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Ward IL, Finning K, Ayoubkhani D, Hendry K, Sharland E, Appleby L, Nafilyan V. Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-21. Eur J Public Health 2024; 34:211-217. [PMID: 38326992 DOI: 10.1093/eurpub/ckad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The risk of suicide is complex and often a result of multiple interacting factors. Understanding which groups of the population are most at risk of suicide is important to inform the development of targeted public health interventions. METHODS We used a novel linked dataset that combined the 2011 Census with the population-level mortality data in England and Wales. We fitted generalized linear models with a Poisson link function to estimate the rates of suicide across different sociodemographic groups and to identify which characteristics are independent predictors of suicide. RESULTS Overall, the highest rates of suicide were among men aged 40-50 years, individuals who reported having a disability or long-term health problem, those who were unemployed long term or never had worked, and those who were single or separated. After adjusting for other characteristics such as employment status, having a disability or long-term health problem, was still found to increase the incidence of suicide relative to those without impairment [incidence rate ratio minimally adjusted (women) = 3.5, 95% confidence interval (CI) = 3.3-3.6; fully adjusted (women) 3.1, 95% CI = 3.0-3.3]. Additionally, while the absolute rate of suicide was lower in women compared with men, the relative risk in people reporting impairments compared with those who do not was higher in women compared with men. CONCLUSIONS The findings of this work provide novel population-level insights into the risk of suicide by sociodemographic characteristics in England and Wales. Our results highlight several sociodemographic groups who may benefit from more targeted suicide prevention policies and practices.
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Affiliation(s)
| | | | | | | | | | - Louis Appleby
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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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.
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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.
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Sharland E, Rzepnicka K, Schneider D, Finning K, Pawelek P, Saunders R, Nafilyan V. Socio-demographic differences in access to psychological treatment services: evidence from a national cohort study. Psychol Med 2023; 53:7395-7406. [PMID: 37194490 PMCID: PMC10721408 DOI: 10.1017/s0033291723001010] [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: 08/23/2022] [Revised: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has offered adults in England evidence-based psychological treatments for common mental disorders (CMDs) such as depression and anxiety disorders. However, inequalities in access have not been explored at the national level. METHODS Using a unique individual patient dataset that linked 2011 Census information of English residents to national IAPT data collected between April 2017 and March 2018, we estimated the rate of access by a wide range of socio-demographic characteristics that are not routinely available. A large household survey was used to estimate the prevalence of probable CMDs by these socio-demographic characteristics. We estimated the probability of access to IAPT amongst people with CMDs by comparing the rates of access from IAPT data and the estimates of prevalence of CMDs from the household survey. Both unadjusted and adjusted (for important patient characteristics) access rates were estimated in logistic regression models. RESULTS As a proportion of those with a probable CMD, access to IAPT varied markedly by socio-demographic characteristics. Older adults, males, people born outside of the UK, people with religious beliefs, people from Asian ethnic backgrounds, people reporting a disability and those without any academic or professional qualifications were underrepresented in IAPT services nationally, in adjusted models. CONCLUSIONS The identification of patients who may be underrepresented in IAPT provides an opportunity for services to target outreach and engagement with these groups. Further understanding of barriers to access should help increase equity in access.
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Affiliation(s)
| | | | | | | | | | - Rob Saunders
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK
| | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Department for Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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4
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Campbell E, Macey E, Shine C, Nafilyan V, Clark NC, Pawelek P, Ward I, Hughes A, Raleigh V, Banerjee A, Finning K. Sociodemographic and health-related differences in undiagnosed hypertension in the health survey for England 2015-2019: a cross-sectional cohort study. EClinicalMedicine 2023; 65:102275. [PMID: 38106553 PMCID: PMC10725049 DOI: 10.1016/j.eclinm.2023.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 12/19/2023] Open
Abstract
Background Hypertension is a leading cause of morbidity and mortality worldwide, yet a substantial proportion of cases are undiagnosed. Understanding the scale of undiagnosed hypertension and identifying groups most at risk is important to inform approaches to detection. Methods In this cross-sectional cohort study, we used data from the 2015 to 2019 Health Survey for England, an annual, cross-sectional, nationally representative survey. The survey follows a multi-stage stratified probability sampling design, involving a random sample of primary sampling units based on postcode sectors, followed by a random sample of postal addresses within these units. Within each selected household, all adults (aged ≥16 years) and up to four children, were eligible for participation. For the current study, individuals aged 16 years and over who were not pregnant and had valid blood pressure data were included in the analysis. The primary outcome was undiagnosed hypertension, defined by a measured blood pressure of 140/90 mmHg or above but no history of diagnosis. Age-adjusted prevalence of undiagnosed hypertension was estimated across sociodemographic and health-related characteristics, including ethnicity, region, rural-urban classification, relationship status, highest educational qualification, National Statistics Socio-Economic Classification (NS-SEC), Body Mass Index (BMI), self-reported general health, and smoking status. To assess the independent association between undiagnosed hypertension and each characteristic, we fitted a logistic regression model adjusted for sociodemographic factors. Findings The sample included 21,476 individuals, of whom 55.8% were female and 89.3% reported a White ethnic background. An estimated 30.7% (95% confidence interval 29.0-32.4) of men with hypertension and 27.6% (26.1-29.1) of women with hypertension were undiagnosed. Younger age, lower BMI, and better self-reported general health were associated with an increased likelihood of hypertension being undiagnosed for men and women. Living in rural areas and in regions outside of London and the East of England were also associated with an increased likelihood of hypertension being undiagnosed for men, as were being married or in a civil partnership and having higher educational qualifications for women. Interpretation Hypertension is commonly undiagnosed, and some of the groups that are at the lowest risk of hypertension are the most likely to be undiagnosed. Given the high lifetime risk of hypertension and its strong links with morbidity and mortality, our findings suggest a need for greater awareness of the potential for undiagnosed hypertension, including among those typically considered 'low risk'. Further research is needed to assess the impact of extending hypertension screening to lower-risk groups. Funding None.
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Affiliation(s)
- Emma Campbell
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Ellie Macey
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Chris Shine
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Vahé Nafilyan
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Nathan Cadogan Clark
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Piotr Pawelek
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Isobel Ward
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Andrew Hughes
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, SW1H 0EU, UK
| | - Veena Raleigh
- The King's Fund, 11–13 Cavendish Square, London, W1G 0AN, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Katie Finning
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
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Panayiotou M, Finning K, Hennessey A, Ford T, Humphrey N. Longitudinal pathways between emotional difficulties and school absenteeism in middle childhood: Evidence from developmental cascades. Dev Psychopathol 2023; 35:1323-1334. [PMID: 34955109 DOI: 10.1017/s095457942100122x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Emotional difficulties are associated with both authorized and unauthorized school absence, but there has been little longitudinal research and the temporal nature of these associations remains unclear. This study presents three-wave random-intercepts panel models of longitudinal reciprocal relationships between teacher-reported emotional difficulties and authorized and unauthorized school absence in 2,542 English children aged 6 to 9 years old at baseline, who were followed-up annually. Minor differences in the stability effects were observed between genders but only for the authorized absence model. Across all time points, children with greater emotional difficulties had more absences, and vice versa (authorized: ρ = .23-.29, p < .01; unauthorized: ρ = .28, p < .01). At the within-person level, concurrent associations showed that emotional difficulties were associated with greater authorized (β = .15-.17, p < .01) absence at Time 3 only, but with less unauthorized (β = -.08-.13, p < .05) absence at Times 1 and 2. In cross-lagged pathways, neither authorized nor unauthorized absence predicted later emotional difficulties, and emotional difficulties did not predict later authorized absence at any time point. However, greater emotional difficulties were associated with fewer unauthorized absences across time (β = -13-.22, p < .001). The implications of these findings are discussed.
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Affiliation(s)
| | | | | | | | - Neil Humphrey
- University of Manchester, Manchester Institute of Education, Manchester, UK
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6
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Finning K, White J, Toth K, Golden S, Melendez-Torres GJ, Ford T. Longer-term effects of school-based counselling in UK primary schools. Eur Child Adolesc Psychiatry 2022; 31:1591-1599. [PMID: 33990854 PMCID: PMC8121011 DOI: 10.1007/s00787-021-01802-w] [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: 11/12/2020] [Accepted: 05/09/2021] [Indexed: 11/01/2022]
Abstract
Children's mental health is deteriorating while access to child and adolescent mental health services is decreasing. Recent UK policy has focused on schools as a setting for the provision of mental health services, and counselling is the most common type of school-based mental health provision. This study examined the longer-term effectiveness of one-to-one school-based counselling delivered to children in UK primary schools. Data were drawn from a sample of children who received school-based counselling in the UK in the 2015/16 academic year, delivered by a national charitable organisation. Mental health was assessed at baseline, immediately post-intervention, and approximately 1 year post-intervention, using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Paired t tests compared post-intervention and follow-up SDQ total difficulties scores with baseline values. Propensity score matching was then used to identify a comparator group of children from a national population survey, and linear mixed effects models compared trajectories of SDQ scores in the two groups. In the intervention group, teacher and parent SDQ total difficulties scores were lower at post-intervention and longer-term follow-up compared to baseline (teacher: baseline 14.42 (SD 7.18); post-intervention 11.09 (6.93), t(739) = 13.78, p < 0.001; follow-up 11.27 (7.27), t(739) = 11.92, p < 0.001; parent: baseline 15.64 (6.49); post-intervention 11.90 (6.78), t(361 = 11.29, p < 0.001); follow-up 11.32 (7.19), t(361) = 11.29, p < 0.001). The reduction in SDQ scores was greater in the intervention compared to the comparator group (likelihood ratio test comparing models with time only versus time plus group-by-time interaction: χ2 (3) = 24.09, p < 0.001), and model-predicted SDQ scores were lower in the intervention than comparator group for 2 years post-baseline. A one-to-one counselling intervention delivered to children in UK primary schools predicted improvements in mental health that were maintained over a 2 year follow-up period.
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Affiliation(s)
- Katie Finning
- University of Exeter College of Medicine and Health, Exeter, UK.
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7
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Nafilyan V, Dolby T, Finning K, Pawelek P, Edge R, Morgan J, Glickman M, Pearce N, van Tongeren M. Differences in COVID-19 vaccination coverage by occupation in England: a national linked data study. Occup Environ Med 2022. [DOI: 10.1136/oemed-2021-108140] [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] [Indexed: 11/04/2022]
Abstract
BackgroundMonitoring differences in COVID-19 vaccination uptake in different groups is crucial to help inform the policy response to the pandemic. A key data gap is the absence of data on uptake by occupation. This study investigates differences in vaccination rates by occupation in England, using nationwide population-level data.MethodsWe calculated the proportion of people who had received three COVID-19 vaccinations (assessed on 28 February 2022) by detailed occupational categories in adults aged 18–64 and estimated adjusted ORs to examine whether these differences were driven by occupation or other factors, such as education. We also examined whether vaccination rates differed by ability to work from home.ResultsOur study population included 15 456 651 adults aged 18–64 years. Vaccination rates differed markedly by occupation, being higher in health professionals (84.7%) and teaching and other educational professionals (83.6%) and lowest in people working in elementary trades and related occupations (57.6%). We found substantial differences in vaccination rates looking at finer occupational groups. Adjusting for other factors likely to be linked to occupation and vaccination, such as education, did not substantially alter the results. Vaccination rates were associated with ability to work from home, the rate being higher in occupations which can be done from home. Many occupations with low vaccination rates also involved contact with the public or with vulnerable peopleConclusionsIncreasing vaccination coverage in occupations with low vaccination rates is crucial to help protecting the public and control infection. Efforts should be made to increase vaccination rates in occupations that cannot be done from home and involve contact with the public.
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8
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Allen K, Melendez-Torres GJ, Ford T, Bonell C, Finning K, Fredlund M, Gainsbury A, Berry V. Family focused interventions that address parental domestic violence and abuse, mental ill-health, and substance misuse in combination: A systematic review. PLoS One 2022; 17:e0270894. [PMID: 35905105 PMCID: PMC9337671 DOI: 10.1371/journal.pone.0270894] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Abstract
Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) are three public health issues that tend to cluster within families, risking negative impacts for both parents and children. Despite this, service provision for these issues has been historically siloed, increasing the barriers families face to accessing support. Our review aimed to identify family focused interventions that have combined impacts on parental DVA, MH, and/or SU. We searched 10 databases (MEDLINE, PsycINFO, Embase, CINAHL, Education Research Information Centre, Sociological Abstracts, Applied Social Sciences Index & Abstracts, ProQuest Dissertations and Theses Global, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials) from inception to July 2021 for randomised controlled trials examining the effectiveness of family focused, psychosocial, preventive interventions targeting parents/carers at risk of, or experiencing, DVA, MH, and/or SU. Studies were included if they measured impacts on two or more of these issues. The Cochrane Risk of Bias Tool 2 was used to quality appraise studies, which were synthesised narratively, grouped in relation to the combination of DVA, MH, and/or SU outcomes measured. Harvest plots were used to illustrate the findings. Thirty-seven unique studies were identified for inclusion. Of these, none had a combined positive impact on all three outcomes and only one study demonstrated a combined positive impact on two outcomes. We also found studies that had combined adverse, mixed, or singular impacts. Most studies were based in the U.S., targeted mothers, and were rated as 'some concerns' or 'high risk' of bias. The results highlight the distinct lack of evidence for, and no 'best bet', family focused interventions targeting these often-clustered risks. This may, in part, be due to the ways interventions are currently conceptualised or designed to influence the relationships between DVA, MH, and/or SU. Trial registration: PROSPERO registration: CRD42020210350.
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Affiliation(s)
- Kate Allen
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katie Finning
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Mary Fredlund
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | | | - Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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9
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Dolby T, Finning K, Baker A, Fowler-Dowd L, Khunti K, Razieh C, Yates T, Nafilyan V. Monitoring sociodemographic inequality in COVID-19 vaccination uptake in England: a national linked data study. J Epidemiol Community Health 2022; 76:646-652. [PMID: 35470259 DOI: 10.1136/jech-2021-218415] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 11/11/2021] [Accepted: 01/31/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The UK began an ambitious COVID-19 vaccination programme on 8 December 2020. This study describes variation in vaccination uptake by sociodemographic characteristics between December 2020 and August 2021. METHODS Using population-level administrative records linked to the 2011 Census, we estimated monthly first dose vaccination rates by age group and sociodemographic characteristics among adults aged 18 years or over in England. We also present a tool to display the results interactively. RESULTS Our sample included 35 223 466 adults. A lower percentage of males than females were vaccinated in the young and middle age groups (18-59 years) but not in the older age groups. Vaccination rates were highest among individuals of White British and Indian ethnic backgrounds and lowest among Black Africans (aged ≥80 years) and Black Caribbeans (18-79 years). Differences by ethnic group emerged as soon as vaccination roll-out commenced and widened over time. Vaccination rates were also lower among individuals who identified as Muslim, lived in more deprived areas, reported having a disability, did not speak English as their main language, lived in rented housing, belonged to a lower socioeconomic group, and had fewer qualifications. CONCLUSION We found inequalities in COVID-19 vaccination uptake rates by sex, ethnicity, religion, area deprivation, disability status, English language proficiency, socioeconomic position and educational attainment, but some of these differences varied by age group. Research is urgently needed to understand why these inequalities exist and how they can be addressed.
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Affiliation(s)
- Ted Dolby
- Health Analysis and Life Events division, Office for National Statistics, Newport, UK
| | - Katie Finning
- Health Analysis and Life Events division, Office for National Statistics, Newport, UK
| | - Allan Baker
- Population Health Analysis Team, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Leigh Fowler-Dowd
- Population Health Analysis Team, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Kamlesh Khunti
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Cameron Razieh
- Health Analysis and Life Events division, Office for National Statistics, Newport, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Vahe Nafilyan
- Health Analysis and Life Events division, Office for National Statistics, Newport, UK
- London School of Hygiene & Tropical Medicine, London, UK
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10
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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.
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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
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11
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Ford T, Mansfield KL, Markham S, McManus S, John A, O'Reilly D, Newlove-Delgado T, Iveson MH, Fazel M, Munshi JD, Dutta R, Leavy G, Downs J, Foley T, Russell A, Maguire A, Moon G, Kirkham EJ, Finning K, Russell G, Moore A, Jones PB, Shenow S. The challenges and opportunities of mental health data sharing in the UK. Lancet Digit Health 2021; 3:e333-e336. [PMID: 34044999 DOI: 10.1016/s2589-7500(21)00078-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/19/2021] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Karen L Mansfield
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Sarah Markham
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Sally McManus
- School of Health Sciences, City, University of London, London, UK
| | - Ann John
- Public Health and Psychiatry, Swansea University Medical School, Swansea University, Swansea, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Royal Group of Hospitals, Belfast, UK
| | - Tamsin Newlove-Delgado
- Children and Young People's Mental Health Research Collaboration, University of Exeter College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Matthew H Iveson
- Centre for Cognitive Ageing and Cognitive Epidemiology, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Jayati Das Munshi
- Department of Psychological Medicine, King's College London, London, UK
| | - Rina Dutta
- Department of Psychological Medicine, Division of Academic Psychiatry, King's College London, London, UK
| | - Gerard Leavy
- School of Psychology, Ulster University, Londonderry, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsely National Health Service Foundation Trust, London, UK
| | - Tom Foley
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Abigail Russell
- Children and Young People's Mental Health Research Collaboration, University of Exeter College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Royal Group of Hospitals, Belfast, UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Elizabeth J Kirkham
- Centre for Clinical Brain Sciences, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Katie Finning
- Children and Young People's Mental Health Research Collaboration, University of Exeter College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ginny Russell
- Children and Young People's Mental Health Research Collaboration, University of Exeter College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Mathews F, Newlove-Delgado T, Finning K, Boyle C, Hayes R, Johnston P, Ford T. Teachers' concerns about pupils' mental health in a cross-sectional survey of a population sample of British schoolchildren. Child Adolesc Ment Health 2021; 26:99-105. [PMID: 32315517 DOI: 10.1111/camh.12390] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Schools are becoming central to the identification and referral of children and young people with poor mental health. Understanding how well a teacher concern predicts mental disorder in a child or young person is important for mental health teams who need to respond to referrals. METHOD This secondary analysis of the 2004 British Child and Adolescent Mental Health Survey used the first item of the Strengths and Difficulties Questionnaire (SDQ) Impact subscale to indicate concern about a child or young person's mental health. Mental disorder according to DSM IVR criteria was assessed using the multi-informant Development and Well-Being Assessment. We compared the proportion with and without mental disorder according to the presence or absence of teacher concern. RESULTS Teacher concern was moderately predictive (49% with teacher concern had a disorder) and sensitive (teacher concern present among 56% with disorder), while lack of teacher concern was highly predictive (only 5% had disorder) and specific (94% no disorder). Teacher concern was associated with significantly poorer mental health (mean teacher SDQ total difficulty score 19.6, SD 5.6 with disorder, mean 15.0; SD 5.1 if no disorder) compared to children without teacher concern (mean 9.6, SD 5.5 with disorder, and 4.9; SD 4.3 if no disorder; F (3, 5,931) = 1527.228, p = .001). If both teacher and parents were concerned, the child or young person was much more likely to have a disorder. CONCLUSION A lack of teacher concern can reassure mental health practitioners in the vast majority of cases. While teacher concern does identify those with poorer mental health, it is only moderately predictive of a disorder. When concerned about a child or young person, discussions with parents or others who know them may help teachers identify those who most need support. KEY PRACTITIONER MESSAGE The emphasis on schools as a major setting to provide support and identify the need for referral to specialist mental health services means service commissioners, providers and practitioners could benefit from insight into how predictive a teacher's concern is of childhood mental health conditions and how this may vary with the type of disorder If teachers are not concerned about a child, practitioners can be reassured that there is unlikely to be a significant problem with their mental health, although this will be less certain in schools whose pupils are likely to have a higher than average levels of difficulty Teacher concerns do not necessarily differentiate between clinically impairing and mild/ moderate mental health difficulties, but do identify children in poorer mental health Asking for corroboration of concern from other sources increases the strength of the association to severe mental health disorders.
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Affiliation(s)
- Frances Mathews
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Katie Finning
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Rachel Hayes
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Epstein S, Roberts E, Sedgwick R, Polling C, Finning K, Ford T, Dutta R, Downs J. School absenteeism as a risk factor for self-harm and suicidal ideation in children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1175-1194. [PMID: 30989389 PMCID: PMC7116080 DOI: 10.1007/s00787-019-01327-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 12/14/2018] [Accepted: 03/30/2019] [Indexed: 11/29/2022]
Abstract
Self-harm and suicidal ideation in children and adolescents are common and are risk factors for completed suicide. Social exclusion, which can take many forms, increases the risk of self-harm and suicidal ideation. One important marker of social exclusion in young people is school absenteeism. Whether school absenteeism is associated with these adverse outcomes, and if so to what extent, remains unclear. To determine the association between school absenteeism and both self-harm (including completed suicide) and suicidal ideation in children and adolescents, we conducted a systematic review of observational studies. We conducted meta-analysis and report a narrative synthesis where this was not possible. Meta-analysis of cross-sectional studies showed that school absenteeism was associated with an increased risk of self-harm [pooled adjusted odds ratio (aOR) 1.37, 95% confidence interval 1.20-1.57, P = 0.01] and of suicidal ideation (pooled aOR 1.20, 95% CI 1.02-1.42, P = 0.03). A small number of studies showed that school absenteeism had a longitudinal association with both adverse outcomes. Heterogeneity in the exposure and outcome variables, study design and reporting was prominent and limited the extent to which it was appropriate to pool results. School absenteeism was associated with both self-harm and suicidal ideation in young people, but this evidence was derived from a small number of cross-sectional studies. Further research into the mechanisms of this association could help to inform self-harm and suicide prevention strategies at clinical, school and population levels.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Catherine Polling
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Finning K, Ford T, Moore DA, Ukoumunne OC. Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey. Eur Child Adolesc Psychiatry 2020; 29:187-198. [PMID: 31054124 PMCID: PMC7024694 DOI: 10.1007/s00787-019-01342-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022]
Abstract
Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5- to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39-2.06) p < 0.001; depression 3.40 (2.46-4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05-1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08-1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.
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Affiliation(s)
- Katie Finning
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Tamsin Ford
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Darren A Moore
- Graduate School of Education, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- School of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
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Finning K, Ukoumunne OC, Ford T, Danielson-Waters E, Shaw L, Romero De Jager I, Stentiford L, Moore DA. Review: The association between anxiety and poor attendance at school - a systematic review. Child Adolesc Ment Health 2019; 24:205-216. [PMID: 32677217 DOI: 10.1111/camh.12322] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anxiety may be associated with poor attendance at school, which can lead to a range of adverse outcomes. We systematically reviewed the evidence for an association between anxiety and poor school attendance. METHODS Seven electronic databases were searched for quantitative studies that reported an estimate of association between anxiety and school attendance. Anxiety had to be assessed via standardised diagnostic measure or validated scale. Articles were screened independently by two reviewers. Meta-analyses were performed where possible, otherwise results were synthesised narratively. RESULTS A total of 4930 articles were screened. Eleven studies from six countries across North America, Europe and Asia, were included. School attendance was categorised into: (a) absenteeism (i.e. total absences), (b) excused/medical absences, (c) unexcused absences/truancy and (d) school refusal. Findings from eight studies suggested associations between truancy and any anxiety disorder, as well as social and generalised anxiety. Results also suggested cross-sectional associations between school refusal and separation, generalised and social anxiety disorders, as well as simple phobia. Few studies investigated associations with absenteeism or excused/medical absences. CONCLUSIONS Findings suggest associations between anxiety and unexcused absences/truancy, and school refusal. Clinicians should consider the possibility of anxiety in children and adolescents with poor attendance. However, there is a lack of high quality evidence, little longitudinal research and limited evidence relating to overall absenteeism or excused/medical absences, despite the latter being the most common type of absence. These gaps should be a key priority for future research.
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Affiliation(s)
- Katie Finning
- Child Mental Health Research Group, University of Exeter Medical School, Exeter, UK
| | - Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Tamsin Ford
- Child Mental Health Research Group, University of Exeter Medical School, Exeter, UK
| | | | - Liz Shaw
- Exeter HS&DR Evidence Synthesis Centre, University of Exeter Medical School, Exeter, UK
| | | | | | - Darren A Moore
- Graduate School of Education, University of Exeter, Exeter, UK
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Goodwin VA, Hill JJ, Fullam JA, Finning K, Pentecost C, Richards DA. Intervention development and treatment success in UK health technology assessment funded trials of physical rehabilitation: a mixed methods analysis. BMJ Open 2019; 9:e026289. [PMID: 31467046 PMCID: PMC6720467 DOI: 10.1136/bmjopen-2018-026289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Physical rehabilitation is a complex process, and trials of rehabilitation interventions are increasing in number but often report null results. This study aimed to establish treatment success rates in physical rehabilitation trials funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme and examine any relationship between treatment success and the quality of intervention development work undertaken. DESIGN This is a mixed methods study. SETTING This study was conducted in the UK. METHODS The NIHR HTA portfolio was searched for all completed definitive randomised controlled trials of physical rehabilitation interventions from inception to July 2016. Treatment success was categorised according to criteria developed by Djulbegovic and colleagues. Detailed textual data regarding any intervention development work were extracted from trial reports and supporting publications and informed the development of quality ratings. Mixed methods integrative analysis was undertaken to explore the relationship between quantitative and qualitative data using joint displays. RESULTS Fifteen trials were included in the review. Five reported a definitive finding, four of which were in favour of the 'new' intervention. Eight trials reported a true negative (no difference) outcome. Integrative analysis indicated those with lower quality intervention development work were less likely to report treatment success. CONCLUSIONS Despite much effort and funding, most physical rehabilitation trials report equivocal findings. Greater focus on high quality intervention development may reduce the likelihood of a null result in the definitive trial, alongside high quality trial methods and conduct.
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Affiliation(s)
- Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jacqueline J Hill
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - James A Fullam
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Katie Finning
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Finning K, Waite P, Harvey K, Moore D, Davis B, Ford T. Secondary school practitioners' beliefs about risk factors for school attendance problems: a qualitative study. Emot Behav Diffic 2019; 25:15-28. [PMID: 32536954 PMCID: PMC7254525 DOI: 10.1080/13632752.2019.1647684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
School staff have an important role to play in identifying and assisting pupils who require additional support to regularly attend school, but their beliefs about risk factors might influence their decisions regarding intervention. This qualitative study investigated educational practitioners' beliefs about risk factors for attendance problems. Sixteen practitioners from three secondary schools were interviewed via focus groups. Data were analysed using thematic analysis. Practitioners identified risk factors related to the individual, their family, peers and school. Poor mental health was identified as a risk factor, but practitioners primarily focused on anxiety rather than other mental health problems like depression or behavioural disorders. The overall perception was that school factors were less important than individual, family and peer factors. Implications include a need for increased awareness of the role of school factors in attendance problems, focus on promoting positive peer and pupil-teacher relationships, and collaborative working between young people, families and schools.
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Affiliation(s)
- Katie Finning
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Polly Waite
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Darren Moore
- Graduate School of Education, University of Exeter, Exeter, UK
| | - Becky Davis
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Tamsin Ford
- College of Medicine and Health, University of Exeter, Exeter, UK
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Finning K, Ukoumunne OC, Ford T, Danielsson-Waters E, Shaw L, Romero De Jager I, Stentiford L, Moore DA. The association between child and adolescent depression and poor attendance at school: A systematic review and meta-analysis. J Affect Disord 2019; 245:928-938. [PMID: 30699878 DOI: 10.1016/j.jad.2018.11.055] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/17/2018] [Accepted: 11/03/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Depression in young people may lead to reduced school attendance through social withdrawal, loss of motivation, sleep disturbance and low energy. We systematically reviewed the evidence for an association between depression and poor school attendance. METHODS Seven electronic databases were searched for quantitative studies with school-aged children and/or adolescents, reporting a measure of association between depression and school attendance. Articles were independently screened by two reviewers. Synthesis incorporated random-effects meta-analysis and narrative synthesis. RESULTS Searches identified 4930 articles. Nineteen studies from eight countries across North America, Europe, and Asia, were included. School attendance was grouped into: 1) absenteeism (i.e. total absences), 2) excused/medical absences, 3) unexcused absences/truancy, and 4) school refusal. Meta-analyses demonstrated small-to-moderate positive cross-sectional associations between depression and absenteeism (correlation coefficient r = 0.11, 95% confidence interval 0.07 to 0.15, p = 0.005, I2 = 63%); and depression and unexcused absences/truancy (r = 0.15, 95% confidence interval 0.13 to 0.17, p < 0.001, I2 = 4%; odds ratio = 3.74, 95% confidence interval 2.11 to 6.60, p < 0.001, I2 = 65%). Few studies reported associations with school refusal or excused/medical absences, and few utilised longitudinal data, although results from two studies suggested an association between depression and subsequent absenteeism. LIMITATIONS Study quality was poor overall, and methodological heterogeneity, despite creating a broad evidence-base, restricted meta-analysis to only small subsamples of studies. CONCLUSIONS Findings suggest associations between depression and poor school attendance, particularly absenteeism and unexcused absences/truancy. Clinicians and school staff should be alert to the possibility of depression in children and adolescents with poor attendance. Future research should utilise longitudinal data to confirm the direction of the association, investigate associations with excused absences, and test potential moderators of the relationship.
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Affiliation(s)
- Katie Finning
- University of Exeter Medical School, Child Mental Health Research Group, 2.05 South Cloisters, St Luke's Campus, College Road, Exeter EX1 2LU, United Kingdom.
| | - Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, United Kingdom
| | - Tamsin Ford
- University of Exeter Medical School, Child Mental Health Research Group, 2.05 South Cloisters, St Luke's Campus, College Road, Exeter EX1 2LU, United Kingdom
| | | | - Liz Shaw
- Exeter HS&DR Evidence Synthesis Centre, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Lauren Stentiford
- University of Exeter Graduate School of Education, Exeter, United Kingdom
| | - Darren A Moore
- University of Exeter Graduate School of Education, Exeter, United Kingdom
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Epstein S, Roberts E, Sedgwick R, Finning K, Ford T, Dutta R, Downs J. Poor school attendance and exclusion: a systematic review protocol on educational risk factors for self-harm and suicidal behaviours. BMJ Open 2018; 8:e023953. [PMID: 30552271 PMCID: PMC6303662 DOI: 10.1136/bmjopen-2018-023953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Schools have an important role in recognising and preventing self-harm and suicidal behaviour in their students, however little is known about which educational factors are associated with heightened risk. We will systematically review the existing evidence on two key educational performance indicators that are routinely collected by school administrative systems: school attendance and exclusion. We will investigate their association with self-harm and suicidal behaviour in school-age children and adolescents. Knowledge of this association could help inform suicide prevention strategies at clinical, school and population levels. METHODS AND ANALYSIS We will conduct a systematic search of Medline, EMBASE, PsycINFO, British Education Index and Education Resources Information Centre (ERIC) from 1 January 1990, and conduct a manual search for additional references. We aim to identify studies that explore the association between poor school attendance or exclusion and self-harm or suicidal behaviours in school-age children and adolescents. Two independent reviewers will screen titles, abstracts and full-text documents and independently extract relevant data for analysis. Study quality will be assessed using a modified Newcastle-Ottawa Scale. A descriptive analysis will be performed, and where appropriate, results will be combined in meta-analyses. ETHICS AND DISSEMINATION This is a systematic review of published literature, and therefore ethical approval will not be sought. We will publish reports in health and education journals, present our work at conferences focused on school mental health and communicate our findings to practitioners and managers in public health, education and child mental health. PROSPERO REGISTRATION NUMBER CRD42018088608.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King’s College London, London, UK
- Department of Psychological Medicine, King’s College London, London, UK
| | - Rosemary Sedgwick
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King’s College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, Barrett B, Finning K, Ganguli P, Warren F, Farrand P, Gilbody S, Kuyken W, O'Mahen H, Watkins E, Wright K, Reed N, Fletcher E, Hollon SD, Moore L, Backhouse A, Farrow C, Garry J, Kemp D, Plummer F, Warner F, Woodhouse R. Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression. Health Technol Assess 2018; 21:1-366. [PMID: 28857042 DOI: 10.3310/hta21460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy - cognitive-behavioural therapy (CBT) - is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 months' follow-up, and to investigate the processes of treatments. DESIGN Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation. SETTING Three community mental health services in England. PARTICIPANTS Adults aged ≥ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services. INTERVENTIONS BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists. OUTCOMES Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months. RESULTS We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) -1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI -1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, £975; CBT, £1235; p < 0.001), but no differences in non-intervention (hospital, community health, social care and medication costs) or total (non-intervention plus intervention) costs. Costs were lower and QALY outcomes better in the BA group, generating an incremental cost-effectiveness ratio of -£6865. The probability of BA being cost-effective compared with CBT was almost 80% at the National Institute for Health and Care Excellence's preferred willingness-to-pay threshold of £20,000-30,000 per QALY. There were no trial-related adverse events. LIMITATIONS In this pragmatic trial many depressed participants in both groups were also taking antidepressant medication, although most had been doing so for a considerable time before entering the trial. Around one-third of participants chose not to complete a PP dose of treatment, a finding common in both psychotherapy trials and routine practice. CONCLUSIONS We found that BA is as effective as CBT, more cost-effective and can be delivered by MHWs with no professional training in psychological therapies. FUTURE WORK Settings and countries with a paucity of professionally qualified psychological therapists, might choose to investigate the delivery of effective psychological therapy for depression without the need to develop an extensive and costly professional infrastructure. TRIAL REGISTRATION Current Controlled Trials ISRCTN27473954. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David A Richards
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Shelley Rhodes
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - David Ekers
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Rod S Taylor
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Katie Finning
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Fiona Warren
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Paul Farrand
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Willem Kuyken
- Oxford Mindfulness Centre, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Heather O'Mahen
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Ed Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Kim Wright
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Nigel Reed
- Lived Experience Group, care of Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Emily Fletcher
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Lucy Moore
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Amy Backhouse
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Claire Farrow
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Julie Garry
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Deborah Kemp
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Faye Plummer
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary, Bradford, UK
| | - Faith Warner
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
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Daniels G, Finning K, Lozano M, Hyland CA, Liew YW, Powley T, Castilho L, Bonet Bub C, Kutner JM, Banch Clausen F, Christiansen M, Sulin K, Haimila K, Legler TJ, Lambert M, Ryan H, Ní Loingsigh S, Matteocci A, Pierelli L, Dovc Drnovsek T, Bricl I, Nogués N, Muñiz-Diaz E, Olsson ML, Wikman A, de Haas M, van der Schoot CE, Massey E, Westhoff CM. Vox Sanguinis International Forum on application of fetal blood grouping: summary. Vox Sang 2017; 113:198-201. [DOI: 10.1111/vox.12616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - K. Finning
- International Blood Group Reference Lab; NHS Blood and Transplant; Northway, Filton Bristol BS34 7QH UK
| | - M. Lozano
- Department of Hemotherapy and Hemostasis; University Clinic Hospital; University of Barcelona; Barcelona Spain
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Daniels G, Finning K, Lozano M, Hyland CA, Liew YW, Powley T, Castilho L, Bonet Bub C, Kutner JM, Banch Clausen F, Christiansen M, Sulin K, Haimila K, Legler TJ, Lambert M, Ryan H, Ní Loingsigh S, Matteocci A, Pierelli L, Dovc Drnovsek T, Bricl I, Nogués N, Muñiz-Diaz E, Olsson ML, Wikman A, de Haas M, van der Schoot CE, Massey E, Westhoff CM. Vox Sanguinis International Forum on application of fetal blood grouping. Vox Sang 2017; 113:e26-e35. [DOI: 10.1111/vox.12615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - C. A. Hyland
- Australian Red Cross Blood Service, Research and Development; 44 Musk Avenue, Kelvin Grove Brisbane Qld 4059 Australia
| | - Y.-W. Liew
- Australian Red Cross Blood Service, Research and Development; 44 Musk Avenue, Kelvin Grove Brisbane Qld 4059 Australia
| | - T. Powley
- Australian Red Cross Blood Service, Research and Development; 44 Musk Avenue, Kelvin Grove Brisbane Qld 4059 Australia
| | - L. Castilho
- Departamento de Hemoterapia; Hospital Israelita Albert Einstein; Avenida Albert Einstein, 627-3° andar Bloco E CEP: 05651-901 São Paulo SP Brazil
| | - C. Bonet Bub
- Departamento de Hemoterapia; Hospital Israelita Albert Einstein; Avenida Albert Einstein, 627-3° andar Bloco E CEP: 05651-901 São Paulo SP Brazil
| | - J. M. Kutner
- Departamento de Hemoterapia; Hospital Israelita Albert Einstein; Avenida Albert Einstein, 627-3° andar Bloco E CEP: 05651-901 São Paulo SP Brazil
| | - F. Banch Clausen
- Laboratory of Blood Genetics, Rigshospitalet, Section 2034, Department of Clinical Immunology; Copenhagen University Hospital; Blegdamsvej 9 Copenhagen Denmark
| | - M. Christiansen
- Department of Clinical Immunology; Aarhus University Hospital; Palle Juul-Jensens Boulevard 99 8200 Aarhus N Denmark
| | - K. Sulin
- Blood Group Unit; Finnish Red Cross Blood Service; Kivihaantie 7 FI-00310 Helsinki Finland
| | - K. Haimila
- Blood Group Unit; Finnish Red Cross Blood Service; Kivihaantie 7 FI-00310 Helsinki Finland
| | - T. J. Legler
- Department of Transfusion Medicine; University Medical Center Göttingen; Georg-August-Universität; Robert-Koch-Str. 40 Göttingen 37075 Germany
| | - M. Lambert
- Irish Blood Transfusion Service; Blood Group Genetics; National Blood Centre; James's Street Dublin 8 Ireland
| | - H. Ryan
- Irish Blood Transfusion Service; Blood Group Genetics; National Blood Centre; James's Street Dublin 8 Ireland
| | - S. Ní Loingsigh
- Irish Blood Transfusion Service; Blood Group Genetics; National Blood Centre; James's Street Dublin 8 Ireland
| | - A. Matteocci
- Department of Transfusion Medicine; San Camillo Forlanini Hospital; Circonvallazione Gianicolense 87 00152 Roma Italy
| | - L. Pierelli
- Department of Experimental Medicine; Sapienza University of Rome; Piazzale Aldo Moro 5 00185 Roma Italy
- Department of Transfusion Medicine; San Camillo Forlanini Hospital; Circonvallazione Gianicolense 87 00152 Roma Italy
| | - T. Dovc Drnovsek
- Department of Immunohematology; Blood Transfusion Centre of Slovenia; Slajmerjeva 6 SI-Ljubljana Slovenia
| | - I. Bricl
- Department of Immunohematology; Blood Transfusion Centre of Slovenia; Slajmerjeva 6 SI-Ljubljana Slovenia
| | - N. Nogués
- Immunohematology Department; Banc de Sang i Teixits; Passeig de Taulat 116 08005 Barcelona Spain
| | - E. Muñiz-Diaz
- Immunohematology Department; Banc de Sang i Teixits; Passeig de Taulat 116 08005 Barcelona Spain
| | - M. L. Olsson
- Department of Laboratory Medicine; Lund University; Lund Sweden
- Department of Clinical Immunology and Transfusion Medicine; LabMedicine; Office of Medical Services; Region Skåne Lund Sweden
| | - A. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - M. de Haas
- Sanquin Diagnostic Services; Department of Immunohematology Diagnostics; Sanquin Research; Plesmanlaan 125 1066 CX Amsterdam The Netherlands
- Center for Clinical Transfusion Research; Leiden The Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden The Netherlands
| | - C. E. van der Schoot
- Sanquin Research; Plesmanlaan 125 1066 CX Amsterdam The Netherlands
- Department of Experimental Immunohematology; Sanquin Research; Amsterdam The Netherlands
- Landsteiner Laboratory; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - E. Massey
- Diagnostic and Therapeutic Services; NHS Blood and Transplant; North Bristol Park, Northway Filton Bristol BS34 7QH UK
| | - C. M. Westhoff
- Immunohematology and Genomics; New York Blood Center; 310 E 67th St New York NY 10065 USA
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Finning K, Harvey K, Moore D, Ford T, Davis B, Waite P. Secondary school educational practitioners’ experiences of school attendance problems and interventions to address them: a qualitative study. Emotional and Behavioural Difficulties 2017. [DOI: 10.1080/13632752.2017.1414442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, The University of Reading Earley Gate, Reading, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Becky Davis
- School of Psychology & Clinical Language Sciences, The University of Reading Earley Gate, Reading, UK
| | - Polly Waite
- School of Psychology & Clinical Language Sciences, The University of Reading Earley Gate, Reading, UK
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Jones J, Finning K, Mattock R, Williams M, Voak D, Scott M, Avent N. The Serological Profile and
Molecular Basis of a New Partial D
Phenotype, DHR. Vox Sang 2017. [DOI: 10.1159/000461941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Finning K, Moore D, Ukoumunne OC, Danielsson-Waters E, Ford T. The association between child and adolescent emotional disorder and poor attendance at school: a systematic review protocol. Syst Rev 2017; 6:121. [PMID: 28659163 PMCID: PMC5490167 DOI: 10.1186/s13643-017-0523-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/03/2017] [Accepted: 06/16/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Anxiety and depression are common in young people and are associated with a range of adverse outcomes. Research has suggested a relationship between emotional disorder and poor school attendance, and thus poor attendance may serve as a red flag for children at risk of emotional disorder. This systematic review aims to investigate the association between child and adolescent emotional disorder and poor attendance at school. METHODS We will search electronic databases from a variety of disciplines including medicine, psychology, education and social sciences, as well as sources of grey literature, to identify any quantitative studies that investigate the relationship between emotional disorder and school attendance. Emotional disorder may refer to diagnoses of mood or anxiety disorders using standardised diagnostic measures, or measures of depression, anxiety or "internalising symptoms" using a continuous scale. Definitions for school non-attendance vary, and we aim to include any relevant terminology, including attendance, non-attendance, school refusal, school phobia, absenteeism and truancy. Two independent reviewers will screen identified papers and extract data from included studies. We will assess the risk of bias of included studies using the Newcastle-Ottawa Scale. Random effects meta-analysis will be used to pool quantitative findings when studies use the same measure of association, otherwise a narrative synthesis approach will be used. DISCUSSION This systematic review will provide a detailed synthesis of evidence regarding the relationship between childhood emotional disorder and poor attendance at school. Understanding this relationship has the potential to assist in the development of strategies to improve the identification of and intervention for this vulnerable group. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016052961.
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Affiliation(s)
- Katie Finning
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Darren Moore
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Obioha C. Ukoumunne
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | - Tamsin Ford
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
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Finning K, Richards DA, Moore L, Ekers D, McMillan D, Farrand PA, O'Mahen HA, Watkins ER, Wright KA, Fletcher E, Rhodes S, Woodhouse R, Wray F. Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation. BMJ Open 2017; 7:e014161. [PMID: 28408544 PMCID: PMC5541446 DOI: 10.1136/bmjopen-2016-014161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 02/21/2017] [Accepted: 03/08/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER ISRCTN27473954, 09/12/2011.
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Affiliation(s)
| | | | - Lucy Moore
- University of Exeter Medical School, Exeter, UK
| | - David Ekers
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Paul A Farrand
- School of Psychology, University of Exeter, Exeter, UK
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, UK
| | | | | | - Kim A Wright
- School of Psychology, University of Exeter, Exeter, UK
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Richards DA, Finning K, Taylor RS. Behavioural activation training for depression - Authors' reply. Lancet 2017; 389:367-368. [PMID: 28137694 DOI: 10.1016/s0140-6736(17)30160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
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Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, O'Mahen H, Watkins ER, Wright KA, Hollon SD, Reed N, Rhodes S, Fletcher E, Finning K. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet 2016; 388:871-80. [PMID: 27461440 PMCID: PMC5007415 DOI: 10.1016/s0140-6736(16)31140-0] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Depression is a common, debilitating, and costly disorder. Many patients request psychological therapy, but the best-evidenced therapy-cognitive behavioural therapy (CBT)-is complex and costly. A simpler therapy-behavioural activation (BA)-might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression. METHODS In this randomised, controlled, non-inferiority trial, we recruited adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder from primary care and psychological therapy services in Devon, Durham, and Leeds (UK). We excluded people who were receiving psychological therapy, were alcohol or drug dependent, were acutely suicidal or had attempted suicide in the previous 2 months, or were cognitively impaired, or who had bipolar disorder or psychosis or psychotic symptoms. We randomly assigned participants (1:1) remotely using computer-generated allocation (minimisation used; stratified by depression severity [Patient Health Questionnaire 9 (PHQ-9) score of <19 vs ≥19], antidepressant use, and recruitment site) to BA from junior mental health workers or CBT from psychological therapists. Randomisation done at the Peninsula Clinical Trials Unit was concealed from investigators. Treatment was given open label, but outcome assessors were masked. The primary outcome was depression symptoms according to the PHQ-9 at 12 months. We analysed all those who were randomly allocated and had complete data (modified intention to treat [mITT]) and also all those who were randomly allocated, had complete data, and received at least eight treatment sessions (per protocol [PP]). We analysed safety in the mITT population. The non-inferiority margin was 1·9 PHQ-9 points. This trial is registered with the ISCRTN registry, number ISRCTN27473954. FINDINGS Between Sept 26, 2012, and April 3, 2014, we randomly allocated 221 (50%) participants to BA and 219 (50%) to CBT. 175 (79%) participants were assessable for the primary outcome in the mITT population in the BA group compared with 189 (86%) in the CBT group, whereas 135 (61%) were assessable in the PP population in the BA group compared with 151 (69%) in the CBT group. BA was non-inferior to CBT (mITT: CBT 8·4 PHQ-9 points [SD 7·5], BA 8·4 PHQ-9 points [7·0], mean difference 0·1 PHQ-9 points [95% CI -1·3 to 1·5], p=0·89; PP: CBT 7·9 PHQ-9 points [7·3]; BA 7·8 [6·5], mean difference 0·0 PHQ-9 points [-1·5 to 1·6], p=0·99). Two (1%) non-trial-related deaths (one [1%] multidrug toxicity in the BA group and one [1%] cancer in the CBT group) and 15 depression-related, but not treatment-related, serious adverse events (three in the BA group and 12 in the CBT group) occurred in three [2%] participants in the BA group (two [1%] patients who overdosed and one [1%] who self-harmed) and eight (4%) participants in the CBT group (seven [4%] who overdosed and one [1%] who self-harmed). INTERPRETATION We found that BA, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals. FUNDING National Institute for Health Research.
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Affiliation(s)
| | - David Ekers
- Psychological Therapy Department, Tees, Esk and Wear Valleys NHS Foundation Trust, Chester-le-Street, County Durham, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Rod S Taylor
- Medical School, University of Exeter, Exeter, UK
| | - Sarah Byford
- Institute of Psychiatry, Kings College London, London, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, The Prince of Wales International Centre, Warneford Hospital, Oxford, UK
| | | | - Ed R Watkins
- School of Psychology, University of Exeter, Exeter, UK
| | - Kim A Wright
- School of Psychology, University of Exeter, Exeter, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Nigel Reed
- Lived Experience Group, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
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Soothill PW, Finning K, Latham T, Wreford-Bush T, Ford J, Daniels G. Use of cffDNA to avoid administration of anti-D to pregnant women when the fetus is RhD-negative: implementation in the NHS. BJOG 2014; 122:1682-6. [DOI: 10.1111/1471-0528.13055] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- PW Soothill
- Fetal Medicine Unit; St Michaels Hospital; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - K Finning
- NHS Blood and Transplant; International Blood Group Reference Laboratory; Filton Bristol UK
| | - T Latham
- NHS Blood and Transplant; International Blood Group Reference Laboratory; Filton Bristol UK
| | - T Wreford-Bush
- Haematology; Southmead Hospital; Westbury-on-Trym Bristol UK
| | - J Ford
- Fetal Medicine Unit; St Michaels Hospital; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - G Daniels
- NHS Blood and Transplant; International Blood Group Reference Laboratory; Filton Bristol UK
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Affiliation(s)
- M. de Haas
- Department of Immunohaematology, Division of Diagnostic Services; Sanquin; Amsterdam the Netherlands
| | - K. Finning
- National Health Service Blood and Transplant; Bristol UK
| | - E. Massey
- National Health Service Blood and Transplant; Bristol UK
| | - D. J. Roberts
- National Health Service Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine, John Radcliffe Hospital; University of Oxford; Oxford UK
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Hill M, Finning K, Martin P, Hogg J, Meaney C, Norbury G, Daniels G, Chitty LS. Non-invasive prenatal determination of fetal sex: translating research into clinical practice. Clin Genet 2010; 80:68-75. [DOI: 10.1111/j.1399-0004.2010.01533.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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van der Schoot CE, de Haas M, Engelfriet CP, Reesink HW, Panzer S, Jungbauer C, Schwartz DMW, Mayr WR, Castilho L, St-Louis M, Long A, Denomme G, Semple E, Fernandes B, Flegel WA, Wagner F, Doescher A, Poli F, Villa MA, Paccapelo C, Karpasitou K, Veldhuisen B, Nogués N, Muñiz-Diaz E, Daniels G, Martin P, Finning K, Reid ME. Genotyping for red blood cell polymorphisms. Vox Sang 2009; 96:167-79. [DOI: 10.1111/j.1423-0410.2008.01131.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Daniels G, Finning K, Martin P, Summers J. Fetal RhD genotyping: A more efficient use of anti-D immunoglobulin. Transfus Clin Biol 2007; 14:568-71. [DOI: 10.1016/j.tracli.2008.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
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Illanes S, Denbow M, Kailasam C, Finning K, Soothill PW. Early detection of cell-free fetal DNA in maternal plasma. Early Hum Dev 2007; 83:563-6. [PMID: 17234369 DOI: 10.1016/j.earlhumdev.2006.11.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 11/06/2006] [Accepted: 11/11/2006] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed to establish the earliest gestational age at which fetal DNA in maternal plasma could be detected and whether this was reliable at 12-13 weeks' gestation. STUDY DESIGN A prospective observational cohort study of 32 pregnancies either after IVF or before prenatal diagnosis by CVS. Maternal blood was taken and RT-PCR was carried out to detect the multi-copy Y chromosome associated DSY14 gene. The end point was gender as assessed at delivery or on karyotype. RESULTS Y signal was obtained as early as 14 days post conception (4 weeks' gestation) and has a good prediction rate by 12 weeks' gestation. CONCLUSION Free fetal DNA allows very early prediction of fetal sex in some cases and could be useful for clinical use for X-linked conditions by the end of the first trimester.
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Affiliation(s)
- S Illanes
- Fetal Medicine Research Unit, Division of Obstetrics and Gynaecology, University of Bristol, Bristol, UK.
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Abstract
OBJECTIVE To evaluate the presence of cell-free fetal DNA signals in maternal urine as a potential source of material for non-invasive prenatal diagnosis. STUDY DESIGN Patients referred to the regional fetal medicine unit who underwent prenatal diagnosis by chorionic villus sampling (CVS) were asked to give blood and urine immediately before the procedure. Maternal blood and urine were centrifuged at 10,000 g for 10 min. Plasma (1 mL) and urine (1 mL) supernatant were transferred to a clean tube and centrifuged again. The plasma (0.8 mL) and urine (0.8 mL) supernatant were removed without disturbing the cell pellet and stored at - 80 degrees C. Following DNA extraction, each sample was tested for the presence of Y chromosome associated DYS14 gene using real-time polymerase chain reaction (PCR). The total amount (maternal and fetal) of DNA in each sample was estimated using a quantitative real-time PCR assay. RESULTS Twenty patients were enrolled in the study. CVS was performed at a median gestational age of 13 weeks (range 11 + 5 - 14 + 1). There were 12 male and 8 female fetuses, as confirmed by karyotype. Y chromosome DNA was not detected in any of the 20 samples of maternal urine, including 12 of the 20 samples in which Y chromosome DNA was detected in maternal plasma (all of whom were subsequently confirmed to be carrying a male fetus). There was considerable variation in the amount of total free DNA detected in maternal urine. CONCLUSIONS Cell-free fetal DNA either was not present or did not amplify in maternal urine.
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Affiliation(s)
- S Illanes
- Fetal Medicine Research Unit, Division of Obstetrics and Gynaecology, University of Bristol, Bristol, UK.
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36
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Daniels G, Finning K, Martin P, Soothill P. Fetal blood group genotyping from DNA from maternal plasma: an important advance in the management and prevention of haemolytic disease of the fetus and newborn. Vox Sang 2004; 87:225-32. [PMID: 15585017 DOI: 10.1111/j.1423-0410.2004.00569.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The cloning of blood group genes and subsequent identification of the molecular bases of blood group polymorphisms has made it possible to predict blood group phenotypes from DNA with a reasonable degree of accuracy. The major application of this technology, which has now become the standard of care, is the determination of a fetal RHD genotype in women with anti-D, to assess whether the fetus is at risk of haemolytic disease of the fetus and newborn (HDFN). Initially, the procurement of fetal DNA required the invasive procedures of amniocentesis or chorionic villus sampling. Since the discovery of fetal DNA in maternal plasma in 1997, the technology of detecting an RHD gene in this very small quantity of fetal DNA has developed rapidly, so that non-invasive fetal D typing can now be provided as a diagnostic service for D-negative pregnant women with anti-D. Within a few years, it is probable that fetuses of all D-negative pregnant women will be tested for RHD, to establish whether the mother requires antenatal anti-D immunoglobulin prophylaxis.
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Affiliation(s)
- G Daniels
- International Blood Group Reference Laboratory, Bristol Institute for Transfusion Sciences, National Blood Service, Bristol, UK.
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37
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Abstract
BACKGROUND 21-hydroxylase deficiency can lead to masculinization of female fetuses. Corticosteroid therapy may reduce these effects. When the fetus is male, this approach means that unnecessary treatment, with theoretic side effects, is given until the result of chorionic villus sampling (CVS), a procedure with known risks, is available. CASE A woman was referred for prenatal assessment at 6 weeks' gestation because her first daughter had been born virilized from 21-hydroxylase deficiency. A real-time polymerase chain reaction assay was performed on maternal blood to detect the fetal Y chromosome-associated SRY gene. A positive signal for the SRY gene was observed. The assay was repeated a few days later, and the result was again consistent with a male fetus. CONCLUSION Analysis of cell-free fetal deoxyribonucleic acid in maternal plasma for fetal sex determination might reduce the need for corticosteroid administration and CVS in women with fetuses at risk for 21-hydroxylase deficiency.
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Affiliation(s)
- J L Bartha
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Bristol, Bristol, United Kingdom.
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38
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Abstract
BACKGROUND AND OBJECTIVES The Rh D antigen comprises a mosaic of at least 30 epitopes expressed on a 30-kD non-glycosylated Rh D polypeptide. The equivalent Rh CeEe polypeptide expressing the Rh C/c and E/e antigens differs in only 36 of the 417 amino acid residues. Partial D individuals have been described who fail to express a number of D epitopes. MATERIALS AND METHODS Serologic methods were applied with monoclonal anti-D to map epitopes on the red cells of a proposita aberrant D typing. Polymerase chain reaction (PCR) and DNA sequencing were also done. RESULTS DNA sequence analysis derived by RT-PCR using total RNA isolated from peripheral blood of this person suggests two mechanisms for the genetic basis of this variants: one here gene conversion events result in the replacement of RHD gene exons with the equivalent RHCE exons; the second where point mutation in the RHD gene generates an amino acid substitution in the Rh D protein. CONCLUSIONS We report here a new partial D, DHR, where a single point mutation (G to A at nucleotide 686) in exon 5 of the RHD gene results in a conservative amino acid substitution (Arg229Lys), in the predicted Rh D protein. This residue is localised on the fourth predicted exofacial loop of the Rh D polypeptide as determined by hydropathy analysis. This substitution results in the lack of epD 1, 2, 12 and 20 (30 epitope model) and indicates the involvement of loop 4, and in particular the requirement of Arg229, in the expression of these epitopes.
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Affiliation(s)
- J W Jones
- Mersey and North Wales Blood Centre, Liverpool, UK
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