fatigue and distress and parental fatigue and distress, as well as family functioning, including both mothers and fathers. DESIGN Cross-sectional study of a clinical cohort of consecutive attenders at a specialist chronic fatigue unit. METHODS Questionnaires were completed by adolescents (N = 115, age 11-18) with a confirmed diagnosis of CFS and their mothers (N = 100) and fathers (N = 65). RESULTS Maternal fatigue was significantly correlated with maternal distress, but not with adolescent fatigue, depression, anxiety, or functioning. This pattern held true for paternal fatigue. Maternal and paternal anxiety and depression were significantly correlated with family functioning. Paternal and maternal distress were correlated with each other. Mothers and fathers tended to have a consistent view of family functioning. Family functioning, specifically being overwhelmed by difficulties and scoring lower on strengths and adaptability, was positively associated with adolescent depression. Unexpectedly, higher levels of adolescent fatigue and poorer physical functioning were associated with better family functioning as rated by the mother. CONCLUSIONS Parents of adolescents with fatigue scored near to or within normative range for non-clinical samples on distress, fatigue, and family functioning. Parental distress may contribute to or result from poorer family functioning. Family functioning, particularly building strengths and adaptability, may be clinically important in CFS, as well as attending to parental (particularly paternal) distress in families where adolescents are low in mood.
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Affiliation(s)
- Maria E Loades
- Department of Psychology, University of Bath, Bath, United Kingdom.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX
| | - Sheila Ali
- South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX
| | - Kate Lievesley
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX
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Abstract
PURPOSE Self-criticism is a transdiagnostic process that has been attracting research and clinical interest. The accurate measurement of this construct is therefore crucial; however, there are currently numerous measures of self-criticism and no guidelines about which to use in different contexts. This systematic review evaluated the measurement properties of self-report questionnaires of self-criticism. METHODS OvidSP and Web of Science were used to search through multiple databases, and an initial grey literature search was completed. Studies were included when the main focus was to evaluate the measurement properties of English version of scales or subscales that aimed to measure self-criticism in an adult population. Both the methodological quality of included studies and the specific measurement properties were evaluated; these ratings were then combined into a best evidence synthesis. RESULTS Five scales and five subscales were identified, described in 16 papers. The scales were designed to measure different types of self-criticism including trait or repetitive self-criticism and self-criticism in response to difficult situations or as a mood regulation strategy. The majority of included studies were either rated as having poor methodological quality, or were given indeterminate or negative ratings for the measurement properties they reported. Questionnaire content varied depending on how the authors conceptualized self-criticism. Issues were also highlighted in relation to the checklist used to rate methodological quality. CONCLUSIONS Tentative recommendations were made about two measures of self-criticism based on existing evidence; future research is required. Furthermore, questionnaire choice should be based on the type of self-criticism being assessed. PRACTITIONER POINTS Self-criticism has been associated with a range of clinical difficulties including depression and eating disorders and is increasingly the focus of research, including treatment studies directly targeting self-criticism. Since different researchers have conceptualized self-criticism differently, a number of self-criticism self-report questionnaires have been developed that vary in terms of design, structure, and content. This systematic review identified and evaluated the measurement properties of self-report questionnaires of self-criticism and makes tentative recommendations about their use in clinical and research settings and areas for future research.
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Affiliation(s)
- Alexandra V Rose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Mograbi DC, Indelli P, Lage CA, Tebyriça V, Landeira-Fernandez J, Rimes KA. Cross-cultural adaptation and validation of the Brazilian version of the Beliefs about Emotions Scale. Trends Psychiatry Psychother 2018; 40:21-28. [PMID: 29668823 DOI: 10.1590/2237-6089-2017-0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/28/2017] [Indexed: 11/22/2022]
Abstract
Introduction Beliefs about the unacceptability of expression and experience of emotion are present in the general population but seem to be more prevalent in patients with a number of health conditions. Such beliefs, which may be viewed as a form of perfectionism about emotions, may have a deleterious effect on symptomatology as well as on treatment adherence and outcome. Nevertheless, few questionnaires have been developed to measure such beliefs about emotions, and no instrument has been validated in a developing country. The current study adapted and validated the Beliefs about Emotions Scale in a Brazilian sample. Methods The adaptation procedure included translation, back-translation and analysis of the content, with the final Brazilian Portuguese version of the scale being tested online in a sample of 645 participants. Internal consistency of the scale was very high and results of a principal axis factoring analysis indicated a two-factor solution. Results Respondents with high fatigue levels showed more perfectionist beliefs, and the scale correlated positively with questionnaires measuring anxiety, depression and fear of negative evaluation, confirming cross-cultural associations reported before. Finally, men, non-Caucasians and participants with lower educational achievement gave greater endorsement to such beliefs than women, Caucasian individuals and participants with higher educational level. Conclusions The study confirms previous clinical findings reported in the literature, but indicates novel associations with demographic variables. The latter may reflect cultural differences related to beliefs about emotions in Brazil.
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Affiliation(s)
- Daniel C Mograbi
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Pamela Indelli
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Caio A Lage
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Vitória Tebyriça
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jesus Landeira-Fernandez
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Green L, Rimes KA, Rahman Q. Beliefs About Others' Perceptions-Gender Typicality: Scale Development and Relationships to Gender Nonconformity, Sexual Orientation, and Well-Being. J Sex Res 2018; 55:837-849. [PMID: 29043852 DOI: 10.1080/00224499.2017.1384785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to develop a measure of "other-perceived" gender typicality and test its relationship with gender nonconformity, sexual orientation, and psychological distress. Data on these variables were collected from 632 participants (142 heterosexual men, 77 gay men, 50 bisexual men, 174 heterosexual women, 85 lesbian women, and 104 bisexual women). We designed a Beliefs About Others' Perceptions-Gender Typicality (BOP-GT) scale on which participants reported how masculine or feminine they thought other people perceived their gendered behavior, interests, appearance, and activities. Factor analysis identified five factors: appearance, emotional response, sporting interests, occupational interests, and interpersonal style. Recalled childhood gender nonconformity (CGN) was significantly associated with each BOP-GT subscale. Heterosexual men rated that other people perceived them to be more masculine scoring on the BOP-GT compared to heterosexual women. Gay men and lesbian women showed cross-sexed patterns on the BOP-GT total scale, appearance, emotional response, and sporting interests scores. Bisexual men and women were generally no different from the other male and female groups, respectively. Bisexual women had greater distress scores, and the BOP-GT emotional response subscale was associated with somewhat greater distress scores. The BOP-GT measure may have use in future research on understanding gendered self-concepts.
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Affiliation(s)
- Laura Green
- a Department of Psychology , Institute of Psychiatry, King's College London
- b School of Health, Sport and Health Sciences , Loughborough University
| | - Katharine A Rimes
- a Department of Psychology , Institute of Psychiatry, King's College London
| | - Qazi Rahman
- a Department of Psychology , Institute of Psychiatry, King's College London
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Loades ME, Rimes KA, Lievesley K, Ali S, Chalder T. Illness beliefs of adolescents with CFS and their parents: the perceived causes of illness and beliefs about recovery. Int J Adolesc Med Health 2018; 32:/j/ijamh.ahead-of-print/ijamh-2017-0197/ijamh-2017-0197.xml. [PMID: 30118437 DOI: 10.1515/ijamh-2017-0197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/21/2018] [Indexed: 11/15/2022]
Abstract
The objective here was to explore beliefs about the causes of chronic fatigue syndrome (CFS) in a cohort of adolescents with CFS and their parents, and to explore the adolescent's beliefs about recovery. Questionnaires were administered to a clinical cohort of adolescents (n = 104) and their parents (n = 102 mothers and 63 fathers), presenting to a specialist CFS unit. These included a question about the causes of their illness. Adolescents were also asked about the projected timeline of their recovery from CFS. The most commonly endorsed causes of CFS by adolescents and their parents were a virus and/or contextual factors and stress. Adolescents and their parents were in close agreement about the causes of CFS. Most adolescents said they did not know how long it would take them to recover from CFS. Informing adolescents about the prognosis for CFS is an important aspect of treatment.
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Affiliation(s)
- Maria E Loades
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK, Phone: +(44) 01225 385249.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park SE5 8AF, London, UK
| | - Kate Lievesley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park SE5 8AF, London, UK
| | - Sheila Ali
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.,South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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Loades ME, Rimes KA, Ali S, Lievesley K, Chalder T. The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome. Clin Child Psychol Psychiatry 2018; 23:398-408. [PMID: 29096528 PMCID: PMC6150417 DOI: 10.1177/1359104517736357] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires. DESIGN Cross-sectional study. SETTING Consecutive attenders to specialist CFS clinics in the United Kingdom. PATIENTS N = 52 adolescents, age 12-18 years with CFS. MEASURES Self-report questionnaires and a brief structured psychiatric diagnostic interview, administered by a researcher. RESULTS On the psychiatric interview, 34.6% met a diagnosis of major depressive disorder and 28.8% had an anxiety disorder. Of these, 15% had co-morbid anxiety and depression. Those with a depression diagnosis reported significantly greater interference on the school and social adjustment scale. They also scored significantly higher on trait anxiety, but not on state anxiety. There were no differences between those who had an anxiety disorder and those who did not on fatigue, disability or depressive symptoms. Children's Depression Inventory (CDI) score was associated with a depression diagnosis on the psychiatric interview. However, neither the state nor the trait subscale of the State-Trait Anxiety Inventory (STAI) was associated with an anxiety diagnosis. CONCLUSION Clinicians should assess for the presence of anxiety and depressive disorders in adolescents with CFS using a validated psychiatric interview. Treatment should be flexible enough to accommodate fatigue, depression and anxiety. Transdiagnostic approaches may suit this purpose. Goals should include pleasurable activities particularly for those who are depressed.
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Affiliation(s)
- Maria Elizabeth Loades
- 1 Department of Psychology, University of Bath, UK.,2 School of Social and Community Medicine, University of Bristol, UK
| | - Katharine A Rimes
- 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sheila Ali
- 4 South London and Maudsley NHS Foundation Trust, UK
| | - Kate Lievesley
- 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,4 South London and Maudsley NHS Foundation Trust, UK
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Abstract
BACKGROUND Lesbian, gay, and bisexual (LGB) individuals report higher levels of depression and anxiety than heterosexual people. Genetic factors may be a 'common cause' of sexual minority status and psychological distress. Alternatively, these may be correlated because of non-genetic environmental factors (e.g. minority stressors). This study investigated minority stressors and distress in monozygotic twins discordant for sexual minority status. This design provides a test of the role of non-shared environmental factors while minimizing differences due to genetics. METHODS Thirty-eight twin pairs in which one was heterosexual and the other was LGB completed a survey. Differences between twin pairs in minority stressors, rumination, psychological distress, and gender non-conformity were examined. Associations between these variables were also tested. RESULTS Although there were no significant group differences for distress, LGB twins had higher rumination, a vulnerability factor for distress, than heterosexual co-twins. LGB twins also had higher scores than heterosexual co-twins on expectations of rejection, active concealment, self-stigma, prejudice events, childhood gender non-conformity, and lower scores on sexual orientation disclosure. Differences between twin pairs in rumination were positively associated with differences in acceptance concerns and self-stigma. Finally, self-stigma was positively associated with rumination in the full sample of heterosexual co-twins and microaggressions were positively associated with rumination when looking at exclusively heterosexual co-twins. CONCLUSIONS These results support environmental factors as a causal explanation for disparities in rumination between LGB and heterosexual individuals. These factors likely include minority stressors. Rumination may also be associated with minority stressors in heterosexual MZ co-twins of LGB individuals.
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Affiliation(s)
- Liam Timmins
- Department of Psychology,Institute of Psychiatry, Psychology and Neuroscience, King's College London,5th Floor, Bermondsey Wing,Guy's Hospital Campus,London SE1 9RT,UK
| | - Katharine A Rimes
- Department of Psychology,Institute of Psychiatry, Psychology and Neuroscience, King's College London,5th Floor, Bermondsey Wing,Guy's Hospital Campus,London SE1 9RT,UK
| | - Qazi Rahman
- Department of Psychology,Institute of Psychiatry, Psychology and Neuroscience, King's College London,5th Floor, Bermondsey Wing,Guy's Hospital Campus,London SE1 9RT,UK
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Rimes KA, Shivakumar S, Ussher G, Baker D, Rahman Q, West E. Psychosocial Factors Associated With Suicide Attempts, Ideation, and Future Risk in Lesbian, Gay, and Bisexual Youth. Crisis 2018; 40:83-92. [PMID: 29932021 DOI: 10.1027/0227-5910/a000527] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lesbian, gay, and bisexual (LGB) youth have elevated suicidality rates. AIMS To investigate LGB-related and other factors associated with suicide attempts, suicidal ideation, and future suicide risk in a large UK sample. METHOD Logistic regression was used to investigate factors associated with suicidality in 3,275 LGB young adults from the Youth Chances project. RESULTS Suicide attempts (lifetime) were reported by 13.6% of participants; 45.2 % had suicidal ideation in the past year and 9.5% said future suicide attempts were likely. LGB stigma and discrimination experiences were significantly associated with all three aspects of suicidality. These included school stigma factors (e.g., teachers not speaking out against prejudice, lessons being negative about sexual minorities), negative reactions to coming out from family and friends, and LGB-related harassment or crime experiences. Bisexuality, not feeling accepted where one lives, younger sexual minority identification, and younger coming out were also associated with suicidality. Significant non-LGB factors included female gender, lower social support, anxiety/depression help-seeking, experiences of abuse/violence, and sexual abuse. LIMITATIONS This study is cross-sectional and further research is needed to test out whether any of these factors have a causal relationship with suicidality. CONCLUSION A wide range of LGB stigma and discrimination experiences are associated with increased suicidality in LGB youth. Health, social care, and education professionals supporting young people should address LGB-specific risk factors.
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Affiliation(s)
- Katharine A Rimes
- 1 Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sandhya Shivakumar
- 1 Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Dan Baker
- 3 Department of Family Care and Mental Health, University of Greenwich, London, UK
| | - Qazi Rahman
- 4 Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Elizabeth West
- 5 Department of Family Care and Mental Health, University of Greenwich, London, UK
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McIntyre R, Smith P, Rimes KA. The role of self-criticism in common mental health difficulties in students: A systematic review of prospective studies. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mhp.2018.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Palmer S, Cramp F, Clark E, Lewis R, Brookes S, Hollingworth W, Welton N, Thom H, Terry R, Rimes KA, Horwood J. The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome. Health Technol Assess 2018; 20:1-264. [PMID: 27365226 DOI: 10.3310/hta20470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment, but there is little research investigating its clinical effectiveness. OBJECTIVES To develop a comprehensive physiotherapy intervention for adults with JHS; to pilot the intervention; and to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT. DESIGN Patients' and health professionals' perspectives on physiotherapy for JHS were explored in focus groups (stage 1). A working group of patient research partners, clinicians and researchers used this information to develop the physiotherapy intervention. This was piloted and refined on the basis of patients' and physiotherapists' feedback (stage 2). A parallel two-arm pilot RCT compared 'advice' with 'advice and physiotherapy' (stage 3). Random allocation was via an automated randomisation service, devised specifically for the study. Owing to the nature of the interventions, it was not possible to blind clinicians or patients to treatment allocation. SETTING Stage 1 - focus groups were conducted in four UK locations. Stages 2 and 3 - piloting of the intervention and the pilot RCT were conducted in two UK secondary care NHS trusts. PARTICIPANTS Stage 1 - patient focus group participants (n = 25, three men) were aged > 18 years, had a JHS diagnosis and had received physiotherapy within the preceding 12 months. The health professional focus group participants (n = 16, three men; 14 physiotherapists, two podiatrists) had experience of managing JHS. Stage 2 - patient participants (n = 8) were aged > 18 years, had a JHS diagnosis and no other musculoskeletal conditions causing pain. Stage 3 - patient participants for the pilot RCT (n = 29) were as for stage 2 but the lower age limit was 16 years. INTERVENTION For the pilot RCT (stage 3) the advice intervention was a one-off session, supplemented by advice booklets. All participants could ask questions specific to their circumstances and receive tailored advice. Participants were randomly allocated to 'advice' (no further advice or physiotherapy) or 'advice and physiotherapy' (an additional six 30-minute sessions over 4 months). The physiotherapy intervention was supported by a patient handbook and was delivered on a one-to-one patient-therapist basis. It aimed to increase patients' physical activity through developing knowledge, understanding and skills to better manage their condition. MAIN OUTCOME MEASURES Data from patient and health professional focus groups formed the main outcome from stage 1. Patient and physiotherapist interview data also formed a major component of stages 2 and 3. The primary outcome in stage 3 related to the feasibility of a future definitive RCT [number of referrals, recruitment and retention rates, and an estimate of the value of information (VOI) of a future RCT]. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events) and resource use (to estimate cost-effectiveness). Outcomes were recorded at baseline, 4 months and 7 months. RESULTS Stage 1 - JHS is complex and unpredictable. Physiotherapists should take a long-term holistic approach rather than treating acutely painful joints in isolation. Stage 2 - a user-informed physiotherapy intervention was developed and evaluated positively. Stage 3 - recruitment to the pilot RCT was challenging, primarily because of a perceived lack of equipoise between advice and physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the advice intervention. Some patients reported that the advice intervention was useful and the physiotherapy intervention was again evaluated very positively. The rate of return of questionnaires was low in the advice group but reasonable in the physiotherapy group. The physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The advice arm experienced more adverse events. The VOI analysis indicated the potential for high value from a future RCT. Such a trial should form the basis of future research efforts. CONCLUSION A future definitive RCT of physiotherapy for JHS seems feasible, although the advice intervention should be made more robust to address perceived equipoise and subsequent attrition. TRIAL REGISTRATION Current Controlled Trials ISRCTN29874209. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Fiona Cramp
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Emma Clark
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Sara Brookes
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | - Nicky Welton
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Howard Thom
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Rohini Terry
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
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Dittner AJ, Hodsoll J, Rimes KA, Russell AJ, Chalder T. Cognitive-behavioural therapy for adult attention-deficit hyperactivity disorder: a proof of concept randomised controlled trial. Acta Psychiatr Scand 2018; 137:125-137. [PMID: 29282731 DOI: 10.1111/acps.12836] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate efficacy, patient acceptability and feasibility of formulation-based cognitive-behavioural therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD). NICE guidelines for adult ADHD recommend further research into psychological treatments. METHOD Sixty participants with adult ADHD were randomly allocated to treatment as usual (TAU) vs. TAU plus up to 16 sessions of individual formulation-based CBT for ADHD. RESULTS Adding formulation-based CBT to TAU for ADHD significantly improved ADHD symptoms on the Barkley Current Symptoms Scale and scores on the Work and Social Adjustment Scale. Adjusted effect sizes (ES) were 1.31 and 0.82 respectively. There were also significant improvements on secondary outcomes including independently evaluated clinical global improvement, self-rated anxiety, depression, global distress and patient satisfaction (adjusted effect sizes 0.52-1.01). CONCLUSIONS This is the first randomised controlled trial to provide preliminary evidence of efficacy and acceptability of individual formulation-based CBT for ADHD when added to TAU over TAU alone. This approach now needs to be tested in a larger multicentred randomised controlled trial.
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Affiliation(s)
- A J Dittner
- Psychological Medicine and Integrated Care Clinical Academic Group, Chronic Fatigue Research and Treatment Unit (formerly Behavioural and Developmental Psychiatry Clinical Academic Group, Maudsley Adult ADHD Service), South London and Maudsley NHS Foundation Trust, King's College London, King's Health Partners, London, UK
| | - J Hodsoll
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, King's Health Partners, London, UK
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, King's Health Partners, London, UK
| | - A J Russell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychology, University of Bath, Bath, UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, King's Health Partners, London, UK
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Thew GR, Gregory JD, Roberts K, Rimes KA. The phenomenology of self-critical thinking in people with depression, eating disorders, and in healthy individuals. Psychol Psychother 2017; 90:751-769. [PMID: 28759151 DOI: 10.1111/papt.12137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 06/03/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the phenomenology of self-criticism, and the relationship with constructs such as rumination and perfectionism. DESIGN The study followed a three-group (Depression, n = 26; Eating Disorder, n = 26; Non-clinical, n = 26) mixed methods design. METHOD Participants completed a set of questionnaires and were interviewed about the occurrence, impact, and content of self-critical thinking, along with their beliefs about self-criticism. RESULTS Both clinical groups reported more frequent, persistent, and less controllable self-criticism compared to controls, present on average 50-60% of the time. They reported a negative impact on mood, and a moderately severe impact on daily activities. They indicated greater desire to change self-criticism whilst judging it more difficult to reduce. Habitual self-criticism was highly correlated with lower self-esteem, lower self-compassion, greater rumination, and greater negative perfectionism. Compared to those with depression, the eating disorder group reported harsher self-criticism, felt it was more part of their personality, and was more beneficial. CONCLUSIONS The findings highlight the importance of exploring people's beliefs about their self-criticism, and imply that treatment for self-criticism may be more challenging with people with eating disorders than people with depression. PRACTITIONER POINTS This study highlights that self-criticism is common in depression and eating disorders and that some people find this a significant problem in its own right. Careful assessment of self-criticism is recommended when working with these clinical presentations, which should include the perceived positive consequences and desire to change.
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Affiliation(s)
- Graham R Thew
- Department of Psychology, University of Bath, Claverton Down, UK
| | - James D Gregory
- Department of Psychology, University of Bath, Claverton Down, UK
| | - Kate Roberts
- B&NES Primary Care Talking Therapies Service, Hillview Lodge, Royal United Hospital, Bath, UK
| | - Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Jones A, Robinson E, Oginni O, Rahman Q, Rimes KA. Anxiety disorders, gender nonconformity, bullying and self-esteem in sexual minority adolescents: prospective birth cohort study. J Child Psychol Psychiatry 2017; 58:1201-1209. [PMID: 28569044 DOI: 10.1111/jcpp.12757] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sexual minority adolescents (i.e. youth not exclusively heterosexual) report more anxiety than heterosexual youth on symptom questionnaires but no research has used standardised diagnostic tools to investigate anxiety disorder risk. This study uses a UK birth cohort to investigate the risk of anxiety disorders in sexual minority and heterosexual youth using a computerised structured clinical interview and explores the influence of gender nonconformity, bullying and self-esteem. METHODS Participants were 4,564 adolescents (2,567 girls and 1,996 boys) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Logistic regression analyses were performed to investigate the association between sexual orientation at 15.5 years and the presence of an anxiety disorder at 17.5 years. Covariates including maternal occupation, ethnicity, mother-reported childhood gender nonconformity at 30, 42 and 57 months, child-reported gender nonconformity at 8 years, child-reported bullying between 12 and 16 years and self-esteem at 17.5 years were added sequentially to regression models. RESULTS Sexual minority adolescents (i.e. those not exclusively heterosexual) had higher early childhood gender nonconformity (CGN), lower self-esteem and reported more bullying than adolescents identifying as 100% heterosexual. Minority sexual orientation at 15.5 years was associated with increased risk of an anxiety disorder at 17.5 years for girls (OR 2.55, CI 1.85-3.52) and boys (OR 2.48, CI 1.40-4.39). Adjusting for ethnicity, maternal occupation, mother-reported and child-reported CGN had minimal impact on this association. Adjusting for bullying between 12 and 16 years and self-esteem at 17.5 years reduced the strength of the associations, although the overall association remained significant for both sexes (girls OR 2.14 and boys OR 1.93). CONCLUSIONS Sexual minority youth are at increased risk of anxiety disorders relative to heterosexual youth at 17.5 years. Bullying between 12-16 years and lower self-esteem may contribute to this risk.
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Affiliation(s)
- Abbeygail Jones
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Robinson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olakunle Oginni
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Qazi Rahman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
This pilot study compared mindfulness-based cognitive therapy (MBCT) with a self-help guide based on cognitive behaviour therapy (CBT) for university students experiencing difficulties due to perfectionism. Participants were randomised to an MBCT intervention specifically tailored for perfectionism or pure CBT self-help. Questionnaires were completed at baseline, 8 weeks later (corresponding to the end of MBCT) and at 10-week follow-up. Post-intervention intention-to-treat (ITT) analyses identified that MBCT participants (n = 28) had significantly lower levels of perfectionism and stress than self-help participants (n = 32). There was significant MBCT superiority for changes in unhelpful beliefs about emotions, rumination, mindfulness, self-compassion and decentering. At 10-week follow-up, effects were maintained in the MBCT group, and analyses showed superior MBCT outcomes for perfectionism and daily impairment caused by perfectionism. Pre-post changes in self-compassion significantly mediated the group differences in pre-post changes in clinical perfectionism. Greater frequency of mindfulness practice was associated with larger improvements in self-compassion. MBCT is a promising intervention for perfectionist students, which may result in larger improvements than pure CBT self-help. The findings require replication with a larger sample.
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Affiliation(s)
- Kirsty James
- 1Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Katharine A Rimes
- 2Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF UK
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Rimes KA, Goodship N, Ussher G, Baker D, West E. Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. Int J Transgend 2017; 20:230-240. [PMID: 32999609 DOI: 10.1080/15532739.2017.1370627] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background : Little research has compared the mental health and victimization experiences of non-binary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth. Aims : To compare mental health, self-harm and suicidality, substance use and victimization experiences between non-binary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB). Methods : Online survey data from 677 participants from the "Youth Chances" community study of 16 to 25 year olds in the United Kingdom was analyzed, comparing across binary participants (transgender females (n = 105) and transgender males (n = 210)) and non-binary participants (MAAB (n = 93) and FAAB (n = 269)). Results : Female SAAB participants (binary and non-binary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and non-binary). Similarly, female SAAB participants (binary and non-binary) were more likely to report childhood sexual abuse than male SAAB participants (binary and non-binary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Non-binary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression/anxiety. Binary participants reported lower life satisfaction than non-binary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimization experiences were generally higher than that of youth in general population studies. Conclusions : These findings highlight the importance of considering both non-binary versus binary gender identity and SAAB in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in non-binary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation.
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Affiliation(s)
- Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola Goodship
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Dan Baker
- Department of Family Care and Mental Health, Avery Hill Campus, University of Greenwich, Eltham, London, UK
| | - Elizabeth West
- Department of Family Care and Mental Health, Avery Hill Campus, University of Greenwich, Eltham, London, UK
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Rimes KA, Lievesley K, Chalder T. Stress vulnerability in adolescents with chronic fatigue syndrome: experimental study investigating heart rate variability and skin conductance responses. J Child Psychol Psychiatry 2017; 58:851-858. [PMID: 28276066 DOI: 10.1111/jcpp.12711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stress vulnerability has been implicated in adolescent chronic fatigue syndrome (CFS), but has rarely been investigated directly. This study compared psychological and physiological responses to a laboratory social performance task in adolescents with CFS with chronic illness (asthma) and healthy control groups. METHODS Adolescents with CFS (n = 60), adolescents with asthma (n = 31) and healthy adolescents (n = 78) completed questionnaires before and after a social performance task. Skin conductance responses (SCR; mean SCR and Max-Min) and heart rate variability (low frequency/high frequency; LF/HF and root mean square difference of successive RR intervals; RMSSD) was measured before, during and after the task. RESULTS Baseline heart rate variability (HRV) (RMSSD) was significantly lower in the CFS and Asthma groups than the HC. During the speech, the CFS and Asthma groups had higher HRV (LF/HF) than the HC, adjusting for baseline LF/HF. Although the asthma group showed a subsequent reduction in HRV during recovery, the CFS group did not. Similarly, during recovery after the task, the CFS group showed a continued increase in skin conductance (Min-Max), unlike the Asthma and HC groups. Compared to control groups, adolescents with CFS expected to find the task more difficult, were more anxious beforehand and afterwards, rated it as more difficult, evaluated their performance more negatively and had lower observer ratings of performance. Parents of adolescents with CFS expected that their child would perform less well in the task than parents of control participants. CONCLUSIONS Adolescents with CFS showed autonomic nervous system responses that are consistent with chronic stress vulnerability, difficulty coping with acute stress and slower recovery after acute stress. Self-report measures also indicated greater trait, pre- and posttask anxiety in the CFS group.
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Affiliation(s)
- Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Lievesley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Tran L, Rimes KA. Unhealthy perfectionism, negative beliefs about emotions, emotional suppression, and depression in students: A mediational analysis. Personality and Individual Differences 2017. [DOI: 10.1016/j.paid.2017.01.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rogers DC, Dittner AJ, Rimes KA, Chalder T. Fatigue in an adult attention deficit hyperactivity disorder population: A trans-diagnostic approach. Br J Clin Psychol 2016; 56:33-52. [DOI: 10.1111/bjc.12119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/13/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Denise C. Rogers
- King's College London; King's Health Partners, (formerly Behavioural and Developmental Psychiatry Clinical Academic Group, Maudsley Adult ADHD Service, South London and Maudsley NHS Foundation Trust); London UK
| | - Antonia J. Dittner
- King's College London; King's Health Partners; Psychological Medicine Clinical Academic Group; Chronic Fatigue Research and Treatment Unit (formerly Behavioural and Developmental Psychiatry Clinical Academic Group, Maudsley Adult ADHD Service); South London and Maudsley NHS Foundation Trust; London UK
| | - Katharine A. Rimes
- Department of Psychology; Institute of Psychiatry, Psychology and Neuroscience; King's Health Partners; King's College London; UK
| | - Trudie Chalder
- Department of Psychological Medicine; King's College London; Weston Education Centre; London UK
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