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Guided self-help Urdu version of the living life to the full intervention for secondary school adolescents with low mood and anxiety in Pakistan: A feasibility study. Heliyon 2022; 8:e09809. [PMID: 35859639 PMCID: PMC9293591 DOI: 10.1016/j.heliyon.2022.e09809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
There is limited evidence on the efficacy of Cognitive Behavioral Therapy (CBT) based guided self-help programs to improve low mood and anxiety in Pakistani adolescents. The aims of the current study were to assess the effectiveness of an eight week low intensity CBT-based guided self-help program, Living Life to the Full (LLTTF) on depression, anxiety and social functioning among secondary school adolescents in Pakistan. Fifty-six participants were randomly allocated to immediate (n = 28) and delayed access (n = 28) groups. Measures of depression, anxiety and social functioning were collected at baseline, post intervention and three months follow-up. There were significant improvements in measures of depression (t = -3.47, p < 0.01; d = 1.0), anxiety (t = -6.55, p < 0.001; d = 1.91) and social functioning (t = -4.28, p < 0.001) between immediate access and delayed access groups. These differences remained significant at three months follow-up. The study suggests that the Urdu LLTTF book course delivered in classes is effective for reducing depression and anxiety as well as improving social function among adolescents in Pakistan.
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Williams C, McClay CA, Martinez R, Morrison J, Haig C, Jones R, Farrand P. Online Cognitive Behavioral Therapy (CBT) Life Skills Program for Depression: Pilot Randomized Controlled Trial. JMIR Form Res 2022; 6:e30489. [PMID: 35175203 PMCID: PMC8895278 DOI: 10.2196/30489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is a common mental health problem with significant personal and social consequences. Studies have suggested that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety when delivered one-to-one by an expert practitioner, but access to this talking therapy is often limited, and waiting lists can be long. However, a range of low-intensity interventions that can increase access to services are available including guided CBT self-help materials delivered via books, classes, and online packages. OBJECTIVE This project aimed to pilot a randomized controlled trial (RCT) of an online CBT-based life skills course with community-based individuals experiencing depression. METHODS Individuals with symptoms of depression were recruited directly from the community via newspaper advertisements. Participants were remotely randomized to receive either immediate access (IA) or delayed access (DA) to a research version of the Living Life to the Full online CBT-based life skills package (3rd edition) with telephone support provided by nonspecialist, charity-based workers while they used the online intervention. The primary end point was at 3 months postrandomization, at which point, the DA group were offered the intervention. Levels of depression, anxiety, social functioning, and satisfaction were assessed. RESULTS There were effective recruitment, randomization, and uptake, with 19 IA and 17 DA control participants entering the pilot study via newspaper advertisements and 13 of the 19 participants taking up the intervention. Overall, 72% (26/36) were not currently under the care of their general practitioner. The online package was acceptable to participants; the mean satisfaction score on the Client Satisfaction Questionnaire was 21 out of 32 (SD 8.89). At 3 months, data collection was achieved from 78% (28/36) of the participants. The efficacy and retention data were used for a power calculation indicating that 72 participants in total will be required for a future substantive RCT. CONCLUSIONS The research design successfully tested the recruitment, data collection, and intervention delivery. The pilot study has provided data for the required sample size for the full RCT. TRIAL REGISTRATION ISRCTN registry ISRCTN12890709; https://doi.org/10.1186/ISRCTN12890709. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-016-1336-y.
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Affiliation(s)
- Christopher Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Carrie-Anne McClay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rebeca Martinez
- Mersey Care National Health Service Foundation Trust, Norris Green Community Hub, Liverpool, United Kingdom
| | - Jill Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Haig
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ray Jones
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Paul Farrand
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, United Kingdom
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Community-centred interventions for improving public mental health among adults from ethnic minority populations in the UK: a scoping review. BMJ Open 2021. [PMCID: PMC8039264 DOI: 10.1136/bmjopen-2020-041102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives Undertake a scoping review to determine the effectiveness of community-centred interventions designed to improve the mental health and well-being of adults from ethnic minority groups in the UK. Methods We searched six electronic academic databases for studies published between January 1990 and September 2019: Medline, Embase, PsychINFO, Scopus, CINAHL and Cochrane. For intervention description and data extraction we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Template for Intervention Description and Replication guide. Quality was assessed using Cochrane risk of bias tools. Grey literature results were deemed beyond the scope of this review due to the large number of interventions and lack of available outcomes data. Results Of 4501 studies, 7 met the eligibility criteria of UK-based community interventions targeting mental health in adults from ethnic minority populations: four randomised controlled trials, one pre/post-pilot study, one cross-sectional study and one ethnographic study. Interventions included therapy-style sessions, peer-support groups, educational materials, gym access and a family services programme. Common components included a focus on tackling social isolation, using lay health workers from within the community, signposting and overcoming structural barriers to access. Four studies reported a statistically significant positive effect on mental health outcomes and six were appraised as having a high risk of bias. Study populations were ethnically heterogeneous and targeted people mainly from South Asia. No studies examined interventions targeting men. Conclusions There is a paucity of high-quality evidence regarding community-centred interventions focused on improving public mental health among ethnic minority groups. Decision makers need scientific evidence to inform effective approaches to mitigating health disparities. Our next steps are to map promising community activities and interventions that are currently being provided to help identify emerging evidence.
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Shahmalak U, Blakemore A, Waheed MW, Waheed W. The experiences of lay health workers trained in task-shifting psychological interventions: a qualitative systematic review. Int J Ment Health Syst 2019; 13:64. [PMID: 31636699 PMCID: PMC6790996 DOI: 10.1186/s13033-019-0320-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction The prevalence of common mental disorders, such as depression and anxiety, is high and the demand for psychological interventions and talking therapies is increasing. In order to meet this need, it is necessary to explore alternative methods to deliver talking therapies. Training lay health workers (LHWs) to deliver psychological interventions might be one possible solution to address current gaps in service provision. A number of studies have successfully used this approach to deliver psychological interventions in order to meet the demand for mental health care. Despite increased interest in this area, the evidence has not been synthesised or systematically reviewed. Methods Electronic databases (MEDLINE, EMBBASE, PsycINFO and CINHAL) were systematically searched to specifically capture studies on task-shifting psychological interventions for common mental disorders. Data were extracted on the experiences of the lay-workers on training and therapy delivery. Thematic analysis was used to analyse the data. Themes and subthemes of LHWs views on receiving training, barriers and facilitators to therapy delivery, factors required to become a successful therapist and the impact of training and therapy delivery on the therapists are described. Results 10 studies were eligible for inclusion. Key messages were: LHWs were satisfied with training but wanted more robust supervision; not enough time was given to training on understanding mental health problems; LHWs grew in confidence and this impacted on their personal relationships with others. Conclusion This is the first review to explore LHWs experiences in training and therapy delivery by synthesising existing qualitative research. A number of key messages derived out of this review can help in further improving the quality of the training programmes and highlighting the benefits that are available for the LHW in delivering psychological interventions.
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Affiliation(s)
- Ujala Shahmalak
- 1Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Amy Blakemore
- 2Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | | | - Waquas Waheed
- 1Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL UK
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Williams C, McClay CA, Matthews L, McConnachie A, Haig C, Walker A, Morrison J. Community-based group guided self-help intervention for low mood and stress: randomised controlled trial. Br J Psychiatry 2018; 212:88-95. [PMID: 29436324 PMCID: PMC6716980 DOI: 10.1192/bjp.2017.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND To date no studies have explored the effectiveness of written cognitive-behavioural therapy (CBT) resources for low mood and stress delivered via a course of self-help classes in a community setting. Aims To assess the effectiveness of an 8-week community-based CBT self-help group classes on symptoms of depression, anxiety and social function at 6 months (trial registration: ISRCTN86292664). METHOD In total, 142 participants were randomly allocated to immediate (n = 71) or delayed access to a low-intensity CBT intervention (n = 71). Measures of depression, anxiety and social function were collected at baseline and 6 months. RESULTS There was a significant improvement for the primary outcome of Patient Health Questionnaire-9 (PHQ-9) score (mean between-group difference: -3.64, 95% CI -6.06 to -1.23; P = 0.004). The percentage of participants reducing their PHQ-9 score between baseline and 6 months by 50% or more was 17.9% for the delayed access group and 43.8% for the immediate access group. Secondary outcomes also improved including anxiety and social function. The intervention was cost neutral. The probabilities of a net benefit at willingness to pay thresholds of £20 000, £25 000 or £30 000 were 0.928, 0.944 and 0.955, respectively. CONCLUSIONS Low-intensity class-based CBT delivered within a community setting is effective for reducing depression, anxiety and impaired social function at little additional cost. Declaration of interest C.W. is president of British Association for Behavioural & Cognitive Psychotherapies (BABCP) - the lead body for CBT in the UK. He is also author of a range of CBT-based resources available commercially. He is developer of the LLTTF classes evaluated in this study. He receives royalty, and is shareholder and director of a company that commercialises these resources.
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Affiliation(s)
- Christopher Williams
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road, Glasgow, Glasgow City G12 0XH
| | - Carrie-Anne McClay
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road, Glasgow, Glasgow City G12 0XH
| | - Lynsay Matthews
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road, Glasgow, Glasgow City G12 0XH
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ
| | - Caroline Haig
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ
| | - Andrew Walker
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ
| | - Jill Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX
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Williams C, McClay CA, Martinez R, Morrison J, Haig C, Jones R, Farrand P. Online CBT life skills programme for low mood and anxiety: study protocol for a pilot randomized controlled trial. Trials 2016; 17:220. [PMID: 27121090 PMCID: PMC4848796 DOI: 10.1186/s13063-016-1336-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low mood is a common mental health problem with significant health consequences. Studies have shown that cognitive behavioural therapy (CBT) is an effective treatment for low mood and anxiety when delivered one-to-one by an expert practitioner. However, access to this talking therapy is often limited and waiting lists can be long, although a range of low-intensity interventions that can increase access to services are available. These include guided self-help materials delivered via books, classes and online packages. This project aims to pilot a randomized controlled trial of an online CBT-based life skills course with community-based individuals experiencing low mood and anxiety. METHODS Individuals with elevated symptoms of depression will be recruited directly from the community via online and newspaper advertisements. Participants will be remotely randomized to receive either immediate access or delayed access to the Living Life to the Full guided online CBT-based life skills package, with telephone or email support provided whilst they use the online intervention. The primary end point will be at 3 months post-randomization, at which point the delayed-access group will be offered the intervention. Levels of depression, anxiety, social functioning and satisfaction will be assessed. DISCUSSION This pilot study will test the trial design, and ability to recruit and deliver the intervention. Drop-out rates will be assessed and the completion and acceptability of the package will be investigated. The study will also inform a sample size power calculation for a subsequent substantive randomized controlled trial. TRIAL REGISTRATION ISRCTN ISRCTN12890709.
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Affiliation(s)
- Christopher Williams
- />Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1st Floor Administration Building, 1055 Great Western Road, Glasgow City, G12 0XH Scotland UK
| | - Carrie-Anne McClay
- />Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1st Floor Administration Building, 1055 Great Western Road, Glasgow City, G12 0XH Scotland UK
| | - Rebeca Martinez
- />Mersey Care NHS Trust, Ferndale Unit, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL England UK
| | - Jill Morrison
- />General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX Scotland UK
| | - Caroline Haig
- />Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ Scotland UK
| | - Ray Jones
- />Faculty of Health and Human Sciences, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA England UK
| | - Paul Farrand
- />Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG UK
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Parnell D, Pringle A, McKenna J, Zwolinsky S, Rutherford Z, Hargreaves J, Trotter L, Rigby M, Richardson D. Reaching older people with PA delivered in football clubs: the reach, adoption and implementation characteristics of the Extra Time Programme. BMC Public Health 2015; 15:220. [PMID: 25884183 PMCID: PMC4397882 DOI: 10.1186/s12889-015-1560-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Older adults (OA) represent a core priority group for physical activity and Public Health policy. As a result, significant interest is placed on how to optimise adherence to interventions promoting these approaches. Extra Time (ET) is an example of a national programme of physical activity interventions delivered in professional football clubs for OA aged 55+ years. This paper aims to examine the outcomes from ET, and unpick the processes by which these outcomes were achieved. Methods This paper represents a secondary analysis of data collected during the evaluation of ET. From the 985 OA reached by ET, n=486 adopted the programme and completed post-intervention surveys (typically 12 weeks). We also draw on interview data with 18 ET participants, and 7 staff who delivered the programme. Data were subject to thematic analysis to generate overarching and sub themes. Results Of the 486 participants, the majority 95%, (n= 462) were White British and 59.7% (n=290) were female. Most adopters (65.4%/n=318) had not participated in previous interventions in the host clubs. Social interaction was the most frequently reported benefit of participation (77.2%, n=375). While the reach of the club badge was important in letting people know about the programme, further work enhanced adoption and satisfaction. These factors included (i) listening to participants, (ii) delivering a flexible age-appropriate programme of diverse physical and social activities, (iii) offering activities which satisfy energy drives and needs for learning and (iv) extensive opportunities for social engagement. Conclusions Findings emerging from this study indicate that physical activity and health interventions delivered through professional football clubs can be effective for engaging OA.
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Affiliation(s)
- Daniel Parnell
- Centre for Active Lifestyles, Institute of Sport, PA and Leisure, Leeds Beckett University, Leeds, UK.
| | - Andy Pringle
- Centre for Active Lifestyles, Institute of Sport, PA and Leisure, Leeds Beckett University, Leeds, UK.
| | - Jim McKenna
- Centre for Active Lifestyles, Institute of Sport, PA and Leisure, Leeds Beckett University, Leeds, UK.
| | - Stephen Zwolinsky
- Centre for Active Lifestyles, Institute of Sport, PA and Leisure, Leeds Beckett University, Leeds, UK.
| | - Zoe Rutherford
- Centre for Active Lifestyles, Institute of Sport, PA and Leisure, Leeds Beckett University, Leeds, UK.
| | - Jackie Hargreaves
- Centre for Active Lifestyles, Institute of Sport, PA and Leisure, Leeds Beckett University, Leeds, UK.
| | - Lizzie Trotter
- Independent Researcher, Football Foundation, Whittington House, 19-30 Alfred Place, London, UK.
| | - Michael Rigby
- Football Foundation, Whittington House, 19-30 Alfred Place, London, UK.
| | - David Richardson
- The Football Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
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McClay CA, Collins K, Matthews L, Haig C, McConnachie A, Morrison J, Lynch P, Waters L, Day I, McAnee G, Williams C. A community-based pilot randomised controlled study of life skills classes for individuals with low mood and depression. BMC Psychiatry 2015; 15:17. [PMID: 25884922 PMCID: PMC4331464 DOI: 10.1186/s12888-015-0384-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/14/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is recommended for the treatment of depression and anxiety. However, access is limited. Low-intensity approaches such as guided CBT self-help (bibliotherapy) can increase access to treatment and is recommended by UK guidelines. No previous research has explored the provision of group-based guidance/support for a bibliotherapy approach for depression and anxiety in community settings. The objective was to carry out a pilot study of a group guided self-help intervention, using community based recruitment methods. METHOD A randomised controlled trial comparing an 8 week CBT group guided self-help intervention to usual care. Recruitment and the delivery of the intervention were carried out in Glasgow and Derry/Londonderry in partnership with national depression charities. Fifty-three people were randomised, however we refer only to the forty-six participants who provided baseline data: 16 males and 30 females, aged 16 or over, with a PHQ-9 score of ≥ 5, were recruited from the community. The mean age of the sample was 43.7 (sd = 13) and 93.5% of participants had suffered from low mood for a year or more. RESULTS There was effective recruitment, randomisation, uptake and adherence with 21 Immediate Access (IA) and 25 Delayed Access Control (DAC) participants. The intervention was highly acceptable to participants attending on average 4.46 of the 8 sessions (sd 3.06), 65.2% attended more than half of all sessions. The mean satisfaction on the Client Satisfaction Questionnaire was 28 out of 32 (sd 4.8). The provisional results in the pilot suggest the intervention may improve both anxiety and depression. At three months, data collection was achieved from 74% of participants. The trial successfully provided estimates of the sample size needed for the future planned trial. CONCLUSIONS Low-intensity group-based classes may offer an alternative method of managing depression and anxiety and warrant further research. TRIAL REGISTRATION Current Controlled Trials ISRCTN84893887 . Registered 3 November 2011.
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Affiliation(s)
- Carrie-Anne McClay
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road Glasgow, Glasgow, G12 0XH, Scotland.
| | - Katrina Collins
- AWARE Defeat Depression, 56 Strand Road, Derry, BT48 7AJ, Ireland.
| | - Lynsay Matthews
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road Glasgow, Glasgow, G12 0XH, Scotland.
| | - Caroline Haig
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, Scotland.
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, Scotland.
| | - Jill Morrison
- General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, G12 9LX, Glasgow, Scotland.
| | - Pat Lynch
- AWARE Defeat Depression, 56 Strand Road, Derry, BT48 7AJ, Ireland.
| | - Louise Waters
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road Glasgow, Glasgow, G12 0XH, Scotland.
| | - Ilena Day
- Action on Depression, 11 Alva Street, Edinburgh, EH2 4PH, Scotland.
| | - Grainne McAnee
- AWARE Defeat Depression, 56 Strand Road, Derry, BT48 7AJ, Ireland.
| | - Christopher Williams
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1st Floor Administration Building, 1055 Great Western Road Glasgow, Glasgow, G12 0XH, Scotland.
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