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Ikhtabi S, Pitman A, Maconick L, Pearce E, Dale O, Rowe S, Johnson S. The prevalence and severity of loneliness and deficits in perceived social support among who have received a 'personality disorder' diagnosis or have relevant traits: a systematic review. BMC Psychiatry 2024; 24:21. [PMID: 38172738 PMCID: PMC10765693 DOI: 10.1186/s12888-023-05471-8] [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: 05/24/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Loneliness and struggles with unmet social needs are a common experience among people with 'personality disorder' diagnoses/traits. Given the impact of loneliness and poor perceived social support on mental health, and the importance of a sense of belonging for recovery, a systematic review examining the prevalence/severity of loneliness and deficits in perceived social support among people with 'personality disorder' diagnoses/traits is an essential step towards developing an intervention targeting the social needs of people with diagnoses/traits 'personality disorder'. Despite an extensive literature on loneliness and deficits of perceived social support among people with 'personality disorder' diagnosis/traits, to date there has been no systematic review of this evidence. METHOD We conducted a systematic review synthesising quantitative data on the prevalence/severity of loneliness and deficits of perceived social support among people with diagnoses/traits of 'personality disorder' in comparison with other clinical groups and the general population. We searched Medline, Embase, PsycINFO, Web of Social Science, Google scholar and Ethos British Library from inception to December 2021. We conducted quality appraisals using the Joanna Briggs Critical appraisal tools and rated the certainty of evidence using the Grading of Recommendation, Assessment, Development and Evaluation approach. A narrative synthesis was used describing the direction and strength of associations prioritising high quality studies. FINDINGS A final set of 70 studies are included in this review, most of which are cross-sectional studies (n = 55), based in the United States (51%) and focused on community samples. Our synthesis of evidence found that, across all types of 'personality disorders' (except 'narcissistic personality' traits), people with traits associated with 'personality disorder' or meeting criteria for a diagnosis of 'personality disorder', have higher levels of loneliness, lower perceived relationship satisfaction, and poorer social support than the general population or other clinical samples. CONCLUSION The quality of evidence is judged as low quality. However, given the distressing nature of loneliness and the known negative effects of loneliness on mental health and recovery, it is important for future research to explore mechanisms by which loneliness may exacerbate 'personality disorder' symptoms and the impact this has on recovery.
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Affiliation(s)
| | - Alexandra Pitman
- UCL Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
| | - Lucy Maconick
- UCL Division of Psychiatry, NIHR Doctoral Research Fellow, Camden and Islington NHS Foundation Trust, London, UK
| | | | - Oliver Dale
- Sussex Partnership Foundation Trust, London, UK
| | | | - Sonia Johnson
- UCL Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
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Maconick L, Ikhtabi S, Broeckelmann E, Pitman A, Barnicot K, Billings J, Osborn D, Johnson S. Crisis and acute mental health care for people who have been given a diagnosis of a 'personality disorder': a systematic review. BMC Psychiatry 2023; 23:720. [PMID: 37798701 PMCID: PMC10552436 DOI: 10.1186/s12888-023-05119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND People who have been given a diagnosis of a 'personality disorder' need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a 'personality disorder' diagnosis using crisis and acute mental health services. METHODS We searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a 'personality disorder' diagnosis. We performed a narrative synthesis of evidence for each model of care found. RESULTS We screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987-2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty. CONCLUSION The literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.
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Affiliation(s)
- Lucy Maconick
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Eva Broeckelmann
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Kirsten Barnicot
- Department of Health Services Research & Management, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Jo Billings
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - David Osborn
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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Ahmed N, Barnett P, Greenburgh A, Pemovska T, Stefanidou T, Lyons N, Ikhtabi S, Talwar S, Francis ER, Harris SM, Shah P, Machin K, Jeffreys S, Mitchell L, Lynch C, Foye U, Schlief M, Appleton R, Saunders KRK, Baldwin H, Allan SM, Sheridan-Rains L, Kharboutly O, Kular A, Goldblatt P, Stewart R, Kirkbride JB, Lloyd-Evans B, Johnson S. Mental health in Europe during the COVID-19 pandemic: a systematic review. Lancet Psychiatry 2023; 10:537-556. [PMID: 37321240 PMCID: PMC10259832 DOI: 10.1016/s2215-0366(23)00113-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.
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Affiliation(s)
- Nafiso Ahmed
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK.
| | - Phoebe Barnett
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK; Centre for Outcomes Research and Effectiveness, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Anna Greenburgh
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Tamara Pemovska
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Theodora Stefanidou
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Natasha Lyons
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, London, UK
| | - Shivangi Talwar
- Division of Psychiatry, University College London, London, UK
| | - Emma R Francis
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Samantha M Harris
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Prisha Shah
- Lived Experience Working Group, University College London, London, UK
| | - Karen Machin
- Lived Experience Working Group, University College London, London, UK
| | - Stephen Jeffreys
- Lived Experience Working Group, University College London, London, UK
| | - Lizzie Mitchell
- Lived Experience Working Group, University College London, London, UK
| | - Chris Lynch
- Lived Experience Working Group, University College London, London, UK
| | - Una Foye
- National Institute of Health and Care Research Mental Health Policy Research Unit, King's College London, London, UK
| | - Merle Schlief
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Rebecca Appleton
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Katherine R K Saunders
- National Institute of Health and Care Research Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sophie M Allan
- Cambridgeshire and Peterborough National Health Service Foundation Trust, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Luke Sheridan-Rains
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | | | - Ariana Kular
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Peter Goldblatt
- Institute of Health Equity, University College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK
| | | | - Brynmor Lloyd-Evans
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
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Toh G, Pearce E, Vines J, Ikhtabi S, Birken M, Pitman A, Johnson S. Digital interventions for subjective and objective social isolation among individuals with mental health conditions: a scoping review. BMC Psychiatry 2022; 22:331. [PMID: 35549899 PMCID: PMC9098213 DOI: 10.1186/s12888-022-03889-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Social isolation encompasses subjective and objective concepts. Both are associated with negative health consequences and are more prevalent among people with mental health problems than among the general population. To alleviate social isolation, digital interventions have potential as accessible alternatives or adjuncts to face-to-face interventions. This scoping review aimed to describe the types of digital interventions evaluated for feasibility, acceptability and effectiveness in alleviating social isolation among individuals with mental health problems, and to present an overview of the quantitative evidence yielded to inform future intervention design. METHODS We searched five electronic databases for quantitative and mixed methods studies published between January 2000 and July 2020. Studies were included if they evaluated digital interventions for individuals with mental health conditions, had subjective and/or objective social isolation as their primary outcome, or as one of their outcomes if no primary outcome was specified. Feasibility studies were included if feasibility outcomes were the primary outcomes and social isolation was among their secondary outcomes. A narrative synthesis was conducted to present our findings. The protocol was registered on Open Science Framework (doi: https://doi.org/10.17605/OSF.IO/CNX8A ). RESULTS Thirty-two studies were included for our review: 16 feasibility studies, seven single-group studies and nine effectiveness trials. There was great variation in the interventions, study designs and sample populations. Interventions included web-based programmes, phone-based programmes, blended interventions, socially assistive robots and virtual reality interventions. Many were feasibility studies, or otherwise not fully powered to detect an effect if one were present, thus preventing clear conclusions about clinical effectiveness. Satisfactory feasibility outcomes indicated potential for future trials to assess these interventions. CONCLUSION Our scoping review identified a range of digital approaches utilized to alleviate social isolation among individuals with mental health disorders. Conclusions regarding clinical effectiveness cannot be reached due to variability of approaches and lack of large-scale randomized controlled trials. To make clear recommendations for digital social isolation interventions, future research needs to be based on rigorous methods and larger samples. Future studies should also focus on utilizing theory-driven approaches and improving existing approaches to advance the field.
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Affiliation(s)
- Gigi Toh
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK.
| | - Eiluned Pearce
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - John Vines
- School of Informatics, University of Edinburgh, Crichton St, Newington, Edinburgh, UK
| | - Sarah Ikhtabi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - Mary Birken
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - Alexandra Pitman
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
- Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK
| | - Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK.
- Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK.
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Ikhtabi S, Pitman A, Toh G, Birken M, Pearce E, Johnson S. The experience of loneliness among people with a "personality disorder" diagnosis or traits: a qualitative meta-synthesis. BMC Psychiatry 2022; 22:130. [PMID: 35177022 PMCID: PMC8855579 DOI: 10.1186/s12888-022-03767-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Loneliness is prevalent among people with a "personality disorder" diagnosis or who have related personality traits, but the experience of loneliness among people with "personality disorder" diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with "personality disorder" diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic. METHOD We conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with "personality disorder" diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis. RESULT We identified 39 articles that described the experience of loneliness in people with "personality disorder" diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a "haunting alienation", (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate "personality disorder" symptoms and distress. CONCLUSION Despite describing a need to belong and efforts to cope with unmet social needs, people with "personality disorder" diagnoses/traits (particularly "emotionally unstable personality disorder") report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with "personality disorder" diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery.
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Affiliation(s)
| | - Alexandra Pitman
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Gigi Toh
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Mary Birken
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Eiluned Pearce
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
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Mann F, Wang J, Pearce E, Ma R, Schlief M, Lloyd-Evans B, Ikhtabi S, Johnson S. Loneliness and the onset of new mental health problems in the general population. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2161-2178. [PMID: 35583561 PMCID: PMC9636084 DOI: 10.1007/s00127-022-02261-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Loneliness is associated with poor health including premature mortality. There are cross-sectional associations with depression, anxiety, psychosis, and other mental health outcomes. However, it is not known whether loneliness is causally linked with the new onset of mental health problems in the general population. Longitudinal studies are key to understanding this relationship. We synthesized evidence from longitudinal studies investigating the relationship between loneliness and new onset of mental health problems, in the general population. METHOD We systematically searched six electronic databases, unpublished sources, and hand-searched references, up to August 2021. We conducted a meta-analysis of eight independent cohorts and narrative synthesis of the remaining studies. RESULTS We included 32 studies, of which the majority focused on depression. Our narrative synthesis found most studies show loneliness at baseline which is associated with the subsequent new onset of depression. The few studies on anxiety and self-harm also showed a positive association. Our meta-analysis found a pooled adjusted odds ratio of 2.33 (95% CI 1.62-3.34) for risk of new onset depression in adults who were often lonely compared with people who were not often lonely. This should be interpreted with caution given evidence of heterogeneity. CONCLUSION Loneliness is a public mental health issue. There is growing evidence it is associated with the onset of depression and other common mental health problems. Future studies should explore its impact across the age range and in more diverse populations, look beyond depression, and explore the mechanisms involved with a view to better informing appropriate interventions.
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Affiliation(s)
- Farhana Mann
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Jingyi Wang
- School of Public Health Shanghai, Fudan University, Shanghai, China
| | - Eiluned Pearce
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Ruimin Ma
- Department of Psychological Medicine, Kings College London, London, UK
| | - Merle Schlief
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Mann F, Wang J, Pearce E, Ma R, Schlief M, Lloyd-Evans B, Ikhtabi S, Johnson S. Correction to: Loneliness and the onset of new mental health problems in the general population. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2179. [PMID: 35876865 PMCID: PMC9636082 DOI: 10.1007/s00127-022-02337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Farhana Mann
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Jingyi Wang
- School of Public Health Shanghai, Fudan University, Shanghai, China
| | - Eiluned Pearce
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Ruimin Ma
- Department of Psychological Medicine, Kings College London, London, UK
| | - Merle Schlief
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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