1
|
Finning K, Haeffner A, Patel S, Longdon B, Hayes R, Ukoumunne OC, Ford T. Is neighbourhood deprivation in primary school-aged children associated with their mental health and does this association change over 30 months? Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02385-y. [PMID: 38356042 DOI: 10.1007/s00787-024-02385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
As both socioeconomic deprivation and the prevalence of childhood mental health difficulties continue to increase, exploring the relationship between them is important to guide policy. We aimed to replicate the finding of a mental health gap that widened with age between those living in the most and least deprived areas among primary school pupils. We used data from 2075 children aged 4-9 years in the South West of England recruited to the STARS (Supporting Teachers and childRen in Schools) trial, which collected teacher- and parent-reported Strength and Difficulties Questionnaire (SDQ) at baseline, 18-month and 30-month follow-up. We fitted multilevel regression models to explore the relationship between Index of Multiple Deprivation (IMD) quintile and SDQ total difficulties score and an algorithm-generated "probable disorder" variable that combined SDQ data from teachers and parents. Teacher- and parent-reported SDQ total difficulties scores indicated worse mental health in children living in more deprived neighbourhoods, which was attenuated by controlling for special educational needs and disabilities but remained significant by parent report, and there was no interaction year group status (age) at baseline. We did not detect an association between probable disorder and IMD although an interaction with time was evident (p = 0.003). Analysis by study wave revealed associations at baseline (odds ratio 1.94, 95% confidence interval 0.97-3.89) and 18 months (1.96, 1.07-3.59) but not 30 months (0.94, 0.54-1.57). These findings augment the existing, highly compelling evidence demonstrating worse mental health in children exposed to socioeconomic deprivation.
Collapse
Affiliation(s)
- Katie Finning
- Public Policy Analysis, Office for National Statistics, Newport, UK
| | - Amy Haeffner
- Exeter Medical school, University of Exeter, Exeter, UK
| | - Sohum Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bryony Longdon
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Hayes
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
| |
Collapse
|
2
|
Bhide S, Efron D, Ukoumunne OC, Anderson V, Nicholson JM, Silk T, Hazell P, Gulenc A, Sciberras E. Family Functioning in Children With ADHD and Subthreshold ADHD: A 3-Year Longitudinal Study. J Atten Disord 2024; 28:480-492. [PMID: 38084374 PMCID: PMC10838481 DOI: 10.1177/10870547231217089] [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] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To compare family functioning over time for elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 179) and subthreshold ADHD (ST-ADHD; N = 86), to children without ADHD (Control; N = 212). METHOD ADHD was assessed using the Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV. At baseline, 18-month follow-up and 36-month follow-up, parents completed measures assessing a range of family functioning domains. RESULTS At baseline, the ADHD group reported higher psychological distress, less parenting self-efficacy, less parenting consistency, and more stressful life events; and both groups reported poorer family quality of life (QoL) and greater parenting anger. Trajectories were largely similar to controls (i.e., stable over time), but unlike controls, ADHD and ST-ADHD groups showed lessening parent-partner support and parenting warmth, respectively; and both groups showed worsening aspects of family QoL. CONCLUSION Families of children with ADHD and ST-ADHD report persistently poor or worsening family functioning; highlighting a need for tailored psycho-social supports.
Collapse
Affiliation(s)
- Sampada Bhide
- School of Pychology, Deakin University, Geelong, VIC, Australia
- Allied Health - Psychology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Medical School, The University of Melbourne, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | - Obioha C Ukoumunne
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, United Kingdom
| | - Vicki Anderson
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Medical School, The University of Melbourne, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | - Tim Silk
- School of Pychology, Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Philip Hazell
- Discipline of Psychiatry, School of Medicine, The University of Sydney and Westmead Hospital, NSW, Australia
| | - Alisha Gulenc
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Emma Sciberras
- School of Pychology, Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| |
Collapse
|
3
|
Hinze V, Montero-Marin J, Blakemore SJ, Byford S, Dalgleish T, Degli Esposti M, Greenberg MT, Jones BG, Slaghekke Y, Ukoumunne OC, Viner RM, Williams JMG, Ford TJ, Kuyken W. Student- and School-Level Factors Associated With Mental Health and Well-Being in Early Adolescence. J Am Acad Child Adolesc Psychiatry 2024; 63:266-282. [PMID: 37866473 PMCID: PMC10935542 DOI: 10.1016/j.jaac.2023.10.004] [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: 12/16/2022] [Revised: 07/28/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Adolescence is a key developmental window that may determine long-term mental health. As schools may influence mental health of students, this study aimed to examine the association of school-level characteristics with students' mental health over time. METHOD Longitudinal data from a cluster randomized controlled trial comprising 8,376 students (55% female; aged 11-14 years at baseline) across 84 schools in the United Kingdom were analyzed. Data collection started in the academic years 2016/2017 (cohort 1) and 2017/2018 (cohort 2), with follow-up at 1, 1.5, and 2 years. Students' mental health (risk for depression [Center for Epidemiologic Studies Depression Scale], social-emotional-behavioral difficulties [Strength and Difficulties Questionnaire]) and well-being (Warwick-Edinburgh Mental Well-Being Scale) and relationships with student- and school-level characteristics were explored using multilevel regression models. RESULTS Mental health difficulties and poorer well-being increased over time, particularly in girls. Differences among schools represented a small but statistically significant proportion of variation (95% CI) in students' mental health at each time point: depression, 1.7% (0.9%-2.5%) to 2.5% (1.6%-3.4%); social-emotional-behavioral difficulties, 1.9% (1.1%-2.7%) to 2.8% (2.1%-3.5%); and well-being, 1.8% (0.9%-2.7%) to 2.2% (1.4%-3.0%). Better student-rated school climate analyzed as a time-varying factor at the student and school level was associated with lower risk of depression (regression coefficient [95%CI] student level: -4.25 [-4.48, -4.01]; school level: -4.28 [-5.81, -2.75]), fewer social-emotional-behavioral difficulties (student level: -2.46 [-2.57, -2.35]; school level: -2.36 [-3.08, -1.63]), and higher well-being (student level: 3.88 [3.70, 4.05]; school-level: 4.28 [3.17, 5.38]), which was a stable relationship. CONCLUSION Student-rated school climate predicted mental health in early adolescence. Policy and system interventions that focus on school climate may promote students' mental health.
Collapse
Affiliation(s)
| | - Jesus Montero-Marin
- University of Oxford, Oxford, United Kingdom; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sarah-Jayne Blakemore
- University of Cambridge, Cambridge, United Kingdom; University College London, London, United Kingdom
| | | | - Tim Dalgleish
- University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Michelle Degli Esposti
- University of Oxford, Oxford, United Kingdom; Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Ball S, Reardon T, Creswell C, Taylor L, Brown P, Ford T, Gray A, Hill C, Jasper B, Larkin M, Macdonald I, Morgan F, Pollard J, Sancho M, Sniehotta FF, Spence SH, Stainer J, Stallard P, Violato M, Ukoumunne OC. Statistical analysis plan for a cluster randomised controlled trial to compare screening, feedback and intervention for child anxiety problems to usual school practice: identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i). Trials 2024; 25:62. [PMID: 38233861 PMCID: PMC10795300 DOI: 10.1186/s13063-023-07898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i) trial is being conducted to establish whether 'screening and intervention', consisting of usual school practice plus a pathway comprising screening, feedback and a brief parent-led online intervention (OSI: Online Support and Intervention for child anxiety), bring clinical and health economic benefits compared to usual school practice and assessment only - 'usual school practice', for children aged 8-9 years in the following: (1) the 'target population', who initially screen positive for anxiety problems according to a two-item parent-report child anxiety questionnaire - iCATS-2, and (2) the 'total population', comprising all children in participating classes. This article describes the detailed statistical analysis plan for the trial. METHODS AND DESIGN iCATS-i2i is a definitive, superiority, pragmatic, school-based cluster randomised controlled trial (with internal pilot), with two parallel groups. Schools are randomised 1:1 to receive either screening and intervention or usual school practice. This article describes the following: trial objectives and outcomes; statistical analysis principles, including detailed estimand information necessary for aligning trial objectives, conduct, analyses and interpretation when there are different analysis populations and outcome measures to be considered; and planned main analyses, sensitivity and additional analyses. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN76119074. Registered on 4 January 2022.
Collapse
Affiliation(s)
- Susan Ball
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
| | - Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- Oxford NHS Foundation Trust, Oxford, UK
| | - Lucy Taylor
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- Oxford NHS Foundation Trust, Oxford, UK
| | - Paul Brown
- Bransgore C of E Primary School, Christchurch, UK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation Trust, Cambridge, UK
| | - Alastair Gray
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Michael Larkin
- Life and Health Sciences, Aston University, Birmingham, UK
| | | | | | - Jack Pollard
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
- UK Health Security Agency, HCAI, Fungal, AMR, AMU and Sepsis Division, London, UK
| | | | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health (CPD), Universitätsmedizin Mannheim, Heidelberg University, Heidelberg, Germany
| | - Susan H Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | | | | | - Mara Violato
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Obioha C Ukoumunne
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
5
|
de Haan A, Meiser-Stedman R, Landolt MA, Kuhn I, Black MJ, Klaus K, Patel SD, Fisher DJ, Haag C, Ukoumunne OC, Jones BG, Flaiyah AM, Catani C, Dawson K, Bryant RA, de Roos C, Ertl V, Foa EB, Ford JD, Gilboa-Schechtman E, Tutus D, Hermenau K, Hecker T, Hultmann O, Axberg U, Jaberghaderi N, Jensen TK, Ormhaug SM, Kenardy J, Lindauer RJL, Diehle J, Murray LK, Kane JC, Peltonen K, Kangaslampi S, Robjant K, Koebach A, Rosner R, Rossouw J, Smith P, Tonge BJ, Hitchcock C, Dalgleish T. Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials. Lancet Child Adolesc Health 2024; 8:28-39. [PMID: 37980918 DOI: 10.1016/s2352-4642(23)00253-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. METHODS This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. FINDINGS We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. INTERPRETATION This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. FUNDING Swiss National Science Foundation.
Collapse
Affiliation(s)
- Anke de Haan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Markus A Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Melissa J Black
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Kristel Klaus
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Shivam D Patel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - David J Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Obioha C Ukoumunne
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK
| | - Benjamin G Jones
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK; Exploristics, Belfast, UK
| | | | - Claudia Catani
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands
| | - Verena Ertl
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Eva Gilboa-Schechtman
- Emotional Processing Laboratory, Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel
| | - Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Katharin Hermenau
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University Medical Centre EWL, Bielefeld University, Bielefeld, Germany
| | - Tobias Hecker
- Division of Clinical Developmental Psychopathology, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Ole Hultmann
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Axberg
- Faculty of Social Studies, VID Specialized University, Oslo, Norway
| | - Nasrin Jaberghaderi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tine K Jensen
- Department of Psychology, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Silje M Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Justin Kenardy
- School of Psychology, University of Queensland, Brisbane, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ramon J L Lindauer
- Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands; Department of Child and Adolescent Psychiatry, Public Mental Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Diehle
- WODC-Research and Documentation Centre, Ministry of Justice and Security, The Hague, Netherlands
| | - Laura K Murray
- Department of Mental Health and International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy C Kane
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Samuli Kangaslampi
- Faculty of Social Sciences, Psychology, Tampere University, Tampere, Finland
| | - Katy Robjant
- Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany
| | - Anke Koebach
- Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Development Research Group, Department of Politics and Administration, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; Centre for Cognitive-Behavioural Therapy, Cape Town, South Africa
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bruce J Tonge
- Centre for Developmental Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| |
Collapse
|
6
|
Abstract
Aims The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival. Methods The study combined data from the National Joint Registry and NHS Digital to report the survival of revision TAA. We have previously reported the failure rates and risk factors for failure after TAA, and the outcome of fusion after a failed TAA, using the same methodology. Survival was assessed using life tables and Kaplan Meier graphs. Cox proportional hazards regression models were fitted to compare failure rates. Results A total of 228 patients underwent revision TAA. The mean follow-up was 2.6 years (SD 2.0). The mean time between the initial procedure and revision was 2.3 years (SD 1.8). The most commonly used implant was the Inbone which was used in 81 patients. A total of 29 (12.7%) failed; nine (3.9%) patients underwent a further revision, 19 (8.3%) underwent a fusion, and one (0.4%) had an amputation. The rate of survival was 95.4% (95% confidence interval (CI) 91.6 to 97.5) at one year, 87.7% (95% CI 81.9 to 91.7; n = 124) at three years and 77.5% (95% CI 66.9 to 85.0; n = 57) at five years. Revision-specific implants had a better survival than when primary implants were used at revision. A total of 50 patients (21.9%) had further surgery; 19 (8.3%) underwent reoperation in the first 12 months. Cox regression models were prepared. In crude analysis the only significant risk factors for failure were the use of cement (hazard ratio (HR) 3.02 (95% CI 1.13 to 8.09)) and the time since the primary procedure (HR 0.67 (95% CI 0.47 to 0.97)). No risk factors for failure were identified in multivariable Cox regression modelling. Conclusion Revision TAAs have good medium term survival and low rates of further surgery. New modular revision implants appear to have improved the survival compared with the use of traditional primary implants at revision.
Collapse
Affiliation(s)
- Toby Jennison
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Andrew J Goldberg
- Wellington Hospital, Wellington, UK
- Imperial College London, London, UK
- Royal Free Hospital, London, UK
| | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| |
Collapse
|
7
|
Montero-Marin J, Hinze V, Crane C, Dalrymple N, Kempnich MEJ, Lord L, Slaghekke Y, Tudor K, Byford S, Dalgleish T, Ford TJ, Greenberg MT, Ukoumunne OC, Williams JMG, Kuyken W. Do Adolescents Like School-Based Mindfulness Training? Predictors of Mindfulness Practice and Responsiveness in the MYRIAD Trial. J Am Acad Child Adolesc Psychiatry 2023; 62:1256-1269. [PMID: 37236303 PMCID: PMC10935541 DOI: 10.1016/j.jaac.2023.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/27/2022] [Revised: 01/30/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE We explored what predicts secondary school students' mindfulness practice and responsiveness to universal school-based mindfulness training (SBMT), and how students experience SBMT. METHOD A mixed-methods design was used. Participants were 4,232 students (11-13 years of age), in 43 UK secondary schools, who received universal SBMT (ie, ".b" program), within the MYRIAD trial (ISRCTN86619085). Following previous research, student, teacher, school, and implementation factors were evaluated as potential predictors of students' out-of-school mindfulness practice and responsiveness (ie, interest in and attitudes toward SBMT), using mixed-effects linear regression. We explored pupils' SBMT experiences using thematic content analysis of their answers to 2 free-response questions, 1 question focused on positive experiences and 1 question on difficulties/challenges. RESULTS Students reported practicing out-of-school mindfulness exercises on average once during the intervention (mean [SD] = 1.16 [1.07]; range, 0-5). Students' average ratings of responsiveness were intermediate (mean [SD] = 4.72 [2.88]; range, 0-10). Girls reported more responsiveness. High risk of mental health problems was associated with lower responsiveness. Asian ethnicity and higher school-level economic deprivation were related to greater responsiveness. More SBMT sessions and better quality of delivery were associated with both greater mindfulness practice and responsiveness. In terms of students' experiences of SBMT, the most frequent themes (60% of the minimally elaborated responses) were an increased awareness of bodily feelings/sensations and increased ability to regulate emotions. CONCLUSION Most students did not engage with mindfulness practice. Although responsiveness to the SMBT was intermediate on average, there was substantial variation, with some youth rating it negatively and others rating it positively. Future SBMT developers should consider co-designing curricula with students, carefully assessing the student characteristics, aspects of the school environment, and implementation factors associated with mindfulness practice and responsiveness. SBMT teacher training is key, as more observed proficiency in SBMT teaching is associated with greater student mindfulness practice and responsiveness to SBMT.
Collapse
Affiliation(s)
- Jesus Montero-Marin
- University of Oxford, Oxford, United Kingdom; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), Spain
| | | | | | | | | | - Liz Lord
- University of Oxford, Oxford, United Kingdom
| | | | - Kate Tudor
- University of Oxford, Oxford, United Kingdom
| | - Sarah Byford
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), Spain
| | - Tim Dalgleish
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | | | | | | | | | | |
Collapse
|
8
|
Abstract
Aims When a total ankle arthroplasty (TAA) fails, it can be converted to a fusion or a revision arthroplasty. Despite the increasing numbers of TAAs being undertaken, there is little information in the literature about the management of patients undergoing fusion following a failed TAA. The primary aim of this study was to analyze the survival of fusions following a failed TAA using a large dataset from the National Joint Registry (NJR). Methods A data linkage study combined NJR and NHS Digital data. Failure of a TAA was defined as a fusion, revision to a further TAA, or amputation. Life tables and Kaplan-Meier graphs were used to record survival. Cox proportional hazards regression models were fitted to compare the rates of failure. Results A total of 131 patients underwent fusion as a salvage procedure following TAA. Their mean age was 65.7 years (SD 10.6) and 73 (55.7%) were male. The mean follow-up was 47.5 months (SD 27.2). The mean time between TAA and fusion was 5.3 years (SD 2.7). Overall, 32 (24.4%) underwent reoperations other than revision and 29 (22.1%) failed. Of these 24 (18.3%) underwent revision of the fusion and five (3.8%) had a below-knee amputation. No patients underwent conversion to a further TAA. Failure usually occurred in the first three postoperative years with one-year survival of fusion being 96.0% (95% confidence interval (CI) 90.7 to 98.3) and three-year survival in 69 patients being 77.5% (95% CI 68.3 to 84.4). Conclusion Salvage fusion after a failed TAA shows moderate rates of failure and reoperations. Nearly 25% of patients required revision within three years. This study is an extension of studies using the same methodology reporting the failure rates and risk factors for failure, which have recently been published, and also one reporting the outcome of revision TAA for a failed primary TAA, using the same methodology, which will shortly be published.
Collapse
Affiliation(s)
- Toby Jennison
- Plymouth Hospitals NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Goldberg
- Wellington Hospital, London, UK
- UCL Division of Surgery, Royal Free Hospital, London, UK
- Imperial College London, London, UK
| |
Collapse
|
9
|
Allan L, O'Connell A, Raghuraman S, Bingham A, Laverick A, Chandler K, Connors J, Jones B, Um J, Morgan-Trimmer S, Harwood R, Goodwin VA, Ukoumunne OC, Hawton A, Anderson R, Jackson T, MacLullich AMJ, Richardson S, Davis D, Collier L, Strain WD, Litherland R, Glasby J, Clare L. A rehabilitation intervention to improve recovery after an episode of delirium in adults over 65 years (RecoverED): study protocol for a multi-centre, single-arm feasibility study. Pilot Feasibility Stud 2023; 9:162. [PMID: 37715277 PMCID: PMC10503099 DOI: 10.1186/s40814-023-01387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Delirium affects over 20% of all hospitalised older adults. Delirium is associated with a number of adverse outcomes following hospital admission including cognitive decline, anxiety and depression, increased mortality and care needs. Previous research has addressed prevention of delirium in hospitals and care homes, and there are guidelines on short-term treatment of delirium during admission. However, no studies have addressed the problem of longer-term recovery after delirium and it is currently unknown whether interventions to improve recovery after delirium are effective and cost-effective. The primary objective of this feasibility study is to test a new, theory-informed rehabilitation intervention (RecoverED) in older adults delivered following a hospital admission complicated by delirium to determine whether (a) the intervention is acceptable to individuals with delirium and (b) a definitive trial and parallel economic evaluation of the intervention are feasible. METHODS The study is a multi-centre, single-arm feasibility study of a rehabilitation intervention with an embedded process evaluation. Sixty participants with delirium (aged > 65 years old) and carer pairs will be recruited from six NHS acute hospitals across the UK. All pairs will be offered the intervention, with follow-up assessments conducted at 3 months and 6 months post-discharge home. The intervention will be delivered in participants' own homes by therapists and rehabilitation support workers for up to 10 intervention sessions over 12 weeks. The intervention will be tailored to individual needs, and the chosen intervention plan and goals will be discussed and agreed with participants and carers. Quantitative data on reach, retention, fidelity and dose will be collected and summarised using descriptive statistics. The feasibility outcomes that will be used to determine whether the study meets the criteria for progression to a definitive randomised controlled trial (RCT) include recruitment, delivery of the intervention, retention, data collection and acceptability of outcome measures. Acceptability of the intervention will be assessed using in-depth, semi-structured qualitative interviews with participants and healthcare professionals. DISCUSSION Findings will inform the design of a pragmatic multi-centre RCT of the effectiveness and cost-effectiveness of the RecoverED intervention for helping the longer-term recovery of people with delirium compared to usual care. TRIAL REGISTRATION The feasibility study was registered: ISRCTN15676570.
Collapse
Affiliation(s)
- Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Abby O'Connell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Shruti Raghuraman
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Bingham
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Abigail Laverick
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Kirstie Chandler
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - James Connors
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Benjamin Jones
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jinpil Um
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | | | - Rowan Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Victoria A Goodwin
- Department of Ageing and Rehabilitation, University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, EX1 2LU, UK
| | - Annie Hawton
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Thomas Jackson
- Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WD, UK
| | - Alasdair M J MacLullich
- Scottish Hip Fracture Audit (SHFA), NHS National Services Scotland, Edinburgh, UK
- Ageing and Health Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Richardson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK
| | - Lesley Collier
- Faculty of Health and Well-Being, University of Winchester, Winchester, SO22 4NR, UK
| | - William David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5AX, UK
| | | | - Jon Glasby
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
10
|
Montero-Marin J, Hinze V, Mansfield K, Slaghekke Y, Blakemore SJ, Byford S, Dalgleish T, Greenberg MT, Viner RM, Ukoumunne OC, Ford T, Kuyken W. Young People's Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2335016. [PMID: 37733343 PMCID: PMC10514742 DOI: 10.1001/jamanetworkopen.2023.35016] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Importance As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical. Objective To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics. Design, Setting, and Participants For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021). Exposures Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored. Main Outcomes and Measures Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Results Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school. Conclusions and Relevance This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences.
Collapse
Affiliation(s)
- Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England, United Kingdom
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), Madrid, Spain
| | - Verena Hinze
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England, United Kingdom
| | - Karen Mansfield
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England, United Kingdom
| | - Yasmijn Slaghekke
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England, United Kingdom
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, England, United Kingdom
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King’s Health Economics, King’s College London, London, England, United Kingdom
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, England, United Kingdom
| | - Mark T. Greenberg
- Edna Bennett Pierce Prevention Research Center, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania
| | - Russell M. Viner
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, England, United Kingdom
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research Applied Research Collaboration (PenARC) South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, England, United Kingdom
| | - Tamsin Ford
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, England, United Kingdom
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England, United Kingdom
| | | |
Collapse
|
11
|
Pollard J, Reardon T, Williams C, Creswell C, Ford T, Gray A, Roberts N, Stallard P, Ukoumunne OC, Violato M. The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis. JCPP Adv 2023; 3:e12149. [PMID: 37720587 PMCID: PMC10501703 DOI: 10.1002/jcv2.12149] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs. Methods A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, 'effect direction' was used as a common metric, with random effects meta-analysis undertaken where possible. Results Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. 'Effect direction' was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP). Conclusions Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.
Collapse
Affiliation(s)
- Jack Pollard
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Tessa Reardon
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Chloe Williams
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Cathy Creswell
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation TrustCambridgeUK
| | - Alastair Gray
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Nia Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | | | - Obioha C. Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Mara Violato
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| |
Collapse
|
12
|
Sabatini S, Dritschel B, Rupprecht FS, Ukoumunne OC, Ballard C, Brooker H, Corbett A, Clare L. Rumination moderates the longitudinal associations of awareness of age-related change with depressive and anxiety symptoms. Aging Ment Health 2023; 27:1711-1719. [PMID: 36762688 DOI: 10.1080/13607863.2023.2176820] [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: 08/28/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Lower awareness of age-related gains (AARC-gains) and higher awareness of age-related losses (AARC-losses) may be risk factors for depressive and anxiety symptoms. We explored whether: (1) Baseline AARC-gains and AARC-losses predict depressive and anxiety symptoms at one-year follow-up; (2) age and rumination moderate these associations; (3) levels of AARC-gains and AARC-losses differ among individuals with different combinations of current and past depression and/or with different combinations of current and past anxiety. METHODS In this one-year longitudinal cohort study participants (N = 3386; mean age = 66.0; SD = 6.93) completed measures of AARC-gains, AARC-losses, rumination, depression, anxiety, and lifetime diagnosis of depression and anxiety in 2019 and 2020. Regression models with tests of interaction were used. RESULTS Higher AARC-losses, but not lower AARC-gains, predicted more depressive and anxiety symptoms. Age did not moderate these associations. Associations of lower AARC-gains and higher AARC-losses with more depressive symptoms and of higher AARC-losses with more anxiety symptoms were stronger in those with higher rumination. Individuals with both current and past depression reported highest AARC-losses and lowest AARC-gains. Those with current, but not past anxiety, reported highest AARC-losses. CONCLUSION Perceiving many age-related losses may place individuals at risk of depressive and anxiety symptoms, especially those who frequently ruminate.
Collapse
Affiliation(s)
- S Sabatini
- School of Medicine, University of Nottingham, Nottingham, UK
| | - B Dritschel
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
| | - F S Rupprecht
- Department of Developmental and Educational Psychology, University of Vienna, Vienna, Austria
| | - O C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC), Exeter, UK
- University of Exeter Medical School, Exeter, UK
| | - C Ballard
- University of Exeter Medical School, Exeter, UK
| | - H Brooker
- University of Exeter Medical School, Exeter, UK
- Ecog Pro Ltd, Bristol, UK
| | - A Corbett
- University of Exeter Medical School, Exeter, UK
| | - L Clare
- NIHR Applied Research Collaboration South West Peninsula (PenARC), Exeter, UK
- University of Exeter Medical School, Exeter, UK
| |
Collapse
|
13
|
Jennison T, Ukoumunne OC, Lamb S, Sharpe I, Goldberg A. Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS Digital. Foot Ankle Int 2023; 44:596-603. [PMID: 37345846 DOI: 10.1177/10711007231176512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 06/23/2023]
Abstract
BACKGROUND Despite the increasing numbers of ankle replacements, there remains debate about which patients should undergo an ankle replacement, and there are limited studies analyzing risk factors for failure of an ankle replacement. The primary aim of this study is to analyze the risk factors for failure of total ankle replacements. METHODS A data linkage study combining the National Joint Registry (NJR) Data and NHS (National Health Service) Digital data was performed. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device. Kaplan-Meier survival charts were used to illustrate survivorship. Multivariable Cox proportional hazards regression models were fitted to analyze potential risk factors for failures or ankle replacements. RESULTS The overall 5-year survival was 90.2% (95% CI 89.2%-91.1%). In multivariable (adjusted) Cox regression models, only age (hazard ratio [HR] 0.96, 95% CI 0.94-0.97), body mass index (BMI; HR 1.03, 95% CI 1.01-1.06), and underlying etiology (HR 0.88, 95% CI 0.80-0.97) were associated with an increased risk of failure. CONCLUSION This study demonstrates that younger patients and those with an increased BMI have an increased risk of failure of a primary ankle replacement. We also show that rheumatoid patients have higher survivorship than those with osteoarthritis. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Toby Jennison
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sallie Lamb
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andy Goldberg
- UCL Division of Surgery, Royal Free Hospital, London, UK
- Imperial College London, MSK Hub, White City Campus, London, UK
- The Wellington Hospital, St John's Wood, London, UK
| |
Collapse
|
14
|
Martins T, Ukoumunne OC, Lyratzopoulos G, Hamilton W, Abel G. Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study. Cancers (Basel) 2023; 15:3100. [PMID: 37370710 PMCID: PMC10296232 DOI: 10.3390/cancers15123100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated ethnic differences in the presenting features recorded in primary care before cancer diagnosis. METHODS English population-based cancer-registry-linked primary care data were analysed. We identified the coded features of six cancers (breast, lung, prostate, colorectal, oesophagogastric, and myeloma) in the year pre-diagnosis. Logistic regression models investigated ethnic differences in first-incident cancer features, adjusted for age, sex, smoking status, deprivation, and comorbidity. RESULTS Of 130,944 patients, 92% were White. In total, 188,487 incident features were recorded in the year pre-diagnosis, with 48% (89,531) as sole features. Compared with White patients, Asian and Black patients with breast, colorectal, and prostate cancer were more likely than White patients to have multiple features; the opposite was seen for the Black and Other ethnic groups with lung or prostate cancer. The proportion with relevant recorded features was broadly similar by ethnicity, with notable cancer-specific exceptions. Asian and Black patients were more likely to have low-risk features (e.g., cough, upper abdominal pain) recorded. Non-White patients were less likely to have alarm features. CONCLUSION The degree to which these differences reflect disease, patient or healthcare factors is unclear. Further research examining the predictive value of cancer features in ethnic minority groups and their association with cancer outcomes is needed.
Collapse
Affiliation(s)
- Tanimola Martins
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK;
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Willie Hamilton
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| |
Collapse
|
15
|
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne OC. Intracluster correlation coefficients from school-based cluster randomized trials of interventions for improving health outcomes in pupils. J Clin Epidemiol 2023; 158:18-26. [PMID: 36997102 DOI: 10.1016/j.jclinepi.2023.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/20/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND OBJECTIVES To summarize intracluster correlation coefficient (ICC) estimates for pupil health outcomes from school-based cluster randomized trials (CRTs) across world regions and describe their relationship with study design characteristics and context. METHODS School-based CRTs reporting ICCs for pupil health outcomes were identified through a literature search of MEDLINE (via Ovid). ICC estimates were summarized both overall and for different categories of study characteristics. RESULTS Two hundred and forty-six articles reporting ICC estimates were identified. The median (interquartile range) ICC was 0.031 (0.011 to 0.08) at the school level (N = 210) and 0.063 (0.024 to 0.1) at the class level (N = 46). The distribution of ICCs at the school level was well described by the beta and exponential distributions. Besides larger ICCs in definitive trials than feasibility studies, there were no clear associations between study characteristics and ICC estimates. CONCLUSION The distribution of school-level ICCs worldwide was similar to previous summaries from studies in the United States. The description of the distribution of ICCs will help to inform sample size calculations and assess their sensitivity when designing future school-based CRTs of health interventions.
Collapse
Affiliation(s)
- Kitty Parker
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Room 2.16, South Cloisters, St Luke's Campus, 79 Heavitree Rd, Exeter EX1 2LU, UK.
| | - Michael Nunns
- Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - ZhiMin Xiao
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, L5 Clifford Allbutt Building, Cambridge Biomedical Campus Box 58, Cambridge CB2 0AH, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Room 2.16, South Cloisters, St Luke's Campus, 79 Heavitree Rd, Exeter EX1 2LU, UK
| |
Collapse
|
16
|
Mansfield KL, Ukoumunne OC, Blakemore S, Montero‐Marin J, Byford S, Ford T, Kuyken W. Missing the context: The challenge of social inequalities to school-based mental health interventions. JCPP Adv 2023; 3:e12165. [PMID: 37753158 PMCID: PMC10519728 DOI: 10.1002/jcv2.12165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Given well-established links between socio-economic adversity and mental health, it is unsurprising that young people's mental health is deteriorating amidst economic crises. The World Health Organisation (WHO) recognises mental health as "crucial to personal, community, and socio-economic development" and outlines goals to reshape environments such as schools to protect mental health. Schools offer an ideal setting to promote wellbeing and prevent mental ill-health during a key developmental window. We describe how social inequalities present a challenge to designing school-based interventions for prevention and promotion for mental health and wellbeing, and suggest priorities to aid and evaluate their effectiveness.
Collapse
Affiliation(s)
| | - Obioha C. Ukoumunne
- NIHR ARC South West PeninsulaDepartment of Health and Community SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Sarah‐Jayne Blakemore
- Department of PsychologyUniversity of CambridgeCambridgeUK
- UCL Institute of Cognitive NeuroscienceLondonUK
| | - Jesus Montero‐Marin
- Department of PsychiatryUniversity of OxfordOxfordUK
- Teaching, Research & Innovation UnitParc Sanitari Sant Joan de DéuSant Boi de LlobregatSpain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health ‐ CIBERESP)MadridSpain
| | - Sarah Byford
- King's College LondonKing's Health EconomicsInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Tamsin Ford
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Willem Kuyken
- Department of PsychiatryUniversity of OxfordOxfordUK
| |
Collapse
|
17
|
Kuyken W, Blakemore SJ, Byford S, Dalgleish T, Ford T, Hinze V, Mansfield K, Montero-Marin J, Ukoumunne OC, Viner RM. Mental health in adolescence: the role of schools-based social emotional teaching. J Ment Health 2023; 32:537-540. [PMID: 37226816 DOI: 10.1080/09638237.2023.2210668] [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] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/23/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's Health Economics, London, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Verena Hinze
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Karen Mansfield
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), Madrid, Spain
| | - Obioha C Ukoumunne
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, NIHR Applied Research Collaboration South-West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Russell M Viner
- Population, Policy & Practice Research Programme, UCL Great Ormond St. Institute of Child Health, London, UK
| |
Collapse
|
18
|
Heather A, Goodwin E, Green C, Morrish N, Ukoumunne OC, Middleton RM, Hawton A. Multiple sclerosis health-related quality of life utility values from the UK MS register. Mult Scler J Exp Transl Clin 2023; 9:20552173231178441. [PMID: 37324245 PMCID: PMC10265354 DOI: 10.1177/20552173231178441] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Background New interventions for multiple sclerosis (MS) commonly require a demonstration of cost-effectiveness using health-related quality of life (HRQoL) utility values. The EQ-5D is the utility measure approved for use in the UK NHS funding decision-making. There are also MS-specific utility measures - e.g., MS Impact Scale Eight Dimensions (MSIS-8D) and MSIS-8D-Patient (MSIS-8D-P). Objectives Provide EQ-5D, MSIS-8D and MSIS-8D-P utility values from a large UK MS cohort and investigate their association with demographic/clinical characteristics. Methods UK MS Register data from 14,385 respondents (2011 to 2019) were analysed descriptively and using multivariable linear regression, with self-report Expanded Disability Status Scale (EDSS) scores. Results The EQ-5D and MSIS-8D were both sensitive to differences in demographic/clinical characteristics. An inconsistency found in previous studies whereby mean EQ-5D values were higher for an EDSS score of 4 rather than 3 was not observed. Similar utility values were observed between MS types at each EDSS score. Regression showed EDSS score and age were associated with utility values from all three measures. Conclusions This study provides generic and MS-specific utility values for a large UK MS sample, with the potential for use in cost-effectiveness analyses of treatments for MS.
Collapse
Affiliation(s)
- A Heather
- PenCHORD (The Peninsula Collaboration for Health Operational Research and Data Science), Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - E Goodwin
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
| | - C Green
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
- Department for Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
- Biogen UK & Ireland, Berkshire, UK
| | - N Morrish
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
| | - OC Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | - A Hawton
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
19
|
Newlove‐Delgado T, Russell AE, Mathews F, Cross L, Bryant E, Gudka R, Ukoumunne OC, Ford TJ. Annual Research Review: The impact of Covid-19 on psychopathology in children and young people worldwide: systematic review of studies with pre- and within-pandemic data. J Child Psychol Psychiatry 2023; 64:611-640. [PMID: 36421049 PMCID: PMC10952503 DOI: 10.1111/jcpp.13716] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The high volume and pace of research has posed challenges to researchers, policymakers and practitioners wanting to understand the overall impact of the pandemic on children and young people's mental health. We aimed to search for and review the evidence from epidemiological studies to answer the question: how has mental health changed in the general population of children and young people? METHODS Four databases (Medline, CINAHL, EMBASE and PsychINFO) were searched in October 2021, with searches updated in February 2022. We aimed to identify studies of children or adolescents with a mean age of 18 years or younger at baseline, that reported change on a validated mental health measure from prepandemic to during the pandemic. Abstracts and full texts were double-screened against inclusion criteria and quality assessed using a risk of bias tool. Studies were narratively synthesised, and meta-analyses were performed where studies were sufficiently similar. RESULTS 6917 records were identified, and 51 studies included in the review. Only four studies had a rating of high quality. Studies were highly diverse in terms of design, setting, timing in relation to the pandemic, population, length of follow-up and choice of measure. Methodological heterogeneity limited the potential to conduct meta-analyses across studies. Whilst the evidence suggested a slight deterioration on some measures, overall, the findings were mixed, with no clear pattern emerging. CONCLUSIONS Our findings highlight the need for a more harmonised approach to research in this field. Despite the sometimes-inconsistent results of our included studies, the evidence supports existing concerns about the impact of Covid-19 on children's mental health and on services for this group, given that even small changes can have a significant impact on provision at population level. Children and young people must be prioritised in pandemic recovery, and explicitly considered in planning for any future pandemic response.
Collapse
Affiliation(s)
| | | | - Frances Mathews
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Lauren Cross
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Eleanor Bryant
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Rebecca Gudka
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Obioha C. Ukoumunne
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
- NIHR Applied Research Collaboration South West Peninsula (PenARC)ExeterUK
| | - Tamsin J. Ford
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| |
Collapse
|
20
|
Sabatini S, Ukoumunne OC, Ballard C, Collins R, Kim S, Corbett A, Aarsland D, Hampshire A, Brooker H, Clare L. What does feeling younger or older than one's chronological age mean to men and women? Qualitative and quantitative findings from the PROTECT study. Psychol Health 2023; 38:324-347. [PMID: 34353194 DOI: 10.1080/08870446.2021.1960989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/16/2022]
Abstract
OBJECTIVE We explored which factors are associated with subjective age (SA), i.e. feeling younger, the same as, or older than one's chronological age, and whether these factors differ between men and women and between two age sub-groups. DESIGN Cross-sectional study using qualitative and quantitative data for 1457 individuals (mean age= 67.2 years). MAIN OUTCOME MEASURES Participants reported how old they feel they are and provided comments in relation to their SA judgments. RESULTS By using content analysis participants' comments were assigned to 13 categories, grouped into three higher-order categories (antecedents of age-related thoughts, mental processes, and issues when measuring subjective age). SA may result from the interaction between factors that increase or decrease age-related thoughts and mental processes that individuals use to interpret age-related changes. Chi-squared tests show that individuals reporting an older SA are more likely to experience significant negative changes and to engage in negative age-related thoughts than individuals reporting an age-congruent SA or a younger SA. Women experience a more negative SA and more age-salient events than men. CONCLUSION Individuals reporting an older SA may benefit from interventions promoting adaptation to negative age-related changes. There is the need to eradicate negative societal views of older women.
Collapse
Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Dag Aarsland
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,Ecog Pro Ltd, Bristol, United Kingdom
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
| |
Collapse
|
21
|
Mathews A, Gibbons N, Harrison E, C Ukoumunne O, Stallard P. A feasibility study to explore the use of digital treatment of sleep as a first-step intervention to improve adolescent mental health. Behav Sleep Med 2023; 21:172-184. [PMID: 35435785 DOI: 10.1080/15402002.2022.2063866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Cognitive behavior therapy for insomnia (CBTi), delivered face-to-face or digitally, can improve the mental health of adults. Although insomnia is common in adolescents, the effects of digital CBTi on adolescent mental health have seldom been investigated. OBJECTIVES The aims of this study were to explore: (i) the acceptability of a digital CBTi intervention, Sleepio, as a first-step intervention for adolescents referred to specialist mental health services (CAMHS), (ii) the impact on sleep and mental health and (iii) subsequent CAMHS interventions. METHOD Sleepio is a computerized CBTi intervention comprised of six sequentially delivered sessions. Digital Sleepio was offered to new referrals to CAMHS with poor sleep and mental health problems. Results. Of the 75 eligible adolescents, 70 (93%; 95% CI: 85% to 98%) accepted Sleepio with 59 starting the programme and consenting to participate in the study. Of these, 37 (63%; 95% CI: 49% to 75%) completed at least half of the programme. There were post-intervention improvements in sleep, mood, and anxiety; the improvement in sleep was greater for those who completed at least half the programme compared to those who did not. Of those who completed all the programme, 55% (15/29) did not need any subsequent specialist CAMHS input. Of the 11 adolescents who accepted but never started Sleepio, none engaged with other CAMHS interventions and were subsequently discharged. CONCLUSION Our study has a number of limitations, in particular the absence of a control group and the loss of follow-up data for programme drop-outs. Nonetheless, these results suggest that digital CBTi may offer a novel and acceptable way of improving the sleep and mental health of adolescents with insomnia. A fully powered randomized controlled trial is required to obtain definitive estimates of the effects of the intervention.
Collapse
Affiliation(s)
| | - Naomi Gibbons
- Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| | - Emma Harrison
- Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| | | | - Paul Stallard
- Department of Health, University of Bath, Bath, UK.,Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| |
Collapse
|
22
|
Butler DM, Myintmo A, Flashman H, Ukoumunne OC, Bethune R. Adherence to Post-polypectomy Surveillance Guidelines at a Large District General Hospital. Cureus 2023; 15:e35516. [PMID: 37007318 PMCID: PMC10051098 DOI: 10.7759/cureus.35516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
Abstract
Introduction In 2020, the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regarding post-polypectomy surveillance. This study aimed to establish clinician adherence at the Royal Devon University Healthcare NHS Foundation Trust to the 2020 guidelines compared to the now-retired 2010 guidelines. Materials and Methods Data on 152 patients treated under the 2010 guidelines and 133 patients treated under the 2020 guidelines were collected retrospectively from the hospital's colonoscopy database. Data were analysed to determine whether patients who had a colonoscopy fulfilled BSG/ACPGBI/PHE guidelines for follow-up. Costs were estimated using the price of colonoscopy in the NHS National Schedule. Results Approximately 41.4% (63/152) of patients were adherent to the 2010 guidelines while 66.2% (88/133) of patients were adherent to the 2020 guidelines. The difference in adherence rate was 24.7% (95% confidence interval 13.5% - 35.9%, p<0.0001). Nearly 37% (35/95) of patients who would have been followed up under the 2010 guidelines did not receive any follow-up as a result of the 2020 guidelines. This represents a cost saving of £36,892.28 per year in our hospital. Approximately 47% (28/60) of patients treated under the 2020 guidelines had surveillance colonoscopy planned when the guidelines recommended no follow-up. If every clinician were fully adherent to the 2020 guidelines, then a further £29,513.82 per year would have been saved. Discussion and Conclusion Following the introduction of the 2020 guidelines, adherence to polyp surveillance guidelines increased in our hospital. However, nearly half of the colonoscopies were performed unnecessarily due to non-adherence. Furthermore, our results demonstrate that the 2020 guidelines have decreased the need for follow-up.
Collapse
|
23
|
Green I, Reardon T, Button R, Williamson V, Halliday G, Hill C, Larkin M, Sniehotta FF, Ukoumunne OC, Ford T, Spence SH, Stallard P, Creswell C. Increasing access to evidence-based treatment for child anxiety problems: online parent-led CBT for children identified via schools. Child Adolesc Ment Health 2023; 28:42-51. [PMID: 36514819 PMCID: PMC10108299 DOI: 10.1111/camh.12612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 10/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anxiety problems are extremely common and have an early age of onset. We previously found, in a study in England, that fewer than 3% of children with an anxiety disorder identified in the community had accessed an evidence-based treatment (Cognitive Behavioural Therapy; CBT). Key ways to increase access to CBT for primary school-aged children with anxiety problems include (a) proactive identification through screening in schools, (b) supporting parents and (c) the provision of brief, accessible interventions (and capitalising on technology to do this). METHOD We provided a brief, therapist guided treatment called Online Support and Intervention (OSI) to parents/carers of children identified, through school-based screening, as likely to have anxiety problems. Fifty out of 131 children from 17 Year 4 classes in schools in England screened positive for 'possible anxiety problems' and 42 (84%) of these (and 7 who did not) took up the offer of OSI. We applied quantitative and qualitative approaches to assess children's outcomes and families' experiences of this approach. RESULTS Inbuilt outcome monitoring indicated session on session improvements throughout the course of treatment, with substantial changes across measures by the final module (e.g. Child Outcome Rating Scale d = 0.84; Goal Based Outcomes d = 1.52). Parent engagement and satisfaction was high as indicated by quantitative and qualitative assessments, and intervention usage. CONCLUSIONS We provide promising preliminary evidence for the use of OSI as an early intervention for children identified as having anxiety problems through school-based screening.
Collapse
Affiliation(s)
- Iheoma Green
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | | | - Victoria Williamson
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Claire Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Michael Larkin
- Department of Psychology, Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Falko F Sniehotta
- Department of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Susan H Spence
- Australian Institute for Suicide Research and Prevention, and School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | | | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
24
|
Jones BG, Reardon T, Creswell C, Dodd HF, Hill C, Jasper B, Lawrence PJ, Morgan F, Rapee RM, Violato M, Placzek A, Ukoumunne OC. Minimising Young Children's Anxiety through Schools (MY-CATS): statistical analysis plan for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders. Trials 2022; 23:1054. [PMID: 36575433 PMCID: PMC9795669 DOI: 10.1186/s13063-022-06899-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Minimising Young Children's Anxiety through Schools (MY-CATS) trial is being conducted to determine whether an online evidence-based parent-guided cognitive behavioural therapy intervention in addition to usual school practice is effective and cost-effective compared with usual school practice in reducing anxiety disorders in children aged 4-7 deemed 'at risk' of anxiety disorders. This update article describes the detailed statistical analysis plan for the MY-CATS trial and reports a review of the underpinning sample size assumptions. METHODS AND DESIGN The MY-CATS study is a two-arm, definitive superiority pragmatic parallel group cluster randomised controlled trial in which schools will be randomised 1:1 to receive either the intervention (in addition to usual school practice) or the usual school practice only. This update to the (published) protocol provides a detailed description of the study methods, the statistical principles, the trial population and the planned statistical analyses, including additional analyses comprising instrumental variable regression and mediation analysis. TRIAL REGISTRATION ISRCTN82398107 . Prospectively registered on 14 January 2021.
Collapse
Affiliation(s)
- Benjamin G. Jones
- grid.8391.30000 0004 1936 8024NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK ,grid.8391.30000 0004 1936 8024Exeter Clinical Trials Unit (ExeCTU), University of Exeter, Exeter, UK
| | - Tessa Reardon
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Helen F. Dodd
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire Hill
- grid.9435.b0000 0004 0457 9566School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Peter J. Lawrence
- grid.5491.90000 0004 1936 9297Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | | | - Ronald M. Rapee
- grid.1004.50000 0001 2158 5405Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Mara Violato
- grid.4991.50000 0004 1936 8948Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Placzek
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Obioha C. Ukoumunne
- grid.8391.30000 0004 1936 8024NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| |
Collapse
|
25
|
Whear R, Bethel A, Abbott R, Rogers M, Orr N, Manzi S, Ukoumunne OC, Stein K, Coon JT. Systematic reviews of convalescent plasma in COVID-19 continue to be poorly conducted and reported: a systematic review. J Clin Epidemiol 2022; 151:53-64. [PMID: 35934268 PMCID: PMC9351208 DOI: 10.1016/j.jclinepi.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To suggest possible approaches to combatting the impact of the COVID-19 infodemic to prevent research waste in future health emergencies and in everyday research and practice. STUDY DESIGN AND SETTING Systematic review. The Epistemonikos database was searched in June 2021 for systematic reviews on the effectiveness of convalescent plasma for COVID-19. Two reviewers independently screened the retrieved references with disagreements resolved by discussion. Data extraction was completed by one reviewer with a proportion checked by a second. We used the Assessment of Multiple Systematic Reviews to assess the quality of conduct and reporting of included reviews. RESULTS Fifty one systematic reviews are included with 193 individual studies included within the systematic reviews. There was considerable duplication of effort; multiple reviews were conducted at the same time with inconsistencies in the evidence included. The reviews were of low methodological quality, poorly reported, and did not adhere to preferred reporting items for systematic reviews and meta-analysis guidance. CONCLUSION Researchers need to conduct, appraise, interpret, and disseminate systematic reviews better. All in the research community (researchers, peer-reviewers, journal editors, funders, decision makers, clinicians, journalists, and the public) need to work together to facilitate the conduct of robust systematic reviews that are published and communicated in a timely manner, reducing research duplication and waste, increasing transparency and accessibility of all systematic reviews.
Collapse
Affiliation(s)
- Rebecca Whear
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK,Corresponding author. St Lukes Campus, University of Exeter, 3.09 South Cloisters, Heavitree Road, Exeter EX1 2LU. Tel.: +1392 726064
| | - Alison Bethel
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Rebecca Abbott
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Noreen Orr
- Evidence Synthesis Team, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sean Manzi
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Obioha C. Ukoumunne
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Ken Stein
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jo Thompson Coon
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| |
Collapse
|
26
|
Sabatini S, Ukoumunne OC, Ballard C, Collins R, Corbett A, Brooker H, Clare L. Cross-Sectional and Longitudinal Associations between Subjective Sleep Difficulties and Self-Perceptions of Aging. Behav Sleep Med 2022; 20:732-761. [PMID: 34689666 DOI: 10.1080/15402002.2021.1994405] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function). PARTICIPANTS/METHODS We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties. RESULTS Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant. CONCLUSIONS Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.
Collapse
Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- College of Medicine and Health, University of Exeter, Exeter, UK.,Nihr Applied Research Collaboration South West Peninsula (Penarc), University of Exeter, Exeter, NIHR, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, UK.,Ecog Pro Ltd, Bristol, UK
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK.,Nihr Applied Research Collaboration South West Peninsula (Penarc), University of Exeter, Exeter, NIHR, UK
| |
Collapse
|
27
|
Reardon T, Ukoumunne OC, Violato M, Ball S, Brown P, Ford T, Gray A, Hill C, Jasper B, Larkin M, Macdonald I, Morgan F, Pollard J, Sancho M, Sniehotta FF, Spence SH, Stallard P, Stainer J, Taylor L, Williamson V, Day E, Fisk J, Green I, Halliday G, Hennigan C, Pearcey S, Robertson O, Creswell C. Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i): protocol for a cluster randomised controlled trial to compare screening, feedback and intervention for child anxiety problems to usual school practice. Trials 2022; 23:896. [PMID: 36273185 PMCID: PMC9587579 DOI: 10.1186/s13063-022-06773-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022] Open
Abstract
Background Systematically screening for child anxiety problems, and offering and delivering a brief, evidence-based intervention for children who are identified as likely to benefit would minimise common barriers that families experience in accessing treatment. We have developed a short parent-report child anxiety screening questionnaire, and procedures for administering screening questionnaires, sharing screening outcomes with families, and offering and delivering a brief parent-led online intervention (OSI: Online Support and Intervention for child anxiety) through schools. This trial aims to evaluate clinical and health economic outcomes for (1) children (aged 8–9) who screen positive for anxiety problems at baseline (target population) and (2) the wider population of all children in participating classes (total population) in schools randomly allocated to receive identification-to-intervention procedures and usual school practice (‘screening and intervention’), compared to assessment and usual school practice only (‘usual school practice’). Methods The trial design is a parallel-group, superiority cluster randomised controlled trial, with schools (clusters) randomised to ‘screening and intervention’ or ‘usual school practice’ arms in a 1:1 ratio stratified according to the level of deprivation within the school. We will recruit schools and participants in two phases (a pilot phase (Phase 1) and Phase 2), with progression criteria assessed prior to progressing to Phase 2. In total, the trial will recruit 80 primary/junior schools in England, and 398 children (199 per arm) who screen positive for anxiety problems at baseline (target population). In schools allocated to ‘screening and intervention’: (1) parents/carers will complete a brief parent-report child anxiety screening questionnaire (at baseline) and receive feedback on their child’s screening outcomes (after randomisation), (2) classes will receive a lesson on managing fears and worries and staff will be provided with information about the intervention and (3) parents/carers of children who screen positive for anxiety problems (target population) will be offered OSI. OSI will also be available for any other parents/carers of children in participating classes (total population) who request it. We will collect child-, parent- and teacher-report measures for the target population and total population at baseline (before randomisation), 4 months, 12 months and 24 months post-randomisation. The primary outcome will be the proportion of children who screen positive for anxiety problems at baseline (target population) who screen negative for anxiety problems 12 months post-randomisation. Discussion This trial will establish if systematic screening for child anxiety problems, sharing screening outcomes with families and delivering a brief parent-led online intervention through schools is effective and cost-effective. Trial registration ISRCTN registry ISRCTN76119074. Prospectively registered on 4.1.2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06773-0.
Collapse
Affiliation(s)
- Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan Ball
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Paul Brown
- Bransgore C of E Primary School, Bransgore, UK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation Trust, Cambridge, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Michael Larkin
- Life and Health Sciences, Aston University, Birmingham, UK
| | | | | | - Jack Pollard
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Susan H Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | | | | | - Lucy Taylor
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Victoria Williamson
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Day
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Jennifer Fisk
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Iheoma Green
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Ciara Hennigan
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Samantha Pearcey
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Olly Robertson
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| |
Collapse
|
28
|
Martins T, Abel G, Ukoumunne OC, Mounce LTA, Price S, Lyratzopoulos G, Chinegwundoh F, Hamilton W. Ethnic inequalities in routes to diagnosis of cancer: a population-based UK cohort study. Br J Cancer 2022; 127:863-871. [PMID: 35661833 PMCID: PMC9427836 DOI: 10.1038/s41416-022-01847-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/26/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND UK Asian and Black ethnic groups have poorer outcomes for some cancers and are less likely to report a positive care experience than their White counterparts. This study investigated ethnic differences in the route to diagnosis (RTD) to identify areas in patients' cancer journeys where inequalities lie, and targeted intervention might have optimum impact. METHODS We analysed data of 243,825 patients with 10 cancers (2006-2016) from the RTD project linked to primary care data. Crude and adjusted proportions of patients diagnosed via six routes (emergency, elective GP referral, two-week wait (2WW), screen-detected, hospital, and Other routes) were calculated by ethnicity. Adjusted odds ratios (including two-way interactions between cancer and age, sex, IMD, and ethnicity) determined cancer-specific differences in RTD by ethnicity. RESULTS Across the 10 cancers studied, most patients were diagnosed via 2WW (36.4%), elective GP referral (23.2%), emergency (18.2%), hospital routes (10.3%), and screening (8.61%). Patients of Other ethnic group had the highest proportion of diagnosis via the emergency route, followed by White patients. Asian and Black group were more likely to be GP-referred, with the Black and Mixed groups also more likely to follow the 2WW route. However, there were notable cancer-specific differences in the RTD by ethnicity. CONCLUSION Our findings suggest that, where inequalities exist, the adverse cancer outcomes among Asian and Black patients are unlikely to be arising solely from a poorer diagnostic process.
Collapse
Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
| | - Gary Abel
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Luke T A Mounce
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Sarah Price
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Frank Chinegwundoh
- Barts Health NHS Trust & Department of Health Sciences, University of London, London, UK
| | - William Hamilton
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| |
Collapse
|
29
|
Reardon T, Ball S, Breen M, Brown P, Day E, Ford T, Gray A, Green I, Hill C, Jasper B, King T, Larkin M, Macdonald I, Morgan F, Pollard J, Sancho M, Sniehotta FF, Spence SH, Stallard P, Stainer J, Ukoumunne OC, Violato M, Williams C, Williamson V, Creswell C. Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i): protocol for single-arm feasibility trial. Pilot Feasibility Stud 2022; 8:176. [PMID: 35948994 PMCID: PMC9363860 DOI: 10.1186/s40814-022-01140-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2022] [Indexed: 12/30/2022] Open
Abstract
Background Anxiety disorders are common among primary-school aged children, but few affected children receive evidence-based treatment. Identifying and supporting children who experience anxiety problems through schools would address substantial treatment access barriers that families and school staff often face. We have worked with families and school staff to co-design procedures that incorporate screening, feedback for parents, and the offer of a brief intervention in primary schools. This study sets out to assess the feasibility of a subsequent school-based cluster randomised controlled trial to evaluate these procedures. Our objectives are to ensure our procedures for identifying and supporting children with anxiety difficulties through primary schools are acceptable and there are no negative impacts, to estimate recruitment and retention rates, and to identify any changes needed to study procedures or measures. Methods We will recruit six primary/junior schools in England (2 classes per school), and invite all children (aged 8–9) (n = 360) and their parent/carer and class teacher in participating classes to take part. Children, parents and class teachers will complete questionnaires at baseline and 12-week follow-up. Children who ‘screen positive’ on a 2-item parent-report child anxiety screen at baseline will be the target population (expected n = 43). Parents receive feedback on screening questionnaire responses, and where the child screens positive the family is offered support (OSI: Online Support and Intervention for child anxiety). OSI is a brief, parent-led online intervention, supported by short telephone sessions with a Children’s Wellbeing Practitioner. Participants’ experiences of study procedures will be assessed through qualitative interviews/discussion groups. Discussion Evidence-based procedures for identifying and supporting children with anxiety difficulties through primary schools would improve children’s access to timely, effective intervention for anxiety difficulties. Trial registration ISRCTN registry: ISRCTN30032471. Retrospectively registered on 18 May 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01140-x.
Collapse
Affiliation(s)
- Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Susan Ball
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Maria Breen
- Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
| | - Paul Brown
- Bransgore C of E Primary School, Christchurch, UK
| | - Emily Day
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation Trust, Cambridge, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iheoma Green
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Thomas King
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Michael Larkin
- Life and Health Sciences, Aston University, Birmingham, UK
| | | | | | - Jack Pollard
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Susan H Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | | | | | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chloe Williams
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| | - Victoria Williamson
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.,Oxford NHS Foundation Trust, Oxford, UK
| |
Collapse
|
30
|
Sabatini S, Martyr A, Ukoumunne OC, Ballard C, Collins R, Pentecost C, Rusted JM, Quinn C, Anstey KJ, Kim S, Corbett A, Brooker H, Clare L. Attitudes toward own aging and cognition among individuals living with and without dementia: findings from the IDEAL programme and the PROTECT study. BMC Geriatr 2022; 22:641. [PMID: 35927646 PMCID: PMC9351129 DOI: 10.1186/s12877-022-03336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background It is unclear whether people with dementia (PwD) have more negative attitudes toward own aging (ATOA) than people without dementia and what factors influence ATOA among PwD. We investigated whether PwD have more negative ATOA than individuals without dementia and whether cognition and dementia subtype are associated with ATOA in PwD. Methods Data from the IDEAL and PROTECT studies were used to compare ATOA between 1502 PwD (mean (SD) age = 76.3 (8.5)) and 6377 individuals without dementia (mean (SD) age = 66.1 (7.1)). Linear regressions and ANOVA were used. Results PwD reported slightly more negative ATOA than people without dementia; this relationship disappeared after controlling for depression and self-rated health. In PwD more positive ATOA showed negligible associations with better general cognition, memory performance, verbal fluency, and visuospatial ability. However, after adjusting for covariates only better visuospatial ability predicted more positive ATOA. Additional analyses showed that before and after controlling for covariates, individuals with poorer self-reported visual acuity have more negative ATOA. Amongst dementia subtypes, people with Parkinson’s disease dementia and dementia with Lewy bodies reported most negative ATOA. Conclusions ATOA between PwD and people without dementia do not differ. ATOA in PwD appear to be affected not by cognitive impairment but by other characteristics that vary across dementia subtypes. Among PwD, those with Parkinson’s disease dementia and dementia with Lewy bodies may have higher risk of experiencing negative ATOA due to the motor and visual impairments that they experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03336-5.
Collapse
Affiliation(s)
- Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
| | - Clive Ballard
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | | | - Catherine Quinn
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, and Neuroscience Research Australia, Sydney, Australia
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
| | - Anne Corbett
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Helen Brooker
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| |
Collapse
|
31
|
Tudor K, Maloney S, Raja A, Baer R, Blakemore SJ, Byford S, Crane C, Dalgleish T, De Wilde K, Ford T, Greenberg M, Hinze V, Lord L, Radley L, Opaleye ES, Taylor L, Ukoumunne OC, Viner R, Kuyken W, Montero-Marin J. Universal Mindfulness Training in Schools for Adolescents: a Scoping Review and Conceptual Model of Moderators, Mediators, and Implementation Factors. Prev Sci 2022; 23:934-953. [PMID: 35267177 PMCID: PMC9343282 DOI: 10.1007/s11121-022-01361-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Accepted: 02/17/2022] [Indexed: 02/02/2023]
Abstract
There is evidence that universal school-based mindfulness training (SBMT) can have positive effects for young people. However, it is unknown who benefits most from such training, how training exerts effects, and how implementation impacts effects. This study aimed to provide an overview of the evidence on the mediators, moderators, and implementation factors of SBMT, and propose a conceptual model that can be used both to summarize the evidence and provide a framework for future research. A scoping review was performed, and six databases and grey literature were searched. Inclusion and exclusion criteria were applied to select relevant material. Quantitative and qualitative information was extracted from eligible articles and reported in accordance with PRISMA-ScR guidelines. The search produced 5479 articles, of which 31 were eligible and included in the review. Eleven studies assessed moderators of SBMT on pupil outcomes, with mixed findings for all variables tested. Five studies examined the mediating effect of specific variables on pupil outcomes, with evidence that increases in mindfulness skills and decreases in cognitive reactivity and self-criticism post-intervention are related to better pupil outcomes at follow-up. Twenty-five studies assessed implementation factors. We discuss key methodological shortcomings of included studies and integrate our findings with existing implementation frameworks to propose a conceptual model. Widespread interest in universal SBMT has led to increased research over recent years, exploring who SBMT works for and how it might work, but the current evidence is limited. We make recommendations for future research and provide a conceptual model to guide theory-led developments.
Collapse
Affiliation(s)
- Kate Tudor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Anam Raja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Baer
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sarah Byford
- Health Service and Population Research, King's College London, London, UK
| | | | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mark Greenberg
- Human Development and Family Studies, Penn State University, State College, USA
| | - Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Liz Lord
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lucy Radley
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Laura Taylor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Russell Viner
- Institute of Child Health, University College London, London, UK
| | | | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, UK
- Teaching, Reseach & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| |
Collapse
|
32
|
Kuyken W, Ball S, Crane C, Ganguli P, Jones B, Montero-Marin J, Nuthall E, Raja A, Taylor L, Tudor K, Viner RM, Allwood M, Aukland L, Dunning D, Casey T, Dalrymple N, De Wilde K, Farley ER, Harper J, Hinze V, Kappelmann N, Kempnich M, Lord L, Medlicott E, Palmer L, Petit A, Philips A, Pryor-Nitsch I, Radley L, Sonley A, Shackleford J, Tickell A, Team M, Blakemore SJ, Ukoumunne OC, Greenberg MT, Ford T, Dalgleish T, Byford S, Williams JMG. Effectiveness of universal school-based mindfulness training compared with normal school provision on teacher mental health and school climate: results of the MYRIAD cluster randomised controlled trial. Evid Based Ment Health 2022; 25:ebmental-2022-300424. [PMID: 35820990 PMCID: PMC9340006 DOI: 10.1136/ebmental-2022-300424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Education is broader than academic teaching. It includes teaching students social-emotional skills both directly and indirectly through a positive school climate. OBJECTIVE To evaluate if a universal school-based mindfulness training (SBMT) enhances teacher mental health and school climate. METHODS The My Resilience in Adolescence parallel group, cluster randomised controlled trial (registration: ISRCTN86619085; funding: Wellcome Trust (WT104908/Z/14/Z, WT107496/Z/15/Z)) recruited 85 schools (679 teachers) delivering social and emotional teaching across the UK. Schools (clusters) were randomised 1:1 to either continue this provision (teaching as usual (TAU)) or include universal SBMT. Data on teacher mental health and school climate were collected at prerandomisation, postpersonal mindfulness and SBMT teacher training, after delivering SBMT to students, and at 1-year follow-up. FINDING Schools were recruited in academic years 2016/2017 and 2017/2018. Primary analysis (SBMT: 43 schools/362 teachers; TAU: 41 schools/310 teachers) showed that after delivering SBMT to students, SBMT versus TAU enhanced teachers' mental health (burnout) and school climate. Adjusted standardised mean differences (SBMT minus TAU) were: exhaustion (-0.22; 95% CI -0.38 to -0.05); personal accomplishment (-0.21; -0.41, -0.02); school leadership (0.24; 0.04, 0.44); and respectful climate (0.26; 0.06, 0.47). Effects on burnout were not significant at 1-year follow-up. Effects on school climate were maintained only for respectful climate. No SBMT-related serious adverse events were reported. CONCLUSIONS SBMT supports short-term changes in teacher burnout and school climate. Further work is required to explore how best to sustain improvements. CLINICAL IMPLICATIONS SBMT has limited effects on teachers' mental and school climate. Innovative approaches to support and preserve teachers' mental health and school climate are needed.
Collapse
Affiliation(s)
- Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Susan Ball
- NIHR Applied Research Collaboration Southwest Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Poushali Ganguli
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Benjamin Jones
- NIHR Applied Research Collaboration Southwest Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Elizabeth Nuthall
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anam Raja
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Kate Tudor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Russell M Viner
- Population, Policy & Practice research programme, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Matthew Allwood
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Louise Aukland
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Darren Dunning
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tríona Casey
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nicola Dalrymple
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katherine De Wilde
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Eleanor-Rose Farley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jennifer Harper
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Verena Hinze
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nils Kappelmann
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Maria Kempnich
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Liz Lord
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Emma Medlicott
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Lucy Palmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Ariane Petit
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Alice Philips
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Isobel Pryor-Nitsch
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Lucy Radley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anna Sonley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jem Shackleford
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Alice Tickell
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Myriad Team
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration Southwest Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Mark T Greenberg
- Department of Human Development and Family Studies, Pennsylvania State University, Pennsylvania, Pennsylvania, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sarah Byford
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - J Mark G Williams
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
33
|
Dunning D, Ahmed S, Foulkes L, Griffin C, Griffiths K, Leung JT, Parker J, Piera Pi-Sunyer B, Sakhardande A, Bennett M, Haag C, Montero-Marin J, Packman D, Vainre M, Watson P, Kuyken W, Williams JMG, Ukoumunne OC, Blakemore SJ, Dalgleish T. The impact of mindfulness training in early adolescence on affective executive control, and on later mental health during the COVID-19 pandemic: a randomised controlled trial. Evid Based Ment Health 2022; 25:ebmental-2022-300460. [PMID: 35820991 PMCID: PMC9340025 DOI: 10.1136/ebmental-2022-300460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/15/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous research suggests that mindfulness training (MT) appears effective at improving mental health in young people. MT is proposed to work through improving executive control in affectively laden contexts. However, it is unclear whether MT improves such control in young people. MT appears to mitigate mental health difficulties during periods of stress, but any mitigating effects against COVID-related difficulties remain unexamined. OBJECTIVE To evaluate whether MT (intervention) versus psychoeducation (Psy-Ed; control), implemented in after-school classes: (1) Improves affective executive control; and/or (2) Mitigates negative mental health impacts from the COVID-19 pandemic. METHODS A parallel randomised controlled trial (RCT) was conducted (Registration: https://osf.io/d6y9q/; Funding: Wellcome (WT104908/Z/14/Z, WT107496/Z/15/Z)). 460 students aged 11-16 years were recruited and randomised 1:1 to either MT (N=235) or Psy-Ed (N=225) and assessed preintervention and postintervention on experimental tasks and self-report inventories of affective executive control. The RCT was then extended to evaluate protective functions of MT on mental health assessed after the first UK COVID-19 lockdown. FINDINGS Results provided no evidence that the version of MT used here improved affective executive control after training or mitigated negative consequences on mental health of the COVID-19 pandemic relative to Psy-Ed. No adverse events were reported. CONCLUSIONS There is no evidence that MT improves affective control or downstream mental health of young people during stressful periods. CLINICAL IMPLICATIONS We need to identify interventions that can enhance affective control and thereby young people's mental health.
Collapse
Affiliation(s)
- Darren Dunning
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | - S Ahmed
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - L Foulkes
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - C Griffin
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - K Griffiths
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | - J T Leung
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - J Parker
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | | | - A Sakhardande
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - M Bennett
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | - C Haag
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Jesus Montero-Marin
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - D Packman
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Maris Vainre
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | - P Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - J Mark G Williams
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Sarah-Jayne Blakemore
- Institute of Cognitive Neuroscience, University College London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, Cambridgeshire, UK
| |
Collapse
|
34
|
Montero-Marin J, Allwood M, Ball S, Crane C, De Wilde K, Hinze V, Jones B, Lord L, Nuthall E, Raja A, Taylor L, Tudor K, Blakemore SJ, Byford S, Dalgleish T, Ford T, Greenberg MT, Ukoumunne OC, Williams JMG, Kuyken W. School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial? Evid Based Ment Health 2022; 25:ebmental-2022-300439. [PMID: 35820993 PMCID: PMC9340034 DOI: 10.1136/ebmental-2022-300439] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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] [Received: 02/03/2022] [Accepted: 05/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Preventing mental health problems in early adolescence is a priority. School-based mindfulness training (SBMT) is an approach with mixed evidence. OBJECTIVES To explore for whom SBMT does/does not work and what influences outcomes. METHODS The My Resilience in Adolescence was a parallel-group, cluster randomised controlled trial (K=84 secondary schools; n=8376 students, age: 11-13) recruiting schools that provided standard social-emotional learning. Schools were randomised 1:1 to continue this provision (control/teaching as usual (TAU)), and/or to offer SBMT ('.b' (intervention)). Risk of depression, social-emotional-behavioural functioning and well-being were measured at baseline, preintervention, post intervention and 1 year follow-up. Hypothesised moderators, implementation factors and mediators were analysed using mixed effects linear regressions, instrumental variable methods and path analysis. FINDINGS SBMT versus TAU resulted in worse scores on risk of depression and well-being in students at risk of mental health problems both at post intervention and 1-year follow-up, but differences were small and not clinically relevant. Higher dose and reach were associated with worse social-emotional-behavioural functioning at postintervention. No implementation factors were associated with outcomes at 1-year follow-up. Pregains-postgains in mindfulness skills and executive function predicted better outcomes at 1-year follow-up, but the SBMT was unsuccessful to teach these skills with clinical relevance.SBMT as delivered in this trial is not indicated as a universal intervention. Moreover, it may be contraindicated for students with existing/emerging mental health symptoms. CLINICAL IMPLICATIONS Universal SBMT is not recommended in this format in early adolescence. Future research should explore social-emotional learning programmes adapted to the unique needs of young people.
Collapse
Affiliation(s)
- Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Teaching, Reseach and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Matthew Allwood
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Susan Ball
- NIHR Applied Research Collaboration (PenARC) South West Peninsula, University of Exeter, Exeter, UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katherine De Wilde
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Verena Hinze
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Benjamin Jones
- NIHR Applied Research Collaboration (PenARC) South West Peninsula, University of Exeter, Exeter, UK
| | - Liz Lord
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Elizabeth Nuthall
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anam Raja
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Kate Tudor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | - Sarah Byford
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mark T Greenberg
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Philadelphia, Pennsylvania, USA
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration (PenARC) South West Peninsula, University of Exeter, Exeter, UK
| | - J Mark G Williams
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
35
|
Kuyken W, Ball S, Crane C, Ganguli P, Jones B, Montero-Marin J, Nuthall E, Raja A, Taylor L, Tudor K, Viner RM, Allwood M, Aukland L, Dunning D, Casey T, Dalrymple N, De Wilde K, Farley ER, Harper J, Kappelmann N, Kempnich M, Lord L, Medlicott E, Palmer L, Petit A, Philips A, Pryor-Nitsch I, Radley L, Sonley A, Shackleford J, Tickell A, Blakemore SJ, Team TM, Ukoumunne OC, Greenberg MT, Ford T, Dalgleish T, Byford S, Williams JMG. Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Evid Based Ment Health 2022; 25:ebmental-2021-300396. [PMID: 35820992 PMCID: PMC9340028 DOI: 10.1136/ebmental-2021-300396] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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] [Received: 12/02/2021] [Accepted: 03/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health. OBJECTIVE The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU). METHODS MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11-14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included. FINDINGS Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI -0.05 to 0.06) for risk for depression; 0.02 (-0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (-0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed. CONCLUSIONS Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence. CLINICAL IMPLICATIONS There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors. TRIAL REGISTRATION Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).
Collapse
Affiliation(s)
- Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Susan Ball
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Poushali Ganguli
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Benjamin Jones
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Elizabeth Nuthall
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anam Raja
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Kate Tudor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Russell M Viner
- Population, Policy & Practice research programme, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Matthew Allwood
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Louise Aukland
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Darren Dunning
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tríona Casey
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nicola Dalrymple
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katherine De Wilde
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Eleanor-Rose Farley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jennifer Harper
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nils Kappelmann
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Maria Kempnich
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Liz Lord
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Emma Medlicott
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Lucy Palmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Ariane Petit
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Alice Philips
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Isobel Pryor-Nitsch
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Lucy Radley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anna Sonley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jem Shackleford
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Alice Tickell
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | - The Myriad Team
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Mark T Greenberg
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sarah Byford
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - J Mark G Williams
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
36
|
Parker K, Eddy S, Nunns M, Xiao Z, Ford T, Eldridge S, Ukoumunne OC. Systematic review of the characteristics of school-based feasibility cluster randomised trials of interventions for improving the health of pupils in the UK. Pilot Feasibility Stud 2022; 8:132. [PMID: 35780160 PMCID: PMC9250211 DOI: 10.1186/s40814-022-01098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background The last 20 years have seen a marked increase in the use of cluster randomised trials (CRTs) in schools to evaluate interventions for improving pupil health outcomes. Schools have limited resources and participating in full-scale trials can be challenging and costly, given their main purpose is education. Feasibility studies can be used to identify challenges with implementing interventions and delivering trials. This systematic review summarises methodological characteristics and objectives of school-based cluster randomised feasibility studies in the United Kingdom (UK). Methods We systematically searched MEDLINE from inception to 31 December 2020. Eligible papers were school-based feasibility CRTs that included health outcomes measured on pupils. Results Of 3285 articles identified, 24 were included. School-based feasibility CRTs have been increasingly used in the UK since the first publication in 2008. Five (21%) studies provided justification for the use of the CRT design. Three (13%) studies provided details of a formal sample size calculation, with only one of these allowing for clustering. The median (IQR; range) recruited sample size was 7.5 (4.5 to 9; 2 to 37) schools and 274 (179 to 557; 29 to 1567) pupils. The most common feasibility objectives were to estimate the potential effectiveness of the intervention (n = 17; 71%), assess acceptability of the intervention (n = 16; 67%), and estimate the recruitment/retention rates (n = 15; 63%). Only one study was used to assess whether cluster randomisation was appropriate, and none of the studies that randomised clusters before recruiting pupils assessed the possibility of recruitment bias. Besides potential effectiveness, cost-effectiveness, and the intra-cluster correlation coefficient, no studies quantified the precision of the feasibility parameter estimates. Conclusions Feasibility CRTs are increasingly used in schools prior to definitive trials of interventions for improving health in pupils. The average sample size of studies included in this review would be large enough to estimate pupil-level feasibility parameters (e.g., percentage followed up) with reasonable precision. The review highlights the need for clearer sample size justification and better reporting of the precision with which feasibility parameters are estimated. Better use could be made of feasibility CRTs to assess challenges that are specific to the cluster design. Trial registration PROSPERO: CRD42020218993.
Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01098-w.
Collapse
Affiliation(s)
- Kitty Parker
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Room 2.16, South Cloisters, St Luke's Campus, 79 Heavitree Rd, Exeter, EX1 2LU, UK.
| | - Saskia Eddy
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael Nunns
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - ZhiMin Xiao
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sandra Eldridge
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK
| |
Collapse
|
37
|
Martins T, Abel G, Ukoumunne OC, Price S, Lyratzopoulos G, Chinegwundoh F, Hamilton W. Assessing Ethnic Inequalities in Diagnostic Interval of Common Cancers: A Population-Based UK Cohort Study. Cancers (Basel) 2022; 14:3085. [PMID: 35804858 PMCID: PMC9264889 DOI: 10.3390/cancers14133085] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study investigated ethnic differences in diagnostic interval (DI)-the period between initial primary care presentation and diagnosis. METHODS We analysed the primary care-linked data of patients who reported features of seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, and ovarian) one year before diagnosis. Accelerated failure time (AFT) models investigated the association between DI and ethnicity, adjusting for age, sex, deprivation, and morbidity. RESULTS Of 126,627 eligible participants, 92.1% were White, 1.99% Black, 1.71% Asian, 1.83% Mixed, and 2.36% were of Other ethnic backgrounds. Considering all cancer sites combined, the median (interquartile range) DI was 55 (20-175) days, longest in lung [127, (42-265) days], and shortest in breast cancer [13 (13, 8-18) days]. DI for the Black and Asian groups was 10% (AFT ratio, 95%CI 1.10, 1.05-1.14) and 16% (1.16, 1.10-1.22), respectively, longer than for the White group. Site-specific analyses revealed evidence of longer DI in Asian and Black patients with prostate, colorectal, and oesophagogastric cancer, plus Black patients with breast cancer and myeloma, and the Mixed group with lung cancer compared with White patients. DI was shorter for the Other group with lung, prostate, myeloma, and oesophagogastric cancer than the White group. CONCLUSION We found limited and inconsistent evidence of ethnic differences in DI among patients who reported cancer features in primary care before diagnosis. Our findings suggest that inequalities in diagnostic intervals, where present, are unlikely to be the sole explanation for ethnic variations in cancer outcomes.
Collapse
Affiliation(s)
- Tanimola Martins
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| | - Gary Abel
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter EX1 2LU, UK; (G.A.); (O.C.U.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter EX1 2LU, UK; (G.A.); (O.C.U.)
| | - Sarah Price
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1–19 Torrington Place, London WC1E 7HB, UK;
| | - Frank Chinegwundoh
- Barts Health NHS Trust & Department of Health Sciences, University of London, London WC1E 7HB, UK;
| | - William Hamilton
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| |
Collapse
|
38
|
Melendez-Torres GJ, Warren E, Ukoumunne OC, Viner R, Bonell C. Locating and testing the healthy context paradox: examples from the INCLUSIVE trial. BMC Med Res Methodol 2022; 22:57. [PMID: 35220938 PMCID: PMC8883633 DOI: 10.1186/s12874-022-01537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The healthy context paradox, originally described with respect to school-level bullying interventions, refers to the generation of differences in mental wellbeing amongst those who continue to experience bullying even after interventions successfully reduce victimisation. Using data from the INCLUSIVE trial of restorative practice in schools, we relate this paradox to the need to theorise potential harms when developing interventions; formulate the healthy context paradox in a more general form defined by mediational relationships and cluster-level interventions; and propose two statistical models for testing the healthy context paradox informed by multilevel mediation methods, with relevance to structural and individual explanations for this paradox.
Methods
We estimated two multilevel mediation models with bullying victimisation as the mediator and mental wellbeing as the outcome: one with a school-level interaction between intervention assignment and the mediator; and one with a random slope component for the student-level mediator-outcome relationship predicted by school-level assignment. We relate each of these models to contextual or individual-level explanations for the healthy context paradox.
Results
Neither model suggested that the INCLUSIVE trial represented an example of the healthy context paradox. However, each model has different interpretations which relate to a multilevel understanding of the healthy context paradox.
Conclusions
Greater exploration of intervention harms, especially when those accrue to population subgroups, is an essential step in better understanding how interventions work and for whom. Our proposed tests for the presence of a healthy context paradox provide the analytic tools to better understand how to support development and implementation of interventions that work for all groups in a population.
Trial registration
Current Controlled Trials, ISRCTN10751359.
Collapse
|
39
|
Reardon T, Dodd H, Hill C, Jasper B, Lawrence PJ, Morgan F, Rapee RM, Ukoumunne OC, Violato M, Davey E, Halliday G, Jones B, Martineau L, McCall A, Niekamp N, Placzek A, Potts R, Weisser T, Creswell C. Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders. Trials 2022; 23:149. [PMID: 35168635 PMCID: PMC8848959 DOI: 10.1186/s13063-022-06010-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention. METHODS The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months. DISCUSSION The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective. TRIAL REGISTRATION ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.
Collapse
Affiliation(s)
- Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Helen Dodd
- College of Medicine and Health, University of Exeter, Exeter, UK.,School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, England
| | | | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emily Davey
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Benjamin Jones
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Lindsey Martineau
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Amy McCall
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Natascha Niekamp
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Anna Placzek
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Potts
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Tamatha Weisser
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
40
|
Finning K, Neochoriti Varvarrigou I, Ford T, Panagi L, Ukoumunne OC. Mental health and school absenteeism in children with long-term physical conditions: A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007. Child Care Health Dev 2022; 48:110-119. [PMID: 34478163 DOI: 10.1111/cch.12910] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children and young people (CYP) with long-term physical conditions (LTCs) are more likely to have poorer mental health and more school absenteeism compared with CYP with no LTCs. However, there is limited longitudinal research, and the extent to which these difficulties persist in CYP with LTCs is unknown. Furthermore, little is known about the relative impact of different types of LTC on mental health and absenteeism. METHODS We investigated cross-sectional and longitudinal associations of different LTCs with mental health and school absenteeism in a large (N = 7977) nationally representative survey of CYP in Great Britain and its 3-year follow-up. Psychopathology was assessed using the parent-reported Strengths and Difficulties Questionnaire (SDQ), and diagnosis of any psychiatric disorder using the Development and Wellbeing Assessment (DAWBA). Days absent and persistent absence (missing 10% or more of school days) were reported by parents. RESULTS Compared with those with no LTCs, CYP with any LTC had higher SDQ total difficulties scores at baseline (adjusted mean difference 1.4, 1.1-1.6) and follow-up (1.1, 0.8-1.4) and were more likely to have a psychiatric disorder at baseline (adjusted odds ratio [aOR] 1.59, 1.34-1.89) and follow-up (1.75, 1.44-2.12). Children with any LTC also missed more days of school at baseline (adjusted incidence rate ratio 1.47, 1.31-1.64) and follow-up (1.17, 1.00-1.36) and were more likely to be persistently absent (aOR baseline 1.78, 1.48-2.14; follow-up 1.27, 1.00-1.61). Neurodevelopmental disorders, migraines and atopic conditions were particularly strongly associated with both mental health and absenteeism. CONCLUSIONS Children with LTCs had poorer mental health and more school absence than those with no LTCs. Clinicians should routinely enquire about mental health and school attendance in CYP with LTCs and should collaborate with families and schools to ensure these children are provided with sufficient mental health and educational support.
Collapse
Affiliation(s)
- Katie Finning
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Laura Panagi
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | |
Collapse
|
41
|
Ford T, Degli Esposti M, Crane C, Taylor L, Montero-Marín J, Blakemore SJ, Bowes L, Byford S, Dalgleish T, Greenberg MT, Nuthall E, Phillips A, Raja A, Ukoumunne OC, Viner RM, Williams JMG, Allwood M, Aukland L, Casey T, De Wilde K, Farley ER, Kappelmann N, Lord L, Medlicott E, Palmer L, Petit A, Pryor-Nitsch I, Radley L, Warriner L, Sonley A, Kuyken W. The Role of Schools in Early Adolescents' Mental Health: Findings From the MYRIAD Study. J Am Acad Child Adolesc Psychiatry 2021; 60:1467-1478. [PMID: 33677037 PMCID: PMC8669152 DOI: 10.1016/j.jaac.2021.02.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/18/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. This study explored school-level influences on the mental health of young people in a large school-based sample from the United Kingdom. METHOD Baseline data from a large cluster randomized controlled trial collected between 2016 and 2018 from mainstream secondary schools selected to be representative in relation to their quality rating, size, deprivation, mixed or single-sex pupil population, and country were analyzed. Participants were pupils in their first or second year of secondary school. The study assessed whether school-level factors were associated with pupil mental health. RESULTS The study included 26,885 pupils (response rate = 90%; age range, 11‒14 years; 55% female) attending 85 schools in the United Kingdom. Schools accounted for 2.4% (95% CI: 2.0%‒2.8%; p < .0001) of the variation in psychopathology, 1.6% (95% CI: 1.2%‒2.1%; p < .0001) of depression, and 1.4% (95% CI: 1.0%‒1.7%; p < .0001) of well-being. Schools in urban locations, with a higher percentage of free school meals and of White British, were associated with poorer pupil mental health. A more positive school climate was associated with better mental health. CONCLUSION School-level variables, primarily related to contextual factors, characteristics of pupil population, and school climate, explain a small but significant amount of variability in mental health of young people. This information might be used to identify schools that are in need of more resources to support mental health of young people. CLINICAL TRIAL REGISTRATION INFORMATION MYRIAD: My Resilience in Adolescence, a Study Examining the Effectiveness and Cost-Effectiveness of a Mindfulness Training Programme in Schools Compared With Normal School Provision; https://www.isrctn.com/; 86619085.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Tim Dalgleish
- University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | | | | | | | - Anam Raja
- University of Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | - Nils Kappelmann
- Max Planck Institute of Psychiatry and International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Liz Lord
- University of Oxford, United Kingdom
| | | | - Lucy Palmer
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | | | | |
Collapse
|
42
|
Chondros P, Ukoumunne OC, Gunn JM, Carlin JB. When should matching be used in the design of cluster randomized trials? Stat Med 2021; 40:5765-5778. [PMID: 34390264 DOI: 10.1002/sim.9152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 05/25/2021] [Accepted: 07/18/2021] [Indexed: 01/10/2023]
Abstract
For cluster randomized trials (CRTs) with a small number of clusters, the matched-pair (MP) design, where clusters are paired before randomizing one to each trial arm, is often recommended to minimize imbalance on known prognostic factors, add face-validity to the study, and increase efficiency, provided the analysis recognizes the matching. Little evidence exists to guide decisions on when to use matching. We used simulation to compare the efficiency of the MP design with the stratified and simple designs, based on the mean confidence interval width of the estimated intervention effect. Matched and unmatched analyses were used for the MP design; a stratified analysis was used for the stratified design; and analyses without and with post-stratification adjustment for factors that would otherwise have been used for restricted allocation were used for the simple design. Results showed the MP design was generally the most efficient for CRTs with 10 or more pairs when the correlation between cluster-level outcomes within pairs (matching correlation) was moderate to strong (0.3-0.5). There was little gain in efficiency for the MP or stratified designs compared to simple randomization when the matching correlation was weak (0.05-0.1). For trials with four pairs of clusters, the simple and stratified designs were more efficient than the MP design because greater degrees of freedom were available for the analysis, although an unmatched analysis of the MP design recovered precision for weak matching correlations. Practical guidance on choosing between the MP, stratified, and simple designs is provided.
Collapse
Affiliation(s)
- Patty Chondros
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Jane M Gunn
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
43
|
Kuźma E, Littlejohns TJ, Khawaja AP, Llewellyn DJ, Ukoumunne OC, Thiem U. Visual Impairment, Eye Diseases, and Dementia Risk: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 83:1073-1087. [PMID: 34397414 DOI: 10.3233/jad-210250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/23/2022]
Abstract
BACKGROUND Visual impairment and eye diseases have been associated with dementia, though with mixed findings and often in cross-sectional studies. OBJECTIVE To identify prospective studies investigating associations between visual impairment or common eye diseases and risk of all-cause dementia or key dementia subtypes. METHODS We searched Medline, PsycINFO, and Embase from inception to January 2020. We also conducted backward and forward citation searches of included studies and set up alerts to identify studies published after the search date. Random-effects meta-analysis was used to combine adjusted estimates across studies. RESULTS Thirty studies met our eligibility criteria. For visual impairment, pooled estimates indicated an increased risk of all-cause dementia (37,705 participants, 3,415 cases, risk ratio [RR] = 1.38, 95%confidence interval [CI]: 1.19-1.59, I2 = 28.6%). Pooled estimates also suggested an increased dementia risk associated with cataract (6,659 participants, 1,312 cases, hazard ratio [HR] = 1.17, 95%CI 1.00-1.38, I2 = 0.0%) and diabetic retinopathy (43,658 participants, 7,060 cases, HR = 1.34, 95%CI 1.11-1.61, I2 = 63.9%), respectively. There was no evidence of an association between glaucoma (175,357 participants, 44,144 cases, HR = 0.97, 95%CI 0.90-1.04, I2 = 51.5%) or age-related macular degeneration (7,800,692 participants, > 2,559 cases, HR = 1.15, 95%CI 0.88-1.50, I2 = 91.0%) and risk of dementia, respectively. CONCLUSION As visual impairment, cataract, and diabetic retinopathy are associated with an increased likelihood of developing dementia, early diagnosis may help identify those at risk of dementia. Given most causes of visual impairment are treatable or preventable, the potential for dementia prevention warrants further investigation.
Collapse
Affiliation(s)
- Elżbieta Kuźma
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany
| | - Thomas J Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,Alan Turing Institute, London, United Kingdom
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, Exeter, United Kingdom
| | - Ulrich Thiem
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany.,University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
44
|
Sabatini S, Ukoumunne OC, Ballard C, Collins R, Corbett A, Brooker H, Clare L. The cross-sectional relationship between pain and awareness of age-related changes. Br J Pain 2021; 15:335-344. [PMID: 34377459 PMCID: PMC8339953 DOI: 10.1177/2049463720961798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Awareness of positive and negative age-related changes (AARC gains and losses) captures the perceived changes that older individuals experience in several domains of their lives including physical, cognitive and social functioning; interpersonal relationships; and lifestyle. Exploring antecedents of AARC is important to identify those individuals that could benefit the most from interventions promoting positive experiences of ageing and/or adaptation to age-related changes. This study investigates the experience of pain as a predictor of lower AARC gains and higher AARC losses. METHODS Analyses are based on cross-sectional data from the PROTECT cohort (2019); 1013 UK residents (mean (SD; range) age: 65.3 (7.1; 51.4-92) years, 84.4% women) completed measures of AARC and pain and provided demographic information. Linear regression models were fitted to examine pain as a predictor of AARC gains and AARC losses. RESULTS Higher levels of pain predicted more AARC losses both before (regression coefficient, B = 0.36; 95% confidence interval (CI): 0.29 to 0.42, p-value < 0.001; R 2 = 0.11) and after adjusting for demographic covariates (B = 0.34; 95% CI: 0.27 to 0.40; p-value < 0.001; Partial R 2 = 0.11). Pain was not significantly associated with AARC gains (unadjusted B = 0.05; 95% CI: -0.03 to 0.12, p-value = 0.21; Partial R 2 = 0.01). CONCLUSION Individuals experiencing pain may perceive more AARC losses. Interventions aiming to decrease levels of pain could include a component targeting self-perceptions of ageing and/or promoting acceptance of the negative changes that can happen with ageing. STATEMENT OF SIGNIFICANCE The predictive role of greater levels of pain for more negative perceptions of age-related changes extends the literature on the negative psychological outcomes of pain and on predictors of perceived awareness of age-related changes (AARC). As individuals experiencing pain may be more at risk of perceiving their own ageing in a more negative way, they may benefit from interventions that combine strategies to reduce levels of pain and the interference that pain exerts on their daily activities with an educational component enhancing positive self-perceptions of ageing and promoting acceptance of negative age-related changes.
Collapse
Affiliation(s)
- Serena Sabatini
- School of Psychology, University of
Exeter, Exeter, UK
- College of Medicine and Health,
University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC),
University of Exeter, Exeter, UK
| | - Clive Ballard
- College of Medicine and Health,
University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health,
University of Exeter, Exeter, UK
| | - Anne Corbett
- College of Medicine and Health,
University of Exeter, Exeter, UK
| | - Helen Brooker
- College of Medicine and Health,
University of Exeter, Exeter, UK
- Ecog Pro Ltd, Bristol, UK
| | - Linda Clare
- College of Medicine and Health,
University of Exeter, Exeter, UK
| |
Collapse
|
45
|
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne OC. Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the United Kingdom: a methodological systematic review. BMC Med Res Methodol 2021; 21:152. [PMID: 34311695 PMCID: PMC8311976 DOI: 10.1186/s12874-021-01348-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Cluster randomised trials (CRTs) are increasingly used to evaluate non-pharmacological interventions for improving child health. Although methodological challenges of CRTs are well documented, the characteristics of school-based CRTs with pupil health outcomes have not been systematically described. Our objective was to describe methodological characteristics of these studies in the United Kingdom (UK). Methods MEDLINE was systematically searched from inception to 30th June 2020. Included studies used the CRT design in schools and measured primary outcomes on pupils. Study characteristics were described using descriptive statistics. Results Of 3138 articles identified, 64 were included. CRTs with pupil health outcomes have been increasingly used in the UK school setting since the earliest included paper was published in 1993; 37 (58%) studies were published after 2010. Of the 44 studies that reported information, 93% included state-funded schools. Thirty six (56%) were exclusively in primary schools and 24 (38%) exclusively in secondary schools. Schools were randomised in 56 studies, classrooms in 6 studies, and year groups in 2 studies. Eighty percent of studies used restricted randomisation to balance cluster-level characteristics between trial arms, but few provided justification for their choice of balancing factors. Interventions covered 11 different health areas; 53 (83%) included components that were necessarily administered to entire clusters. The median (interquartile range) number of clusters and pupils recruited was 31.5 (21 to 50) and 1308 (604 to 3201), respectively. In half the studies, at least one cluster dropped out. Only 26 (41%) studies reported the intra-cluster correlation coefficient (ICC) of the primary outcome from the analysis; this was often markedly different to the assumed ICC in the sample size calculation. The median (range) ICC for school clusters was 0.028 (0.0005 to 0.21). Conclusions The increasing pool of school-based CRTs examining pupil health outcomes provides methodological knowledge and highlights design challenges. Data from these studies should be used to identify the best school-level characteristics for balancing the randomisation. Better information on the ICC of pupil health outcomes is required to aid the planning of future CRTs. Improved reporting of the recruitment process will help to identify barriers to obtaining representative samples of schools.
Collapse
Affiliation(s)
- Kitty Parker
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Room 2.16, South Cloisters, St Luke's Campus, 79 Heavitree Rd, Exeter, EX1 2LU, UK.
| | - Michael Nunns
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - ZhiMin Xiao
- School of Health and Social Care, University of Essex, Colchester, CO4 3SQ, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, L5 Clifford Allbutt Building, Cambridge Biomedical Campus Box 58, Cambridge, CB2 0AH, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Room 2.16, South Cloisters, St Luke's Campus, 79 Heavitree Rd, Exeter, EX1 2LU, UK
| |
Collapse
|
46
|
Bjornstad G, Cuffe-Fuller B, Ukoumunne OC, Fredlund M, McDonald A, Wilkinson K, Lloyd J, Hawton A, Berry V, Tarrant M, Borek A, Fitzpatrick K, Gillett A, Rhodes S, Logan S, Morris C. Healthy Parent Carers: feasibility randomised controlled trial of a peer-led group-based health promotion intervention for parent carers of disabled children. Pilot Feasibility Stud 2021; 7:144. [PMID: 34301334 PMCID: PMC8298691 DOI: 10.1186/s40814-021-00881-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
Background Parent carers of children with special educational needs or disability are at higher risk of poor mental and physical health. The need for a tailored, peer-led group programme was raised by parent carers, who co-developed the Healthy Parent Carers programme with researchers. This study aimed to test the feasibility of programme delivery in community settings, and the feasibility and acceptability of a randomised controlled trial design. Methods Participants were individually randomised with concealed allocation to a structured group programme and access to online resources (intervention), or access to the online resources only (control). Measures of wellbeing and secondary and economic outcomes were collected before randomisation, immediately post-intervention, and 6 months post-intervention. Descriptive statistics on recruitment and attrition, demographics, attendance, and fidelity of intervention delivery were analysed with feedback on the acceptability of the trial design. Results One hundred and ninety-three parent carers expressed an interest in taking part. Ninety-two participants recruited from across six sites were randomised (47 intervention, 45 control). Lead and assistant facilitators were trained and delivered the group sessions. Sixteen (34%) participants in the intervention arm did not attend any sessions, and attendance varied across sites and sessions. One participant withdrew post-randomisation, and 83 (90%) participants completed outcome measures at the six-month follow-up. Conclusions The study demonstrated that it was feasible to deliver the programme in community settings. The number of parent carers who expressed interest signifies the need for such a programme and the feasibility of recruiting to a definitive trial. Loss to follow-up was low. Further research is needed to explore ways to reduce barriers to participation in person and assess the feasibility and acceptability of programme content and delivery for more ethnically diverse groups, and potentially using interpreters. Given the Covid-19 pandemic and delivery format feedback, there is also a need to investigate remote or blended delivery strategies. Although the results indicate that a definitive trial is feasible, programme impact would be strengthened through exploration of these uncertainties. Trial registration ISRCTN, ISRCTN15144652, registered on 25 October 2018, ClinicalTrials.gov, NCT03705221, registered on 15 October 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00881-5.
Collapse
Affiliation(s)
- Gretchen Bjornstad
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK.,NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Beth Cuffe-Fuller
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Mary Fredlund
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK.,NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Annabel McDonald
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Kath Wilkinson
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Jenny Lloyd
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK.,Relational Health Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
| | - Annie Hawton
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK.,Health Economics Group and NIHR Applied Research Collaboration (PenARC) South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
| | - Vashti Berry
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Mark Tarrant
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Aleksandra Borek
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Katharine Fitzpatrick
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Annette Gillett
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit, University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Stuart Logan
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK.,NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK.,NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| |
Collapse
|
47
|
Wilkinson K, Ball S, Mitchell SB, Ukoumunne OC, O'Mahen HA, Tejerina-Arreal M, Hayes R, Berry V, Petrie I, Ford T. The longitudinal relationship between child emotional disorder and parental mental health in the British Child and Adolescent Mental Health surveys 1999 and 2004. J Affect Disord 2021; 288:58-67. [PMID: 33839559 DOI: 10.1016/j.jad.2021.03.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Research suggests parental psychopathology has an adverse effect on child mental health. However, due to the interactional nature of parent-child relationships and with a high rate of emotional disorders reported in school-age children, it is important to know whether the effect is reciprocal. METHODS We explored the longitudinal relationship between child and parent mental health in the British Child and Adolescent Mental Health Surveys (N=7,100 child-parent dyads) and their three-year follow-ups. The Development and Well-Being Assessment with DSM-IV diagnostic criteria was used to measure child psychiatric diagnoses, while parental mental health was assessed using the General Health Questionnaire. Multivariable logistic regression was used to explore the longitudinal association between child emotional disorder and parent mental health. RESULTS Parents of children who had an emotional disorder at baseline were more likely to have poor mental health three years later compared with parents whose children had no psychiatric diagnosis (33.3% versus 16.7%; crude odds ratio=2.52; adjusted odds ratio=2.19, 95% CI=1.58 to 3.05, p<0.001). Children of parents with poor mental health at baseline were more likely to develop an emotional disorder three years later compared with children whose parents had good mental health (5.2% versus 2.5%; crude odds ratio=2.08; adjusted odds ratio=1.63, 95% CI=1.18 to 2.25, p=0.003). LIMITATIONS The findings of this research are limited by the survey data collected, the measures used and survey dropout. CONCLUSIONS We detected a bi-directional relationship between child and parent mental health, suggesting that effective intervention for one individual may benefit other family members.
Collapse
Affiliation(s)
- K Wilkinson
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - S Ball
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - S B Mitchell
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - O C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - H A O'Mahen
- University of Exeter Mood Disorders Centre, Sir Henry Wellcome Building, Streatham Drive, Exeter, EX4 4QG, UK
| | - M Tejerina-Arreal
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - R Hayes
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - V Berry
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - I Petrie
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - T Ford
- Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 2AH, UK
| |
Collapse
|
48
|
Sabatini S, Woods RT, Ukoumunne OC, Ballard C, Collins R, Clare L. Associations of subjective cognitive and memory decline with depression, anxiety, and two-year change in objectively-assessed global cognition and memory. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2021; 29:840-866. [PMID: 33971790 DOI: 10.1080/13825585.2021.1923634] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research studies exploring the association of cognitive complaints with objectively assessed cognitive decline report inconsistent results. However, many of these have methodological limitations. We investigated whether 1) more severe subjective cognitive decline (SCD) and subjective memory decline (SMD) predict change in objectively assessed global cognition, remote memory, recent memory, learning; 2) the predictive value of more severe SMD over change in objectively assessed remote memory, recent memory, and learning is stronger for individuals that report an SMD that started within the past five years than for those that report an SMD that started five or more years previously and/or stronger for those that experienced SMD within the past two years than for those who had not; and 3) greater depression and anxiety are associated with more severe SCD and SMD. We used two-year longitudinal data from the CFAS-Wales study (N = 1,531; mean (SD) age = 73.0 (6.0) years). We fitted linear regression models. More severe SCD and SMD did not predict change in objectively assessed global cognition, remote memory, and recent memory but predicted lower scores in learning. The prediction of SMD over change in learning was not stronger when individuals reported an SMD that started within the past five years compared to when they reported an SMD that started five or more years previously nor when individuals reported an SMD that started within the past two years than those who did not. Greater depression and anxiety were associated with more severe SCD and SMD. More severe SMD may be useful for predicting lower learning ability and for identifying individuals experiencing depression and anxiety.
Collapse
Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Robert T Woods
- Dementia Services Development Centre, School of Health Sciences, Bangor University, Bangor, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
49
|
Montero-Marin J, Nuthall E, Byford S, Crane C, Dalgleish T, Ford T, Ganguli P, Greenberg MT, Ukoumunne OC, Viner RM, Williams JMG, Kuyken W. Update to the effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial. Trials 2021; 22:254. [PMID: 33827652 PMCID: PMC8024679 DOI: 10.1186/s13063-021-05213-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MYRIAD (My Resilience in Adolescence) is a superiority, parallel group, cluster randomised controlled trial designed to examine the effectiveness and cost-effectiveness of a mindfulness training (MT) programme, compared with normal social and emotional learning (SEL) school provision to enhance mental health, social-emotional-behavioural functioning and well-being in adolescence. The original trial protocol was published in Trials (accessible at https://doi.org/10.1186/s13063-017-1917-4 ). This included recruitment in two cohorts, enabling the learning from the smaller first cohort to be incorporated in the second cohort. Here we describe final amendments to the study protocol and discuss their underlying rationale. METHODS Four major changes were introduced into the study protocol: (1) there were changes in eligibility criteria, including a clearer operational definition to assess the degree of SEL implementation in schools, and also new criteria to avoid experimental contamination; (2) the number of schools and pupils that had to be recruited was increased based on what we learned in the first cohort; (3) some changes were made to the secondary outcome measures to improve their validity and ability to measure constructs of interest and to reduce the burden on school staff; and (4) the current Coronavirus Disease 2019 (SARS-CoV-2 or COVID-19) pandemic both influences and makes it difficult to interpret the 2-year follow-up primary endpoint results, so we changed our primary endpoint to 1-year follow-up. DISCUSSION These changes to the study protocol were approved by the Trial Management Group, Trial Steering Committee and Data and Ethics Monitoring Committees and improved the enrolment of participants and quality of measures. Furthermore, the change in the primary endpoint will give a more reliable answer to our primary question because it was collected prior to the COVID-19 pandemic in both cohort 1 and cohort 2. Nevertheless, the longer 2-year follow-up data will still be acquired, although this time-point will be now framed as a second major investigation to answer some new important questions presented by the combination of the pandemic and our study design. TRIAL REGISTRATION International Standard Randomised Controlled Trials ISRCTN86619085 . Registered on 3 June 2016.
Collapse
Affiliation(s)
- Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Elizabeth Nuthall
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Sarah Byford
- Kings Health Economics, Kings College London, London, UK
| | - Catherine Crane
- Oxford Institute of Clinical Psychology Training, Warneford Hospital, Oxford, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Mark T. Greenberg
- Prevention Research Center, Pennsylvania State University, State College, PA USA
| | - Obioha C. Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, Exeter, UK
| | | | - J. Mark G. Williams
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| |
Collapse
|
50
|
Montero-Marin J, Nuthall E, Byford S, Crane C, Dalgleish T, Ford T, Ganguli P, Greenberg MT, Ukoumunne OC, Viner RM, Williams JMG, Kuyken W. Update to the effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial. Trials 2021. [PMID: 33827652 DOI: 10.1186/s13063-021-05213-9--] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND MYRIAD (My Resilience in Adolescence) is a superiority, parallel group, cluster randomised controlled trial designed to examine the effectiveness and cost-effectiveness of a mindfulness training (MT) programme, compared with normal social and emotional learning (SEL) school provision to enhance mental health, social-emotional-behavioural functioning and well-being in adolescence. The original trial protocol was published in Trials (accessible at https://doi.org/10.1186/s13063-017-1917-4 ). This included recruitment in two cohorts, enabling the learning from the smaller first cohort to be incorporated in the second cohort. Here we describe final amendments to the study protocol and discuss their underlying rationale. METHODS Four major changes were introduced into the study protocol: (1) there were changes in eligibility criteria, including a clearer operational definition to assess the degree of SEL implementation in schools, and also new criteria to avoid experimental contamination; (2) the number of schools and pupils that had to be recruited was increased based on what we learned in the first cohort; (3) some changes were made to the secondary outcome measures to improve their validity and ability to measure constructs of interest and to reduce the burden on school staff; and (4) the current Coronavirus Disease 2019 (SARS-CoV-2 or COVID-19) pandemic both influences and makes it difficult to interpret the 2-year follow-up primary endpoint results, so we changed our primary endpoint to 1-year follow-up. DISCUSSION These changes to the study protocol were approved by the Trial Management Group, Trial Steering Committee and Data and Ethics Monitoring Committees and improved the enrolment of participants and quality of measures. Furthermore, the change in the primary endpoint will give a more reliable answer to our primary question because it was collected prior to the COVID-19 pandemic in both cohort 1 and cohort 2. Nevertheless, the longer 2-year follow-up data will still be acquired, although this time-point will be now framed as a second major investigation to answer some new important questions presented by the combination of the pandemic and our study design. TRIAL REGISTRATION International Standard Randomised Controlled Trials ISRCTN86619085 . Registered on 3 June 2016.
Collapse
Affiliation(s)
- Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Elizabeth Nuthall
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Sarah Byford
- Kings Health Economics, Kings College London, London, UK
| | - Catherine Crane
- Oxford Institute of Clinical Psychology Training, Warneford Hospital, Oxford, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Mark T Greenberg
- Prevention Research Center, Pennsylvania State University, State College, PA, USA
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, Exeter, UK
| | | | - J Mark G Williams
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | | | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
| |
Collapse
|