Social determinants of mental health trajectories during midlife: a prospective British birth cohort study

BACKGROUND

There is an ongoing debate about whether mental wellbeing follows a U-shaped pattern across the lifespan, with a universal low point during midlife. However, existing research largely looks at average distributions of mental health problems and does not consider the underlying trajectories and social determinants. We investigate the social factors linked to changes in mental health during midlife.

METHODS

For this prospective observational study, we used representative data from the 1970 British Cohort Study for the ages 34, 42, and 46-48 years (N=8581, 51·5% female, 48·5% male; born in the same week in 1970) to identify participants with declining mental health in midlife, and then used logistic regressions to determine what social factors (eg, education and employment status) were associated with this decline. Mental health was measured using the short version of the Malaise Inventory (scored 0-9). Using the cutoff point of 4 (indicating high risk of depression), we categorised participants who changed from below the cutoff to above the cutoff from age 34 to 46 years as "declining mental health" (as opposed to "stable" and "improved" mental health who were grouped together into one category). All analyses controlled for sex and parental socioeconomic status.

FINDINGS

Of the participants who responded to all mental health questions, 5302 (82·2%) remained stable, 429 (6·7%) had improved, and 671 (10·5%) had declining mental health. Our logistic regressions show that university education was linked to a lower risk of declining mental health controlled for sex and parental socioeconomic status odds ratio [OR] 0·79, 95% CI 0·85-0·94; controlling for sex and parental socioeconomic status). Experiencing unemployment during this period was linked to a higher risk of declining mental health (OR 1·75, 1·24-2·42), whereas people with permanent or temporary sickness or disability were three times more likely to experience a deterioration of mental health compared with those in full-time employment (OR 3·12, 2·46-3·93).

INTERPRETATION

The midlife decline in mental health might not be a universal phenomenon, but it might rather be influenced by social factors and changes in people's lives. Individuals experiencing unemployment, particularly those excluded from the labour market, are at a considerably higher risk of experiencing a decline in mental health. This is study provides only descriptive evidence and should be followed up by causal analyses.

FUNDING

Economic and Social Research Council (ESRC).

The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis

BACKGROUND

Lower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing childhood adversity could reduce socioeconomic inequities in these outcomes.

METHODS

We analysed data from two early-life longitudinal cohorts: the Longitudinal Study of Australian Children (LSAC; n=1873) and the UK Avon Longitudinal Study of Parents and Children (ALSPAC; n=7085).

EXPOSURE

low/medium (below university degree) versus high maternal education, as a key indicator of family socioeconomic position (0-1 year).

OUTCOMES

BMI and log-transformed glycoprotein acetyls (GlycA) (LSAC: 11-12 years; ALSPAC: 15.5 years). Mediator: multiple adversities (≥2/<2) indicated by family violence, mental illness, substance abuse and harsh parenting (LSAC: 2-11 years; ALSPAC: 1-12 years). A causal mediation analysis was conducted.

RESULTS

Low/medium maternal education was associated with up to 1.03 kg/m2 higher BMI (95% CI: 0.95 to 1.10) and up to 1.69% higher GlycA (95% CI: 1.68 to 1.71) compared with high maternal education, adjusting for confounders. Causal mediation analysis estimated that decreasing the levels of multiple adversities in children with low/medium maternal education to be like their high maternal education peers could reduce BMI inequalities by up to 1.8% and up to 3.3% in GlycA.

CONCLUSIONS

Our findings in both cohorts suggest that slight reductions in socioeconomic inequities in children's BMI and inflammation could be achieved by addressing childhood adversities. Public health and social policy efforts should help those affected by childhood adversity, but also consider underlying socioeconomic conditions that drive health inequities.

Mental Health and Wellbeing of Population with Migrant Background in Switzerland - a Scoping Review and Evidence Map of Quantitative Evidence

We aimed to map the evidence, based on population-based and migrant-specific datasets in Switzerland, on mental health and wellbeing of the population with migrant background. The research questions were: What is known from the existing quantitative evidence about the mental health of the population with migrant background living in Switzerland? What are the research gaps that can be addressed with existing secondary datasets in Switzerland? We used the scoping review approach to describe existing research. We searched Ovid MEDLINE and APA PsycInfo (2015 - September 2022). This resulted in a total of 1862 potentially relevant studies. In addition, we manually searched other sources, such as Google Scholar. We used a evidence map to visually summarise research characteristics and identify research gaps. In total, 46 studies were included in this review. Most studies used cross-sectional design (78.3%, n = 36) and theirs aims were descriptive (84.8%, n = 39). The studies tend to examine mental health or wellbeing of the population with migrant background in the context of social determinants (69.6%, n = 32). The most frequently studied social determinants were at the individual level (96.9%, n = 31). Out of 46 included studies, 32.6% (n = 15) included depression or anxiety, and 21.7% (n = 10) post-traumatic stress disorder and other traumas. Other outcomes were less commonly investigated. There was a lack of studies using longitudinal data investigating mental health of migrants that go beyond descriptive aims (i.e., explanatory and predictive), and have large nationally representative samples. Moreover, there is a need for research examining social determinants of mental health and wellbeing at the structural, family and community levels. We propose that existing nationally representative population-based surveys are used to a greater extent to study various aspects of migrants' mental health and wellbeing.

Mediating mechanisms of the relationship between exposure to deprivation and threat during childhood and adolescent psychopathology: evidence from the Millennium Cohort Study

The key aim of our study was to examine pathways from exposure to childhood adversities (i.e., deprivation and threat) to adolescent psychopathology. The assessed mediating mechanisms included cognitive ability and emotion regulation, as proposed by the Dimensional Model of Adversity and Psychopathology (DMAP). The study comprised participants from the nationally representative Millennium Cohort Study. Latent scores for deprivation and threat were derived using confirmatory factor analysis from indicators collected when participants were at age of 9 months, 3 and 5 years. Cognitive ability was measured using the Verbal Similarities subscale of the British Ability Scales II at age 11, and emotion regulation was measured using emotion dysregulation subscale of the Child Social Behavioural Questionnaire at age 7. Psychopathology, defined as psychological distress, was assessed using the Kessler 6 scale at age 17. We conducted causal mediation analysis adjusting for multiple confounding factors. We did not find total effect of either exposure to deprivation or threat on psychological distress, but we did find significant indirect effects of exposure to deprivation on psychological distress via cognitive ability (- 0.11, 95% CI - 0.20 to - 0.05) and emotion regulation (0.03, 0.02 to 0.12), and exposure to threat on psychological distress via cognitive ability (- 0.04, - 0.07 to - 0.01) and emotion regulation (0.09, 0.03 to 0.15). The lack of associations between deprivation or threat and psychological distress may be due to reporting bias or developmental period of psychopathology. Results of mediation analysis partially support the DMAP but indicate limited benefits to reduce adolescent psychological distress by targeting cognitive ability or emotion regulation to those exposed to childhood adversities.

Testing lifecourse theories characterising associations between maternal depression and offspring depression in emerging adulthood: the Avon Longitudinal Study of Parents and Children

BACKGROUND

Maternal depression is a major determinant of offspring mental health. Yet, little is understood about how the duration and timing of maternal depression shapes youth risk for depressive symptoms, which if understood could inform when best to intervene. This study aimed to determine how the timing and duration of maternal depression was related to offspring depression in emerging adulthood, and if these associations varied by sex.

METHODS

We analysed data from the Avon Longitudinal Study of Parents and Children (a prenatal cohort in the Avon area of England, 1991-2003), n = 3,301. We applied the structured lifecourse modelling approach to maternal depression (assessed at 13 points from prenatal period to adolescence) and emerging adult depressive symptoms (age 21). Lifecourse models assessed were accumulation (sum of timepoints when maternal depression was reported), sensitive periods (each period assessed as one during which maternal depression has a stronger effect) and instability (frequent fluctuations in maternal depression).

RESULTS

Female adolescents (n = 2,132) had higher SMFQ scores (mean = 6.15, SD = 5.90) than males (n = 1,169, mean = 4.87, SD = 4.82). Maternal depression was most common in the infancy period (21.2% males; 21.4% females). For males, accumulation was the most appropriate lifecourse model; for each additional period of maternal depression, depressive symptoms in emerging adulthood increased by 0.11 (95% CI: 0.07, 0.15, one-sided p value ≤ .001). For females, exposure to maternal depression was associated with increasing depressive symptoms in emerging adulthood, with the largest effect in mid-childhood (increase of 0.27 units, 95% CI 0.03-0.50, p = .015 for difference between mid-childhood and other time-periods) and a smaller, equal effect at all other time-periods (increase of 0.07 units per time-period, 95% CI: 0.03-0.12, p = .002).

CONCLUSIONS

This study highlights the importance of ongoing maternal depression for the development of depression in offspring through to emerging adulthood. Because long-term exposure to maternal depression was particularly important, early interventions are warranted.

Association of Interparental Violence and Maternal Depression With Depression Among Adolescents at the Population and Individual Level

Importance

Parental intimate partner violence (IPV) and maternal depression are associated with increased risk of depression in children at the population level. However, it is not known whether having information about these experiences can accurately identify individual children at higher risk of depression.

Objective

To examine the extent to which experiencing parental IPV and/or maternal depression before age 12 years is associated with depression at age 18 years at the population and individual level.

Design, Setting, and Participants

This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK population-based birth cohort, which initially recruited pregnant mothers with estimated due dates in 1991 and 1992. Data used in this study were collected from 1991 to 2009. Data analysis was performed from February to March 2022.

Exposures

Mother-reported parental IPV was assessed on 8 occasions (child age, 1-11 years). Maternal depression was assessed via the Edinburgh Postnatal Depression Scale or by the mother taking medication for depression, as reported by the mother on 8 occasions (child age, 2-12 years).

Main Outcomes and Measures

Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) and Clinical Interview Schedule-Revised (CIS-R) when the child was aged 18 years. Binary indicators of a case of depression were derived the cutoff point of 11 points or above for the SMFQ and 12 points or above for the CIS-R.

Results

The study included 5029 children (2862 girls [56.9%]; 2167 boys [43.1%]) with a measure of depressive symptoms at age 18 years. IPV only was associated with a 24% (adjusted risk ratio, 1.24; 95% CI, 0.97-1.59) higher risk of depression at age 18 years, exposure to maternal depression only was associated with a 35% (adjusted risk ratio, 1.35; 95% CI, 1.11-1.64) higher risk, and exposure to both IPV and maternal depression was associated with a 68% (adjusted risk ratio, 1.68; 95% CI, 1.34-2.10) higher risk. At the individual level, the area under the receiver operating characteristic curve was 0.58 (95% CI, 0.55-0.60) for depression according to the SMFQ and 0.59 (95% CI, 0.55-0.62) for the CIS-R, indicating a 58% to 59% probability (ie, 8%-9% above chance) that a random participant with depression at age 18 years had been exposed to IPV and/or maternal depression compared with a random participant who did not have depression.

Conclusions and Relevance

In this cohort study, parental IPV and maternal depression were associated with depression in adolescence at the population level. However, estimation of an individual developing depression in adolescence based only on information about IPV or maternal depression is poor. Screening children for maternal depression and IPV to target interventions to prevent adolescent depression will fail to identify many children who might benefit and may unnecessarily target many others who do not develop depression.

Correlates of mental health in the Swiss Household Panel – a network analysis

Background

Firstly, we aim to describe any differences in the mean levels of correlates and indicators of mental health and wellbeing between young (25-39 years) and middle-aged adults (40-55 years). Secondly, we aim to compare the network models depicting interrelations between correlates and indicators of mental health and wellbeing among these age groups.

Methods

This paper draws on longitudinal data from 6 waves (2013-2018) of the Swiss Household Panel (SHP) study, with a total sample of 5,315 individuals, including 2,044 young (25-39 years) and 3,271 middle-aged (40-55 years) participants. We used network analysis to examine and present complex relationships between the correlates and the indicators of mental health and wellbeing.

Results

Middle-aged individuals had worse mental health and wellbeing on all indicators but energy and optimism, which did not differ across groups. The effect sizes (according to Cohen’s d) were small, reaching the maximum of 0.20 for sadness. Despite higher household income and financial satisfaction, perceived job insecurity and work strain were higher in midlife, with socioeconomic prestige being lower. Moreover, middle-aged individuals had lower social support, relationships satisfaction, and health satisfaction. The network was denser in midlife, with two direct interrelations being stronger in this age group: health satisfaction and energy/optimism as well as accommodation satisfaction and life satisfaction. There were also several other differences in indirect interrelations between correlates and indicators of mental health and wellbeing, including a potentially more important role of self-mastery in midlife in bridging socioeconomic indicators, wellbeing and mental health.

Conclusions

We suggest further exploring the workplace as an avenue to improving population mental health and wellbeing, with a particular focus on the role of self-mastery.

Key messages

• Middle-aged individuals appear to have worse mental health and lower wellbeing than young adults.

• Health satisfaction is not only lower in midlife, but it seems of greater importance for mental health and wellbeing.

Psychological distress from early adulthood to early old age: evidence from the 1946, 1958 and 1970 British birth cohorts

BACKGROUND

Existing evidence on profiles of psychological distress across adulthood uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to study the profile of psychological distress within the same individuals from early adulthood to early old age across three British birth cohorts.

METHODS

We used data from three British birth cohorts: born in 1946 (n = 3093), 1958 (n = 13 250) and 1970 (n = 12 019). The profile of psychological distress - expressed both as probability of being a clinical case or a count of symptoms based on comparable items within and across cohorts - was modelled using the multilevel regression framework.

RESULTS

In both 1958 and 1970 cohorts, there was an initial drop in the probability of being a case between ages 23-26 and 33-34. Subsequently, the predicted probability of being a case increased from 12.5% at age 36 to 19.5% at age 53 in the 1946 cohort; from 8.0% at age 33 to 13.7% at age 42 in the 1958 cohort and from 15.7% at age 34 to 19.7% at age 42 in the 1970 cohort. In the 1946 cohort, there was a drop in the probability of caseness between ages 60-64 and 69 (19.5% v. 15.2%). Consistent results were obtained with the continuous version of the outcome.

CONCLUSIONS

Across three post-war British birth cohorts midlife appears to be a particularly vulnerable phase for experiencing psychological distress. Understanding the reasons for this will be important for the prevention and management of mental health problems.

How is the distribution of psychological distress changing over time? Who is driving these changes? Analysis of the 1958 and 1970 British birth cohorts

AIMS

The main objective of this study was to investigate distributional shifts underlying observed age and cohort differences in mean levels of psychological distress in the 1958 and 1970 British birth cohorts.

METHODS

This study used data from the 1958 and 1970 British birth cohorts (n = 24,707). Psychological distress was measured by the Malaise Inventory at ages 23, 33, 42 and 50 in the 1958 cohort and 26, 34, 42 and 46-48 in the 1970 cohort.

RESULTS

The shifts in the distribution across age appear to be mainly due to changing proportion of those with moderate symptoms, except for midlife (age 42-50) when we observed polarisation in distress- an increase in proportions of people with no symptoms and multiple symptoms. The elevated levels of distress in the 1970 cohort, compared with the 1958 cohort, appeared to be due to an increase in the proportion of individuals with both moderate and high symptoms. For instance, at age 33/34 42.3% endorsed at least two symptoms in the 1970 cohort vs 24.7% in 1958, resulting in a shift in the entire distribution of distress towards the more severe end of the spectrum.

CONCLUSIONS

Our study demonstrates the importance of studying not only mean levels of distress over time, but also the underlying shifts in its distribution. Due to the large dispersion of distress scores at any given measurement occasion, understanding the underlying distribution provides a more complete picture of population trends.

1173The impact of adverse and positive experiences on inflammatory outcomes in Australian and UK children

Background

Inflammation is one of key mechanisms linking childhood experiences to later chronic disease risk. Childhood adversity is associated with inflammation, but little is known about positive experiences. We examine how adverse and positive experiences are associated with inflammatory markers in late childhood, and whether they have an interaction effect.

Methods

Data sources: Longitudinal Study of Australian Children (LSAC; N = 1237) and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3488). Exposures: Adverse and positive experiences assessed from 0 to 11 (LSAC) and 0-14 years (ALSPAC). Adversity indicators included parent legal problems, family violence, mental illness, substance abuse, harsh parenting, parental divorce, neighbourhood violence, family member death, and bullying victimization. Positive experiences included positive parenting practice, trusting and supportive relationships, supportive neighbourhood and home learning environments, social engagement and enjoyment. Outcomes: Inflammation quantified by high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA). Analyses: Linear regression was used to estimate relative change in inflammatory markers, adjusted for sociodemographics. Outcomes were log-transformed.

Results

Exposure to adversity was associated with higher levels of inflammation (e.g., CRP: β = 8.8%, 95% CI= -16.5% to 34.2% in LSAC), whereas exposure to positive experiences was associated with lower levels (e.g., CRP: β=-18.9%, 95% CI= -45.8% to 7.9% in LSAC), after adjusting for sociodemographics. There was no interaction effect of adverse and positive experiences on inflammation.

Conclusions

Adverse and positive experiences have independent and small effects on children’s inflammation across two cohorts.

Key messages

Positive experiences are critical to inform interventions to improve inflammatory outcomes for children who face adversity.

Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort

BACKGROUND

We sought to: [1] estimate the prevalence of multimorbidity at age 46-48 in the 1970 British Cohort Study-a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity.

METHOD

A prospective longitudinal birth cohort of a community-based sample from the 1970 British Cohort Study (BCS70). Participants included all surviving children born in mainland Britain in a single week in April 1970; the analytical sample included those with valid data at age 46-48 (n = 7951; 2016-2018). The main outcome was multimorbidity, which was operationalised as a binary indicator of two or more long-term health conditions where at least one of these conditions was of physical health. It also included symptom complexes (e.g., chronic pain), sensory impairments, and alcohol problems.

RESULTS

Prevalence of mid-life multimorbidity was 33.8% at age 46-48. Those with fathers from unskilled social occupational class (vs professional) at birth had 43% higher risk of mid-life multimorbidity (risk ratio = 1.43, 95% confidence interval 1.15 to 1.77). After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity (risk ratio = 0.90, 95% confidence interval 0.84 to 0.96); a decrease of one body mass index point at age 10 was associated with 3% lower risk (risk ratio = 1.03, 95% confidence interval 1.01 to 1.05); one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk (risk ratio = 0.96, 95% confidence interval 0.91 to 1.00); an increase of one internalising problem at age 16 was equated with 4% higher risk (risk ratio = 1.04, 95% confidence interval 1.00 to 1.08) and of one externalising problem at age 16 with 6% higher risk (risk ratio = 1.06, 1.03 to 1.09).

CONCLUSION

Prevalence of multimorbidity was high in mid-life (33.8% at age 46-48) in Britain. Potentially modifiable early-life exposures, including early-life social circumstances, cognitive, physical and emotional development, were associated with elevated risk of mid-life multimorbidity.

Does time heal all wounds? Life course associations between child welfare involvement and mortality in prospective cohorts from Sweden and Britain

Child welfare involvement reflects childhood adversity and is associated with increased adult mortality, but it remains unclear how this association changes over the life course. Drawing on the Stockholm Birth Cohort Multigenerational Study (Sweden) and the National Childhood Development Study (Great Britain) this study examines whether inequalities within these cohorts diverge or converge. Involvement with child welfare services (ICWS) is divided into two levels ('child welfare contact' and 'out-of-home care'). For each cohort, we quantify absolute health inequalities as differences in cumulative probabilities of death (18-58 years) and temporary life expectancy; and relative inequalities as hazard ratios in ten-year intervals and ratios of lifetime lost. Persistently, ICWS was associated with premature mortality. The strength of the association varied by age, sex and level of ICWS. Consistently across both countries, the most robust relationship was between out-of-home care and mortality, with statistically significant age-specific hazard ratios ranging between 1.8 and 3.4 for males and 1.8-2.1 for females. Child welfare contact that did not result in out-of-home placement showed less consistent results. Among females the mortality gap developed later compared to males. Estimates attenuate after controlling for family socioeconomic and other background variables but patterns remain intact. Our results show that absolute inequalities widen with increasing age, while relative inequalities might peak in early adulthood and then stabilize in midlife. The relative disadvantage among looked-after children in early adulthood is heightened by overall low rates of mortality at this age. Absolute inequality increases with age, highlighting the weight of the accumulation of disadvantage in mortality over time. The bulk of excess deaths that could be attributed to ICWS occurs from midlife onwards. Mechanisms that uphold the disadvantage after childhood experiences require further exploration. This study highlights that the association between out-of-home care and premature mortality seems to transcend welfare systems.

Perspectives of paediatric hospital staff on factors influencing the sustainability and spread of a safety quality improvement programme

OBJECTIVE

Situation Awareness For Everyone (SAFE) is a quality improvement programme aiming to improve situation awareness in paediatric clinical teams. The aim of our study was to examine hospital staff perceptions of the facilitators and barriers/challenges to the sustaining and subsequent spread of the huddle, the key intervention of the SAFE programme.

SETTING

Interviews were held on two wards in two children hospitals and on two children wards in two district general hospitals.

METHOD

Semistructured interviews were conducted with 23 staff members from four National Health Service paediatric wards. A deductive thematic analysis was conducted, drawing on an existing framework, which groups the factors influencing programme sustainability into four categories: innovation, leadership, process and context.

PARTICIPANTS

23 staff in two children's hospitals and two children's wards across four UK hospitals, comprising of nurses and doctors, administration or housekeeping staff, ward managers and matrons, and allied professionals.

PRIMARY OUTCOMES

Understanding factors contributing to the sustaining and spread of a quality improvement intervention.

RESULTS

Perceptions of the benefits, purpose and fit of the huddle, team commitment, sharing learning, adaptation of the method and senior leadership were identified as facilitators. High staff turnover, large multiple specialty medical staff teams, lack of senior leadership and dislike of change were identified as barriers/challenges.

CONCLUSIONS

Sustaining and spreading quality improvement interventions in a complex clinical setting requires understanding of the interplay between the actual innovation and existing leadership, process and contextual factors. These must be considered at the planning stage of an innovation to maximise the potential for sustainability and spread to other settings.

Mental health crisis in midlife – a proposed research agenda

There is a growing amount of evidence indicating increased levels of psychological distress, suicide rates and decreased well-being in midlife (age 45-55). We refer to this phenomenon as the ‘midlife mental health crisis’. As there is little empirical evidence or theoretical grounds to explain the midlife mental health crisis, we propose a research agenda.

In order to facilitate further research, we consulted members of public, mental health professionals and researchers on potential reasons for the midlife mental health crisis. Subsequently, we translated those into research questions testable with the British birth cohorts. We propose a series of studies using three statistical modelling approaches: descriptive (what is the midlife mental health crisis?), predictive (who is at increased risk of experiencing the midlife mental health crisis?) and explanatory (what are the processes leading to the midlife mental health crisis?).

Mental health crisis in midlife – a proposed research agenda

There is a growing amount of evidence indicating increased levels of psychological distress, suicide rates and decreased well-being in midlife (age 45-55). We refer to this phenomenon as the ‘midlife mental health crisis’. As there is little empirical evidence or theoretical grounds to explain the midlife mental health crisis, we propose a research agenda.

In order to facilitate further research, we consulted members of public, mental health professionals and researchers on potential reasons for the midlife mental health crisis. Subsequently, we translated those into research questions testable with the British birth cohorts. We propose a series of studies using three statistical modelling approaches: descriptive (what is the midlife mental health crisis?), predictive (who is at increased risk of experiencing the midlife mental health crisis?) and explanatory (what are the processes leading to the midlife mental health crisis?).

Inequality in hospitalization due to non-communicable diseases in Sweden: Age-cohort analysis of the Uppsala Birth Cohort Multigenerational Study

We aimed to investigate cohort differences in age trajectories of hospitalization due to non-communicable conditions, and if these varied by paternal socioeconomic position. We used the Uppsala Birth Cohort Multigenerational Study—including virtually complete information on medical diagnoses.

Our sample constituted 28,448 individuals (103,262 observations). The outcome was five-year prevalence of hospitalization due to major non-communicable conditions in 1989–2008. The exposures were age (19–91), year-of-birth (1915–1929; 1938–1972), gender (man vs woman), and parental socioeconomic position (low, medium, and high). We used multilevel logit models to examine associations between exposures and the hospitalization outcome.

Younger cohorts had a higher prevalence of hospitalization at overlapping ages than those born earlier, with inter-cohort differences emerging from early-adulthood and increasing with age. For instance, at age 40 predicted probability of hospitalization increased across birth-cohorts—from 1.2% (born in 1948-52) to 2.0% (born in 1963-67)—whereas at age 50 it was 2.9% for those born in 1938-42 compared with 4.6% among participants born in 1953-57. Those with medium and low socioeconomic position had 13.0% and 20.0% higher odds of experiencing hospitalization during the observation period, respectively—when age, year-of-birth and gender were accounted for.

We found that no progress was made in reducing the socioeconomic inequalities in hospitalization across cohorts born between 1915 and 1972. Hence, more effective policies and interventions are needed to reduce the overall burden of morbidity—particularly among the most vulnerable.

•

What is already known on this subject?

•

The evidence on trends in morbidity in Sweden is mainly cross-sectional and focused on individual conditions.

•

Rates of various indicators of morbidity (e.g. poor mobility, psychological distress, disability) have increased over time.

•

What this study adds.

•

Successively younger birth cohorts had a higher prevalence of hospitalization, with differences emerging in early-adulthood.

•

Those in medium and low parental socioeconomic position (vs high) had 13% and 20% higher odds of hospitalization.

•

No progress was made in reducing the socioeconomic inequalities across cohorts born between 1915 and 1972.

The association between early life mental health and alcohol use behaviours in adulthood: A systematic review

This systematic review aims to summarise current evidence on the association between early life mental health and alcohol use behaviours in adulthood. Peer-reviewed publications were located by searching EMBASE, Medline, PsycINFO, and the ISI Web of Science up to 31 October 2018. Prospective longitudinal studies reporting associations between externalising problems (EXT), internalising problems (INT), depression, anxiety before age 18, and alcohol use behaviours (alcohol consumption, heavy/problematic drinking, alcohol use disorder) after age 18 were included. After screening 17259 articles, 36 articles met the inclusion criteria. Information extracted included strength of associations, age when mental health and alcohol use behaviours were measured, sex differences in the association, and other sample characteristics. 103 tests in 23 articles were identified on the externalising domain and 135 tests in 26 articles on the internalising domain. 37 out of 103 tests reported positive associations between EXT and alcohol use behaviours. The likelihood of observing positive associations was higher for more severe alcohol use outcomes, but this trend disappeared among high-quality studies. Findings on associations between internalising domain and alcohol use varied across their subtypes. INT tended to be negatively associated with alcohol consumption but positively associated with more severe outcomes (heavy/problematic drinking, alcohol use disorder). Depression tended to be positively associated with alcohol outcomes, while no clear association between anxiety and alcohol outcomes was evident. Variation of the association across developmental timing, sex, culture, historical period was explored where appropriate. Great heterogeneity in the current literature calls for greater attention to view the relationship developmentally.

Post-war (1946-2017) population health change in the United Kingdom: A systematic review

We systematically reviewed the evidence on secular trends in main chronic conditions, disability and self-assessed general health among adults in the United Kingdom, as reported in primary/secondary care databases and population-based surveys. Searches were conducted separately for: (1) trends in age-standardised or age-specific prevalence of major non-communicable diseases, disability, and self-reported general health; (2) trends in health expectancy. The databases searched were MEDLINE, EMBASE/EMBASE Classic and Web of Science (all from 1946/7). The evidence was synthesised narratively. There were 39 studies reporting trends in prevalence of health conditions and 15 studies in health expectancy. We did not find evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer's disease and other dementias. Both increasing or stable prevalence rates with simultaneous rising life expectancy support the expansion of morbidity theory, meaning that people are expected to spend a greater number of years with chronic condition(s). The evidence on disability-expressed as prevalence or health expectancy-was mixed, but also appeared to support the expansion of morbidity among those aged 65 or over. The evidence on trends in disability for younger age is lacking. Across the studied period (1946-2017), the UK population endured more years with chronic morbidity and disability, which may place a serious strain on the health care system, the economy and the society.

Predictors of mental health help-seeking among polish people living the United Kingdom

BACKGROUND

Migration has been shown to be associated with negative mental health outcomes. Moreover, migrants tend to underutilise mental health services. The current study aimed to assess the association between predictors, divided into three groups (predisposing, enabling and need), and two outcome variables: (1) past professional mental health help-seeking during the stay in the United Kingdom; (2) intentions of mental health help-seeking from a mental health professional within the next three months.

METHODS

The study utilised a population-based cross-sectional survey with the final sample of 536 participants. Multivariate linear and logistic regression models were used to examine the association between predictors and the outcomes.

RESULTS

We found strong evidence that older age, mental health stigma and living circumstances (predisposing factors), as well as knowledge of the National Health Service, social support, and education (enabling factors) were associated with past and future help-seeking for mental health problems. Finally, mental health status was associated with both past help-seeking and intentions.

CONCLUSION

Due to large numbers of migrants in the UK it is vital to ensure that these populations receive adequate mental health support. Findings of the present study may inform development of policies and interventions better tailored to specific migrant populations.

Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards

BACKGROUND

'Situation Awareness For Everyone' (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the 'huddle', a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle.

METHODS

A cross-sectional observational design was used to psychometrically develop the 'Huddle Observation Tool' (HOT) over three phases using standardised psychometric methodology. Huddles were observed across four NHS paediatric wards participating in SAFE by five researchers; two wards within specialist children hospitals and two within district general hospitals, with location, number of beds and length of stay considered to make the sample as heterogeneous as possible. Inter-rater reliability was calculated using the weighted kappa and intraclass correlation coefficient.

RESULTS

Inter-rater reliability was acceptable for the collaborative culture (weighted kappa=0.32, 95% CI 0.17 to 0.42), environment items (weighted kappa=0.78, 95% CI 0.52 to 1) and total score (intraclass correlation coefficient=0.87, 95% CI 0.68 to 0.95). It was lower for the structure and risk management items, suggesting that these were more variable in how observers rated them. However, agreement on the global score for huddles was acceptable.

CONCLUSION

We developed an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. Future research should examine whether observational evaluations of huddles are associated with other indicators of safety on clinical wards (eg, safety climate and incidents of patient harm), and whether scores on the HOT are associated with improved situation awareness and reductions in deterioration and adverse events in clinical settings, such as inpatient wards.

Mental health provision in schools: approaches and interventions in 10 European countries

BACKGROUND

The role of schools in providing community-based support for children's mental health and well-being is widely accepted and encouraged. Research has mainly focused on designing and evaluating specific interventions and there is little data available regarding what provision is available, the focus and priorities of schools and the professionals involved in providing this support. The current study presents these data from schools in 10 European countries.

METHODS

Online survey of 1466 schools in France, Germany, Ireland, Netherlands, Poland, Serbia, Spain, Sweden, UK and Ukraine. The participating countries were chosen based on their geographical spread, diversity of political and economic systems, and convenience in terms of access to the research group and presence of collaborators.

RESULTS

Schools reported having more universal provision than targeted provision and there was greater reported focus on children who already have difficulties compared with prevention of problems and promotion of student well-being. The most common interventions implemented related to social and emotional skills development and anti-bullying programmes. Learning and educational support professionals were present in many schools with fewer schools reporting involvement of a clinical specialist. Responses varied by country with 7.4-33.5% between-country variation across study outcomes. Secondary schools reported less support for parents and more for staff compared with primary schools, with private schools also indicating more staff support. Schools in rural locations reported less student support and professionals involved than schools in urban locations.

CONCLUSION

The current study provides up-to-date and cross-country insight into the approaches, priorities and provision available for mental health support in schools; highlighting what schools prioritise in providing mental health support and where coverage of provision is lacking.

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services

The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London. Two levels of implementation emerged from the analysis: (1) the service level, regarding the implementation of outcome measures across a service to inform service improvement and (2) the session level, regarding the implementation of outcome measures within individual clinical sessions. The present research described training and ongoing support as a crucial facilitator of use at both service and session levels. This included help overcoming local contextual barriers, such as resources, information systems and administrative processes. The research showed that a balance is needed between a mandatory and uniform approach across a service and providing clinicians with support to use outcome measures with all service users for whom they are appropriate.

When is Sessional Monitoring More Likely in Child and Adolescent Mental Health Services?

Sessional monitoring of patient progress or experience of therapy is an evidence-based intervention recommended by healthcare systems internationally. It is being rolled out across child and adolescent mental health services (CAMHS) in England to inform clinical practice and service evaluation. We explored whether patient demographic and case characteristics were associated with the likelihood of using sessional monitoring. Multilevel regressions were conducted on N = 2609 youths from a routinely collected dataset from 10 CAMHS. Girls (odds ratio, OR 1.26), older youths (OR 1.10), White youths (OR 1.35), and youths presenting with mood (OR 1.46) or anxiety problems (OR 1.59) were more likely to have sessional monitoring. In contrast, youths under state care (OR 0.20) or in need of social service input (OR 0.39) were less likely to have sessional monitoring. Findings of the present research may suggest that sessional monitoring is more likely with common problems such as mood and anxiety problems but less likely with more complex cases, such as those involving youths under state care or those in need of social service input.

Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol

INTRODUCTION

Evidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the 'clinical gaze' to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE.

METHODS AND ANALYSIS

In this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change.

ETHICS AND DISSEMINATION

Ethics approval was obtained from London-Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and-given the short timeframes of the project-initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK.

Mental health provision in schools: priority, facilitators and barriers in 10 European countries

BACKGROUND

Although schools are a key setting for the provision of mental health support for young people, little is known about the facilitators and barriers for providing such support. This study aimed to collect information from schools in 10 European countries regarding the priority given to mental health support for students, existence of a mental health-related school policy, links with relevant external agencies, schools' perceptions on whether they are providing sufficient mental health support and the barriers to provision of mental health support.

METHODS

Data from 1346 schools were collected in France, Germany, Ireland, the Netherlands, Poland, Serbia, Spain, Sweden, United Kingdom and Ukraine through an online survey.

RESULTS

Around 3% of the surveyed schools indicated that mental health provision was not a priority, compared to 47% indicating that it was a high/essential priority. More than half the surveyed schools did not implement a school policy regarding mental health. Half the surveyed schools reported not providing sufficient support with the key barriers identified including limited staff capacity, funding, access to specialists and lack of national policy and less than a third of schools reported good or excellent links with local mental health services. However, the responses varied by country with 8-19% between-country variation across the study outcomes. Secondary schools reported significantly better links with agencies, were more likely to have a school policy and were less likely to indicate having sufficient existing support compared to primary schools. Privately funded schools reported that mental health support was a higher priority and identified less barriers to provision compared to publicly funded schools.

CONCLUSIONS

This study provides an up-to-date and cross-country insight into schools' perceptions regarding priority given to mental health support and the barriers they face in providing sufficient mental health and wellbeing support for their students. The cross-country comparisons allow for a better understanding of the relationships between policy, practice and implementation and provide a platform for shared experiences and learning.

Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review

Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective.