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Senior M, Pierce M, Taxiarchi VP, Garg S, Edge D, Newlove-Delgado T, Neufeld SAS, Abel KM. 5-year mental health outcomes for children and adolescents presenting with psychiatric symptoms to general practitioners in England: a retrospective cohort study. Lancet Psychiatry 2024; 11:274-284. [PMID: 38490760 DOI: 10.1016/s2215-0366(24)00038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Little information is available on the clinical trajectories of children and adolescents who attend general practice (GP) with psychiatric symptoms. We aimed to examine 5-year service use in English primary care for children and adolescents with neurodevelopmental or mental health symptoms or diagnoses. METHODS In this retrospective cohort study, we used anonymised primary care health records from the Clinical Practice Research Datalink Aurum database (CPRD-Aurum). We identified children and adolescents (aged 3-18 years) presenting to primary care in England between Jan 1, 2000, and May 9, 2016, with a symptom or diagnosis of a mental health, behavioural, or neurodevelopmental condition. Participants were excluded if they had less than 1 year of follow-up. We followed up participants from their index date until either death, transfer out of the practice, or the end of data collection on May 5, 2021, and for trajectory analysis we limited follow-up to 5 years. We used group-based multi-trajectory models to identify clusters with similar trajectories over 5 years of follow-up for three primary outcomes: mental health-related GP contacts, psychotropic medication prescriptions, and specialist mental health-care contact. We did survival analysis to examine the associations between trajectory-group membership and hospital admission for self-harm or death by suicide, as indicators of severe psychiatric distress. FINDINGS We included 369 340 children and adolescents, of whom 180 863 (49·0%) were girls, 188 438 (51·0%) were boys, 39 (<0·1%) were of indeterminate gender, 290 125 (78·6%) were White, 9161 (2·5%) were South Asian, 10 418 (2·8%) were Black, 8115 (2·2%) were of mixed ethnicity, and 8587 (2·3%) were other ethnicities, and the median age at index presentation was 13·6 years (IQR 8·4-16·7). In the best-fitting, seven-group, group-based multi-trajectory model, over a 5-year period, the largest group (low contact; 207 985 [51·2%]) had low rates of additional service contact or psychotropic prescriptions. The other trajectory groups were moderate, non-pharmacological contact (43 836 [13·0%]); declining contact (25 469 [8·7%]); year-4 escalating contact (18 277 [6·9%]); year-5 escalating contact (18 139; 5·2%); prolonged GP contact (32 147 [8·6%]); and prolonged specialist contact (23 487 [6·5%]). Non-White ethnicity and presentation in earlier study years (eg, 2000-2004) were associated with low-contact group membership. The prolonged specialist-contact group had the highest risk of hospital admission for self-harm (hazard ratio vs low-contact group 2·19 [95% CI 2·03-2·36]) and suicide (2·67 [1·72-4·14]). INTERPRETATION Most children and adolescents presenting to primary care with psychiatric symptoms or diagnoses have low or declining rates of ongoing contact. If these trajectories reflect symptomatic improvement, these findings provide reassurance for children and adolescents and their caregivers. However, these trajectories might reflect an unmet need for some children and adolescents. FUNDING National Institute for Health and Care Research and the Wellcome Trust.
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Affiliation(s)
- Morwenna Senior
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK.
| | - Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Shruti Garg
- Division of Neuroscience, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK; Equality, Diversity & Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK; NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | | | | | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Nevriana A, Kosidou K, Hope H, Wicks S, Dalman C, Pierce M, Abel KM. Parental Mental Illness and the Likelihood of Child Out-of-Home Care: A Cohort Study. Pediatrics 2024; 153:e2023061531. [PMID: 38312009 DOI: 10.1542/peds.2023-061531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES To detail the relationship between parental mental illness and the likelihood of out-of-home care (OHC) among their children, and to identify factors which modify this relationship. METHODS Using Swedish national registers, children born in 2000 to 2011 (n = 1 249 463) were linked to their parents. Time-dependent parental mental illness (nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism, and intellectual disability), was identified through International Classification of Diseases codes. RESULTS After adjustment for socioeconomic factors, children living with mentally ill parents were 4 times as likely to be placed in OHC than children without (95% confidence interval [CI] 4.24-4.61). The highest hazard ratio (HR) was in the youngest children aged 0 to 1 year (5.77, 95% CI 5.42-6.14), exposed to maternal illness (HR 4.56, 95% CI 4.37-4.76), and parental intellectual disability (HR 4.73, 95% CI 4.09-5.46). Children with parental mental illness with multiple risk factors were at particularly high risk. Compared with children without parental mental illness, and those with university-educated parents, children whose parents had mental illness and only had education to age 16 had a 15 times higher risk of OHC (95% CI 13.75-16.54). CONCLUSIONS Children with parental mental illness are considerably more likely to be removed from home into care during childhood, particularly during the first year of life and if they are from socially disadvantaged families. Greater knowledge of these risks should lead to increased support for vulnerable new families.
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Affiliation(s)
- Alicia Nevriana
- Department of Global Public Health
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health
- Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
| | - Holly Hope
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Susanne Wicks
- Department of Global Public Health
- Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health
- Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
| | - Matthias Pierce
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kathryn M Abel
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, United Kingdom
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Littell JH, Abel KM, Biggs MA, Blum RW, Foster DG, Haddad LB, Major B, Munk-Olsen T, Polis CB, Robinson GE, Rocca CH, Russo NF, Steinberg JR, Stewart DE, Stotland NL, Upadhyay UD, van Ditzhuijzen J. Correcting the scientific record on abortion and mental health outcomes. BMJ 2024; 384:e076518. [PMID: 38413135 DOI: 10.1136/bmj-2023-076518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Julia H Littell
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Robert W Blum
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - Brenda Major
- Department of Psychological and Brain Sciences, University of California Santa Barbara, USA
| | - Trine Munk-Olsen
- Department of Clinical Research (Research Unit for Child and Adolescent Psychiatry), University of Southern Denmark, Odense, Denmark
- The National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Chelsea B Polis
- Center for Biomedical Research, Population Council, New York, NY, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Corinne H Rocca
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | | | - Julia R Steinberg
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Donna E Stewart
- Departments of Psychiatry, Obstetrics and Gynecology, Medicine, Surgery, Anesthesiology, Family and Community Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Nada Logan Stotland
- Department of Psychiatry and Behavioral Sciences, Rush Medical Center, Rush University, Chicago, IL, USA
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Jenneke van Ditzhuijzen
- Interdisciplinary Social Science: Social Policy and Public Health, Utrecht University, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, Netherlands
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Hope H, Pierce M, Gabr H, Radojčić MR, Swift E, Taxiarchi VP, Abel KM. The causal association between maternal depression, anxiety, and infection in pregnancy and neurodevelopmental disorders among 410 461 children: a population study using quasi-negative control cohorts and sibling analysis. Psychol Med 2024:1-9. [PMID: 38205522 DOI: 10.1017/s0033291723003604] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND To address if the long-standing association between maternal infection, depression/anxiety in pregnancy, and offspring neurodevelopmental disorder (NDD) is causal, we conducted two negative-control studies. METHODS Four primary care cohorts of UK children (pregnancy, 1 and 2 years prior to pregnancy, and siblings) born between 1 January 1990 and 31 December 2017 were constructed. NDD included autism/autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disability, cerebral palsy, and epilepsy. Maternal exposures included depression/anxiety and/or infection. Maternal (age, smoking status, comorbidities, body mass index, NDD); child (gender, ethnicity, birth year); and area-level (region and level of deprivation) confounders were captured. The NDD incidence rate among (1) children exposed during or outside of pregnancy and (2) siblings discordant for exposure in pregnancy was compared using Cox-regression models, unadjusted and adjusted for confounders. RESULTS The analysis included 410 461 children of 297 426 mothers and 2 793 018 person-years of follow-up with 8900 NDD cases (incidence rate = 3.2/1000 person years). After adjustments, depression and anxiety consistently associated with NDD (pregnancy-adjusted HR = 1.58, 95% CI 1.46-1.72; 1-year adj. HR = 1.49, 95% CI 1.39-1.60; 2-year adj. HR = 1.62, 95% CI 1.50-1.74); and to a lesser extent, of infection (pregnancy adj. HR = 1.16, 95% CI 1.10-1.22; 1-year adj. HR = 1.20, 95% CI 1.14-1.27; 2-year adj. HR = 1.19, 95% CI 1.12-1.25). NDD risk did not differ among siblings discordant for pregnancy exposure to mental illness HR = 0.97, 95% CI 0.77-1.21 or infection HR = 0.99, 95% CI 0.90-1.08. CONCLUSIONS Maternal risk appears to be unspecific to pregnancy: our study provided no evidence of a specific, and therefore causal, link between in-utero exposure to infection, common mental illness, and later development of NDD.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hend Gabr
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Mathematics, Insurance, and Statistics, Faculty of Commerce, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Maja R Radojčić
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eleanor Swift
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Osam CS, Hope H, Ashcroft DM, Abel KM, Pierce M. Maternal mental illness and child atopy: a UK population-based, primary care cohort study. Br J Gen Pract 2023; 73:e924-e931. [PMID: 37783510 PMCID: PMC10562998 DOI: 10.3399/bjgp.2022.0584] [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] [Received: 11/24/2022] [Accepted: 05/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The number of children exposed to maternal mental illness is rapidly increasing and little is known about the effects of maternal mental illness on childhood atopy. AIM To investigate the association between maternal mental illness and risk of atopy among offspring. DESIGN AND SETTING Retrospective cohort study using a UK primary care database (674 general practices). METHOD In total, 590 778 children (born 1 January 1993 to 30 November 2017) were followed until their 18th birthday, with 359 611 linked to their hospital records. Time-varying exposure was captured for common (depression and anxiety), serious (psychosis), addiction (alcohol and substance misuse), and other (eating and personality disorder) maternal mental illness from 6 months before pregnancy. Using Cox regression models, incidence rates of atopy were calculated and compared for the exposed and unexposed children in primary (asthma, eczema, allergic rhinitis, and food allergies) and secondary (asthma and food allergies) care, adjusted for maternal (age, atopy history, smoking, and antibiotic use), child (sex, ethnicity, and birth year/season), and area covariates (deprivation and region). RESULTS Children exposed to common maternal mental illness were at highest risk of developing asthma (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] = 1.15 to 1.20) and allergic rhinitis (aHR 1.17, 95% CI = 1.13 to 1.21), as well as a hospital admission for asthma (aHR 1.29, 95% CI = 1.20 to 1.38). Children exposed to addiction disorders were 9% less likely to develop eczema (aHR 0.91, 95% CI = 0.85 to 0.97) and 35% less likely to develop food allergies (aHR 0.65, 95% CI = 0.45 to 0.93). CONCLUSION The finding that risk of atopy varies by type of maternal mental illness prompts important aetiological questions. The link between common mental illness and childhood atopy requires GPs and policymakers to act and support vulnerable women to access preventive (for example, smoking cessation) services earlier.
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Affiliation(s)
- Cemre Su Osam
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and Health, and National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester; Greater Manchester Mental Health NHS Foundation Trust, Manchester
| | - Matthias Pierce
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
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Abel KM, Radojčić MR, Rayner A, Butt R, Whelan P, Parr I, Gledhill LF, Minchin A, Bower P, Hope H. Representativeness in health research studies: an audit of Greater Manchester Clinical Research Network studies between 2016 and 2021. BMC Med 2023; 21:471. [PMID: 38031070 PMCID: PMC10687774 DOI: 10.1186/s12916-023-03170-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There are increasing concerns that participants in health research in the UK are not representative of the UK population, risking widening health inequities. However, detailed information on the magnitude of the problem is limited. Therefore, we evaluated if the health research conducted in the Greater Manchester region was broadly representative of its diverse population. METHODS We conducted an audit of all health research studies conducted exclusively in Greater Manchester, using data from a national research network. Two researchers selected studies that were (1) an interventional or observational study of a health outcome; (2) 'closed' for recruitment between May 2016 and May 2021 and (3) human research. They extracted study information (dates, contacts, sample recruited, clinical speciality). Participant characteristics were sourced from published and unpublished manuscripts and requested directly from principal investigators and named study contacts. Data were extracted, summarised and compared to the Greater Manchester population for the following metrics: ethnicity, sex, age, deprivation and smoking status. A weighted mean age estimate was calculated to account for variation in age reporting. Too few studies provided patient-level deprivation data so, using the area code of the recruitment site, the area level multiple deprivation, health deprivation and disability index and decile was derived. These data were geo-mapped using QGIS 3.26. RESULTS Overall, 145/153 (95%) studies met inclusion criteria and participant information was sourced for 85/145 (59%) studies, representing 21,797 participants. Participant information was incomplete for all metrics. Where ethnicity (N = 10,259) data were available and compared to Greater Manchester estimates there was evidence that ethnic minorities were under-represented (6% versus 16%). Most of the recruitment occurred in central Manchester (50%) and with NHS hospital settings (74%). CONCLUSIONS Greater Manchester health research in 2016-2021 was centralised and under-represented ethnic minorities. We could not report which ethnic minority group was least represented because sourcing detailed participant information was challenging. Recommendations to improve the reporting of key participant characteristics with which to monitor representativeness in health research are discussed.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Maja R Radojčić
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Archie Rayner
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rabia Butt
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
| | - Pauline Whelan
- Centre for Health Informatics, Division of Imaging, Informatics and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- GM.Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Isaac Parr
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
| | - Lauren F Gledhill
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Ashley Minchin
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
| | - Peter Bower
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Pierce M, Bai Y, Nevriana A, Dalman C, Hope HF, Kosidou K, Ohlis A, Wicks S, Abel KM. Prevention of Childhood Adversities and Children's Common Mental Disorders and School Grades. JAMA Netw Open 2023; 6:e2336408. [PMID: 37796502 PMCID: PMC10556962 DOI: 10.1001/jamanetworkopen.2023.36408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/10/2023] [Indexed: 10/06/2023] Open
Abstract
Importance Adversity during childhood can limit children's chances of achieving their optimal developmental and psychological outcomes. Well-designed observational studies might help identify adversities that are most implicated in this, thereby helping to identify potential targets for developing interventions. Objective To compare the association between preventing childhood poverty, parental mental illness and parental separation, and the population rate of offspring common mental disorders (ages 16-21 years) or average school grades (age 16 years). Design, Setting, and Participants A population-based, longitudinal cohort study using Swedish registries was conducted. A total of 163 529 children born in Sweden between January 1, 1996, and December 31, 1997, were followed up until their 21st birthday. They were linked to registries using Sweden's national personal identification number. Children were linked to birth parents, hospital records, and school data. Parents were linked to registries containing health, income, sociodemographic, and obstetric data. Analyses were conducted between January 10, 2021, and August 26, 2022. Exposures Childhood adversities of relative poverty (household disposable income <50% of the median), parental inpatient admission for a mental illness, or parental separation. Adversities were categorized into developmental periods: ages 0 to 3, 4 to 7, 8 to 11, and 12 to 16 years. Main Outcomes and Measures The main outcomes were children's hospital records with a diagnosis of anxiety or depression between ages 16 and 21 years and school grades at the end of compulsory education (age 16 years). The parametric g-formula modeled population changes in outcomes associated with the counterfactual, hypothetical preventing adversity exposures, accounting for fixed and time-varying confounders. Adjustments were made for parental demographic characteristics, obstetric variables, and socioeconomic data at birth. Results A total of 163 529 children were included in the cohort (51.2% boys, 51.4% born in 1996). Preventing all adversities was associated with an estimated change in the prevalence of offspring common mental disorders from 10.2% to 7.6% and an improvement in school grades with an SD of 0.149 (95% CI, 0.147-0.149). Preventing parental separation provided for the greatest improvement, with an estimated 2.34% (95% CI, 2.23%-2.42%) fewer children with a common mental disorder and an improvement in school grades by 0.127 SDs (0.125-0.129). Greater improvements were shown by hypothetically targeting adolescents (age 12-16 years) and those whose parents had a mental illness when the child was born. Conclusions and Relevance The results of this cohort modeling study suggest that preventing childhood adversity could provide notable improvements in the rates of common mental disorders and school grades. Many children might achieve better life outcomes if resources are properly allocated to the right adversities (parental separation), the right groups (children with parental mental illness), and at the right time (adolescence).
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Affiliation(s)
- Matthias Pierce
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Yushi Bai
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Alicia Nevriana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Holly F. Hope
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Anna Ohlis
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Susanne Wicks
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Kathryn M. Abel
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Abstract
Mood disorders can come and go during the reproductive stages of a woman's life and beyond and can include premenstrual-related mood disorders, depression and other psychiatric disorders during pregnancy, postpartum mood disorders, and depression during menopause, as well as comorbid psychiatric conditions. Women may have regular contact with health care providers at these various stages in their lives, providing an opportunity for treatment intervention. However, clinicians struggle to effectively identify and manage these disorders, leaving women's mental health issues unaddressed and causing unnecessary suffering, multiple comorbidities, and unwanted outcomes. Context is essential for diagnoses and treatment, and spending time with patients, taking a full history, and taking the time to understand each patient's perspective during these complex periods lead to more accurate diagnoses, ultimately facilitating more effective treatment plans. An array of options is available for treating women's mental health, including antidepressants, oral contraceptives, hormones and recently approved neurosteroids, and nonpharmacological approaches. Clinicians need to be aware of which treatment options are available and evidence-based, guideline-directed solutions to help women manage their mental health. Creating patient-centered, individualized, evidence-based treatment plans is key to optimizing outcomes for women across their lifespan.
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Taxiarchi VP, Senior M, Ashcroft DM, Carr MJ, Hope H, Hotopf M, Kontopantelis E, McManus S, Patalay P, Steeg S, Webb RT, Abel KM, Pierce M. Changes to healthcare utilisation and symptoms for common mental health problems over the first 21 months of the COVID-19 pandemic: parallel analyses of electronic health records and survey data in England. Lancet Reg Health Eur 2023; 32:100697. [PMID: 37671125 PMCID: PMC10477036 DOI: 10.1016/j.lanepe.2023.100697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 09/07/2023]
Abstract
Background Few studies have investigated the effect of the COVID-19 pandemic on mental health beyond 2020. This study quantifies changes to healthcare utilisation and symptoms for common mental health problems over the pandemic's first 21 months. Methods Parallel cohort studies using primary care database and survey data for adults (≥16 years) in England from January 2015 to December 2021: 16,551,842 from the Clinical Practice Research Datalink (CPRD) and 40,699 from the UK Household Longitudinal Survey (UKHLS). Interrupted time-series models estimated changes in monthly prevalence of presentations and prescribed medications for anxiety and depression (CPRD); and self-reported psychological distress (UKHLS). The pandemic period was divided into five phases: 1st Wave (April-May 2020); post-1st Wave (June-September 2020); 2nd Wave (October 2020-February 2021); post 2nd Wave (March-May 2021); 3rd Wave (June-December 2021). Findings Primary care presentations for depression or anxiety dropped during the first wave (4.6 fewer monthly appointments per 1000 patients, 4.4-4.8) and remained lower than expected throughout follow-up. Self-reported psychological distress exceeded expected levels during the first (Prevalence Ratio = 1.378, 95% CI 1.289-1.459) and second waves (PR = 1.285, 1.189-1.377), returning towards expected levels during the third wave (PR = 1.038, 0.929-1.154). Increases in psychological distress and declines in presentations were greater for women. The decrease in primary care presentations for depression and anxiety exceeded that for physical health conditions (rheumatoid arthritis, diabetes, urinary tract infections). Anxiety and depression prescriptions returned to pre-pandemic levels during the second wave due to increased repeat prescriptions. Interpretation Despite periods of distress during the pandemic, we did not find an enduring effect on common mental health problems. The fall in primary care presentations for anxiety or depression suggests changing healthcare utilisation for mental distress and a potential treatment gap. Funding National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Vicky P. Taxiarchi
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Morwenna Senior
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Darren M. Ashcroft
- Faculty of Biology, Medicine and Health, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
| | - Matthew J. Carr
- Faculty of Biology, Medicine and Health, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
| | - Holly Hope
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, London EC1V 0HB, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies and MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sarah Steeg
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, UK
| | - Roger T. Webb
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Kathryn M. Abel
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Matthias Pierce
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
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Lee SI, Hanley S, Vowles Z, Plachcinski R, Moss N, Singh M, Gale C, Fagbamigbe AF, Azcoaga-Lorenzo A, Subramanian A, Taylor B, Nelson-Piercy C, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Dolk H, Hope H, Phillips K, Abel KM, Eastwood KA, Kent L, Locock L, Loane M, Mhereeg M, Brocklehurst P, McCann S, Brophy S, Wambua S, Hemali Sudasinghe SPB, Thangaratinam S, Nirantharakumar K, Black M. The development of a core outcome set for studies of pregnant women with multimorbidity. BMC Med 2023; 21:314. [PMID: 37605204 PMCID: PMC10441728 DOI: 10.1186/s12916-023-03013-3] [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: 03/24/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity. METHODS We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations. RESULTS Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs. CONCLUSIONS Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephanie Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Ngawai Moss
- Patient and public representative, London, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Hospital Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
| | | | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- Center for Epidemiology and Research in Population Health (CERPOP), INSERM, Toulouse, France
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Ulster University, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Louise Locock
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- The Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Mohamed Mhereeg
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sharon McCann
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Lee SI, Hanley S, Vowles Z, Plachcinski R, Azcoaga-Lorenzo A, Taylor B, Nelson-Piercy C, McCowan C, O'Reilly D, Hope H, Abel KM, Eastwood KA, Locock L, Singh M, Moss N, Brophy S, Nirantharakumar K, Thangaratinam S, Black M. Key outcomes for reporting in studies of pregnant women with multiple long-term conditions: a qualitative study. BMC Pregnancy Childbirth 2023; 23:551. [PMID: 37528358 PMCID: PMC10391909 DOI: 10.1186/s12884-023-05773-5] [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] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/10/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maternal multiple long-term conditions are associated with adverse outcomes for mother and child. We conducted a qualitative study to inform a core outcome set for studies of pregnant women with multiple long-term conditions. METHODS Women with two or more pre-existing long-term physical or mental health conditions, who had been pregnant in the last five years or planning a pregnancy, their partners and health care professionals were eligible. Recruitment was through social media, patients and health care professionals' organisations and personal contacts. Participants who contacted the study team were purposively sampled for maximum variation. Three virtual focus groups were conducted from December 2021 to March 2022 in the United Kingdom: (i) health care professionals (n = 8), (ii) women with multiple long-term conditions (n = 6), and (iii) women with multiple long-term conditions (n = 6) and partners (n = 2). There was representation from women with 20 different physical health conditions and four mental health conditions; health care professionals from obstetrics, obstetric/maternal medicine, midwifery, neonatology, perinatal psychiatry, and general practice. Participants were asked what outcomes should be reported in all studies of pregnant women with multiple long-term conditions. Inductive thematic analysis was conducted. Outcomes identified in the focus groups were mapped to those identified in a systematic literature search in the core outcome set development. RESULTS The focus groups identified 63 outcomes, including maternal (n = 43), children's (n = 16) and health care utilisation (n = 4) outcomes. Twenty-eight outcomes were new when mapped to the systematic literature search. Outcomes considered important were generally similar across stakeholder groups. Women emphasised outcomes related to care processes, such as information sharing when transitioning between health care teams and stages of pregnancy (continuity of care). Both women and partners wanted to be involved in care decisions and to feel informed of the risks to the pregnancy and baby. Health care professionals additionally prioritised non-clinical outcomes, including quality of life and financial implications for the women; and longer-term outcomes, such as children's developmental outcomes. CONCLUSIONS The findings will inform the design of a core outcome set. Participants' experiences provided useful insights of how maternity care for pregnant women with multiple long-term conditions can be improved.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Stephanie Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ngawai Moss
- Patient and public representative, London, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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12
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Pierce M, Di Prinzio P, Dalman C, Abel KM, Morgan VA. Hospital inpatient admissions of children of mothers with severe mental illness: A Western Australian cohort study. Aust N Z J Psychiatry 2023; 57:528-536. [PMID: 35642532 DOI: 10.1177/00048674221100161] [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: 11/17/2022]
Abstract
BACKGROUND Children of parents with mental illness face a number of adversities, potentially contributing to poor health. AIM The aim of this study was to quantify the association between maternal severe mental illness and children's hospital admissions. METHOD Record linkage cohort study of 467,945 children born in Western Australia between 1 January 1980 and 31 December 2001. Follow-up was from age 28 days until fifth birthday. Linked registers captured information on potential confounders. Rate ratios and adjusted rate ratios measured relative change in the numbers of admissions and total days of stay, while rate differences measured absolute change in outcomes. Cause-specific increases were calculated for ICD-9 chapters and for 'potentially preventable' conditions. RESULTS After adjusting for potential confounders, children of mothers with severe mental illness had a 46% relative increased rate in hospital admissions (95% confidence interval = [38%, 54%]) and an absolute increase in 0.69 extra days in hospital per child, per year (95% confidence interval = [0.67, 0.70]). The relative increase in admissions was greatest in the child's first year of life (adjusted rate ratio = 1.76, 95% confidence interval = [1.64, 1.88]; rate difference = 0.32, 95% confidence interval = [0.30, 0.34]). Rates of admissions were increased for a range of causes, particularly injuries, infections and respiratory disease, and for conditions classified as 'potentially preventable'. CONCLUSION Children of mothers with severe mental illness have a substantial excess in hospital use compared to children of well mothers. This vulnerable group should be targeted with interventions to avert preventable morbidity and premature mortality in later life.
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Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Patsy Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Greater Manchester Mental Health Trust, Manchester, UK
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
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13
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Astle DE, Moore A, Marryat L, Viding E, Mansfield KL, Fazel M, Pierce M, Abel KM, Green J, John A, Broome MR, Upthegrove R, Bould H, Minnis H, Gajwani R, Groom MJ, Hollis C, Liddle E, Sayal K, Berry V, Collishaw S, Dawes H, Cortese S, Violato M, Pollard J, MacCabe JH, Blakemore SJ, Simonoff E, Watkins E, Hiller RM, Townsend E, Armour C, Geddes JR, Thompson L, Schwannauer M, Nicholls D, Hotopf M, Downs J, Rahman A, Sharma AN, Ford TJ. We need timely access to mental health data: implications of the Goldacre review. Lancet Psychiatry 2023; 10:242-244. [PMID: 36931773 DOI: 10.1016/s2215-0366(23)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Duncan E Astle
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Pierce
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Population Health Science, Centre for Academic Mental Health and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- NIHR MindTech MIC & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth Liddle
- Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Vashti Berry
- Children & Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, University College London, London, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Matthias Schwannauer
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK; Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
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Nevriana A, Rossides M, Kosidou K, Pierce M, Dalman C, Wicks S, Abel KM. Correspondence for "Parental history of psychiatric disorders and risk of type 1 diabetes in the offspring". Diabetes Metab 2023; 49:101434. [PMID: 36809821 DOI: 10.1016/j.diabet.2023.101434] [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] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Affiliation(s)
- Alicia Nevriana
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden; Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 171 77, Sweden.
| | - Marios Rossides
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm 171 76, Sweden; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 171 77, Sweden; Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm 171 76, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden; Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm 104 31, Sweden
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden; Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm 104 31, Sweden
| | - Susanne Wicks
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden; Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm 104 31, Sweden
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, United Kingdom
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Radojčić MR, Pierce M, Hope H, Senior M, Taxiarchi VP, Trefan L, Swift E, Abel KM. Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000-19 primary care data. Lancet Psychiatry 2023; 10:119-128. [PMID: 36638816 DOI: 10.1016/s2215-0366(22)00404-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prescription of antipsychotics to children and adolescents has been increasing worldwide. We described up-to-date trends in antipsychotic prescribing and identified likely indications in a contemporary English cohort. METHODS We used a large primary care database, the Clinical Practice Research Datalink (CPRD) Aurum database, and we included all children and adolescents aged 3-18 years in the database and registered in England between Jan 1, 2000, and Dec 31, 2019, excluding those whose gender was recorded as indeterminate. Participants were followed up until the earliest of Dec 31, 2019, June 30 of the year they turned 18 years, their death, when they transferred from the primary care practice, or when the practice left the database. Data were not collected on ethnicity. We recorded antipsychotic prescriptions using the date a prescription was issued. As CPRD prescriptions are not linked to indications, we developed an algorithm to ascertain the most likely indication associated with participants' first antipsychotic prescription using clinical codes. We reported prescribing trends as annual period prevalence and the rate of first antipsychotic prescription, and we used joinpoint regression analysis to identify changes in the outcome trend. We stratified prevalence estimates by age group, gender, and Index of Multiple Deprivation quintiles, we reported frequencies of likely indications associated with incident prescriptions, and we explored clinical preference for typical versus atypical antipsychotics within deprivation quintiles. FINDINGS Between Jan 1, 2000, and Dec 31, 2019, we included 7 216 791 children and adolescents, of whom 3 480 730 (48·2%) were girls and 3 736 061 (51·8%) were boys, with a mean age at the start of follow-up of 7·3 years (SD 4·9; range 3-18). Median follow-up was 4·1 years (IQR 1·5-8·5). 19 496 (0·3%) individuals received 243 529 antipsychotic prescriptions over follow-up, including 225 710 (92·7%) atypical and 17 819 (7·3%) typical antipsychotic prescriptions. The annual period prevalence of antipsychotic prescriptions rose from 0·057% (95% CI 0·052-0·063%) in 2000 to 0·105% (0·100-0·111%) in 2019. From joinpoint analyses, the period prevalence of all antipsychotic prescriptions increased by an average of 3·3% per year (2·2-4·9%) and the rate of first prescriptions increased by 2·2% per year (1·7-2·7%). The most likely indications of the first identified antipsychotic prescriptions were for autism spectrum disorder (2477 [12·7%]), non-affective psychosis (1669 [8·6%]), anxiety disorders (1466 [7·5%]), ADHD (1391 [7·1%]), depression (1256 [6·4%]), and conduct disorders (1181 [6·1%]). INTERPRETATION The observed increase in antipsychotic prescriptions over 20 years results from the accumulation of repeated prescriptions to the same individuals combined with an increase in new prescriptions. These findings highlight the need for continued monitoring of trends in antipsychotic use and, although this was not examined in this paper, the findings highlights the need for better information about long-term antipsychotic safety. FUNDING None.
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Affiliation(s)
- Maja R Radojčić
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Morwenna Senior
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Laszlo Trefan
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eleanor Swift
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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16
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Subramanian A, Azcoaga-Lorenzo A, Anand A, Phillips K, Lee SI, Cockburn N, Fagbamigbe AF, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Hope H, Kennedy JI, Abel KM, Eastwood KA, Locock L, Black M, Loane M, Moss N, Plachcinski R, Thangaratinam S, Brophy S, Agrawal U, Vowles Z, Brocklehurst P, Dolk H, Nelson-Piercy C, Nirantharakumar K. Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019. BMC Med 2023; 21:21. [PMID: 36647047 PMCID: PMC9843951 DOI: 10.1186/s12916-022-02722-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. METHODS A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. RESULTS During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14-1.18) and 1.55 (1.53-1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33-2.47), 1.71 (1.65-1.76), 1.41 (1.35-1.47) and 1.39 (1.30-1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18-1.20) and 1.05 (1.03-1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. CONCLUSIONS The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
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Affiliation(s)
- Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- INSERM, Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, CIC 1436, France
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Health Data Research UK, Oxford, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
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17
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Howard LM, Trevillion K, Potts L, Heslin M, Pickles A, Byford S, Carson LE, Dolman C, Jennings S, Johnson S, Jones I, McDonald R, Pawlby S, Powell C, Seneviratne G, Shallcross R, Stanley N, Wieck A, Abel KM. Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study. Br J Psychiatry 2022; 221:628-636. [PMID: 35505514 DOI: 10.1192/bjp.2022.48] [Citation(s) in RCA: 5] [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: 12/20/2022]
Abstract
BACKGROUND Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown. AIMS We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)). METHOD Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother-infant interaction quality and safeguarding outcome. RESULTS Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86-1.04, P = 0.29; an absolute difference of -5%, 95% CI -14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes. CONCLUSIONS We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
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Affiliation(s)
- Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Potts
- Biostatistics and Health Informatics, King's College London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics, King's College London, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Lauren E Carson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Clare Dolman
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stacey Jennings
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Ian Jones
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, UK
| | - Rebecca McDonald
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Claire Powell
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Rebekah Shallcross
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, UK
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18
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Abstract
BACKGROUND Perinatal self-harm is of concern but poorly understood. AIMS To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome. METHOD This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome. RESULTS The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination. CONCLUSIONS Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Cemre Su Osam
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Catharine Morgan
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Ann John
- Swansea University Medical School, Swansea University, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK and Greater Manchester Mental Health NHS Foundation Trust, UK
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19
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Howard LM, Trevillion K, Potts L, Heslin M, Pickles A, Byford S, Carson LE, Dolman C, Jennings S, Johnson S, Jones I, McDonald R, Pawlby S, Powell C, Seneviratne G, Shallcross R, Stanley N, Wieck A, Abel KM. Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study - CORRIGENDUM. Br J Psychiatry 2022; 221:1. [PMID: 35920025 DOI: 10.1192/bjp.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Nevriana A, Pierce M, Abel KM, Rossides M, Wicks S, Dalman C, Kosidou K. Association between parental mental illness and autoimmune diseases in the offspring - A nationwide register-based cohort study in Sweden. J Psychiatr Res 2022; 151:122-130. [PMID: 35477076 DOI: 10.1016/j.jpsychires.2022.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023]
Abstract
Mental illness has been previously linked with autoimmune diseases, yet the associations between parental mental illness and offspring's risk of autoimmune diseases is largely unknown. We conducted a population-based cohort study of 2,192,490 Swedish children born between 1991 and 2011 and their parents to determine the associations between parental mental illness and risk of autoimmune diseases among the offspring. Time-dependent diagnoses of parental mental illness (psychosis, alcohol/drug misuse, depression, anxiety, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism spectrum disorder) and offspring autoimmune diseases (type 1 diabetes (T1D), juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, psoriasis, multiple sclerosis, inflammatory bowel disease (IBD), coeliac disease) were identified from inpatient/outpatient healthcare visits. Associations were measured by hazard ratios (HRs) adjusted for potential confounders. Overall, parental mental illness was associated with a small increase in risk of offspring's autoimmune diseases (HR 1.05, 95% CI 1.02-1.08). However, parental common mental disorder (anxiety/depression) was associated with higher risk of JIA, psoriasis, and T1D (HR T1D 1.11, 95% CI 1.01-1.22), while maternal psychosis with reduced risk of coeliac disease (HR 0.68, 95% CI 0.49-0.95) and paternal alcohol/drug misuse with reduced risk of IBD (HR 0.80, 95% CI 0.64-0.99). Maternal eating disorders were associated with a markedly increased risk for T1D (HR 1.41, 95% CI 1.05-1.89). Further studies are needed to confirm these findings and to understand underlying mechanisms. There is a need for greater clinical awareness about potential risk of JIA, psoriasis, and T1D among children of parents with common psychiatric morbidity.
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Affiliation(s)
- Alicia Nevriana
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, United Kingdom
| | - Marios Rossides
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, 171 76, Stockholm, Sweden; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Susanne Wicks
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm Region, 104 31, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm Region, 104 31, Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm Region, 104 31, Stockholm, Sweden
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21
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Howard LM, Abel KM, Atmore KH, Bick D, Bye A, Byford S, Carson LE, Dolman C, Heslin M, Hunter M, Jennings S, Johnson S, Jones I, Taylor BL, McDonald R, Milgrom J, Morant N, Nath S, Pawlby S, Potts L, Powell C, Rose D, Ryan E, Seneviratne G, Shallcross R, Stanley N, Trevillion K, Wieck A, Pickles A. Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT. Programme Grants Appl Res 2022. [DOI: 10.3310/ccht9881] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background
It is unclear how best to identify and treat women with mental disorders in pregnancy and the year after birth (i.e. the perinatal period).
Objectives
(1) To investigate how best to identify depression at antenatal booking [work package (WP) 1]. (2) To estimate the prevalence of mental disorders in early pregnancy (WP1). (3) To develop and examine the efficacy of a guided self-help intervention for mild to moderate antenatal depression delivered by psychological well-being practitioners (WP1). (4) To examine the psychometric properties of the perinatal VOICE (Views On Inpatient CarE) measure of service satisfaction (WP3). (5) To examine the clinical effectiveness and cost-effectiveness of services for women with acute severe postnatal mental disorders (WPs 1–3). (6) To investigate women’s and partners’/significant others’ experiences of different types of care (WP2).
Design
Objectives 1 and 2 – a cross-sectional survey stratified by response to Whooley depression screening questions. Objective 3 – an exploratory randomised controlled trial. Objective 4 – an exploratory factor analysis, including test–retest reliability and validity assessed by association with the Client Satisfaction Questionnaire contemporaneous satisfaction scores. Objective 5 – an observational cohort study using propensity scores for the main analysis and instrumental variable analysis using geographical distance to mother and baby unit. Objective 6 – a qualitative study.
Setting
English maternity services and generic and specialist mental health services for pregnant and postnatal women.
Participants
Staff and users of mental health and maternity services.
Interventions
Guided self-help, mother and baby units and generic care.
Main outcome measures
The following measures were evaluated in WP1(i) – specificity, sensitivity, positive predictive value, likelihood ratio, acceptability and population prevalence estimates. The following measures were evaluated in WP1(ii) – participant recruitment rate, attrition and adverse events. The following measure was evaluated in WP2 – experiences of care. The following measures were evaluated in WP3 – psychometric indices for perinatal VOICE and the proportion of participants readmitted to acute care in the year after discharge.
Results
WP1(i) – the population prevalence estimate was 11% (95% confidence interval 8% to 14%) for depression and 27% (95% confidence interval 22% to 32%) for any mental disorder in early pregnancy. The diagnostic accuracy of two depression screening questions was as follows: a weighted sensitivity of 0.41, a specificity of 0.95, a positive predictive value of 0.45, a negative predictive value of 0.93 and a likelihood ratio (positive) of 8.2. For the Edinburgh Postnatal Depression Scale, the diagnostic accuracy was as follows: a weighted sensitivity of 0.59, a specificity of 0.94, a positive predictive value of 0.52, a negative predictive value of 0.95 and a likelihood ratio (positive) of 9.8. Most women reported that asking about depression at the antenatal booking appointment was acceptable, although this was reported as being less acceptable for women with mental disorders and/or experiences of abuse. Cost-effectiveness analysis suggested that both the Whooley depression screening questions and the Edinburgh Postnatal Depression Scale were more cost-effective than with the Whooley depression screening questions followed by the Edinburgh Postnatal Depression Scale or no-screen option. WP1(ii) – 53 women with depression in pregnancy were randomised. Twenty-six women received modified guided self-help [with 18 (69%) women attending four or more sessions] and 27 women received usual care. Three women were lost to follow-up (follow-up for primary outcome: 92%). At 14 weeks post randomisation, women receiving guided self-help reported fewer depressive symptoms than women receiving usual care (adjusted effect size −0.64, 95% confidence interval −1.30 to 0.06). Costs and quality-adjusted life-years were similar, resulting in a 50% probability of guided self-help being cost-effective compared with usual care at National Institute for Health and Care Excellence cost per quality-adjusted life-year thresholds. The slow recruitment rate means that a future definitive larger trial is not feasible. WP2 – qualitative findings indicate that women valued clinicians with specialist perinatal expertise across all services, but for some women generic services were able to provide better continuity of care. Involvement of family members and care post discharge from acute services were perceived as poor across services, but there was also ambivalence among some women about increasing family involvement because of a complex range of factors. WP3(i) – for the perinatal VOICE, measures from exploratory factor analysis suggested that two factors gave an adequate fit (comparative fit index = 0.97). Items loading on these two dimensions were (1) those concerning aspects of the service relating to the care of the mother and (2) those relating to care of the baby. The factors were positively correlated (0.49; p < 0.0001). Total scores were strongly associated with service (with higher satisfaction for mother and baby units, 2 degrees of freedom; p < 0.0001) and with the ‘gold standard’ Client Service Questionnaire total score (test–retest intraclass correlation coefficient 0.784, 95% confidence interval 0.643 to 0.924; p < 0.0001). WP3(ii) – 263 of 279 women could be included in the primary analysis, which shows that the odds of being readmitted to acute care was 0.95 times higher for women who were admitted to a mother and baby unit than for those not admitted to a mother and baby unit (0.95, 95% confidence interval 0.86 to 1.04; p = 0.29). Sensitivity analysis using an instrumental variable found a markedly more significant effect of admission to mother and baby units (p < 0.001) than the primary analysis. Mother and baby units were not found to be cost-effective at 1 month post discharge because of the costs of care in a mother and baby unit. Cost-effectiveness advantages may exist if the cost of mother and baby units is offset by savings from reduced readmissions in the longer term.
Limitations
Policy and service changes had an impact on recruitment. In observational studies, residual confounding is likely.
Conclusions
Services adapted for the perinatal period are highly valued by women and may be more effective than generic services. Mother and baby units have a low probability of being cost-effective in the short term, although this may vary in the longer term.
Future work
Future work should include examination of how to reduce relapses, including in after-care following discharge, and how better to involve family members.
Trial registration
This trial is registered as ISRCTN83768230 and as study registration UKCRN ID 16403.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Howard
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kathryn M Abel
- Centre for Women’s Mental Health, The University of Manchester, Manchester, UK
| | - Katie H Atmore
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Debra Bick
- Division of Women and Children’s Health, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Amanda Bye
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lauren E Carson
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Clare Dolman
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Myra Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stacey Jennings
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Ian Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | | | - Rebecca McDonald
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jeannette Milgrom
- Department of Clinical and Health Psychology, Parent–Infant Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Selina Nath
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Laura Potts
- Biostatistics and Health Informatics, King’s College London, London, UK
| | - Claire Powell
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elizabeth Ryan
- Biostatistics and Health Informatics, King’s College London, London, UK
| | | | - Rebekah Shallcross
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Harrington, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics, King’s College London, London, UK
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22
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Wittkowski A, Emsley R, Bee PE, Camacho E, Calam R, Abel KM, Duxbury P, Gomez P, Cartwright K, Reid HE. A Feasibility Randomized Controlled Trial of a Parenting Intervention Offered to Women With Severe Mental Health Problems and Delivered in a Mother and Baby Unit Setting: The IMAgINE Study Outcomes. Front Psychiatry 2022; 13:815018. [PMID: 35651824 PMCID: PMC9149174 DOI: 10.3389/fpsyt.2022.815018] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Approximately 1-2% of mothers may experience severe mental illness (SMI) requiring admission to an inpatient Mother and Baby Unit (MBU). MBUs aim to provide mental health assessment and treatment and strengthen the mother-infant relationship, essential for infant development. Whilst MBUs offer various interventions, they do not routinely offer structured parenting interventions. The Baby Triple P Positive Parenting Program (BTP) was developed to enhance parenting competence, psychological coping and the quality of partner and other social support. Guided by lived experience consultation, we aimed to determine the feasibility and acceptability of delivering BTP plus Treatment as Usual (TAU) in this setting. Method A multi-site, parallel-group, single-blind pilot randomized controlled trial (registration: ISRCTN12765736) comparing BTP+TAU to TAU in participants, recruited from two MBUs in England. The Baby Triple P intervention consisted of eight parenting sessions, with the final four being delivered over the telephone following MBU discharge. Feasibility outcomes were participant intervention engagement and study retention. Clinical outcomes including maternal parenting competence, bonding and mental health outcomes were assessed at baseline, post-baseline/intervention (10 weeks) and six-month follow-up. Data were analyzed using descriptive statistics and linear regression models. An economic feasibility analysis was also conducted. Results Thirty-seven of the 67 eligible participants consented; 34 were randomized (16 to BTP+TAU and 18 to TAU), of whom 20 were retained at post-intervention data collection and 21 at six-month follow-up. Twelve participants (75%) completed the intervention, which was rated as highly acceptable. Clinical outcomes signaled potential improvements in maternal parenting competence, bonding, mood and mental health symptomatology in participants who received the intervention. Healthcare resource use and EQ-5D-5L questionnaires were well-completed by participants. Delivering BTP in this setting is estimated to cost £443-822 per participant. Conclusions This is the first trial of a parenting intervention in a MBU setting. BTP is feasible and acceptable to mothers with SMI, with a promising signal for treatment efficacy. Although minor modifications may be required for the collection of observer-rated measures post-MBU discharge, the findings indicate that a larger, definitive trial could be conducted, especially if the setting is extended to include perinatal mental health community settings.
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Affiliation(s)
- Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Penny E. Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kathryn M. Abel
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Paula Duxbury
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Paula Gomez
- Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Cartwright
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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23
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Stibbs-Eaton L, Hodgson C, Kolade A, Crowell J, Gemignani J, Hope H, Pierce M, Elmadih A, Zhao C, Downey D, Elliott R, Abel KM. Vocal brain development in infants of mothers with serious mental illness (CAPRI-Voc): study protocol. BMJ Open 2022; 12:e053598. [PMID: 35301204 PMCID: PMC8932262 DOI: 10.1136/bmjopen-2021-053598] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Improving the lives of children and adolescents with parental mental illness (CAPRI) remains an urgent political and public health concern for the UK and European Union. Recurrent parental mental illness is believed to lead to fractures in the family, academic and social lives of these children, yet interventions are poorly targeted and non-specific. Part of an interdisciplinary programme of work (the CAPRI Programme; grant number: 682741), CAPRI-Voc aims to achieve two goals: first, to test the feasibility of our longitudinal imaging paradigm in mother-infant pairs where the mother has a diagnosis of severe mental illness. Second, to compare development of vocal processing in these infants with infants in the general population. METHODS AND ANALYSIS Recruitment of 100 infants of mothers with mental illness, alongside 50 infants of healthy mothers. Both cohorts of infants will undergo functional near infrared spectroscopy (fNIRS) brain imaging at three time points: 9, 12 and 18 months to explore differences between cohorts in their neural responses to vocal stimuli in our language paradigm. Mothers will complete an interview and psychological questionnaires. We shall also complete an infant developmental battery and mother-child interaction play session. Data on recruitment, retention and dropout will be recorded. ETHICS AND DISSEMINATION It will be made clear that fNIRS is a safe, non-invasive technology widely used in infant clinical and psychological research. We shall reassure mothers that no definitive causal link exists between maternal mental illness and language development in infants, and that individual data will only exist as part of the wider dataset. As the study includes both children and vulnerable adults, all research staff will complete National Health Service (NHS) Safeguarding level 3 training. Dissemination will be via direct feedback to stakeholders, patient and advisory groups, and through presentations at conferences, journal publications and university/NHS trust communications. The study was approved through North West-Greater Manchester West Research Ethics Committee (17/NW/0074) and Health Research Authority (212715).
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Affiliation(s)
- Lucy Stibbs-Eaton
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catherine Hodgson
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Adekeye Kolade
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Jennifer Crowell
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Jessica Gemignani
- Department of Developmental Psychology and Socialisation, University of Padua, Padova, Italy
| | - Holly Hope
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Matthias Pierce
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Alya Elmadih
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Chen Zhao
- Psychology and Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Darragh Downey
- Division of Dentistry, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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24
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Lee SI, Azcoaga-Lorenzo A, Agrawal U, Kennedy JI, Fagbamigbe AF, Hope H, Subramanian A, Anand A, Taylor B, Nelson-Piercy C, Damase-Michel C, Yau C, Crowe F, Santorelli G, Eastwood KA, Vowles Z, Loane M, Moss N, Brocklehurst P, Plachcinski R, Thangaratinam S, Black M, O'Reilly D, Abel KM, Brophy S, Nirantharakumar K, McCowan C. Epidemiology of pre-existing multimorbidity in pregnant women in the UK in 2018: a population-based cross-sectional study. BMC Pregnancy Childbirth 2022; 22:120. [PMID: 35148719 PMCID: PMC8840793 DOI: 10.1186/s12884-022-04442-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although maternal death is rare in the United Kingdom, 90% of these women had multiple health/social problems. This study aims to estimate the prevalence of pre-existing multimorbidity (two or more long-term physical or mental health conditions) in pregnant women in the United Kingdom (England, Northern Ireland, Wales and Scotland). STUDY DESIGN Pregnant women aged 15-49 years with a conception date 1/1/2018 to 31/12/2018 were included in this population-based cross-sectional study, using routine healthcare datasets from primary care: Clinical Practice Research Datalink (CPRD, United Kingdom, n = 37,641) and Secure Anonymized Information Linkage databank (SAIL, Wales, n = 27,782), and secondary care: Scottish Morbidity Records with linked community prescribing data (SMR, Tayside and Fife, n = 6099). Pre-existing multimorbidity preconception was defined from 79 long-term health conditions prioritised through a workshop with patient representatives and clinicians. RESULTS The prevalence of multimorbidity was 44.2% (95% CI 43.7-44.7%), 46.2% (45.6-46.8%) and 19.8% (18.8-20.8%) in CPRD, SAIL and SMR respectively. When limited to health conditions that were active in the year before pregnancy, the prevalence of multimorbidity was still high (24.2% [23.8-24.6%], 23.5% [23.0-24.0%] and 17.0% [16.0 to 17.9%] in the respective datasets). Mental health conditions were highly prevalent and involved 70% of multimorbidity CPRD: multimorbidity with ≥one mental health condition/s 31.3% [30.8-31.8%]). After adjusting for age, ethnicity, gravidity, index of multiple deprivation, body mass index and smoking, logistic regression showed that pregnant women with multimorbidity were more likely to be older (CPRD England, adjusted OR 1.81 [95% CI 1.04-3.17] 45-49 years vs 15-19 years), multigravid (1.68 [1.50-1.89] gravidity ≥ five vs one), have raised body mass index (1.59 [1.44-1.76], body mass index 30+ vs body mass index 18.5-24.9) and smoked preconception (1.61 [1.46-1.77) vs non-smoker). CONCLUSION Multimorbidity is prevalent in pregnant women in the United Kingdom, they are more likely to be older, multigravid, have raised body mass index and smoked preconception. Secondary care and community prescribing dataset may only capture the severe spectrum of health conditions. Research is needed urgently to quantify the consequences of maternal multimorbidity for both mothers and children.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Astha Anand
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Beck Taylor
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- INSERM, Centre for Epidemiology and Research in Population Health (CERPOP), CIC 1436, Toulouse, France
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Health Data Research, London, UK
| | - Francesca Crowe
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Maria Loane
- The Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
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25
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Kontopantelis E, Mamas MA, Webb RT, Castro A, Rutter MK, Gale CP, Ashcroft DM, Pierce M, Abel KM, Price G, Faivre-Finn C, Van Spall HGC, Graham MM, Morciano M, Martin GP, Sutton M, Doran T. Excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation, and region in England and Wales during 2020: A registry-based study. PLoS Med 2022; 19:e1003904. [PMID: 35167587 PMCID: PMC8846534 DOI: 10.1371/journal.pmed.1003904] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups. METHODS AND FINDINGS We used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups; for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived; for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording. CONCLUSIONS In this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL.
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Affiliation(s)
- Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
- NIHR School for Primary Care Research, University of Oxford, Oxford, England
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, England
- * E-mail:
| | - Mamas A. Mamas
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, England
- Department of Cardiology, Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Roger T. Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, University of Manchester and Manchester Academic Health Sciences Centre (MAHSC), England
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, England
| | - Ana Castro
- Department of Health Sciences, University of York, England
| | - Martin K. Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, England
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, England
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
- Leeds Institute for Data Analytics, University of Leeds, Leeds, England
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Darren M. Ashcroft
- NIHR School for Primary Care Research, University of Oxford, Oxford, England
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, England
- Division of Pharmacy & Optometry, University of Manchester, Manchester, England
| | - Matthias Pierce
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, University of Manchester, Manchester, England
| | - Kathryn M. Abel
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, University of Manchester, Manchester, England
| | - Gareth Price
- Manchester Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, England
| | - Corinne Faivre-Finn
- Manchester Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, England
| | - Harriette G. C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michelle M. Graham
- Division of Cardiology, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Marcello Morciano
- NIHR School for Primary Care Research, University of Oxford, Oxford, England
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, England
| | - Glen P. Martin
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Matt Sutton
- NIHR School for Primary Care Research, University of Oxford, Oxford, England
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Tim Doran
- Department of Health Sciences, University of York, England
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26
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Davies SM, Jardine J, Gutridge K, Bernard Z, Park S, Dawson T, Abel KM, Whelan P. Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study. JMIR Form Res 2021; 5:e30668. [PMID: 34898446 PMCID: PMC8713104 DOI: 10.2196/30668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 01/30/2023] Open
Abstract
Background The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (≥1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting.
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Affiliation(s)
- Sian M Davies
- GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jenni Jardine
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kerry Gutridge
- GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Zara Bernard
- GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | | | - Kathryn M Abel
- GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Pauline Whelan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,GM.Digital Research Unit, Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, United Kingdom
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27
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Abel KM, Carr MJ, Ashcroft DM, Chalder T, Chew-Graham CA, Hope H, Kapur N, McManus S, Steeg S, Webb RT, Pierce M. Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients. JAMA Netw Open 2021; 4:e2134803. [PMID: 34783824 PMCID: PMC8596199 DOI: 10.1001/jamanetworkopen.2021.34803] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Infection with SARS-CoV-2 is associated with fatigue and sleep problems long after the acute phase of COVID-19. In addition, there are concerns of SARS-CoV-2 infection causing psychiatric illness; however, evidence of a direct effect is inconclusive. OBJECTIVE To assess risk of risk of incident or repeat psychiatric illness, fatigue, or sleep problems following SARS-CoV-2 infection and to analyze changes according to demographic subgroups. DESIGN, SETTING, AND PARTICIPANTS This cohort study assembled matched cohorts using the Clinical Practice Research Datalink Aurum, a UK primary care registry of 11 923 499 individuals aged 16 years or older. Patients were followed-up for up to 10 months, from February 1 to December 9, 2020. Individuals with less than 2 years of historical data or less than 1 week follow-up were excluded. Individuals with positive results on a SARS-CoV-2 test without prior mental illness or with anxiety or depression, psychosis, fatigue, or sleep problems were matched with up to 4 controls based on sex, general practice, and year of birth. Controls were individuals who had negative SARS-CoV-2 test results. Data were analyzed from January to July 2021. EXPOSURE SARS-CoV-2 infection, determined via polymerase chain reaction testing. MAIN OUTCOMES AND MEASURES Cox proportional hazard models estimated the association between a positive SARS-CoV-2 test result and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue, or psychotropic prescribing. Models adjusted for comorbidities, ethnicity, smoking, and body mass index. RESULTS Of 11 923 105 eligible individuals (6 011 020 [50.4%] women and 5 912 085 [49.6%] men; median [IQR] age, 44 [30-61] years), 232 780 individuals (2.0%) had positive result on a SARS-CoV-2 test. After applying selection criteria, 86 922 individuals were in the matched cohort without prior mental illness, 19 020 individuals had prior anxiety or depression, 1036 individuals had psychosis, 4152 individuals had fatigue, and 4539 individuals had sleep problems. After adjusting for observed confounders, there was an association between positive SARS-CoV-2 test results and psychiatric morbidity (adjusted hazard ratio [aHR], 1.83; 95% CI, 1.66-2.02), fatigue (aHR, 5.98; 95% CI, 5.33-6.71), and sleep problems (aHR, 3.16; 95% CI, 2.64-3.78). However, there was a similar risk of incident psychiatric morbidity for those with a negative SARS-CoV-2 test results (aHR, 1.71; 95% CI, 1.65-1.77) and a larger increase associated with influenza (aHR, 2.98; 95% CI, 1.55-5.75). CONCLUSIONS AND RELEVANCE In this cohort study of individuals registered at an English primary care practice during the pandemic, there was consistent evidence that SARS-CoV-2 infection was associated with increased risk of fatigue and sleep problems. However, the results from the negative control analysis suggest that unobserved confounding may be responsible for at least some of the positive association between COVID-19 and psychiatric morbidity.
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Affiliation(s)
- Kathryn M. Abel
- Greater Manchester Mental Health Trust, Manchester, United Kingdom
- Centre for Women’s Mental Health, University of Manchester, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthew J. Carr
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Holly Hope
- Centre for Women’s Mental Health, University of Manchester, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Navneet Kapur
- Greater Manchester Mental Health Trust, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Sally McManus
- National Centre for Social Research, London, United Kingdom
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Sarah Steeg
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Roger T. Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Matthias Pierce
- Centre for Women’s Mental Health, University of Manchester, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, United Kingdom
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Hope H, Osam CS, Kontopantelis E, Hughes S, Munford L, Ashcroft DM, Pierce M, Abel KM. The healthcare resource impact of maternal mental illness on children and adolescents: UK retrospective cohort study. Br J Psychiatry 2021; 219:515-522. [PMID: 35048862 PMCID: PMC8387858 DOI: 10.1192/bjp.2021.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/03/2023]
Abstract
BACKGROUND The general health of children of parents with mental illness is overlooked. AIMS To quantify the difference in healthcare use of children exposed and unexposed to maternal mental illness (MMI). METHOD This was a retrospective cohort study of children aged 0-17 years, from 1 April 2007 to 31 July 2017, using a primary care register (Clinical Practice Research Datalink) linked to Hospital Episodes Statistics. MMI included non-affective/affective psychosis and mood, anxiety, addiction, eating and personality disorders. Healthcare use included prescriptions, primary care and secondary care contacts; inflation adjusted costs were applied. The rate and cost was calculated and compared for children exposed and unexposed to MMI using negative binomial regression models. The total annual cost to NHS England of children with MMI was estimated. RESULTS The study included 489 255 children: 238 106 (48.7%) girls, 112 741 children (23.0%) exposed to MMI. Compared to unexposed children, exposed children had a higher rate of healthcare use (rate ratio 1.27, 95% CI 1.26-1.28), averaging 2.21 extra contacts per exposed child per year (95% CI 2.14-2.29). Increased healthcare use among exposed children occurred in inpatients (rate ratio 1.37, 95% CI 1.32-1.42), emergency care visits (rate ratio 1.34, 95% CI 1.33-1.36), outpatients (rate ratio 1.30, 95% CI 1.28-1.32), prescriptions (rate ratio 1.28, 95% CI 1.26-1.30) and primary care consultations (rate ratio 1.24, 95% CI 1.23-1.25). This costs NHS England an additional £656 million (95% CI £619-£692 million), annually. CONCLUSIONS Children of mentally ill mothers are a health vulnerable group for whom targeted intervention may create benefit for individuals, families, as well as limited NHS resources.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK,Correspondence: Holly Hope.
| | - Cemre Su Osam
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sian Hughes
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Population Health Analysis, Department of Health and Social Care, UK
| | - Luke Munford
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kathryn M. Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
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Kontopantelis E, Mamas MA, Webb RT, Castro A, Rutter MK, Gale CP, Ashcroft DM, Pierce M, Abel KM, Price G, Faivre-Finn C, Van Spall HG, Graham MM, Morciano M, Martin GP, Doran T. Excess deaths from COVID-19 and other causes by region, neighbourhood deprivation level and place of death during the first 30 weeks of the pandemic in England and Wales: A retrospective registry study. Lancet Reg Health Eur 2021; 7:100144. [PMID: 34557845 PMCID: PMC8454637 DOI: 10.1016/j.lanepe.2021.100144] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excess deaths during the COVID-19 pandemic compared with those expected from historical trends have been unequally distributed, both geographically and socioeconomically. Not all excess deaths have been directly related to COVID-19 infection. We investigated geographical and socioeconomic patterns in excess deaths for major groups of underlying causes during the pandemic. METHODS Weekly mortality data from 27/12/2014 to 2/10/2020 for England and Wales were obtained from the Office of National Statistics. Negative binomial regressions were used to model death counts based on pre-pandemic trends for deaths caused directly by COVID-19 (and other respiratory causes) and those caused indirectly by it (cardiovascular disease or diabetes, cancers, and all other indirect causes) over the first 30 weeks of the pandemic (7/3/2020-2/10/2020). FINDINGS There were 62,321 (95% CI: 58,849 to 65,793) excess deaths in England and Wales in the first 30 weeks of the pandemic. Of these, 46,221 (95% CI: 45,439 to 47,003) were attributable to respiratory causes, including COVID-19, and 16,100 (95% CI: 13,410 to 18,790) to other causes. Rates of all-cause excess mortality ranged from 78 per 100,000 in the South West of England and in Wales to 130 per 100,000 in the West Midlands; and from 93 per 100,000 in the most affluent fifth of areas to 124 per 100,000 in the most deprived. The most deprived areas had the highest rates of death attributable to COVID-19 and other indirect deaths, but there was no socioeconomic gradient for excess deaths from cardiovascular disease/diabetes and cancer. INTERPRETATION During the first 30 weeks of the COVID-19 pandemic there was significant geographic and socioeconomic variation in excess deaths for respiratory causes, but not for cardiovascular disease, diabetes and cancer. Pandemic recovery plans, including vaccination programmes, should take account of individual characteristics including health, socioeconomic status and place of residence. FUNDING None.
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Affiliation(s)
- Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, M13 9PL Manchester, England, United Kingdom
- NIHR School for Primary Care Research, University of Oxford, Oxford, England, United Kingdom
- Health Organisation, Policy and Economics (HOPE) research group, University of Manchester, Manchester, England, United Kingdom
| | - Mamas A. Mamas
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, M13 9PL Manchester, England, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, England, United Kingdom
- Department of Cardiology, Jefferson University, Philadelphia, United States
| | - Roger T. Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, University of Manchester and Manchester Academic Health Sciences Centre (MAHSC), England, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, England, United Kingdom
| | - Ana Castro
- Department of Health Sciences, University of York, England, United Kingdom
| | - Martin K. Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, England, United Kingdom
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, England, United Kingdom
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England, United Kingdom
- Leeds Institute for Data Analytics, University of Leeds, Leeds, England, United Kingdom
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
| | - Darren M. Ashcroft
- NIHR School for Primary Care Research, University of Oxford, Oxford, England, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, England, United Kingdom
- Division of Pharmacy & Optometry, University of Manchester, Manchester, England, United Kingdom
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, University of Manchester, Manchester, England, United Kingdom
| | - Kathryn M. Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, University of Manchester, Manchester, England, United Kingdom
| | - Gareth Price
- Manchester Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, England, United Kingdom
| | - Corinne Faivre-Finn
- Manchester Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, England, United Kingdom
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michelle M. Graham
- Division of Cardiology, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Marcello Morciano
- NIHR School for Primary Care Research, University of Oxford, Oxford, England, United Kingdom
- Health Organisation, Policy and Economics (HOPE) research group, University of Manchester, Manchester, England, United Kingdom
| | - Glen P. Martin
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, M13 9PL Manchester, England, United Kingdom
| | - Tim Doran
- Department of Health Sciences, University of York, England, United Kingdom
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Pierce M, McManus S, Hope H, Hotopf M, Ford T, Hatch SL, John A, Kontopantelis E, Webb RT, Wessely S, Abel KM. Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data. Lancet Psychiatry 2021; 8:610-619. [PMID: 33965057 PMCID: PMC9764381 DOI: 10.1016/s2215-0366(21)00151-6] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The mental health of the UK population declined at the onset of the COVID-19 pandemic. Convenience sample surveys indicate that recovery began soon after. Using a probability sample, we tracked mental health during the pandemic to characterise mental health trajectories and identify predictors of deterioration. METHODS This study was a secondary analysis of five waves of the UK Household Longitudinal Study (a large, national, probability-based survey that has been collecting data continuously since January, 2009) from late April to early October, 2020 and pre-pandemic data taken from 2018-19. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). We used latent class mixed models to identify discrete mental health trajectories and fixed-effects regression to identify predictors of change in mental health. FINDINGS Mental health was assessed in 19 763 adults (≥16 years; 11 477 [58·1%] women and 8287 [41·9%] men; 3453 [17·5%] participants from minority ethnic groups). Mean population mental health deteriorated with the onset of the pandemic and did not begin improving until July, 2020. Latent class analysis identified five distinct mental health trajectories up to October 2020. Most individuals in the population had either consistently good (7437 [39·3%] participants) or consistently very good (7623 [37·5%] participants) mental health across the first 6 months of the pandemic. A recovering group (1727 [12·0%] participants) showed worsened mental health during the initial shock of the pandemic and then returned to around pre-pandemic levels of mental health by October, 2020. The two remaining groups were characterised by poor mental health throughout the observation period; for one group, (523 [4·1%] participants) there was an initial worsening in mental health that was sustained with highly elevated scores. The other group (1011 [7·0%] participants) had little initial acute deterioration in their mental health, but reported a steady and sustained decline in mental health over time. These last two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods, and be of Asian, Black or mixed ethnicity. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health. INTERPRETATION Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. Around one in nine individuals had deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions, or infection with SARS-CoV-2 might benefit most from early intervention. FUNDING None.
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Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Sally McManus
- National Centre for Social Research, London, UK; Violence and Society Centre, City, University of London, London, UK
| | - Holly Hope
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Carr MJ, Steeg S, Webb RT, Kapur N, Chew-Graham CA, Abel KM, Hope H, Pierce M, Ashcroft DM. Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study. Lancet Public Health 2021; 6:e124-e135. [PMID: 33444560 PMCID: PMC7843955 DOI: 10.1016/s2468-2667(20)30288-7] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. METHODS We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019-September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles. FINDINGS We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3-47·4), anxiety disorders by 47·8% (44·3-51·2), and first antidepressant prescribing by 36·4% (33·9-38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18-44 and 45-64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8-40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0-76·4]). INTERPRETATION Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised. FUNDING National Institute for Health Research and Medical Research Council.
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Affiliation(s)
- Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK.
| | - Roger T Webb
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Centre for Mental Health and Safety, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Nav Kapur
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Centre for Mental Health and Safety, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Holly Hope
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
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Zhao C, Schiessl I, Wan MW, Chronaki G, Abel KM. Development of the neural processing of vocal emotion during the first year of life. Child Neuropsychol 2020; 27:333-350. [DOI: 10.1080/09297049.2020.1853090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chen Zhao
- Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ingo Schiessl
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester, UK
| | - Ming Wai Wan
- Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Georgia Chronaki
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Developmental Cognitive Neuroscience (DCN) Laboratory, School of Psychology,Faculty of Science and Technology, University of Central Lancashire, Preston, UK
| | - Kathryn M. Abel
- Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Swift ER, Pierce M, Hope H, Osam CS, Abel KM. Young women are the most vulnerable to postpartum mental illness: A retrospective cohort study in UK primary care. J Affect Disord 2020; 277:218-224. [PMID: 32829198 DOI: 10.1016/j.jad.2020.08.016] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Whilst childbirth is a leading cause of mental illness in women, how it affects women at different ages is unknown. AIMS We examine whether the effect of childbirth on mental illness varies at different ages. METHODS From 2,657,751 women identified from a UK population-based primary care database, 355,864 postpartum periods, with no history of mental illness, were matched on year of birth and general practice to 1,420,350 non-postpartum periods. Cox regression models were used to compare incident mental illness between postpartum and non-postpartum periods. These were measured using hazard ratios (HR) and hazard ratios adjusted for parity and prior pregnancy loss (aHR). RESULTS Strong evidence is presented that the effect of livebirth on mental illness was age-dependant for depression (p <0·001), anxiety (p 0·048) and affective psychosis (p 0·031). In 15-19 year olds, depression was over seven times more likely to occur in postpartum periods than non-postpartum periods (aHR 7·09, 95%CI 6·65-7·56); twice the effect in women overall (aHR 3·24 95%CI 3·18-3·29). 15-19 year olds were 50% more likely to develop anxiety in postpartum periods than non-postpartum periods (aHR 1·52, 95%CI 1·38-1·67), with little effect in women overall (aHR 1·07 95%CI 1·04-1·10). Livebirth had over twice the effect on affective psychosis in women aged 15-24 (15-19 year olds: aHR 2·71 95%CI 1·23-5·97; 20-24 year olds: aHR 2·79 95%CI 1·68-4·63) compared to women overall (aHR 1·66, 95%CI 1·29-2·14). CONCLUSIONS Younger women are far more vulnerable to the effect of childbirth on their mental health, particularly depression and anxiety.
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Affiliation(s)
- Eleanor R Swift
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom; The National Institute for Health Research, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Cemre Su Osam
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom; The National Institute for Health Research, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Pierce M, Abel KM, Muwonge J, Wicks S, Nevriana A, Hope H, Dalman C, Kosidou K. Prevalence of parental mental illness and association with socioeconomic adversity among children in Sweden between 2006 and 2016: a population-based cohort study. Lancet Public Health 2020; 5:e583-e591. [PMID: 33120044 DOI: 10.1016/s2468-2667(20)30202-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Children of parents with mental illness are a vulnerable group, but their numbers and their exposure to adversity have rarely been examined. We examined the prevalence of children with parents with mental illness in Sweden, trends in prevalence from 2006 to 2016, and these children's exposure to socioeconomic adversity. METHODS We did a population-based cohort study among all children (aged <18 years) born in Sweden between Jan 1, 1991, and Dec 31, 2011, and their parents, followed up between Jan 1, 2006, and Dec 31, 2016. We included children who were identified in the Total Population Register and linked to their birth parents, excluding adopted children and those with missing information on both birth parents. We used a comprehensive register linkage, Psychiatry Sweden, to follow up for indicators of parental mental illness and socioeconomic adversity. Marginal predictions from a standard logistic regression model were used to estimate age-specific, 3-year period prevalence of parental mental illness and trends in prevalence for 2006-16. Using cross-sectional data on each child, indicators of socioeconomic adversity were compared between children with and without concurrent parental mental illness using logistic regression. FINDINGS Of 2 198 289 children born in Sweden between Jan 1, 1991, and Dec 31, 2011, we analysed 2 110 988 children (96·03% of the total population). The overall prevalence of children with diagnosed parental mental illness between 2006 and 2016 was 9·53% (95% CI 9·50-9·57). This prevalence increased with age of the child, from 6·72% (6·65-6·78) of the youngest children (0 to <3 years) to 10·80% (10·73-10·89) in the oldest (15 to <18 years). The prevalence of diagnosed parental mental illness increased from 8·62% (8·54-8·69) in 2006-09 up to 10·95% (10·86-11·03) in 2013-16. Children with any type of parental mental illness had markedly higher risk of socioeconomic adversity, such as living in poorer households or living separately from their parents. INTERPRETATION Currently, 11% of all Swedish children have a parent with a mental illness treated within secondary care. These children have markedly higher risk of broad socioeconomic adversity than do other children. There is a need to understand how socioeconomic adversity and parental mental illness influence vulnerability to poor life outcomes in these children. FUNDING European Research Council, National Institute for Health Research, Region Stockholm, and the Swedish Research Council.
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Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, UK
| | - Joseph Muwonge
- Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Susanne Wicks
- Center for Epidemiology and Community Medicine, Stockholm, Sweden; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Alicia Nevriana
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Christina Dalman
- Center for Epidemiology and Community Medicine, Stockholm, Sweden; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kyriaki Kosidou
- Center for Epidemiology and Community Medicine, Stockholm, Sweden; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
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Abel KM, Bee P, Gega L, Gellatly J, Kolade A, Hunter D, Callender C, Carter LA, Meacock R, Bower P, Stanley N, Calam R, Wolpert M, Stewart P, Emsley R, Holt K, Linklater H, Douglas S, Stokes-Crossley B, Green J. An intervention to improve the quality of life in children of parents with serious mental illness: the Young SMILES feasibility RCT. Health Technol Assess 2020; 24:1-136. [PMID: 33196410 DOI: 10.3310/hta24590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/21/2022] Open
Abstract
BACKGROUND Quality of life for children and adolescents living with serious parental mental illness can be impaired, but evidence-based interventions to improve it are scarce. OBJECTIVE Co-production of a child-centred intervention [called Young Simplifying Mental Illness plus Life Enhancement Skills (SMILES)] to improve the health-related quality of life of children and adolescents living with serious parental mental illness, and evaluating its acceptability and feasibility for delivery in NHS and community settings. DESIGN Qualitative and co-production methods informed the development of the intervention (Phase I). A feasibility randomised controlled trial was designed to compare Young SMILES with treatment as usual (Phase II). Semistructured qualitative interviews were used to explore acceptability among children and adolescents living with their parents, who had serious mental illness, and their parents. A mixture of semistructured qualitative interviews and focus group research was used to examine feasibility among Young SMILES facilitators and referrers/non-referrers. SETTING Randomisation was conducted after baseline measures were collected by the study co-ordinator, ensuring that the blinding of the statistician and research team was maintained to reduce detection bias. PARTICIPANTS Phase I: 14 children and adolescents living with serious parental mental illness, seven parents and 31 practitioners from social, educational and health-related sectors. Phase II: 40 children and adolescents living with serious parental mental illness, 33 parents, five referrers/non-referrers and 16 Young SMILES facilitators. INTERVENTION Young SMILES was delivered at two sites: (1) Warrington, supported by the National Society for the Prevention of Cruelty to Children (NSPCC), and (2) Newcastle, supported by the NHS and Barnardo's. An eight-session weekly group programme was delivered, with four to six children and adolescents living with serious parental mental illness per age-appropriate group (6-11 and 12-16 years). At week 4, a five-session parallel weekly programme was offered to the parents/carers. Sessions lasted 2 hours each and focused on improving mental health literacy, child-parent communication and children's problem-solving skills. MAIN OUTCOME MEASURES Phase ll children and parents completed questionnaires at randomisation and then again at 4 and 6 months post randomisation. Quality of life was self-reported by children and proxy-reported by parents using the Paediatric Quality of Life questionnaire and KIDSCREEN. Semistructured interviews with parents (n = 14) and children (n = 17) who participated in the Young SMILES groups gathered information about their motivation to sign up to the study, their experiences of participating in the group sessions, and their perceived changes in themselves and their family members following intervention. Further interviews with individual referrers (n = 5) gathered information about challenges to recruitment and randomisation. Two focus groups (n = 16) with practitioners who facilitated the intervention explored their views of the format and content of the Young SMILES manual and their suggestions for changes. RESULTS A total of 35 families were recruited: 20 were randomly allocated to Young SMILES group and 15 to treatment as usual. Of those, 28 families [15/20 (75%) in the intervention group and 13/15 (87%) in the control group] gave follow-up data at the primary end point (4 months post baseline). Participating children had high adherence to the intervention and high completion rates of the questionnaires. Children and adolescents living with their parents, who had serious mental illness, and their parents were mainly very positive and enthusiastic about Young SMILES, both of whom invoked the benefits of peer support and insight into parental difficulties. Although facilitators regarded Young SMILES as a meaningful and distinctive intervention having great potential, referrers identified several barriers to referring families to the study. One harm was reported by a parent, which was dealt with by the research team and the NSPCC in accordance with the standard operating procedures. LIMITATIONS The findings from our feasibility study are not sufficient to recommend a fully powered trial of Young SMILES in the near future. Although it was feasible to randomise children and adolescents living with serious parental mental illness of different ages to standardised, time-limited groups in both NHS and non-NHS settings, an intervention like Young SMILES is unlikely to address underlying core components of the vulnerability that children and adolescents living with serious parental mental illness express as a population over time. CONCLUSIONS Young SMILES was widely valued as unique in filling a recognised gap in need. Outcome measures in future studies of interventions for children and adolescents living with serious parental mental illness are more likely to capture change in individual risk factors for reduced quality of life by considering their unmet need, rather than on an aggregate construct of health-related quality of life overall, which may not reflect these young people's needs. FUTURE WORK A public health approach to intervention might be best. Most children and adolescents living with serious parental mental illness remain well most of the time, so, although their absolute risks are low across outcomes (and most will remain resilient most of the time), consistent population estimates find their relative risk to be high compared with unexposed children. A public health approach to intervention needs to be both tailored to the particular needs of children and adolescents living with serious parental mental illness and agile to these needs so that it can respond to fluctuations over time. TRIAL REGISTRATION Current Controlled Trials ISRCTN36865046. FUNDING This project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Penny Bee
- Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Judith Gellatly
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Adekeye Kolade
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Diane Hunter
- National Society for the Prevention of Cruelty to Children, London, UK
| | - Craig Callender
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Peter Bower
- National Primary Care Research and Development Centre, University of Manchester, Manchester, UK
| | - Nicky Stanley
- School of Social Work, University of Central Lancashire, Preston, UK
| | - Rachel Calam
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Miranda Wolpert
- Evidence Based Practice Unit, University College London, London, UK.,Anna Freud Centre, London, UK
| | - Paul Stewart
- National Society for the Prevention of Cruelty to Children, London, UK
| | - Richard Emsley
- Department for Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kim Holt
- Department of Social Work, Education and Community Wellbeing, University of Northumbria, Newcastle upon Tyne, UK
| | - Holly Linklater
- Department of Education and Inclusive Pedagogy, University of Edinburgh, Edinburgh, UK
| | - Simon Douglas
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Bryony Stokes-Crossley
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
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Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, Kontopantelis E, Webb R, Wessely S, McManus S, Abel KM. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry 2020; 7:883-892. [PMID: 32707037 PMCID: PMC7373389 DOI: 10.1016/s2215-0366(20)30308-4] [Citation(s) in RCA: 1504] [Impact Index Per Article: 376.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. METHODS In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23-30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. FINDINGS Waves 6-9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8-20·0) in 2018-19 to 27·3% (26·3-28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3-11·6) in 2018-19, to 12·6 (12·5-12·8) in April, 2020. This was 0·48 (95% CI 0·07-0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18-24-year-olds (2·69 points, 95% CI 1·89-3·48), 25-34-year-olds (1·57, 0·96-2·18), women (0·92, 0·50-1·35), and people living with young children (1·45, 0·79-2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20-1·06). INTERPRETATION By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. FUNDING None.
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Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Holly Hope
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Roger Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sally McManus
- National Centre for Social Research, London, UK; School of Health Sciences, City, University of London, London, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health Trust, Manchester, UK
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Pierce M, McManus S, Jessop C, John A, Hotopf M, Ford T, Hatch S, Wessely S, Abel KM. Says who? The significance of sampling in mental health surveys during COVID-19. Lancet Psychiatry 2020; 7:567-568. [PMID: 32502467 PMCID: PMC7266586 DOI: 10.1016/s2215-0366(20)30237-6] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/02/2022]
Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK.
| | - Sally McManus
- National Centre for Social Research, London, UK; School of Health Sciences, City University London, London, UK
| | | | - Ann John
- Population Data Science, Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea University, Swansea, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK
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Pierce M, Hope HF, Kolade A, Gellatly J, Osam CS, Perchard R, Kosidou K, Dalman C, Morgan V, Di Prinzio P, Abel KM. Effects of parental mental illness on children's physical health: systematic review and meta-analysis. Br J Psychiatry 2020; 217:354-363. [PMID: 31610824 DOI: 10.1192/bjp.2019.216] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 01/01/2023]
Abstract
BACKGROUND Children of parents with mental disorder face multiple challenges. AIMS To summarise evidence about parental mental disorder and child physical health. METHOD We searched seven databases for cohort or case-control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive-compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620). RESULTS Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04-1.26), asthma (OR = 1.26, 95% CI 1.12-1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74-3.73; diarrhoea: OR = 2.16, 95% CI 1.65-2.84). Evidence was inconclusive for obesity and other atopic disorders. CONCLUSIONS Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations. DECLARATION OF INTEREST None.
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Affiliation(s)
- Matthias Pierce
- Research Fellow, Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Holly F Hope
- Research Associate, Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Adekeye Kolade
- Research Assistant, Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Judith Gellatly
- Research Fellow, Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Cemre Su Osam
- PhD Student, Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Reena Perchard
- Clinical Research Fellow, Division of Developmental Biology & Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kyriaki Kosidou
- Senior Consultant, Department of Public Health Sciences, Division Public Health Epidemiology, Karolinska Institutet, Stockholm; and Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
| | - Christina Dalman
- Professor of Psychiatric Epidemiology and Research Group Leader, Department of Public Health Sciences, Division Public Health Epidemiology, Karolinska Institutet, Stockholm; and Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
| | - Vera Morgan
- Winthrop Professor and Head, Neuropsychiatric Epidemiology Research Unit, Division of Psychiatry, University of Western Australia, Australia
| | - Patricia Di Prinzio
- Research Fellow, Neuropsychiatric Epidemiology Research Unit, Division of Psychiatry, University of Western Australia, Australia
| | - Kathryn M Abel
- Professor of Psychological Medicine and Director, Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Abel KM, Hope H, Swift E, Parisi R, Ashcroft DM, Kosidou K, Osam CS, Dalman C, Pierce M. Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. Lancet Public Health 2020; 4:e291-e300. [PMID: 31155222 PMCID: PMC6557735 DOI: 10.1016/s2468-2667(19)30059-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 12/11/2022]
Abstract
Background Little information exists about the prevalence of children exposed to maternal mental illness. We aimed to estimate the prevalence of children and adolescents exposed to maternal mental illness in the UK between 2005 and 2017 using primary care data. Methods In this national retrospective cohort study, we included children aged 0–16 years born between Jan 1, 1991, and Dec 31, 2015, who were linked to their mothers and registered on the primary care Clinical Practice Research Datalink (CPRD) between 2005 and 2017. We extracted data on diagnosis, symptoms, and therapy from the CRPD to define the following maternal mental illnesses: depression, anxiety, non-affective psychosis, affective psychosis, eating disorders, personality disorders, alcohol misuse disorder, and substance misuse disorder. We also extracted data on socioeconomic status from the Index of Multiple Deprivation 2010 and data on ethnicity from the Hospital Episode Statistics dataset. The main outcome was prevalence of maternal mental illness. Prevalence was calculated for each 2-year period of childhood (from age 0–<2 to 14–<16 years) using marginal predictions from a logistic regression model. We used survival analysis to estimate the incidence and cumulative risk of children experiencing maternal mental illness by age 16 years. Findings We identified 783 710 children registered in the UK CPRD mother-baby link database, and included 547 747 children (381 685 mothers) in our analysis. Overall prevalence of maternal mental illness was 23·2% (95% CI 23·1–23·4), which increased during childhood (21·9%, 21·7–22·1 among the 0–<2 year age group vs 27·3%, 26·8–27·8 among the 14–<16 year age group). Depression and anxiety were the most prevalent maternal mental illnesses. The proportion of children exposed to maternal mental illness increased from 22·2% (21·9–22·4) between 2005 and 2007 to 25·1% (24·8–25·5) between 2015 and 2017. Geographically, the highest prevalence of maternal mental illness was observed in Northern Ireland (29·8%, 29·0–30·5). In England, prevalence of maternal mental illness was highest among children in the most deprived areas (28·3%, 27·8–28·8). The incidence of maternal mental illness was highest between 0–3 months (26·7 per 100 person years, 26·4–27·1). By age 16 years, the cumulative risk of maternal mental illness was 53·1% (52·8–53·3). Interpretation One in four children aged 0–16 years are exposed to maternal mental illness and the prevalence of diagnosed and treated maternal mental illness is increasing. Policy makers and commissioners should consider this information and channel resources to target individuals in greatest need. Funding The European Research Council and the National Institute for Health Research.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK.
| | - Eleanor Swift
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Kyriaki Kosidou
- Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Cemre Su Osam
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Matthias Pierce
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
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Hope H, Parisi R, Ashcroft DM, Williams R, Coton S, Kosidou K, Pierce M, Abel KM. Fertility trends of women with serious mental illness in the United Kingdom 1992-2017: A primary care cohort study using the clinical practice research datalink. J Affect Disord 2020; 269:141-147. [PMID: 32250867 DOI: 10.1016/j.jad.2020.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/13/2019] [Revised: 12/20/2019] [Accepted: 03/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Changes in care may mean women with serious mental illness (SMI) are more fertile. We investigated 1) the live-birth and pregnancy rate of women with and without SMI over time, 2) the likelihood of pregnancy when using second or first-generation antipsychotics. METHOD Retrospective cohort study of women (15-45 years) registered in Clinical Practice Research Datalink (CPRD) general practices between 1992 and 2017. Each analysis year, women with SMI (affective and non-affective psychotic disorder) were matched with up to four women with no record of SMI on age, calendar year and general practice. Pregnancy and live-birth rates and the rate ratio (RR) comparing women with and without SMI were estimated. The stability of the RR between years was tested. For women with SMI, the pregnancy rates when on or off first or second-generation antipsychotics were calculated and compared using Poisson regression models. RESULTS In total, 12,524 women with SMI were matched to 50,074 women without SMI, median age 34 [IQR 28-39] years. Between 1992 and 2017 women with SMI had 50% fewer live-births than women without SMI (RR 0..50, 95%CI 0.45-0.55). The pregnancy rate ratio increased from 0.64 (95%CI 0.48-0.86) (1992-1994) to 1.00 (95%CI 0.81-1.22) (2016-2017), (p < 0.0001), but this change was only seen in women with affective disorders. Women are most likely to become pregnant after discontinuing either a second-generation or first-generation antipsychotic (RR 1.74, 95%CI 1.42-2.13). CONCLUSIONS Women with SMI are increasingly experiencing pregnancy but not live-birth, which suggests the reproductive health needs of these women are unmet.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, UK
| | - Sonia Coton
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, UK
| | - Kyriaki Kosidou
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Matthias Pierce
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, UK
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Osam CS, Pierce M, Hope H, Ashcroft DM, Abel KM. The influence of maternal mental illness on vaccination uptake in children: a UK population-based cohort study. Eur J Epidemiol 2020; 35:879-889. [PMID: 32328992 PMCID: PMC7524844 DOI: 10.1007/s10654-020-00632-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/08/2020] [Indexed: 11/24/2022]
Abstract
Reduced vaccination uptake is a growing and global public health concern. There is limited knowledge about the effect of maternal mental illness (MMI) on rates of childhood vaccination. This retrospective cohort study examined 479,949 mother-baby pairs born between 1993 and 2015 in the Clinical Practice Research Datalink (CPRD GOLD), a UK-based, primary health-care database. The influence of MMI on children’s vaccination status at two and five years of age was investigated using logistic regression adjusting for sex of the child, child ethnicity, delivery year, maternal age, practice level deprivation quintile and region. The vaccinations were: 5-in-1 (DTaP/IPV/Hib) and first dose MMR by the age of two; and all three doses of 5-in-1, first and second dose of MMR vaccines by the age of five. Exposure to MMI was defined using recorded clinical events for: depression, anxiety, psychosis, eating disorder, personality disorder and alcohol and substance misuse disorders. The likelihood that a child completed their recommended vaccinations by the age of two and five was significantly lower among children with MMI compared to children with mothers without mental illness [adjusted odds ratio (aOR) 0.86, 95% CI 0.84–0.88, p < 0.001]. The strongest effect was observed for children exposed to maternal alcohol or substance misuse (at two years aOR 0.50, 95% CI 0.44–0.58, p < 0.001). In the UK, an estimated five thousand more children per year would be vaccinated if children with MMI had the same vaccination rates as children with well mothers. Maternal mental illness is a hitherto largely unrecognised reason that children may be missing vital vaccinations at two and five years of age. This risk is highest for those children living with maternal alcohol or substance misuse.
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Affiliation(s)
- Cemre Su Osam
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Matthias Pierce
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Holly Hope
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.,Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester, M25 3BL, UK
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Nevriana A, Pierce M, Dalman C, Wicks S, Hasselberg M, Hope H, Abel KM, Kosidou K. Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden. BMJ 2020; 369:m853. [PMID: 32269017 PMCID: PMC7190076 DOI: 10.1136/bmj.m853] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the association between parental mental illness and the risk of injuries among offspring. DESIGN Retrospective cohort study. SETTING Swedish population based registers. PARTICIPANTS 1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers. EXPOSURES Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers. MAIN OUTCOME MEASURES Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders. RESULTS Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders. CONCLUSIONS Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child's life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.
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Affiliation(s)
- Alicia Nevriana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
| | - Susanne Wicks
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
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Di Prinzio P, Abel KM, Ambrosi TL, Jablensky A, Croft M, Shah S, McNeil TF, Pierce M, Morgan VA. Parsing components of risk of premature mortality in the children of mothers with severe mental illness. Schizophr Res 2020; 218:180-187. [PMID: 31980344 DOI: 10.1016/j.schres.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 11/28/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Children of mothers with severe mental illness are at increased risk of premature death including in infancy and early childhood. Importantly, these children are also more likely to be exposed to adverse socio-demographic risk factors and serious obstetric complications which, of themselves, may increase risk for childhood mortality. We examined mortality outcome at different ages up to 5 years taking account of these risks. METHOD We used linked data across Western Australian whole-population psychiatric, inpatient, death, and midwives' registers to identify 15,486 births to mothers with severe mental illness and 452,459 births to mothers with no mental illness. Multivariable models were adjusted for exposure to adverse socio-demographic risk factors and serious obstetric complications. RESULTS Overall risk of premature death was increased amongst children of mothers with severe mental illness (2.3%, 354 deaths) compared with children of mothers with no mental illness (1.4%, 6523 deaths); the same was true for specific risk of stillbirth, neonatal, post‑neonatal and early childhood deaths. Risk was substantially attenuated after adjustment for adverse socio-demographic exposures, and further still after adjustment for exposure to serious obstetric complications. We observed no effects for the timing of maternal illness diagnosis. CONCLUSIONS To minimise the risk of premature mortality in the children of mothers with severe mental illness, priority should be given to the prompt diagnosis of maternal mental illness with targeted delivery of high quality antenatal and psychiatric care, as well as social and structural supports for affected families that continue after birth.
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Affiliation(s)
- Patsy Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Medicine, Biology and Health Sciences, University of Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, UK
| | - Taryn L Ambrosi
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Maxine Croft
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Sonal Shah
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Thomas F McNeil
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Matthias Pierce
- Centre for Women's Mental Health, Faculty of Medicine, Biology and Health Sciences, University of Manchester, M13 9PL, UK
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
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Abel KM, Hope H, Faulds A, Pierce M. Promoting resilience in children and adolescents living with parental mental illness (CAPRI): children are key to identifying solutions. Br J Psychiatry 2019; 215:513-515. [PMID: 31190644 DOI: 10.1192/bjp.2019.118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 01/17/2023]
Abstract
UNLABELLED The lives of Children and Adolescents with PaRental mental Illness (CAPRI) represent a public health priority. Identifying those at most risk within the risk subset is crucial to promote resilience for this group. The ability to develop child-centred interventions will underpin the success of evidence-based services and CAPRI themselves are key to unlocking current service barriers. DECLARATION INTEREST None.
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Affiliation(s)
- Kathryn M Abel
- Professor of Psychological Medicine and Reproductive Psychiatry, Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Holly Hope
- Post-doctoral Researcher, Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Annie Faulds
- Doctoral Student in Clinical Psychology, University of Sheffield, UK
| | - Matthias Pierce
- Research Fellow, Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Abel KM, Heuvelman H, Rai D, Timpson NJ, Sarginson J, Shallcross R, Mitchell H, Hope H, Emsley R. Intelligence in offspring born to women exposed to intimate partner violence: a population-based cohort study. Wellcome Open Res 2019; 4:107. [PMID: 31681855 PMCID: PMC6820818 DOI: 10.12688/wellcomeopenres.15270.1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Intimate partner violence (IPV) is a risk factor for developmental problems in offspring. Despite a high prevalence of IPV in the UK and elsewhere, the longer-term outcomes of offspring born to exposed mothers remain under-researched. Methods: Population-based cohort study. We assessed IPV prevalence by type and timing for 3,153 mother-child pairs with complete data within our study population and examined associations between IPV and offspring IQ. We used multiple-imputation to evaluate bias due to our exclusion of observations with missing covariate data. Results: Nearly one in five mothers reported IPV during the study period, with 17.6% reporting emotional violence and 6.8% reporting physical violence. Taking into account potential confounders, the IQ scores of children born to mothers exposed to physical violence remained lower than those of maternally unexposed children (full-scale IQ = -2.8 points [95%CI -4.9 to -0.7], verbal IQ = -2.2 [95%CI -4.4 to -0.1], performance IQ = -2.7 [95%CI -5.0 to -0.5]) and odds of below-average intelligence (IQ<90) remained increased for full-scale (OR 1.48 [95%CI 1.03 to 2.14] and performance IQ (OR 1.48 [95%CI 1.08 to 2.04]) but not verbal IQ (OR 1.06 [95%CI 0.69 to 1.64]). Most physical violence occurred postnatally, and relative odds were most substantial when mothers were exposed to violence across pre-/perinatal and postnatal study periods (OR performance IQ<90 = 2.97 [95%CI 1.30 to 6.82]). Conclusions: Maternal exposure to physical IPV is associated with lower offspring IQ at age 8. Associations persisted after adjusting for potential confounders and were driven by violence occurring postnatally.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Rd, Prestwich, Manchester, M25 3BL, UK
| | - Hein Heuvelman
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Avon & Wiltshire Mental Health Partnership NHS Trust, Jenner House, Langley Park, Chippenham, SN15 1GG, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jane Sarginson
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK
| | - Rebekah Shallcross
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Heather Mitchell
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Rd, Prestwich, Manchester, M25 3BL, UK
| | - Holly Hope
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Richard Emsley
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Gellatly J, Bee P, Kolade A, Hunter D, Gega L, Callender C, Hope H, Abel KM. Developing an Intervention to Improve the Health Related Quality of Life in Children and Young People With Serious Parental Mental Illness. Front Psychiatry 2019; 10:155. [PMID: 31024349 PMCID: PMC6465622 DOI: 10.3389/fpsyt.2019.00155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Children and adolescents living with parental mental illness (CAPRI) are at increased risk of behavioral, social and educational difficulties, mental and physical health problems and have poorer quality of life (QoL). Adverse outcomes can extend into adulthood but are not inevitable. Recent policy and stakeholder consultation recognize the urgent need for interventions that extend beyond objective, service-led measures of health. Systematic evidence synthesis has demonstrated a lack of evidence-based interventions for enhancing holistic, child-centered outcomes. We aimed to co-develop a manualised, community-based intervention to improve QoL in CAPRI. Precedence was given to the QoL domains that were prioritized by stakeholders and deemed feasible to modify within a health and social care context. We describe here the modeling phase of developing the intervention emphasizing co-production activities with CAPRI, their families and professionals who support them. Methods: Semi-structured interviews and focus groups with CAPRI (n = 14), parents (n = 7), and professionals from health, social and educational sectors (n = 31) in the UK. Topic guides qualitatively explored participants prior experiences, unmet needs, perceived barriers and facilitators to receiving/delivering support, and their ideals for a new intervention. Findings were synthesized with existing research evidence and presented to a mixed panel of clinical academics and health and social care professionals. A consensus exercise was used to identify the preferred structure, format and content of the manualised intervention. Results: An 8-week group intervention for 6-16 year olds and their parents, called Young SMILES, has been co-developed along with associated training materials for facilitators. Each session addresses an identified need, but is underpinned by cross-cutting themes pertaining to mental health literacy, parent-child communication, and problem solving skills. Sessions are delivered by two trained facilitators and held in accessible and acceptable community locations weekly for 2 h. Conclusion: Young SMILES captures a broad age range and level of need for CAPRI and can be evaluated with quantifiable child-centered outcomes. In line with current policy directives, this is the first UK-based, multi-context intervention to improve QoL in this population. Implementation and referral mechanisms are currently being evaluated in a multi-site feasibility trial.
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Affiliation(s)
- Judith Gellatly
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Division of Nursing, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Penny Bee
- Division of Nursing, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Adekeye Kolade
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | | | - Lina Gega
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Craig Callender
- St. Nicholas Hospital, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Holly Hope
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Kathryn M. Abel
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Trevillion K, Shallcross R, Ryan E, Heslin M, Pickles A, Byford S, Jones I, Johnson S, Pawlby S, Stanley N, Rose D, Seneviratne G, Wieck A, Jennings S, Potts L, Abel KM, Howard LM. Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period. BMJ Open 2019; 9:e025906. [PMID: 30904867 PMCID: PMC6475160 DOI: 10.1136/bmjopen-2018-025906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs. METHODS AND ANALYSIS Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition. ETHICS AND DISSEMINATION The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.
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Affiliation(s)
- Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Rebekah Shallcross
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
| | - Elizabeth Ryan
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Andrew Pickles
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Susan Pawlby
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Gertrude Seneviratne
- Psychological Medicine and Integrated Care Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stacey Jennings
- Addictions, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Laura Potts
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Kathryn M Abel
- Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, Manchester, UK
- Manchester Mental Health & Social Care Trust, Manchester, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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Zhao C, Chronaki G, Schiessl I, Wan MW, Abel KM. Is infant neural sensitivity to vocal emotion associated with mother-infant relational experience? PLoS One 2019; 14:e0212205. [PMID: 30811431 PMCID: PMC6392422 DOI: 10.1371/journal.pone.0212205] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022] Open
Abstract
An early understanding of others' vocal emotions provides infants with a distinct advantage for eliciting appropriate care from caregivers and for navigating their social world. Consistent with this notion, an emerging literature suggests that a temporal cortical response to the prosody of emotional speech is observable in the first year of life. Furthermore, neural specialisation to vocal emotion in infancy may vary according to early experience. Neural sensitivity to emotional non-speech vocalisations was investigated in 29 six-month-old infants using near-infrared spectroscopy (fNIRS). Both angry and happy vocalisations evoked increased activation in the temporal cortices (relative to neutral and angry vocalisations respectively), and the strength of the angry minus neutral effect was positively associated with the degree of directiveness in the mothers' play interactions with their infant. This first fNIRS study of infant vocal emotion processing implicates bilateral temporal mechanisms similar to those found in adults and suggests that infants who experience more directive caregiving or social play may more strongly or preferentially process vocal anger by six months of age.
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Affiliation(s)
- Chen Zhao
- Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Georgia Chronaki
- Developmental Cognitive Neuroscience (DCN) Laboratory, School of Psychology, University of Central Lancashire, Preston, United Kingdom
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Developmental Brain-Behaviour Laboratory, Psychology, University of Southampton, United Kingdom
| | - Ingo Schiessl
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ming Wai Wan
- Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kathryn M. Abel
- Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Mitchell H, Abel KM, Dunlop BJ, Walker T, Ranote S, Robinson L, Edgar F, Millington T, Meacock R, Shaw J, Gutridge K. Acceptability and feasibility pilot randomised controlled trial of medical skin camouflage for recovery of women prisoners with self-harm scarring (COVER): the study protocol. BMJ Open 2019; 9:e021891. [PMID: 30782675 PMCID: PMC6340434 DOI: 10.1136/bmjopen-2018-021891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Self-harm in prison is a major public health concern. Less than 5% of UK prisoners are women, but they carry out more than a fifth of prison self-harm. Scars resulting from self-harm can be traumatising and stigmatising, yet there has been little focus on recovery of women prisoners with self-harm scarring. Medical skin camouflage (MSC) clinics treat individuals with disfiguring skin conditions, with evidence of improved well-being, self-esteem and social interactions. Only one community study has piloted the use of MSC for self-harm scarring. METHODS AND ANALYSIS We describe an acceptability and feasibility pilot randomised controlled trial; the first to examine MSC for women prisoners who self-harm. We aim to randomise 20-25 women prisoners to a 6-week MSC intervention and 20-25 to a waitlist control (to receive the MSC after the study period). We aim to train at least 6-10 long-term prisoners with personal experience of self-harm to deliver the intervention. Before and after intervention, we will pilot collection of women-centred outcomes, including quality of life, well-being and self-esteem. We will pilot collection of self-harm incidents during the intervention, resources used to manage/treat self-harm and follow-up of women at 12 weeks from baseline. Data on recruitment, retention and dropout will be recorded. We aim for the acceptability of the intervention to prison staff and women prisoners to be explored in qualitative interviews and focus groups. ETHICS AND DISSEMINATION Ethical approval for COVER has been granted by the North East-York Research Ethics Committee (REC) for phases 1 and 2 (reference: 16/NE/0030) and West of Scotland REC 3 for phases 3 and 4 (reference: 16/WS/0155). Informed consent will be the primary consideration; it will be made clear that participation will have no effect on life in prison or eligibility for parole. Due to the nature of the study, disclosures of serious self-harm may need to be reported to prison officials. We aim for findings to be disseminated via events at the study prison, presentations at national/international conferences, journal publications, prison governor meetings and university/National Health Service trust communications. TRIAL REGISTRATION NUMBER NCT02638974; Pre-results.
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Affiliation(s)
- Heather Mitchell
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Kathryn M Abel
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Brendan James Dunlop
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Tammi Walker
- Department of Psychology, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Sandeep Ranote
- North West Boroughs Healthcare NHS Foundation Trust, Warrington, United Kingdom
| | - Louise Robinson
- Lancashire Care NHS Foundation Trust, Preston, UK
- Centre for Mental Health and Risk, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Fiona Edgar
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Mental Health and Criminal Justice Group, University of Central Lancashire, Preston, UK
| | - Tracy Millington
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenny Shaw
- Offender Health Research Network, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
| | - Kerry Gutridge
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Paul S, Austin J, Elliott R, Ellison-Wright I, Wan MW, Drake R, Downey D, Elmadih A, Mukherjee I, Heaney L, Williams S, Abel KM. Neural pathways of maternal responding: systematic review and meta-analysis. Arch Womens Ment Health 2019; 22:179-187. [PMID: 29987638 PMCID: PMC6440933 DOI: 10.1007/s00737-018-0878-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/02/2018] [Accepted: 05/11/2018] [Indexed: 11/28/2022]
Abstract
Functional magnetic resonance imaging (fMRI) has increasingly been employed to establish whether there is a specific brain neural network dedicated to maternal responsiveness. We undertook systematic review and meta-analysis of all studies in which healthy new mothers were exposed to visual stimuli of own versus other infants to determine the quality of evidence for a dedicated maternal neural network. Systematic literature review revealed a pattern of specific neural responses commonly induced by visual infant paradigms. Brain areas consistently reported as activated in mothers in response to own versus unknown infant included the left thalamus, bilateral pre-central gyrus, left limbic lobe, uncus, amygdala and left caudate. These regions are implicated in reward, attention, emotion processing and other core social cognitive skills. Meta-analysis, however, revealed a more limited subset of brain areas activated in mothers specifically in response to their own versus unknown infant and suggested considerable inter-study variability. Further work is needed if functional imaging is to become an objective tool for the assessment of neural pathways associated with distinct patterns of maternal care behaviour. Such a tool would be invaluable in developing biomarkers of neural activity associated with healthy maternal care and for monitoring treatment/intervention effects of costly parenting interventions.
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Affiliation(s)
- Sarika Paul
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Josie Austin
- Centre for Women’s Mental Health, University of Manchester, Manchester, UK ,School of Health Sciences, University of Manchester, Manchester, UK
| | - Rebecca Elliott
- School of Health Sciences, University of Manchester, Manchester, UK ,Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | | | - Ming Wai Wan
- Centre for Women’s Mental Health, University of Manchester, Manchester, UK ,School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard Drake
- School of Health Sciences, University of Manchester, Manchester, UK ,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK ,Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Darragh Downey
- Centre for Women’s Mental Health, University of Manchester, Manchester, UK ,School of Health Sciences, University of Manchester, Manchester, UK ,Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Alya Elmadih
- Centre for Women’s Mental Health, University of Manchester, Manchester, UK ,School of Health Sciences, University of Manchester, Manchester, UK
| | - Ipshita Mukherjee
- School of Health Sciences, University of Manchester, Manchester, UK ,Pennine Acute Hospital NHS Trust, Manchester, UK
| | - Lisa Heaney
- Centre for Women’s Mental Health, University of Manchester, Manchester, UK ,School of Health Sciences, University of Manchester, Manchester, UK
| | - Steve Williams
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Kathryn M. Abel
- Centre for Women’s Mental Health, University of Manchester, Manchester, UK ,School of Health Sciences, University of Manchester, Manchester, UK ,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK ,Greater Manchester Mental Health NHS Trust, Manchester, UK
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