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Havers L, Bhui K, Shuai R, Fonagy P, Fazel M, Morgan C, Fancourt D, McCrone P, Smuk M, Hosang GM, Shakoor S. A cross-sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community. J Adolesc 2024. [PMID: 38769710 DOI: 10.1002/jad.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in socially/societally disadvantaged individuals (e.g., females, low socioeconomic status [SES]), as well as neurodivergent individuals. The intersection of these characteristics may be important for the differential distribution of adversity and mental health problems, though limited findings pertain to the extent to which intersectional effects moderate this association. METHODS Combined depression/anxiety symptoms were measured using the emotional problems subscale of the Strengths and Difficulties Questionnaire in 13-14-year-olds in Cornwall, United Kingdom in 2017-2019. In a cross-sectional design (N = 11,707), multiple group structural equation modeling was used to estimate the effects of youth adversity on depression/anxiety symptoms across eight intersectionality profiles (based on gender [female/male], SES [lower/higher], and traits of hyperactivity/inattention [high/low]). Moderation effects of these characteristics and their intersections were estimated. RESULTS Youth adversity was associated with higher levels of depression/anxiety (compared to an absence of youth adversity), across intersectional profiles. This effect was moderated by gender (stronger in males; β = 0.22 [0.11, 0.36]), and SES (stronger in higher SES; β = 0.26 [0.14,0.40]); with indications of moderation attributable to the intersection between gender and hyperactivity/inattention (β = 0.21 [-0.02,0.44]). CONCLUSIONS Youth adversity is associated with heightened depression/anxiety across intersectional profiles in 13-14-year-olds. The stronger effects observed for males, and for higher SES, may be interpreted in terms of structural privilege. Preliminary findings suggest that vulnerability and resilience to the effects of youth adversity may partially depend on specific intersectional effects. Importantly, the current results invite further investigation in this emerging line of inquiry.
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Affiliation(s)
- Laura Havers
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, and Wadham College, University of Oxford, Oxford, UK
- Oxford Health and East London NHS Foundation Trusts, Oxford, London, UK
- World Psychiatric Association Collaborating Centre, Oxford, UK
| | - Ruichong Shuai
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Craig Morgan
- Health Service and Population Research, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary, University of London, London, UK
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Sania Shakoor
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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Soneson E, Howarth E, Weir A, Jones PB, Fazel M. Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study. J Med Internet Res 2024; 26:e46764. [PMID: 38652534 PMCID: PMC11077415 DOI: 10.2196/46764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. OBJECTIVE We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health. METHODS We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. RESULTS A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. CONCLUSIONS The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Emma Howarth
- School of Psychology, University of East London, London, United Kingdom
| | - Alison Weir
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
- Howard Community Academy, Anglian Learning multi-academy trust, Bury St Edmunds, United Kingdom
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Carey EG, Adeyemi FO, Neelakantan L, Fernandes B, Fazel M, Ford T, Burn AM. Preferences on Governance Models for Mental Health Data: Qualitative Study With Young People. JMIR Form Res 2024; 8:e50368. [PMID: 38652525 PMCID: PMC11077411 DOI: 10.2196/50368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/08/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Improving access to mental health data to accelerate research and improve mental health outcomes is a potentially achievable goal given the substantial data that can now be collected from mobile devices. Smartphones can provide a useful mechanism for collecting mental health data from young people, especially as their use is relatively ubiquitous in high-resource settings such as the United Kingdom and they have a high capacity to collect active and passive data. This raises the interesting opportunity to establish a large bank of mental health data from young people that could be accessed by researchers worldwide, but it is important to clarify how to ensure that this is done in an appropriate manner aligned with the values of young people. OBJECTIVE In this study, we discussed the preferences of young people in the United Kingdom regarding the governance, sharing, and use of their mental health data with the establishment of a global data bank in mind. We aimed to determine whether young people want and feel safe to share their mental health data; if so, with whom; and their preferences in doing so. METHODS Young people (N=46) were provided with 2 modules of educational material about data governance models and background in scientific research. We then conducted 2-hour web-based group sessions using a deliberative democracy methodology to reach a consensus where possible. Findings were analyzed using the framework method. RESULTS Young people were generally enthusiastic about contributing data to mental health research. They believed that broader availability of mental health data could be used to discover what improves or worsens mental health and develop new services to support young people. However, this enthusiasm came with many concerns and caveats, including distributed control of access to ensure appropriate use, distributed power, and data management that included diverse representation and sufficient ethical training for applicants and data managers. CONCLUSIONS Although it is feasible to use smartphones to collect mental health data from young people in the United Kingdom, it is essential to carefully consider the parameters of such a data bank. Addressing and embedding young people's preferences, including the need for robust procedures regarding how their data are managed, stored, and accessed, will set a solid foundation for establishing any global data bank.
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Affiliation(s)
- Emma Grace Carey
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Lakshmi Neelakantan
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Blossom Fernandes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Havers L, Shuai R, Fonagy P, Fazel M, Morgan C, Fancourt D, McCrone P, Smuk M, Bhui K, Shakoor S, Hosang GM. Youth adversity and trajectories of depression/anxiety symptoms in adolescence in the context of intersectionality in the United Kingdom. Psychol Med 2024:1-11. [PMID: 38623689 DOI: 10.1017/s0033291724000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Youth adversity is associated with persistence of depression and anxiety symptoms. This association may be greater for disadvantaged societal groups (such as females) compared with advantaged groups (e.g. males). Given that persistent symptoms are observed across a range of disadvantaged, minoritized, and neurodivergent groups (e.g. low compared with high socio-economic status [SES]), the intersection of individual characteristics may be an important moderator of inequality. METHODS Data from HeadStart Cornwall (N = 4441) was used to assess the effect of youth adversity on combined symptoms of depression and anxiety (Strengths and Difficulties Questionnaire emotional problems subscale) measured at three time-points in 11-14-year-olds. Latent trajectories and regressions were estimated for eight intersectionality profiles (based on gender, SES, and hyperactivity/inattention), and moderating effects of the individual characteristics and their intersections were estimated. RESULTS Youth adversity was associated with higher average depression/anxiety symptoms at baseline (11-12-years) across all intersectionality profiles. The magnitude of effects differed across profiles, with suggestive evidence for a moderating effect of youth adversity on change over time in depression/anxiety symptoms attributable to the intersection between (i) gender and SES; and (ii) gender, SES, and hyperactivity/inattention. CONCLUSIONS The detrimental effects of youth adversity pervade across intersectionality profiles. The extent to which these effects are moderated by intersectionality is discussed in terms of operational factors. The current results provide a platform for further research, which is needed to determine the importance of intersectionality as a moderator of youth adversity on the development of depression and anxiety symptoms in adolescence.
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Affiliation(s)
- Laura Havers
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Ruichong Shuai
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Craig Morgan
- Health Service and Population Research, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary, University of London, London, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, and Wadham College, University of Oxford, Oxford, UK
- Oxford Health, Oxford and East London NHS Foundation Trusts, London, UK
- World Psychiatric Association Collaborating Centre, Oxford, UK
| | - Sania Shakoor
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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Soneson E, White SR, Howarth E, Ford T, Fazel M, Jones PB. Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity. Epidemiol Psychiatr Sci 2024; 33:e1. [PMID: 38264958 PMCID: PMC7615639 DOI: 10.1017/s2045796024000027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
AIMS Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. METHODS We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). RESULTS Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78-0.91). CONCLUSIONS Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.
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Affiliation(s)
- E. Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - S. R. White
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - E. Howarth
- School of Psychology, University of Sussex, Brighton, UK
| | - T. Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - M. Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - P. B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Abdi S, Akinsulure-Smith AM, Sarkadi A, Fazel M, Ellis BH, Gillespie S, Juang LP, Betancourt TS. Promoting positive development among refugee adolescents. J Res Adolesc 2023; 33:1064-1084. [PMID: 37807940 DOI: 10.1111/jora.12890] [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] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.
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Affiliation(s)
- Saida Abdi
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | | | | | - Sarah Gillespie
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Abstract
BACKGROUND A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents. METHODS This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions. RESULTS In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements. CONCLUSIONS There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
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McPherson T, Ravenscroft J, Ali R, Barlow R, Beattie P, Bewley A, Bennett S, Bleiker T, Buckley L, Burgess G, Copperwheat S, Cunliffe T, Dejong H, Fazel M, Heyman I, Howard E, Lambert A, Manktelow C, Moledina Z, Mohandas P, Moss C, Northover G, Paz I, Proctor A, Roxborough C, Shibib S, Solman L, Srinivasan J, Wood D, Baron S. British Society for Paediatric and Adolescent Dermatology assessment and support of mental health in children and young people with skin conditions: a multidisciplinary expert consensus statement and recommendations. Br J Dermatol 2023; 189:459-466. [PMID: 37291902 DOI: 10.1093/bjd/ljad193] [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] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Psychological and mental health difficulties are common in children and young people (CYP) living with skin conditions and can have a profound impact on wellbeing. There is limited guidance on how best to assess and support the mental health of this population, who are at risk of poor health outcomes. OBJECTIVES To provide consensus-based recommendations on the assessment and monitoring of and support for mental health difficulties in CYP with skin conditions (affecting the skin, hair and nails); to address practical clinical implementation questions relating to consensus guidance; and to provide audit and research recommendations. METHODS This set of recommendations was developed with reference to the AGREE II instrument. A systematic review and literature appraisal was carried out. A multidisciplinary consensus group was convened, with two virtual panel meetings held: an initial meeting to discuss the scope of the study, to review the current evidence and to identify areas for development; and a second meeting to agree on the content and wording of the recommendations. Recommendations were then circulated to stakeholders, following which amendments were made and agreed by email. RESULTS The expert panel achieved consensus on 11 recommendations for healthcare workers managing CYP with skin conditions. A new patient-completed history-taking aid ('You and Your Skin') was developed and is being piloted. CONCLUSIONS The recommendations focus on improved mental health assessments for CYP presenting with a skin condition, with clinical guidance and suggested screening measures included. Information on accessing psychological support for CYP, when required, is given, and recommendations for staff training in mental health and neurodiversity provided. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.
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Affiliation(s)
- Tess McPherson
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Ravenscroft
- Department of Dermatology, Nottingham University Hospital, Nottingham, UK
- Centre for Evidence Based Dermatology, Nottingham University, Nottingham, UK
| | - Rukshana Ali
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Barlow
- Department of Dermatology, Birmingham City Hospital, Birmingham, UK
| | - Paula Beattie
- Department of Dermatology, Royal Hospital for Children, Glasgow, UK
| | - Anthony Bewley
- Department of Dermatology, Barts Health NHS Trust, London, UK
- Department of Dermatology, Queen Mary University London, London, UK
| | - Sophie Bennett
- Great Ormond Street Hospital for Children NHS Foundation Trust, Health, London, UK
| | - Tanya Bleiker
- Department of Dermatology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Liz Buckley
- Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Gary Burgess
- Great Ormond Street Hospital for Children NHS Foundation Trust, Health, London, UK
| | - Sarah Copperwheat
- Department of Dermatology, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Tim Cunliffe
- Primary Care, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Hannah Dejong
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mina Fazel
- University of Oxford, Oxford, UK
- Oxford Psychological Medicine Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, Health, London, UK
| | - Emma Howard
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Claire Manktelow
- University of Nottingham Health Service, Cripps Health Centre, Nottingham, UK
| | | | - Padma Mohandas
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - Celia Moss
- Department of Dermatology, Birmingham Children's Hospital, Birmingham, UK
| | | | - Isabel Paz
- University of Oxford, Oxford, UK
- Oxford Psychological Medicine Centre, Oxford Health NHS Foundation Trust Psychological Services, Oxford, UK
| | | | | | - Shatha Shibib
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Lea Solman
- Great Ormond Street Hospital for Children NHS Foundation Trust, Health, London, UK
| | - Jo Srinivasan
- Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Damian Wood
- Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Susannah Baron
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hosang GM, Havers L, Shuai R, Fonagy P, Fazel M, Morgan C, Karamanos A, Fancourt D, McCrone P, Smuk M, Bhui K, Shakoor S. Protocol for secondary data analysis of 4 UK cohorts examining youth adversity and mental health in the context of intersectionality. PLoS One 2023; 18:e0289438. [PMID: 37651364 PMCID: PMC10470884 DOI: 10.1371/journal.pone.0289438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Youth adversity (e.g., abuse and bullying victimisation) is robust risk factor for later mental health problems (e.g., depression and anxiety). Research shows the prevalence of youth adversity and rates of mental health problems vary by individual characteristics, identity or social groups (e.g., gender and ethnicity). However, little is known about whether the impact of youth adversity on mental health problems differ across the intersections of these characteristics (e.g., white females). This paper reports on a component of the ATTUNE research programme (work package 2) which aims to investigate the impact and mechanisms of youth adversity on depressive and anxiety symptoms in young people by intersectionality profiles. METHODS The data are from 4 UK adolescent cohorts: HeadStart Cornwall, Oxwell, REACH, and DASH. These cohorts were assembled for adolescents living in distinct geographical locations representing coastal, suburban and urban places in the UK. Youth adversity was assessed using a series of self-report questionnaires and official records. Validated self-report instruments measured depressive and anxiety symptoms. A range of different variables were classified as possible social and cognitive mechanisms. RESULTS AND ANALYSIS Structural equation modelling (e.g., multiple group models, latent growth models) and multilevel modelling will be used, with adaptation of methods to suit the specific available data, in accord with statistical and epidemiological conventions. DISCUSSION The results from this research programme will broaden our understanding of the association between youth adversity and mental health, including new information about intersectionality and related mechanisms in young people in the UK. The findings will inform future research, clinical guidance, and policy to protect and promote the mental health of those most vulnerable to the negative consequences of youth adversity.
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Affiliation(s)
- Georgina Mayling Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Laura Havers
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Ruichong Shuai
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, United Kingdom
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Craig Morgan
- Health Service and Population Research, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, United Kingdom
- Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Alexis Karamanos
- Department of Population Health Sciences, King’s College London, London, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary, University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences and Wadham College, University of Oxford, Oxford, United Kingdom
- Oxford Health and East London NHS Foundation Trusts, Oxford, United Kingdom
- World Psychiatric Association Collaborating Centre, Oxford, United Kingdom
| | - Sania Shakoor
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
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10
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Fernandes B, Neelakantan L, Shah H, Sumant S, Collins PY, Velloza J, Bampton E, Ranganathan S, Sibisi R, Bashir T, Bowes J, David EL, Kaur H, Malik U, Shannon I, Gurumayum S, Burn AM, Sieberts SK, Fazel M. Evidencing the Impact of Web-Based Coproduction With Youth on Mental Health Research: Qualitative Findings From the MindKind Study. JMIR Public Health Surveill 2023; 9:e42963. [PMID: 37335609 PMCID: PMC10365598 DOI: 10.2196/42963] [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] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Public involvement in research is a growing phenomenon as well as a condition of research funding, and it is often referred to as coproduction. Coproduction involves stakeholder contributions at every stage of research, but different processes exist. However, the impact of coproduction on research is not well understood. Web-based young people's advisory groups (YPAGs) were established as part of the MindKind study at 3 sites (India, South Africa, and the United Kingdom) to coproduce the wider research study. Each group site, led by a professional youth advisor, conducted all youth coproduction activities collaboratively with other research staff. OBJECTIVE This study aimed to evaluate the impact of youth coproduction in the MindKind study. METHODS To measure the impact of web-based youth coproduction on all stakeholders, the following methods were used: analysis of project documents, capturing the views of stakeholders using the Most Significant Change technique, and impact frameworks to assess the impact of youth coproduction on specific stakeholder outcomes. Data were analyzed in collaboration with researchers, advisors, and YPAG members to explore the impact of youth coproduction on research. RESULTS The impact was recorded on 5 levels. First, at the paradigmatic level, a novel method of conducting research allowed for a widely diverse group of YPAG representations, influencing study priorities, conceptualization, and design. Second, at the infrastructural level, the YPAG and youth advisors meaningfully contributed to the dissemination of materials; infrastructural constraints of undertaking coproduction were also identified. Third, at the organizational level, coproduction necessitated implementing new communication practices, such as a web-based shared platform. This meant that materials were easily accessible to the whole team and communication streams remained consistent. Fourth, at the group level, authentic relationships developed between the YPAG members, advisors, and the rest of the team, facilitated by regular web-based contact. Finally, at the individual level, participants reported enhanced insights into mental well-being and appreciation for the opportunity to engage in research. CONCLUSIONS This study revealed several factors that shape the creation of web-based coproduction, with clear positive outcomes for advisors, YPAG members, researchers, and other project staff. However, several challenges of coproduced research were also encountered in multiple contexts and amid pressing timelines. For systematic reporting of the impact of youth coproduction, we propose that monitoring, evaluation, and learning systems be designed and implemented early.
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Affiliation(s)
- Blossom Fernandes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Lakshmi Neelakantan
- Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Himani Shah
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Sushmita Sumant
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Pamela Y Collins
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Emily Bampton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Refiloe Sibisi
- Higher Health, Higher Education and Training: Health, Wellness, and Development Centre, Pretoria, South Africa
| | - Toiba Bashir
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Joshua Bowes
- Mindkind Young People's Advisory Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Esther Larisa David
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Harsimar Kaur
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Umairah Malik
- Mindkind Young People's Advisory Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Issy Shannon
- Mindkind Young People's Advisory Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Suvlaxmi Gurumayum
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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11
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Astle DE, Moore A, Marryat L, Viding E, Mansfield KL, Fazel M, Pierce M, Abel KM, Green J, John A, Broome MR, Upthegrove R, Bould H, Minnis H, Gajwani R, Groom MJ, Hollis C, Liddle E, Sayal K, Berry V, Collishaw S, Dawes H, Cortese S, Violato M, Pollard J, MacCabe JH, Blakemore SJ, Simonoff E, Watkins E, Hiller RM, Townsend E, Armour C, Geddes JR, Thompson L, Schwannauer M, Nicholls D, Hotopf M, Downs J, Rahman A, Sharma AN, Ford TJ. We need timely access to mental health data: implications of the Goldacre review. Lancet Psychiatry 2023; 10:242-244. [PMID: 36931773 DOI: 10.1016/s2215-0366(23)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Duncan E Astle
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Pierce
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Population Health Science, Centre for Academic Mental Health and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- NIHR MindTech MIC & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth Liddle
- Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Vashti Berry
- Children & Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, University College London, London, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Matthias Schwannauer
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK; Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
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12
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Fazel M, Dufresne A, Vanacker H, Waissi W, Blay JY, Brahmi M. Immunotherapy for Soft Tissue Sarcomas: Anti-PD1/PDL1 and Beyond. Cancers (Basel) 2023; 15:cancers15061643. [PMID: 36980528 PMCID: PMC10046205 DOI: 10.3390/cancers15061643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Sarcomas gather a heterogeneous group of mesenchymal malignant tumors including more than 150 different subtypes. Most of them represent aggressive tumors with poor prognosis at the advanced stage, despite the better molecular characterization of these tumors and the development of molecular-driven therapeutic strategies. During the last decade, immunotherapy has been developed to treat advanced cancers, mainly thanks to immune checkpoint inhibitors (ICI) such as anti-PD1/PDL1 and later to adoptive immune cell therapies. In this review, we aim to summarize the state of the art of immunotherapy in soft tissue sarcomas (STS). Overall, the clinical trials of ICI that included a wide diversity of STS subtypes reported limited efficacy with some outlying responders. Both emerging biomarkers are of interest in selecting good candidates and in the development of combination therapies. Finally, the recent breakthroughs of innovative adoptive therapies in STS seem highly promising.
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Affiliation(s)
- Mina Fazel
- Centre Léon Bérard, 28 Rue Laënnec, 69008 Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon, 8 Avenue Rockefeller, 69008 Lyon, France
| | | | - Hélène Vanacker
- Centre Léon Bérard, 28 Rue Laënnec, 69008 Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Waisse Waissi
- Centre Léon Bérard, 28 Rue Laënnec, 69008 Lyon, France
| | - Jean-Yves Blay
- Centre Léon Bérard, 28 Rue Laënnec, 69008 Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Mehdi Brahmi
- Centre Léon Bérard, 28 Rue Laënnec, 69008 Lyon, France
- Correspondence:
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13
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Fazel M, Soneson E, Sellars E, Butler G, Stein A. Partnerships at the Interface of Education and Mental Health Services: The Utilisation and Acceptability of the Provision of Specialist Liaison and Teacher Skills Training. Int J Environ Res Public Health 2023; 20:4066. [PMID: 36901077 PMCID: PMC10001585 DOI: 10.3390/ijerph20054066] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Partnerships between school staff and mental health professionals have the potential to improve access to mental health support for students, but uncertainty remains regarding whether and how they work in practice. We report on two pilot projects aimed at understanding the implementation drivers of tailored strategies for supporting and engaging front-line school staff in student mental health. The first project provided regular, accessible mental health professionals with whom school staff could meet and discuss individual or systemic mental health concerns (a school 'InReach' service), and the other offered a short skills training programme on commonly used psychotherapeutic techniques (the School Mental Health Toolbox; SMHT). The findings from the activity of 15 InReach workers over 3 years and 105 individuals who attended the SMHT training demonstrate that school staff made good use of these services. The InReach workers reported more than 1200 activities in schools (notably in providing specialist advice and support, especially for anxiety and emotional difficulties), whilst most SMHT training attendees reported the utilisation of the tools (in particular, supporting better sleep and relaxation techniques). The measures of acceptability and the possible impacts of the two services were also positive. These pilot studies suggest that investment into partnerships at the interface of education and mental health services can improve the availability of mental health support to students.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Elise Sellars
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK
| | - Gillian Butler
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford OX3 7JX, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
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14
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Soneson E, Das S, Burn AM, van Melle M, Anderson JK, Fazel M, Fonagy P, Ford T, Gilbert R, Harron K, Howarth E, Humphrey A, Jones PB, Moore A. Leveraging Administrative Data to Better Understand and Address Child Maltreatment: A Scoping Review of Data Linkage Studies. Child Maltreat 2023; 28:176-195. [PMID: 35240863 PMCID: PMC9806482 DOI: 10.1177/10775595221079308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research. METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020 for studies that linked two or more datasets (at least one of which was administrative in nature) to study child maltreatment. We report findings with numerical and narrative summary. RESULTS We included 121 studies, mainly from the United States or Australia and published in the past decade. Data came primarily from social services and health sectors, and linkage processes and data quality were often not described in sufficient detail to align with current reporting guidelines. Most studies were descriptive in nature and research questions addressed fell under eight themes: descriptive epidemiology, risk factors, outcomes, intergenerational transmission, predictive modelling, intervention/service evaluation, multi-sector involvement, and methodological considerations/advancements. CONCLUSIONS Included studies demonstrated the wide variety of ways in which data linkage can contribute to the public health response to child maltreatment. However, how research using linked data can be translated into effective service development and monitoring, or targeting of interventions, is underexplored in terms of privacy protection, ethics and governance, data quality, and evidence of effectiveness.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Shruti Das
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Headington, Oxford, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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15
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Manchanda T, Stein A, Fazel M. Investigating the Role of Friendship Interventions on the Mental Health Outcomes of Adolescents: A Scoping Review of Range and a Systematic Review of Effectiveness. Int J Environ Res Public Health 2023; 20:2160. [PMID: 36767526 PMCID: PMC9915149 DOI: 10.3390/ijerph20032160] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Friendships are crucial in adolescent development. This paper presents a scoping review, followed by a systematic review, to assess friendship interventions and their impacts on the mental health outcomes of adolescents aged 12-24 years. Studies were included if they incorporated a friend or authentic social group in an intervention dedicated to improving mental health outcomes and well-being. Twenty-four studies were included in the scoping review, and eighteen in the systematic review. Data from 12,815 adolescents were analysed; three prominent themes emerged. The most common theme was promoting mental health literacy, followed by supporting help-seeking, and friendship-building/combating isolation. Most evaluations focused on the individual who had received the intervention, rather than their wider friends who would have been potential contacts and experienced any altered interactions. Of the studies focusing on friendship-building, all had positive short-term outcomes but inconclusive long-term effects. Two studies recruited friends from an individual's authentic social group. While opportunities for improving mental health literacy and help-seeking emerged as key themes, the role of friends in mental health interventions has only been included in a small number of studies. Given that friends are a key point of contact for many adolescents, a better understanding of their domains of influence, particularly on mental health, will potentially enhance interventions.
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16
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Sieberts SK, Marten C, Bampton E, Björling EA, Burn AM, Carey EG, Carlson S, Fernandes B, Kalha J, Lindani S, Masomera H, Neelakantan L, Pasquale L, Ranganathan S, Joy Scanlan E, Shah H, Sibisi R, Sumant S, Suver C, Thungana Y, Tummalacherla M, Velloza J, Collins PY, Fazel M, Ford T, Freeman M, Pathare S, Zingela Z, Doerr M. Young people's data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom. PLoS One 2023; 18:e0279857. [PMID: 37074995 PMCID: PMC10115253 DOI: 10.1371/journal.pone.0279857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people's preferences for how their data are governed and quantifies potential participants' willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16-24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the "right people" access their data. Throughout the study, we recognized young people's commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research.
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Affiliation(s)
| | - Carly Marten
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Emily Bampton
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Elin A Björling
- Human Centered Design and Engineering, University of Washington, Seattle, Washington, United States of America
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Emma Grace Carey
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Sonia Carlson
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Blossom Fernandes
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Jasmine Kalha
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, Maharashtra, India
| | - Simthembile Lindani
- Department of Psychiatry, Walter Sisulu University, Eastern Cape, South Africa
| | - Hedwick Masomera
- Department of Psychiatry, Walter Sisulu University, Eastern Cape, South Africa
- Nelson Mandela University, Gqeberha, Eastern Cape, South Africa
| | - Lakshmi Neelakantan
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Lisa Pasquale
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Swetha Ranganathan
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, Maharashtra, India
| | | | - Himani Shah
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, Maharashtra, India
| | - Refiloe Sibisi
- Activate Change Drivers ZA, Johannesburg, Gauteng, South Africa
- University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Sushmita Sumant
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, Maharashtra, India
| | - Christine Suver
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Yanga Thungana
- Department of Psychiatry, Walter Sisulu University, Eastern Cape, South Africa
| | | | - Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Pamela Y Collins
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
- Cambridgeshire and Peterborough Foundation NHS Trust, Fulbourn, Cambridgeshire, United Kingdom
| | - Melvyn Freeman
- University of Stellenbosch, Stellenbosch, Western Cape, South Africa
- Higher Health, Centurion, Gauteng, South Africa
| | - Soumitra Pathare
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, Maharashtra, India
| | - Zukiswa Zingela
- Nelson Mandela University, Gqeberha, Eastern Cape, South Africa
| | - Megan Doerr
- Sage Bionetworks, Seattle, Washington, United States of America
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17
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Skripkauskaite S, Fazel M. Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis. JMIR Pediatr Parent 2022; 5:e41480. [PMID: 36399378 PMCID: PMC9719061 DOI: 10.2196/41480] [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: 07/27/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern. OBJECTIVE This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk. METHODS We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences. RESULTS In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81). CONCLUSIONS A substantial number of adolescents are spending ≥3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers.
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Affiliation(s)
- Simona Skripkauskaite
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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18
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Bear HA, Ayala Nunes L, DeJesus J, Liverpool S, Moltrecht B, Neelakantan L, Harriss E, Watkins E, Fazel M. Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review. J Med Internet Res 2022; 24:e40347. [DOI: 10.2196/40347] [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] [Received: 06/16/2022] [Revised: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background
Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking.
Objective
This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity.
Methods
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years.
Results
Of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation.
Conclusions
Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations.
Trial Registration
PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f
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19
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Geulayov G, Mansfield K, Jindra C, Hawton K, Fazel M. Loneliness and self-harm in adolescents during the first national COVID-19 lockdown: results from a survey of 10,000 secondary school pupils in England. Curr Psychol 2022:1-12. [PMID: 36124048 PMCID: PMC9476392 DOI: 10.1007/s12144-022-03651-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 12/02/2022]
Abstract
Adolescents' loneliness and self-harm have received considerable attention during the COVID-19 pandemic with concerns that the socioecological changes taking place would contribute to an escalation of both loneliness and self-harm. However, empirical evidence is scant. We estimated the prevalence of loneliness and self-harm in adolescent school pupils and investigated the association of loneliness and change in loneliness during the UK's first lockdown with self-harm during lockdown in a cross-sectional school survey (OxWell) involving 10,460 12-18-year-olds from south England. Loneliness was measured with four items. Self-harm was ascertained through a detailed questionnaire. The prevalence of loneliness and self-harm were estimated applying post-stratification weights to account for differences between the study sample and the target population. The associations between indicators of loneliness and self-harm were examined using mixed effect models. 1,896 of 10,460 adolescents (18.1%) reported feeling lonely 'often' (weighted proportion 16.8%). 3,802/10,460 (36.4%; weighted proportion 35%) felt more lonely since lockdown. Self-harm during lockdown was reported by 787/10,460 adolescents (7.5%; weighted proportion 6.7%). Controlling for confounders, adolescents who reported feeling lonely 'often' [adjusted odds ratio (aOR) 2.8, 95% CI 2.1-3.9, p < 0.0001] or 'sometimes' (aOR 2.2, 95% CI 1.5-3.2, p < 0.0001) were more likely to self-harm during lockdown relative to adolescents who reported 'never' or 'hardly ever' feeling lonely. Exacerbation in loneliness during lockdown was associated with an increase in the odds of self-harm during lockdown. Loneliness, heightened loneliness and self-harm were common during lockdown and closely linked. It is important to support schools in address loneliness and self-harm as part of efforts to improve well-being as the long tail of the pandemic continues to impact on child and adolescent mental health. Understanding how loneliness and self-harm may co-vary could be important for future self-harm reduction strategies in young persons. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-03651-5.
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Affiliation(s)
- Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Karen Mansfield
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Christoph Jindra
- Institute for Educational Quality Improvement, Humboldt University, Berlin, Germany
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mina Fazel
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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20
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Geulayov G, Borschmann R, Mansfield KL, Hawton K, Moran P, Fazel M. Utilization and Acceptability of Formal and Informal Support for Adolescents Following Self-Harm Before and During the First COVID-19 Lockdown: Results From a Large-Scale English Schools Survey. Front Psychiatry 2022; 13:881248. [PMID: 35815012 PMCID: PMC9263724 DOI: 10.3389/fpsyt.2022.881248] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/20/2022] [Indexed: 12/28/2022] Open
Abstract
Background Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic. Aims To examine the utilization and acceptability of formal, informal, and online support accessed by adolescents following self-harm before and during the pandemic. Method Cross-sectional survey (OxWell) of 10,560 secondary school students aged 12-18 years in the south of England. Information on self-harm, support(s) accessed after self-harm, and satisfaction with support received were obtained via a structured, self-report questionnaire. No tests for significance were conducted. Results 1,457 (12.5%) students reported having ever self-harmed and 789 (6.7%) reported self-harming during the first national lockdown. Informal sources of support were accessed by the greatest proportion of respondents (friends: 35.9%; parents: 25.0%). Formal sources of support were accessed by considerably fewer respondents (Child and Adolescent Mental Health Services: 12.1%; psychologist/ psychiatrist: 10.2%; general practitioner: 7.4%). Online support was accessed by 8.6% of respondents, and 38.3% reported accessing no support at all. Informal sources of support were rated as most helpful, followed by formal sources, and online support. Of the respondents who sought no support, 11.3% reported this as being helpful. Conclusions More than a third of secondary school students in this sample did not seek any help following self-harm. The majority of those not seeking help did not find this to be a helpful way of coping. Further work needs to determine effective ways of overcoming barriers to help-seeking among adolescents who self-harm and improving perceived helpfulness of the supports accessed.
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Affiliation(s)
- Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Rohan Borschmann
- Justice Health Unit (Centre for Health Equity), Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Karen L. Mansfield
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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21
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Blackmore R, Gibson-Helm M, Melvin G, Boyle JA, Fazel M, Gray KM. Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic. Aust N Z J Psychiatry 2022; 56:525-534. [PMID: 34250839 DOI: 10.1177/00048674211025687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman's language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale. METHODS This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results. RESULTS Cronbach's alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]). CONCLUSION These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mina Fazel
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), Faculty of Social Sciences, University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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22
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Albright G, Fazel M, Khalid N, McMillan J, Hilty D, Shockley K, Joshi S. High School Educator Training by Simulation to Address Emotional and Behavioral Concerns in School Settings: A Randomized Study. J Technol Behav Sci 2022; 7:277-289. [PMID: 35372668 PMCID: PMC8959801 DOI: 10.1007/s41347-022-00243-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 10/29/2022]
Abstract
The purpose of this study is to examine the impact of an online virtual human role-play simulation in teaching high school educators and staff to identify, talk to, and if necessary, refer students in psychological distress to support services. High school educators (N = 31,144) from 43 US states and 5 American territories completed a baseline survey and then randomly assigned to a wait-list control or treatment group. Participants in the treatment group completed the training simulation which included active learning strategies to teach evidenced-based communication strategies such as motivational interviewing to build skills and shift attitudes. Immediately after the training, treatment group participants completed a post-survey and then a 3-month follow-up survey. Baseline and post-surveys included the validated gatekeeper behavior scale measures which assess attitudinal constructs that predict helping behaviors. Self-reported helping behaviors were collected at baseline from both groups and at the 3-month follow-up for the treatment group. The treatment group participants' post and follow-up data were compared to the control group's baseline measures. The treatment group post-training scores were significantly higher (p < .001) than the control group's baseline scores for all gatekeeper behavior scale attitudinal constructs of preparedness, likelihood, and self-efficacy to engage in helping behaviors. A teacher subsample reported significant increases (p < .001) in the number of students referred to mental health support services when compared to baseline measures of the control group. Role-play simulations hold promise in teaching educators to become the "eyes and ears" of student mental health by empowering them to identify students in psychological distress, engage them in effective conversations about their concerns, and if necessary, make a referral to behavioral health support services. Future studies need to implement measures that document students entering counseling as a result of self-reported referrals and examine the impact of the training on the overall mental health culture within schools. Such studies could lead to simulations being widely adopted to support public health initiatives that address student mental health and wellness.
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Affiliation(s)
- Glenn Albright
- Department of Psychology, Baruch College, City University of New York, One Bernard Baruch Way, New York, NY 10010 USA
| | - Mina Fazel
- Medical Services Division, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Nikita Khalid
- Educational Psychology, Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016 USA
| | - Jeremiah McMillan
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602 USA
| | - Don Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, 2230 Stockton Boulevard, DavisSacramento, CA USA
| | - Kristen Shockley
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602 USA
| | - Shashank Joshi
- Division of Child & Adolescent Psychiatry, Stanford University, 401 Quarry Road, Stanford, CA 94305-5719 USA
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23
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Hugh-Jones S, Janardhana N, Al-Janabi H, Bhola P, Cooke P, Fazel M, Hudson K, Khandeparkar P, Mirzoev T, Venkataraman S, West RM, Mallikarjun P. Safeguarding adolescent mental health in India (SAMA): study protocol for codesign and feasibility study of a school systems intervention targeting adolescent anxiety and depression in India. BMJ Open 2022; 12:e054897. [PMID: 35379625 PMCID: PMC8981280 DOI: 10.1136/bmjopen-2021-054897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Symptoms of anxiety and depression in Indian adolescents are common. Schools can be opportune sites for delivery of mental health interventions. India, however, is without a evidence-based and integrated whole-school mental health approach. This article describes the study design for the safeguarding adolescent mental health in India (SAMA) project. The aim of SAMA is to codesign and feasibility test a suite of multicomponent interventions for mental health across the intersecting systems of adolescents, schools, families and their local communities in India. METHODS AND ANALYSIS Our project will codesign and feasibility test four interventions to run in parallel in eight schools (three assigned to waitlist) in Bengaluru and Kolar in Karnataka, India. The primary aim is to reduce the prevalence of adolescent anxiety and depression. Codesign of interventions will build on existing evidence and resources. Interventions for adolescents at school will be universal, incorporating curriculum and social components. Interventions for parents and teachers will target mental health literacy, and also for teachers, training in positive behaviour practices. Intervention in the school community will target school climate to improve student mental health literacy and care. Intervention for the wider community will be via adolescent-led films and social media. We will generate intervention cost estimates, test outcome measures and identify pathways to increase policy action on the evidence. ETHICS AND DISSEMINATION Ethical approval has been granted by the National Institute of Mental Health Neurosciences Research Ethics Committee (NIMHANS/26th IEC (Behv Sc Div/2020/2021)) and the University of Leeds School of Psychology Research Ethics Committee (PSYC-221). Certain data will be available on a data sharing site. Findings will be disseminated via peer-reviewed journals and conferences.
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Affiliation(s)
- Siobhan Hugh-Jones
- Psychology, University of Leeds Faculty of Medicine and Health, Leeds, West Yorkshire, UK
| | - N Janardhana
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Hareth Al-Janabi
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Poornima Bhola
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Paul Cooke
- School of Languages, Cultures and Societies, University of Leeds Faculty of Arts Humanities and Cultures, Leeds, West Yorkshire, UK
| | - Mina Fazel
- Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kristian Hudson
- Improvement Academy, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | | | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Pavan Mallikarjun
- The Barberry Centre for Mental Health, University of Birmingham, Birmingham, UK
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24
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Soneson E, Burn AM, Anderson JK, Humphrey A, Jones PB, Fazel M, Ford T, Howarth E. Determining stakeholder priorities and core components for school-based identification of mental health difficulties: A Delphi study. J Sch Psychol 2022; 91:209-227. [PMID: 35190077 PMCID: PMC8891236 DOI: 10.1016/j.jsp.2022.01.008] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/05/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022]
Abstract
Only approximately half of children and young people (CYP) with mental health difficulties access mental health services in England, with under-identification of need as a contributing factor. Schools may be an ideal setting for identifying mental health difficulties in CYP, but uncertainty remains about the processes by which these needs can best be identified and addressed. In this study, we conducted a two-round, three-panel Delphi study with parents, school staff, mental health practitioners, and researchers to inform the development of a program to identify mental health difficulties in primary schools. We aimed to assess and build consensus regarding (a) the aims of such a program, (b) identification model preferences, (c) key features of the identification model, and (d) key features of the implementation model. A total of 54 and 42 participants completed the Round 1 and 2 questionnaires, respectively. In general, responses indicated that all three panels supported the idea of school-based identification of mental health difficulties. Overall, 53 of a possible 99 items met the criteria for inclusion as program core components. Five main priorities emerged, including that (a) the program should identify children experiencing mental health difficulties across the continuum of severity, as well as children exposed to adversity, who are at greater risk of mental health difficulties; (b) the program should train staff and educate pupils about mental health in parallel; (c) parental consent should be obtained on an opt-out basis; (d) the program must include clear mechanisms for connecting identified pupils to care and support; and (e) to maximize implementation success, the program needs to lie within a school culture that values mental health and wellbeing. In highlighting these priorities, our study provides needed stakeholder consensus to guide further development and evaluation of mental health interventions within schools.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, UK.
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, UK; NIHR Applied Research Collaboration East of England, University of Cambridge, UK
| | - Joanna K Anderson
- Department of Psychiatry, University of Cambridge, UK; NIHR Applied Research Collaboration East of England, University of Cambridge, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, UK; NIHR Applied Research Collaboration East of England, University of Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK; NIHR Applied Research Collaboration East of England, University of Cambridge, UK
| | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, UK; NIHR Applied Research Collaboration East of England, University of Cambridge, UK
| | - Emma Howarth
- School of Psychology, University of East London, Stratford Campus, UK
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25
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Ramasamy S, Fazel M, Patel G. 260 Comparison of Patient Satisfaction and Outcomes of Day Case Mastectomy Versus Inpatient Model, Using a Validated Questionnaire. Br J Surg 2022. [PMCID: PMC9383525 DOI: 10.1093/bjs/znac039.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Many women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered. Method A retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed. Results Out of the 202 patients analysed, over 75% had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p = 0.26, p = 0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p = 0.27). Conclusions The result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.
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Affiliation(s)
- S. Ramasamy
- Milton Keynes University Hospital, Milton Keynes, United Kingdom
| | - M. Fazel
- Northampton General Hospital, Northampton, United Kingdom
| | - G. Patel
- Milton Keynes University Hospital, Milton Keynes, United Kingdom
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26
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Glogowska M, Stepney M, Rocks S, Fazel M. Implementation of significant mental health service change: perceptions and concerns of a mental health workforce in the context of transformation. J Health Organ Manag 2022; 36:66-78. [PMID: 35147380 PMCID: PMC9627961 DOI: 10.1108/jhom-06-2021-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose As part of an evaluation of the nationally mandated Child and Adolescent Mental Health Services (CAMHS) “transformation” in one foundation NHS trust, the authors explored the experiences of mental health staff involved in the transformation. Design/methodology/approach The authors employed a qualitative methodology and followed an ethnographic approach. This included observation of mental health staff involved in the transformation and informal interviews (80 h). The authors also undertook semi-structured interviews with key staff members (
n
= 16). Data were analysed thematically. Findings The findings fall into three thematic areas around the transformation, namely (1) rationale; (2) implementation; and (3) maintenance. Staff members were supportive of the rationale for the changes, but implementation was affected by perceived poor communication, resulting in experiences of unpreparedness and de-stabilisation. Staff members lacked time to set up the necessary processes, meaning that changes were not always implemented smoothly. Recruiting and retaining the right staff, a consistent challenge throughout the transformation, was crucial for maintaining the service changes. Originality/value There is little published on the perceptions and experiences of mental health workforces around the CAMHS transformations across the UK. This paper presents the perceptions of mental health staff, whose organisation underwent significant “transformational” change. Staff demonstrated considerable resilience in the change process, but better recognition of their needs might have improved retention and satisfaction. Time for planning and training would enable staff members to better develop the processes and resources necessary in the context of significant service change. Developing ways for services to compare changes they are implementing and sharing good practice around implementation with each other are also vital.
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Affiliation(s)
- Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephen Rocks
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Illingworth G, Mansfield KL, Espie CA, Fazel M, Waite F. Sleep in the time of COVID-19: findings from 17000 school-aged children and adolescents in the UK during the first national lockdown. Sleep Adv 2022; 3:zpab021. [PMID: 35128401 PMCID: PMC8807290 DOI: 10.1093/sleepadvances/zpab021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Sleep is essential to young people's wellbeing, yet may be constricted by the adolescent delayed sleep phase coupled with school start times. COVID-19 restrictions caused major disruptions to everyday routines, including partial school closures. We set out to understand changes in students' self-reported sleep quality, and associations with mental wellbeing and interpersonal functioning, during these restrictions. METHODS The OxWell school survey-a cross-sectional online survey-collected data from 18 642 children and adolescents (aged 8-19 years, 60% female, school year 4-13) from 230 schools in southern England, in June-July 2020. Participants completed self-report measures of the impact of COVID-19 restrictions on sleep quality, happiness, and social relationships. Sleep timing was compared with data collected from 4222 young people in 2019. RESULTS Females and older adolescents were more likely to report deteriorations in sleep during the national lockdown. Regression analysis revealed that changes in happiness (β = .34) and how well students were getting on with others in their household (β = .07) predicted change in sleep quality. Students' bedtimes and wake times were later, and sleep duration was longer in 2020 compared to the 2019 survey. Secondary school students reported the greatest differences, especially later wake times. CONCLUSIONS During COVID-19 restrictions, sleep patterns consistent with adolescent delayed sleep phase were observed, with longer sleep times for secondary school students in particular. Perceived deteriorations in sleep quality were associated with reductions in happiness and interpersonal functioning, highlighting the importance of including sleep measures in adolescent wellbeing research.
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Affiliation(s)
- Gaby Illingworth
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Karen L Mansfield
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Mansfield KL, Puntis S, Soneson E, Cipriani A, Geulayov G, Fazel M. Study protocol: the OxWell school survey investigating social, emotional and behavioural factors associated with mental health and well-being. BMJ Open 2021; 11:e052717. [PMID: 34880020 PMCID: PMC9066348 DOI: 10.1136/bmjopen-2021-052717] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Improving our understanding of the broad range of social, emotional and behavioural factors that contribute to mental health outcomes in adolescents will be greatly enhanced with diverse, representative population samples. We present a protocol for a repeated self-report survey assessing risk and protective factors for mental health and well-being in school pupils aged 8-18 years with different socioeconomic backgrounds in England. The survey will provide a comprehensive picture of mental health and associated risks at the community level to inform the development of primary and secondary prevention and treatment strategies in schools. METHODS AND ANALYSIS This protocol is for a large-scale online repeated self-report survey, representative of children and adolescents aged 8-18 years attending schools or further education colleges in participating counties in England. The survey consists of around 300 questions, including validated measures of mental health and well-being, risk and protective factors, and care-seeking behaviour and preferences. Additional questions each year vary to address current events and novel hypotheses, developed by the research team, collaborators and stakeholders. Primary analyses will investigate current and changing risk and protective factors, care-seeking behaviour and attitudes to allowing linkage of their sensitive data to other databases for research, and will compare measures of mental health to measures of well-being. ETHICS AND DISSEMINATION The study was approved by the University of Oxford Research Ethics Committee (Reference: R62366). Tailored data summaries will be provided to participating schools and stakeholders within 3 months of data collection. The main findings will be presented at scientific meetings, published in peer-reviewed journals and shared via digital and social media channels. At the end of the study, other researchers will be able to apply for access to anonymous data extracts.
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Affiliation(s)
| | - Stephen Puntis
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Galit Geulayov
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Fazel M, Townsend A, Stewart H, Pao M, Paz I, Walker J, Sawyer SM, Sharpe M. Integrated care to address child and adolescent health in the 21st century: A clinical review. JCPP Advances 2021. [DOI: 10.1002/jcv2.12045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Mina Fazel
- Department of Psychiatry University of Oxford Oxford UK
- The Oxford Psychological Medicine Centre Oxford University Hospitals NHSFT Oxford UK
| | - Alice Townsend
- Sunderland and South Tyneside NHS Foundation Trust Tyne and Wear UK
| | - Harriet Stewart
- The Oxford Psychological Medicine Centre Oxford University Hospitals NHSFT Oxford UK
| | - Maryland Pao
- Department of Health and Human Services National Institute of Mental Health National Institutes of Health Bethesda Maryland USA
| | - Isabel Paz
- The Oxford Psychological Medicine Centre Oxford University Hospitals NHSFT Oxford UK
| | - Jane Walker
- Department of Psychiatry University of Oxford Oxford UK
- The Oxford Psychological Medicine Centre Oxford University Hospitals NHSFT Oxford UK
| | - Susan M. Sawyer
- Centre for Adolescent Health Royal Children’s Hospital Parkville Victoria Australia
- Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
| | - Michael Sharpe
- Department of Psychiatry University of Oxford Oxford UK
- The Oxford Psychological Medicine Centre Oxford University Hospitals NHSFT Oxford UK
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30
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Fazel M, Puntis S, White SR, Townsend A, Mansfield KL, Viner R, Herring J, Pollard AJ, Freeman D. Willingness of children and adolescents to have a COVID-19 vaccination: Results of a large whole schools survey in England. EClinicalMedicine 2021; 40:101144. [PMID: 34608453 PMCID: PMC8482530 DOI: 10.1016/j.eclinm.2021.101144] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vaccine hesitancy has affected COVID-19 adult vaccination programs in many countries. Data on hesitancy amongst child and adolescent populations is largely confined to parent opinion. We investigated the characteristics of vaccine hesitant children and adolescents using results from a large, school-based self-report survey of the willingness to have a COVID-19 vaccination in students aged 9 -18 years in England. METHODS Data from the OxWell Student Survey on mental health, life experiences and behaviours were used, collected from four counties across England. Local authority partners recruited schools. The vaccine hesitancy question gave six response options and were clustered to inform delivery: eager and willing were categorised as vaccination 'opt-in', don't know and not bothered categorised as 'undecided', and unwilling and anti-vaccination categorised as 'opt-out'. We conducted a multinomial regression to determine associations between vaccine hesitancy and sociodemographic, health behaviour and social connection variables. FINDINGS 27,910 students from 180 schools answered the vaccine hesitancy question between 14th May and 21st July 2021, of whom 13984 (50.1%) would opt-in to take a vaccination, 10322 (37.0%) were undecided, and 3604 (12.9%) would opt-out. A lower percentage of younger students reported that they would opt-in to vaccination, for example, 35.7% of 9-year-olds and 51.3% of 13-year-olds compared to 77.8% of 17-year-olds would opt-in to take a vaccination. Students who were 'opt-out' or 'undecided' (a combined 'vaccine hesitant' group) were more likely to come from deprived socioeconomic contexts with higher rates of home rental versus home ownership and their school locations were more likely to be in areas of greater deprivation. They were more likely to smoke or vape, spend longer on social media, feel that they did not belong in their school community but had lower levels of anxiety and depression. The vaccine hesitant students- the undecided and opt-out groups- were similar in profile, although the opt-out students had higher reported confirmed or probable previous COVID-19 infection than the opt-in group, whereas those undecided, did not. INTERPRETATION If government vaccination strategies move towards vaccinating younger school-aged students, efforts to increase vaccination uptake may be necessary. Compared with students who would opt-in, those who were vaccine hesitant had greater indicators of social deprivation and felt a lack of community cohesion by not feeling a sense of belonging at their school. There were indications that those students who would opt-out had higher levels of marginalisation and mistrust. If programmes are rolled out, focus on hesitant younger students will be important, targeting more marginalised and deprived young people with information from trusted sources utilising social media; improving access to vaccination centres with provision both in and outside school; and addressing fears and worries about the effects of the vaccine. The main limitation of this study is that the participant group may not be wholly representative of England or the UK, which may bias population-level estimates of willingness to be vaccinated. FUNDING The Westminster Foundation, the National Institute for Health Research (NIHR) Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust and the NIHR Oxford Health Biomedical Research Centre.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford OX3 7JX, UK
- Oxford Centre for Psychological Medicine, Oxford University Hospitals NHSFT, Oxford, UK
| | - Stephen Puntis
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford OX3 7JX, UK
| | - Simon R. White
- Department of Psychiatry, University of Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, UK
| | - Alice Townsend
- Sunderland and South Tyneside NHS Foundation Trust, Tyne and Wear, UK
| | - Karen L. Mansfield
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford OX3 7JX, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Russell Viner
- UCL Great Ormond St. Institute of Child Health, London, UK
| | | | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford OX3 7JX, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Senior M, Fanshawe T, Fazel M, Fazel S. Prediction models for child and adolescent mental health: A systematic review of methodology and reporting in recent research. JCPP Adv 2021; 1:e12034. [PMID: 37431439 PMCID: PMC10242964 DOI: 10.1002/jcv2.12034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There has been a rapid growth in the publication of new prediction models relevant to child and adolescent mental health. However, before their implementation into clinical services, it is necessary to appraise the quality of their methods and reporting. We conducted a systematic review of new prediction models in child and adolescent mental health, and examined their development and validation. METHOD We searched five databases for studies developing or validating multivariable prediction models for individuals aged 18 years old or younger from 1 January 2018 to 18 February 2021. Quality of reporting was assessed using the Transparent Reporting of a multivariable prediction models for Individual Prognosis Or Diagnosis checklist, and quality of methodology using items based on expert guidance and the PROBAST tool. RESULTS We identified 100 eligible studies: 41 developing a new prediction model, 48 validating an existing model and 11 that included both development and validation. Most publications (k = 75) reported a model discrimination measure, while 26 investigations reported calibration. Of 52 new prediction models, six (12%) were for suicidal outcomes, 18 (35%) for future diagnosis, five (10%) for child maltreatment. Other outcomes included violence, crime, and functional outcomes. Eleven new models (21%) were developed for use in high-risk populations. Of development studies, around a third were sufficiently statistically powered (k = 16%, 31%), while this was lower for validation investigations (k = 12, 25%). In terms of performance, the discrimination (as measured by the C-statistic) for new models ranged from 0.57 for a tool predicting ADHD diagnosis in an external validation sample to 0.99 for a machine learning model predicting foster care permanency. CONCLUSIONS Although some tools have recently been developed for child and adolescent mental health for prognosis and child maltreatment, none can be currently recommended for clinical practice due to a combination of methodological limitations and poor model performance. New work needs to use ensure sufficient sample sizes, representative samples, and testing of model calibration.
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Affiliation(s)
- Morwenna Senior
- Department of PsychiatryOxford Health NHS Foundation Trust, University of OxfordOxfordUK
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Mina Fazel
- Department of PsychiatryOxford Health NHS Foundation Trust, University of OxfordOxfordUK
| | - Seena Fazel
- Department of PsychiatryOxford Health NHS Foundation Trust, University of OxfordOxfordUK
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Mansfield KL, Newby D, Soneson E, Vaci N, Jindra C, Geulayov G, Gallacher J, Fazel M. COVID-19 partial school closures and mental health problems: A cross-sectional survey of 11,000 adolescents to determine those most at risk. JCPP Adv 2021; 1:e12021. [PMID: 34514466 PMCID: PMC8420157 DOI: 10.1002/jcv2.12021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022] Open
Abstract
Background Understanding adolescents' mental health during lockdown and identifying those most at risk is an urgent public health challenge. This study surveyed school pupils across Southern England during the first COVID‐19 school lockdown to investigate situational factors associated with mental health difficulties and how they relate to pupils' access to in‐school educational provision. Methods A total of 11,765 pupils in years 8–13 completed a survey in June–July 2020, including questions on mental health, risk indicators and access to school provision. Pupils at home were compared to those accessing in‐school provision on risk and contextual factors and mental health outcomes. Multilevel logistic regression analyses compared the effect of eight risk and contextual factors, including access to in‐school provision, on depression, anxiety and self‐reported deterioration in mental wellbeing. Results Females, pupils who had experienced food poverty and those who had previously accessed mental health support were at greatest risk of depression, anxiety and a deterioration in wellbeing. Pupils whose parents were going out to work and those preparing for national examinations in the subsequent school year were also at increased risk. Pupils accessing in‐school provision had poorer mental health, but this was accounted for by the background risk and contextual factors assessed, in line with the allocation of in‐school places to more vulnerable pupils. Conclusions Although the strongest associations with poor mental health during school closures were established risk factors, further contextual factors of particular relevance during lockdown had negative impacts on wellbeing. Identifying those pupils at greatest risk for poor outcomes is critical for ensuring that appropriate educational and social support can be given to pupils either at home or in‐school during subsequent lockdowns.
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Affiliation(s)
| | | | - Emma Soneson
- Department of Psychiatry University of Cambridge Cambridge UK
| | - Nemanja Vaci
- Department of Psychology University of Sheffield Sheffield UK
| | - Christoph Jindra
- Institut zur Qualitätsentwicklung im Bildungswesen Humboldt-Universität zu Berlin Berlin Germany
| | | | | | - Mina Fazel
- Department of Psychiatry University of Oxford Oxford UK
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Çeri V, Ak F, Fındık OTP, Arman A, Fiş NP, Beser C, Göksu M, Fazel M. Syrian refugee children face more peer victimization in schools what leads to poor mental health: a brief report. Eur Child Adolesc Psychiatry 2021; 30:1475-1477. [PMID: 34061260 DOI: 10.1007/s00787-021-01787-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Veysi Çeri
- Child and Adolescent Substance Abuse Treatment Center, Diyarbakir, Turkey.
| | - Feyzanur Ak
- Refugees Association of Turkey, Istanbul, Turkey
| | | | - Ayse Arman
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Neşe Perdahlı Fiş
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Can Beser
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Muhsine Göksu
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mina Fazel
- Department of Child Psychiatry, Oxford University, Oxford, United Kingdom
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Fellmeth G, Nosten S, Khirikoekkong N, Oo MM, Gilder ME, Plugge E, Fazel M, Fitzpatrick R, McGready R. Suicidal ideation in the perinatal period: findings from the Thailand-Myanmar border. J Public Health (Oxf) 2021; 44:e514-e518. [PMID: 34343323 PMCID: PMC9715289 DOI: 10.1093/pubmed/fdab297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of maternal death globally. Migrant and refugee populations may experience higher risk of suicide. We report data on suicidal ideation from migrant and refugee women living on the Thailand-Myanmar border. METHODS Women were recruited in their first trimester of pregnancy. Depression status was assessed by diagnostic interview in the first, second and third trimesters and at 1 month post-partum. We calculated prevalence of suicidal ideation and used logistic regression to identify associated socio-demographic factors. RESULTS During the perinatal period, 5.3% (30/568) women experienced suicidal ideation. Refugee women were more likely to experience suicidal ideation than migrant women (8.0 versus 3.1%; P = 0.01). Most women with suicidal ideation did not have severe depression. Previous trauma (OR 2.32; 95% CI: 1.70-3.15) and unplanned pregnancy (OR 2.74; 95% CI: 1.10-6.86) were significantly associated with suicidal ideation after controlling for all other variables. CONCLUSIONS Suicidal ideation represents an important symptom among migrant and refugee women on the Thailand-Myanmar border. Screening only those with severe depression may be insufficient to identify women at risk of suicide. Community-level interventions addressing social and gender inequalities and prioritization of family planning programmes are needed alongside targeted suicide prevention initiatives to help lower the rates of people dying by suicide.
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Affiliation(s)
- G Fellmeth
- Address correspondence to Gracia Fellmeth, E-mail:
| | - S Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - N Khirikoekkong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - M M Oo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - M E Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - E Plugge
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - M Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - R Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Sellars E, Pavarini G, Michelson D, Creswell C, Fazel M. Young people's advisory groups in health research: scoping review and mapping of practices. Arch Dis Child 2021; 106:698-704. [PMID: 33208398 DOI: 10.1136/archdischild-2020-320452] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 08/11/2020] [Accepted: 10/21/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Young people's advisory groups (YPAGs) for research are comprised of children or adolescents who work with researchers to shape different stages of the research process. Their involvement is expected to ensure studies better reflect the preferences and needs of targeted youth populations. However, despite their increasing use in health research, there is little systematic evidence on the methods and impacts associated with YPAGs. METHOD To address this gap, we conducted a scoping review of YPAGs in youth-focused health studies. We systematically searched MEDLINE for empirical studies in populations between 12 years and 18 years of age published in 2019. If a potential YPAG was identified, authors were contacted for additional information about the activities and level of involvement of the YPAG. FINDINGS Of all studies that collected primary data from persons aged 12-18 years, only 21 studies reported using youth advice during their research. This represents less than 1% of all published empirical child and adolescent studies. There was variation in the type of research activity undertaken by YPAGs and their level of involvement. Most studies involved YPAGs in co-production of research design and/or in dissemination activities. The majority of authors that responded were positive about the impact of YPAGs. INTERPRETATION Recommendations for consistent reporting of YPAG involvement in empirical studies include reporting on the match between YPAG and study populations, frequency/format of meetings, and the nature and level of involvement.
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Affiliation(s)
- Elise Sellars
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | - Cathy Creswell
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Fellmeth G, Plugge E, Fazel M, Nosten S, Oo MM, Pimanpanarak M, Phichitpadungtham Y, Fitzpatrick R, McGready R. Perinatal depression in migrant and refugee women on the Thai-Myanmar border: does social support matter? Philos Trans R Soc Lond B Biol Sci 2021; 376:20200030. [PMID: 33938275 PMCID: PMC8090811 DOI: 10.1098/rstb.2020.0030] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Migrant and refugee women are at risk of perinatal depression due to stressors experienced before, during and after migration. This study assesses the associations between social support and perinatal depression among migrant and refugee women on the Thai-Myanmar border. We conducted a cohort study of pregnant and post-partum women. Depression status was assessed using a structured clinical interview. Received support, perceived support and partner support were measured in the third trimester. Logistic regression was used to calculate associations between social support measures and perinatal depression controlling for demographic, socio-economic, migration, obstetric and psychosocial factors. Four hundred and fifty-one women (233 migrants; 218 refugees) were included. The prevalence of perinatal depression was 38.6% in migrants and 47.3% in refugees. Migrants had higher levels of received, perceived and partner support than refugees. After controlling for all other variables, higher levels of received support remained significantly associated with a lower likelihood of perinatal depression in migrants (adjusted odds ratio 0.82; 95% CI 0.68-0.99). In both groups, depression history and trauma were strongly associated with perinatal depression. Our study highlights the importance of received social support to perinatal depression in migrant women on the Thailand-Myanmar border. The perinatal period offers a valuable opportunity to ask women about their support and offer community-level or public policy interventions to nurture support networks in current locations and resettlement destinations. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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Affiliation(s)
- Gracia Fellmeth
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LT, UK
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Emma Plugge
- Health and Justice Team, Health Improvement Directorate, Public Health England, 60 Caversham Road, Reading RG1 7EB, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - May May Oo
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Yuwapha Phichitpadungtham
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Raymond Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LT, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
- Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok 10400, Thailand
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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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Fazel M, Rocks S, Glogowska M, Stepney M, Tsiachristas A. How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England. PLoS One 2021; 16:e0250691. [PMID: 33951078 PMCID: PMC8099077 DOI: 10.1371/journal.pone.0250691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This 'transformation' variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations. METHODS A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised. OUTCOMES Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20). INTERPRETATION Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- * E-mail:
| | - Stephen Rocks
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Apostolos Tsiachristas
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
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King T, Fazel M. Examining the mental health outcomes of school-based peer-led interventions on young people: A scoping review of range and a systematic review of effectiveness. PLoS One 2021; 16:e0249553. [PMID: 33857174 PMCID: PMC8049263 DOI: 10.1371/journal.pone.0249553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/21/2021] [Indexed: 11/19/2022] Open
Abstract
Schools worldwide have implemented many different peer-led interventions with mixed results, but the evidence base on their effectiveness as mental health interventions remains limited. This study combines a scoping review and systematic review to map the variations of peer-led interventions in schools and to evaluate the quality of the existing evidence base. This scoping review and systematic review evaluated the existing literature across 11 academic databases. Studies were included if they reported a peer-led intervention that aimed to address a mental health or wellbeing issue using a peer from the same school setting. Data were extracted from published and unpublished reports and presented as a narrative synthesis. 54 studies met eligibility criteria for the scoping review, showing that peer-led interventions have been used to address a range of mental health and wellbeing issues globally. 11 studies met eligibility criteria for the systematic review with a total of 2,239 participants eligible for analysis (929 peer leaders; 1,310 peer recipients). Two studies out of seven that looked at peer leaders showed significant improvements in self-esteem and social stress, with one study showing an increase in guilt. Two studies out of five that looked at peer recipient outcomes showed significant improvements in self-confidence and in a quality of life measure, with one study showing an increase in learning stress and a decrease in overall mental health scores. The findings from these reviews show that despite widespread use of peer-led interventions, the evidence base for mental health outcomes is sparse. There appear to be better documented benefits of participation for those who are chosen and trained to be a peer leader, than for recipients. However, the small number of included studies means any conclusions about effectiveness are tentative.
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Affiliation(s)
- Thomas King
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Fazel M, Hoagwood K. School mental health: integrating young people's voices to shift the paradigm. Lancet Child Adolesc Health 2021; 5:156-157. [PMID: 33484659 DOI: 10.1016/s2352-4642(20)30388-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK.
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, School of Medicine, New York University and New York University Langone Health, NY, USA
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Blackmore R, Boyle JA, Fazel M, Ranasinha S, Gray KM, Fitzgerald G, Misso M, Gibson-Helm M. The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003337. [PMID: 32956381 PMCID: PMC7505461 DOI: 10.1371/journal.pmed.1003337] [Citation(s) in RCA: 247] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies. METHODS AND FINDINGS A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43-38.5), the prevalence of depression was 31.5% (95% CI 22.64-40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75-15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63-2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies. CONCLUSIONS This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mina Fazel
- Department of Psychiatry, Oxford University, Oxford, United Kingdom
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kylie M. Gray
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, United Kingdom
| | - Grace Fitzgerald
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
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Rocks S, Glogowska M, Stepney M, Tsiachristas A, Fazel M. Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study. BMC Health Serv Res 2020; 20:623. [PMID: 32641117 PMCID: PMC7346657 DOI: 10.1186/s12913-020-05463-4] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/24/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England. METHODS We conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week's users was collected. RESULTS A similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas. CONCLUSIONS The introduction of a SPA has the potential to improve young people's access to mental health services. By addressing some of the barriers to access, simplifying where to go to get help and making it easier to contact the service directly, a SPA can help more individuals and families access timely support. However, the introduction of a SPA does not in itself expand the capacity of CAMHS, and therefore expectations within services and across sectors need to be tempered accordingly. SPA services providing different referral approaches can further improve access for the harder to reach populations.
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Affiliation(s)
- Stephen Rocks
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, England
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP, England
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, England
| | - Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, England
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, England
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, England.
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Fazel M. Focusing a lens on refugee families to address layers of avoidance. Lancet Public Health 2020; 4:e318-e319. [PMID: 31279411 DOI: 10.1016/s2468-2667(19)30107-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Mina Fazel
- Department of Psychiatry, Warneford Hospital, Oxford OX37JX, UK.
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Blackmore R, Gray KM, Boyle JA, Fazel M, Ranasinha S, Fitzgerald G, Misso M, Gibson-Helm M. Systematic Review and Meta-analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers. J Am Acad Child Adolesc Psychiatry 2020; 59:705-714. [PMID: 31778780 DOI: 10.1016/j.jaac.2019.11.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [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: 03/18/2019] [Revised: 10/25/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Over half of the world's refugee population are under the age of 18 years. This systematic review aims to summarize the current body of evidence for the prevalence of mental illness in child and adolescent refugee populations. METHOD Eight electronic databases, gray literature, and Google Scholar were searched for articles from 1 January 2003 to 5 February 2018. Strict inclusion criteria regarding the diagnosis of mental illness were imposed. Study quality was assessed using a template according to study design, and study heterogeneity using the I2 statistic. Random effects meta-analyses results were presented given heterogeneity among studies. The protocol for this systematic review was registered with PROSPERO (CRD42016046349). RESULTS Eight studies were eligible, involving 779 child and adolescent refugees and asylum seekers, with studies conducted in 5 countries. The overall prevalence of posttraumatic stress disorder (PTSD) was 22.71% (95% CI 12.79-32.64), depression 13.81% (95% CI 5.96-21.67), and anxiety disorders 15.77% (95% CI 8.04-23.50). Attention-deficit/hyperactivity disorder (ADHD) was 8.6% (1.08-16.12) and oppositional defiant disorder (ODD) was 1.69% (95% CI -0.78 to 4.16). Because of the high heterogeneity, further subgroup analyses were conducted. CONCLUSION Refugee and asylum seeker children have high rates of PTSD, depression, and anxiety. Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest that a high proportion of refugee children are at risk for educational disadvantage and poor social integration in host communities, potentially affecting their life course.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Kylie M Gray
- Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Jacqueline A Boyle
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | | | - Sanjeeva Ranasinha
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Grace Fitzgerald
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Marie Misso
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia.
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Mansoubi M, Weedon BD, Esser P, Mayo N, Fazel M, Wade W, Ward TE, Kemp S, Delextrat A, Dawes H. Cognitive Performance, Quality and Quantity of Movement Reflect Psychological Symptoms in Adolescents. J Sports Sci Med 2020; 19:364-373. [PMID: 32390730 PMCID: PMC7196751] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/04/2020] [Indexed: 06/11/2023]
Abstract
The presentation of unhealthy psychological symptoms are rising sharply in adolescents. Detrimental lifestyle behaviours are proposed as both possible causes and consequences. This study set out to compare selected measures of quality and quantity of movement between adolescents with and without unhealthy psychological symptoms. Using a cross sectional design, 96 participants completed the study from a whole year group of 166, age (13.36 ± 0.48) male 50.6% from a secondary school in Oxfordshire, England as a part of a larger study (EPIC) between January and April 2018. Measures were taken of quality and quantity of movement: reaction/movement time, gait pattern & physical activity, alongside psychological symptoms. Differences in movement behaviour in relation to psychological symptom and emotional problem presentation were determined using ANOVA. In the event of a significant result for the main factor of each parameter, a Bonferroni -corrected post hoc test was conducted to show the difference between categories in each group. Results for both unhealthy psychological symptoms and emotional problems were grouped into four categories ('Close to average', 'slightly raised', 'high' and 'very high'). Early adolescents with very high unhealthy psychological symptoms had 16.79% slower reaction times (p = 0.003, ηp2 = 0.170), 13.43% smaller walk ratio (p = 0.007, ηp2 = 0.152), 7.13% faster cadence (p = 0.005, ηp2 = 0.149), 6.95% less step time (p = 0.007, ηp2 = 0.153) and 1.4% less vigorous physical activity (p = 0.04, ηp2 = 0.102) than children with close to average psychological symptoms. Early adolescents with very high emotional problems had 12.25% slower reaction times (p = 0.05, ηp2 = 0.081), 10.61% smaller walk ratio (p = 0.02, ηp2 = 0.108), 6.03% faster cadence (p = 0.01, ηp2 = 0.134), 6.07% shorter step time (p = 0.007, ηp2 = 0.141) and 1.78% less vigorous physical activity (p = 0.009, ηp2 = 0.136) than children with close to average emotional problems. Different movement quality and quantity of was present in adolescents with unhealthy psychological symptoms and emotional problems. We propose movement may be used to both monitor symptoms, and as a novel therapeutic behavioural approach. Further studies are required to confirm our findings.
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Affiliation(s)
- Maedeh Mansoubi
- Centre for Movement, Occupational and Rehabilitation Science (MOReS), Oxford Brookes University, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), UK
- Oxford Clinical Allied Technology and Trial Services Unit (OxCATTS), UK
| | - Benjamin David Weedon
- Centre for Movement, Occupational and Rehabilitation Science (MOReS), Oxford Brookes University, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), UK
| | - Patrick Esser
- Centre for Movement, Occupational and Rehabilitation Science (MOReS), Oxford Brookes University, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), UK
- Oxford Clinical Allied Technology and Trial Services Unit (OxCATTS), UK
| | - Nancy Mayo
- University of Oxford, Department of Psychiatry, Medical Science division, UK
| | - Mina Fazel
- University of Oxford, Department of Psychiatry, Medical Science division, UK
| | | | - Tomas E Ward
- Insight Centre for Data Analytics, Dublin City University, UK
| | | | - Anne Delextrat
- Centre for Movement, Occupational and Rehabilitation Science (MOReS), Oxford Brookes University, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Science (MOReS), Oxford Brookes University, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), UK
- Oxford Clinical Allied Technology and Trial Services Unit (OxCATTS), UK
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Mansfield KL, Gallacher JE, Mourby M, Fazel M. Five models for child and adolescent data linkage in the UK: a review of existing and proposed methods. Evid Based Ment Health 2020; 23:39-44. [PMID: 32046992 PMCID: PMC7034351 DOI: 10.1136/ebmental-2019-300140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 01/10/2023]
Abstract
Over the last decade dramatic advances have been made in both the technology and data available to better understand the multifactorial influences on child and adolescent health and development. This paper seeks to clarify methods that can be used to link information from health, education, social care and research datasets. Linking these different types of data can facilitate epidemiological research that investigates mental health from the population to the patient; enabling advanced analytics to better identify, conceptualise and address child and adolescent needs. The majority of adolescent mental health research is not able to maximise the full potential of data linkage, primarily due to four key challenges: confidentiality, sampling, matching and scalability. By presenting five existing and proposed models for linking adolescent data in relation to these challenges, this paper aims to facilitate the clinical benefits that will be derived from effective integration of available data in understanding, preventing and treating mental disorders.
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Affiliation(s)
- Karen Laura Mansfield
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Miranda Mourby
- Centre for Health, Law and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Children's Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Rocks S, Fazel M, Tsiachristas A. Impact of transforming mental health services for young people in England on patient access, resource use and health: a quasi-experimental study. BMJ Open 2020; 10:e034067. [PMID: 31948991 PMCID: PMC7044818 DOI: 10.1136/bmjopen-2019-034067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/21/2019] [Accepted: 12/17/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To evaluate the impact of child and adolescent mental health services (CAMHS) transformation in South East England on patient access, resource utilisation and health outcomes. DESIGN In an observational study, we use difference-in-differences analysis with propensity score matching to analyse routinely collected patient level data. SETTING Three CAMHS services in South East England. PARTICIPANTS All patients attending CAMHS between April 2012 and December 2018, with more than 57 000 spells of care included. MAIN OUTCOME MEASURES The rate and volume of people accessing CAMHS; waiting times to the first contact and waiting times between the first and second contact; and health outcomes, including the Strengths and Difficulties Questionnaire (SDQ) and the Revised Child Anxiety and Depression Scale (RCADS). RESULTS The intervention led to 20% (incidence rate ratio: 1.20; 95% CI: 1.15 to 1.24) more new patients starting per month. There was mixed evidence on waiting times for the first contact. The intervention led to 10% (incidence rate ratio: 1.10; 95% CI: 1.02 to 1.18) higher waiting time for the second contact. The number of contacts per spell (OR: 1.08; 95% CI: 0.94 to 1.25) and the rereferral rate (OR: 1.06; 95% CI: 0.96 to 1.17) were not significantly different. During the post intervention period, patients in the intervention group scored on average 3.3 (95% CI: -5.0 to -1.6) points lower on the RCADS and 1.0 (95% CI: -1.8 to -0.3) points lower on the SDQ compared with the control group after adjusting for the baseline score. CONCLUSIONS Overall, there are signs that transformation can help CAMHS achieve the objectives of greater access and improved health outcomes, but trade-offs exist among different performance metrics, particularly between access and waiting times. Commissioners and providers should be conscious of any trade-offs when undertaking service redesign and transformation.
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Affiliation(s)
- Stephen Rocks
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Fazel M, Stratford HJ, Rowsell E, Chan C, Griffiths H, Robjant K. Five Applications of Narrative Exposure Therapy for Children and Adolescents Presenting With Post-Traumatic Stress Disorders. Front Psychiatry 2020; 11:19. [PMID: 32140112 PMCID: PMC7043101 DOI: 10.3389/fpsyt.2020.00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/09/2020] [Indexed: 12/21/2022] Open
Abstract
Narrative exposure therapy (NET) is an individual therapeutic approach that has an emerging evidence base for children. It was initially trialed with refugee and asylum seeking populations, in low, middle and high-income settings, utilizing either lay or professional therapists. The results of treatment trials for PTSD in refugee children with NET (or the child "KIDNET" adaptation) demonstrates how this is an effective intervention, is scalable and culturally dexterous. This paper describes, in five cases from clinical practice settings, the applicability of NET into broader, routine practice. The cases outlined describe the use of NET with adolescents with: autism spectrum disorders, psychotic symptoms, and intellectual disabilities; histories of forced abduction into child soldiering; complex physical health problems needing multiple interventions; and victims of childhood sexual abuse. The cases are discussed with regards to how the NET lifeline facilitated engagement in treatment, practical adaptations for those with intellectual disabilities and how NET, with its relatively short training for health professionals, can be modified to different contexts and presentations. The importance of improving access to care is discussed to ensure that young people are supported with their most complex and disruptive memories.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Children's Psychological Medicine, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hannah J Stratford
- Highfield Adolescent Unit, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Eleanor Rowsell
- The Sue Nicholls Centre, Oxford Health NHS Foundation Trust, Aylesbury, United Kingdom
| | - Carmen Chan
- Horizon (Supporting Young People and Families Affected by Sexual Harm), Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Helen Griffiths
- Children's Psychological Medicine, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Smits A, Lammers G, Fazel M, Janssens K. Sleep problems in people with intellectual disability (ID); diagnosis and treatment. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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